[6] Termed a trichobezoar, these masses can be benign, or cause significant health concerns and require emergency surgery to remove them.
Rapunzel syndrome is a further complication whereby the hairball extends past the stomach and can cause blockages of gastrointestinal system.
However, if trichophagia is severe or chronic, a large mass of undigested hair can accumulate in the stomach, resulting in a trichobezoar.
[11] Once the trichobezoar grows large enough, it can extend beyond the stomach and lead to bowel obstructions, ulcers, perforations, acute pancreatitis and appendicitis (this is called Rapunzel syndrome).
[12] In one study, it was found that a significant percentage of patients with trichotillomania used drugs and alcohol to cope with negative feelings relating to pulling behaviors, with most sufferers reporting symptoms of anxiety and depression.
[13] It is important for physicians to recognize and treat these secondary symptoms in order to relieve hair-pulling and eating behaviors.
[15] Trichophagia can present at any age, with childhood cases typically being more common and of a more habitual nature, while in adulthood it is associated with underlying psychopathologies and more severe symptoms.
Decreased distress tolerance and increased impulsivity were also found in trichotillomania patients with a family history of obsessive-compulsive disorder.
[18] The commonality of comorbid psychopathologies in individuals with trichotillomania and trichophagia could be indirectly caused by the social rejection sufferers face due to their symptoms.
Researchers suggest that bringing awareness of the disorders to the general population could help relieve the stigmas faced by patients.
[9] Some symptoms, such as hair loss, can be caused by other somatic conditions, the presence of which needs to be excluded before a diagnosis of trichotillomania or trichophagia.
[11] Rapunzel syndrome, an extreme form of trichobezoar in which the "tail" of the hair ball extends into the intestines, and can be fatal if misdiagnosed.