Psychosomatic factors in first-onset alopecia areata.

Although the onset of alopecia areata has often been anecdotally linked with emotional stress, findings from the few controlled studies have not been univocal. The authors compared outpatients experiencing a recent onset of alopecia areata (N=21) with outpatients affected by skin conditions commonly believed as having a low psychosomatic component (N=102). Participants were administered Paykel's Interview for Recent Life Events, the Experiences in Close Relationships scale, the 20-item Toronto Alexithymia Scale, and the Multidimensional Scale of Perceived Social Support. Multiple logistic regression was used to control for age and gender. The total number of recent life events (last 12 months) was not different between the alopecia patients and the comparison subjects. Also, the alopecia patients and the comparison subjects did not differ in terms of the number of undesirable or major events. The comparison subjects even experienced a greater number of uncontrollable events. Alopecia areata tended to be associated with high avoidance in attachment relationships, high alexithymic characteristics, and poor social support. The results suggest that personality characteristics might modulate individual susceptibility to alopecia areata.

[1]  A. Picardi,et al.  Il questionario «Experiences in Close Relationships» (ECR) per la valutazione dell'attaccamento negli adulti: Ampliamento delle evidenze di validità per la versione Italiana , 2002 .

[2]  G. Zimet,et al.  The Multidimensional Scale of Perceived Social Support , 1988 .

[3]  T. Lotti,et al.  Neuropeptides and skin disorders. The new frontiers of neuro–endocrine–cutaneous immunology , 1999, International journal of dermatology.

[4]  J. Cacioppo,et al.  The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. , 1996, Psychological bulletin.

[5]  K. Bartholomew,et al.  Attachment styles among young adults: a test of a four-category model. , 1991, Journal of personality and social psychology.

[6]  A. Picardi,et al.  La scala "Experiences in close relationships" (ECL), un nuovo strumento per la valutazione dell’attaccamento negli adulti: traduzione, adattamento e validazione della versione italiana , 2000 .

[7]  Psychiatric Symptoms in Dermatology Patients , 1983, British Journal of Psychiatry.

[8]  D. Barnett,et al.  Perceived social support mediates between prior attachment and subsequent adjustment: a study of urban African American children. , 1999, Developmental psychology.

[9]  Sheldon Cohen Social relationships and health. , 2004, The American psychologist.

[10]  G. Perini,et al.  Life events and alopecia areata. , 1984, Psychotherapy and psychosomatics.

[11]  Sheldon Cohen,et al.  Health psychology: psychological factors and physical disease from the perspective of human psychoneuroimmunology. , 1996, Annual review of psychology.

[12]  K. Bartholomew Adult attachment processes: individual and couple perspectives. , 1997, The British journal of medical psychology.

[13]  Kristy A. Nielson,et al.  Intact Physiological Response to Arousal with Impaired Emotional Recognition in Alexithymia , 2001, Psychotherapy and Psychosomatics.

[14]  S. Kazarian,et al.  Dimensions of social support in the MSPSS: Factorial structure, reliability, and theoretical implications , 1991 .

[15]  Benjamin H. Gottlieb,et al.  Social support measurement and intervention: A guide for health and social scientists. , 2000 .

[16]  R. Bagby,et al.  The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. , 1994, Journal of psychosomatic research.

[17]  J. Tsiantis,et al.  Children with alopecia areata: psychiatric symptomatology and life events. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[18]  S. Powell,et al.  Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. , 1990, Journal of personality assessment.

[19]  P. Pasquini,et al.  Psychiatric morbidity in dermatological outpatients: an issue to be recognized , 2000, The British journal of dermatology.

[20]  H. Berenbaum,et al.  A Twin Study of Alexithymia , 2001, Psychotherapy and Psychosomatics.

[21]  M. Mikulincer,et al.  The relationship between adult attachment styles and emotional and cognitive reactions to stressful events. , 1998 .

[22]  K. Bartholomew,et al.  Adult Attachment Patterns and Social Support Processes , 1997 .

[23]  G. Arciero,et al.  Stress, attachment and skin diseases: a case‐control study , 1995 .

[24]  G. Fava,et al.  Psychosomatic Medicine: Emerging Trends and Perspectives , 2000, Psychotherapy and Psychosomatics.

[25]  P. Sifneos Alexithymia: past and present. , 1996, The American journal of psychiatry.

[26]  F. Camacho,et al.  No evidence of cytomegalovirus DNA in alopecia areata. , 1998, The Journal of investigative dermatology.

[27]  V. Randall Is alopecia areata an autoimmune disease? , 2001, The Lancet.

[28]  R. Pihl,et al.  Influence of alexithymic characteristics on physiological and subjective stress responses in normal individuals. , 1986, Psychotherapy and psychosomatics.

[29]  N. Collins,et al.  Adult Attachment Styles, Perceived Social Support and Coping Strategies , 1998 .

[30]  S. Cobb Presidential Address-1976. Social support as a moderator of life stress. , 1976, Psychosomatic medicine.

[31]  E. Paykel Methodological aspects of life events research. , 1983, Journal of psychosomatic research.

[32]  G. Fava,et al.  Versione Italiana della scala di Paykel per gli eventi stressanti , 1981 .

[33]  L. Grassi,et al.  Social Support and Psychological Distress in Primary Care Attenders , 2000, Psychotherapy and Psychosomatics.

[34]  M. Popkin,et al.  Lifetime prevalence of psychiatric disorders in patients with alopecia areata. , 1991, Comprehensive psychiatry.

[35]  M. Biondi,et al.  Psychological Stress and Neuroendocrine Function in Humans: The Last Two Decades of Research , 1999, Psychotherapy and Psychosomatics.

[36]  G. Taylor Psychosomatics and self-regulation. , 1992 .

[37]  A. Picardi,et al.  Stressful Life Events and Skin Diseases: Disentangling Evidence from Myth , 2001, Psychotherapy and Psychosomatics.

[38]  "Passing through life": alexithymia and attachment disorders. , 1995, Journal of psychosomatic research.

[39]  I. Lesser A Review of the Alexithymia Concept , 1981, Psychosomatic medicine.

[40]  C. Anderson Expression of affect and physiological response in psychosomatic patients. , 1981, Journal of psychosomatic research.

[41]  S. Buzwell,et al.  Avoidant attachment as a risk factor for health. , 1994, The British journal of medical psychology.

[42]  L. Goldsmith,et al.  Alopecia à deux: simultaneous occurrence of alopecia in a husband and wife. , 1994, Archives of dermatology.

[43]  G. Zimet,et al.  The Multidimensional Scale of Perceived Social Support: a confirmation study. , 1991, Journal of clinical psychology.

[44]  P. A. Wells,et al.  Does fortune favour the bald? Psychological correlates of hair loss in males. , 1995, British journal of psychology.

[45]  M. Moffaert,et al.  Psychodermatology: an overview. , 1992, Psychotherapy and psychosomatics.

[46]  P. Näätänen,et al.  The Influence of Alexithymic Characteristics on the Self-Perception and Facial Expression of a Physiological Stress State , 1999, Psychotherapy and Psychosomatics.

[47]  G J Taylor,et al.  Alexithymia: concept, measurement, and implications for treatment. , 1984, The American journal of psychiatry.

[48]  L. Kirkpatrick,et al.  Effects of adult attachment and presence of romantic partners on physiological responses to stress. , 1996, Journal of personality and social psychology.

[49]  M. Gunnar,et al.  Stress reactivity and attachment security. , 1996, Developmental psychobiology.

[50]  Lee A. Kirkpatrick,et al.  Attachment style and presence of a romantic partner as moderators of psychophysiological responses to a stressful laboratory situation , 1996 .

[51]  Kelly A. Brennan,et al.  Self-report measurement of adult attachment: An integrative overview. , 1998 .

[52]  J. Koo,et al.  ALOPECIA AREATA AND INCREASED PREVALENCE OF PSYCHIATRIC DISORDERS , 1994, International journal of dermatology.

[53]  H. Weiner Contributions of psychoanalysis to psychosomatic medicine. , 1982, The Journal of the American Academy of Psychoanalysis.

[54]  M. Lumley,et al.  Alexithymia, social support and health problems. , 1996, Journal of psychosomatic research.

[55]  R. Pihl,et al.  The stress-alexithymia hypothesis: theorectical and empirical considerations. , 1985, Psychotherapy and psychosomatics.

[56]  C. Koblenzer Psychosomatic concepts in dermatology. A dermatologist-psychoanalyst's viewpoint. , 1983, Archives of dermatology.

[57]  C. Leonardi,et al.  Alopecia areata and presence of cytomegalovirus DNA. , 1995, JAMA.

[58]  C. Lücking,et al.  Alexithymia and attachment representation in idiopathic spasmodic torticollis. , 1999, The Journal of nervous and mental disease.

[59]  Sheldon Cohen,et al.  Social support theory and measurement. , 2000 .

[60]  S. Bressi,et al.  Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study. , 1996, Journal of psychosomatic research.

[61]  P Bebbington,et al.  The buffer theory of social support – a review of the literature , 1987, Psychological Medicine.

[62]  Generality of support sources and psychometric properties of a scale of perceived social support in Turkey , 2000, Social Psychiatry and Psychiatric Epidemiology.

[63]  L. Melton,et al.  Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. , 1995, Mayo Clinic proceedings.

[64]  T. Wills,et al.  Stress, social support, and the buffering hypothesis. , 1985, Psychological bulletin.

[65]  G J Taylor,et al.  The Twenty-item Toronto Alexithymia Scale--II. Convergent, discriminant, and concurrent validity. , 1994, Journal of psychosomatic research.

[66]  M. Mikulincer,et al.  Effects of adult attachment style on the perception and search for social support. , 1995, The Journal of psychology.

[67]  Rodney D Sinclair,et al.  Genetics of alopecia areata , 2000, The Australasian journal of dermatology.

[68]  C. Lyketsos,et al.  Hostile personality characteristics, dysthymic states and neurotic symptoms in urticaria, psoriasis and alopecia. , 1985, Psychotherapy and psychosomatics.

[69]  B. Major,et al.  Mental models of attachment and coping with abortion. , 1998, Journal of personality and social psychology.

[70]  J. Shapiro,et al.  Alopecia areata update. , 2000, Journal of the American Academy of Dermatology.

[71]  A. Troisi,et al.  Insecure attachment and alexithymia in young men with mood symptoms. , 2001, The Journal of nervous and mental disease.