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H Gerber A, W Griffin J, M Keifer C, D Lerner M, C McPartland J. Social Anhedonia Accounts for Greater Variance in Internalizing Symptoms than Autism Symptoms in Autistic and Non-Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06266-w. [PMID: 38340278 DOI: 10.1007/s10803-024-06266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Social anhedonia is a transdiagnostic trait that reflects reduced pleasure from social interaction. It has historically been associated with autism, however, very few studies have directly examined behavioral symptoms of social anhedonia in autistic youth. We investigated rates of social anhedonia in autistic compared to non-autistic youth and the relative contributions of autism and social anhedonia symptoms to co-occurring mental health. METHODS Participants were 290 youth (Mage=13.75, Nautistic=155) ranging in age from 8 to 18. Youth completed a cognitive assessment and a diagnostic interview. Their caregiver completed questionnaires regarding symptoms of autism and co-occurring psychiatric conditions. RESULTS Autistic youth were more likely to meet criteria for social anhedonia than non-autistic youth. There was a significant positive relationship between age and social anhedonia symptom severity, but there was no association between sex and social anhedonia. Dominance analysis revealed that social anhedonia symptom severity had the strongest association with symptoms of depression and social anxiety, while symptoms of ADHD, generalized anxiety, and separation anxiety were most strongly associated with autism symptom severity. CONCLUSION This was the first study to tease out the relative importance of social anhedonia and autism symptoms in understanding psychiatric symptoms in autistic youth. Findings revealed higher rates of social anhedonia in autistic youth. Our results indicate that social anhedonia is an important transdiagnostic trait that plays a unique role in understanding co-occurring depression and social anxiety in autistic youth. Future research should utilize longitudinal data to test the transactional relationships between social anhedonia and internalizing symptoms over time.
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Affiliation(s)
- Alan H Gerber
- Child Study Center, Yale School of Medicine, New Haven, CT, CT 06519, USA
| | - Jason W Griffin
- Child Study Center, Yale School of Medicine, New Haven, CT, CT 06519, USA
| | - Cara M Keifer
- Child Study Center, Yale School of Medicine, New Haven, CT, CT 06519, USA
| | - Matthew D Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - James C McPartland
- Child Study Center, Yale School of Medicine, New Haven, CT, CT 06519, USA
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2
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Ikhtabi S, Pitman A, Maconick L, Pearce E, Dale O, Rowe S, Johnson S. The prevalence and severity of loneliness and deficits in perceived social support among who have received a 'personality disorder' diagnosis or have relevant traits: a systematic review. BMC Psychiatry 2024; 24:21. [PMID: 38172738 PMCID: PMC10765693 DOI: 10.1186/s12888-023-05471-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Loneliness and struggles with unmet social needs are a common experience among people with 'personality disorder' diagnoses/traits. Given the impact of loneliness and poor perceived social support on mental health, and the importance of a sense of belonging for recovery, a systematic review examining the prevalence/severity of loneliness and deficits in perceived social support among people with 'personality disorder' diagnoses/traits is an essential step towards developing an intervention targeting the social needs of people with diagnoses/traits 'personality disorder'. Despite an extensive literature on loneliness and deficits of perceived social support among people with 'personality disorder' diagnosis/traits, to date there has been no systematic review of this evidence. METHOD We conducted a systematic review synthesising quantitative data on the prevalence/severity of loneliness and deficits of perceived social support among people with diagnoses/traits of 'personality disorder' in comparison with other clinical groups and the general population. We searched Medline, Embase, PsycINFO, Web of Social Science, Google scholar and Ethos British Library from inception to December 2021. We conducted quality appraisals using the Joanna Briggs Critical appraisal tools and rated the certainty of evidence using the Grading of Recommendation, Assessment, Development and Evaluation approach. A narrative synthesis was used describing the direction and strength of associations prioritising high quality studies. FINDINGS A final set of 70 studies are included in this review, most of which are cross-sectional studies (n = 55), based in the United States (51%) and focused on community samples. Our synthesis of evidence found that, across all types of 'personality disorders' (except 'narcissistic personality' traits), people with traits associated with 'personality disorder' or meeting criteria for a diagnosis of 'personality disorder', have higher levels of loneliness, lower perceived relationship satisfaction, and poorer social support than the general population or other clinical samples. CONCLUSION The quality of evidence is judged as low quality. However, given the distressing nature of loneliness and the known negative effects of loneliness on mental health and recovery, it is important for future research to explore mechanisms by which loneliness may exacerbate 'personality disorder' symptoms and the impact this has on recovery.
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Affiliation(s)
| | - Alexandra Pitman
- UCL Division of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
| | - Lucy Maconick
- UCL Division of Psychiatry, NIHR Doctoral Research Fellow, Camden and Islington NHS Foundation Trust, London, UK
| | | | - Oliver Dale
- Sussex Partnership Foundation Trust, London, UK
| | | | - Sonia Johnson
- UCL Division of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
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3
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Brederoo SG, de Boer JN, Linszen MMJ, Blom RE, Begemann MJH, Sommer IEC. Social Deafferentation and the Relation Between Loneliness and Hallucinations. Schizophr Bull 2023; 49:S25-S32. [PMID: 36840539 PMCID: PMC9960004 DOI: 10.1093/schbul/sbac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND HYPOTHESIS The social deafferentation hypothesis (SDA) has been proposed as an explanatory mechanism of hallucinations, based on the theory that social withdrawal triggers the initial phase of schizophrenia. The current study tests the SDA by assessing how loneliness is associated with different types of hallucinations. Under the SDA, increased loneliness is hypothesized to affect the occurrence of hallucinations that carry social meaning, but not of nonsocial hallucinations. STUDY DESIGN As part of an online survey, 2038 adolescents and young adults from the general population (median age 21 years; 75% female) filled out the Questionnaire for Psychotic Experiences, and the shortened De Jong Gierveld Loneliness Scale. Binomial logistic regression was used to investigate the effects of loneliness severity on past month prevalence of hallucinations, and on the presence of social versus nonsocial hallucinations. STUDY RESULTS Loneliness increased the prevalence of hallucinations across modalities in the past month. Moreover, stronger degree of loneliness increased the likelihood of hearing voices or laughter, and of hallucinating being touched. Conversely, loneliness decreased the likelihood of experiencing the nonsocial hallucination of a tingling feeling. As expected, loneliness did not increase the prevalence of experiencing nonsocial hallucinations. Surprisingly, neither was loneliness associated with experiencing felt presence. CONCLUSIONS Our results are novel in showing that loneliness specifically increases the likelihood of hearing human sounds such as voices or laughter, or feeling a human touch. Hallucinations without social meaning were not more likely to be experienced with increasing loneliness. This forms a confirmation of the SDA.
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Affiliation(s)
- Sanne G Brederoo
- To whom correspondence should be addressed; Cognitive Neuroscience Center, Internal Zipcode FA32, Antonius Deusinglaan 2, 9713 AW, Groningen, The Netherlands; tel: +31 50 361 64 44; e-mail:
| | - Janna N de Boer
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Mascha M J Linszen
- Department of Psychiatry, University Medical CenterGroningen, Groningen, The Netherlands
| | - Renske E Blom
- GGZ Centraal Mental Health Institute, Ermelo, The Netherlands
| | - Marieke J H Begemann
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Iris E C Sommer
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Department of Psychiatry, University Medical CenterGroningen, Groningen, The Netherlands
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4
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Pollet TV, Thompson A, Malcolm C, McCarty K, Saxton TK, Roberts SGB. Are we measuring loneliness in the same way in men and women in the general population and in the older population? Two studies of measurement equivalence. PLoS One 2022; 17:e0266167. [PMID: 36580475 PMCID: PMC9799294 DOI: 10.1371/journal.pone.0266167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/16/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND High levels of loneliness are associated with negative health outcomes and there are several different types of interventions targeted at reducing feelings of loneliness. It is therefore important to accurately measure loneliness. A key unresolved debate in the conceptualisation and measurement of loneliness is whether it has a unidimensional or multidimensional structure. The aim of this study was to examine the dimensional structure of the widely used UCLA Loneliness Scale and establish whether this factorial structure is equivalent in men and women. METHODS AND SAMPLE Two online UK-based samples were recruited using Prolific. The participants in Study 1 were 492 adults, selected to be nationally representative by age and gender, whilst the participants in Study 2 were 290 older adults aged over 64. In both studies, participants completed the UCLA Loneliness Scale (Version 3) as part of a larger project. RESULTS In both studies, the best fitting model was one with three factors corresponding to 'Isolation,' 'Relational Connectedness,' and 'Collective Connectedness.' A unidimensional single factor model was a substantially worse fit in both studies. In both studies, there were no meaningful differences between men and women in any of the three factors, suggesting measurement invariance across genders. CONCLUSION These results are consistent with previous research in supporting a multidimensional, three factor structure to the UCLA scale, rather than a unidimensional structure. Further, the measurement invariance across genders suggests that the UCLA scale can be used to compare levels of loneliness across men and women. Overall the results suggest that loneliness has different facets and thus future research should consider treating the UCLA loneliness scale as a multidimensional scale, or using other scales which are designed to measure the different aspects of loneliness.
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Affiliation(s)
- Thomas V. Pollet
- Dept. of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Alexandra Thompson
- Dept. of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Connor Malcolm
- Dept. of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Kristofor McCarty
- Dept. of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Tamsin K. Saxton
- Dept. of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Sam G. B. Roberts
- Dept. of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
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Wong KKY, Wang Y, Esposito G, Raine A. A three-timepoint network analysis of Covid-19's impact on schizotypal traits, paranoia and mental health through loneliness. UCL OPEN ENVIRONMENT 2022; 4:e044. [PMID: 37228468 PMCID: PMC10208351 DOI: 10.14324/111.444/ucloe.000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 08/16/2022] [Indexed: 05/27/2023]
Abstract
The 2019 coronavirus (Covid-19) pandemic has impacted people's mental wellbeing. Studies to date have examined the prevalence of mental health symptoms (anxiety and depression), yet fewer longitudinal studies have compared across background factors and other psychological variables to identify vulnerable subgroups in the general population. This study tests to what extent higher levels of schizotypal traits and paranoia are associated with mental health variables 6- and 12-months since April 2020. Over 2300 adult volunteers (18-89 years, female = 74.9%) with access to the study link online were recruited from the UK, the USA, Greece and Italy. Self-reported levels of schizotypy, paranoia, anxiety, depression, aggression, loneliness and stress from three timepoints (17 April to 13 July 2020, N1 = 1599; 17 October to 31 January 2021, N2 = 774; and 17 April to 31 July 2021, N3 = 586) were mapped using network analysis and compared across time and background variables (sex, age, income, country). Schizotypal traits and paranoia were positively associated with poorer mental health through loneliness, with no effect of age, sex, income levels, countries and timepoints. Loneliness was the most influential variable across all networks, despite overall reductions in levels of loneliness, schizotypy, paranoia and aggression during the easing of lockdown (time 3). Individuals with higher levels of schizotypal traits/paranoia reported poorer mental health outcomes than individuals in the low-trait groups. Schizotypal traits and paranoia are associated with poor mental health outcomes through self-perceived feelings of loneliness, suggesting that increasing social/community cohesion may improve individuals' mental wellbeing in the long run.
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Affiliation(s)
- Keri Ka-Yee Wong
- Department of Psychology and Human Development, University College London, London, UK
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Adrian Raine
- Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, Philadelphia, PA, USA
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6
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Christensen R, Haenschel C, Gaigg SB, Fett AKJ. Loneliness, positive, negative and disorganised Schizotypy before and during the COVID-19 pandemic. Schizophr Res Cogn 2022; 29:100243. [PMID: 35223431 PMCID: PMC8860670 DOI: 10.1016/j.scog.2022.100243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Abstract
Loneliness is common in psychosis and occurs along a continuum. Here we investigate inter-relationships between loneliness, three-dimensional schizotypy, and depressive symptoms before and during the COVID-19 pandemic. The sample included 507 university students (48.3% participated before and 51.7% during the COVID-19 pandemic) who completed the Multidimensional Schizotypy Scale-Brief, the Counseling Center Assessment of Psychological Symptoms depression scale and the University of California, Los Angeles Loneliness Scale. Schizotypy and depression scores were regressed onto loneliness individually and in multiple regressions. The cohorts did not differ in any of the schizotypy domains (all p > .29). Depressive symptoms (p = .05) and loneliness (p = .006) were higher during the pandemic than before. Across cohorts, loneliness was significantly associated with positive (β = 0.23, p < .001), negative (β = 0.44, p < .001), and disorganised schizotypy (β = 0.44, p < .001), and with depression (β = 0.72, p < .001). Schizotypy together explained a significant amount of variance in loneliness (R2 = 0.26), with significant associations with positive (β = −0.09, p = .047), negative (β = 0.31, p < .001) and disorganised schizotypy (β = 0.34, p < .001). When depression was included (β = 0.69, p < .001), only positive (β = −0.09, p = .008) and negative schizotypy (β = 0.22, p < .001) significantly predicted loneliness. When all schizotypy dimensions and depression were considered together, only negative schizotypy and depression significantly predicted loneliness. Loneliness and depressive symptoms were higher during the pandemic, but this did not relate to cohort differences in schizotypy. Loneliness is uniquely associated with negative schizotypy and depression, but not disorganised schizotypy. Certain aspects of positive schizotypy may protect against loneliness. Loneliness and depressive symptoms were higher in students during the COVID-19 pandemic than before. Cohorts of students assessed before and during the pandemic showed similar levels of schizotypy.
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Affiliation(s)
- Ronja Christensen
- Department of Psychology, City, University of London, London ECIV 0HB, UK.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, De Crespigny Park, SE5 8AF London, UK
| | - Corinna Haenschel
- Department of Psychology, City, University of London, London ECIV 0HB, UK
| | - Sebastian B Gaigg
- Department of Psychology, City, University of London, London ECIV 0HB, UK
| | - Anne-Kathrin J Fett
- Department of Psychology, City, University of London, London ECIV 0HB, UK.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, De Crespigny Park, SE5 8AF London, UK
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7
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Panayiotou M, Badcock JC, Lim MH, Banissy MJ, Qualter P. Measuring Loneliness in Different Age Groups: The Measurement Invariance of the UCLA Loneliness Scale. Assessment 2022:10731911221119533. [PMID: 36031881 DOI: 10.1177/10731911221119533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Age differences in the prevalence of loneliness have been a key focus among researchers, practitioners, and policy makers. However, the degree to which those reflect genuine differences in the experience of loneliness or the way individuals understand and respond to loneliness measures is yet to be examined. The current study explored the age measurement invariance of the 20-item Revised University of California Los Angeles, Loneliness Scale (UCLA-LSR) and its shorter forms in a U.K. sample of adults aged 18 to 99 years (M = 50.6, SD = 19.7). The fit of different structures/versions was explored through multigroup confirmatory factor analysis (CFA; N = 4,375) and local structural equation modeling (N = 19,521). Results indicated a poor and/or inconsistent structure for the 20-item UCLA-LSR and many of its shorter forms. Of the structures considered, 12 showed acceptable model fit and received age measurement invariance testing through multigroup CFA and alignment; 10 of these achieved full, partial, or approximate measurement invariance. Our findings suggest that the age measurement invariance of loneliness measures should not be assumed, and crucially, this must be explored before accurate and meaningful age comparisons can be made. Implications for measurement research, and clinical and community practice, are discussed.
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Affiliation(s)
| | | | - Michelle H Lim
- Swinburne University of Technology, Melbourne, Victoria, Australia
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8
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Chau AKC, So SH, Sun X, Zhu C, Chiu CD, Chan RCK, Leung PWL. A network analysis on the relationship between loneliness and schizotypy. J Affect Disord 2022; 311:148-156. [PMID: 35594977 DOI: 10.1016/j.jad.2022.05.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Schizotypy is a multidimensional personality trait related to the heightened risk for the development of schizophrenia spectrum disorders. While it has been suggested that loneliness may be associated with schizotypy in general, whether it relates to the specific schizotypal traits differentially remains unknown. Besides, as loneliness often co-occurs with depression and anxiety, it is important to delineate its relationship with schizotypy in consideration of these co-occurring emotional disturbances. METHODS A demographically diverse sample of young people was obtained from multiple sources. The validated sample consisted of 2089 participants (68.4% female, age range: 18-30). The structural relationship between loneliness and schizotypy was modelled using a network analytic approach. The Gaussian graphical model with loneliness and nine schizotypal traits as nodes was first estimated without, and then with adjustment for the levels of depressive and anxiety symptoms. Edges were estimated as unique associations between nodes. RESULTS 'Suspiciousness', 'odd beliefs or magical thinking', 'no close friends', 'constricted affect' and 'excessive social anxiety' were linked to loneliness directly. Loneliness was found to be more strongly associated with 'suspiciousness' and 'no close friends' than other schizotypal traits. After adjustment for the levels of depressive and anxiety symptoms, the above direct edges remained robust. LIMITATIONS The use of cross-sectional data indicated only undirected associations between variables. CONCLUSIONS Loneliness was more strongly linked to some schizotypal traits than others, with the relationships maintaining above and beyond the effects of anxiety and depression. These findings warrant further investigation of the specific relationships between loneliness and individual schizotypal traits.
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Affiliation(s)
- Anson Kai Chun Chau
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Suzanne H So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Xiaoqi Sun
- Department of Psychology, Hunan Normal University, Hunan, China
| | - Chen Zhu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Chui-De Chiu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Patrick Wing-Leung Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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9
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Masucci MD, Martin V, Le TP, Cohen AS. Negative schizotypy attenuates the effect of momentary stress on social dysfunction related to COVID-19 social distancing. Schizophr Res 2022; 243:24-31. [PMID: 35231831 PMCID: PMC9189049 DOI: 10.1016/j.schres.2022.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/15/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
Abstract
Schizotypy is associated with a broad range of motivational and social dysfunctions. However, there is reason to suspect that negative schizotypy may limit social dysfunction in specific contexts that typically increase isolation and loneliness. We analyzed whether positive, negative and disorganized facets of schizotypy would mitigate detrimental reactions to stress in the context of a global stressor (the COVID-19 pandemic) that has widely necessitated social and physical isolation. Responses to two measures of schizotypy were compared to ecological momentary assessments of social dysfunction for 85 undergraduates using multilevel modelling techniques. Negative schizotypy moderated the relation between momentary stress and loss of social support, such that negative schizotypy limited the magnitude of social dysfunction stemming from increases in momentary stress. This pattern was not seen for other facets of schizotypy. Implications for the treatment and measurement of schizotypy symptoms are discussed.
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Affiliation(s)
- Michael D. Masucci
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA,Address correspondence to: Michael Masucci, Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70808,
| | - Victoria Martin
- The Graduate Center, City University of New York, New York, NY, USA
| | - Thanh P. Le
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Alex S. Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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10
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Chau AKC, So SHW, Sun X, Zhu C, Chiu CD, Chan RCK, Leung PWL. The co-occurrence of multidimensional loneliness with depression, social anxiety and paranoia in non-clinical young adults: A latent profile analysis. Front Psychiatry 2022; 13:931558. [PMID: 36186883 PMCID: PMC9517946 DOI: 10.3389/fpsyt.2022.931558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Loneliness is a negative experience arising from a mismatch between perceived and actual social relationships. Several dimensions of loneliness have been suggested, namely intimate, relational and collective loneliness. Loneliness has been linked to poorer mental health, with its co-occurrence with depression, social anxiety, and paranoia most widely reported. While expressions of these symptoms are heterogeneous across individuals in the non-clinical population, it remains unclear how these symptoms co-occur with one another and with various dimensions of loneliness. It is also of interest how trait factors such as core schemas about self/others may moderate these relationships between loneliness and co-occurring symptoms. METHODS A demographically diverse sample of young adults was recruited from multiple sources. The validated sample consisted of 2,089 participants (68.4% female), who completed an online survey consisting of questionnaires assessing levels of multidimensional loneliness, depression, social anxiety, paranoia, core schemas, and demographic characteristics. Latent profile analysis (LPA) was used to identify distinct profiles of loneliness and the three symptoms. Positive and negative core schemas about self and others were modeled as predictors of these profiles. RESULTS Five distinct profiles were identified. Profile 1 had low levels across all symptoms and dimensions of loneliness (n = 1,273, 60.9%). Profiles 2-5 were elevated on dimensions of loneliness, and were heightened in depression (n = 189, 9.0%), social anxiety (n = 206, 9.9%), paranoia (n = 198, 9.5%), and all symptoms (n = 223, 10.7%), respectively. Relative to Profile 1, the other four profiles scored higher on negative-self (adjusted ORs = 1.36-1.49, ps < 0.001) and negative-other schemas (adjusted ORs = 1.24-1.44, ps < 0.001), and lower on positive-self (adjusted ORs = 0.82-0.85, ps < 0.001) and positive-other schemas (adjusted ORs = 0.81-0.90, ps < 0.001). CONCLUSION More marked intimate, relational and collective loneliness were evident across profiles that had heightened depression, social anxiety and/or paranoia, suggesting that loneliness may serve as a general risk factor for these psychopathologies. Our findings shed light on the heterogeneity of the co-occurrence of loneliness and various mental health difficulties in non-clinical young adults. Core schemas are suggested to be putative psychological mechanisms underlying their co-occurrence and even development.
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Affiliation(s)
- Anson Kai Chun Chau
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xiaoqi Sun
- Department of Psychology, School of Educational Sciences, Hunan Normal University, Changsha, China.,Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China
| | - Chen Zhu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chui-De Chiu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, The University of Chinese Academy of Sciences, Beijing, China
| | - Patrick W L Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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11
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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.
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Affiliation(s)
- Matthias A. Reinhard
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 7, 80336 Munich, Germany
| | - Tabea Nenov-Matt
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 7, 80336 Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 7, 80336 Munich, Germany
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12
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Walter EE, Fernandez F, Barkus E. Not all stress is created equal: Acute, not ambient stress, impairs learning in high schizotypes. Psych J 2021; 11:179-193. [PMID: 33915603 DOI: 10.1002/pchj.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/08/2022]
Abstract
Learning from feedback is essential for daily functioning, with factors that impact learning having implications for healthy and clinical populations. Reinforcement learning appears impaired across the psychosis continuum, with deficits reported in patients with psychotic disorders as well as high schizotypes from the general population. Stress can impair learning, and sensitivity to stress is present along the psychosis continuum. The aim of the present study was to understand if stress impairs reinforcement learning in those at the lower end of the psychosis continuum. We investigated both naturalistic stress in everyday life using daily hassles (Study 1: n = 70; 31% male, M age = 22.67 years) and acute psychosocial stress using the Trier Social Stress Test (Study 2: n = 57; 32% male, M age = 22.43 years). In the presence of naturalistic stress, learning did not differ across schizotypes. However, under acute psychosocial stress, high schizotypes experienced impaired learning. Our results suggest trail-and-error learning is robust to the ebbs and flows of everyday stress for high schizotypes; however, acute stress is associated with decrements in learning. This indicates that the magnitude of stressors should be considered when designing cognitive and functional interventions for those along the psychosis continuum.
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Affiliation(s)
- Emma E Walter
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Francesca Fernandez
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Emma Barkus
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
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13
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Roodenrys S, Barkus E, Woolrych TJ, Miller LM, Favelle SK. The intentionality bias in schizotypy: a social matter. Cogn Neuropsychiatry 2021; 26:55-72. [PMID: 33403932 DOI: 10.1080/13546805.2020.1865894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We aimed to investigate the association between schizotypy and intentionality bias, the tendency to interpret ambiguous actions as being intentional, for social and non-social actions separately. This bias contributes to interpersonal difficulties, and has been associated with psychotic symptoms, such as delusions. However, results have been inconsistent for an association between putative psychosis proneness, schizotypy, and intentionality bias. Further, the multidimensional nature of schizotypy has not been considered. Agreeableness was measured to examine the specificity of the relationship, and inhibition to examine its potential role as a mediator. METHODS Two online studies are reported (n = 280 and n = 163) in which participants made intentionality judgements about ambiguous actions described in sentences. They also completed questionnaire measures of schizotypy and agreeableness, and inhibitory efficiency (a sentence completion task). RESULTS Schizotypy was associated with perceiving ambiguous actions as intentional, particularly in social contexts, after controlling for agreeableness. The association with social intentionality was stronger for schizotypy subscales capturing paranoia and unusual beliefs. Inhibitory efficiency as not a significant predictor of intentionality bias. CONCLUSION These finding suggest intentionality biases for social and non-social events are distinguishable. In relation to schizotypy, social situations appear to generate perceptions of intentionality. Intentionality bias represents a phenotypic cognitive risk for psychosis which should be further investigated.
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Affiliation(s)
- Steven Roodenrys
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Emma Barkus
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Tracey J Woolrych
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Leonie M Miller
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Simone K Favelle
- School of Psychology, University of Wollongong, Wollongong, Australia
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14
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Badcock JC, Adery LH, Park S. Loneliness in psychosis: A practical review and critique for clinicians. ACTA ACUST UNITED AC 2020. [DOI: 10.1111/cpsp.12345] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Tan M, Shallis A, Barkus E. Social anhedonia and social functioning: Loneliness as a mediator. Psych J 2020; 9:280-289. [DOI: 10.1002/pchj.344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Melody Tan
- Cognitive Basis of Atypical Behaviour Initiative (CBABi)School of Psychology, University of Wollongong Wollongong Australia
| | - Amy Shallis
- Cognitive Basis of Atypical Behaviour Initiative (CBABi)School of Psychology, University of Wollongong Wollongong Australia
| | - Emma Barkus
- Cognitive Basis of Atypical Behaviour Initiative (CBABi)School of Psychology, University of Wollongong Wollongong Australia
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16
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Le TP, Cowan T, Schwartz EK, Elvevåg B, Holmlund TB, Foltz PW, Barkus E, Cohen AS. The importance of loneliness in psychotic-like symptoms: Data from three studies. Psychiatry Res 2019; 282:112625. [PMID: 31662188 DOI: 10.1016/j.psychres.2019.112625] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 12/26/2022]
Abstract
Poor social connection or loneliness is a prominent feature of schizotypy and may exacerbate psychosis risk. Previous studies have examined the inter-relationships between loneliness and psychosis risk, but critically, they have largely been conducted in non-clinical samples or exclusively used laboratory questionnaires with limited consideration of the heterogeneity within schizotypy (i.e., positive, negative, disorganized factors). The present study examined links between loneliness and psychotic-like symptoms across the dimensions of schizotypy through cross-sectional, laboratory-based questionnaires (Study 1; N = 160), ambulatory assessment (Study 2; N = 118) in undergraduates, and ambulatory assessment in inpatients in a substance abuse treatment program (Study 3; N = 48). Trait positive schizotypy consistently predicted cross-sectional and state psychotic-like symptoms. Loneliness, assessed via cross-sectional and ambulatory means, was largely linked with psychotic-like symptoms. Importantly, psychotic-like symptoms were dynamic: psychotic-like symptoms largely increased with loneliness in individuals with elevated positive and disorganized schizotypal traits, though there were some inconsistency related to disorganized schizotypy and state psychotic-like symptoms. Negative schizotypy and loneliness did not significantly interact to predict psychotic-like symptoms, suggesting specificity to positive schizotypy. Ambulatory approaches provide the opportunity for ecologically valid identification of risk states across psychopathology, thus informing early intervention.
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Affiliation(s)
- Thanh P Le
- Department of Psychology, Louisiana State University, United States.
| | - Tovah Cowan
- Department of Psychology, Louisiana State University, United States
| | - Elana K Schwartz
- Department of Psychology, Louisiana State University, United States
| | - Brita Elvevåg
- Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Norway; The Norwegian Centre for eHealth Research, University Hospital of North Norway, Norway
| | - Terje B Holmlund
- Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Norway
| | - Peter W Foltz
- Institute of Cognitive Science, University of Colorado, United States
| | - Emma Barkus
- School of Psychology, University of Wollongong, United States
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, United States
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Chau AKC, Zhu C, So SHW. Loneliness and the psychosis continuum: a meta-analysis on positive psychotic experiences and a meta-analysis on negative psychotic experiences. Int Rev Psychiatry 2019; 31:471-490. [PMID: 31331209 DOI: 10.1080/09540261.2019.1636005] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There is an increase in interest in the relationships between loneliness and psychosis. The notion of psychosis continuum implies that psychotic experiences extend from clinical populations with psychotic disorders to non-clinical populations. This meta-analytic review aimed to examine the respective associations of loneliness with positive and negative psychotic experiences along the psychosis continuum. A systematic database search was conducted and a total of 30 studies were included in the first meta-analysis and 15 studies were included in the second meta-analysis. There was a medium association between loneliness and positive psychotic experiences (r = 0.302, p < 0.001). In particular, the association between loneliness and paranoia was robust (r = 0.448, p < 0.001). The second meta-analysis revealed a medium association between loneliness and negative psychotic experiences (r = 0.347, p < 0.001). The associations between loneliness and both positive and negative psychotic experiences were found to be smaller among clinical than non-clinical samples. The above findings provided evidence for the associations between loneliness and the two core dimensions of psychotic experiences along the phenomenological continuum. Future research should examine the dynamics of these relationships in both clinical and non-clinical samples, preferably using a single-symptom approach.
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Affiliation(s)
- Anson K C Chau
- Department of Psychology, The Chinese University of Hong Kong , Hong Kong SAR , PR China
| | - Chen Zhu
- Department of Psychology, The Chinese University of Hong Kong , Hong Kong SAR , PR China
| | - Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong , Hong Kong SAR , PR China
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18
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Barkus E, Badcock JC. A Transdiagnostic Perspective on Social Anhedonia. Front Psychiatry 2019; 10:216. [PMID: 31105596 PMCID: PMC6491888 DOI: 10.3389/fpsyt.2019.00216] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/25/2019] [Indexed: 12/28/2022] Open
Abstract
Humans are highly social beings, yet people with social anhedonia experience reduced interest in or reward from social situations. Social anhedonia is a key facet of schizotypal personality, an important symptom of schizophrenia, and increasingly recognized as an important feature in a range of other psychological disorders. However, to date, there has been little examination of the similarities and differences in social anhedonia across diagnostic borders. Here, our goal was to conduct a selective review of social anhedonia in different psychological and life course contexts, including the psychosis continuum, depressive disorder, posttraumatic stress disorder, eating disorders, and autism spectrum disorders, along with developmental and neurobiological factors. Current evidence suggests that the nature and expression of social anhedonia vary across psychological disorders with some groups showing deficient learning about, enjoyment from, and anticipation of the pleasurable aspects of social interactions, while for others, some of these components appear to remain intact. However, study designs and methodologies are diverse, the roles of developmental and neurobiological factors are not routinely considered, and direct comparisons between diagnostic groups are rare-which prevents a more nuanced understanding of the underlying mechanisms involved. Future studies, parsing the wanting, liking, and learning components of social reward, will help to fill gaps in the current knowledge base. Consistent across disorders is diminished pleasure from social situations, subsequent withdrawal, and poorer social functioning in those who express social anhedonia. Nonetheless, feelings of loneliness often remain, which suggests the need for social connection is not entirely absent. Adolescence is a particularly important period of social and neural development and may provide a valuable window on the developmental origins of social anhedonia. Adaptive social functioning is key to recovery from mental health disorders; therefore, understanding the intricacies of social anhedonia will help to inform treatment and prevention strategies for a range of diagnostic categories.
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Affiliation(s)
- Emma Barkus
- Cognitive Basis of Atypical Behaviour Initiative (CBABi), School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Johanna C. Badcock
- Centre for Clinical Research in Neuropsychiatry (CCRN), Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
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