What is Rapunzel Syndrome and why does it occur?

Rapunzel syndrome is a rare clinical entity that takes its name from its curious relationship with hair. People pull their hair out impulsively and they eat it without being aware of their action. The accumulated hair forms a ball inside the stomach and, if the problem is not detected in time, it can cause death. It seems that there are psychological and emotional alterations that underlie the bottom of the psyche still unresolved.

We can affirm without fear of being wrong that it is unlikely that any of you suffer from the unknown “Rapunzel Syndrome”. A rare clinical entity that takes its name from the famous tale of the Grimm brothers entitled “Rapunzel” in which a beautiful young woman is locked up by an evil witch in an impregnable keep sealed tightly. Rapunzel had the charm of beautiful, long and resplendent blonde hair and that was the system by which the witch climbed every day to bring her food after ordering her with her cavernous voice: Rapunzel, Rapunzel, let go of your long hair!

The familiarity of the name might give us the impression that it is very common, but nothing could be further from the truth. This he owes it to his curious relationship with hair Well, these people impulsively pull their hair out and eat it without being aware of their action.

Symptoms of Rapunzel syndrome

At first they go to the doctor complaining of various gastrointestinal symptoms which are usually quite non-specific, such as abdominal pain, anorexia and vomiting. And, in the most serious cases, complications such as intestinal obstruction and peritonitis.

A good clinical examination will reveal that Everything is due to the accumulated hair that lodges in the stomach in the form of a dangerous ball called a “trichobezoar”. This is perennially implanted because human hair is very resistant to digestion due to its smooth surface.

The continuous ingestion of hair causes it to mix with mucus and food, thus a blunt ball is formed that accumulates in the folds of the stomach. The long filaments of the hair unfold like a long tail, hence the name Rapunzel, towards the proximal part of the intestine, being able to perforate it and cause death.

curiously this syndrome was first described back in 1968 by Vaughan et al. Currently, there are only less than a hundred cases registered worldwide and it usually appears in the age range between 15 and 20 years.

It seems that people suffer from mental disorders such as trichophagia and trichotillomania. In some cases, symptoms of depression, anxiety and low self-esteem also appear.

Relationship with emotional and psychological disturbances

The curious thing in these cases is that despite the fact that the apparent cause of the syndrome is the continuous ingestion of hair, there is a deeper origin and these people are not aware of why they behave like this, much less of any sign of emotional suffering that triggers the behavior.

If we look carefully, we will see that stretching and twisting of hair are fairly common activities. We all have those images in our heads of lazy adolescents chewing gum and fiddling with their hair while sitting in front of a book engrossed in their own thoughts.

Well, trichotillomania skyrockets, says Marilyn Shelock, president of the London Trichotillomania Institute before crises of depression and stress.

These people are idly stroking the hair while the psychological tension increases inside them and culminates in the pulling of the hair that It provides them with a sense of relief and gratification.This process is curiously painless and only a tickling sensation remains at the end or itching in the area where the hair is pulled out. It is also common to observe the appearance of specific rituals and thus the uprooting is accompanied by its ingestion, called trichophagia, or by suck your hair for a long time. Hair can be pulled from different parts of the body such as the head, beard, eyebrows and eyelashes. These areas are the most frequent but it can also occur on the trunk, pubis or armpits.

What precipitates Rapunzel syndrome?

These people live disconnected from any awareness of emotional suffering that underlies the emergency of the alarm signal of the first symptoms and that must be addressed by a psychologist without fail.

Trichotillomania is considered by the Diagnostic and Statistical Manual of Mental Disorders DSM-V, as an “Impulse Control Disorder” and in more than a quarter of cases it is related to stressful situations such as:

Having suffered a recent painful affective loss. Disorders in the mother-child relationship. Fear of being alone.

All of these are often cited as critical factors leading to its genesis.

I still vividly remember the case of Araceli, a young opponent of the judge devoured by worry, stress and anxiety when it comes to singing songs in front of her coach. Faced with so much pressure, he blindly began to pull out strands of his hair. At the same time, he compulsively picked at any hair he discovered on his legs, causing bigger and bigger wounds and scabs that he tore off over and over again. Little by little indisguisable bald spots appeared despite the original hairstyles that he sought to hide them and his self-esteem began to suffer seriously.

As we can see, trichotillomania is related to other psychiatric symptoms such as anxiety, excoriation disorder – when the person scratches compulsively – or with obsessive compulsive disorder.

In these cases it is essential that the person is put into treatment being approached through a combination of pharmacology, antidepressants and anxiolytics, with Intensive psychotherapy aimed at controlling the impulse to pull out one’s hair and improve understanding and management of their emotional world.