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

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

Cognitive behavioral analysis system of psychotherapy reduces loneliness in patients with persistent depressive disorder

Background: Loneliness is a distressing and prevalent symptom in patients with persistent depressive disorder (PDD) that is associated with depression severity, a history of childhood maltreatment and rejection sensitivity. As loneliness is no primary focus of psychotherapy to date and the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) particularly addresses interpersonal relationships, we investigate the effects of CBASP on loneliness in an open study in inpatients with PDD. Methods: Sixty patients with PDD (DSM-5) underwent a comprehensive 10-weeks inpatient program of CBASP. Loneliness, social network characteristics, and depressive symptoms were assessed before and after treatment. Further, history of childhood maltreatment, peer victimization, and rejection sensitivity were measured at baseline. Results: Loneliness and depressive symptoms significantly and independently decreased, whereas social network characteristics showed no change after 10 weeks of CBASP. Higher levels of loneliness, larger social network size at baseline, and a history of emotional neglect predicted a larger reduction of loneliness, whereas higher levels of rejection sensitivity and depressive symptoms at baseline were associated with an inferior outcome. Limitations: Unspecific factors of the inpatient setting cannot be ruled out and a control group is lacking. Conclusions: After 10 weeks of CBASP, PDD patients reported a reduced burden of loneliness. The study provides first evidence that CBASP, which addresses dysfunctional interpersonal patterns and their origin in childhood maltreatment and peer victimization, could provide valuable techniques for developing mechanism based psychotherapeutic intervention for loneliness