The importance of loneliness in psychotic-like symptoms: Data from three studies

Abstract

Poor social connection or loneliness is a prominent feature of schizotypy and may exacerbate psychosis risk. Previous studies have examined the interrelationships 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 = 78), 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 crosssectional 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.

Psychosis proneness, loneliness, and hallucinations in nonclinical individuals

“…Undergraduate students who endorsed more schizotypal items also reported more loneliness in their day-to-day lives. This is consistent with previous research indicating that loneliness is related to psychotic-like experiences and is a risk factor for the development of psychotic disorders [ 19 , 20 ]. Additionally, this finding might have important implications for interventions on loneliness with individuals who might be at risk for psychosis [ 24 ].…”

“…The association between loneliness and hallucinations has been demonstrated across several different disorders including borderline personality disorder [ 17 ], Alzheimer’s disease [ 18 ], and psychosis [ 19 ]. Additionally, in the presence of loneliness, psychotic-like symptoms increased for individuals with high levels of negative and disorganized schizotypal traits [ 20 ]. This finding supports the argument that the context of loneliness might increase the likelihood of psychotic-like experiences in already vulnerable individuals.…”

Subjective impact of the COVID-19 pandemic on schizotypy and general mental health in Germany and the UK, for independent samples in May and in October 2020

“…On the other hand, we found that schizotypy scores stayed the same or even increased, which is highly interesting, considering that already during the first timepoint nearly 10% of the responders indicated a subjective increase of symptoms. Recent work shows the impact of adverse life events or loneliness on developing psychotic-like experiences (Beards et al, 2013; Chau et al, 2019; Le et al, 2019; Betz et al, 2020). The social and life-changing consequences of this pandemic (i.e., general reduction of social interaction, job insecurity, experiencing health problems) might therefore provide a long-term risk in those individuals with high schizotypy scores.…”

“…This might have been expected that with the continuing course of the pandemic, social isolation might increase, and with that, potentially loneliness too. Loneliness significantly interacts with schizotypy, and has been clinically linked to risk-for psychosis (Chau et al, 2019; Le et al, 2019). Again, this finding is of great clinical relevance and furthermore requires the attention of decision makers in a situation like the current.…”

Subjective Impact of the COVID-19 Pandemic on Schizotypy and General Mental Health in Germany and the United Kingdom, for Independent Samples in May and in October 2020

“…Based on a recent review by Preti et al (2020) the current pandemic poses an especially large risk for people suffering from paranoid or high schizotypal traits, as the measures taken to prevent the spread of the virus might ultimately lead to increased anxiety and depressive symptoms, increased avoidance behaviors, stronger disruption of social contacts, and delayed return to normality in these individuals. Furthermore, studies show links between recent adverse life events ( Beards et al, 2013 ; Betz et al, 2020 ) or isolation and loneliness ( Chau et al, 2019 ; Le et al, 2019 ) and schizotypy or psychosis-like experiences. Both these aspects, loneliness and adverse life events, are present in the current pandemic, which might have a worsening effect on schizotypal trait expression in people with pre-existing high schizotypy scores, perhaps leading to increased distress or disability.…”