Loneliness, Social Isolation and Their Difference: A Cross-Diagnostic Study in Persistent Depressive Disorder and Borderline Personality Disorder

Abstract

Background: Interpersonal difficulties are a key feature of persistent depressive disorder (PDD) and borderline personality disorder (BPD). Caught in a vicious circle of dysfunctional interpersonal transaction, PDD and BPD patients are at great risk of experiencing prolonged loneliness. Loneliness, in turn, has been associated with the development of mental disorders and chronic illness trajectories. Besides, several factors may contribute to the experience of loneliness across the lifespan, such as social network characteristics, a history of childhood maltreatment (CM), and cognitive-affective biases such as rejection sensitivity (RS). This cross-diagnostic study approached the topic of perceived loneliness by comparing PDD and BPD patients with healthy controls (HC) in its interplay with symptom burden, social network characteristics, RS as well as CM.Method: Thirty-four PDD patients (DSM-5; 15 female, Mage = 38.2, SD = 12.3), 36 BPD patients (DSM-5; 19 female, Mage = 28.8, SD = 9.2), and 70 age- and gender-matched HC were assessed cross-sectionally using the following self-report measures: UCLA Loneliness Scale, Social Network Index (SNI; size, diversity, and embeddedness), Beck Depression Inventory (BDI-II), Borderline Symptom List (BSL-23), Childhood Trauma Questionnaire (CTQ), and Rejection Sensitivity Questionnaire (RSQ).Results: Both patient groups reported significantly higher levels of perceived loneliness, symptom severity, and smaller social network characteristics compared to HC. Loneliness was significantly correlated with severity of self-reported clinical symptoms in PDD and at trend level in BPD. Besides, loneliness tended to be related to social network characteristics for all groups except PDD patients. Both PDD and BPD patients showed higher RS as well as CTQ scores than HC. A history of emotional abuse and emotional neglect was associated with loneliness, and this association was mediated by RS as demonstrated by an exploratory mediation analysis.Discussion: Loneliness is highly prevalent in PDD and BPD patients and contributes to the overall symptom burden. Interestingly, loneliness showed an association with prior experiences of CM as well as current RS. We therefore propose a comprehensive model on how intra- und interpersonal aspects may interplay in the dynamics of loneliness in light of CM. Finally, this model may have further implications for psychotherapeutic interventions.

Reduced Social Connectedness and Compassion Toward Close Others in Patients With Chronic Depression Compared to a Non-clinical Sample

“…However, it should be noted that we assessed severe and traumatic adversities in childhood, which may not have the same beneficial effects on prosocial attitudes and motivation in terms of posttraumatic growth. Further, our findings are consistent with a recent study that found an association between emotional abuse with loneliness, with the association mediated by increased rejection sensitivity ( 45 ).…”

“…Patients with PDD reported higher levels of childhood adversity (CTQ total score: M = 53.17, SD = 16.36) compared to a representative sample ( 43 ) as well as a healthy control group from a recent other study ( 45 ), especially regarding emotional abuse [ M = 13.72, SD = 5.77 vs. M = 6.49, SD = 2.60 ( 43 ) and M = 7.0, SD = 3.5 ( 45 ), respectively] and emotional neglect M = 16.40, SD = 5.34 vs. M = 10.05, SD = 4.23 ( 43 ) and M = 8.3, SD = 3.1 ( 45 ), respectively; see Supplementary Table 2 for details]. Overall childhood adversity was significantly negatively correlated with connectedness to family members ( Table 2 ).…”

Borderline Personality Features in Patients With Persistent Depressive Disorder and Their Effect on CBASP Outcome

“…Foxhall et al (29) have proposed rejection sensitivity to be linked to both CM (i.e., particularly emotional abuse and neglect) and to BPD. Similarly, rejection sensitivity appears to be elevated in PDD compared to healthy controls (27,28) and was correlated not only with BPD symptoms but also with self-reported depression. Rejection sensitivity may in fact be a mediating factor between childhood adversity and later psychopathology though this hypothesis still needs to be tested in larger cross-diagnostic studies (29).…”

“…One putative link from CM to later psychopathology may be an induced trait of rejection sensitivity, i.e., oversensitivity to and expectation of social rejection ( 26 ). Rejection sensitivity has been found to be associated with PDD ( 27 , 28 ) and BPD ( 29 ). Thus, rejection sensitivity may theoretically mediate the path from CM to both PDD and BPD symptoms.…”

Loneliness of the Blind and the Visually Impaired

“…Interestingly, our results indicated that the visually impaired had significantly lower scores on all subscales but the Growth and development one. We would intuitively expect that those who may feel so poignantly different from the rest of the population, who live using other senses instead of sight which is a major sense used by non-visually impaired individuals (see Osaba et al, 2019), may be experiencing social inadequacy in a world which is not, fundamentally, geared to accommodate them, and thus may feel alienated, to a larger extent than the regular population (see Nenov-Matt et al, 2020 for a discussion of the loneliness-social isolation interaction). However, the present findings showed a significantly different picture, where the general population had significantly higher subscale scores than the visually impaired.…”