Loneliness as a Component of Psychiatric Disorders

Richard Booth, PhD

Disclosures

Medscape General Medicine. 2000;2(2) 

In This Article

Abstract & Introduction

Abstract

Research addressing loneliness has increased dramatically during the past 2 decades; however, despite the mental health risks associated with being lonely, the relationship between loneliness and psychiatric disorders has not been sufficiently explored. This article summarizes some of the more pertinent literature on loneliness to provide a descriptive analysis of lonely people and present some salient mental health risks associated with loneliness. Research linking loneliness with various psychiatric conditions is also discussed. This article is an attempt to effect a discussion about loneliness and its appropriateness for inclusion in the Diagnostic and Statistical Manual of Mental Disorders.

Introduction

In 1959, Fromm-Reichmann published an article in Psychiatry simply entitled "Loneliness,"[1] which became one of the catalysts for structuring later systematic research in this long-neglected area of study. Over the next 2 decades, thinkers in various disciplines began to develop theoretical foundations for understanding loneliness more fully.[2,3] In 1982, Peplau and Perlman edited a work containing some of the most complete representations of theory-building and empirical research on loneliness up to that time.[4] During the past 25 years, our comprehension of loneliness has increased to the point that some clinical interventions, based on empirical data derived from grounded theory, have begun to emerge and be incorporated into clinical practice.[5,6]

Because millions of people suffer from loneliness every day,[7] and because loneliness is fundamentally debilitating, it is appropriate for both clinicians and researchers to attempt to understand it, both as a condition in itself and as it relates to other conditions. To date, loneliness has been included in the North American Nursing Diagnosis Association (NANDA) listing of nursing diagnoses[8] but has not been incorporated in the Diagnostic and Statistical Manual (DSM-IV), nor is it listed in the index of that work. One reason for the omission may well be the widespread lack of familiarity among clinicians with the concept of loneliness as a discrete construct that is accompanied by dysfunctional and sometimes life-threatening correlates. Another reason may be that loneliness is masked by or mistaken for a condition with which it shares a number of overlapping characteristics, namely depression. The fundamental purpose of this article is to increase clinicians' awareness of loneliness, with a view toward clarifying what loneliness is and is not. In addition, it is important to point out certain relationships between loneliness and psychiatric disorders, while preserving the integrity of loneliness as a discrete condition related to, but separate from, other dysfunctional conditions.

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