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.