Last year, Dr. Sri Komanduri, a gastrointestinal surgeon then at Rush Medical Center in Chicago and now at nearby Northwestern Memorial Hospital, removed a 10-pound mass of hair from an 18-year-old woman, writing an account of it in the New England Journal of Medicine.
"Essentially, the entire stomach was kind of engulfed with this thing," he told ABCNews.com.
While people often swallow unusual objects such as coins, Komanduri said that the mass of those objects keeps them from accumulating in the stomach.
"Things like hair don't have much substance or weight to them, and they tend to pool," he said.
He noted that surgery was not the typical solution for patients, as most of the hair accumulations could be removed by pushing it out during an endoscopy or using other nonsurgical techniques.
He said that in the past 10 years he has seen five cases of hair accumulation in the gut, but this was the first time surgery was needed. He also noted that the masses of hair are not typically found until some other problem forces doctors to look in the stomach.
In the vast majority of cases, the effects are psychological. Patients are ashamed of their behavior, and depression can result -- although doctors are not sure whether it is caused by the trichotillomania itself or by the problem in the brain that leads to the illness. The condition can also leave patients with bald spots or repetitive stress injuries.
But even with those effects, people with the disease are reluctant to come forward.
Franklin explains the mindset of many children as "I know I'm doing something that's unusual, I'm ashamed of it, I don't want to tell anybody."
But by observing their children to see if they pull out hair excessively and by laying out the complications of excessive hair-pulling, he said parents can go a long way toward helping.
But, Franklin added, they need to avoid sounding accusatory.
"You won't get an accurate answer from a kid who feels stressed out and on the spot when you ask those questions," he said.
But Franklin notes it isn't easy. He said he has seen cases of a husband and wife where the husband was unaware that his wife was pulling out her hair while he was asleep.
Dougherty notes that many cases are not identified by the parents but are caught by the dermatologist when the parents bring their children in worrying about hair loss or a potential skin problem.
Doctors say that parent awareness is the key to helping children with trichotillomania, and they can benefit by more media attention, spotlighting a potentially embarrassing but not uncommon condition.
"There's a lot of shame and a lot of reasons kids want to keep it to themselves," said Franklin. "This is fairly common and treatable, and something that's not so shameful."
For More on the Web: