Acta Derm Venereol 92
Acta Derm Venereol 2012; 92: 304–306
© 2012 The Authors. doi: 10.2340/00015555-1239
Journal Compilation © 2012 Acta Dermato-Venereologica. ISSN 0001-5555
Alopecia areata is not painful or life-threatening, but its
aesthetic repercussions can lead to profound changes
in patients’ psychological status and relationships. The
psycho logical status and personality traits of 73 patients
and 73 controls were evaluated with the Minnesota Multi-
phasic Personality Inventory (MMPI-2). Analysis of the
MMPI-2 profile showed that scores for some scales (i.e.
Depression, Anxiety, Family relationships) were higher
for patients with alopecia areata than for controls. Pa-
tients with alopecia appeared to experience more depres-
sive, hysterical and anxiety feelings, have more hypo-
chondriac tendencies, and to be more in conflict with
their social environment. In order to provide more ef-
fective management, the psychological status of patients
with alopecia areata should be evaluated in dermatolo-
gical settings. Key words: alopecia areata; psychological
status; Minnesota Multiphasic Personality Inventory;
(Accepted July 11, 2011.)
Acta Derm Venereol 2012; 92: 304–306.
Damiano Abeni, Laboratory of Health Services Research,
IDI-IRCCS, IT-00167 Rome, Italy. E-mail: email@example.com
Alopecia areata (AA) is a non-scarring, autoimmune,
inflammatory disorder characterized by patchy areas of
hair loss (1). It has been hypothesized that AA is an organ-
specific autoimmune disease with genetic predisposition
and an environmental trigger (2).
Emotional or stressful life events are often mentioned
as possible causes of onset and exacerbation of the di-
sease, with perceived stress sometimes appearing to be
more important than the stressful situation itself (3, 4).
Many studies focused on personality traits describe
patients with AA as having psychopathological disorders,
such as depression, anxiety, social phobia, adjustment dis-
orders and paranoid disorders, more often than the general
population (5, 6), and psychiatric morbidity has been obser-
ved among patients with skin diagnoses, with a particularly
high prevalence in patients with alopecia (7, 8).
Other studies, however, reveal that anxiety and de-
pression do not play a major role in the aetiopathogene-
sis of the disease, and patients do not have personality
traits that are qualitatively different from other patients
with skin diseases (9).
Different types of alopecia may lead to different
psychological problems. AA is generally more frequent
and is more responsive to medical treatment than other,
more severe, forms of the disease (10, 11).
Although alopecia is not painful or life-threatening,
hair loss can lead to profound emotional stress and
reduced self-esteem (12). These negative effects may
alter patients’ social interactions, daily activities and
The present study evaluated the personality traits and
psychological status of patients with alopecia, using the
Italian version of the Minnesota Multiphasic Personality
Inventory (MMPI-2), which is the most-used personality
measure in clinical psychology. In addition, a psycho-
logical interview was conducted with patients in order
to investigate their present psychological status and to
reveal the presence of any stressful events occurring in
the 6 months preceding the onset of the disease.
MATERIALS AND METHODS
A cross-sectional study was performed in the Dermatological
Day-Hospital of the Istituto Dermopatico dell’Immacolata (IDI-
IRCCS) in Rome, Italy, between November 2009 and October
2010. The study was approved by the ethics committee of IDI-
IRCCS and all participants provided written informed consent.
Inclusion criteria for patients were: age ≥18 years; diagnosis
of AA, totalis, or universalis; Italian language; no dementia or
cognitive impairment, and no use of psychoactive drugs. The
control group included volunteers working at IDI-IRCCS (e.g.
nurses, researchers, administrators). Marital status and educa-
tional level data were collected for both groups. Duration of
disease, family history, and clinical type were collected only
from patients. Patients also underwent a clinical interview fo-
cused on recent stressful life-events (i.e. in the 6-month period
before the onset of AA).
Both the patient group and the control group completed the
pencil and paper version of the MMPI-2 for the psychological
evaluation of personality traits.
The MMPI-2 is a self-administered standardized questionn-
aire. It evaluates personality traits and psychological disorders,
and contains 567 true-false items. It has three validity scales:
L (lie-rational judgements), F (frequency-low frequency of
endorsement) and K (correction-response distortion and normal
profile). Validity scales assess the sincerity of the answers. Ten
clinical scales, denominated Hypochondriasis, Depression,
Hysteria, Psychopathic deviance, Masculinity-Femininity, Pa-
ranoia, Psychasthenia, Schizophrenia, Hypomania and Social
introversion provide a reliable personality profile. In addition,
there are 15 content scales: Anxiety, Fears, Obsessiveness, De-
pression, Health concerns, Bizarre thoughts, Anger, Cynicism,
Psychological Status of Patients with Alopecia Areata
Stefania ALFANI1, Valeria ANTINONE2, Aurelia MOzzETTA2, Cristina DI PIETRO1, Cinzia MAzzANTI3, Piero STELLA3,
Desanka RASKOVICH4 and Damiano ABENI1
1Laboratory of Health Services Research, 2Service of Clinical Psychology and Psychotherapy Psychosomatics, 3Day Hospital Dermatologico, and
4II Dermatology Division, IDI-IRCCS, Rome, Italy