Alopecia areata: psychiatric comorbidity and adjustment to illness

Decades ago, alopecia areata (AA) was regarded as a well-known example of psychosomatic disease. The poor development of measurement methods and criteria for the classification of psychiatric disorders at that time was probably partly to blame for the lack of methodologic validity of some studies.

We studied a random sample of 32 patients with AA (patchy form). Sociodemographic, dermatologic, and psychiatric variables were collected. Psychiatric examination was carried out by standardized interviews: Schedules for Clinical Assessment in Neuropsychiatry (SCAN), International Personality Disorders Examination (IPDE), and Psychological Adjustment to Illness Scale (PAIS), using the Research Diagnostic Criteria of the International Classification of Diseases, 10th edition, to assess the diagnosis. A descriptive and association study was performed, correlating the patient's adjustment and adaptation to the illness to various factors (linear regression techniques and analysis of variance).

Sixty-six per cent of patients presented with psychiatric comorbidity, mainly adjustment disorders (F.43.2), generalized anxiety disorders (F.41.1), and depressive episodes (F.32). Overall adaptation to the illness, however, was satisfactory, showing few repercussions in family or social life, work, or sexual adjustment. Poor adjustment was associated with a dependent personality (Pearson's r = 0.66), antisocial personality (r = 0.39), generalized anxiety (P = 0.003), and depression (P = 0.02).

There is a high psychiatric comorbidity in AA (anxiety and mood disorders), requiring systematic psychiatric evaluations of these patients. A satisfactory overall adaptation to mild/moderate forms of the disease is the norm, but adaptation and comorbidity in severe forms (totalis, universalis) are unknown. A dermatology/liaison psychiatry setting could improve the management of AA.