Hair and head hair in particular, have a defining role in the construction of identity and self-image. Hair loss, on the other hand, may represent subjugation, weakness and impotency, and is commonly associated with unattractiveness, low self-esteem, social dysfunction, aging, as well as feelings of sadness, depression, and grief. Hair loss is intricately connected to emotional stress. Several studies conducted over the last 40 years have revealed a significant association between stress and hair loss, in that exposure to stressful life events may act as a trigger for various hair-related conditions.

Among the most prevalent psychiatric disorders encountered in dermatological and cosmetic surgery settings is Body Dysmorphic Disorder (BDD). Diagnostic criteria for BDD include preoccupation with perceived defects or flaws in appearance that are not observable-or appear slight-to others; during the course, individuals have performed repetitive behaviors such as mirror-checking, excessive grooming, cosmetic procedures and others or repetitive mental acts. Patients with BDD symptoms experience significant psychological distress and impairment in social, occupational, and other areas of functioning.

This cross-sectional study was performed in DHI, the largest private medical center for hair restoration in Athens. A total of 228 participants were included in the study. All participants completed a set of questionnaires that included demographic items and assessment of clinical characteristics Our study reported high prevalence of BDD symptoms in this population. Over 58% of the sample scored above the normal range of BDD symptoms, while over 35% reported moderately severe and severe symptoms of BDD.

Our results confirm previous reports of the relatively high prevalence of BDD in dermatology patients.

The study was a collaboration of DHI with the Eginition Hospital and the 1st Psychiatric Clinic at National and Kapodistrian University of Athens.

The need for a psychological investigation for patients intending to proceed with hair restoration has led DHI to include the Stress Analysis in its routine diagnostic procedure. The DHI Stress Analysis was developed in collaboration with academics from the Medical School of the University of Athens and is part of the DSA diagnostic system that provides a complete and personalized diagnosis for all types of alopecia, both in men and women suffering from hair loss.

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