Loneliness in Personality Disorders

Abstract

Purpose of review: Loneliness is a common experience in patients with personality disorders (PDs) that are characterized by impairment in self (identity, self-direction) and interpersonal functioning (empathy, intimacy). Here, we review studies assessing the association of loneliness with PD or PD traits including DSM-5's Alternative Model of PD (AMPD).

Recent findings: The number of loneliness studies varied greatly among different PDs with most studies conducted in borderline PD. Across PDs, loneliness was associated with the severity of psychopathological symptoms and with several AMPD trait domains. Consequently, loneliness may contribute to PD severity and further impair personality functioning. Loneliness and PD share intra- and interpersonal factors (i.e., increased rejection sensitivity, information processing biases, social withdrawal) and common origins in childhood maltreatment that may explain their close association. Future research needs to investigate mechanisms on how loneliness and core characteristics of PD mutually reinforce each other in order to therapeutically address loneliness in PD.

Keywords: Alternative model of personality disorders; Loneliness; Perceived social isolation; Personality disorders; Psychotherapy; Social network.

Fig. 1

Theoretical model of loneliness in PD: Impairment in dimensions of self and interpersonal functioning according to the DSM-5 Alternative Model of Personality Disorders parallels intra- and interpersonal factors of loneliness. Childhood maltreatment and interpersonal trauma may predispose to feel lonely. Interpersonally, social withdrawal and dysfunctional behavior may provoke social network impairment, rejection, and loss of social support that maintains loneliness. Intrapersonal factors such as rejection sensitivity (hypervigilance to social cues and rejection expectancy), information processing biases, distrust, shame (e.g., internalized stigma), and self-blame further hinder reconnection attempts to overcome loneliness. Specific dysfunctional personality traits (e.g., detachment and negative affectivity) need to be identified that further interplay with these intra- and interpersonal factors and increase loneliness. Intra-/interpersonal model of loneliness adapted from [33, 81]