Six years, four therapists, and “many” medications later, Mackensie is still learning how not to “give in to the pull.” As much as the teen enjoys reading and listening to music, she says they aren’t immersive enough to keep her from pulling. (Pull-free activities are typically those that involve the full body. ) Exercise has seemed to help: She hasn’t pulled during the spin classes she tried recently. Lately, she’s gotten immersed by drawing in art journal: “I’m using both my hands and they’re all covered in glue. I never pull when I’m art journaling.”

The origins of trich are mysterious. Research has proven some people may be genetically predisposed to the disorder, although lifestyle factors like stress and anxiety play a role. Behavior therapy is the most effective treatment. Medication, while not the first line of defense, can target coexisting conditions like anxiety, depression, or ADD/ADHD. National Health Services cites selective serotonin reuptake inhibitors (SSRIs), typically used for depression and anxiety, as one potential medical treatment.

READ MORE: What Are The Signs of Depression in Women?

Mackensie is focused on not pulling – but she’s also focused on living a life outside of trich. This year, she attended her fifth TLC Conference put on by the Trichotillomania Learning Center and gave the conference’s welcome speech. (The girl is also her high school’s mascot – she knows how to command a room!) She channelled her enthusiasm into a panel for teens, encouraging her friends to get to know themselves outside of their shared disorder. You can watch her speech below:

To some, that might have been a dull medical conference — but Mackensie was excited to tell YouBeauty about the friends she’s made over the years thanks to the organization: “Even someone you never met in person before, you just become best friends. We have a group chat on Facebook and we’re always just messaging throughout the school day,” she said. “It’s great to know there are so many people who suffer with the same thing and feel the exact same way.”