Psychological impact of hair loss

Volume 6 Issue 4 April 2016

Consultation Liaison Psychiatry Focus: ‘Dermatology’

Hair plays an important role in determining the appearance, personality, self-image, and social perception. Hair style, length and volume are an important factors in determining a person’s identity. Hair loss or alopecia can result in dissatisfaction in appearance, self-esteem, and impaired psychosocial functioning in both men and women. Alopecia is broadly classified into scarring and non-scarring types. Among scarring alopecia most common causes include trauma, lichen planus, discoid lupus erythematosus, infections etc. In non-scarring types androgenetic (patterned hair loss), alopecia areata and telogen effluvium are most common.

Effects of alopecia on mental health

In males the most common cause of alopecia is androgenetic alopecia or male pattern baldness. This is characterized by thinning and loss of hair over fronto-temporal and vertex regions. This is mediated by the hormone dihydrotestosterone (DHT). It usually leads to poor self- esteem and depression. In females’ femininity, beauty, sexual attractiveness, and personality are related to hair. Hair loss can therefore seriously affect their self-esteem and body image.

Effect of mental health problems on hair loss

Obsessive compulsive disorder can be associated with frequent plucking out of one’s own hair (trichotillomania). Stressful events can lead to excess hair shedding (telogen effluvium) and also can exacerbate some hair related disorders like alopecia areata, lichenplanus etc.

Management of hair loss

Adequate treatment of the hair loss problem with restoration of hair, results in improvement of patient’s self-image in many if not all patients. In some cases like in alopecia areata proper medical treatment can result in complete cure of the disease process. In others cases like in androgenetic alopecia surgical treatment with hair transplantation can solve the cosmetic problem and enhance the personality and self-image. Other options to cover baldness include camouflaging with micro tattooing, hair pieces etc.

Psychiatrist’s liaison is vital for patients with depression, anxiety, social phobia, and identity issues. Management plan includes psychological approaches like cognitive behavior therapy and pharmacotherapy eg. antidepressants especially SSRIs and anxiolytics in specific cases with depression and anxiety.

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