Patients with Alopecia Areata Show Increased Rates of Distressed Personality, Depression, Anxiety

By Andrew John, MD /alert Contributor

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Distressed personality, or “Type D” personality, is more common in people with alopecia areata than in those without the condition, according to findings recently published in The Journal of the European Academy of Dermatology & Venereology.

“Distressed personality (or Type D personality) is a personality trait that has been associated with poor quality of life in patients suffering from a variety of skin diseases such as psoriasis or urticaria,” Manuel Sánchez-Díaz, of the dermatology unit at Hospital Universitario Virgen de las Nieves, IBS Granada, Granada, Spain, and colleagues wrote. “To date the potential association between alopecia areata  and distressed personality has not been studied.”

Sánchez-Díaz and colleagues performed a cross-sectional study of 60 patients with moderate to severe alopecia areata and 60 healthy controls matched for age and sex. Patients with alopecia were recruited from the Trichology Clinic of the Hospital Universitario Virgen de las Nieves in Spain or via email by the  Asociación de Alopecia de Madrid, a Spanish organization for patients with alopecia. The researchers collected data on participants’ clinical variables, sociodemographic information, anxiety, depression, distressed personality and sexual dysfunction using validated questionnaires for all participants.

Most patients (66.7%) were recruited from the Trichology Clinic. Patients were a mean of 39 years old in both groups, and the majority of study participants were women (75%; n = 45). The mean duration of disease was 9.83 years. Among patients with alopecia areata, the mean basal SALT score was 56.74% (SD 42.01). More than one-third of patients had alopecia areata universalis (36.7%; n = 22).

Patients with alopecia areata demonstrated a significantly higher prevalence of distressed personality compared with controls, the researchers reported (35% versus 15%; P = .01). These patients also reportedly demonstrated greater rates of depression, anxiety and sexual dysfunction (P < .05). Sánchez-Díaz and colleagues wrote that the occurrence of distressed personality was associated with poorer quality of life (P = .001), as well as anxiety and depression scores (P < .001) and disease severity (P = .04).

Men with alopecia did not demonstrate any differences in the prevalence of sexual dysfunction compared with controls, the researchers wrote, but women with alopecia showed an increased rate of sexual dysfunction compared with their counterparts in the control group (66.67% versus 42.2%; P = .04). However, the researchers wrote, there was no link between distressed personality and sexual dysfunction.

The study was limited by its cross-sectional design, Sánchez-Díaz and colleagues wrote, as well as its small sample size, a possible underestimation of the prevalence of distressed personality and possible selection bias.

“…Type D personality could be a more frequent type of personality among patients suffering from alopecia areata,” the researchers concluded. “Furthermore, patients with Type D personality appear to have poorer quality of life and higher rates of mood status disturbances when compared to patients without Type D personality. Therefore, the  detection of Type D personality in patients with alopecia areata could serve as an indicator of more psychologically vulnerable patients, probably related to dysfunctional coping strategies. The screening for this feature could be useful to detect patients at higher risk of anxiety, depression and poor quality of life.”

Disclosures: No authors declared financial ties to drug makers.

Photo Credit: Getty Images.


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