Loneliness and social disconnectedness in pathological social withdrawal

Abstract

Pathological social withdrawal (PSW) refers to a set of socially-avoidant behaviours including low social engagement. Because social disconnectedness is associated with loneliness, which in turn is linked with psychiatric conditions, investigating loneliness in PSW is important for understanding the societal burden of PSW. Here, we investigated relationships between PSW, disconnectedness from other social groups, loneliness and psychiatric disturbances in Taiwan. Individuals with PSW showed greater perceived disconnection with their peers and more loneliness than those without PSW. Duration of being socially-withdrawn and the degree of disconnection with peers were each associated with loneliness. A positive correlation between loneliness and psychiatric disturbances also emerged. As poorer perceived closeness with friends may explain loneliness and psychiatric symptoms amongst individuals with PSW, future treatment should focus on social skills or nurturing social interactions with peers, beyond family members.

Introduction

Pathological Social Withdrawal (PSW) – characterized by a lack of interest in social relationships and extreme avoidant behaviours including spending most of their time at home – has emerged as a possible psychiatric condition or an extreme avoidant personality trait (Kato et al., 2012). Although described first in Japan as a culture-bound condition (hikikomori), these cases have since been reported in other Asian countries/regions with some studies estimating prevalence rates of up to 10% (Koyama et al., 2010; Wong et al., 2015; Wu, Catmur, Wong, & Lau, 2019). Data also indicate that the global presence of these conditions and note the associated emotional distress and societal burden (Wu, Catmur, Wong, & Lau, 2019). Given the defining feature of social withdrawal, a few studies have measured loneliness as a source of emotional distress in individuals with PSW (Teo et al., 2015). However, this earlier study did not compare loneliness to community comparison participants, nor assess whether loneliness is linked to disconnection with peers only or other social groups. Here, we seek to address these gaps.

Loneliness is proposed to be an aversive yet adaptive emotion that emerges when there is perceived social disconnect and thus, potential for reduced social support (Adams, Openshaw, Bennion, Mills, & Noble, 1988). Loneliness acts to signal this threat and motivates a course of social behaviour to address social disconnectedness (Cacioppo & Hawkley, 2009). Loneliness can follow persistent social withdrawal (Cacioppo et al., 2015; Parkhurst & Hopmeyer, 1999) but is proposed to activate the initial period of social withdrawal too (Hawkley & Cacioppo, 2010). Specifically, several psychological theories propose that a brief period of social withdrawal could promote re-engagement with others by enabling individuals to observe and evaluate immediate social situations, facilitating re-engagement. Recent studies have begun to recognise the frequency with which loneliness is experienced in the transition from late adolescence into early adulthood (Qualter et al., 2015). As the age of onset of PSW is late adolescence/early adulthood (Koyama et al., 2010), loneliness may not be just a consequence of extreme avoidance of social relationships, but also activate early withdrawal behaviours after the initial perceived social disconnection. Indeed, while previous studies have reported associations between loneliness and PSW, but there are few data on relationships between all three variables (social disconnect, loneliness, withdrawal behaviour).

We aimed to investigate loneliness and perceived closeness with other social groups in PSW and their connections. The first research question assessed whether there was lower perceived closeness with other social groups amongst individuals with PSW than those without. We hypothesized that this greater disconnect would be greater for peers than family members given that the needs of belonging shift from family to peers by early adulthood (Parkhurst & Hopmeyer, 1999). We also tested a second hypothesis that higher loneliness levels would characterise those with PSW than those without, and explored whether, amongst those with PSW, the length of withdrawal and perceived closeness with friends would correlate with loneliness. Finally, the third research question investigated the correlation between loneliness and psychiatric disturbances. We expected that PSW individuals who were most lonely would report more psychiatric symptoms.