Modeling of Psychological Antecedents and Consequences of Alopecia Areata Based on the Transdiagnostic Approach

Moradi Tavalaei, Arezoo; Bigdeli, Imanollah; Mashhadi, Ali; Razmara, Mahdi; Jafferany, Mohammad

doi:10.30473/hpj.2025.73428.6204

Articles in Press

Document Type : Scientific Research

Authors

¹ Ferdowsy university of Mashhad, Mashhad, Iran

² Ferdowsi University of Mashhad, Mashhad, Iran

³ Mashhad University of Medical Science, Mashhad, Iran

⁴ Central Michigan University, Michigan, USA

10.30473/hpj.2025.73428.6204

Abstract

Objective: Alopecia areata (AA) is a complex autoimmune condition with non-scarring alopecia, and it occurs in approximately 2% of the global population. Although its pathogenesis includes both genetic and immunological factors, mounting evidence supports the significance of psychological determinants in inducing as well as exacerbating the condition. The transdiagnostic approach, which is a method characterizing key psychological processes underlying greater than one disorder, offers a new paradigm to study AA's psychosocial determinants. The current research analyzes how transdiagnostic factors, particularly neuroticism, anxiety sensitivity, emotion regulation, mindfulness, and experiential avoidance, correlate with severity of AA and emotional comorbidities in an Iranian clinical sample. Our research contributes to closing relevant gaps in extant research in that: (1) the variables are compared simultaneously, not separately, and (2) a full mediation model is considered to shed light on personality-outcome pathways. Method: We performed a cross-sectional survey of 200 AA patients (123 men, 77 women; mean age=29.93±7.93 years) enrolled from clinics of dermatology of Imam Reza Hospital, Mashhad. Candidates were confirmed by board-certified dermatologists for AA diagnosis, while disease severity was measured using the Alopecia Areata Severity Index (AASI). All participants completed validated Persian versions of Multidimensional Emotional Disorder Inventory (MEDI) for emotional disorders, Anxiety Sensitivity Index-16 (ASI-16), Freiburg Mindfulness Inventory-Short Form (FMI-SF), Gross & John Emotion Regulation Questionnaire (ERQ), Multidimensional Experiential Avoidance Questionnaire (MEAQ). Structural Equation Modeling (SEM) through Smart-PLS 3.0 examined direct/indirect associations between transdiagnostic variables, with mediation testing through bootstrapping (5000 samples). The research was ethically approved in ethical commite of ferdowsi university of Mashhad (IR.UM.REC.1402.174). Results: Key findings of this study are: Neuroticism had the highest correlation with emotional disorders (β=0.819, p<0.001), explaining 67.1% variance. High neuroticism predicted lower mindfulness (β=-0.560) and higher disease severity (β=0.206). Mindfulness mediated 38.7% of neuroticism's effect on emotional disorders (β=-0.206, p<0.001) and reduced experiential avoidance (β=-0.687). Anxiety sensitivity had direct effects on emotional disorders (β=0.280) and emotion dysregulation (β=-0.393), but indirect effects through avoidance were nonsignificant (p=0.818). Counter hypotheses, emotion dysregulation, and experiential avoidance could not mediate psychological effects (p>0.05). The demographic variable of age/sex showed few effects of moderation (all p>0.10). Conclusion: This study provides the first evidence for transdiagnostic mechanisms in AA, identifying neuroticism and mindfulness as pivotal treatment targets. We suggest for: Revised AA management guidelines incorporating psychological assessments, Development of brief mindfulness interventions tailored for dermatology settings, Increased collaboration between dermatologists and psychologists. These innovations could transform AA from a purely dermatological condition to a biopsychosocial model of care, potentially improving treatment adherence and reducing relapse rates.

Keywords

Main Subjects

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Modeling of Psychological Antecedents and Consequences of Alopecia Areata Based on the Transdiagnostic Approach

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Articles in Press, Accepted Manuscript Available Online from 11 March 2026

Articles in Press, Accepted Manuscript
Available Online from 11 March 2026