Visible disfigurement can result in lowered self-confidence and negative self-image. Concern about physical looks was evident among all the eight adolescents interviewed in the present study. Concerns about looking older in males and looking ugly without hair in females were common. Men usually are expected and socialized

to be less worried over their looks than women (Pope, Phillips, & Olivardia, 2000). Females reported a number of future concerns and the most apparent one was the fear of not being able to get married because of their hair loss. Related Palbociclib nmr concerns were about getting love, having to live alone for the rest of their lives, being ridiculed throughout the life, and fear of never getting back their lost self-confidence. Hair loss is a traumatic experience for both men and women, but it is “significantly more distressing for women” (Matuszek, Nelson, & Quick, 1995) and distressing reactions can occur irrespective of the type of hair loss. Cash et al. (2005) found that though men regard hair loss as undesirable and are embarrassed, they can cope and maintain integrity FDA approved Drug Library manufacturer of their body image, as male baldness is usually accepted and relatively more common. Males were concerned

about their alopecia getting worse with the passage of time and not being able to get back their lost self-confidence. They did not convey psychological concerns such as not being able to get married or getting love. Unpredictable patterns of hair loss can result in feelings of apprehension, uncertainty,

and feeling unable to control one’s appearance and get back self-confidence (Cash et al., 2005). Men have fewer psychosocial concerns when faced with a physically altering condition (Pope et al., 2000). Another superordinate theme that emerged was experiencing negative cognitions and emotions. Constant negative thoughts and language are likely to create anxiety, worry, and self-blame, which could be classified as negative forms of coping. Thoughts about hurting one self, hurting someone else, and thoughts of being worthless were common. Alopecia, which was not surprising as AA has negative psychological repercussions (Hunt & McHale, 2005), manifested in the form from of anxiety, depression, lower self-esteem, and poorer quality of life (McGarvey et al., 2001). Coping mechanisms changed and improved with time. Initial maladaptive forms of coping behaviours emerged such as blaming God, fate, and intropunitive coping; and were latter replaced by more adaptive forms of coping such as use of remedies and treatment, wearing of veils and caps (practical coping), self-distraction, support seeking, religious coping, acceptance, humourous coping, and future planning coping. Furthermore it takes time to adjust to the unpredictable nature of the illness, and development of more adaptive behaviours takes place at a later stage (Papadopolous & Bor, 1999).