Ellen Crupi can easily recall when she first pulled out a strand of her long dark hair in the same way some people might remember their first kiss or losing their first tooth. She was 12 years old and in gym class at her suburban Rhode Island middle school, waiting for teams to be chosen. 

“I was probably just playing with my hair to calm myself down, and I pulled a piece out. I don’t know why,” says the 54-year-old Crupi, who lives in Bethesda. “Ever since that moment, I was hooked. I just felt a zing.”

Pulling out her hair became a coping mechanism for Crupi, a way to tackle anxiety or even boredom, and nothing she was too concerned about at first.