Different Kinds Of Loneliness – Having Poor Quality Relationships Is Associated With Greater Distress Than Having Too Few

By Emma Young

Loneliness not only feels bad, experts have characterised it as a disease that increases the risk of a range of physical and psychological disorders. Some national prevalence estimates for loneliness are alarming. Although they can be as low as 4.4 per cent (in Azerbaijan), in other countries (such as Denmark) as many as 20 per cent of adults report being either moderately or severely lonely. 

However, there’s no established way of identifying loneliness. Most diagnostic methods treat it as a one-dimensional construct: though it can vary in degrees, someone is either “lonely”, or they’re not. A new approach, outlined in a paper published recently in Social Psychiatry and Psychiatric Epidemiology, suggests that loneliness should in fact be divided into three sub-types, two of which are associated with poor mental health. 

Philip Hyland at Trinity College Dublin and colleagues studied a nationally representative sample of 1,839 US adults aged between 18 and 70, all of whom had experienced at least one traumatic event in their lifetime. (This allowed the team to also look for associations between childhood or adult trauma and loneliness.) Most were married or living with a partner. 

Participants completed a six-item scale that measured feelings of “social loneliness” (focusing on perceptions of the quantity of one’s social relationships) and “emotional loneliness” (which focused on perceptions of the quality of one’s relationships). They also completed questionnaires assessing levels of childhood and adult trauma, depression and anxiety, and their psychological wellbeing. 

Following convention, the 17.1 per cent of participants who scored a certain amount above the average loneliness score for the sample (by more than one standard deviation)  were classified as “lonely” – a figure comparable to that found previously in many other countries.

However, the researchers also used a statistical technique to look for qualitative differences between the participants’ loneliness responses, and this revealed four distinct classes. 

The first class – which they called “low loneliness” – was characterised by low scores on both types of loneliness, social and emotional. Just over half the participants fell into this category. The second class – “social loneliness” – making up 8.2 per cent of the sample, comprised people low on emotional loneliness, but high on social loneliness. The third class – “emotional loneliness” – made up just over a quarter of the total sample and was characterised by the opposite pattern of high emotional loneliness but low levels of social loneliness. People in the fourth and final “social and emotional loneliness” class, accounting for 12.4 per cent of the sample, scored high for both types of loneliness.

The researchers found a clear gradient of psychological distress across the classes. People in the low loneliness class were, predictably, least distressed, followed by people in the “social loneliness” class, then the “emotional loneliness” class, and finally the “social and emotional loneliness” class. In fact, people in both these last two classes had levels of symptoms of depression, anxiety and negative psychological wellbeing that were reflective of a psychiatric disorder.

In other words, quality of relationships appears more important to mental health than the sheer number of them.“These results indicate that while the experience of social loneliness is associated with slight diminutions in overall mental health, relative to the low loneliness class, the experience of emotional loneliness has a substantially greater, and more negative impact on overall mental health status,” the researchers write. “The combination of social and emotional loneliness is associated with the poorest mental health status,” they note. 

People who belonged to the emotional loneliness class were more likely to be female, younger than average for the group, not in a relationship and to have suffered an increased number of childhood traumas. (Every childhood traumatic experience increased the odds of belonging to the emotional loneliness class by 28 per cent.) The same associations were true for the “social and emotional” loneliness class – except they were also characterised by a greater number of adult traumas. 

At 39.0 per cent, the total percentage of participants who fell into the two loneliness classes characterised by clinically relevant levels of psychological distress was much higher than the 17.1 per cent loneliness figure obtained using the conventional one-dimensional approach. “This finding indicates that by recognising naturally occurring subtypes of loneliness, the number of people experiencing a form… that is likely to be of clinical relevance is more than double the number identified when loneliness is conceptualised as a unidimensional construct,” the researchers note. 

The work suggests that in assessing loneliness, whether in an individual or at a national level, it’s important to recognise there are various subtypes. It also supports findings from some other studies that it’s the quality, not quantity, of your relationships that really matters. As the researchers conclude: “From a societal perspective, and in the interests of reducing the burden of psychological distress, efforts should be made to enhance the quality of social connections as opposed to promoting the virtues of larger social networks.”

Quality not quantity: loneliness subtypes, psychological trauma, and mental health in the US adult population

Emma Young (@EmmaELYoung) is Staff Writer at BPS Research Digest

35 thoughts on “Different Kinds Of Loneliness – Having Poor Quality Relationships Is Associated With Greater Distress Than Having Too Few”

    1. Great study! The mindfulness programme that I developed for hospital staff and will be rolled out with Humanist Chaplains and Celebrants combines group activities that develop a sense of relatedness with psycho-education and short mindfulness practice designed to develop insight into the way a separate sense of self is constructed in stressful social environments. This study reports on the outcomes of a trial recording self-report measures of stress, mindfulness and relatedness.


      The paper does not go into much detail about the course design and theoretical foundations of ‘social mindfulness’. I am publishing a short booklet on ‘Social Mindfulness: a guide to meditations from Mindfulness-Based Organisational Education’, which will act as a support to the programme and explains the ideas that underpin this approach.

  1. What was the definition for childhood and adult traumas? Objective or reported? Criteria?
    Given the very weak dose-response relationship for “traumatic stress” – is this more about what was perceived and recalled as traumatic – since this actually seems to be the key criteria for something being “traumatic”.

    Correlation doesn’t equal causation – and since it is about recall and developed meanings (see the Centrality of Events Questionnaire for PTSD) – might it be that those who have high social and emotional loneliness are more likely to see themselves as having been impacted by a traumatic events and have a higher likelihood of seeing those traumatic events as central to their autobiography?

    (Some of the strangeness in PTSD is that the usual explanation that the event-memory hasn’t been integrated properly into autobiographical memory seems to be the reverse – the event-memory has been too integrated and become central to the sense of self and future.)

  2. Isn’t it the negative evaluation of one’s state of relationships that account fort he problems, rather then the facts themselfs?
    People with poor selfesteem tend to have fewer contact and with lower qualitiy.
    So maybe the main problem in not lonelyness, but negative ideas about oneself (with mostly goes along with negative thoughts about others).

  3. This is taken from an interview Rhonda Patrick, Found My Fitness, did with Matthew Walker, PH.D. Professor at UC Berkeley author or “Why We Sleep”. Fascinating interview!

    Loneliness as a contagion promoted by sleep loss

    “We have not been able to discover a single psychiatric condition in which sleep is normal.” – Matthew Walker, Ph.D. CLICK TO TWEET
    Another, somewhat troubling, consequence of sleep deprivation is that it triggers the onset of a “loneliness phenotype.” Lack of sleep induces critical changes within the brain, altering behavior and emotions, while also disturbing essential metabolic processes and influencing the expression of immune-related genes. The end result is that people who are sleep-deprived avoid social interaction. This asocial profile is recognizable by other people, who, in turn, shun the sleep-deprived people in a psychosocial loop that perpetuates in a vicious cycle of loneliness and other mental health disorders.

  4. Parents need to stay out of relationships-especially if they claim to be religious.

    1 Corinthians 7:9 tells parents the precise moment they should let their children marry.

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