Article

Trichologic consultation and personality disorders

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  • International Hair Research Foundation
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... Another study of 285 men and women with either FPHL (20.7%) or telogen effluvium (79.3%) found that 75% of women displayed signs of a personality disorder, relative to 10.3% of the population base in Italy (on the basis of the diagnostic criteria of the Diagnostic Statistical Manual Mental Disorders, Revised Third Edition [DSM-III-R]). Both the Personality Disorders Questionnaire-Revised (PDQ-R; a validated self-rated 152-item true/false questionnaire) and the 6-point Symptom Checklist-90 (SCL-90, measures psychopathologic response to alopecia with scores that range from 0 for not at all to 5 for very much) were used to assess for personality disorders (Fossati et al., 1993). In a follow-up study, 76.3% of 116 patients with FPHL self-reported a personality disorder that overwhelmingly exceeded the population estimate (on the basis of both the PDQ-R and SCL-90 scales; Maffei et al., 1994). ...
... At times, women use extraordinary measures to cope with and mask their diagnosis as well as feelings of being less attractive, including concealing thin areas with remaining scalp hair, covering thin areas with a hat, or using cosmetic products to camouflage the areas of hair loss (Cash, 1999). Patients may also avoid situations that can aggravate their distress, such as windy weather or brightly lit environments, to minimize bringing attention to themselves (Cash, 1999;Fossati et al., 1993). Compensatory measures such as men growing a beard, exercising to change one's physique, and buying expensive clothes are also steps taken with the hope of improving one's self-esteem (Famenini et al., 2015). ...
Article
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Alopecia is a dermatologic condition that affects the pilosebaceous unit in both men and women. In addition to a thorough medical history and physical examination, a host of diagnostic tools may be warranted to differentiate nonscarring and scarring alopecias. Female pattern hair loss represents the most common form of hair loss experienced by up to 40% of women by a certain age. Although alopecia is a benign disorder, even the most negligible amount of hair loss can be devastating to a patient’s self-esteem, self-image, and overall quality of life. We present this comprehensive review of quality of life studies in women with alopecia to describe the multitude of feelings and emotions associated with the disorder and remind dermatologists of the psychological impact it can have on women.
... Anderson [1] emphasized stress as the cause of alopecia and its relapse. Maffei et al. [2] and Fossati et al. [3] showed that hair loss patients have a high rate of morbid personality disorder before diagnosis of alopecia. Although hair loss is a disease that affects daily life, medical doctors argue that it greatly impacts personal life [4]. ...
Article
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In this study, we measured the extent of ten levels of classified symptoms by 300 (male and female) patients visiting the hair loss clinics of "S" hospitals in Gangbuk and Gangnam between January 2009 and June 2011 by analyzing the patients' chief complaints. The method of measurement was based on a symptom questionnaire possessing 51 categories. Through the statistical analysis of data mining techniques, decision trees, and logistic regression, we derived a logistic regression model and decision tree model that improved both the response rate and significant hair loss-related characteristics of the questionnaire. The results of this study indicate that dry hair, seborrheic scalps and skin, tobacco and/or coffee addiction, anxiety, nausea, indigestion, and facial flushing correlate to hair loss. We anticipate that the subjective symptoms of hair loss can provide a foundation for preventing secondary diseases and provide clinical data information during the period of treatment. This can contribute to the improvement of patient satisfaction after customized treatment.
Chapter
A full head of hair is an essential part of the general body image ideal, it has always been regarded as a symbol of virility and strength and is closely related to physical attractiveness. In contrast, baldness has always been associated with unfavorable meanings and negative feelings.
Article
Background While dermatologists focus on practices to promote anti‐aging, thinning hair that frames a more rejuvenated face can affect age perception and cosmesis. Objectives To characterize the effects of age‐related hair changes on age determination and perceived attractiveness. Methods A search was conducted for articles on intrinsic and extrinsic aging as it relates to hair. Key studies on the hair aging process and its effects on self‐perception, confidence, and anti‐aging were reviewed. Results According to several studies, hair density peaks about 27 years of age or earlier and then decreases from the mid‐thirties onward. This serves as an opportunity to prevent or treat hair loss in a similar way we treat aging skin. Without optimizing appearance of hair, overall cosmesis to foster self‐perception can be curtailed despite multiple efforts to rejuvenate and restore the aging face. Conclusion The discrepancy between rejuvenated faces and thinner appearing hair that frames the face highlights the importance of a holistic approach to the anti‐aging consultation. To more comprehensively address the aesthetic patient, we need to promote awareness of the onset of these hair changes in order to incorporate prevention and therapeutic strategies to preserve hair to complement overall appearance.
Article
Background Androgenic alopecia (AGA) is viewed as a relatively mild dermatologic condition; however, affected individuals feel that alopecia is a serious condition with major consequences in their life. Objective The objective of this study was to assess the health status, the risk of anxiety/depression, the coping strategies, and alexithymia in subjects with AGA. Methods Consecutive subjects referred to the outpatients department of the Istituto Dermopatico dell’Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IDI IRCCS) dermatologic hospital with a diagnosis of AGA were enrolled. AGA was assessed using the Ludwig scale in female subjects and following Hamilton–Norwood’s classification in male subjects. The questionnaires provided to the patient and collected before the visit were the Medical Outcomes Study Short Form-12 (SF-12), the 12-item General Health Questionnaire (GHQ-12), the Coping Orientations to Problems Experienced (COPE), and the Toronto Alexithymia Scale-20 (TAS-20). Multiple logistic regressions were performed to examine the relationship of sociodemographic variables and clinical characteristics with coping. Results 351 subjects were enrolled during the study period. Sixty percent of female subjects with AGA were GHQ-12 positive (values ≥4) compared with 32 % of male subjects with AGA. AGA male and AGA female subjects had a statistically worse score than non-AGA male subjects for the physical component summary (PCS) and the mental component summary (MCS) of the SF-12, and for the GHQ-12. Compared with male subjects, AGA female subjects were more likely to adopt an ‘active emotional coping’ strategy according to COPE scores, and less likely to have ‘externally oriented thinking,’ and more ‘difficulty identifying feelings’ according to the TAS-20 scores. In a logistic regression model, including sex, MCS, total TAS-20, and the COPE scores as independent variables and the AGA severity as a dependent variable, only sex had a significant odds ratio (OR) [13.32; 95 % CI 4.77–38.58, p < 0.001]. Female subjects were almost 13 times more likely to have more severe AGA than male subjects. In three other models (i.e., one for each coping category) which included sex, AGA severity, MCS, and TAS-20, the ‘problem-focused coping’ strategy was negatively associated with alexithymia (OR 0.48; 95 % CI 0.27–0.86, p = 0.01), the ‘active emotional coping’ strategy was associated with gender (women had an OR of 2.69; 95 % CI 1.5–4.8, p = 0.001), and the ‘avoidant coping’ strategy was associated with alexithymia (OR 4.12; 95 % CI 2.23–7.58, p < 0.001) and with lower MCS values (OR 0.37; 95 % CI 0.22–0.64, p < 0.001). Conclusion The study confirmed the high prevalence of depression/anxiety in AGA subjects, with a significantly higher prevalence in AGA female than male subjects. It is interesting to observe that patients reactions to their AGA related more to the emotional and psychological states deriving from their alopecia than to the objective clinical rating. Avoidant coping strategies were selected more frequently by AGA subjects if they were GHQ-12 positive and had alexithymia. To have alexithymia modified all coping strategies in AGA female subjects but not in AGA male subjects. Physicians should be aware that the impact of AGA is not limited to symptoms, and should help people to deal with their emotional responses to alopecia, such as anger and worry, and their beliefs about the consequences of their condition, and how it will impact on their daily life.
Article
The few articles published on the interactions between psychological factors and alopecia seem to yield contrasting results. To assess the relationships between alopecia, gender, Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorders, and psychopathologic symptoms reactive to alopecia, we administered the Personality Disorders Questionnaire-Revised and the Symptoms Checklist-90 to a randomly selected sample of 116 outpatients with androgenetic alopecia. The prevalence of personality disorders in subjects with androgenetic alopecia proved to be significantly higher than the prevalence of such diagnoses in the general population. Women did not show a higher prevalence of personality disorders or more psychopathologic symptoms than men. The factor analysis demonstrated the existence of three personality profiles (F1, F2, and F3) significantly and specifically associated with the subject's gender and with the psychopathologic reactive symptoms, measured using the Symptoms Checklist-90. The most important factor in developing a psychopathologic reaction to alopecia seems to be the presence of a Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorder and not the subject's gender.
Article
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.
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