Every morning, Mackensie fills in her eyebrows with eyeliner — the beginning and end of her daily makeup routine. It’s uncomplicated. Usually, it’s enough. But on this late Saturday afternoon, she’s gone unexpectedly HAM in a makeup store.
She tears polishes from a wall, painting every nail a different color. She angles to see herself in the corner of a mirror, wielding a flat Q-tip soaked in black liquid. After eyeliner, bronzer. After bronzer — two shades too dark — red, red lipstick.
“I look so different,” she says, gleeful and skittish.
The Lenox Square Mall Sephora can inspire this sort of behavior in the uninitiated. Mackensie explains that her trips there are usually limited to a few minutes, tagging along with people who know exactly what they want. She’s never actually tried stuff on.
“You could literally come here and do your whole makeup for your wedding!” she says. “I hope we don’t run into anyone I know.”
Suddenly she’s done. She looks at the mirror again, braces flashing, unruly curly hair piled into a bun that covers slivers of her bare scalp. She laughs, raising a pale hand to a much darker cheek. She does look different. She decides that feels good.
We visit two malls over two days, and Mackensie adores them both: the pristine tile, the organization, the food courts. Inside stores, she walks with one arm outstretched. She flattens her hands against Vera Bradley bags, drops Claire’s rings onto her small fingers. At Macy’s she clutches tops with phrases on them, reading each one out loud: “‘I’m actually really smart.’ That describes me! ... ‘To bae or nah to bae.’ I hate the word bae.” A boatneck shirt in purple ombre printed with two faded palm trees is “so Tumblr.” She says her ideal style is “schoolgirl chic.”
But the thing is, Mackensie never buys or even tries on anything. She hates spending money. When not bound to her school’s navy-polo, gray-skirt uniform, she wears old souvenir T-shirts with denim or stretchy black pants and sneakers. Her winter jacket is pink fleece. The mall never appeals to her functionally — it’s just a bounty of stuff to see and touch and imagine herself wearing.
When she was in fifth grade, Mackensie began pulling the hair from her eyebrows. They were thick, and she was self-conscious, so she used her fingers to thin them out. The summer before sixth grade, she began pulling from her scalp. A large bald spot formed on the back of her head, so over winter break, her dad cut off all of her hair. She started wearing a wig. By now — 10th grade — Mackensie’s wild, wiry curls have grown back, and she uses her bun or a hairpiece to hide her bald spots.
According to the national Trichotillomania Learning Center, 2-5% of the general public have the hair-pulling disorder. It’s a BFRB, or body-focused repetitive behavior. Another BFRB is skin-picking, which many people with trichotillomania — and 5% of the general public — also do.
Trichotillomania — trich (pronounced “trick”), for short — is listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, but according to the TLC, the five criteria associated with the official diagnosis don’t always present themselves in every person with trich. You can feel pleasure or relief while pulling (one criteria), but not necessarily tension before you begin pulling (another criteria). Some don’t realize they’re pulling until another person points it out, or, as the TLC explains, until “he/she discovers of pile of hair, scratches on the skin, open scabs or bleeding fingers.” Examining the damage after a pull is often part of the process, which can mean anything from twirling a loose strand of hair around a finger, to, for some, tasting or swallowing it.
Some people with trichotillomania identify their behavior as self-harm. But the TLC says pulling isn’t like cutting — though people who suffer from BFRBs, including Mackensie, do often suffer from anxiety or depression, too.
"It's an interesting question we talk about all the time," says Leslie Lee, TLC's program manager. "Because these are 'women's issues,' right? Hair and skin. I got an email the other day from a 22-year-old man who said, 'Do I have a women's problem?’”
When Mackensie pulls, she’s “looking for a coarse hair, kind of,” she says. “I don’t think it feels good necessarily ... Some people are like, ‘Oh, I love the feeling.’ I guess I do, but I started pulling from the wig too, so I guess just the feeling of getting rid of a hair, then playing with it and feeling it, which I really like.”
She’s tried different “fiddle toys” — like Koosh balls — but she says nothing provides her the same relief. She’s gone through four therapists, including her current beloved one, whom she sees once every other week. She’s tried hypnosis. She can’t recall all the drugs she’s been prescribed — among them Prozac and Naltrexone, often prescribed to recovering drug addicts or alcoholics. These methods and medications have helped others curb their trich, but Mackensie says she’s never been “pull-free” for more than two weeks.
Mackensie doesn’t have a job or an allowance, but she does make money. From September to January, she says, she collected about $200 through the Buckhead Exchange, a Facebook group for buying and selling in her affluent Atlanta neighborhood. There’s a group for teens, but Mackensie spends most of her time in the group for moms, who buy the childhood clothes and toys and books she lists for sale. She’s also obsessed with getting free products and gift cards and subscriptions through sites like icravefreebies.com — recently, she accidentally subscribed her white Jewish family to Essence.
Mackensie isn’t particularly interested in sports or the arts. Her short-lived stints in band playing the French horn and trumpet are spoken of with mock horror by her mom, who recalls spending one recital in the audience slunk low in her seat, hand over her eyes. But Mackensie has found her extracurricular joy as the varsity football mascot. She’s a lion, packing all her 5-foot enthusiasm into an overheated costume.
But the thing Mackensie really loves, more than malls and freebies and mascotting — miles ahead, in fact — is, and of course it is: One Direction.
On display in Mackensie’s room are three life-size cutouts of 1D members and north of 60 posters on her walls. She has One Direction–branded bracelets, books, Barbie dolls and figurines, socks (which she won’t wear because they’ll get dirty), pillowcases (which she won’t use because they might get lost or ruined in the wash), first-row ticket stubs, wrapping paper, balloons, and temporary tattoos. The worst question you could ask her is which member of 1D is her least favorite. Instead, she’ll diplomatically put them in order: Harry, Niall, Louis, and Liam. (Zayn was fifth even before he left the band.) Her love for them is unconditional and earnest.
“Sometimes I'll be pulling, and I'll think, Harry wouldn’t want you to do this, so I’ll stop for a few minutes,” she says. “A lot of people don’t understand that. I usually keep it to myself or tell my therapist. They’ve helped me a lot and that’s why I like them so much. My goal in life is to meet them and thank them. I know this sounds totally weird, but I want Harry to kiss my bald spot or something. I’m like, that’ll help me stop pulling.”
Taped to her bedside table is a list she made of reasons she doesn’t want trich, with entries like “eyebrow makeup sucks” and “hair piece is annoying.” But also: “Harry would be proud (heart emoji).”
“I have a theory,” Mackensie says about the reminders. “Once you've had trich for a long time, you get so far and deep into it that it's, like, taken over you — you feel like there's no help and that nothing you can do will help it. And you get brainwashed, in a way, into thinking that you like having it and that you don’t want to stop. So I'm kind of in that hole right now.”
To know Mackensie is to know she loves attention. She’ll remind you of this, too, whenever she says something particularly spotlight-hungry (like “I love the spotlight"). It's simple: Attention, she says, makes her happy, and she's channeled that into a one-woman trichotillomania-awareness campaign.
Last fall, she emailed several media organizations, including BuzzFeed, introducing herself as a 15-year-old from Atlanta. It worked; over the next four months, Mackensie appeared on the websites of MTV, Gurl, and Cosmopolitan, and in J-14's iconic congested pages, talking about her experiences with trich.
On Twitter, Mackensie routinely tweets at reporters and searches for the word "trichotillomania," sending strangers who tweet about their disorder links to TLC's website and stories about her. She urged the combined 5,600 followers of her One Direction fan Twitter and Instagram accounts to buy the J-14 that featured her. She doubles these efforts on her Facebook page. She used to have a Tumblr, until the mother of a girl at her school saw it and contacted the school. It was “just a hipster Tumblr” with about 3,100 followers, Mackensie says — she learned basic HTML so she could customize her page. But there was also an “about me” section that described trich and her past experiences with depression and cutting. The title of the blog was Sugar-Coated Whore.
The school contacted Mackensie's mom, who made Mackensie shut it down. "She didn't know it was that bad," Mackensie says. "I was really upset. It was good to let out my feelings, because I learned through the trich community that it's good to share your story."
That's not to say Mackensie's family isn't supportive — their two-story brick home in Buckhead is warm and silly, particularly when Mackensie's younger sister, 13-year-old Reagan, is around. It's just that raising a kid with trich has been hard. What do you do when your fifth-grader comes home with no eyebrows because she tore them all out?
"As a parent, I was literally like, I want to die," Mackensie's mom, Faryl, says, driving to pick Mackensie up from school one day.
Faryl is an accountant. Mackensie's father, Kevin, is an ophthalmologist. When Mackensie began pulling, they understood it was a medical issue — not all parents do. That didn't make it any easier; this wasn't a rough two-week adjustment period. When Mackensie relapsed in seventh grade, pulling out every last eyebrow hair, her parents rushed home early from one of Reagan’s soccer games. For a long time, Faryl says, she and Kevin would wake up in the morning thinking, "Another shitty day!" They became the self-described hair police, busting into Mackensie’s room to see if she was pulling, telling her to put a hat or gloves on.
"That's the worst thing to do, but you can't help it,” Faryl says.
Cutting off her hair entirely was a big, messy decision — Kevin and Mackensie were on board, but Faryl was resistant. It ended up being a turning point, though. It helped them get past the shock — to realize Mackensie could only stop on her own.
"You feel bad about it,” Faryl says. “But it was just easier to look at."
The social event of the year for freshmen and sophomores at the tony Lovett School in Atlanta is the pre-debutante cotillion, or PDC, a version of Sadie Hawkins with upper-crust rules. Before girls can invite boys, they must first be invited by a hosting committee. There is a required manners class — for girls only. If a girl wants to attend as a sophomore, she has to have attended as a freshman. This year, Mackensie went with a football player; she asked him with a note written on a $1 football from Target.
Mackensie's classmates have known about her trichotillomania since the sixth grade, when Mackensie gave her blessing to the PE teacher to explain the disorder to the class. She isn't ostracized for it; open bullying isn’t tolerated at Lovett. But that doesn't mean Lovett is paradise, socially. Once last year, the administration called an emergency assembly after Yik Yak — an anonymous social network, incidentally co-founded by a Lovett alum — had been flooded with vile messages about students and faculty members.
"Everyone says Lovett isn't cliquey, but it is," Mackensie says.
"Lovett is SO cliquey," her friend Josephine chimes in. It's Friday night, and the girls are out to dinner at Flip, a burger bar that calls itself a boutique. Josephine is outspoken like Mackensie, but in a more grown-up way — where Mackensie has unfiltered enthusiasm, Josephine plays it cool. Mackensie says she doesn't spend much time thinking about her generation, while Josephine can go off about Vine and people her age not being able to carry on conversations with adults. Their worlds within school are different, too. Mackensie worries most about keeping up good grades. Josephine worries most about being able to stand up for herself.
"Like, if someone disagrees with or a good amount of people disagree with you, being able to not give in just to be like them and to have their acceptance,” Josephine explains. “A lot of my guy friends drink, and I don't want to.”
"I'm, like, out of the loop," Mackensie says. "I didn't even know that was going on."
"Oh, yeah. Silly boy stuff," Josephine replies. She has a boyfriend who she's gone to two PDC dances with now. Mackensie says she doesn't like anyone right now — and she's fine with that. Her PDC date was just a friend; she spent slow dances asking what he thought of the Spanish exam.
Before leaving the restaurant, they pose for a photo that will later become one of the thousands Mackensie has uploaded to Facebook. It’s been hard for Mackensie to find a group of friends in high school. She knows she tends to over-apply the term "best friend."
"A best friend invites you over to places,” she explains. “I don't really get invited places much."
Mackensie has a new psychiatrist — Dr. Eric Fier, an animated, comradely doctor with an exceptionally hip office in Atlanta’s Old Fourth Ward. During Mackensie’s second appointment, the doctor spends about an hour alone with her before bringing in Faryl. All together now, they talk about whether there have been any obvious differences in Mackensie’s pulling.
“As Mackensie will tell you,” Dr. Fier says, “she's not going to really stop until she makes a commitment to stop … And she's not there.”
“You’re not at that point?” Faryl turns to Mackensie.
“I don’t know!” Mackensie says.
“What do you mean you don’t know?” Dr. Fier asks.
Mackensie goes into her theory about trich and brainwashing.
“So, she has a relationship with trich,” Dr. Fier says, facing Faryl now. “Trich really is a relationship. It's like any addiction, whether it's drinking, whether it's coming home and smoking some weed, whether it's pulling your hair when you're stressed out. And like many relationships, you know, it's got certain elements about it that, even though you know we're not going to stay together forever — this isn't really a good long-term relationship, I'm not sure that I like myself most when I’m in this relationship — it still sometimes feels pretty good, and it is pretty familiar, and the thought of stepping out of this relationship and just trying to see who I am without being in this relationship is a little bit scary.
“I have this conversation with kids all day long,” Dr. Fier continues. “I asked Mackensie straight out, ‘At what point in time, what day, what month, what year, what age, do you think you're ready to stop trichin'?’ She said, ‘I'm not sure yet.’”
“[My therapist] and I are working on that, trying to get to that feeling,” Mackensie says.
The focus of their work, the doctor says, should be getting her anxiety down, but also nudging Mackensie out of her familiar world, building her confidence through new friendships and interests outside trich.
“I just don't want you to think that what stands between her and stopping trich is magic or anything. Mackensie is what stands between Mackensie and stopping trich.”
Later, in the waiting room while her mom schedules her next appointment, Mackensie admits this stressed her out.
“I don’t really want to do new things,” she says, solemnly — unusual for her. “I’m happy where I am. I just don’t want it to influence my parents so that they completely change, like, how they do everything.”
Mackensie hasn't stopped smiling since the Skype call began. "Oh my god, you guys are hurting my mouth so much."
One of the girls is sharing her screen with the other three, clicking through Facebook photos of a guy at her school. "He's into Muse!" the girl says. "Like, he has good taste in music too. He's everything I aspire to bang in one." They laugh and can't stop laughing.
Mackensie attended (and spoke at) her fifth TLC conference last week — she knows these girls from past conferences and from a Facebook group for teenagers with trich. They're making plans — when to buy tickets to the conference, what day they should arrive. Mackensie wants everyone to come early.
"Then we can have a whole day together! And we can go work out, 'cause, you know, 'working out with best friends.'"
The others — all slightly older — seem to adore Mackensie, the little sister of the group, teasing and praising her at once. They talk about getting through their schools' firewalls and looking at colleges and maybe going vegan, but the conversation always finds a way back to trich — to their annoying ingrown hairs or things their therapists recently said. The conversation isn't agonizing or emotional. It's often really funny. One girl shows off her hairpieces hung with Command strips to her wall. Mackensie says she used to keep hers on a stuffed bunny.
"Weed is actually so good for pulling," one of the girls mentions — she also knits to keep her hands busy. "It's not, like, perfect, but it's probably the best thing I've tried."
For another girl, exercise and NAC (N-acetylcysteine) twice a day has been the most effective — though the pill is awful to take. When she says she’s been “pull-free” for 17 days, everyone cheers.
Dozens of articles and TV segments feature trichotillomania every year. Usually a young woman is at the center of the story, and usually the headline is something like “I pull out my own hair!” The girls read or watch all of these pieces; they know that often, the stories can come across like carnival introductions to a mystery disease. "They usually don't make it out to seem like we're normal people," one girl says on the Skype call. "They act like it controls our entire life and every single second of it. I just don't feel like that's really how it is."
Trich provides a reliable mystery narrative largely because there’s no universal treatment or cure. How could there be, with such little understanding of the disorder? There's never been a large-scale impact study to determine how many people are truly affected by trich. And because it afflicts largely young women — or at least young women are the most vocal about it — trich tends to conjure this 6-o'clock-news-ready image of an average teenage girl harboring a dark secret.
The morning after her Skype call, Mackensie is scrolling through the Facebook group for teens with trich. Someone posted an image that says "Finding friends with the same mental disorder as you: priceless." Another person in the group just messaged her for advice on how to reach out to the media. Mackensie makes a face; she doesn't really want to share the spotlight.
She's still trying to convince herself that she's not the "girl with trich," and that trich doesn't define her — and yet it's given her a platform, and an identity at an age when it's hard to find one or keep one.
"I haven't really admitted that, but yeah, it does," she says. "And it's all just 'cause it's kind of a safe thing — something about me that I know."
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CORRECTION: This piece has been updated to clarify that the Trichotillomania Learning Center has funded several studies since 2006.