"Because I always had long hair, I had fascination with playing with my hair," says hair puller Julie Cerrito.
In her early twenties, Cerrito's fascination turned into a disorder known as trichotillomania. It started with pulling out gray hairs, but later got out of control.
"Because of years of doing it, I have areas of hair that permanently won't grow back," Cerrito says.
It's believed 90 percent of hair-pullers are women. Experts are not sure what causes people to do it. Some say they experience relief of tension or anxiety. Others say they do it out of boredom.
"It's crucial we figure out what the individuals getting out of it in the short term so we can find other ways to help get their needs met," says Ben Johnson, Ph.D., A.B.P.P., Director of the Rhode Island Center for Cognitive Behavioral Therapy and Clinical Assistant Professor of the Brown University Department of Psychiatry and Human Behavior in North Kingstown, R.I.
Cerrito believes stress triggers her hair-pulling. After years of traditional therapy, she's now undergoing cognitive therapy.
"We help people learn to identify the urge, be aware of the urge before they start pulling and engage in what we call a competing response," Dr. Johnson says.
For Cerrito, it means using two hands while reading or squeezing a stress ball while driving and getting help with chores from her children.
"It was shameful for the children because it was worse a few years ago," Cerrito says.
She's learned positive distractions help her resist the urge to pull.
"To say that you pull out your hair is so strange, that's why there is a veil of secrecy," Cerrito says.
By ending that secrecy, she hopes she and others can get the help they need to stop.
Pulling from the scalp is most common but some people pull their lashes, eyebrows and pubic hair. Experts say those preoccupied with their bodies or those with stress, depression or anxiety are more prone to hair pulling.