# Importance of alexithymia on anxiety and depression in alopecia areata: a cohort study

## TL;DR

This study finds that patients with alopecia areata have higher rates of depression, anxiety, and alexithymia compared to the general population, with links to disease characteristics and lower education.

## Contribution

The study is the first to investigate alexithymia subtypes in alopecia areata patients and their associations with depression and anxiety.

## Key findings

- 32% of alopecia areata patients showed alexithymia, with difficulties identifying feelings linked to anxiety and depression.
- Lower education levels were associated with higher alexithymia, depression, and anxiety in patients.
- Alexithymia was more common in patients with earlier disease onset and nonfamilial alopecia areata.

## Abstract

Alopecia areata (AA) is an autoimmune hair loss disease, considered a psychosomatic disease with comorbid symptoms of depression and anxiety. Alexithymia, defined as difficulties in recognizing and describing feelings, has been found to be a vulnerability factor for developing anxiety and depression and somatic disease. The psychological burden of AA needs to be further investigated in larger studies by using standardized instruments developed to identify alexithymia, and clinical depression and anxiety. The outcome is important when treating patients with AA as well as for decisions on treatment.

To explore the prevalence of alexithymia and its subtypes and how they relate to depressive and anxiety symptoms in patients with AA.

In this cohort study 100 patients with AA were interviewed about sociodemographic data, AA disease variables, and previous and present mental health. The Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI) and the Toronto Alexithymia Scale-20 (TAS-20) were used to identify alexithymia, depression and anxiety. Associations between alexithymia and subtype scores – difficulties identifying feelings (DIF), difficulties describing feelings (DDF) and externally oriented thinking (EOT) – were analysed in relation to depression and anxiety scores. Relations between alexithymia, depressive and anxiety scores, and AA and sociodemographic variables were examined.

Prevalences of depression, anxiety and alexithymia in patients with AA were 16% (n = 16/100), 22% (n = 22/100) and 32% (n = 32/100), respectively. There was a statistically significant relation between DIF and anxiety and between DIF, DDF and depression. Lower levels of education were related to alexithymia, depression and anxiety symptoms. Alexithymia was statistically significantly more frequent among those who were younger at AA onset, in the relapsing form of AA and with nonfamilial AA. Previous mental affective illness was reported in 77% (n = 77/100) of patients with AA during the life course.

Patients with AA had a higher prevalence of depression, anxiety and alexithymia compared with normative data. Alexithymia was found among those with earlier AA onset, younger age at interview and lower educational levels. Higher EOT scores were found among those with anxiety and lower education.

Patients with alopecia areata appear to be psychologically vulnerable, reporting higher levels of alexithymia, depression and anxiety. There are associations with the subtypes of alexithymia where depressive alopecia areata patients rate difficulties in both identifying and describing feelings, whereas patients with anxiety rate difficulties in identifying feelings and in externally oriented thinking. Information about the mental ill health in patients with alopecia areata is important for understanding the complexity of the disease as well in decision making about treatment options