Review Article| Volume 19, ISSUE 2, P161-166, March 2001

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The psychology of hair loss and its implications for patient care

      Hair, especially scalp hair, is imbued with greater social and psychological significance than with biological importance. Hair provides some cranial cushioning and shielding from the sun’s rays; however, throughout history and across cultures, hair conveys considerable symbolism.
      • Etcoff N
      • Kligman A.M
      • Freeman B
      History of baldness From magic to medicine.

      Morris, D. Bodywatching: A field guide to the human species. New York: Crown, 1985:21–36.

      It can serve as a social signal of gender, age, status, values, and group membership. From monks to skinheads, prisoners of war to warriors, “bigwig” European aristocrats to moptop Beatles, and hippies to head-shaven celebrity athletes, hair makes a statement, whether chosen or imposed.
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        • Etcoff N
        Survival of the prettiest. Doubleday, New York1999
        • Kligman A.M
        • Freeman B
        History of baldness.
        Clin Dermatol. 1988; 6: 83-88
      1. Morris, D. Bodywatching: A field guide to the human species. New York: Crown, 1985:21–36.

      2. Cash T.F Pruzinsky T Body images Development, deviance, and change. Guilford, New York1990
        • Cash T.F
        The psychosocial consequences of androgenetic alopecia.
        Br J Dermatol. 1999; 141: 398-405
        • Cash T.F
        • Pruzinsky T
        The psychosocial effects of androgenic alopecia and their implications for patient care.
        in: Stough D.B Haber R.S Hair replacement Surgical and medical. Mosby, St. Louis, MO1996: 1-8
        • Cash T.F
        Body image and cosmetic surgery.
        Am J Cosmetic Surg. 1996; 13: 345-351
      3. Thompson J.K Heinberg L.J Altabe M Exacting beauty Theory, assessment, and treatment of body image disturbance. American Psychological Association, Washington, DC1999
        • Olsen E.A
        Androgenetic alopecia.
        in: Olsen E.A Disorders of hair growth Diagnosis and treatment. McGraw-Hill, New York1994: 257-283
        • Dawber R.P.R
        • Ebling F.J.G
        • Wojnarowska F.T
        Disorders of hair.
        in: 5th edition. Textbook of dermatology. vol. 4. Blackwell Scientific, Oxford1992: 2571-2577
        • Orentreich N
        • Durr N.P
        Biology of scalp hair growth.
        Clin Plastic Surg. 1998; 9: 197-205
        • Sawaya M.E
        • Price V.H
        Different levels of 5-α-reductase type I and type II, aromatase, and androgen receptor hair follicles of women and men with androgenetic alopecia.
        J Invest Dermatol. 1997; 109: 296-300
        • Van Neste D.J
        • Rushton H.D
        Hair problems in women.
        Clin Dermatol. 1997; 15: 113-125
        • Norwood O.T
        Male pattern baldness.
        Southern Med J. 1975; 68: 1359-1365
        • Hamilton J.B
        Patterned loss of hair in man.
        Ann NY Acad Sci. 1951; 53: 708-728
        • Jackson L.A
        Physical appearance and gender. SUNY Press, Albany, NY1992
        • Cash T.F
        The psychological effects of androgenetic alopecia in men.
        J Am Acad Dermatol. 1992; 26: 926-931
        • Girman C.J
        • Rhodes T
        • Lilly F.R.W
        • et al.
        Effects of self-perceived hair loss in a community sample of men.
        Dermatology. 1998; 197: 223-229
        • Budd D
        • Himmelberger D
        • Rhodes T
        • et al.
        The effects of hair loss in European men.
        Eur J Dermatol. 2000; 10: 122-127
        • Cash T.F
        • Price V.H
        • Savin R.C
        Psychological effects of androgenetic alopecia on women.
        J Am Acad Dermatol. 1993; 29: 568-575
        • Franzoi S.L
        • Anderson J
        • Frommelt S
        Individual differences in men’s perceptions of and reactions to thinning hair.
        J Soc Psychol. 1990; 130: 209-218
        • Maffei C
        • Fossati A
        • Rinaldi F
        • et al.
        Personality disorders and psychopathologic symptoms in patients with androgenetic alopecia.
        Arch Dermatol. 1994; 130: 868-872
        • Muth J.L
        • Cash T.F
        Body-image attitudes.
        J Appl Soc Psych. 1997; 27: 1438-1452
        • Toback C
        • Rajkumar S
        The emotional disturbance underlying alopecia areata, alopecia totalis and trichotillomania.
        Child Psychiat Hum Devel. 1979; 10: 114-117
      4. Whiting DA, Howsden, FL. Color atlas of differential diagnosis of hair loss. Cedar Grove, NJ: Canfield, 1996:32–7.

        • Munstedt K
        • Manthey N
        • Sachsse S
        • et al.
        Changes in self-concept and body image during alopecia induced cancer chemotherapy.
        Support Care Cancer. 1997; 5: 139-143
        • Pickard-Holley S
        The symptom experience of alopecia.
        Semin Oncol Nurs. 1995; 11: 235-238
      5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Ed. Washington, DC: American Psychiatric Association, 1994:466–8.

        • Phillips K.A
        The broken mirror. Oxford, New York1996
        • Kaufman K.D
        • Olsen E.A
        • Whiting D
        • et al.
        Finasteride in the treatment of men with androgenetic alopecia.
        J Am Acad Dermatol. 1998; 39: 578-589
        • Cash T.F
        The treatment of body image disturbances.
        in: Thompson J.K Body image, eating disorders, and obesity. American Psychological Association, Washington, DC1996: 83-107
        • Cash T.F
        The body image workbook. New Harbinger, Oakland, CA1997
        • Cash T.F
        • Grant J.R
        The cognitive-behavioral treatment of body-image disturbances.
        in: Van Hasselt V Hersen M Sourcebook of psychological treatment manuals for adult disorders. Plenum, New York1996: 567-614
        • Rosen J.C
        Body dysmorphic disorder.
        in: Thompson J.K Body image, eating disorders, and obesity. American Psychological Association, Washington, DC1996: 149-170
        • Grant J.R
        • Cash T.F
        Cognitive-behavioral body-image therapy.
        Behav Therap. 1995; 26: 69-84
        • Cash T.F
        • Lavallee D.M
        Cognitive-behavioral body-image therapy.
        J Rational-Emotive Cog-Behav Therap. 1997; 15: 281-294