Would you be brave enough to enter a beauty pageant if you had a debilitating secret? If the top of your head — the first thing many people notice — looked frightening to some people?
Twenty-year-old Jena Metts wants to be Miss Kentucky. But she has a secret — she's almost bald.
The most distressing part? She pulls out her hair herself. And though she would dearly love to, she can't stop. She lives with it every minute of the day — pulling out her own hair, strand by strand.
"My last bad pulling spell was probably last week," she said. "I have to really make sure my little short hairs on the top don't stick up."
"I, like, literally have arguments with myself in my head," she said. "I'm like, stop pulling, stop pulling."
It's called trichotillomania, or "trich" for short. Although trich is treated as a psychiatric illness, the latest evidence suggests that it's not a "bad habit" like biting your nails or cracking your knuckles, or even an obsessive compulsive disorder.
Trich may have more in common with Tourette's syndrome, a neurological disorder characterized by repetitive, involuntary movements or vocalizations called "tics."
"Trichotillomania is such a medical mystery because we still know very little about the genetics and biology of it," says Dr. Nancy Keuthen, who heads a trichotillomania clinic in Boston.
According to the Trichotillomania Learning Center (TLC), up to 11 million people in the U.S. suffer from the uncontrollable urge to pull out their own hair, eyebrows, even their eyelashes.
"They may spend hours in front of a mirror in these very odd postures trying to locate that one hair that they know is there that they feel doesn't belong," Keuthen said.
No one understands how to cure trich. The standard treatments, such as drug and behavioral therapy, seem to do little for people like Metts. Over the past 10 years she's seen dozens of psychologists and psychiatrists, and taken a variety of anti-depressants. She says some of them worked in the short term, but none proved a permanent solution.
"I would kind of grow, my system would get used to having it, and I'd start pulling again," she said.
Metts has also tried a number of behavior modification tricks over the years.
"I tape my fingers," she said. "And then I wear gloves at night." She showed ABC News a beanie she wears "just to avoid temptation."
She's never gone more than three months without pulling.
"Whenever I get emotional, or sometimes very stressed, or if I'm upset, I go for my hair," she said. "And [it's] perfectionism sometimes. If there's like a little hair sticking out, I want to pull it."
"People say they experience pleasure or relief when they do it," Keuthen explained. "And then they often experience a lot of guilt for having pulled out their hair. And the guilt then drives them to pull more."
Trich can be a lifelong and devastating battle. Rosalina Castillo, 23, belongs to a support group in Los Angeles called Heart. She's been pulling her eyelashes and hair since she was 7. She wore wigs to hide her bald spots, but she says she went through high school always afraid of being discovered.
"I'd have comments like, 'Are you wearing a wig?' 'I think she's wearing a wig.' 'We should find out if she … maybe we should pull her wig off and see,'" Castillo recalled.
She avoided swimming, slumber parties and sports, and she still refuses to go out on a date.