September 17 marks the start of National No Pulling Week, highlighting trichotillomania, a condition which means people compulsively pull their own hair out, and a few celebs have recently revealed they have it. Often a taboo topic, it can have a huge impact on sufferers' lives.
By Abi Jackson
A few weeks ago, Team GB cyclist Joanna Rowsell whipped off her helmet to accept her Olympic gold medal, revealing her bald head in the process - and becoming an instant poster girl for alopecia.
In just a few seconds, Rowsell, 23, who started losing her hair when she was 10, had achieved something monumental. Not only was she an Olympic hero, she was shining light on an issue that silently plagues thousands - female hair loss.
Alopecia isn't a subject that's discussed very openly in society and, though Rowsell has helped no end, a lot of people still don't know what it is. Perhaps even less known, and certainly less understood, is Trichotillomania (TTM, or 'tric' for short).
Just like other forms of alopecia, the results are the same - patchy or even total baldness. But with TTM, the sufferer has pulled the hair out themselves, which can be particularly distressing.
Sam Faiers, from The Only Way Is Essex, recently revealed that she lost her eyelashes due to TTM, and it's thought that around 4% of the population will experience compulsive hair pulling at some point in their lives.
Women seem more prone than males, with pulling usually starting around age 12, but it can start later in life too.
Despite being self-inflicted and yes - very difficult to understand - the hair loss is no less difficult to live with, as Lucinda Ellery sees almost every day.
"There's a massive lack of awareness, and girls with TTM are very isolated," says Ellery, who runs a specialist hair-loss consultancy.
Living with female hair loss is something Ellery knows first-hand. She was sent to a convent following the sudden death of her father when she was nine, and her long, blonde hair fell out almost overnight (alopecia can be triggered by trauma or extreme stress).
As a teenager she began buying wigs, which sparked her life-long interest in developing high-quality, comfortable and realistic-looking hairpieces and extensions.
Today, Ellery helps women across the UK affected by hair loss, has particular empathy for women with TTM, and has become the UK's leading expert on the condition.
"Girls with TTM do feel they're disfiguring themselves and find this very hard to live with," she says.
"As women, we don't like thinking about hair loss at the best of times, let alone if you're causing it yourself. Women worry that people will think they're freaks."
On the contrary, the girls and women Ellery supports are anything but. Many of the women are highly successful ("lawyers, doctors, teachers") and the younger girls are usually very bright and high-achievers at school.
Often the TTM seems to have been triggered by high stress or anxiety, such as a relationship breakdown, divorce, or even pressures at school or work. These are patterns often seen with eating disorders, and other forms of self-harm, also rooted in psychological factors and very difficult to curb.
Hair pulling becomes a compulsive response, with many saying they're barely even aware that they're doing it at first. The ritual can feel like a comfort or a release of tension.
But eventually they'll realise they've caused a bald patch, and by this point the habit can be deeply ingrained and trying to stop can be incredibly frustrating. As well as living with the hair loss, sufferers have to cope with shame and embarrassment as well.
"Often girls will seek medical help only to be told to 'just stop'," says Ellery. "If only it was that simple!
"There's no magic cure or pill. The condition needs a lot of understanding."
Charlotte Suggett, 22, was 11 when she started pulling her hair, soon after her dad had been diagnosed with cancer. By the time he died a year on, Suggett had full-blown TTM, but it was a few years before she knew there was actually a name for what she was doing.
"My mum and sisters tried to help me by doing things like shouting 'Stop' each time my hand went up to my head," she says. "I had never heard of the condition, neither had my family or friends. It was a few years before I was flicking through a magazine and noticed a story about it, and that's when I first learnt the name 'trichotillomania'."
By 13, Suggett had a significant bald patch on the top of her head.
"I did feel like I was an odd one out," she recalls. "I had a comb-over from the age of 13, while all my friends had long, flowing hair that they could run their fingers through, and get out of the swimming pool and not worry about the shape it would dry into."
To people who ask, 'Why don't you just stop pulling it out?' (and this is an incredibly common response to TTM) Suggett says: "Why can't people just stop smoking? Or biting their nails?"
She's the first to admit that TTM can seem mysterious - even after trawling the web for more information about it herself, she was confused as to why it was happening.
"I know my mum and friends were only trying to help me when they told me to take my hand away from my head but I was already so angry at myself that I'd snap at them."
Eventually realising that she wasn't the only person with her "little rituals" was a huge relief.
Ellery hopes that highlighting TTM in the media will increase understanding among the medical community, schools and parents, so that girls affected can receive much-needed support as quickly as possible.
She's also keen to stress that TTM isn't a hopeless cause - in fact, to date she has successfully helped hundreds conquer their pulling compulsions and regain a full head of hair, thanks to her revolutionary Intralace Systems.
The systems involve a special mesh being fixed to the head, with hair extensions woven through it, designed to look realistic and be as comfortable as possible. And meanwhile, underneath, the natural hair is left to grow, out of reach of pulling.
While that's happening, women can focus on tackling the emotional side of their TTM, which Ellery knows is fundamental to the 'treatment' process. Realising you're not alone - and being able to chat about the hair pulling openly and without fear of judgement with other sufferers - is often crucial, as is re-building self confidence and developing other ways of coping with stress.
Suggett lived with her comb-over for a decade but, after hearing about Ellery's consultancy on a Channel 4 documentary two years ago, got in touch.
Now, months on, she's been fitted with a full Intralace and for the first time in years doesn't have to "worry about the wind blowing in the wrong direction".
"I can finally just relax and feel comfortable in myself," says Suggett.
Her hair underneath is already growing back. Tackling her TTM could be a long-term challenge, but Ellery ensures she's always on hand to offer support.
"The Intralace isn't a cure but it's all about creating hope and having faith," says Ellery. "And on a basic level, having somebody to speak to."
:: National No Pulling Week begins on September 17, launched by Lucinda Ellery. For more information about The Lucinda Ellery Consultancy visit www.lucindaellery-hairloss.co.uk