Silent Trichophagia Behind Visible Trichotillomania: A Case Report of a Giant Gastric Trichobezoar in an Adolescent With Intellectual Disability and Anemophobia

Somatic complications of trichotillomania arising from undetected trichophagia are not well characterized in adolescents with intellectual disability. We report a case of a 16-year-old girl with intellectual disability whose clinical picture unfolded in four successive steps over four years: untreated anemophobia for two years despite an outpatient consultation, trichotillomania emerging two years later, silent trichophagia concealed from the family for one year, and finally a giant gastric trichobezoar revealed by hair-containing vomiting, associated with severe iron-deficiency anemia. Following combined management, including surgery, sertraline, and family psychoeducation, trichophagia resolved completely, while residual trichotillomania episodes without hair ingestion persisted at outpatient follow-up. This case highlights the need for systematic and active screening for trichophagia in any patient followed for trichotillomania, even when hair-pulling is visible and known to the family, and underscores the importance of identifying and managing comorbid anxiety disorders in the management of this condition.