Illness Perception, Emotional Distress, and Obsessive–Compulsive Symptomatology in Patients with Alopecia Areata: A Mediation Study

Alopecia Areata (AA) is a chronic disorder with significant psychological impact due to its unpredictability. While emotional distress (ED) is well-recognized in AA, the interplay between illness perception (IP) and obsessive-compulsive (OCD) symptomatology remains underexplored. This -sectional, observational study aimed to investigate the prevalence of OCD symptoms and ED in AA outpatients, analyzed the relationship between IP and OCD symptomatology. One-hundred-thirty-five AA outpatients, from a specialized Hospital in Rome, Italy, were recruited. Participants completed the DASS-21 for ED, the Brief IPQ for IP, and the OCI-R for OCD symptomatology. AA severity was assessed using standardized scores. Statistical analyses included correlations and a simple mediation model. OCD symptomatology was found in 18.5% of the sample, and clinical-level ED in 20.7%. Strong associations were found between OCI-R and DASS-21 (r = 0.56, <i>p</i> < 0.001), and DASS-21 and Brief IPQ (r = 0.56, <i>p</i> < 0.001). The mediation analysis indicated that ED fully mediated the relationship between IP and OCD symptomatology (indirect effect: b = 0.20, 95% CI [0.10, 0.30]), suggesting IP's impact on OCD symptoms primarily occurs via ED. Negative IP exacerbate ED, which, in turn, drives OCD behaviors. Psychological assessment and targeted interventions in individuals with AA are needed.