;Resize=(1200,627)&hash=63f417ae01b613aa0121e2b5efad33beefb9496d61d6bf0bf37627c433963b8d "Rapunzel Syndrome: What is behind this life-threatening disease")
A few weeks ago, a case attracted international attention. Doctors in the eastern Czech town of Opava removed a huge matted ball of hair from the stomach of an eleven-year-old during an emergency operation. The hair structure, known in medicine as a trichobezoar, was already 20 centimeters long and eight centimeters in diameter. “In extreme cases, the stomach wall could have been damaged or even perforated,” reported the attending physician. So the girl was lucky and could still be saved.
Clumps of hair in the gastrointestinal tract can be life-threatening
If such trichobezoars form in the digestive system, one speaks of Rapunzel syndrome. This is due to a mental illness known as trichophargia. Those affected tear the hair from their heads and then eat them.
Since hair is not digested, over time a clump of hair forms in the digestive tract, which expands like a braid into the intestine – hence the name Rapunzel syndrome. This can lead to a life-threatening intestinal obstruction.
If this extends into the duodenum, the pancreas can also become inflamed. The clump of hair also disrupts the digestive process, so that those affected often suffer from a lack of nutrients.
Symptoms and Warning Signs of Rapunzel Syndrome
The hairball is not easy to diagnose and can only be detected by ultrasound, gastroscopy or computed tomography. But there are six prominent warning signs that are among the typical symptoms of Rapunzel syndrome. These are:
- pain in the upper abdomen
- Vomit
- loss of appetite
- constipation
- a bloated stomach
- bald spots on the head from pulling out the hair
Young girls affected by Rapunzel syndrome
Rapunzel syndrome is relatively rare. Young girls are primarily affected. Loud “Doccheck.com’ are only known to be among ten cases in the literature in German-speaking countries by 2022.
Nevertheless, mental illnesses have increased significantly in the pandemic years. So reports the “German Medical Journal“ only in April 2022 by a four-year-old girl who had to have a painful hair tumor removed from her upper abdomen.
Obsessive-compulsive disorder is behind Rapunzel syndrome
Behind the syndrome is primarily an obsessive-compulsive disorder, trichotillomania, in which those affected compulsively pull out their hair. Trichotillomania is an impulse control disorder associated with psychological trauma such as death, loss, violence, abuse, as well as depression, anxiety disorders, bulimia, and personality disorders.
According to the German society for obsessive-compulsive disorders (DGZ), a family predisposition and neurobiological factors such as overactivity of certain brain regions also play a role in the development of this disease. It occurs in childhood and can last for months or years. However, it usually begins between the ages of eleven and 15 and affects women (3.5 percent) more often than men (1.5 percent), the DGZ continues.
0.5 to 1.05 percent of the population in Germany suffer from trichotillomania. Since the disease is associated with a lot of shame and is often kept secret, the number of unreported cases is significantly higher, writes the specialist society. However, only a small part of it suffers from the compulsion to eat the hair, i.e. trichophargia. Experts assume around 20 percent.
However, Rapunzel syndrome can also develop in connection with pica syndrome. With this mental disorder, those affected eat things that are not intended for consumption such as paper, sand, dirt, dirt and, among other things, hair that is not their own.
Rapunzel Syndrome: Clumps of hair must be surgically removed
Clumps of hair in the gastrointestinal tract must be surgically removed to prevent patients from dying. However, the underlying disease that is behind it and causes those affected to eat hair has not yet been treated.
These causes must be clarified psychiatrically and treated psychotherapeutically. While there are no specific medications for trichotillomania, antidepressants may also help to better control the urge to eat hair.