Every hair follicle experiences three stages: growth (anagen), involution (catagen), and resting (telogen). The growth stage may last for 2 to 6 years. Then the involution stage is about a couple of days. The hair follows the next step, going into the resting phase and finally, the hair falls out. Each person may lose from 50 to 100 hairs a day normally (flow chart below) (2). In order to treat your stress related hair loss, you need to know what type of hair loss you have. Otherwise you may waste months or even years incorrectly treating your hair loss, when you could have simply changed the treatment and solved the problem quickly. I believe that four types of hair loss may be caused (or exacerbated) by stress or anxiety: Telogen effluvium (TE), trichotillomania, alopecia areata (3) and androgenic alopecia.
Telogen EffluviumThis occurs when the growth phase is abnormally short, resulting in large numbers of hair follicles prematurely entering the resting phase. A great many hairs will fall out suddenly during daily routines when you comb or wash your hair (2). Women tend to suffer from this condition more than men (4). Emotional stress is the most common causes of TE (Table below) (2). This stress may act as a primary factor for hair loss, or a secondary factor as a response to hair loss. Stress is considered a negative hair growth factor which has an adverse impact on the life cycle of a human’s hair (5). Acute TE is a self-limiting condition, and eventually, it goes away by itself. Therefore, we only observe the symptoms until it heals spontaneously. There are not many treatment options for chronic TE. But as you’ll see at the end of this article there are powerful ways to limit the condition.
TrichotillomaniaTrichotillomania is an urgent desire to pull out your hair in response to a stressful situation. Hair pulling can be a way of handling negative or uncomfortable feelings, such as stress, tension, loneliness, boredom or frustration. It occurs more often in women than in men (2). Sixty-five percent of patients with trichotillomania were diagnosed with obsessive compulsive disorders and anxiety disorders (6). In a study by Grant and colleagues, roughly 530 adults with trichotillomania were examined in a variety of clinical interventions including symptom severity, psychosocial measures of functioning, psychiatric comorbidity and neurocognitive testing assessing motor inhibition and cognitive flexibility. The result showed that those with major depressive disorder (MDD) had worse symptoms than those with an anxiety disorder only, and patients with MDD and an anxiety disorder suffered the most severe symptoms (7). In situations where an individual suffers Trichotillomania, clearly treating the underlying psychological problems is far more important than focusing on the hair loss. And since the underlying cause of the hair loss is psychological, that is precisely where treatment should be focused.
Alopecia AreataThere are thought to be a variety of causes of alopecia areata including severe stress and anxiety. In alopecia areata, the hair follicles are damaged by the immune system, thereby causing hair loss. Alopecia areata happens in 2 percent of the general population, and the rate of men and women is equal. The disease may be present at any age but is more common in children and young adults (8). In a clinical study, the research team compared the mental health of patients with alopecia areata with the healthy population. There were significant differences between two groups, i.e. the result demonstrated the rate of anxiety and depression was higher in patients with alopecia areata (9). Sellami and colleagues conducted another clinical study to investigate the relationship between alopecia areata and emotional disorders such as alexithymia, anxiety, and depression. They showed again that patients with alopecia areata had a high rate of anxiety and depressive manifestations (4).
Androgenic AlopeciaThough the primary cause of androgenic alopecia is the hormone Dihydrotestosterone (DHT), there is strong evidence to suggest that DHT is increased in the blood by increased presence of the stress hormone cortisol. Therefore, it seems salient to suggest adrogenic alopecia (hair loss induced by adrogen hormone) is exacerbated by increased cortisol hormone. We might even go so far to say that androgenic alopecia would not occur at all if it weren’t for elevated cortisol interacting with testosterone to result in elevated serum DHT — though there is as yet limited evidence to prove this.
ConclusionsIn a nutshell, there is a high likelihood that those with mild anxiety-induced hair loss are suffering from telogen effluvium, i.e. simply stress-weakened hair. However, the other three conditions, trichotillomania, alopecia areata and adrogenic alopecia have been raising concerns for human beings, notably for the high stress categories of the population. Since elevated DHT is also linked to prostate cancer, stress should be considered of high importance in the treatment and prevention of disease.
- Hunt N, McHale S. The psychological impact of alopecia. BMJ. 2005;331(7522):951-3.
- Thiedke CC. Alopecia in women. American family physician. 2003;67(5):1007-14.
- K. D. Can stress cause hair loss? Mayo Clinic2016 [Available from: http://www.mayoclinic.org/healthy-lifestyle/stress-management/expert-answers/stress-and-hair-loss/faq-20057820.
- Sellami R, Masmoudi J, Ouali U, Mnif L, Amouri M, Turki H, et al. The relationship between alopecia areata and alexithymia, anxiety and depression: a case-control study. Indian journal of dermatology. 2014;59(4):421.
- Grover C, Khurana A. Telogen effluvium. Indian J Dermatol Venereol Leprol. 2013;79(5):591-603.
- Grzesiak M, Reich A, Szepietowski JC, Hadrys T, Pacan P. Trichotillomania Among Young Adults: Prevalence and Comorbidity. Acta dermato-venereologica. 2017;97(4):509-12.
- Grant JE, Redden SA, Medeiros GC, Odlaug BL, Curley EE, Tavares H, et al. Trichotillomania and its clinical relationship to depression and anxiety. International journal of psychiatry in clinical practice. 2017:1-5.
- Bertolino AP. Alopecia areata. A clinical overview. Postgraduate medicine. 2000;107(7):81-5, 9-90.
- Baghestani S, Zare S, Seddigh SH. Severity of Depression and Anxiety in Patients with Alopecia Areata in Bandar Abbas, Iran. Dermatology reports. 2015;7(3):6063.