Why Hair Loss Can Be So Stressful

Hair loss can cause significant distress

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Recently, the world collectively gawked as Will Smith slapped Chris Rock during the Academy Awards. Chris Rock had made a joke about the short hairstyle worn by Jada Pinkett Smith, Will Smith's wife. This had ostensibly provoked Smith since his wife had shaven her head because of her alopecia. My medical training kicked in.

"What kind of alopecia does Jada Pinkett Smith have?"

Alopecia is a catch-all term for hair loss, and there are many different types. A common cause of hair loss is androgenetic alopecia, known as male- or female-pattern baldness. Another cause of alopecia is telogen effluvium, in which patients can lose lots of hair at once, usually three to six months after a mentally or physically stressful event. Other causes of hair loss include traction alopecia–hair loss caused by hairstyles that pull on the hair–and alopecia areata, where the body's immune system attacks its own hair follicles, leaving smooth and oval bald patches on the scalp.

Then there are the rare scarring alopecias, such as frontal fibrosing alopecia and central centrifugal cicatricial alopecia, where inflammation leads to permanent loss of the hair follicles–meaning those hairs will never come back.

Dr. George Cotsarelis, a dermatologist at the University of Pennsylvania, opined that Pinkett Smith had alopecia areata, sometimes responsive to medical treatment.

In the overall scheme of things, hair loss is one of the least dangerous medical conditions I see in clinic. Most causes of alopecia are not life-threatening. Yet, in my experience, some of my most anxious patients are those who suffer from hair loss.

Research on the effects of alopecia on mental health is limited, especially since it's difficult to tease out whether a patient's psychological distress contributed to the alopecia or vice versa. Yet, in the few published studies, patients described loneliness, isolation, shame, lack of confidence, and a distorted self-image after losing their hair.

Hair is deeply ingrained into one's self-image, inextricably linked to perceptions of beauty, health, youth, and gender. Moreover, hairstyling is also an essential part of many cultural and religious practices. Losing hair can worsen a patient's self-esteem, body image, and sense of distance from their social community.

I can't defend Will Smith or his actions, but I wonder what he must have experienced as he saw Jada Pinkett Smith struggle with her alopecia for years. What did he think as he watched his wife grieving the loss of her hair? How did he feel as she decided to reclaim her self-image by cutting her hair short? I have no way of knowing—but I do know that, for many, hair is deeply rooted in how we define ourselves.

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