Features of psychosocial adaptation in patients with diffuse alopecia depending on its genesis and intensity of manifestations of mental maladaptation

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Background. Alopecia, regardless of its etiology (metabolic, autoimmune, mixed), is not only a dermatological but also a distinctly psychosocial phenomenon that deeply affects the quality of life, social identity and psychological adaptation of the individual. Unlike other somatic conditions, hair loss has a high level of visual accessibility, which often leads to social stigmatisation, avoidance of social situations, emotional isolation and the development of anxiety and depressive disorders, so the study of psychosocial adaptation in patients with alopecia is not only scientifically sound but also a socially significant area of modern psychiatry, psychosomatic medicine and psychodermatology. Purpose – to investigate the peculiarities of psychosocial adaptation in patients with diffuse alopecia, depending on its genesis and severity of mental maladjustment, in order to create, in the future, differentiated and individualised approaches to the management of this category of patients. Materials and methods. 153 women aged 25 to 45 years with diffuse alopecia were examined. With the help of a structured interview according to the ICD-10 criteria and using the psychodiagnostic method, three groups were identified among the patients: without signs of mental maladjustment (MAD), numbering 45 people, with some signs of maladjustment, numbering 73 people, and with the presence of adaptation disorders in accordance with the ICD-10 criteria, numbering 35 people. Within each of these groups, two subgroups were identified based on the genesis of alopecia: metabolic (45 patients) or mixed (108 patients). The study of psychosocial adaptation (PA) features was conducted using the methodology of social and psychological adaptation by C. Rogers and R.F. Dymond. Statistical analysis included descriptive statistics, analysis of variances using the nonparametric Mann-Whitney test and correlation analysis using the Spearmanʼs rank correlation method. Results. The study confirmed the dependence of psychosocial maladjustment (PSA) manifestations on the state of mental health and the presence of adaptation disorders: the worst indicators were found in patients with clinically diagnosed adaptation disorders, the state of PA was significantly better in patients with some signs of adaptation disorders, and the best indicators were demonstrated by patients with no PD. It should be noted that the manifestations of adaptation disorders had a more significant impact on the severity of DCD compared to the genesis of alopecia. Thus, in the group of patients with adjustment disorders, both the total score for C. Rogers et R.F. Dymond and the scores in individual areas were the lowest of all groups and worse than in patients with mixed alopecia. In the structure of PA disorders, the lowest scores in patients without signs of PD were found in the areas of desire for dominance, emotional comfort and self-perception. In patients with individual manifestations of PD and clinically manifested adjustment disorders, the worst scores were found in the area of self-perception, and slightly higher scores were found in the areas of striving for dominance and emotional comfort. At the same time, the scores in these areas in patients with adjustment disorders were very low. These trends, in our opinion, reflect, first of all, the influence of depressive and anxiety manifestations and the desire for self-isolation, which increase in parallel with the severity of adjustment disorders. The results of the correlation analysis confirmed the above patterns and for the first time allowed us to quantify the relationship between psychopathological manifestations and the degree of PA in women with alopecia. This made it possible to determine the hierarchy of psychopatholoical factors that influence PA. Our data suggest that the most important factors are the severity of depressive and anxiety manifestations, and less significant are the severity of obsessive-compulsive and psychosomatic manifestations, as well as individual psychological characteristics of patients. Conclusions. For the first time, we compared the severity of PAS manifestations in women with alopecia of different genesis and different severity of adjustment disorders using a standardised methodology, which allows us to better understand the patterns of relationships between clinical, psychopathological and psychosocial factors in alopecia. The results of the study can be useful for the development of multidisciplinary support programmes, the inclusion of psychological screening in dermatological practice, as well as the optimisation of medical and psychological care for this patient population.

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