As this month marks Alopecia Awareness Month and the 15th Birthday of Alopecia UK, this post has been written to shed a light on the psychological impact of hair loss.
Hair is an important element of our identity1,2. From a young age we are told stories of beautiful maidens letting down their ‘lustrous locks’ or handsome princes with a ‘shining mane’ adorning their heads. Hair is seen historically as a symbol of health, wealth, and fertility. People use hair to express themselves and create their own image in society. From bold colours to complicated styles, hair is intrinsically linked with personality. As a style conscious population, we are also subjected to media images of perfect hair, as well as a plethora of hair-enhancing products, and the trend of blow-dry bars in cities.
So, what happens when a person starts to lose their hair? With so much emphasis on how a person looks, inevitably for some people hair loss will be psychologically devastating1. Hair loss is a common condition that presents to dermatology clinics with psychological, emotional, and social consequences2. People with hair loss report an increased incidence of depression, anxiety, relationship problems, lack of self-confidence, increased self-consciousness and low self-esteem3. Females seem to be more psychologically affected than males4 according to the literature, but in my practice, I have found that often the gender difference is not necessarily true. Some men feel ‘resigned’ to hair loss and develop feelings of hopelessness.
There are several types of hair loss and the reasons behind them include a complex interplay of genetics, hormonal influences, underlying medical conditions, and often, no cause can be found. Some common types of hair loss include:
- Alopecia areata – a specific form of hair loss occurring in rounded patches on the scalp, can also involve hair loss from other parts of the face and torso (e.g. eyebrows, eyelashes, beard).
- Telogen effluvium – this is a temporary type of hair loss seen after a trigger (e.g. illness, pregnancy, stressful life event).
- Androgenetic alopecia – this is the most common type of progressive hair loss that occurs in both sexes. Affected people experience hair thinning over time, males around the temples and back of the scalp, and females around the top and front of the scalp.
- Scarring alopecia’s – this is a type of hair loss caused by damage to the hair follicle (e.g. due to infection or an autoimmune process). Scar tissue replaces the hair follicle, causing potentially irreversible hair loss. Scarring alopecia is an umbrella term that covers specific disorders affecting the hair follicle (e.g. lichen planopilaris, folliculitis decalvans).
If you are worried about hair loss it is a good idea to visit a doctor that has knowledge about this problem. This would ideally be your general practitioner or a dermatologist. You might feel like hair loss is not something your doctor is interested in, but it is important to share your concerns in case there is something that can be done. You may need to have some simple blood tests to rule out other common causes of hair loss (e.g. thyroid problems or iron deficiency). All the above do have treatment options available that can either slow down or stop progression, or support regrowth. However, each case is individual and may/may not respond to conventional treatment. Non-conventional options include hair transplantation, laser caps, or platelet-rich-plasma injections, which are suitable for some forms of hair loss but not all.
Hair loss can be challenging to treat, and your doctor may need to try several options before making any real progress. To get through this difficult time make sure you have realistic expectations from the treatment, discuss the possible outcomes with your doctor, including how long it may take to see results. If possible, discuss your problems with hair loss with people you can trust to provide support (e.g. friends, partners, or family).
Prognosis of hair loss is variable and unpredictable, making this is a particularly difficult condition to cope with. The impact of hair loss may continue for several years after the initial diagnosis, this is further complicated by the lack of effective or affordable treatments available3. Feelings of embarrassment, low mood and social anxiety are common. People affected by hair loss might want to hide the condition, this may start by experimenting with different hairstyles, or hats and scarves, which are good options, but may then progress to physically hiding from the world (e.g. avoiding going out or doing activities that can draw attention to your hair). Losing confidence in social situations due to feelings of embarrassment makes people affected by hair loss feel lonely and isolated. As hair has such a physical presence and is linked to images of attractiveness, people can start to feel unattractive, this can impact current and future relationships. Common thoughts can include:
‘Will he/she find me attractive?’
‘Does he/she still love/desire me?’
‘Are they looking at my hair?’
Apart from medical therapies for hair loss, it is important to develop skills to deal with living with a diagnosis of hair loss, especially as this has such a psychological impact on people. Hair loss is a physical condition, but it can have consequences for a person’s mental health. The fact that the condition can last a long time and become chronic means that the better equipped you are to deal with the physical signs, the less negative impact it can have on your life. To make sure that negative thoughts about hair loss do not take over it may help to be as informed as possible. Try to think outside the box and consider how else you could maintain your quality of life whilst living with hair loss. For example:
- Obtain as much information as possible about your type of hair loss (approved patient information leaflets are available from bad.org.uk; or look at www.nhs.uk for information)
- Consider all options of treatment that are offered by your doctor. Important questions to ask are:
- What is the likelihood of success of this treatment?
- What are the side effects of this treatment?
- How long do I need to take this treatment?
- What if this treatment does not work?
- How much will it cost?
- It may be important to consider alternative options for dealing with hair loss. For example, wigs can be available on the NHS in some cases (ask your doctor if you are eligible) or can be bought privately.
- Other products that can be used to disguise hair loss include hair thickening powders (can buy inexpensively from approved sources), hair extensions (prices will vary), or permanent skin tattooing for small areas (e.g. eyebrows).
- For some people, hair transplantation may be an option. Research the providers of this service and ensure they are qualified to provide this treatment. It may be expensive and is not always successful, so take your time before making any decisions.
- It might be difficult to imagine that ‘talking therapies’ might help hair loss. It might not help hair grow back, but it is possible to develop life skills to deal with this problem. Ways to do this include cognitive behavioural therapy, mindfulness, and acceptance and commitment therapy (to name a few). Ask your doctor if you can be referred to a psychologist who can help teach you techniques on how to cope with any distressing feelings, you may also be able to self-refer (search ‘talking therapies’ or IAPT in your area).
- There are also several mobile apps that may be suitable, these may have a fee so check the small print. Some suggested resources are available here: https://www.nhs.uk/apps-library/category/mental-health/
- Consider joining support groups for hair loss and keep in touch with national organisations, for example Alopecia UK .
Increasingly we are defined by how we look. However, we are now observing a shift in the ‘norm’ and there is more focus on accepting differences in appearance, and in fact celebrating them. Feeling confident about oneself and creating an image that is acceptable to you is probably the healthiest way of dealing with a chronic condition like hair loss. In addition to seeking medical treatment, it can be helpful to looking into how we can strengthen our mind to cope with common physical conditions.
Through the internet and social media there is a wealth of information about hair loss in the public domain, including various types of treatments. Hair loss is an individual problem and suitable treatments are dependent on the type of hair loss experienced. Your doctor is the best person to advise you. There are several alternative treatments advertised, and some can be very expensive. It is important to obtain as much information as possible before embarking on any treatment courses that require a high financial commitment. Unfortunately, there are people who will take advantage of the vulnerability of people with hair loss and offer ‘miracle’ cures, there will be little scientific evidence for this, again always discuss with your doctor.
If you are suffering from persistent negative thoughts, or feel like you need to talk to someone straight away about the way that you are feeling, then you might like to get in contact with Mind, Samaritans or Changing Faces, who may be able to help.
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- Sellami R. The relationship between alopecia areata and alexithymia, anxiety and depression: a case-control study. Indian J Dermatol 2014; 59(4): 421
- Chaing YZ et al. The role of beliefs: lessons from a pilot study on illness perception, psychological distress and quality of life in patients with primary cicatricial alopecia. Br J Dermatol 2015; 172: 130-137
- Williamson D et al. The effect of hair loss on quality of life. J Eur Acad Dermatol Venereol 2001; 15: 137-139
- Cash TF. The psychosocial consequences of androgenetic alopecia: a review of the research literature. Br J Dermatol 1999; 141: 398-405