Out of every one hundred people reading this article right now, between two and ten people have a condition that most of them will never have heard about. It affects nine times more women than men, and statistically more young people than adults. It was given its name in the nineteenth century but wasn't officially recognised as a condition in the Western world until 1989. I'm talking about trichotillomania.

            A bit of a mouthful, I agree. From the Greek—so popular with the medical world—it breaks down into thrix, which means hair; tillein, which means to pull; and mania, madness or frenzy. This suffix makes it sound fairly alarming, and probably adds to the taboo that seems to surround the condition, or any other given a similar title. You'll find few people who refer to it by this name though; to the scientists who study it, it's TTM; to sufferers it's trich, just as they are trichsters. Familiarity is necessary with something that can dictate the way you live your life.

            Trich comes in varying degrees of severity, but can be defined as the impulse to pull hair out of your body for non-cosmetic reasons. Any hair on your body is fair game. The preconceived image of a trichster is of a young woman hiding large bald patches on her scalp with a hat or wig. In reality, it is most common to pull facial hair, though there are some trichsters who focus on their body hair instead.

            Cringing yet? Undoubtedly an inability for non-sufferers to understand the compulsion is one of the reasons trich does not receive the coverage it should. That is not written in condemnation; trichsters don't understand it either. Nor do the scientists. They can't even agree on what the condition actually is.

            For psychiatrists, trich is an impulse control disorder. This puts it into the same category as compulsive gambling, kleptomania (compulsive stealing) and pyromania (compulsive fire-lighting). The taboo is beginning to make sense, but the association does too.  Many sufferers attest to an impulse to pull which grows progressively stronger until it is succumbed to, when it is followed by an intense feeling of release.

            Not all professionals agree with this classification, however. It is also recognised that trichsters are most likely to pull when involved in a passive activity, like reading or watching television. This does not involve a compulsion; in fact sufferers only realise they have been pulling when they get up and a pile of hair falls from their lap.

            There are also those who argue that trich is caused by a chemical imbalance in the brain, perhaps genetic. Scientists have recently discovered a mutation in the gene HOXB8, which causes mice affected to groom excessively. Since this particular gene is 98% the same in humans, it is being suggested that mutations of the gene could cause trich.

            Then there are clinical psychiatrists who classify trich as a mental disorder, with either obsessive-compulsive disorder, or self-harm. It has been linked to diverse conditions, like Body Dysmorphic Disorder, Anorexia Nervosa, Bulimia, Onychophagia (obsessive and severe nail-biting – involving painful gnawing down into the nail-bed), Skin Picking, and Tourette's Syndrome.

            Experts may argue about their different viewpoints, but it doesn't help sufferers get on with living with the condition. The Internet allows trichsters to answer each other's questions, and gain support from other sufferers. It is impossible to estimate the numbers of websites that are available, but most people start at www.trich.org. This is the site of the Trichotillomania Learning Centre (TLC) that has been working from Santa Cruz, California since 1991, and is the only organisation of its kind in the world.

            Trichsters have developed a variety of ways of combating their condition. The 21 Day Treatment, the best publicised, involves going cold turkey, and constantly reminding yourself of how many days you've been "pull-free". There are countless accounts on the Internet of former trichsters who have overcome their impulses in this way although it seems that the urge never completely goes away. Even people who have been pull-free for years still count their lives in the number of days they have resisted temptation. Just like smoking, trich appears to have an addictive edge that is difficult to overcome.

            It is very difficult for non-sufferers to really understand and appreciate how a trichster feels. For parents, it is a habit to be broken; friends can see it as a choice being made, and they cannot comprehend an inability to stop. The importance of the trichster community cannot be overestimated. Overwhelmingly, every time a new member joins a support group, their first post mentions feeling completely alone.

            It is this isolation of sufferers that needs to be addressed. The average GP sees perhaps two or three cases of trichotillomania in a year, in a country where statistically there are 150,000 people with the condition. Type "trichotillomania" into the library computer and you'll receive no responses. My spell-check doesn't even recognise the word. If you Google the term, the same authors will come up again and again: Cheryn Salazar, Douglas Woods, and Frederick Penzel.  There simply isn't enough public knowledge about it.

            I don't doubt that many people would respond to this cry for publicity by arguing that the damage done by trich is merely of a cosmetic and psychological nature. But trichotillomania, left to run rampant, can lead to trichophagia; the ingesting of hair after it has been pulled. This can cause hairballs to form in your stomach or intestines, which can be fatal.

Trich is not a new condition, yet in the twenty-first century it is still an ignored disorder and surrounded by stigma. This needs to be changed if sufferers are going to get the support and treatment they need, and escape from the intense loneliness the condition breeds.