Beyond Hair Loss, Alopecia Can Bring Anxiety and Depression

This post was co-authored by Jasleen Ghuman and Robert T. Muller, Ph.D.

Our hair has so many implications for our self-image and mental health. For those affected by alopecia areata, an autoimmune disease that causes severe hair loss, struggles around hair and self-esteem can be a daily issue.

Abby (name changed for anonymity), first experienced signs of alopecia areata when she noticed a bald spot on her head about the size of a dime. Within six to eight weeks of discovering it, she had lost all her hair. Physically, alopecia areata may not look debilitating, but Abby explains that, emotionally, she felt like her loss of femininity destroyed her. As time passed, she was able to shift her perspective and self-image, deciding that, despite looking different, she was more than her hair.

“I rocked my bald head just like I used to rock my long locks. I used to associate hair with femininity, but after alopecia areata, I realized that feeling feminine comes from within!”

Source: Gadiel Lazcano/Unsplash

Jeff Donovan, a dermatologist specializing in the treatment of alopecia, explains that both men and women can be affected by self-conscious thoughts when experiencing hair loss. Hair loss associated with alopecia areata not only affects the scalp area, but also the beard, eyebrows, eyelashes, and armpits. For many, hair can represent more than just societal standards. For example, in the Sikh religion, hair is a representation of God's creation, which is why those who practice, no matter their gender, keep their hair untouched.

While more mental health resources for those affected by alopecia areata are needed, the Canadian Alopecia Areata Foundation (CANAAF) provides support and education to newly diagnosed individuals as well as those who have been living with alopecia areata for a prolonged period. Anthony Gilding, the director of science and research with CANAAF, explains that those living with alopecia may become fearful of how people will perceive them, which can impact their social lives. Additionally, alopecia has a tendency to reduce overall life quality for patients, many of whom have elevated rates of anxiety and depression.

Gilding conducted a study on the impact of alopecia areata on patients’ and caregivers’ quality of life and mental health and found that many showed a high risk for adjustment disorder and severe social anxiety. In addition, individuals living with alopecia areata spent hundreds to thousands of dollars on cosmetic cover-ups, like hair pieces and eyebrow microblading.

Source: Maria Lupan/Unsplash

Finding treatment options can be a stressful task for those affected by alopecia areata, as there are long waitlists to see a specialist. Donovan explains that Baricitinib, a Janus kinase inhibitor (JAK), is a new US Food and Drug Administration (FDA)-approved drug that treats alopecia areata; however, it is still in the process of being approved in Canada. While promising, it is important to note JAK inhibitors typically only work in about 25 percent of alopecia areata cases. Other temporary treatment options include wigs, platelet-rich plasma (PRP) injections, and tablet scalp tattooing (micropigmentation). Unfortunately, these treatments can be expensive.

Without knowing what triggers this autoimmune disease, distressing changes in physical appearance and a lack of specific treatment options can leave sufferers unsure of how to cope. Mental health resources such as therapy may be needed to better support individuals afflicted with alopecia areata.