To evaluate the reason of major behavioral problems in alopecia universalis patients, we tried to examine by way of MCMI- III whether these signs are transient, developmental or ingrained.

279 patients with alopecia universalis were studied before and 3 months after treatment with MCMI-III and scheduled psychiatric interview. They were stratified in regard to sex, age, socioeconomic class, age of onset of alopecia (before or after 18yrs) and response. The results were compared with 3000 normal examinees.

There was significant preponderance of personality disorders among patients with early onset (p < 0.003) but not late onset (p = 0.1) alopecia including schizotypal, schizoid, self defeating, borderline and avoidant personalities compared to general population. This was not affected by treatment. (p < 0.004) All patients showed higher scales in axis II disorders including depression, anxiety, drug abuse, alcohol abuse and major thought disorders. (Overall p < 0.02) These were ameliorated with treatment of alopecia. These data were confirmed by scheduled interviews.

This is the first report of severe personality disorder in the context of a medical (dermatological) condition. Childhood onset chronic illnesses can cause serious personality disorders that are stronger predictors than genetics or learned behavior encompassed in previous theories on personality. Alopecia universalis has a more sustained effect due to jeopardizing the development of self image. We recommend that many diseases with their onset during childhood, including type I diabetes, epilepsy, childhood cancers … must not only be treated for concomitant anxiety and depression but for abnormal personality development.