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 18^yrs) 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.