Hair loss is a common problem that can be caused by a variety of conditions.
Imagine, though, it happening to a young boy because he pulled out his hair.
That's what Max Sherwood of Riverdale, Iowa, had to endure. Max, 11, has trichotillomania, a psychological disorder that causes people to pull out hair from their head and other parts of the body to the extent that it causes patches of baldness.
"He started to pull out his eyebrows when he was in second grade, then he quit," mother Candace Sherwood said. "Then, when he started fourth grade, he started to pull out his hair."
At a loss, the Sherwoods attended a trichotillomania conference and learned about Hair Club for Kids, an organization that provides free hair systems for children with medical conditions that cause hair loss.
Lee Zoppa, a vice president of Hair Club for Kids, says it's not hair replacement, but a semi-permanent hair piece made of synthetic fibers woven in with real hair. It lasts about four months, and children who get hair systems get free replacements as often as they need them up until age 17.
Max got his system in October of 2009. After wearing it for just a few months, Max stopped pulling out the hair on his head.
"Because of the glue in the hair system, he couldn't pull his hair out and he retrained his brain to focus on things other than pulling his hair," his mother said.
But even though Max no longer pulls his hair, trichotillomania doesn't go away, and there's a chance something will trigger his hair pulling again. Even though he's only 11, his battle with trichotillomania has already been a long one full of many challenges in addition to the hair pulling.
Walking around with patches of baldness subjected Max to taunts from children and adults.
"One day, there was a grandma who said to him, 'What do you have in your hair?' Max was really embarrassed and he hid behind me," Sherwood said. "A girl at school said, 'You look like an old man' and another one said, 'You need a new hairdresser.'"
Experts say social stigma is perhaps the most debilitating aspect of trichotillomania.
"People are very worried about being discovered, and social impairment is a pretty big problem," said Dr. Martin Franklin, associate professor of clinical psychology and psychiatry at the University of Pennsylvania School of Medicine in Philadelphia. "There are worries about going out, swimming and a lot of shame."
The majority of adults who suffer from trichotillomania also suffer from depression, and children might have academic difficulties, Franklin said.
The hair pulling typically starts in childhood, often because of anxiety or boredom.
"Some say it's pleasurable in a way," Franklin said. "It calms them down or gets them interested when they're bored."
Max is a highly intelligent child, and often got bored in class, his mother said. He also had to switch schools, which created a lot of anxiety, Sherwood added.
Treatment options include medication and behavior therapy, but some studies suggest a combination of both is the most effective. Trichotillomania used to be considered a kind of obsessive-compulsive disorder (OCD), but the medications used to treat OCD are generally ineffective. Instead, experts classify trichotillomania as a body-focused repetitive behavior disorder.
"The behavior therapy includes trying to get folks to use a substitute behavior and engage in a competing response," Franklin said.
Max said he now stretches rubber bands instead of pulling his hair, which does help him a little bit.
Max and his parents are thrilled with the progress he has made with his hair system. He's done so well, indeed, that his hair finally grew back.
"He got the first haircut he had in two years," his mother said.
But, she said, Max's hair system remains in a very important place in the house.
"We keep it in his bedroom," she said, "to remind him that he stopped pulling."