Shame is something that Stephanie can relate to. More often than not she suffered in silence, hiding her hair-pulling from her parents. “My mum used scream at me to stop pulling my hair, so I used to hide it by scooping up the hair once I’d pulled it out and either throwing it away or hiding it under my pillow. I was ashamed of what I’d done, as if I was a naughty child doing something wrong.”

One of the many misconceptions about Trichotillomania is that it is tended to consider it an obsessive compulsive disorder (OCD). While it may have some aspects of an OCD, such as the compulsion to pull, those who do it cannot be considered obsessive. It is actually more of an impulse control disorder as are conditions such as compulsive gambling, kleptomania, and pyromania.

There is also a tendency among non-Trich sufferers to minimise the problem, particularly among physicians and parents of child hair-pullers. Lack of information and the perception of it being merely a ‘phase she or he will grow out of’ leads to the false impression that Trichotillomania is something that people engage in from time to time.

Barbara Carovella, Stephanie’s mother, willingly admits that she never understood what her daughter was going through, or even knew that there was a name for it. “I honestly thought it was something that she would grow out of; that it was no big deal. If I had known that her twirling her hair when she was little would turn into Trichotillomania I would have broken the habit immediately.”

It’s easy to see that Barbara seems to blame herself for Stephanie’s disorder.  “How was I to know that she had Trichotillomania? We didn’t even know there was name for her problem until she was about 20. I’d never heard of it, or even heard it spoken of. If I had known it was a disorder perhaps I would have been a little more understanding. But it wasn’t heard of. And it needs to be. Parents need to be made aware of the disorder, and be prepared to deal with the emotional roller-coaster that can come with it. They need to know it’s not something that their child is going to just grow out of.”

According to Dr Catherine Madigan of Anxiety Australia, Trich sufferers cannot control the impulse to pull out their hair. It can occur in states of relaxation such as watching  television, where they are not even aware of their behaviour or in times of stress where hair pulling serves as a release of tension.  However severe, repetitive hair pulling, on a daily basis leads to significant hair loss and potential skin damage.

"Trichotillomania is often associated with depression, lack of impulse control, or a habit disorder and may be precipitated by a stressful event such as a parental divorce, death of a relative or something as simple as studying for a test," says Madigan. “The disorder can also lead to low self-esteem, social insecurities, and even severe depression.”