Is Your Alopecia Areata Making You Anxious or Depressed?

Many people describe an overwhelming sense of shock and loss when they first notice their hair falling out in patches, says Alan J. Bauman, MD, a hair restoration physician at Bauman Medical in Boca Raton, Florida. “It is not just about hair; it is about identity and confidence.”

Losing your hair, even in small amounts, can provoke strong emotions. “The most common emotional reactions [to alopecia areata] are anxiety, depression, or grief,” says Catherine Schuler, PsyD, a clinical psychologist at the Center for Anxiety & Behavior Therapy in Bryn Mawr, Pennsylvania, who also has alopecia areata.

• Withdrawn and isolated
• Fearful and angry
• Embarrassed
• Guilty

“There is so much uncertainty in receiving this diagnosis — you have no idea how much hair you will lose, at what rate, and if it will ever grow back,” says Dr. Schuler. “There is a sense of constant worry about how much hair is falling out.”

“For example, if someone is sad and upset when talking about their alopecia or in moments where they are frustrated by it, but they are able to engage in their life — go to work, care for themselves and their families, do activities that they enjoy, spend time with friends — then this is likely more in the ‘normal’ range,” says Schuler. But if you isolate yourself, avoid work or school, or say no to enjoyable activities with friends and family, then Schuler says she would consider a depression diagnosis.

• Sadness and irritability
• Emptiness and hopelessness
• Changes in appetite (eating much more or much less than normal)
• Sleeping too much or not enough
• Fatigue
• Restlessness, pacing, and hand-wringing
• Feelings of worthlessness
• Excessive guilt
• Trouble with memory and concentration
• Difficulty with decision-making
• Thoughts of self-harm

• Excessive worry about everyday things
• Difficulty controlling nervous feelings
• Irritability, restlessness, and difficulty concentrating
• Trouble sleeping
• Fatigue
• Pain in your head, muscles, or stomach
• Trembling or twitching
• Heart palpitations
• Excessive sweating
• Feeling out of breath or breathing very fast
• Difficulty swallowing
• Nausea or diarrhea

Many people with alopecia areata avoid favorite activities, check frequently for hair loss, seek excessive reassurance from others, or spend a lot of time researching the topic, says Schuler.

“All of these reactions are very normal upon first getting the diagnosis, as well as at any big moments of change, like if someone decides to begin wearing wigs, shave their head, or there has been a big shift in the rate of hair loss,” says Schuler. “But if these symptoms persist, then it may be an anxiety disorder.”

If you experience anxiety symptoms above, let your provider know, and they can recommend treatment and support.

Connecting with others who have alopecia areata can be tremendously helpful in navigating the uncertainty and fear that can accompany the diagnosis, says Schuler. “I would highly encourage anyone receiving an alopecia areata diagnosis to seek therapy, as well as seek out support from others with the diagnosis.”

• Alopecia areata causes patchy hair loss, which can trigger strong negative emotions in anyone affected.
• People with alopecia areata have a higher risk of anxiety and depression disorders, but treatment options are available.
• If you have alopecia areata, you can find support through mental health professionals and community support groups.