Meet Queen Sarah, a teenager who pulled all her hair out while battling crippling anxiety and depression, now a stunning beauty queen!
After developing the condition seven-years-ago, Sarah describes it has an "irresistible urge" to pull out her hair.
But two-years-ago, after receiving psychiatric help she started to embrace her condition and stopped hiding her baldness in public.
To raise further awareness, Sarah, from Philadelphia, America, started entering beauty pageants and has placed multiples times while share her empowering message that she's beautiful without hair.
Sarah, a cinematic film student, said: "I used to feel ashamed of my appearance, but now have worked through my anxieties and want to promote self-love and awareness in pageants.
"I have dealt with this hair-pulling disorder for seven years, I started pulling out my eyebrows and eyelashes, then the hair on my head and now I'm pretty much bald.
"The compulsion is like an irresistible urge, like an itch you need to scratch but rather than scratching, you pull out your hair and don't realise you're doing it.
"When I started pulling out my head hair, I started wearing hats, bandanas and wigs to hide it, no one knew about it until two years ago.
"I received help to show my baldness for the first time two years ago, I was very uncomfortable, my anxiety hit the roof for ten seconds and then I realised no one died and nothing bad happened.
"I feared taking my hat off in public for five years and when I did nothing bad happened to me, I realised I don't have to hide this big massive secret from the world.
"From there, I started entering pageants to spread awareness of trichotillomania and used my platform to talk about being able to stand proud without hair and be happy.
"I've had an outpouring of positivity from people who have been very supportive, since being more open about my condition and others have spoken to me about their issues too.
"Now I frequently enter pageants to show that the magazine image of beauty of people with long hair is not necessary and that you can be happy being bald.
"I'm confident enough to say now that I don't need long hair, I'm happy and beautiful with short hair."
Sarah was bullied during her early-teenage years for being an 'outcast', she believes the stress of that led her to start hairpulling.
Five-years into her trichotillomania her depression and anxiety worsened, leading her to seek professional help.
Sarah said: "I couldn't function and wasn't really leaving my room, so I agreed to go and get psychiatric help.
"Their treatment worked towards being confident enough to stop hiding my hairpulling and to take off my hat in public.
"When I took the plunge, in that moment of truth when I took my hat off, the world didn't end and it gave me confidence to be bald in public ever since."
Sarah says the response to her hairpulling has been accepted since revealing the effects of her disorder.
She added: "I have a condition that makes me pull out my hair, I had no idea whether people would be accepting, so it was a big leap.
"But it's been really positive, it's showed me how much good there is in the world and despite some negative comments I know I'm helping others."
Sarah explains the compulsion of her condition, she said: "There is a pain when I pull my hair out but I'm not thinking when it happens, it's a subconscious reaction, it's hard to explain to people.
"The impulse in general is like nail-biting, it's a behaviour that a person doesn't even realise they are doing."
Sarah's been entering beauty pageants for two years now, winning first place and runner-up positions and using her platform to talk about trichotillomania.
She said: "I was honestly astonished and elated when I won, I entered with the mindset that it could go really wrong and people wouldn't understand.
"I'm ok with having trichotillomania now, I can't believe where I am today, I'm dead serious when I say I wouldn't change it as this has defined me in the best possible way."
Sarah went to Prom three-months-ago and while she admits she looked different to how she previously imagined herself, she enjoyed the experience.
She said: "Everyone pictures being beautiful with long hair at prom, but that didn't bother me, it was a cool experience not relying on extensions or make-up to feel beautiful.
"Going to prom is a big moment universally, so I've since posted my picture on Facebook groups to show them not only did I look pretty but I felt beautiful and confident too.
"I am content with how I look now, sometimes I wear a wig but only when I want to, I don't have eyebrows or eyelashes and my hair is short and patchy, but I wouldn't change it for the world."
Sarah is fundraising to continue her pageantry work, you can donate by visiting: www.gofundme.com/trichawareness