Personality disorder traits are associated with greater loneliness

Recent developments in mental health research have highlighted the role of social factors in the lives of individuals with personality disorder diagnoses or traits. A growing body of literature has revealed the profound sense of disconnection and unmet social needs characterizing this group, raising questions about the impact of loneliness and perceived social support (PSS) on their path to recovery. Sarah Ikhtabi and colleagues conducted a systematic review to quantify the prevalence and severity of loneliness and PSS deficits. This research was published in BMC Psychiatry.

The researchers followed PRISMA guidelines for methodological rigor and registered the protocol on PROSPERO. Their search strategy encompassed a comprehensive review of four major databases—Medline, Embase, PsycINFO, and Web of Social Science—extended by searches in Google Scholar and the Ethos British Library database to capture dissertations and theses, from database inception to December 13, 2021. Search terms included a broad range of social concepts, loneliness, and various aspects of personality disorder assessments, aiming for an exhaustive coverage of the topic.

For inclusion, studies had to report on the prevalence or severity of loneliness and/or PSS deficits in individuals with personality disorder traits or diagnoses, utilizing validated measures of loneliness or PSS. The review process involved rigorous screening, data extraction, and quality assessment by the research team, with disagreements resolved through discussion or consultation with a third reviewer.

Methodological quality was assessed using the Joanna Briggs Institute tools, and evidence certainty was evaluated using the GRADE approach. The narrative synthesis of results emphasized the comparison of loneliness and PSS deficits in people with personality disorders against other groups, paying special attention to high-quality studies while also acknowledging findings from lower-quality research to provide a comprehensive overview.

Ikhtabi and colleagues found a significant correlation between personality disorders and increased levels of loneliness as well as deficits in PSS. Individuals with personality disorders, particularly those identified with traits of Emotionally Unstable Personality Disorder and Avoidant Personality Disorder, were found to experience higher levels of loneliness and deficiencies in social support compared to other clinical groups and the general population.

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This research also highlights a complex association between narcissistic personality traits and loneliness/PSS, which varies depending on the type of narcissism (vulnerable/covert versus grandiose/overt).

Despite the strong associative evidence presented, the review notes a lack of longitudinal studies that would allow for a more definitive understanding of the causality of these relationships, acknowledging the low certainty of the current evidence base due to methodological limitations.

The review, “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”, was authored by Sarah Ikhtabi, Alexandra Pitman, Lucy Maconick, Eiluned Pearce, Oliver Dale, Sarah Rowe and Sonia Johnson.