Sara pulls the woven, green hat from her head to show her nearly bald scalp, with only a few tufts of long, thin hair surrounding her crown. Sara has trichotillomania. She pulls her own hair out.

This is not the first time I met with Sara. In fact, we’d been working together for months, but this is the first time she felt comfortable enough to show me what she’s done to herself.“This is where I pull from, Dr. Deibler,” she explains. I nod and say nothing, not because it’s unimportant, but because it’s important to react as if this discussion is like any other discussion, even though she has never before revealed her trichotillomania to anyone.It hadn’t always been this way for Sara.

She began pulling her eyelashes and eyebrows at age 7. Now, at age 14, she’s pulled nearly all of the hair from her head and wears a cap so that no one can see. It’s not that she’s never sought help. She’d been to therapist after therapist, each one helping her cope with her parents’ divorce and family problems, but none of whom knew how to help Sara with her hair.

Now, she was working hard in her treatment to develop awareness, build coping skills, and develop new behavior patterns. She and her mother attended our trichotillomania support group to meet others who were struggling. And, over time, Sara improved, not just her pulling, but her happiness, confidence and self-acceptance.

That was three years ago. She doesn’t come by much anymore because she doesn’t need to. She no longer struggles, but she remembers what it was like to struggle. Earlier this year, she spoke to our support group for those who struggle with hair pulling. Many who attended wore head coverings, hairstyles, or makeup to hide their hair loss too, but not Sara. She was able to tell them what trichotillomania was like for her, as she sat in front of them with her long, beautiful, blonde hair and showed them how this struggle can change. In Sara, they saw themselves and they saw hope.

I often tell my patients that aside from treatment itself, an important thing unfolds in recovery: When people stop hiding, they start getting better. And this is what has happened for Sara; she stopped hiding and started living.


Dr. Deibler

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