Maybe you’ve heard of trichotillomania — often abbreviated to TTM or “trich” — more commonly known as hair pulling disorder. It’s a behavioral disorder that results in an obsessive compulsion to pull out one’s hair — be it on the eyebrows, eyelashes, and/or the scalp. According to theTrichotillomania Learning Center, 2 to 4% of the population, or roughly two to 10 million Americans, suffer from it — and 80 to 90% of them are female. The overall group even includes some people you might recognize: Katy Perry, Olivia Munn, and one of the 10 to 20% of affected males, Justin Timberlake, have all openly discussed their experiences.

According to Dr. John Walkup, M.D., co-program director at New York-Presbyterian’s Youth Anxiety Center, TTM can be exhibited in two different ways: people who “pull in a dreamlike state” — they don’t even realize they’re doing it — and people who deliberately identify specific strands of hair and pull with a more focused approach. (Or a blend of both.) Causes really depend on the person — it could be stress, anxiety, depression, some sort of behavioral issue, or, in some cases, a dermatological situation. And there’s no known cure.

“The treatment is really one where you identify the behavior — you understand when it happens and what the triggers are — and then you develop behavioral strategies to disrupt or interrupt it,” Dr. Walkup explains. First and foremost, anyone who thinks they might suffer from TTM or hair pulling disorder should seek help from a qualified healthcare professional who has specialized expertise in treating it. And a good place to start is the Trichotillomania Learning Center website, which can direct you to specialists in your area.

Of course, dealing with the day to day of trich — especially in our selfie and Jenner-obsessed world — is no easy task. “If you think about how important appearance is to first impressions, [dealing with TTM] could be a very big deal for people,” Dr. Walkup says. And, for someone suffering from hair pulling disorder, such normal activities as a visit to the salon can be an intimidating experience. However, there are salons (or individual stylists within some regular salons) that specialize in styling for people who suffer from all types of hair loss — be it female pattern hair loss, chemo treatments, alopecia, or TTM. Most importantly, these salons offer a safe place, where one won’t feel judged or embarrassed about the hair pulling or the resulting bald spots.

Sheila started working with trich clients seven years ago with a part-time gig doing extensions. “My first client was known as the hat lady. She pretty much pulled everything out of her head, and after we put the [hair] piece on, she threw her hat away, and everyone was crying happy tears. So I fell in love, and I’ve been working with TTM clients ever since,” she says. Sheila works out of Salon Ziba in New York City, at a location with a private room where she is able to work with clients without the rest of the salon’s patrons looking on.

“The privacy factor is probably the most important part of their visit,” agrees William Collier, owner of William Collier Design, about the need for a private room. “Frequently they haven’t shared this information with maybe anybody, or maybe just a few people.” His Seattle-based salon specializes in providing wigs and hairpieces for people suffering from hair loss. William has been in the hair styling business for over 40 years and started in the industry working with “models and that sort of thing.” But after working with chemo patients, he decided to concentrate on an area that felt more fulfilling and “gratifying.”

An experienced stylist can also offer some tricks and hacks to styling around or hiding bald spots for their day-to-day. For less severe TTM clients, Sheila might strategically cut and blend the hair to seamlessly integrate the grow-out strands. She sometimes uses dry color spray or hair fiber powder to fill in bald spots. Or, she’ll teach her clients creative ponytails or half-up-dos that cover the areas. “I show them what they can do to hide the areas, if it’s possible,” Sheila says. (She also points out that men have an easier time camouflaging their patches — they can just shave their heads.)

There are also specialized extensions, like the patented Intralace system from Lucinda Ellery. Lucinda has “studios, not salons,” as she says, in Beverly Hills and London, and she just opened up a New York location. The extensions are handmade from human hair and are put in place with an intricate weaving system and what she refers to as “silicone taps,” sort of like surgical grade tape. “Once it’s in position, you’re good to go, wash and brush your hair and set and treat it as if it were your own,” she says. “In a way we took Hollywood technology and turned it mainstream,” she adds.

Costs for these services can run the gamut, depending on the stylist and salon. For William Collier’s wigs and hairpieces, it depends on how much hair is needed. “It can range from a $350 synthetic wig up to $5,000 plus. It just depends on hair quality and length,” says Judi Wygant, manager and hair replacement consultant at William Collier. She encourages clients to come in for a complimentary initial consultation and she “handholds” them through the insurance reimbursement process, if applicable.

Lucinda Ellery’s patented extensions fall on the higher end of the spectrum. The extensions themselves run from $2,000 to $3,500, plus follow-ups every six weeks for 1.5 to two hours at the rate of $150 per hour for one or two years. After doing the math, that’s a pretty big investment. Sheila charges for extensions based on the client’s requirements. For her trich-friendly cutting and styling, she charges her regular client rates, because that’s the point. She doesn’t believe that clients who suffer from trich should be paying more than anyone else.

Of course, people dealing with hair pulling are often quiet about their disorder, so that doesn’t necessarily help when it comes to finding the closest trich-friendly salon. Again, the Trichotillomania Learning Center website is a great resource for local salons that provide such services, plus a good old Google search helps, too. William Collier actively advertises itself as a trich-friendly salon. Sheila has a dedicated trichotillomania tab on her own website, and Salon Ziba calls out her trich-friendly styling services on its telephone hold message when you call to make an appointment. And, there’s word of mouth, too.

When Seattle area-based Andrea would visit regular salons, she’d have to face trich-ignorant stylists asking why she had bald spots. “This has by far been the most personal and emotional issue I have ever had to deal with…. and it’s so blatantly obvious,” she says. Andrea would claim the patches were caused by a non-existent thyroid issue. She eventually found William Collier on the TLC website. But “it took me months before I got the courage to call and make an initial appointment,” she says. Her fears were assuaged when she met with Judi for the initial free consultation, and then William personally worked with her to fit her wig, cut it to her style preferences (bangs!), and show her how to blow dry, curl/flat-iron, and care for the piece. “William Collier was an amazing salon. The staff were so kind and gentle,” she adds. “They gave me the space to experience all of my emotions as they bubbled up throughout my couple of appointments. They offered not only Kleenex, hugs, and their understanding, but an amazing array of wigs.”

But, it’s important to know that these hair styling techniques — or “solutions” or “systems” as some may refer to their services — are not by any means ways of managing, treating,  or curing TTM. Dr. Walkup emphasizes to anyone suffering from TTM: first and foremost, seek treatment from a qualified healthcare professional. Salons are a way for a person who pulls to aesthetically maintain a daily look, and just have a place to go and get their hair done like any other person --without judgement or discomfort.