Treatment of Recurrent Rapunzel Syndrome and Trichotillomania: Case Report and Literature Review

Background: Trichotillomania (obsession with one's hair) was first described in the literature over 100 years ago and was recognized by the American Psychiatric Association as a distinct disorder in 1987. Objective: The authors discuss a rare presentation of a case of recurrent Rapunzel syndrome in a 37-year-old woman. Method: The authors present a biopsychosocial treatment plan for a therapeutic approach. Results: This patient was unique for her relatively advanced age at onset, the recurrent nature, association with pancreatitis, and the consumption of artificial hair extensions, rather than her own hair. This patient presented with small-bowel obstruction requiring laparotomy. After surgery, she was evaluated by the psychiatric service; after discharge, she removed her hair extensions, continued to take her prescribed medication, attended a psychiatric program, and was monitored by family and friends. Conclusion: There are no definitive guidelines for treating trichotillomania. In this case, quetiapine, hair-extension removal, family involvement, and regular follow-up helped with the initial cessation of her hair consumption. Antidepressant treatment helped control the obsession while behavioral therapy and family involvement provided the means for habit-reversal training. (Psychosomatics 2010; 51: 443-446)