Psychotrichology: psychosomatic aspects of hair diseases

Hair growth and hair disorders with changes in hair density or quality not only influence an individual's appearance but also often lead to an enormous emotional burden with low self-confidence, impaired quality of life, and even psychological disorders. Psychosomatic hair diseases cover a wide spectrum of specific psycho-dermatological disease patterns. This review provides an overview and classification of psychosomatic hair diseases based on primary and secondary disorders. Somatoform disorders are among the primary psychiatric diseases, especially body dysmorphic disorder in which patients have an exaggerated and excessive preoccupation of normal and physiological hair loss. Self-inflicted skin diseases as trichotillomania, often with an impairment of impulse control, also belong to this group. Secondary/reactive psychosocial disorders may occur in congenital and acquired hair disorders. These may be accompanied by feelings of disfigurement, depressive and anxiety disorders including social avoidance. Furthermore, psychosomatic comorbidity could complicate coping with hair loss. Psychosomatic therapy and coping are based on an early and accurate differential diagnostic approach to psychosomatic disorders. Psychotrichological disorders need to be treated promptly with psychosomatic basic care, improvement of coping strategies, behavior therapy, depth psychology, and/or appropriate psychopharmacotherapy with antidepressants or anxiolytics.