"It's a little bit different for each person," explained Mouton-Odum. "Some kids may pull because they're overwhelmed. Some pull because they're bored. Sometimes it's a sensory experience, maybe they feel one hair that feels rougher or thicker or bumpier. So it could be many different things that drive it ... that's what makes therapy so interesting, is we have to figure out what those driving forces are."
Many experts, including Mouton-Odum, believe that hair-pulling is part of a larger "spectrum" of disorders that share the same root as Obsessive Compulsive Disorder: compulsive shopping, pathological gambling, hypochondria, compulsive skin picking and body dysmorphic disorder. Like OCD, trichotillomania is repetitive and seemingly involuntary.
But, she said, there are important differences.
"People with OCD cannot stand their compulsions. They feel compelled to do them, because it relieves anxiety. People with trichotillomania like to pull their hair. It feels good. It's pleasurable," she said.
Mouton-Odum uses cognitive behavioral therapy, a goal-oriented form of psychotherapy that emphasizes the role of thoughts in damaging behavior and emotions, to treat Emily. She has a few other methods to help prevent the hair-pulling and divert the impulse into less destructive behavior.
"We'll use ... hats or gloves, or Band-Aids on the fingers ... things that prevent a person from pulling out their hair," explained Mouton-Odum.
"Another option is to use a substitute behavior, playing with a koosh ball or a toy, or a pipe cleaner, something that can relieve or satisfy a physiological sensation or a sensory need that can help a person to get through that urge," she said.
This combination therapy has helped Emily seize control of her hair-pulling, and channel her perfectionism into winning over the compulsion.
"I've been ready to just kick it. I just want to get in gear and just kick trich's butt," she said. "I just want to get that out of the way and just say I accomplished this. I got through this."