title: Female alopecia: the mediating effect of attachment patterns on changes in subjective health indicators.
abstract: BACKGROUND
  The interrelationship between female alopecia and psychological disorders is complex, with a range of psychosocial consequences, but also antecedents. Psychosocial antecedents are to a large extent interpersonal and can be assumed to have a mediating effect on health care utilization and subjective health.
  
  
  OBJECTIVE
  To analyse whether changes in health-related quality of life (QoL) are mediated by relational or attachment styles and whether these styles are associated with a particular, dysmorphophobic type of alopecia.
  
  
  METHODS
  Seventy-four women with androgenetic and diffuse alopecia underwent psychological assessment at the first consultation at a university clinic and at 2 months' follow-up. Attachment styles were evaluated by an observer rating scale. As a primary endpoint a disease-specific QoL instrument was employed.
  
  
  RESULTS
  Findings indicated an association between patients with nonvisible hair loss and the ambivalent attachment style. Global clinical impressions and attachment indicators, e.g. attachment security and coping strategies, showed significant contributions in predicting changes in the QoL scales 'self-esteem' and 'emotions'.
  
  
  CONCLUSIONS
  These findings suggest that attachment security may be one of the underlying mechanisms mediating subjective health and that a specific attachment vulnerability can be identified in a subgroup of patients with female alopecia. Future studies will have to focus on the relevance of attachment patterns in the doctor-patient relationship and on psychotherapeutic interventions.
authors.affiliation: Department of Medical Psychology, Pav S 35, University Hospital of Hamburg Eppendorf, Martinistr 52, 20246 Hamburg, Germany. sischmid@uke.uni-hamburg.de
authors.forename: S
authors.initials: S
authors.lastname: Schmidt
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000505:Alopecia / Q000523:psychology* / Q000628:therapy; D001828:Body Image; D004644:Emotions; D005260:Female; D006801:Humans; D008875:Middle Aged; D009769:Object Attachment; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010698:Phobic Disorders / Q000209:etiology; D011788:Quality of Life; D012044:Regression Analysis