Trichophagia: Eating Hair and Rapunzel Syndrome

If you eat some of the hair you pull, or you’ve just found out your child does, you might feel worried or embarrassed. You needn’t be. Eating hair is a well-known part of trichotillomania (trich), a condition where people feel a strong urge to pull out their own hair, and it has a medical name: trichophagia.

Most people who eat hair never have physical problems from it. The risk is small but worth knowing about, and this guide explains what to watch for and when to see a doctor.

What is trichophagia?

Trichophagia (trik-oh-FAY-jee-uh) means repeatedly eating hair. Usually it’s hair you’ve just pulled: the whole strand, or only the root, the small white bulb at the end. Some people chew and spit it out; others swallow it. Less often, people eat other people’s hair, pet hair or hair extensions.

It usually happens as part of a routine after pulling: looking at the hair, running it across the lips, biting off the root, then swallowing. Trich is a body-focused repetitive behaviour (BFRB), one of a group of conditions where people repeatedly pull, pick or bite at their hair, skin or nails, and eating hair is one of the rituals that often go with it.

Estimates of how common it is range from about 1 in 20 to about 1 in 3 people with trich. A 2008 US study of 68 adults found 21% were doing it at the time and another 13% now and then.

In the DSM-5, the American manual doctors use to diagnose mental health conditions, regularly eating hair counts as a form of pica: eating things that aren’t food.

Why do I eat my hair?

No one fully knows. Research on trichophagia is scarce, and an old idea that it comes from low iron isn’t supported by evidence.

Many people with trich describe the mouth part of the ritual as satisfying in the same way pulling is. The feel of the root on the lips or teeth, the texture, the moment of biting it off: your brain learns to seek these sensations out. It doesn’t mean you’re hungry, and it doesn’t make your trich unusual.

Our guide to why pulling hair feels good explains the roots, textures and rituals many people share.

Is eating hair dangerous?

Usually not, but it can be. Your body can’t digest hair, and its smooth surface means the stomach muscles can’t easily push it on. If you swallow hair often, over months or years, it can collect in the stomach and form a hairball.

That’s rare. A 2021 review found that only a small proportion of people who regularly eat hair develop a hairball. But a hairball can cause serious problems if it grows without anyone knowing, so the review’s authors advise that anyone treating people with trich, of any age, should ask about eating hair and stomach symptoms. Hair only builds up if it’s swallowed.

What is a trichobezoar?

A trichobezoar (trik-oh-BEE-zor) is a hairball in the stomach or gut. “Tricho” means hair, and a bezoar is a mass of material the body can’t digest. Swallowed hair tangles with mucus and food and gets packed tighter, sometimes until it fills the stomach like a mould.

It can go unnoticed for years because it may cause no symptoms at first. As it grows, it can block food from passing through, cause ulcers (sores) and bleeding, and in rare cases make a hole in the stomach or bowel. These problems need hospital treatment.

Food moves on through the gut. Hair can’t be digested, so if it’s swallowed often it can gather in the stomach over months or years.

Rapunzel syndrome is a rare kind of trichobezoar where a “tail” of hair stretches from the stomach into the small intestine. Surgeons first described it in 1968, naming it after the fairy tale character with very long hair. The tail can cause a blockage, and it’s removed with an operation.

Term	What it means	How common
Trichophagia	Eating hair, often pulled hair or roots	Estimates range from about 1 in 20 to about 1 in 3 people with trich
Trichobezoar	A hairball in the stomach or gut	Rare: a small minority of people who eat hair
Rapunzel syndrome	A hairball with a tail that reaches into the small intestine	Very rare

What are the warning signs?

The warning signs are stomach problems that keep coming back or get worse:

stomach pain or cramps, often in the upper belly
nausea or vomiting, sometimes with hair in the vomit
losing your appetite, or a bloated belly
losing weight without trying, or, in children, not gaining weight as expected
constipation or diarrhoea
bad breath that doesn’t go away
tiredness or looking pale, which can be a sign of anaemia (not enough healthy red blood cells)
a lump you can feel in the upper belly

All of these have plenty of other causes, which is why hairballs are often missed at first. What helps a doctor put it together is knowing that you swallow hair.

When should I see a doctor?

See a doctor within the next few days if you swallow hair and have any of the warning signs above, and tell them you swallow hair. If you swallow hair regularly but feel well, it’s still worth mentioning at your next appointment, so a doctor can decide whether you need any checks.

Doctors can usually find a hairball with a CT scan, a detailed type of X-ray that picks up around 97% of them. Large hairballs are usually removed with surgery.

Please tell the doctor, even if it feels embarrassing. Medical reports show people often don’t mention swallowing hair, even when asked, and that can delay diagnosis. Swallowing hair is a known, named condition, and doctors aren’t there to judge you. Our guide to talking to your doctor about hair pulling has words you can use.

What helps with eating hair?

The approaches that help with pulling also help with eating hair, because it’s usually part of the same chain: when you pull less, there’s less hair to eat. There are no trials of treatment for trichophagia on its own. Things that help:

Break the chain early. Notice the moment a hair heads towards your mouth, and put it down straight away, in a tissue or away from you.
Give your mouth something else to do: sugar-free gum, crunchy snacks such as carrot sticks, a drink through a straw, or chewable jewellery designed to be chewed.
Tell your therapist about the mouth part. Many people hide it, but it’s a clue to what your pulling gives you, and practitioners who work with trich will have heard it before.

If the mouth is part of your ritual, give it something else to do.

Habit Reversal Training (HRT), which teaches you to notice the first moves of pulling and do something else instead, is the approach to trich with the most research behind it. There’s more in our guide to Habit Reversal Training. Our guide on how to stop pulling your hair has practical strategies you can start with today.

If you’ve had a hairball removed, doctors recommend support for the pulling afterwards, because hairballs can come back if swallowing carries on.

What if my child eats their hair?

Stay calm, and book an appointment with your child’s doctor. Tell them your child eats hair, because children often won’t say so themselves, and go sooner if there are warning signs. Hairballs are most often found in children and teenagers, and the rare serious cases mostly involved young children whose symptoms weren’t checked early. If a young child also eats wool, fluff or carpet fibres, mention that too.

Please don’t tell your child off or punish them. Like pulling, it isn’t a choice they can simply stop, and shame pushes it out of sight. Our guide to when to take your child to a doctor about hair pulling covers who to see and what they’ll check.

For support at home, start with The Parent’s Guide to Trichotillomania: understanding what your child is going through.

Where can I get support?

You don’t need to wait for stomach symptoms to get help. Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory. Our guide to finding someone who understands trich explains what to ask on a first call. There’s more on swallowing hair in our complete guide to trichotillomania.

If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call 995 or go to your nearest emergency department.

Samaritans of Singapore (SOS) — 1767 (24h)
IMH Mental Health Helpline — 6389 2222

Questions people ask

Is it normal to bite or chew the root after pulling a hair?

It’s very common. Looking at the root, running it across your lips and biting it off are rituals many people with trich share. Chewing and spitting out doesn’t put hair in your stomach. If you swallow hair or roots regularly, mention it to a doctor.

Can a hairball in the stomach go away on its own?

Not usually. Hair resists digestion, and a hairball tends to grow as long as hair keeps being swallowed. Medicines and treatments meant to dissolve it have been reported as ineffective. A doctor will decide how to remove it, which for large hairballs usually means surgery.

Is trichophagia a type of pica?

Yes, technically. In the DSM-5, the manual doctors use to diagnose mental health conditions, regularly eating hair falls under pica, which means eating things that aren’t food. In practice, most people who eat hair do it as part of their trich, and it’s treated alongside their pulling.

Does eating hair mean my trich is more severe?

Not necessarily. In a 2008 study, people with trich who ate hair were more alike than different from those who didn’t. They did score higher for severity on one rating scale and were more likely to be men. It’s a common part of trich, and the same approaches help.

Can a hairball come back after it’s removed?

It can if hair swallowing carries on. Some people have needed a second operation, often years later. That’s why doctors recommend support for the pulling and eating after surgery, not just removing the hairball.

Is eating hair caused by low iron?

There’s no good evidence for that. Some early reports suggested a link with iron deficiency, but research hasn’t supported it. Low iron can be a result of a large hairball, though, because it can cause bleeding from the stomach and affect how you absorb food.