Loneliness as a Component of Psychiatric Disorders

Richard Booth, PhD


Medscape General Medicine. 2000;2(2) 

In This Article

The Relationship Between Loneliness and Depression

Not all lonely people are depressed, nor are all depressed people lonely, but the 2 conditions share significant variance in many of the studies that have measured them both. Some people experience transient loneliness, others a more permanent type of loneliness. As indicated above, those suffering chronic forms of loneliness are more likely to also be depressed than those whose loneliness is more fleeting, reactive, and situational.

Because loneliness and depression share some characteristics, differential diagnosis can be challenging. Summarizing the research in an earlier work[26] delineates 4 areas that should be probed prior to making a diagnosis. It is important for clinicians to note that the conditions may well be coexistent and that each patient presents somewhat differently. It should also be noted that these 4 suggested target areas should be considered minimal areas of exploration, that is, they should be considered the beginning exploratory domains of differential diagnosis.

First, if the major area of patient dissatisfaction is focused on interpersonal issues rather than more global concerns about his or her life, the clinician may well be dealing with loneliness. Lonely people, if they are not also depressed, tend to be primarily concerned with their interpersonal distress, which, of course, may be accompanied by anger, anxiety, or any number of other factors. Depressed people, on the other hand, tend to have more global concerns that span the breadth of their lives, so that they are not necessarily primarily focused on their relationship problems. Second, clinicians will want to probe duration issues, that is, how long patients have felt sad, worthless, or whatever their presenting complaints might be. The longer those negative affects have been present, the greater the likelihood that depression is part of the clinical picture. Third, clinicians should determine the type and degree of guilt the patient is experiencing, since guilt appears to be more typical of depression than loneliness -- although some lonely patients also complain about feeling guilty. In effect, each patient must be carefully assessed to determine the probable valence of the presenting factors. Finally, clinicians should explore the area of vegetative symptomatology, since some researchers have found many of these to be more descriptive of depression than loneliness.