Mindy Atkinson of Cincinnati is one of an estimated 4 million to 11 million people in the United States who suffer from the impulse-control disorder trichotillomania (TTM), a condition that causes people to compulsively pull out hair, resulting in noticeable hair loss.

For Atkinson, the problem emerged during her adolescent years because of peer pressure, normal teen/parental disagreements and pressure to achieve good grades.

"One day, I was upset about something and I just started pulling hairs out my right eyebrow," she says. "I didn't even really notice it until I went to the bathroom and noticed my eyebrows weren't even anymore. So after that, any time I was anxious or stressed out, my hands would immediately run to my face. That was my stress reliever."

Atkinson looks perfectly normal until very close examination; she pencils in her eyebrows and has no eyelashes. She also fixes her hair to cover missing patches.

She started pulling hair from her head this year; for the past nine years she only pulled from her eyelashes and eyebrows. She attributes the stresses of her senior year in college for her pulling from a new location.

"I guess I was so stressed that one day I started pulling from the side of my head," she says. "I had a dark shirt on, and realized I had this mass of blonde hair on my shoulder. I didn't even realize I was doing it."

While 1 to 2 percent of the population is reported as having the disorder, that count might be far from accurate, according to Christine Pearson, executive director for the Trichotillomania Learning Center in Santa Cruz, Calif. If doctors screened for the disorder on a routine basis, a larger number of people would be identified, she says.

"Doctors have patients fill out long questionnaires of medical history, but they never ask patients if they pull their hair, pick their skin or bite their nails," Pearson says. "It's more common than people think."

TTM falls somewhere between obsessive-compulsive disorders and such conditions as Tourettes syndrome, according to Pearson. Some theorize the condition might be due to a chemical imbalance or a genetic predisposition triggered by some event. Pearson says that event could be something catastrophic, such as the death of a family member, or something as insignificant as a bad test score.

"It's like if a child's allergic to strawberries -- a mother will never know until the child actually eats one, and that could take years," Pearson says. "The disorder gets triggered by any number of different events in people's lives."

Those with the disorder go into "zones" where they're completely unaware of their behavior, Atkinson says. The behavior not only includes picking hair from any area of the body, but also chewing or eating hair. In extreme cases, some people actually develop hairballs in their stomachs, she says.

While the disorder can be traced back to biblical references to hair pulling, the medical profession looks at the condition as relatively new, Pearson says. Most physicians and psychiatrists are unaware and need to be educated about the symptoms and treatments, she says.

"Those who have TTM go to a doctor and just end up feeling stupid because the doctor knows nothing about it," Pearson says.

Atkinson describes the frustration of trying to find physicians who treat or even know about TTM.

"Most of the time, I end up educating them," she says. "Most people end up learning about Trich online or they try going to the library and looking it up in these complicated medical books that are impossible to read."

Treatment for the disorder focuses on cognitive-behavior therapy, attempting to help patients identify factors that trigger their hair pulling and redirect their responses. However, other treatments are being tested. Several different medications are being used to reduce the severity of TTM symptoms, mostly serotonin re-uptake inhibitors such as Prozac. Those with TTM have also reported some relief from alternative therapies such as hypnosis, biofeedback, dietary changes, exercise and support groups.

A TTM support group sponsored by the Mental Health Association of Cincinnati began two years ago at the urging of a University of Cincinnati student, says Sheila Sims, community resource director of the Support Group Clearing House. She says people seem relieved to discuss their TTM behavior.

"Like any other disorder, people will just be happy to hear it has a name and they're not alone," Sims says.

The disorder primarily begins in adolescence and can continue throughout a person's life. While there have been some success stories from those who were cured, Atkinson says that's normally not the case.

"What you mostly see is people who go through ups and downs, people who have good times and bad times," she says. "That's what's typical."

Atkinson says living with the disorder is a struggle, but she has come to terms with her life.

"I would love to be cured, be a success story," she says. "But if that day comes or even if it never does, I have come to a point where I won't let it take over my feelings or my self-worth anymore, the ability to feel proud of who I am."