Alopecia areata, especially when severe, often profoundly affects the lives of those afflicted. The unpredictability of its severity and frequency of recurrence may lead to feelings of loss of control and helplessness. Severe hair loss evokes not only cosmetic concerns but may also evoke feelings of vulnerability (nakedness), loss of self-esteem, alterations in self-image, and, perhaps, even self-identity. A grief reaction often occurs with the loss of significant amounts of scalp hair. Family, friends, and, often, physicians may suggest to patients that their hair loss is a result of stress, which may further induce feelings of responsibility and guilt for the alopecia. Finally, patients are often reassured by family and friends that at least alopecia areata is not "cancer" but only a benign cosmetic problem. This later reassurance generally reinforces the patient's sense of guilt for not coping better with the situation and often precludes the patient being able to verbalize feelings that can, in time, lead to emotional
Fiedler VC. Alopecia Areata: A Review of Therapy, Efficacy, Safety, and Mechanism. Arch Dermatol. 1992;128(11):1519–1529. doi:10.1001/archderm.1992.01680210097016
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