Loneliness as a Component of Psychiatric Disorders

Richard Booth, PhD


Medscape General Medicine. 2000;2(2) 

In This Article

Summary and Implications

Research clearly demonstrates that loneliness is a problematic condition, accompanied by sometimes intractable sadness, a sense of futility, social reticence and self-consciousness, interpersonal inadequacy, problem-solving ineffectiveness, and many other challenges. Moreover, the data support the notion that many psychiatric dysfunctions are associated with loneliness, including narcissism, suicidality, depression, anxiety, alcoholism, dependency, and hypochondriasis, to name but a few. Hence, lonely people face not merely interpersonal challenges but cognitive and affective challenges as well.

It is difficult to say exactly how loneliness may affect the activities of daily living, such as studying, working, and interacting within long-term relationships such as marriages and other partnerships. It would appear reasonable to hypothesize, however, that the anger, anxiety, and narcissistic preoccupation, for example, that are so often found in lonely people may act as interference effects in overall life satisfaction, and that those living or working with lonely people may well be negatively influenced by their loneliness.

Part of the challenge to mental health clinicians and researchers is to determine whether loneliness is a sufficiently consistent and salient component of certain already diagnosable disorders that it warrants consideration as a condition secondary to or associated with an already diagnosable condition, as well as whether loneliness is a significant and salient enough condition in and of itself to merit an independent diagnosis. At present, the data clearly show that being lonely can be an extremely debilitating way to live, and taking into account the correlates of loneliness that place patients at significant risk, serious consideration of this issue does not seem premature.

An important challenge for clinicians is to become sufficiently informed about loneliness so that depression is not diagnosed and treated when loneliness may be the primary presenting problem. The data cited in this paper, as well as the 4 suggestions for differential diagnosis, should be considered preliminary guidelines rather than strict rules for differentiating the 2 conditions. As clinicians become more familiar with loneliness and become convinced of its importance in the lives of many million people, the mental health community's level of alertness will be heightened, and with that awareness will come treatment that directly comports with the actual presenting symptomatology.

Loneliness was ignored for too long until the past few decades. Partly because virtually everyone is lonely sometimes, feeling lonely can seem like such a normal part of life that it is overlooked as an insignificant patient complaint, and efforts to draw attention to its salience may even seem off-putting. However, loneliness is a debilitating condition, and the longer people suffer from it, the more vulnerable they become to both physical and psychological risk factors.

Understanding human discomfort, identifying it correctly, and matching intervention strategies with the actual problem are vital concerns to healthcare professionals. Healing, or facilitating the process of helping people feel and become more whole, is the primary goal of the human sciences and professions. Attending to lonely people's difficulties in enlightened ways, and following correct methods to identify their primary presenting symptoms, is an important and necessary, yet difficult, challenge.