"They Looked at Me Like I Was Crazy": Practitioner Experiences Among People Engaging in Hair-Pulling

Trichotillomania is a disorder affecting 1-2% of the population during their lifetime and is characterised by recurrent hair-pulling that often leads to distress, low self-esteem, social ostracism, and lowered relationship satisfaction. Despite the availability of effective therapies, individuals with trichotillomania frequently report dissatisfaction with clinical care. This qualitative study explored the experiences of 20 adults with trichotillomania, focusing on their interactions with mental health practitioners. Using reflexive thematic analysis of semi-structured interviews, we constructed two themes: feeling (mis)understood and therapeutic (dis)connections. Participants described significant challenges in finding knowledgeable, compassionate practitioners, often encountering practitioners with dismissive attitudes, inaccurate assumptions, or misunderstanding of their condition. A common frustration involved practitioners conflating hair-pulling with self-harm, which many participants viewed as invalidating. However, some participants reported supportive therapeutic relationships that fostered acceptance and coping. Positive experiences were marked by practitioner empathy, validation, and tailored advice. These findings highlight the critical role of therapeutic alliance and practitioner compassion in treatment satisfaction and engagement. Greater awareness of trichotillomania and sensitivity to individuals' explanatory models among practitioners are essential for improving clinical outcomes.