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Stress can be visible in all kinds of ways, including a head of hair that’s not quite as thick as you remember.

Emotional or physical stress can lead to noticeable hair loss, ranging from bare patches to overall thinning of your mane. How does it happen and what can you do about it? We asked dermatologist Melissa Piliang, MD, to explain.

How does stress cause hair loss?

During times of stress, your body naturally increases cortisol levels as part of its “fight-or-flight” response. The steroid hormone affects your whole body — and that includes hair growth.

“When cortisol levels stay high, hair follicles may switch from growth mode into a resting phase,” explains Dr. Piliang. “That can lead to increased shedding seen days, weeks or even months later.”

Hair growth also takes a lot of energy and nutrients. When your body is under stress, it may divert some hair-growing resources to protect your vital organs (such as your brain, heart and lungs).

“It’s a matter of priorities,” says Dr. Piliang. “Hair isn’t essential for your survival. Your organs are.”

Stressors that can trigger hair loss

While we often connect stress to emotional situations, that’s not the only way it arrives. Your body can be stressed by:

• Rapid weight loss
• Nutritional deficiencies
• Illness
• Surgery
• Poor sleep
• Smoking
• Alcohol use

“Any of those stress factors could trigger hair loss,” emphasizes Dr. Piliang.

Signs of stress-related hair loss

Stress-related hair loss doesn’t always look the same for everyone — and it doesn’t mean you wake up bald one morning. If it happens, you may notice:

• More hair shedding than usual in the shower or on your brush
• Thinning hair across the scalp
• A widening part or a thinner ponytail
• Sudden, patchy hair loss

You may also notice other non-hair-related signs of stress, like trouble sleeping, increased anxiety or changes in appetite.

Types of stress-related hair loss

Stress can trigger hair loss in different ways. The most common include:

Telogen effluvium

Telogen effluvium (TE) is the most common type of stress-related hair loss. It happens when a large number of your hair follicles shift from growth mode to resting phase and shed at the same time.

This can lead to noticeable hair loss, sometimes even two to three months after a particularly stressful event, says Dr. Piliang.

Alopecia areata

Alopecia areata is an autoimmune condition where your immune system attacks hair follicles. This can result in sudden, patchy hair loss.

Stress may play a role in an alopecia areata flare-up if you’re prone to the condition: “Stress can definitely throw off your immune system and maybe tip it to the point where you see alopecia areata,” notes Piliang.

But it’s not always clear whether stress is a direct trigger for alopecia areata or if the troubling sight of hair loss creates stress afterward.

Trichotillomania (hair pulling)

Stress can fuel an urge to pull out hair as a less-than-healthy coping mechanism. Over time, this behavior — known as trichotillomania — can leave bald patches on your head or result in noticeable hair thinning.

“It’s kind of similar to chewing nails,” says Dr. Piliang. “Every time you pull out a hair, it causes a little pain. That little bit of pain is like an endorphin that temporarily distracts your mind and dulls stress.”