Psychological aspects of hair disease

Balding men are viewed as less desirable in a physical, personal, and social sense. Given the stereotype, it is not surprising that some men with androgenetic alopecia (AGA) appear to have a lower self-image, depression resulting in increased introversion, and increased feelings of unattractiveness. Ours is a culture that places a premium on physical appearance. In this context, appearance-altering conditions can be psychosocially insidious, especially conditions such as AGA with an uncertain course and a negative social meaning. To date, little or no data have been available regarding the psychosocial and quality-of-life aspects of AGA in a representative sample of community men. It is unknown whether AGA is a causal factor in the development of low self-esteem, depression, introversion, and feeling of unattractiveness, or whether there are underlying problems in certain patients prior to hair loss. Longitudinal studies will be important to investigate the temporal relationships between the degree of hair loss and psychosocial variables associated with AGA. A patient with male pattern baldness will be better treated and consequently more satisfied (better quality of life) if he receives effective anti-alopecia agents and simultaneously is evaluated and treated, if needed, for his psychological disorder.

The presence of trichodynia in patients with telogen effluvium and androgenetic alopecia

BACKGROUND

Trichodynia refers to pain, discomfort, and/or paresthesia in the skin of the scalp or the hair. There may be an associated psychologic comorbidity. Although androgenetic alopecia (AGA) and telogen effluvium (TE) are different entities in terms of pathogenesis, etiology, and clinical picture, both may be influenced by psychologic stress and may be the cause of secondary stress.

AIMS

To investigate the presence of trichodynia in patients with TE and AGA and to evaluate psychologic comorbidity in patients with trichodynia.

MATERIALS AND METHODS

A total of 248 patients (153 females, 95 males), presenting with hair loss due to either TE or AGA, were enrolled in this study. The prevalence of trichodynia in these two groups was compared with that in controls (n = 184). In addition, psychiatric evaluation was performed in 25 patients with trichodynia (13 females, 12 males) and in 25 controls (16 females, nine males) without alopecia and trichodynia by a psychiatrist; Diagnostic and Statistical Manual of Mental Disorders (DSM)IV criteria were used for the assessment.

RESULTS

Trichodynia was found in 72 patients (29%) with hair loss and in six controls (3.3%; P < 0.0001); 25 of the 72 patients with trichodynia underwent psychiatric evaluation and 19 of the 25 patients were found to have psychopathologic signs (76%). In the control group, only five patients had psychopathologic signs (20%; P = 0.0004). Of those with hair loss, trichodynia was more frequent in the TE group than in the AGA group (P < 0.0071).

CONCLUSIONS

Trichodynia is a common symptom in patients with TE and AGA, and often coexists with psychopathologic findings, including depression, obsessive personality disorder, and anxiety.

Female alopecia: the mediating effect of attachment patterns on changes in subjective health indicators

BACKGROUND

The interrelationship between female alopecia and psychological disorders is complex, with a range of psychosocial consequences, but also antecedents. Psychosocial antecedents are to a large extent interpersonal and can be assumed to have a mediating effect on health care utilization and subjective health.

OBJECTIVES

To analyse whether changes in health-related quality of life (QoL) are mediated by relational or attachment styles and whether these styles are associated with a particular, dysmorphophobic type of alopecia.

METHODS

Seventy-four women with androgenetic and diffuse alopecia underwent psychological assessment at the first consultation at a university clinic and at 2 months' follow-up. Attachment styles were evaluated by an observer rating scale. As a primary endpoint a disease-specific QoL instrument was employed.

RESULTS

Findings indicated an association between patients with nonvisible hair loss and the ambivalent attachment style. Global clinical impressions and attachment indicators, e.g. attachment security and coping strategies, showed significant contributions in predicting changes in the QoL scales 'self-esteem' and 'emotions'.

CONCLUSIONS

These findings suggest that attachment security may be one of the underlying mechanisms mediating subjective health and that a specific attachment vulnerability can be identified in a subgroup of patients with female alopecia. Future studies will have to focus on the relevance of attachment patterns in the doctor-patient relationship and on psychotherapeutic interventions.

Perception of men with androgenetic alopecia by women and nonbalding men in Korea: how the nonbald regard the bald

BACKGROUND

Baldness has significant negative psychosocial effects. It has been asserted that the negative effects of baldness are often trivialized by the nonbald. Most studies concerning the perception of baldness have focused on the perceptions of the bald by themselves. In this study, we assessed the perception of baldness by the nonbald in Korea.

METHOD

A questionnaire on the perception of balding men was answered by 130 women (age range 15-58 years), 90 nonbalding men (age range 18-72 years) and 30 balding men (age range 20-63 years).

RESULTS

Balding men were perceived as being older and less attractive by over 90% of respondents. A perception that balding men are less confident, duller, and less potent was reported by less than half of respondents. A perception that balding men are less attractive was significantly more common among women than among nonbalding men (P < 0.05). A perception that balding men appear less confident was significantly more common among balding men than among nonbalding men (P < 0.05).

CONCLUSION

In this study of Koreans, the perception of balding men by others was similar to the perception of balding men by themselves. It is likely that androgenetic alopecia adversely influences social interactions of those who are subject to it.

Psychological features of androgenetic alopecia

OBJECTIVE

To evaluate the psychological features of subjects with male (MAGA) and female androgenetic alopecia (FAGA).

METHODS

We performed a retrospective study of 100 patients with FAGA and the same number of patients with MAGA based on the features registered in the personal history of individuals who attended our Trichology Unit (Hospital Universitario Virgen Macarena, Sevilla, Spain) from January 1993 to January 1995.

RESULTS

Depression was more frequent in FAGA than in MAGA (55:3), but anxiety (78:41) and aggressiveness or hostility were more frequent in MAGA than in FAGA (22:3), and three men were considered anxious and depressive. Treatment resulted in improvement in 89% of FAGA and 76% of MAGA, and the subjects continued attending with periodic check-ups. There were requests for surgical treatment by 3% of FAGA and 12% of MAGA, and 6% of FAGA and 12% of MAGA did not return for follow-up consultation. All of the MAGA showed aggressiveness and lack of willingness to follow the correct treatment.

CONCLUSIONS

In general, AGA patients tend to have elusive personalities and, although the individuals may go to the trichology centre accompanied they preferred to present alone to the desk or at least to the trichological examination room, except for subjects with depression who would often not agree to the physician removing hairs for the trichogram. Most subjects accepted the prescribed medical or surgical treatment, but several phoned before the second treatment session because the results of the first session were not as good as they had expected. The drop-out rate was higher in men (1 in 2), who were probably subjects showing aggressiveness.

Strategies of coping and quality of life in women with alopecia

BACKGROUND

Measurements of the quality of life (QoL) have recently become an integral part of dermatological studies. Our hypothesis is that QoL in patients with certain diseases can be affected by strategies of coping behaviour, as well as by personality traits.

OBJECTIVES

The aim of this study was to explore the particular correlation between QoL and strategies of coping in female patients with alopecia.

PATIENTS

Fifty female patients, diagnosed with either diffuse or androgenetic alopecia, were evaluated by the use of Hairdex, an instrument developed to measure QoL in patients with hair loss. Most patients also underwent additional psychological assessments.

RESULTS

Findings indicated that patients with highly visible hair loss reported a more negative impact on four Hairdex dimensions (functioning, emotions, self-confidence and stigmatization) than patients whose hair loss was only slightly visible. However, a subgroup of patients, with non-visible symptoms of hair loss, showed striking signs of psychological disturbance. These disturbed patients displayed either dysmorphophobic or affective disorder tendencies.

CONCLUSIONS

Future studies using QoL as an instrument in research on patients with alopecia should consider that in cases of female alopecia these measurements may be affected by psychological disturbances.

The psychosocial consequences of androgenetic alopecia: a review of the research literature

Androgenetic alopecia is a common dermatological condition, with potentially adverse psychosocial sequelae. The present review critically examines scientific evidence concerning the effects of androgenetic hair loss on social processes and psychological functioning, as well as the psychosocial outcomes of medical treatments. Research confirms a negative but modest effect of visible hair loss on social perceptions. More importantly, androgenetic alopecia is typically experienced as a moderately stressful condition that diminishes body image satisfaction. Deleterious effects on self-esteem and certain facets of psychological adjustment are more apparent among women than men and among treatment-seeking patients. Various 'risk factors' vis-à-vis the psychological adversity of androgenetic alopecia are identified. Medical treatments, i.e. minoxidil and finasteride, appear to have some psychological efficacy. A conceptual model is delineated to explain the psychological effects of hair loss and its treatment. Directions for needed research are discussed. Strategies are presented for the clinical management of psychological issues among these patients.