Yesterday, US TV presenter Ricki Lake shared snaps of her freshly-shaved head on Instagram – in an effort to highlight hair loss and how it has affected her mental health.
She describes her journey with hair loss, and how she has been ‘suffering mostly in silence’ for the past 30 years, and that the experience has been ‘debilitating, embarrassing, painful, scary, depressing, lonely, all the things’.
Hair loss, also known as alopecia – an autoimmune condition where your immune system attacks your hair follicles and ‘shuts them down’ – is a common disease that affects 15 in 10,000 people in the UK, according to Patient, though to varying degrees.
Research has found that those who suffer from alopecia are at risk of mental health problems. One study found that those who have been diagnosed with alopecia areata (the ‘mildest’ version of hair loss) can suffer from anxiety, mood and personality disorders, self-harm and suicide, as well as attention-deficit/hyperactivity disorders and other mental health conditions.
Of course, not all of the above applies to everyone who suffers from alopecia – but hair loss can have a severe impact on mental health.
Here we investigate alopecia areata, what causes it and how it can be linked to mental health.
What are the different types of alopecia?
- Alopecia areata
This is the most common version, and involves one or more patches across the head. The likelihood of the hair growing back is quite high and this usually happens within a few months or years, according to the British Association of Dermatologists. If the patches cover more than half the scalp, full regrowth is less likely. - Alopecia totalis
If a person loses all the hair on their head, it’s known as totalis. The effect on the follicles is the same, but the chance of regrowth is much lower, however it is possible.
- Alopecia universalis
When a person loses all the hair on their head and body. Once again, chances of regrowth are much smaller and it’s very unlikely that all of the hair will return.
Most people with alopecia areata will develop the condition in their childhood or before they turn 40 years old. This is different to androgenetic alopecia, often referred to as male pattern or female pattern baldness, which is the most common type of hair loss.
Androgenetic alopecia affects ‘approximately 50% of men over the age of 50 and around 50% of women over the age of 65’, according to Alopecia UK, and unlike areata it is ‘irreversible’.
What causes alopecia areata?
Alopecia areata falls into the category of autoimmune diseases; which is where the immune system attacks itself, or in this case, the hair follicles.
T cells will ‘kill’ the follicle, and the hair will then fall out – but the follicle is not damaged and there is no scarring on the skin – it feels very smooth.
It’s believed that 20% of cases have a family history of the condition and a genetic disposition to develop it.
Stress is also thought to be a trigger for hair loss, however research around this has shown inconclusive results.
Dr Sarita Singh, consultant dermatologist at Chelsea and Westminster Hospital and and lead for paediatric and adult alopecia services, has conducted her own study on the relationship between stress and hair loss.
‘Severe forms of AA (totalis and universalis) are very challenging to treat and have a significant impact on quality of life,’ she tells Metro.co.uk.
‘Studies have demonstrated that AA is associated with a substantial psychological burden including depression, anxiety, adjustment disorder and social withdrawal. NICE recommends that patients with alopecia are referred for counselling and psychological support.’
She also explains that there is not much research available on the psychological impact of hair loss, but has found that her patients often ‘report a stressful life event’ before getting diagnosed, including bereavement, divorce or illness.
Dr Singh, who also works with MyHealthCare Clinic, adds: ‘It is commonly assumed that AA is caused by stress but there is little scientific evidence to support this. Further research is required to examine whether there is any causal association between stress and AA.
‘Patients suffering from AA report poor quality of life (QOL) and have a high prevalence of psychiatric disorders with up to 39% lifetime prevalence of depression and up to 62% prevalence of generalised anxiety disorder, although exact numbers differ across studies.’
Through another study, high levels of anxiety and depression were found in 50% of patients, who scored in the range of ‘moderately depressed’ or ‘anxious’.
Many of them also said that having alopecia had a big effect on daily activities, work and relationships.
How to deal with the mental health impact of having alopecia
Beyond losing hair, alopecia can cause people to become afraid of using beauty or haircare products on their remaining hair, it can affect their sex lives and relationships, and depending on where the patch is located – i.e. if it’s possible to hide it or not – they might change their social habits.
After all, for many people, hair is part of their identity – and suddenly losing chunks or all of it, both across your head and body, can be incredibly stressful.
I myself was diagnosed with alopecia areata in 2018, and noticed the patch as I was heading out for lunch with a friend. My panic was so severe that I went straight to the hospital, worried that I might be dying from an illness – and the stress and anxiety continued for many months afterwards.
It is completely normal to be upset about being diagnosed with alopecia, and there can be a long adjustment period as you come to terms with your illness – that’s OK.
Try to remember that alopecia is not dangerous in the physical sense and although it is not curable, there are treatments to encourage the hair follicles to wake up, such as steriod creams and injections.
As for the mental health side of things, Dr Singh has seen beneficial results with cognitive behavioural therapy.
‘A recurrent theme from studies is the impact of health beliefs on the psychological well-being of these patients,’ she explains.
‘Therapies to modulate health beliefs such as CBT (cognitive behavioural therapy) could therefore be protective against the significant mental health problems experienced by this patient group.’
You might also take comfort in hearing other people’s stories or talking about your experiences with those who know what it feels like.
Alopecia UK runs a private Facebook group, and there are also additional social media groups where people share tips on how to cope, as well as advice on wigs and photos of their patches/bald/shaved heads.
However, for others, it might be upsetting to see photos of more severe cases of alopecia, so take caution before you join the groups (or adjust your settings so that it doesn’t appear in your feed every day, if that helps).
You can also talk to your local GP to request specialist treatment, as well as discuss therapy or other mental health treatments that are available to you, beyond CBT.
Or, if you want, just shave it all off and embrace the hair loss – like the brave Ricki Lake has done.
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source https://metro.co.uk/2020/01/03/alopecia-can-affect-mental-health-11995132/
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