Loneliness in Personality Disorders

Developing loneliness interventions for people with personality disorders: A call to action

Loneliness is common in personality disorders (PDs) and may contribute to their severity and persistence. Systematic research on loneliness interventions for PD is sparse but clearly needed. According to the Alternative Model of Personality Disorders, loneliness may be related to personality functioning and may link to domains of self (identity and self-direction) and interpersonal functioning (empathy and intimacy). A deeper understanding of the interaction between perceived loneliness and individual dysfunction across these domains is essential for establishing novel psychological interventions that effectively treat loneliness. As a first step in developing a valid therapy model, we suggest a modular framework that encompasses loneliness-associated perceptions, cognitions, feelings, and behaviors that can be targeted with specific strategies. To further develop this framework, additional empirical research, for example, clinical studies on loneliness-tailored interventions in PD, should be performed in parallel with more conceptual research that challenges and integrates current hypotheses and theories.

Can social isolation alleviate symptoms of anxiety and depression disorders?

This study examines the complex interplay between social behavior and mental health, focusing on the neurobiological mechanisms underlying human interactions and their alterations associated with anxiety and depression disorders. These conditions are characterized by heightened threat perception, pervasive worry, physiological responses, emotional dysregulation, and maladaptive behaviors. Through narrative review, this study examines both aspects, addressing social isolation as both a risk factor and an avoidance behavior that may provide temporary relief but ultimately perpetuate the clinical condition in the long term. The findings offer valuable insights for clinical practice, emphasizing interventions that enhance cognitive flexibility to foster stable and supportive interpersonal relationships.

Neurobiological correlates of personality dimensions in borderline personality disorder using graph analysis of functional connectivity

Borderline personality disorder (BPD) is is a type B personality disorder primarily characterized by a pattern of unstable interpersonal relationships, a distorted self-concept, and intense emotional reactions, associated with extreme and opposing mental and behavioral states, which coexist and lead to destructive behaviors such as self-harm, commonly recurring over time.. The Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition (PID-5) provides a dimensional assessment of maladaptive domains associated with personality disorders, improving the understanding of their complex clinical presentations. While altered brain functional connectivity (FC) has been reported in BPD, neurobiological-clinical correlations remain debated. This study explores the relationship between the personality dimensions of BPD and resting-state fMRI (rs-fMRI) FC. Twenty-eight patients with BPD (6M/22F, 23.7 ± 3.4 years) and twenty-eight matched healthy controls (6M/22F, 24.3 ± 2.8 years) underwent a psychiatric assessment, including the PID-5, and an MRI protocol including rs-fMRI. Functional data were analyzed via graph theory to derive network properties at global and nodal levels, which were correlated with the PID-5 subdomains. The results revealed impairments across all personality trait facets. Patients had lower global connectivity and compromised centrality of several limbic structures and frontotemporal regions. Significant correlations were found between separation insecurity and global efficiency (R = 0.60, adjusted-p = 0.035) and between depressivity and the degree of the left middle temporal gyrus (R = 0.69, adjusted-p = 0.023) in females. These findings suggest links between negative affectivity traits, in particular separation insecurity and depressivity, and specific brain network dysfunctions in BPD.

Perception of Loneliness in Adolescence: Role of Maladaptive Personality Traits and Trauma-Related Symptomatology

BACKGROUND/OBJECTIVES

Loneliness is a heterogeneous phenomenon, generally defined as an emotional experience based on the perceived distance between an individual's actual social relationships and those he or she would like to have. Adolescence is particularly vulnerable to loneliness because of the many changes in values, feelings, and emotions that characterize it. Among the aspects that may influence this feeling of discomfort, the literature identifies maladaptive personality and a dysfunctional response to traumatic events. Our study aims to identify the possible role that maladaptive personality traits and post-traumatic stress symptomatology in the form of Post-Traumatic Stress Disorder (PTSD) and Disturbance in Self-Organization (DSO) may play in the perception of loneliness in adolescents: Methods: We identified a mediation model constructed through structural equation modeling (SEM) to test PTSD and DSO post-traumatic stress symptomatology as independent variables and maladaptive personality as a mediator in the relationship between these and perceptions of loneliness in a population of adolescents of both sexes, Italian high school students; Results: Our study identifies the significant role of PTSD and DSO symptomatology in influencing the state of loneliness, both directly and indirectly through maladaptive personality traits, which appear to exert a substantial influence on the perception of loneliness, potentially functioning as mediators in the relationship between the latter and PTSD/DSO symptomatology. Presumably, a maladaptive personality may complicate recovery from adverse and traumatic experiences by preventing the implementation of functional coping strategies and promoting dysfunctional responses.

CONCLUSIONS

Our findings underscore the importance of researchers and clinicians adequately considering different personality traits and the early identification of post-traumatic stress symptomatology. A focus on adolescents' communication and interpersonal skills and their ability to respond effectively to stressful and traumatic events may prove useful in identifying more effective strategies for preventing and managing loneliness and related distress in adolescents.

Loneliness in narcissistic vulnerability: Examining domains of personality functioning

Research has indicated loneliness to be a detrimental correlate of narcissistic vulnerability. However, no research has examined if this relationship persists across time or why it occurs. The present study explores the link between narcissistic vulnerability and loneliness across time and examines which domains of personality dysfunction (i.e., identity, self-direction, empathy, and intimacy) may account for why narcissistic vulnerability is related to loneliness. Adult participants (N = 298) were recruited from Prolific and completed study questionnaires assessing narcissistic vulnerability, narcissistic grandiosity, loneliness, domains of self and interpersonal functioning, and neuroticism. Two months later, participants repeated the measure of loneliness. Correlations among all study variables were calculated, followed by linear regression analyses to investigate how personality functioning domains may mediate the longitudinal relationship between narcissistic vulnerability and loneliness. The effects of baseline loneliness, relationship status, and trait neuroticism were controlled for. Narcissistic vulnerability, but not narcissistic grandiosity, was associated with loneliness at baseline and 2 months later. Intimacy functioning, but not identity, self-direction, or empathy functioning, was a significant mediator of the relationship between narcissistic vulnerability and loneliness over time. These findings suggest that narcissistic vulnerability may contribute to the development or maintenance of loneliness across time, highlighting the role of impaired intimacy functioning in this relationship. The impact of these findings on our understanding of interpersonal functioning in narcissistic vulnerability, as well as clinical implications, is discussed.

Connecting loneliness with pathological personality traits: Evidence for genetic and environmental mediation from a study of older twins

Loneliness has broad public health importance, especially in older adulthood, and there is some evidence suggesting it is associated with several personality disorders (PDs). The etiology of these PD-loneliness associations, however, has rarely been studied, especially in the context of the maladaptive traits of the DSM-5 alternative model of personality disorder (AMPD). To address these limitations, we estimated phenotypic, genetic, and unique environmental associations between loneliness and maladaptive personality traits in a sample of older adults from the Minnesota Twin Registry (n = 1,356, Mage = 70.4). Loneliness was moderately to strongly associated with each of the AMPD domains of negative affect, detachment, antagonism, disinhibition, and psychoticism (r = .22-.58), with evidence of both genetic (rg = .45-.75) and unique environmental (re = .10-.48) influences explaining the associations to varying degrees. We argue that loneliness may be an underappreciated concomitant of personality pathology, with PD traits perhaps underlying its development. Indeed, these findings suggest that loneliness may be a manifestation of the genetic and environmental forces that also lead to pathological personality variation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Loneliness Is Associated With Lower Self- and Clinician-Rated Levels of Personality Functioning

Personality disorders (PDs) are associated with interpersonal dysfunction, loneliness, and reduced social embeddedness. This study investigates loneliness and social network size in association with self- and clinician-rated personality functioning regarding the DSM-5's Alternative Model for Personality Disorders (AMPD). Eighty psychiatric inpatients including participants with and without PDs completed the Semi-structured Interview for Personality Functioning, the Level of Personality Functioning Scale - Brief Form, the UCLA Loneliness Scale, and the Social Network Index. Patients with PDs reported more loneliness and personality dysfunctioning than patients without PDs. Social network size did not differ between patient groups and showed lower correlations with personality functioning compared to loneliness. Loneliness was further associated with deficits in personality functioning. Deficits in distinct AMPD domains and loneliness may constitute transdiagnostically relevant factors that are related and mutually reinforcing. This could be important for identifying patients beyond PD diagnoses who are at risk of poor psychosocial functioning and require tailored psychotherapy.

Understanding loneliness: The roles of self- and interpersonal dysfunction and early parental indifference

Many factors are implicated in developing and maintaining loneliness, including aspects of personality functioning and experience of early adverse childhood events. This study aimed to examine the relationship between domains of personality dysfunction, including self- and interpersonal functioning, and loneliness and determine whether such personality factors mediate the relationship between childhood parental indifference and loneliness. In total, 393 community-dwelling adults, mean age 34.3 (SD = 12.67), were recruited online for cross-sectional assessment of loneliness, personality functioning, big-five personality traits and perceived childhood parental indifference. Linear regression analyses were conducted followed by a parallel mediation model. Self- and interpersonal dysfunction were positively associated with loneliness and remained significant predictors of loneliness after controlling for five-factor personality traits. Impaired personality functioning accounted for 12% of loneliness variance. Finally, self-dysfunction mediated the relationship between childhood parental indifference and loneliness. Findings emphasize the importance of addressing personality functioning when developing psychosocial interventions aimed at tackling loneliness.

Aggressive intentions after social exclusion and their association with loneliness

Both social exclusion and loneliness are aversive experiences that can lead to hostile behavioral reactions, including aggressive behavior. This study aimed to assess whether a social exclusion scenario in the subject's imagination elicits aggressive reactions towards an excluding person as measured with the hot sauce paradigm. Furthermore, we studied the effect of loneliness on such reactions. In total, 251 subjects (67.7% female; mean age 27.3 ± 9.3 years) participated in this study which was based on an online survey. After trait loneliness was assessed with the UCLA Loneliness scale at baseline, two imaginary scenarios were presented in randomized order, i.e., an exclusion condition (with one of two working colleagues excluding the participant from a social activity) and an inclusion condition (without exclusion). Following each scenario, participants had the task to allocate the amount of hot sauce to each colleague that they find appropriate. Participants distributed significantly more hot sauce to the excluder than to the includers. The amount of hot sauce was significantly correlated with loneliness for all includer interactions (i.e., after the inclusion as well as the exclusion scenario), but not for the interaction with the excluder. Our results support the hypothesis that social exclusion elicits aggressive behavior. Interestingly, the experience of loneliness seems to be associated with an increase in aggressive behavioral tendencies or a lack of their inhibition. The cognitive and/or emotional processes underlying the interplay between social exclusion, loneliness and aggression should be a focus of future research.