Traumatic Experiences, Dissociative Symptoms, and Alexithymia in Patients with Alopecia Areata

Academic Background

Alopecia Areata (AA) is an inflammatory autoimmune disease targeting hair follicles, with its exact etiology remaining unclear. Studies suggest that genetic, environmental, autoimmune, and psychological factors may play significant roles in the onset of AA, particularly the relationship between psychological stress and traumatic experiences. Recent research indicates that traumatic experiences, dissociative symptoms, and alexithymia may be linked to the pathogenesis of AA. Dissociative symptoms refer to a psychological defense mechanism occurring after trauma, manifesting as disconnection in memory, consciousness, or sense of identity, while alexithymia is characterized by difficulty in identifying and describing emotions. These psychological factors may influence the onset of AA through immune system regulation. However, the specific mechanisms of these factors in AA patients have not been systematically studied. To address this, researchers Furkan Demirgil et al. conducted a study to explore the manifestations of traumatic experiences, dissociative symptoms, and alexithymia in AA patients and their relationship with the disease.

Source of the Paper

This paper was co-authored by Furkan Demirgil, Nesim Kuğu, and Yavuz Yılmaz, affiliated with the Department of Psychiatry at Mersin Toros State Hospital and Cumhuriyet University Faculty of Medicine in Sivas, Turkey. The paper was published in the Journal of Dermatology in 2024, with DOI 10.¹¹¹¹⁄₁₃₄₆-8138.17572.

Research Process and Results

Study Participants and Grouping

The study included 174 participants, divided into three groups: 1. AA Group: 58 AA patients who visited the dermatology outpatient clinic between August 2021 and February 2023. 2. Dermatological Disease Control Group: 58 patients with dermatological conditions (e.g., moles, warts, scabies, fungal infections) believed to have low psychological components. 3. Healthy Control Group: 58 healthy individuals without chronic diseases.

All participants completed assessments using the Childhood Trauma Questionnaire (CTQ-28), Dissociative Experiences Scale (DES), DSM-5 Posttraumatic Stress Disorder Checklist (PCL-5), and Toronto Alexithymia Scale (TAS-20). They also underwent the Structured Clinical Interview for DSM-5 (SCID-5-CV) to exclude other psychiatric diagnoses.

Results

1. Childhood Trauma Experiences: The AA group had significantly higher CTQ-28 total scores than the control groups (p<0.001), particularly in emotional neglect (p<0.001) and physical neglect (p=0.022). The study found that emotional neglect in childhood increased the risk of developing AA by sixfold.
2. Dissociative Symptoms: No significant differences were found in DES scores among the three groups (p=0.085), although the AA group had slightly higher scores than the control groups.
3. Alexithymia: The AA group had significantly higher TAS-20 scores than the control groups (p=0.016), indicating a higher prevalence of alexithymia.
4. Posttraumatic Stress Disorder (PTSD): The AA group also had significantly higher PCL-5 scores than the healthy control group (p=0.024), suggesting a higher likelihood of PTSD symptoms.

Data Analysis and Conclusions

SPSS 21.0 was used for statistical analysis, with one-way ANOVA and Kruskal-Wallis tests employed for multi-group comparisons. Post hoc analysis (Bonferroni correction) further identified the sources of group differences. Spearman correlation analysis was used to assess relationships between scales.

The study concluded that emotional and physical neglect in childhood may play a significant role in the onset of AA. Additionally, alexithymia and PTSD symptoms are more prevalent in AA patients. The study recommends that psychological evaluation and intervention, particularly for childhood trauma and emotional disorders, should be emphasized in the treatment of AA.

Research Highlights

1. Innovation: This study is the first to systematically explore the manifestations of childhood trauma, dissociative symptoms, and alexithymia in AA patients and their relationship with the disease, filling a gap in the field.
2. Multi-level Analysis: The study not only focused on traumatic experiences but also delved into the role of psychological factors (e.g., dissociative symptoms and alexithymia) in AA.
3. Clinical Application: The findings provide a scientific basis for psychological interventions in AA, emphasizing the importance of addressing psychological trauma and emotional disorders in treatment.

Additional Valuable Information

The study also noted that higher levels of alexithymia and PTSD symptoms in AA patients may be related to disease development and recurrence. Future research could further explore whether treatments targeting these psychological factors can prevent the onset or alleviate the symptoms of AA.