Surgeons in India, in an unusual surgery last month, removed a 4-pound hairball from the stomach of a 19-year-old girl.
According to a report by Indian website NDTV.com, the girl couldn't eat or drink for days. She reportedly had a habit of eating her hair and chalk, which led to the formation of what is known as a trichobezoar -- a solid mass that, in this case, blocked her digestive tract.
Such cases of stomach hairballs -- which are thankfully quite rare -- pose a potentially deadly situation and are often associated with a disorder known as trichotillomania. Individuals with trichotillomania feel compelled to pull out their hair, resulting in hair loss, according to information provided by the Trichotillomania Learning Center in California. A minority of these people -- 5 to 20 percent -- may occasionally or routinely swallow their hair, potentially leading to these blockages.
Jenni Ruud, a 35-year-old Illinois mother-of-three, described her emotional turmoil after her daughter, Lily, was diagnosed with trichotillomania in the second grade.
"I became very depressed as a parent," she said, "until I found the tools and people I needed so I [could] support my daughter and accept her for who she is."
Though Lily -- now 12 -- has never been diagnosed with swallowing her hair, she said she has endured bullying because of her condition and uses a headband to cover up her bald areas.
"It's kind of embarrassing," she said. "It's kind of sad. You're very self-conscious. ... You'll see all these girls with hair, and I don't remember what it's like to have hair.
"Part of me wants to pull and part of me is like, 'No!'" she said. "It's so hard to control."
The cause of trichotillomania is not known. This condition is fairly common, affecting about one in 50 people at some point during their lives. While hair pulling may happen in anyone at any age, background, or sex, most adult cases occur in women.
There are a number of signs that might alert families and friends that their loved ones are pulling out their hair, said Dr. Jon E. Grant, a professor in the department of psychiatry and behavioral neuroscience at the University of Chicago.
Grant said that large amounts of hair in the bathroom or bedroom and noticeable hair loss are examples of telltale signs. He also said that changes to hairstyle or fashion -- such as wearing caps -- could be a sign. "People don't want the public embarrassment of people pointing out bald patches," he said.
The most helpful treatments for hair pulling are behavioral therapies. These focus on teaching "people to be more mindful of their urges," said Martin E. Franklin, associate professor of clinical psychology and psychiatry at the University of Pennsylvannia, who studies trichotillomania in children and adolescents. "[We] have the patient engage in physical behavior that's incompatible with pulling," he said, adding that this keeps their hands busy while they wait for the urge to pass.
The urge among some of those with trichotillomania to swallow their pulled out hair is another issue that medical experts must deal with, as it is a practice which can cause serious medical problems, Grant said. Parents of hair pullers should ask their children in a nonjudgmental way if they are swallowing their hair, he said. It's strongly recommended that hair eaters been seen by a doctor to rule out an intestinal blockage.
If one can treat the hair pulling, then hair swallowing can be avoided, he said. He added that most people don't eat enough hair to cause hairballs to form.
Dr. Samantha Cook, a pediatrician at Marshall University in Huntington, W.Va., said that common signs of stomach hairballs include bad breath, occasional vomiting, stomach pain, dark green-to-black colored stools, decreased appetite, weight loss, and stunted growth -- though she added that these signs are not always present. Occasionally, hair swallowers will eat other strange things, such as soil, rocks, foam, even rubber gloves.
Removal of hairballs depends on their size and location. "Small ones may be removed via endoscopy," she said, "[while] larger ones must be surgically removed by cutting open the stomach." (To watch a video of the surgical removal of a giant hairball, click here.)
Five years ago, Cook said she cared for a patient with a special type of giant hairball, known as Rapunzel syndrome. This term is used to describe a stomach hairball blockage that has a "tail" that extends into the intestines, in honor of the long-haired fairytale princess who dangled down her tresses to her prince suitor.