Sandy Rosenblatt stood in front of the mirror in her playroom. Her parents were getting a divorce, and she felt all the tension closing in. Staring at that mirror, the 7-year-old started plucking out her eyelashes one by one. She often watched her mother groom her eyebrows with tweezers, and she swelled with pride at the thought of emulating her.
Satisfied, she ran upstairs and burst into her mother's bedroom, shouting, "Mom! Look what I did!"
Turning to see what surprise her daughter had in store, her eyes fell on Sandy's eyelash-less face. Horrified, she cried out, "Don't ever do that again!"
But it was too late.
Rosenblatt, now 39, is one of millions of people suffering from Trichotillomania (pronounced trick-o-til-o-MAY-nee-ah), a disorder in which people have an irresistible desire to pull out their hair from the scalp, eyebrows, legs, pubic area or any place where hair grows on the body. Experts say about 1 in 50 people - or 2 to 4 percent of the population - have the disorder, though numbers may be larger due to the fact people are too embarrassed to admit to medical professionals they pull their hair and go to great lengths to hide their behavior from family and friends.
"Often a person has a life of subterfuge and secrecy even from the people they're married to," says Charles Mansueto, director of the Behavior Therapy Center of Greater Washington in Silver Spring, Md., who has studied Trichotillomania, commonly referred to as Trich, for 20 years.
As a 7-year-old, Rosenblatt couldn't hide her hair pulling so easily. One day, her father came home and found his daughter with bald patches the size of baseballs on the sides of her head. Not knowing what to do, her parents took her to a therapist. In the comfort of his office, they played Connect Four, colored and talked about school - a gentle attempt to pinpoint a source of anxiety. But at home, the course of action was more traumatic, as the therapist instructed her parents to tape her eyes shut before bed with a pink cloth so she couldn't pick her eyebrows and eyelashes while falling asleep.
About an equal number of boys and girls under age 10 are prone to develop Trichotillomania, but hair pulling becomes more common for girls around the age of puberty. While those who seek treatment are women nine times out of 10, experts believe not as many men get help because they can disguise their appearance easier by shaving off patchy bald spots on their heads or beards.
Yet people who do want help may not be able to find it, as Mansueto says there aren't enough professionals who can properly treat the disorder or even diagnose it. "It's not uncommon for us to hear that people have gone to doctors, and doctors look at them oddly and [say,] 'You do that?'"
[Read: 5 Tips for a Smooth Doctor's Visit.]
Many physicians confuse the condition with obsessive-compulsive disorder and often prescribe antidepressants meant to treat OCD, which do not successfully treat Trichotillomania. Mansueto - a member of the Trichotillomania Learning Center's Scientific Advisory Board - says no medications stop hair pulling or make a significant impact in preventing the behavior. The best treatments fall under cognitive behavior therapy, which Mansueto describes as teaching people to "channel some of their motivations in other directions so to leave the body intact."
Hair pulling is classified as a body-focused repetitive behavior, which includes actions such as nail biting, skin picking and tongue chewing. Though the condition was introduced in the Diagnostic and Statistical Manual of Mental Disorders in 1987, it wasn't until the early 2000s when health agencies recognized Trichotillomania as a widespread disorder that causes suffering. "[People] drop out of college because they're pulling while they're studying," Mansueto says. "They don't get involved in relationships and avoid intimacy. They can't do ordinary things like dive in a pool or be out in the wind for fear of being detected."
While Trichotillomania remains a foreign word to many - it did garner some attention last year when actress Olivia Munn revealed she pulls out her eyelashes - the scientific community has made progress in understanding the disorder. The new edition of the DSM removed criteria that people feel tension before pulling and gratification afterward, since it's different for everyone. Lindsay Woolman, author of "The Perfect Pull," a fiction book about a teenage girl with Trichotillomania, describes the sensation as "an intense urge that comes over you."
"When you're doing it, it's very relaxing," she says. "It's very slow and methodical. It just slows your mind down."
Woolman, 35, started picking her skin and acne at age 11. Over the next few years, she moved on to pulling her eyebrows, eyelashes and body hair. The one area off-limits: her scalp. "I've been able to hide it," she said in a phone call from San Diego, where she lives.
In her 20s, Woolman found a support group that helped her become pull-free for three years. But she relapsed during the writing process of her book. Having forgotten the sensation, she plucked a few hairs as an experiment. "I started pulling again just trying to get the description correct, and get the sensation and the feeling as accurate as possible," she says. "As it goes having a disorder, I've got it in me really strong, so I ended up starting over again pulling and haven't been able to stop."
[Read: The Do's and Don'ts of Healthy Hair.]
Rosenblatt recently managed to remain pull-free for five weeks. Then she had one stressful weekend and couldn't resist pulling out her corner eyelashes. Sitting on her couch in Rockville, Md., she points to the corner spot facing the TV. "For a long time, I avoided sitting there," she says, eyeing the spot as if it were a beloved enemy. After a tiring day, Rosenblatt would sink into the corner to watch "Game of Thrones" or "The Voice," absorbing the show while running her fingers around the crown of her head, searching for the hairs that feel "different."
"It's a specific hair I'm going for. There's almost a satisfaction in it when it comes out. It's like a soothing mechanism," she says, slowing her voice down as if feeling the pleasure from a pull.
Rosenblatt, an executive director of assisted living homes in the Washington area, shared her secret in October when she wrote a piece for The Huffington Post. Since then, five of her friends have confided in her that they, too, have the disorder.
Some people spend their lives feeling ashamed, believing they're the only person on earth who inflicts self-harm by ripping out their hair. It's something Jillian Corsie, a 25-year-old filmmaker in New York City, wants to change. She doesn't have Trichotillomania, but a close friend growing up did, and the fact that so few people know about it bothers her. "This disorder is three times more prevalent than anorexia," she says. "Why is it that we don't know about this?"
A year ago she started "Trichster," a documentary that follows eight people with the disorder. The film (set to be released spring 2014) is intended to raise awareness and fight the stigma that people with Trich are ugly freaks. "I'm trying to show them as people first and those who have a disorder second," Corsie says. "I'm trying to humanize something that a lot of people see and wrongly perceive."
Rosenblatt, who now publicly blogs about Trich, once distanced herself from the girl who was tripped by kids on the bus. She pushed aside the ex-boyfriends who told her to wear fake eyelashes because "they would make her prettier." Though she stashes black noir eyeliner everywhere - her car, purse, desk drawer - to mask her missing eyelashes, she's slowly allowing people to see her without makeup. And she's strong enough to look at photos of that 7-year-old girl - photos she once told her parents to hide - because she's accepted this is who she is.
"We all have secrets," she says. "Every one of us has some sort of secret we're ashamed of, or embarrassed about and don't want anyone to know. But, really, are they that bad? The people you want around you are going to love you no matter what."