Dr Madigan is quick to point out that it is unusual for Trich sufferers to be open about their disorder because of the obvious hair loss, and the stigma that is considered abnormal behaviour not only by themselves but by society. She adds that Trichotillomania is very similar to other psychological problems with respect to the silence and social stigma.

“For young adolescents already dealing with peer and social pressures and the normal turbulence of being a teenager, coping with a seemingly uncontrollable ‘weird’ behaviour all by themselves, while attempting to hide it from everyone else, including their family, can be particularly hard.”

Trich sufferers find it hard to deal with some aspects of society. They are so ashamed of their condition that everyday life aspects such as going shopping or even to the hairdressers becomes a burden they are unwilling to face.

“It’s not as if I don’t want to go to the hairdressers, but I’m almost scared to,” Stephanie says, adding, “I find when I do go to the hairdressers they have no idea what TTM is. Not only that but they tend to give me a look of sympathy. I don’t want anyone’s pity. I want them to understand Trichotillomania, and accept it. I don’t want to be treated like a social outcast.”

One of the sad aspects of Trichotillomania is that many of those that suffer from it are unaware that they even have the condition. It is a disorder that is not highly publicised, and it wasn’t until 1989 that it was even mentioned in the media. As a result many Trich sufferers have gone without adequate information about their condition, and some aren’t even aware that there is treatment for it. As a consequence the one symptom Trich sufferers share is shame.

Research into treatment for Trichotillomania has grown steadily over the past ten years. Although there is no treatment that is more effective than the other, with people reacting to treatment differently, a number of those treatment options have shown promise to people with TTM.

These treatments include cognitive behaviour therapy, pharmaceutical therapy, support groups, and alternative therapy.

Cognitive behavioural therapy is a form of therapy that seeks to alter a Trich sufferer's behaviour by identifying the precise factors that trigger their hair-pulling and teaches those who suffer from it learning skills to interrupt and redirect responses to those triggers. Dr Neomie Da Costa, a therapist specialising in Trichotillomania and a sufferer herself who has been ‘pull-free’ for three years believes strongly in the therapy. She has used it herself, and beaten TTM because of it. “Cognitive behaviour therapy encourages hair-pullers to develop an increased awareness of the time of day it occurs, their emotional states, and other factors that might promote hair pulling. It’s an important precursor in being able to control the Trich sufferer’s behaviour,” she says.

Some hair-pullers have success with simple behavioural devices such as putting bandages on their fingers to interfere with pulling, keeping records of their hair pulling, or changing environmental cues that can trigger pulling.