Psychology of Loneliness New Research

PSYCHOLOGY OF EMOTIONS, MOTIVATIONS AND ACTIONS
PSYCHOLOGY OF LONELINESS
NEW RESEARCH
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PSYCHOLOGY OF EMOTIONS,
MOTIVATIONS AND ACTIONS
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PSYCHOLOGY OF EMOTIONS, MOTIVATIONS AND ACTIONS
PSYCHOLOGY OF LONELINESS
NEW RESEARCH
LÁZÁR RUDOLF
EDITOR
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CONTENTS
Preface vii
Chapter 1 The Veteran's Loneliness: Emergence, Facets,
and Implications for Intervention 1
Jacob Y. Stein
Chapter 2 Loneliness and Preference for Solitude
among Older Adults 37
Aya Toyoshima
Chapter 3 Loneliness and Suicide 67
Rebecca L. Kauten, Jessica M. LaCroix,
Amber M. Fox and
Marjan Ghahramanlou-Holloway
Chapter 4 Social, Interpersonal and Emotional
Antecedents of Loneliness 95
Leehu Zysberg
Chapter 5 Loneliness Among Romanian Immigrants
Living in Portugal 123
Félix Neto and Maria da Conceição Pinto
Index 141
PREFACE
In this compilation, the authors begin by discussing veterans'

loneliness post-war, delineating this experience's developmental course and
the underlying relational deficits at its infrastructure throughout that
course. The authors also compare the characteristics of this loneliness to
those of other types of loneliness, highlighting the necessity of
understanding the veteran's experience as a specific form of loneliness.
Next, developmental change in elderly people linked to loneliness and
preference for solitude are examined through findings of recent studies,
and reconsidering loneliness and the positive aspects of solitude.
Preference for solitude is similarly examined. One chapter examines
loneliness and suicide through Aaron Beck’s cognitive behavioral theory
and largely through Erik Erickson’s theory of psychosocial development.
Intervention strategies to address loneliness and suicide are studied, and
recommendations for clinical practice and future areas of study are
presented. Lastly, a study is presented focusing on determinants of
loneliness among Romanian migrants living in Portugal. The goal of the
study was to answer two questions: “(1) What influences do acculturation
problems have on loneliness? (2) What influences does adaptation to the
society of settlement have on loneliness?”
Chapter 1 - Veterans' loneliness may persist decades after the war and
may be detrimental, particularly when deployment has been traumatic.
viii Lázár Rudolf
Indeed, mitigating loneliness via social support may be essential for

alleviating war-induced posttraumatic stress disorder (PTSD).
Nevertheless, rarely has veterans' loneliness been empirically investigated,
and its unique features have never been systematically delineated. Since
experiences of loneliness vary qualitatively, and these variations may have
implications regarding the kind of support and clinical intervention
necessary for their amelioration, understanding its nature may be critical.
The current chapter fills this gap by delineating this experience's
developmental course and the underlying relational deficits at its
infrastructure throughout that course. Based on veterans' accounts and
extant multidisciplinary literature, the veteran's loneliness is traced from
enlistment, through deployment, war, and homecoming. An experiential
loneliness bound to the “veteran identity” is depicted, and the significance
of transitions between social contexts and experiential worlds is
underscored. Comparing the characteristics of this loneliness to those of
other types of loneliness the chapter highlights the necessity of
understanding the veteran's experience as a specific form of loneliness,
with implications for intervention, both clinical and societal. The chapter
therefore concludes with implications for practitioners and social support
networks, as well as desirable directions for future research.
Chapter 2 - Older adults tend to find it difficult to engage in social
activities, as their social environments can be adversely affected as a result
of negative life events such as bereavements, retirement, and the loss of
physical function. Such individuals also find it difficult to develop new
close relationships in later life. Further, the ratio of time spent alone tends
to increase with age, with studies showing that older adults spend 48% of
their daily lives engaging in solitary activities. However, although there are
some negative factors that enhance loneliness in later life, the levels of
loneliness reported by older adults are not as high as those reported by
other age groups, which is a somewhat paradoxical finding.
Geropsychological studies have determined that older adults manage the
consequences of failure and loss using two strategies: primary control
strategies and secondary control strategies. Primary control strategies refer
to individuals’ attempts to change the external world to fit their personal
Preface ix
needs and desires, while secondary control strategies concern individuals’

inner emotions and involve their efforts to influence their own preferences.
As primary control strategies can be costly, older adults are more likely to
rely on secondary control strategies. Thus, it is possible that older adults
use secondary control to change their preferences and adapt to the new
limitations to their social activities. Meanwhile, preference for solitude,
which relates to a high level of competency in terms of spending time
alone (e.g., feeling positive emotions in such a situation), may be another
important factor in this regard. In this chapter, developmental change in
elderly people in relation to loneliness and preference for solitude are
reviewed; this is achieved by examining the findings of recent studies, and
reconsidering loneliness and the positive aspects of solitude.
Chapter 3 - Loneliness has been conceptualized both as an objective
state of physical alienation and a subjective state of distress due to feeling
alone. The construct of loneliness has been empirically linked with a
variety of mental health conditions including depression, hopelessness,
suicide ideation, and/or suicide-related behaviors. This chapter examines
More specifically, the authors review how ambivalence resulting from
competing drives of connectedness, authenticity, and self-protection may
contribute to loneliness and explore manifestations of loneliness and
suicidality during childhood, adolescence, young adulthood, middle
adulthood, and older adulthood. Intervention strategies to address
loneliness in the context of suicide are explored, and recommendations for
clinical practice and future areas of empirical inquiry are presented.
Chapter 4 - While the literature is replete with evidence and theory
regarding the emotional consequences of loneliness and the challenges
they pose to individuals, there is still not enough evidence examining the
emotional antecedents of the phenomenon. This chapter reviews the
existing literature on emotional antecedents of loneliness, dwells on recent
evidence linking loneliness and certain underlying emotional mechanisms
and presents an integrative model to guide research and future practice in
diverse settings.
x Lázár Rudolf
Chapter 5 - This study approaches the determinants of loneliness

among Romanian migrants living in Portugal. Two research questions
guided the study: (1) What influences do acculturation problems have on
loneliness? (2) What influences does adaptation to the society of settlement
have on loneliness? The sample of this research consisted of 181
Romanian immigrants living in Portugal (49% females). The average
duration of stay in Portugal was 9 years. Loneliness was measured by the
ULS-6. In addition, other scales were used to assess Portuguese language
proficiency, perceived discrimination, sociocultural adaptation,
multicultural ideology, psychological problems and self-esteem. Results
showed that both indicators of acculturation problems and of adaptation
significantly predicted loneliness. Implications of the findings for future
research are discussed.
In: Psychology of Loneliness ISBN: 978-1-53612-900-7
Editor: Lázár Rudolf © 2017 Nova Science Publishers, Inc.
Chapter 1
THE VETERAN'S LONELINESS:

EMERGENCE, FACETS, AND
IMPLICATIONS FOR INTERVENTION
Jacob Y. Stein*, PhD

Bob Shapell School of Social Work,
Tel Aviv University, Tel Aviv, Israel
I-CORE Research Center for Mass Trauma,
Tel Aviv University, Tel Aviv, Israel
ABSTRACT
Veterans' loneliness may persist decades after the war and may be
detrimental, particularly when deployment has been traumatic. Indeed,
mitigating loneliness via social support may be essential for alleviating
war-induced posttraumatic stress disorder (PTSD). Nevertheless, rarely
has veterans' loneliness been empirically investigated, and its unique
features have never been systematically delineated. Since experiences of
* Corresponding Author address: Jacob Y. Stein, I-CORE Research Center for Mass Trauma,
Bob Shapell School of Social Work, Tel Aviv University, 69978 Tel Aviv, Israel.
Email: cobisari@gmail.com.
2 Jacob Y. Stein
loneliness vary qualitatively, and these variations may have implications

regarding the kind of support and clinical intervention necessary for their
amelioration, understanding its nature may be critical. The current
chapter fills this gap by delineating this experience's developmental
course and the underlying relational deficits at its infrastructure
throughout that course. Based on veterans' accounts and extant
multidisciplinary literature, the veteran's loneliness is traced from
enlistment, through deployment, war, and homecoming. An experiential
loneliness bound to the “veteran identity” is depicted, and the
significance of transitions between social contexts and experiential
worlds is underscored. Comparing the characteristics of this loneliness to
those of other types of loneliness the chapter highlights the necessity of
understanding the veteran's experience as a specific form of loneliness,
with implications for intervention, both clinical and societal. The chapter
therefore concludes with implications for practitioners and social support
networks, as well as desirable directions for future research.
Keywords: loneliness, veterans, identity, experiential loneliness, trauma
INTRODUCTION
In a recent evocative article that appeared in the veteran-issues online

magazine US Defense Watch, former U.S Army Intelligence officer and
veteran of the Gulf War, Ray Starmann (2015), asserted the following:
Millions of vets are and have been successful in all endeavors. They
are doctors, lawyers, business people and a thousand other professions.
Not all have PTSD; not all are the troubled, brooding, street corner
homeless guy, although they exist and need help desperately. No matter
how successful a vet might be materially, more often than not, vets are
often alone, mentally and spiritually each day and for the rest of their
lives.
Starmann had written his article as the 2015 Veterans Day was
approaching, so as to provide a glimpse at the solitary world of the veteran.
However, for those unfamiliar with the veteran experience, the solitary
world of veterans depicted by Starmann may seem striking, perplexing and
The Veteran's Loneliness 3
enigmatic. The enigma is accentuated when this solitary reality is

contrasted with the ostensible embracing welcome that many civilians
offer their nation's returning veterans, and more so in cases wherein
veterans evince an apparently successful reintegration into society, as
portrayed by Starmann. Thus, as one reads Starmann's depiction of the
veteran's isolation, one may come to wonder: what is it that is so critically
lacking in veterans' social networks? What is it that renders them so alone?
Moreover, how does this loneliness materialize? And how might it best be
addressed and ameliorated? These are the questions that are at the center of
the current chapter.
It is important to address these questions and unravel the enigma for
several reasons. First, because loneliness is an emotional state that may
entail extreme torment and suffering, and as such shares common features
with physical pain (e.g., MacDonald & Leary, 2005). Additionally,
loneliness may be extremely detrimental, as it precipitates impediments to
physical and mental health, hindered well-being and premature mortality
(S. Cacioppo, Grippo, London, Goossens, L., & Cacioppo, 2015). Even
more alarming is the evidence that loneliness plays a pivotal role in suicide
behaviors (Van Orden et al., 2010). At a time when veteran suicides are
spiking (e.g., Kang et al., 2015), veteran loneliness is an issue that must be
understood to the core, and efficient means for its amelioration are to be
sought with utmost urgency. Finally, understanding veterans' loneliness
may be informative in that it sheds light on the processes that occur in the
various social networks in which these individuals are situated, both
military and civilian.
In the current chapter I then strive to delineate both the characteristics
of the veteran's loneliness, and the manner in which it unfolds from the
time of enlistment to the veteran's return to civilian life. Towards this end,
in the preparation of this chapter an "insider's perspective" of the
experience was sought, and a rich description of the experience is put forth
below. The ultimate objective of the current chapter is to inform mental
health professionals, as well as supporting figures within veterans' close
social networks, as to the manner in which the loneliness under scrutiny
may best be addressed. Indeed, understanding the lonely aspect of being a
4 Jacob Y. Stein
veteran may be of immense value also for those who care for the returning
veteran, first and foremost family and friends (Lyons, 2007). At the outset,
however, the nature and multifariousness of loneliness must be addressed,
for it is these that mandate the discernment of one type of loneliness from
other types.
Loneliness – Its Nature and Relation to Recovery from Trauma
Loneliness may be conceptualized as the epitome of relational deficit

within a given social configuration. From a cognitive perspective,
loneliness is conceptualized as a perceived discrepancy between an
individual’s desired social relations and those that he or she currently
inhabits (Peplau & Perlman, 1982; Russell, Cutrona, McRae, & Gomez,
2012). As such, loneliness is, by definition, a subjective rather than
objective experience of isolation. Moreover, it is invariably experienced as
unpleasant as opposed to neutral or positive modes of isolation, such as
aloneness or solitude (Gotesky, 1965). However, loneliness is anything but
a unified experience (e.g., Hawkley, Browne, & Cacioppo, 2005; Rokach,
1988), and is in fact a term that lends itself to diverse, although
conceptually related, phenomena (Stein & Tuval-Mashiach, 2015b).
According to Stein and Tuval-Mashiach (2015b), experiences of
loneliness may be qualitatively discerned from one another by examining
the characteristics of one or more of seven elements that constitute every
experience of loneliness: a) the experiencing subject (e.g., the lonely
person's age, gender, personality), b) the relationship within which the
experience transpires (e.g., familial, social, romantic), c) the Other with
whom the relationship is formed (e.g., friends, intimate partner, oneself as
an Other), d) the relational needs that are to be fulfilled in the relationship
and the relational expectations it fosters (e.g., belongingness, intimacy,
love, attention), e) the discrepancy between desired and attained
relatedness (e.g., intensity or severity), f) the manner in which the person
experiences him or herself as isolated (e.g., socially isolated, emotionally
isolated), and g) the quality or intensity of the painful affective state that
constitutes the experience of loneliness (e.g., depression, hollowness,

forsakenness). Loneliness in this respect is polymorphic. The social
isolation of an ostracized adolescent yearning for friends and the emotional
isolation of a widow longing for her lost companion, are both forms of
loneliness albeit a very different from of loneliness (Weiss, 1973), as is the
existential isolation demarcated by philosophers (e.g., Mijuskovic, 2015)
and existential psychologists (e.g., Ettema, Derksen, & van Leeuwen,
2010; Moustakas, 1961; Yalom, 1980). These phenomena all share a
mutual core, but are nonetheless associated with different psychosocial
deficits. Therefore, it is argued, they may require different interventions for
their amelioration. Conversely, recent research indicates that the loneliness
of active duty soldiers is likewise contextually-bound, and must be
understood somewhat differently than the loneliness that is prevalent
among civilians (J. T. Cacioppo et al., 2016). Ultimately, the alleviation of
loneliness may be achieved by addressing the person's maladaptive
perceptions or social tendencies (Masi, Chen, Hawkley, & Cacioppo,
2011), or otherwise by environmental changes that entail the adequate
provision of relational provisions and apt social support.
Arguably, providing the necessary support and facilitating healing
highly depend on the identification of the relevant relational needs of the
lonely person and the relationships within which these must be realized
(Dykstra, 1993). From a motivation-oriented evolutionary perspective,
loneliness is understood primarily as a transient phenomenon that, although
may include an initial phase of withdrawal, eventually motivates
individuals to seek reconnection (Qualter et al., 2015). Understanding
personal inclinations towards either withdrawal or reconnection then
depends on understanding of the underlying foundations of the individual's
experience of loneliness. These realizations become pertinent when one
takes into consideration that veterans must often also cope with the
traumatizing aspects of war.
War entails numerous stressors, including a constant threat of
annihilation, ubiquitous death, incessant anxiety, exhaustion, deprivation,
moral conflicts, guilt, homesickness and the loss of friends (e.g., Nash,
2007). These, for many veterans, may result in prolonged torment and
6 Jacob Y. Stein
anguish that manifest as combat stress injuries (Figley & Nash, 2007),
most conspicuous of which is posttraumatic stress disorder (PTSD; e.g.,
Fulton et al., 2015). Nevertheless, phenomena that have been identified as
antonymic to loneliness (e.g., reconnection, reintegration, social support),
may play a pivotal role in the process of recovering from trauma (Herman,
1992) as well as in mitigating the development of PTSD (e.g., Brewin,
Andrews, & Valentine, 2000). Studies have found that perceived social
support was implicated in less loneliness and PTSD among veterans both
cross-sectionally and longitudinally throughout the course of 20 years after
the war (Karstoft, Armour, Elklit, & Solomon, 2013; Solomon, Bensimon,
Greene, Horesh, & Ein-Dor, 2015). Moreover, Solomon, Waysman and
Mikulincer (1990) found that in the case of post-war PTSD support may be
protective only if it indeed manages to alleviate loneliness.
Notwithstanding, it would seem that any information addressing the nature
and developmental course of veterans' loneliness may not to be found in
one organized source in the trauma literature, but rather must be
aggregated piecemeal from various sources.
Loneliness-Focused Trauma Literature: A Gap Delineated
Trauma has long been recognized as one of many potential antecedents

of loneliness (Rokach, 1989). In the specific domain of war related trauma,
there are volumes replete with allusions to post-war isolation and its
concomitants. Such allusions appear in interdisciplinary works raging
across psychology and psychiatry (e.g., Caplan, 2011; Figley &
Leventman, 1980; Herman, 1992; Lifton, 1973), sociology (e.g., Schuetz,
1945; Waller, 1944), and philosophy (Sherman, 2015). Adding to this rich
literature are non-academic monographs written by veterans (e.g., Johnson,
2010; Paulson & Krippner, 2004), letters written by veterans (Gill, 2011),
and literary memoirs (e.g., Hynes, 1996).
When loneliness has indeed been examined systematically, it was
found among veterans several decades after their traumatic war
experiences. Kuwert, Knaevelsrud, and Pietrzak, (2014), for instance,
found that among older veterans in the US, 44% reported feeling lonely at
least some of the time, and of these, over 10% reported feeling lonely most
of the time. Similarly, comparing veterans who sustained a psychiatric
breakdown in the heat of battle – a phenomenon known as combat stress
reaction (CSR) – with veterans who did not, Solomon et al. (2015) found
that the CSR casualties evinced steady high rates of loneliness throughout
20 years after their war experiences, whereas non-CSR veterans' loneliness
decresed throughout the years. Furthermore, Solomon and her colleagues
found that the baseline severity of PTSD symptomatology was cross-
sectionally positively associated with loneliness, suggesting that loneliness
may play a role in posttraumatic psychopathology. Indeed, "feelings of
detachment or estrangement from others" (but not loneliness) have been
incorporated in the recent edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-5; American Psychiatric Association [APA],
2013, p. 272) as possible constituents of PTSD.
Regardless of the above indications that war-induced trauma may
result in loneliness, and despite the fact that loneliness has been recognized
as a clinically pertinent issue (S. Cacioppo et al., 2015); it remains the case
that systematic loneliness-focused investigations with traumatized
populations are scant. Indeed, most of the aforementioned literature, with
the exception of the few studies cited above, consists of anthologies and
monographs rather than peer-reviewed studies. Moreover, if this literature
has referred to veterans' loneliness, it has done so mainly in passing or by
alluding to related terms from the vast loneliness nomenclature (e.g.,
isolation, estrangement, alienation). This paucity is indicated, for instance,
in the fact that none of the trauma encyclopedias that were published in the
past decade (Doctor & Shiromoto, 2010; Figley, 2012; Reyes, Elhai, &
Ford, 2008) have allocated an entry for loneliness. As part of this
investigative dearth, to date, there exists no systematic investigation as to
the manner in which veterans' post-war loneliness transpires, and no
delineation of the course in which it unfolds and manifests itself. Due to
this gap in the literature, attempts to explain why veterans' loneliness
lingers for decades after the war, as well as attempts to trace it to its
origins, remain largely speculative and tentative. Filling this gap, in the
8 Jacob Y. Stein
current chapter I trace the experience back to its origins. This explication
will facilitate a deeper understanding of veterans' motivations to reconnect
or otherwise further withdraw in various social contexts, as well as
promote the devising of apt clinical and supportive practices.
Gaining Entrance to the Experience
The bulk of the current chapter is an attempt to grant readers an

entrance into the veteran's experience of loneliness and its phenomenology.
This endeavor is engaged below in two complementary manners: (a) via
veterans' narrative explications and (b) via the vast extant literature relating
to veterans' war and post-war experiences. Narratives are most informative
when attempting to understand the unfolding of human experience,
particularly that of loneliness, from an insider's perspective (Wood, 1986).
This is because narratives consist of rich accounts wherein experiences
(e.g., war and homecoming) are temporally concatenated in a plot, and are
linked to the characters (i.e., self and Others) and meanings (e.g., deficient
relational needs and expectations) that are most pertinent from the
narrator's perspective (e.g., Polkinghorne, 1988). Moreover, it is within
narrative that phenomena may receive the title "loneliness," thus indicating
that the phenomena under inspection are indeed construed as such by the
persons who have experienced them (Wood, 1986).
Veterans' oral and printed accounts are ubiquitous these days, and
many of these reveal experiences entailing a state of painful isolation (i.e.,
loneliness). At the center of the current chapter stand two such exemplary
accounts. Both accounts were chosen for their rich explicatory nature, and
because their authors do not present the accounts as personal narratives per
se, but rather strive to explain the loneliness of a veteran qua veteran to an
outsider (i.e., a non-veteran, a civilian). The original authors have given
their permission to use the accounts in the current project. The first account
is one shared by a Vietnam veteran, L.V. The narrative was sent to me by
L.V via e-mail correspondence (August, 20, 2015) in response to my
inquiry concerning the experience of post-war loneliness. Complementing
L.V's account is Starmann's (2015) aforementioned piece, entitled The

Solitary World of the Vet. Starmann's article was purposively chosen also
because its publication enabled many other veterans to react to the
depiction it offers. Veterans responding to Starmann's article, whether on
the US Defense Watch site, where it had originally appeared, or on social
media (i.e., Facebook), where it was shared several thousand times, have
all confirmed that Starmann's articulate depiction is faithful to their own
experience, thus confirming that the account is anything but idiosyncratic.
Below, the discussion of L.V's and Starmann's accounts will be
grounded in extant literature. Undeniably, neither such literature nor the
veterans' narratives indicate the prevalence of the phenomena under
scrutiny. To the best of my knowledge, quantitative epidemiological
studies seeking to establish such prevalence have not yet been conducted.
Nevertheless, recognizing the common factors among narratives and extant
literature serves to further demonstrate that these phenomena transcend the
idiographic accounts, and are readily transferable to other veterans in more
diverse post-war realities. L.V's and Starmann's accounts are therefore
discussed not only as private cases but also and primarily as exemplars of
the lonely-veteran experience.
THE VETERANS' LONELINESS
In order to gain a fuller understanding of veterans' post-war loneliness

it may be beneficial to trace their experiences from the time of enlistment
and deployment, through their war experiences, and finally to the post-war
era from the initial time of homecoming to the more protracted civilian life
wherein the loneliness at hand consolidates. Veterans' relational ties, the
characteristics of their social networks, and their social connections and
detachments throughout this temporal-experiential course vary
considerably, and with them vary their experiences of loneliness.
10 Jacob Y. Stein
Enlistment, Deployment and Homesickness
As he set out to explain what it is that the veteran's loneliness entails

and where and when it is fashioned, L.V noted the following:
Being lonely is very difficult for humans; we have always been

around a lot of other people and engaged in the act of living with and
interacting with others from the day we are born. We have sought love,
sought to be "included" and sought the approval of those with whom we
interact. Then as a young man, in my case, we leave those with whom we
have made an integral part of our life and go away, alone and to
unfamiliar places. We then share the most basic of human emotions with
others who are in a situation similar to ours. We begin to bond because of
this shared "lonesome for home and family and longtime friends feeling."
We get close as a group, then experience horrors that we have never
experienced before; most are so basically alien to what we have ever
known or could have dreamed. The greater the threat, the horror, the pain
we feel, the closer we become.
A primary goal in the initial phase of military training (i.e., boot camp)
is the socialization of new recruits by stripping them of their civilian
identity and instilling a military identity in its stead (Van Gennep, 1960).
The transition into military life therefore entails a transition from the
familiar, and perhaps typically caring, environment of one's family to the
foreign military regime of the military. Thus, of great significance in
adjusting to such transitions are the relationships in the soldier's family of
origin prior to enlistment. Families that foster social growth and
competence may in time facilitate closeness in the new social network of
the military unit (Shulman, Levy-Shiff, & Scharf, 2000). At this
preliminary point of transition, however, loneliness may become manifest
first and foremost in the form of homesickness, implicated in the need for a
familiar relational bond such as the family or friends left back home. This
homesickness may be one of the first challenges soldiers must face right at
the outset of their service (e.g., Flach, De Jager, & Van de Ven, 2000). It
may exacerbate at times of deployment when the geographical distance
complements and amplifies the sense of detachment from one's home,

parents, spouse, and children.
However, there is something much more profound in this transition,
and it is underscored by the particular significance of the relationships
formed among the members of the combat unit. Combat soldiers bond, in
part, by undergoing shared experiences. The newly acquired social
network becomes tighter and more significant as its members undergo
mutual trials and tribulations. In this respect, the aforementioned
homesickness is not only one of the warriors' shared experiences, but may,
in fact, serve as a catalyst in the unit's bonding process thereafter (Waller,
1944). Such bonding, if attained, may fill the relational deficit created at
the time of enlistment when the new recruit leaves home and all that it
entails, but may later hinder the renewed entry into civilian society
(Demers, 2011). Indeed, researchers recently found that for active-duty
soldiers the experience of loneliness is more closely related to their bonds
within the unit than to their relations with their actual families (J. T.
Cacioppo et al., 2016). This finding makes perfect sense when the unit's
cohesion is considered.
Traversing into the war environment, it would seem that the soldiers'
shared experiences become more extreme and tormenting, and as they do,
the comrades' bond becomes tighter. In this shared fate, interdependence
may be established among the members of the combat unit, resulting in a
cohesion that may be indispensable for survival (Adler & Castro, 2013).
Overcoming extreme hardship togehter may enable the overcoming of
soldiers' initial loneliness and facilitate the forging of a comradery that
must hold in circumstances of life and death on the battlefield. Fostering
resilience in the face of potential threats to social ties
(i.e., social resilience) may then be pertinent among soldiers (J. T.
Cacioppo, Reis, & Zautra, 2011), and has therefore begun to attract
researchers' attention (J. T. Cacioppo, Adler, et al., 2015).
From an evolutionary perspective, animals and humans alike depend
on companionship and mutual protection and assistance for their survival
(J. T. Cacioppo, Cacioppo, et al., 2015). Loneliness then signals that there
is a need to strengthen such bonds. This becomes even more pertinent at
12 Jacob Y. Stein
times of actual threat. During war, the lack of unit cohesiveness may be a
catalyst for the mental breakdown on the battlefield (Dasberg, 1976;
Solomon, 1993), and may result in subsequent PTSD after the shooting
ends (Brailey, Vasterling, Proctor, Constans, & Friedman, 2007).
Acknowledging the intensity of the soldiers' bond may be crucial for
understanding the emergence and severity of the loneliness that veterans
experience upon homecoming.
Homecoming, Experiential Loneliness and

Communicative Isolation
Eventually, the war ends and the unit, which has since become family,
is dispersed. L.V makes note of this transition explicitly:
Then, one day it is over. We know we will never see most of this
“new” family again. We know that many of those who still have to stay
and endure the horrors, will never actually leave. . . . This is traumatic to
most, but not as much as finding out that when you do return, nobody has
a clue what you have been through, or even who you have now become.
You are alone, really alone.
The sense of being alone may then manifest itself as soon as the
veteran returns home. Homecoming has been extremely difficult in this
sense for veterans in the time when Homer wrote the Iliad and Odyssey
(Shay, 1994, 2002), as it has been after the World Wars (e.g., Shuetz,
1945), after Vietnam (e.g., Figley & Leventman, 1980), or following the
wars in Iraq and Afghanistan (e.g., Ahern et al., 2015; Caplan, 2011). Post-
war loneliness to a great extent revolves around the loss of shared
experiences. Upon homecoming, the world's population becomes
bifurcated in the veteran's eyes: civilians on the one side, and veterans on
the other (e.g., Ahern et al., 2015; Stein & Tuval-Mashiach, 2015a; Waller,
1944). The former do not share the war and post-war experiences and are
thus incapable of understanding the returning veteran, and the latter are
capable of listening and understanding but are usually not around to do so.
Linking the above notions together, Starmann (2015) notes the following:
Many vets experienced and saw and heard and did things
unimaginable to the average person. They also lived a daily camaraderie
that cannot be repeated in the civilian world. In fact, many vets spend the
rest of their lives seeking the same esprit de corps that simply is absent
from their civilian lives and jobs. They long to spend just 15 minutes
back with the best friends they ever had, friends that are scattered to
every corner of the earth, and some to the afterlife itself. Vets are haunted
by visions of horror and death, by guilt of somehow surviving and living
the good life, when some they knew are gone. They strangely wish
sometimes that they were back in those dreadful circumstances, not to
experience the dirt and horror and terror and noise and violence again, but
to be with the only people a vet really knows, other vets.
Veterans may practically miss being around those who have shared the
experiences that have made them who they are. For many, the end of the
war puts an end to their aspiration to feel ultimately connected. It leaves
them very much alone with their experiences in a civilian world oblivious
to the meaning of the experiences they have endured during their
deployments. Seeking a conceptual understanding of this form of isolation,
Stein and Tuval-Mashiach (2015a) suggest that the loneliness at hand may
be best characterized as loneliness of experiential isolation or in short,
experiential loneliness (p. 127). Conversely, Wood (1986) terms this facet
of loneliness failed intersubjectivity, denoting the person's unfulfilled
desire for interpersonal connection on the subjective level. The
psychological underpinnings of such phenomena are multifaceted.
Bearing subjective experiences alone undermines the human need for
shared inner realities. We all need to sense that others experience, feel,
think, evaluate, and altogether view the world as we do (Echterhoff,
Higgins and Levine, 2009). In part, this is what motivates people to tell
stories of those experiences. That said, typically, people assume that those
who have undergone the same experiences as them are most capable of
understanding how they felt in these experiences; and at times, that only
14 Jacob Y. Stein
such individuals can do so (e.g., Hodges, Kiel, Kramer, Veach, &

Villanueva, 2010). This persuasion, which may be pivotal in determining
sources of emotional support and stress following stressful life events
(Suitor, Keeton, & Pillemer, 1995), seems to lie in the substructure of
veterans' post-war loneliness. At times, this feeling is exacerbated by the
realization that others do not want to listen or otherwise are not really
interested in understanding, thus ultimately culminating in the devastating
feeling that no one really cares. In her analysis, for instance, Sherman
(2015) notes in that for the veteran who needs others to really listen, the
words "thank you for your service!" may be experienced as hollow lip-
service, for they come instead of a sincere interest in that which the veteran
had undergone during the war and since he or she has returned.
Turning to L.V's explication of what this lonely experience entails, the
personal meaning of such an experiential loneliness begins to emerge:
The lonely feelings become enmeshed with feelings of helplessness

and the scars of experiences that you never find a way to flush from your
mind. You can write a superb study that many will read in curiosity or
awe or for understanding. But I do not believe it is possible to explain or
understand the type of deep, black loneliness that emerges in the context
of or aftermath of combat and the later return to a world with those who
have no such basis of experience or understanding. And for most, this is
simply a subject not discussed. It is a very different kind of loneliness
than simply missing a girl friend or family members. It is much more
pervasive. You can go visit family and friends, [but] you cannot solve the
loneliness issues that arise from horrific traumatic experiences that only
others who have similar experiences can ever understand.
In these assertions, L.V practically deemed my current endeavor in this

chapter all but a futile attempt to communicate the experience at hand, and
he is certainly not alone in these sentiments. From the veterans'
perspective, his or her post-war loneliness may be experienced as a
perpetual, incommunicable, and irrevocable loneliness, explicitly
differentiated from any other kind of more quotidian forms of loneliness.
Words fail extreme loneliness (Fromm-Reichmann, 1959/1990), and they
fail the experiences incorporated in the gestalt we recognize as “war.” This

phenomenon may be referred to as communicative isolation, wherein one
is severed from society by the constraints of language. Thus, veterans may
feel experientially isolated in regards to their loneliness just as they are in
regards to the combat experiences they bear, and which have given rise to
this loneliness that they now experience. The failure of language in this
sense is twofold. First, the lonely veteran learns that words cannot
adequately communicate to civilians the ineffable war experience. Alfred
Schütz notes in this respect that,
When the soldier returns and starts to speak – if he starts to speak at

all – he is bewildered to see that his listeners, even the sympathetic ones,
do not understand the uniqueness of these individual experiences which
have rendered him another man. (Schuetz, 1945, p. 374)
Starmannn (2015) expounds on this communicative barrier:
A problem with the solitary world of the vet is that the vet has a hard
time explaining what he or she did to those who didn’t serve. Some vets
want to talk, but they have no outlet. . . . Part of this taciturn mentality is
that vets speak another language, a strange and archaic language of their
past. How do you talk to civilians about “fire for effect” or “grid 7310” or
“shake and bake” or “frag orders” or “10 days and a wake up” or a
thousand and one other terms that are mystifying to the real world? You
can't.
But it is much more than the technicalities of military routines that is

incommunicable. The whole gamut of experiences one endures in battle
are fundamentally different from civilians' mundane experiences – the loss
of friends, the looming death, the incessant sense of threat and uncertainty,
the struggle with the forces of nature and the perniciousness and brutality
of human actions – all of these words are hollow representations of the
experiences they attempt to represent. Thus silence emerges, for, as
Wittgenstein (1921/2002, p. 89) famously noted “What we cannot speak
about we must pass over in silence.”
16 Jacob Y. Stein
The second linguistic barrier, indeed the Janusian face of the extreme
nature of war, concerns the realization that for the veteran, civilian
language has also changed its meaning. As Waller notes, “the words which
mean so much to the civilian mean very little to the soldier” (Waller, 1944,
p. 32). Words such as “pain,” “loss,” “friendship,” “responsibility,”
“honor,” “loyalty,” “impossible,” and many others which are common
stock in civilian discourse may have all changed their meanings for
veterans who have encountered these in their most extreme forms. Such
communicative barriers may once again lead to silence and withdrawal, as
the veteran presupposes the emergence of misunderstanding a priori. These
withdrawals permeate and impede several relational domains, including
family, friends and society as a whole (Lyons, 2007). To exemplify, in
their investigation of reintegration problems among veterans retuning from
Iraq and Afghanistan Sayer et al. (2010) found that the leading challenges
for reintegration are all interpersonal (e.g., dealing with strangers, making
new friends, keeping up nonmilitary friendships, belonging in “civilian”
society). More to the point, at the top of the list for most veterans in the
study was the challenge of confiding or sharing personal thoughts and
feelings with others.
Civilian Life, the Veteran Identity, and Experiential Alienation
Evidently, the sense of loneliness at hand is rooted in emotional

transitions which are only partially congruent with physical transitions:
from home to the military, from training to war, and from war back home.
Perhaps more than any other experience during one's military service, war
ultimately changes the combatant's identity (e.g., Gill, 2011). In fact,
participation in war is the primary factor which constitutes the combat
veteran's identity as such. It is this altered identity that civilians typically
underappreciate. Starmann (2015) notes that, “Civilians must understand
that for a vet nothing is ever the same again.” Schütz complements this
realization by noting that the returning veteran “is not the same man who
left. He is neither the same for himself nor for those who await his return”
(Schuetz, 1945, p.375).
Emphasizing the critical junctions wherein emotional transitions occur,
L.V brought his account to a close with a summarizing statement that
encapsulates all that has already been said, and reveals most explicitly the
unmet relational needs encompassed in the veteran's experientially lonely
state:
In an abbreviated sense, being lonely is fighting for acceptance in

your original world, being ripped away and then enduring the same
process in a new world but under horrific circumstances, then returning to
your original world only to discover that you are not understood, do not
belong there the same way you did before, and the new world you have
just left no longer exists, leaving you alone. Even when there are still the
trappings of the world you once knew, they are no more, and there is no
one to comfortably talk with about these things, so you keep these
feelings inside and withdraw into them unless distracted by work or some
crisis or some event powerful enough to draw your mind away from
simply feeling like you no longer belong, anywhere really.
Of immense importance here is yet another long standing fundamental

human need, the need to belong (Baumeister & Leary, 1995; Gere &
MacDonald, 2010). Aside from the compromised need to be understood,
veterans also forfeit this form of connection, and thus feel further detached
from society. The returning veteran's sense of being “a stranger among
strangers” (Schuetz, 1945, p. 369), his or her experiential alienation, so to
speak, once again underscores the existence of the aforementioned two
populations, veterans and civilians, who are separated by an unshared and
incommensurable experiential background. Such alienation was
highlighted recently among UK veterans who sustained psychological
injuries during combat (Brewin, Garnett, & Andrews, 2011). The
researchers argue that this alienation was the most pressing issue relating
to their mental health and suicidal behaviors. Participants in several related
qualitative studies (Ahern et al., 2015; Brewin et al., 2011; Demers, 2011;
R. T. Smith & True, 2014; Stein, 2017; Stein & Tuval-Mashiach, 2015a),
18 Jacob Y. Stein
repeatedly noted that it is this alienation, in part, that drives veterans to

withdraw from civilians, family included, on the one hand; and at the same
time seek the companionship of other veterans, “brothers in arms” and
experiential partners. From the lonely veterans' perspective, only a network
consisting of such experiential partners may assuage their loneliness, and
only among them they truly belong (e.g., Ahern et al., 2015). In this
respect, the veteran's loneliness is highly bound to their veteran identity as
they are required to make the transition into a civilian identity that is
altogether unfamiliar to them and undesired (R. T. Smith & True, 2014).
This alienation is a signature feature of the veteran's loneliness, for it is
anchored in the alteration of veterans' world views. The shattering of basic
world views, particularly assumptions concerning self-worth and world
benevolence, have been associated with the human reaction to trauma
(Janoff-Bulman, 1992). As Brewin et al. (2011) suggest the alteration of
such world views may be significant when concerning the alienation at
hand in that it keeps the veteran from sharing civilians' preconceptions and
hinders reintegration. However, the crux of this alteration in prior
perspective may be missed when examined via a-relational categories such
as "perception of the world" and "perception of the self". Rather, it may be
more informative to view these changes as an alteration in the perception
of self in relation to the world, particularly that of veterans versus civilians.
As one of the participants in Brewin and colleagues' study (2011) noted,
“our lives are completely alien to civilian lives. I think it always will be a
them-and-us situation” (p. 1737). Civilians do not typically construct their
identities as contrasted to veterans' identities, but the opposite is often true:
veterans define themselves in contrast to civilians.
In a parallel vein, increasing attention is being devoted in the US to the
emergence of a civilian-military gap. Several domains have been
underscored wherein military personnel find that they endorse significantly
different views from the civilian population (e.g., Rahbek-Clemmensen et
al., 2012; Szayana, McCarthy, Sollinger, Demaine, Marquis, & Steele,
2007). Veterans' loneliness, and particularly their sense of experiential
alienation, is closely related to this gap. Nevertheless, to the best of my
knowledge, these have never been explicitly considered in this context.
Undeniably, the reception of the returning veteran by society may

contribute immensely to this sense of estrangement. Unwelcoming, hostile,
rejecting or ostracizing receptions may be the worst in this sense (e.g., after
the Vietnam War; e.g., Figley & Leventman, 1980; Lifton, 1973).
However, the reception does not have to be a hostile one for experiential
isolation to transpire (Caplan, 2011). In fact, for the veteran, the vagaries
of civilian life may be construed as the antithesis of war, and civilians
leading their lives as usual, may be held in contempt and “guilty” of being
apathetic to the war. As some veterans note, “We’ve been at war while the
country has been at the mall” (Sherman, 2015, p. 1). It is the experiential
chasm that opens up between veterans and civilians that matters.
Furthermore, the sensation that civilians are stigmatic about veterans'
posttraumatic reactions may exacerbate the latter's sense of alienation (e.g.,
Caplan, 2011; Brewin et al., 2011). Such stigmas may motivate veterans to
eschew any inclination to reconnect and reintegrate, thus jeopardizing the
formation and reestablishment of adaptive civilian networks.
The veteran's experiential loneliness is also implicated in what may be
referred to as an internal-external discrepancy, wherein veterans wish that
others would share their experiences, and at the same time feel that their
subjectivities must remain confined within the boundaries of their bodies.
Due to shame or fear of society's judgmental gaze and stigmatization,
veterans, at times, invest tremendous efforts in zealously safeguarding their
experiences deep within and simultaneously put on a facade as if all is
well. It is in this respect that L.V noted that, “you keep these feelings
inside and withdraw into them.” The result is often a lack of much needed
authentic expression, silence, withdrawal, and isolation. The loneliness at
hand is then not about the perceived presence or absence of other people or
even about the relation with civilians per se. Rather it is about others'
capacity to relate to certain experiences. Indeed, as loneliness is considered
to be a subjective rather than objective sense of isolation, it is emphasized
in the literature that one may feel extremely lonely even when in a crowd
(e.g., Peplau & Perlman, 1982). As if echoing this realization, L.V noted of
his own lonely experience that, “I have been in large crowds of people at
social events and not felt the presence of a single person.”
20 Jacob Y. Stein
Ultimately withdrawing into the confinements of the self, and fearing

the stigma of mental injury results in the reluctance to seek help (e.g.,
Hoge et al., 2004; Kim, Britt, Klocko, Riviere, & Adler, 2011). Refraining
from help-seeking then adds another layer to the veteran's stratified
experience of loneliness.
The Conviction of Being Alone in Coping
Approaching his final conclusion, Starmann (2015) notes the

following:
All of this adds to the solitary world of the vet. Some are better at
handling life afterwards than others. Some don’t seem affected at all, but
they are. They just hide it. Some never return to normal. But, what is
normal to a vet anymore?
The veteran's loneliness is a stratified experience in which multiple

facets accumulate and create a taxing experiential gestalt. The past and
present emotional turmoil that veterans bear within, the lack of
communicative capacities and opportunities for sharing within an
understanding environment, all amass and give rise to a fifth element,
being alone in coping. As the different facets of experiential loneliness
accumulate, veterans may be convinced that they have no other choice but
to cope alone with the collateral damage of the war. When this conviction
creeps into veterans' minds they become exposed to a whole new gamut of
relational deficits, once again painting the loneliness at hand in new colors.
Here loneliness is demarcated by the need for support in the form of
assistance and guidance, and often also for therapy. Indeed, this sense of
being alone in coping may be part and parcel of what veterans mean when
they speak of being alone (Stein, 2017). Certainly this is the facet of
loneliness which agencies such as the VA and veteran emergency hotlines
refer to when they reach out to veterans and proclaim “you are not alone!”
Notably, coping alone may refer to coping with anything and

everything, from the transition to civilian life and adaptation to it, to the
emotional baggage from the war (e.g., guilt, loss), and up to the psychiatric
symptoms endured on the battlefield (e.g., CSR; Solomon, 1993) or
thereafter (e.g., PTSD). Interestingly, however, both L.V's and Starmann's
accounts do not refer to psychopathology, neither CSR nor PTSD. The
isolated states they share are purportedly representatives of the experience
of (nearly) anyone who has been to war and lived to tell the tale. As Hynes'
(1996) acclaimed titled reads, they represent The Soldier's Tale. As such,
their accounts do not indicate the additional experiential isolation which
may characterize coping with mental injuries or mental illnesses. Indeed,
the complexity of reintegration and the experiential isolation it entails are
challenging for veterans and may warrant counseling also when they are
relatively healthy (Castro, Kintzle, & Hassa, 2015).
It stands to reason, however, that veterans' experiential loneliness may
be exacerbated as their emotional trials and tribulations intensify, and
particularly when these manifest themselves in psychiatric pathology
(Solomon et al., 2015). This is evident, for instance, in Dasberg's (1976)
depiction of the loneliness associated with CSR. Accordingly, treading so
closely to death's grasp, an overwhelming vulnerability and existential fear
may render these combat soldiers ultimately lonely and forsaken. In this
mental state, any sense of belonging and cohesion is torn apart at the seams
as the soldier anticipates his or her approaching annihilation. The
realization that one must inevitably face death alone is a conviction that
one can hardly shake off, and hence it is suggested that it lingers on also
after the shooting is long over (Solomon et al., 2015).
Taking into account the aforementioned civilian-military gap, it is not
surprising that remaining alone in coping is exacerbated by a lack of trust
in civilians (e.g., Kubany, Gino, Denny, & Torigoe, 1994), and particularly
in the care system (e.g., Hoge et al., 2004). As psychiatrist Jonathan Shay
notes, combat “destroys the capacity for social trust” (Shay, 1994, p. 33)
because it shatters the illusion that people are basically benevolent and
good (Janoff-Bulman, 1992). This distrust is directed at one and all, and
may also play a role in veterans' sense of loneliness. Distrust in people is
22 Jacob Y. Stein
magnified when care systems such as the Veterans Health Administration

(VHA) fail to deliver safe, effective, patient-centered care (Kizer & Jha,
2014). The lack of provision of apt care by those who are most responsible
for the veteran's well-being, those who have sent him or her to the war,
may be experienced as institutional betrayals (C. T. Smith & Freyd, 2014),
thus worsening the psychological toll of war.
As studies show, the more people believe they can trust others, the less
isolated and lonely they tend to feel over time (Rotenberg et al., 2010).
Thus, the distrust that may characterize the veteran's post-war experience
may also contribute to feeling alone in coping. Moreover, compared to the
trust that veterans afford each other during and after combat – trust that is
considered as “unparalleled” (Nash, 2007, p. 25) – this new experience of
distrust and the resulting predicament of having to cope alone, may mark
the end product of a trajectory leading from the “brotherhood of veterans”
to a lonely civil detachment.
DISCUSSION
Ultimately, understanding the veteran's loneliness may facilitate apt

interventions and reconnection, as well as direct future research. I will
address these aspects in relation to the multifaceted experience of
loneliness depicted above.
Implications for Intervention and Reconnection
As clinicians consider implications for intervention, the first aspects to

be addressed are the unique as well as the similar features that the veteran's
loneliness shares with other forms of loneliness. The loneliness at hand in
its experientially-bound core is different from other forms of loneliness
(e.g., lack of friends, lack of intimate partner, social exclusion or
ostracism, existential solipsism). Undeniably, the constituents of this
experiential loneliness (i.e., failed intersubjectivity, experiential alienation,
communicative isolation, the internal-external discrepancy, and the sense

of having to cope alone with the aftermath of adversity) may all be shared
by any that have undergone emotional, psychological, or physical
adversities, traumatic or otherwise. As such, much like trauma itself, these
experiences may be part and parcel of the human condition (Moustakas,
1961; Stolorow, 2007), and may concern any who wish to diminish the
trauma victim's loneliness by being an intersubjectively attuned “relational
home” in which severe emotional pain can be held (Stolorow, 2007, p. 10).
The special character of the veteran's post-war loneliness, however, may be
unique also within the more delimited context of traumatic experiences.
This special character lies in the twofold relation it bears to the
interpersonal context wherein it transpires.
First, as noted above, veterans' identities as veterans form in contrast
to the “civilian” identity, which they may eschew (e.g., Smith & True,
2014). Concomitantly, their loneliness also forms in relation to society at
large, and their relational deficits often concern society as a whole. Such
construal may be expected in collective or national traumas wherein
society presumably plays a role in welcoming and ambracing the
traumatized person after the trauma is over. Secondly, veterans' loneliness
transpires against the backdrop of the closely-knit, experientially-
connected, group of comrades. As noted, loneliness invariably manifests
itself as a perceived discrepancy between the person's desired and current
relational connections (Peplau & Perlman, 1982), and the severity of any
experience of loneliness is intensified as this discrepancy grows (Russell et
al., 2012). For veterans, this discrepancy is amplified by the intensity of the
bond they have come to know under the extreme conditions of war, as well
as their conviction that this type of relationship can never be achieved
outside of the military. In this respect, veterans may be different from other
trauma victims (e.g., rape victims, disaster victims) in that they have an
alternative society (i.e., fellow veterans) to which they may compare their
sense of experiential connection and disconnection.
Thus, I would argue from a prospective and preventive point of view,
that as veterans approach the time of discharge, they may benefit from apt
preparation that includes forewarnings concerning the encounter with this
24 Jacob Y. Stein
experiential gap and manners in which it may be adaptively approached

(e.g., Hoge, 2010). Veterans should be informed prior to discharge of the
plausible inclination to reproach civilian society, to withdraw into their
veteran-self, and shun at civilians' expressions of interest. Concomitantly,
veterans may be taught how they might foster more adaptive approaches.
The specific features of the loneliness at hand, however, must also be
accounted for in interventions that strive to facilitate active reconnection
and reintegration after homecoming.
Ultimately, since the veteran's loneliness may be closely tied to the
“veteran identity” and to the experiences constituting that identity, the
focus of intervention must be on assisting veterans in finding their place
within newly acquired civilian social networks while retaining their
veteran identities – once a warrior always a warrior (Hoge, 2010). This
may be done in two complementary avenues. On the one hand,
intervention must provide veterans with the necessary tools to bridge the
experiential gap they experience. They must find a way to challenge the
conviction that society is dichotomously bifurcated into civilians and
veterans. On the other hand, society as a whole, and particularly veterans'
proximate social support networks, must also work to minimize this gap.
This line of thoughts calls into question the mainstream approach to
loneliness reduction interventions.
Loneliness is typically treated in the literature in the terms of perceived
social isolation (e.g., S. Cacioppo et al., 2015). Concomitantly, several
effective interventions have been underscored by the literature. These
include a) altering maladaptive social cognitions, b) increasing
opportunities for social interaction, c) improving social skills, and d)
facilitating social support (Masi et al., 2011). According to Masi and his
colleagues, interventions seeking to alter maladaptive social cognitions are
slightly but significantly more effective than other interventions. This
intervention typically aims to teach lonely individuals to identify automatic
negative thoughts about themselves (e.g., likability, attractiveness) and
their social environment and regard them as hypotheses to be tested rather
than consolidated facts.
The first conclusion to be drawn from the current chapter must be that
the alleviation of veterans' loneliness may necessitate either abandoning
these alternative approaches to loneliness reduction or otherwise adapting
them to its unique features. Altering one's perception of his or her self-
worth or likability, or otherwise simply seeking to meet new people or
learning how to better engage them will not do.
Rather, when seeking to increase social support, for instance, the
support needed may be that of a sincere attempt to understand veterans'
war and post-war experiences. Clinicians, family members and friends who
wish to understand the veteran could, for example, get better acquainted
with the war experience by reading descriptions of it by those who have
experienced it. In this respect, Litz, Lebowitz, Gray and Nash (2016) argue
that clinicians must get familiar with the military culture and the warrior
ethos, as well as the particular meaning that the war had for the veteran,
prior to their attempts to remedy the aftermath of veterans' traumatic
experiences. In a similar vein, support providers might wish to get
acquainted with veterans' perspectives concerning the aftermath of war. An
alternative or complementary route may be educating oneself by consulting
the more scientific literature (e.g., Lyons, 2007). Clinicians would do best
to facilitate and encourage such psycho-education. It is noteworthy,
however, that making an effort to understand the veteran's experience
would ideally be a societal endeavor rather than a task bestowed solely
upon veterans' families or friends. What is ultimately needed is the
cultivation of a society that is committed to listening to veterans' stories
and that would be caring enough to seek to understand their war and post-
war experiences (Caplan, 2011; Sherman, 2015). As Sherman (2015, p. 40)
asserts, “healing after war is a nation’s work.” In this respect, Starmann
(2015) brought the address to an end by stating the following:
So, this Veterans’ Day, if you see a vet sitting by themselves at a

restaurant or on a train or shopping at the grocery store alone, take a
moment to speak with them. Take them out of their solitary world for a
moment. You’ll be happy you did.
26 Jacob Y. Stein
From the other side of the equation, veterans themselves may also
work to minimize the aforementioned experiential gap. When addressing
social skills, veterans may benefit from learning to communicate their
experiences so as to breach their communicative barriers. In their attempts
to overcome linguistic barriers at times of disclosure, veterans may learn to
utilize several linguistic devices that might bring the experience to life and
vivify it so as to have their audiences connect to the experience on an
experiential level (Stein & Tuval-Mashiach, 2017). Furthermore,
addressing maladaptive social cognitions, veterans must learn to trust that
others will apprehend these disclosures to the best of their capacity. They
may also benefit from challenging the conviction that they and the civilian
population are inherently different.
Undeniably, when considering opportunities for positive social
interactions it may be argued that other veterans may be the most apt for
the task of reestablishing experiential-connection. This is because veterans
already share the war and post-war experiences. This may enable an
immediate connection both via veterans' mutual experientially isolated
states and the shared experiences lying in the infrastructure of these lonely
states. This realization has already inspired several veteran-to-veteran peer
support initiatives (e.g., Greden et al., 2010) aiming, among other things, at
reducing fear of stigma, increasing veterans' willingness to seek therapy for
PTSD and ultimately put an end to their insistence to cope alone. Forming
a collective story together may encourage veterans to feel less alone with
their own plight and everyday challenges, find once again the comradery
they had during their time of service, and ultimately drive them to seek
help (Caddick, Phoenix, & Smith, 2015; Hundt, Robinson, Arney, Stanley,
& Cully, 2015). Indeed, some veterans tell their stories particularly to
further this end (e.g., Johnson, 2010; Paulson & Krippner, 2004).
Notwithstanding, the investigation of these interventions is at its
preliminary stages. Thus, while several benefits of peer-support
interventions have been documented (e.g., the facilitation of support and
experiential belongingness), and while their employment has attracted
attention in governmental institutions such as the Department of Veteran
Affairs (VA; Chinman et al., 2008), their effectiveness in lowering PTSD
symptomatology remains undetermined and necessitates further research.

Hopefully, adhering to any of the suggested intervention routes above may
motivate veterans to reconnect in some way, and cease remaining alone
with their experiences.
Limitations and Future Directions
The developmental course of the veteran's loneliness delineated above

is limited in several manners that must be acknowledged. For one, there are
undeniably individual differences in veterans' reactions to war and their
social resilience thereafter. Moreover, the above relates solely to Western
veterans' experiences, primarily ranging from the World Wars (e.g.,
Schuetz, 1945; Waller, 1944) to the present (e.g., Ahern, 2015), and only
among men. The examination of other cultures and societies, as well as the
investigation of women veterans' experiences, may reveal somewhat
different courses in which the veteran's loneliness develops and manifests.
Of primary interest may be societies which differ in respect to norms of
disclosure and sharing of war experiences, or societies wherein civilian-
military gaps may be expected to be less prominent. These may include,
for instance, societies wherein military enlistment is conscription based
(e.g., Israel). Nevertheless, as scholars (e.g., Schuetz, 1945; Shay, 1994,
2002) trace such phenomena back to the time of Homer (9th century B.C.),
it would seem that many aspects of this loneliness may be universally
associated with the warrior's homecoming experience.
Second, in the current explication the prominence of experiential
loneliness has been underscored, and it has been suggested that it is this
form of isolation rather than other forms which veterans might most
readily experience after their participation in war. Nevertheless, there
currently exists no quantitative study wherein the prevalence of this
phenomenon has been empirically investigated. Naturally, veterans may
experience other forms of loneliness, and certainly not all veterans
experience experiential loneliness even when they do experience
experiential isolation. Either they do not perceive their isolation as
28 Jacob Y. Stein
loneliness or otherwise are not bothered by it. Future research should

establish such prevalences.
Finally, several factors may contribute to the manifestation of veterans'
unenviable experience of loneliness. These may include the manifestation
of PTSD or CSR (Dasberg, 1976; Solomon et al., 2015), dissociation from
the self (DePrince & Freyd, 2007), the kind of support one receives upon
return (Solomon et al., 1990), individual trait differences concerning the
need for social sharing, institutional betrayals upon homecoming (e.g., C.
T. Smith & Freyd, 2014), and cultural norms, to name but a few. The
investigation of these and other factors should be pursued in future
research. The first step must be the creation of a valid measurement of
experiential loneliness. Once the experience is better investigated, and its
characteristics become common knowledge, it may be hoped that veterans
will feel a little bit less alone.
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Chapter 2
LONELINESS AND PREFERENCE FOR

SOLITUDE AMONG OLDER ADULTS
Aya Toyoshima, PhD*

Graduate School of Human Sciences, Osaka University,
Suita City, Japan
ABSTRACT
Older adults tend to find it difficult to engage in social activities, as

their social environments can be adversely affected as a result of negative
life events such as bereavements, retirement, and the loss of physical
function. Such individuals also find it difficult to develop new close
relationships in later life. Further, the ratio of time spent alone tends to
increase with age, with studies showing that older adults spend 48% of
their daily lives engaging in solitary activities. However, although there
are some negative factors that enhance loneliness in later life, the levels
of loneliness reported by older adults are not as high as those reported by
other age groups, which is a somewhat paradoxical finding.
Geropsychological studies have determined that older adults manage the
consequences of failure and loss using two strategies: primary control
strategies and secondary control strategies. Primary control strategies
*
Corresponding author: Email: ayat@hus.osaka-u.ac.jp.
38 Aya Toyoshima
refer to individuals’ attempts to change the external world to fit their

personal needs and desires, while secondary control strategies concern
individuals’ inner emotions and involve their efforts to influence their
own preferences. As primary control strategies can be costly, older adults
are more likely to rely on secondary control strategies. Thus, it is possible
that older adults use secondary control to change their preferences and
adapt to the new limitations to their social activities. Meanwhile,
preference for solitude, which relates to a high level of competency in
terms of spending time alone (e.g., feeling positive emotions in such a
situation), may be another important factor in this regard. In this chapter,
developmental change in elderly people in relation to loneliness and
preference for solitude are reviewed; this is achieved by examining the
findings of recent studies, and reconsidering loneliness and the positive
aspects of solitude.
Keywords: preference for solitude, loneliness, subjective well-being, older

adults
1. INTRODUCTION
Research into the loneliness experienced by older adults is important

for promoting general well-being, especially considering the rapidly aging
populations in many countries around the world. In fact, as a result of this
rapid increase in population age, the problems faced by lonely elderly
people are now gaining a great deal of academic attention, especially in
Asian countries. Focusing on Japan, the number of older adults living
alone has increased dramatically, from 17.3% in 1995 to 22% in 2005, and
it is estimated that approximately 25% of older adults in Japan currently
live alone (Cabinet Office, Government of Japan, 2015). The main cause of
this situation is the increased prevalence of nuclear families in the country,
which has resulted in some older adults living alone, without social
interaction with neighbors; thus, older adults often die alone in their
homes, a phenomenon known as “kodoku-shi” (solitary death).
Loneliness and Preference for Solitude among Older Adults 39
1.1. Loneliness and Social Isolation
Before beginning an in-depth analysis of loneliness among older

adults, it would be beneficial to describe the difference between
“loneliness” and “social isolation.”
Since the research of Weiss (1973) and Perlman and Peplau (1981),
which are regarded as the first studies of loneliness, loneliness has become
an important research topic in the fields of personality and social
psychology; specifically, Perlman and Peplau (1981) defined loneliness as
“the unpleasant experience that occurs when a person’s network of social
relations is deficient in some important way, either quantitatively or
qualitatively” (p. 31). More recently, however, loneliness researchers have
determined loneliness to be a subjective perception of social isolation or
negative emotional experience, and a condition that is distinguishable from
objective social isolation (Cacioppo & Hawkley, 2009; Cornwell & Waite,
2009). One of the most widely used (e.g., Lasgaard, 2007; Toyoshima &
Sato, 2017; Wilson, Cutts, Lees, Mapungwana, & Maunganidze, 1992)
instruments for assessing loneliness is the UCLA Loneliness Scale
(Russell, 1996); examples of the items of this scale include: “how often do
you feel that you lack companionship?” and “how often do you feel part of
a group of friends?” This instrument is popular because, while some items
in this scale inquire into social relationships with others, others focus on
whether individuals perceive their social relationships negatively.
In contrast, social isolation refers to a situation in which a person lacks
social contacts. Gierveld and Havens (2004) suggested that “social
isolation relates to the objective characteristics of a situation and refers to
the absence of relationships with other people” (p. 110). Specifically,
sociologists and geropsychologists assess social isolation by analyzing an
individual’s social activities, the members of their social networks, and
their frequency of contact with family members, neighbors, and friends
(Victor, Cambler, & Bond, 2009). In fact, there are numerous indicators of
social isolation: living alone, having a small social network, low
participation in social activities, and a perceived lack of social support
40 Aya Toyoshima
(Berkman & Syme 1979; Dean, Matt, & Wood, 1992; Hawkley, Masi,
Berry, & Cacioppo, 2006; Krause 1987; Thoits & Hewitt, 2001).
Previous studies have found it difficult to distinguish concepts of
loneliness from those of social isolation, mainly because researchers have
varying definitions of these concepts. Moreover, in pathological terms,
loneliness and social isolation have been referred to as negative aspects of
the social relationships of older adults; in conceptual gerontology,
preventing these social diseases tends to be a priority, despite the lack of a
clear definition of the concepts (Victor, Cambler, & Bond, 2009).
Although loneliness relates to an individual’s subjective perception, a lack
of social relationships, similar to social isolation, can also cause this
emotion. This is a primary reason people tend to confuse the concepts of
loneliness and social isolation. Loneliness is a possible outcome when
individuals find themselves having a small number of relationships
(Gierveld & Havens, 2004); however, it is important to note that people
who are socially isolated do not always feel lonely, and that people can feel
lonely even when staying with others in groups or colonies. Consequently,
in this chapter, to avoid confusion with social isolation, the author
describes “loneliness” as a subjective perception featuring negative
emotion.
The cognitive discrepancy model of loneliness (Thibaut & Kelley,
1959) explains the psychological process through which an individual
develops a comparison level for his or her entire network of social
relationships. Such a comparison level can be thought of as representing
the quantity or quality of social contact desired by a person. Russell,
Cutrona, McRae, and Gomez (2012) examined relationships between
desired and actual social contact and loneliness, and found that people who
reported identical levels of desired and actual social contact showed the
lowest levels of loneliness. Further, they also found that loneliness
increases as the actual number of close friends exceeds the ideal number;
therefore, it is possible that people feel lonely when they have more social
contacts than they desire, despite the fact that they are not socially isolated.
1.2. Effects of Loneliness on Physical Health and

Cognitive Function
It has become widely known that loneliness influences physical health;

for example, it has been reported that loneliness is linked to high blood
pressure (Cacioppo et al., 2000) and sleep problems (Hawkley, Preacher, &
Cacioppo, 2011; Pressman, Cohen, Miller, Barkin, Rabin, & Treanor,
2005). However, this seems to be a more severe problem for older adults
than younger generations, as the negative impacts of loneliness on health
have been regularly shown in studies on older adults (blood pressure;
Hawkley et al., 2006; poor sleep quality: McHugh & Lawlor, 2013;
Stafford, Bendayan, Tymoszuk, & Kuh, 2017).
Interestingly, studies have also found that loneliness is a strong
predictor of mortality (Berkman & Syme, 1979; Patterson & Veenstra,
2010; Shiovitz-Ezra & Ayalon, 2010), with higher rates of mortality being
reported among isolated older adults (Luo & Waite, 2014; Perissinotto,
Cenzer, & Covinsky, 2012). For example, Holt-Lunstad, Smith, Baker,
Harris, and Stephenson (2015) conducted a meta-analysis to examine the
effect of loneliness as a risk factor for mortality, and reported that
loneliness predicts mortality, and that it has a similarly strong influence in
this regard as that of social isolation and living alone.
The psychological definition of loneliness is that it is a subjective
perception that has a serious impact on health in later life. Several studies
have found loneliness and the experience of negative emotions to have
impacts on health over long-term periods, although some of the studies that
have produced this finding tend to mix the definitions of loneliness and
social isolation, and more research is needed to obtain a definitive
conclusion in this regard (Ong, Uchino, & Wethington, 2016).
The association between loneliness and cognitive function has also
been analyzed, and these studies have found that loneliness negatively
influences cognitive function (e.g., Cacioppo & Cacioppo, 2014; Zhong,
Chen, Tu, & Conwell, 2017) and is a risk factor of dementia. In an
experimental study, Cacioppo and Hawkley (2009) suggested that
perceived social isolation, which they included as part of the concept of
42 Aya Toyoshima
loneliness, is related to poorer cognitive performance and faster cognitive

decline. Thus, as a risk factor of dementia, it is possible that loneliness has
an interactive relationship with confounding factors such as social activity,
personality traits, and physical health.
In summary, in this section, the author introduced the effect of
loneliness on physical health and cognitive function, which is an important
topic concerning older adults and impacts their ability to enhance their
health and enjoy a successful aging process. From the evidence provided in
this section, it is clear that loneliness must be treated as an evil that should
be excluded from aging societies.
1.3. Psychological Factors of Loneliness
From a psychological perspective, social psychologists have suggested

that maintaining and forming social relationships play important roles in
regard to one’s subjective well-being. However, being isolated from social
groups and experiencing conditions in which one cannot mix with groups
represent crisis states. Experiencing such situations causes us to feel
negative emotions (i.e., loneliness), which prompts us to try to undo our
isolation from society (Cacioppo & Patrick, 2008). Some researchers have
treated loneliness as a means of measuring negative aspects of subjective
well-being (e.g., Toyoshima, Martin, Sato, & Poon, 2017; Windle &
Woods, 2004); furthermore, loneliness has also been associated with
depression (Cacioppo, Hawkley, & Thisted, 2010; Koenig, Isaacs, &
Schwartz, 1994), low self-esteem (Schultz & Moore, 1988), and aggression
(Crick & Grotpeter, 1995; Diamant & Windholz, 1981). It is particularly
difficult to distinguish between loneliness and depressive symptoms
because both concepts concern negative emotions, and feeling lonely is a
symptom of many mood disorders. However, loneliness has been found to
be a significant predictor of changes in depressive symptoms (Cacioppo,
Hawkley, & Thisted, 2010).
Loneliness has also been associated with suicidal ideation and behavior
(Barnow, Linden, & Freyberger, 2004; Goldsmith, Pellmar, Kleinman, &
Bunney, 2002; Waern, Rubenowitz, & Wilhelmson, 2003), and analysis of
psychological processes can explain why individual social perception has
such a strong effect on people’s decisions concerning their own lives.
Although it is distressing that feeling lonely can force people to kill
themselves, most people who feel lonely and/or loneliness do not commit
suicide. Further, such a risk of suicidal ideation is low when we only
experience loneliness in brief episodes during our daily lives; however,
such ideation becomes severe when people feel loneliness for long periods,
as it can develop into depressive symptoms (Cacioppo & Patrick, 2008).
Thus, experiencing severe levels of loneliness has the possibility to create
depressive feelings that develop into suicidal ideation. There is no direct
connection between feeling lonely in daily life and depressive symptoms
and suicide; however, there are individual differences between people in
terms of sensitivity to loneliness, personality, family structure, and
frequency of feeling lonely, meaning the same event could impact some
people more severely than others. Thus, considering that severe and long-
term loneliness can be a risk factor of depressive symptoms and suicide,
this shows that the loneliness people regularly feel in daily life generally
equates to severe loneliness. In other words, there are a number of levels
between the loneliness that occurs in daily social life and the severe
loneliness that enhances the risk of depression, suicide, and even dementia.
The above illustrates that studies have shown that feeling loneliness is
a risk factor for many health problems, including physical and mental
health issues. This is not surprising, because loneliness relates to
undesirable experiences and negative emotions. Innumerable studies have
reported on the negative impact of loneliness on our physical and mental
health, and these findings clearly show the importance of maintaining
subjective well-being in older adults. It is easy to imagine that older adults
face an increased risk of loneliness and require interventions to decrease
loneliness; thus, in aging societies, the problem of loneliness for older
adults represents a large obstacle to enhancing their health and subjective
well-being.
44 Aya Toyoshima
2. AGING PARADOX OF LONELINESS
In the previous section, the author described the negative impact of

loneliness on older adults and emphasized the importance of loneliness
studies in aging societies. However, some studies have reported that older
adults show lower levels of loneliness than younger generations. This
phenomenon also extends to studies concerning the prevalence of issues
relating to developmental changes and social factors. Thus, in this section,
in an attempt to understand loneliness among older adults from a
geropsychological viewpoint, the author reviews methods of explaining
this paradoxical phenomenon.
2.1. Periods of Time Spent Alone Increase with Age
Being isolated from social groups and spending time alone can be
regarded as crisis states related to feeling lonely. As people age, time spent
alone increases and time spent engaging in social activities decreases. In
other words, in comparison to younger adults, older adults spend less time
with others (Carstensen, 2001; Cornwell, 2015; Larson, Zuzanek, &
Mannell, 1986) and less time engaging with their personal networks
(Cornwell, 2015; Horgas, Wilms, & Baltes, 1998).
The ratio of time spent alone tends to universally increase with age,
regardless of whether the person in question is living alone or with a
family, with one study showing that while younger adults spend 29% of
their time engaging in solitary activities, this increases to as much as 48%
among retired, older adults (Larson, 1990). Furthermore, it has also been
found that the variety of activities that older and younger adults engage in
differs. (Marcum, 2013). In later life, people tend to focus on relationships
with people they feel close to (spouse, children, close friends, etc.) and
neglect creating new relationships with others; moreover, they also have
relatively less diverse and more family-centric networks (Antonucci &
Akiyama, 1987). Socioemotional selectivity theory (Carstensen, 2006)
suggests that older adults invest a great deal in maintaining close
relationships and prefer to maintain emotions that are as positive as

possible; this is thought to be because older adults feel that they have a
more limited future than younger adults. The decreasing of engagement in
these social activities with age becomes a risk factor for frequently feeling
lonely.
There are other risk factors concerning enhanced loneliness in later
life. For example, a lack of companionship has been found to be closely
related with loneliness (Blau, 1961; Lowenthal & Haven, 1968), and older
adults also tend to experience the bereavements of close friends more often
than younger adults, which also has a negative impact. Moreover, the
inability to control their personal environments can also cause loneliness in
older adults (Averill, 1973; Schulz, 1976); for example, retirement and the
change of lifestyle it brings is a critical stage for older adults. In such
situations, people are forced to adapt to a drastic change in their lifestyle,
one that they have never experienced before. Another possible trigger of
loneliness is declining physical and mental health. In later life, people
experience a number of negative life events, such as the bereavement of
friends and family members, undesired retirement, and decreasing health,
and these are regarded as risk factors of feeling lonely (Perlman & Peplau,
1981).
Indeed, the quantity of social interactions does not always enhance
subjective well-being in older adults, possibly due to the limitations on
social interactions that arise with age. In essence, older adults tend to find
it difficult to maintain social interaction with others when their social
environments are changed by life events such as bereavements, and they
also find it difficult to create new social relationships.
2.2. Loneliness does not always Increase with Age
Interestingly, while the amount of time spent alone increases as one

ages (e.g., Larson, 1990), for adults aged 65–75 (young-elderly) the level
of loneliness does not rise in conjunction with this increase (e.g., Sörensen
& Pinquart, 2002). Specifically, for middle-aged adults and young-old, the
46 Aya Toyoshima
level of loneliness appears to remain stable, while for the oldest elderly,
those aged over 80, higher levels of loneliness are commonly found
(Sörensen & Pinquart, 2002). In other words, the results of the meta-
analysis conducted by Sörensen and Pinquart (2002) suggest that
loneliness does not increase with age. Further, other studies have supported
this finding by suggesting that loneliness decreases from middle to older
age (Cacioppo et al., 2010). A possible reason for this is that the sources of
loneliness differ between life stages; for example, in early childhood, a
lack of peer friendship is the main source of loneliness, while romantic
relationships are valued more highly during younger adulthood (Qualter et
al., 2015). However, it should also be noted that sources of loneliness are
perceived differently depending on one’s age and culture (Rokach & Neto,
2005).
While studies in various countries have reported that the loneliness
scores for young- old, do not exceed those for children and younger adults
(Toyoshima & Sato, 2017; Yang & Victor, 2011), there are some issues in
regard to methodology and participants that impact these results;
nevertheless, all such studies agree that, with age, the number of social
activities decreases and the risk of loneliness increases. There are three
challenges to explaining this paradoxical phenomenon; that is, that older
adults tend to report lower levels of loneliness than expected. The first is
the methodological challenge. Many loneliness scales have been
developed. For example, the de Jong Gierveld Loneliness Scale (Gierveld
& Tilburg, 2006) and the Social-Emotional Loneliness Scale for Adults
(DiTomasso, Brannen, & Best, 2004) are widely used. Thus, the results of
previous studies have been affected by the researchers’ choice of scale.
This also causes a problem in regard to the validity and reliability of using
multi-generation data, which occurs when the researchers compare
loneliness between older adults and various other age groups (Penning,
Liu, & Chou, 2014). The second challenge is similar to the first, and relates
to the fact that triggers and sources of loneliness differ between age groups
(Qualter et al., 2015). Finally, the third challenge concerns the possibility
that for older adults the association between social activity and loneliness
is weaker than for younger adults. This means that the psychological
process that relates to engaging in social activities and its effects on

loneliness changes with age.
The first and second challenges can be addressed by conducting a
meta-analysis and reviewing the articles of numerous previous studies. In
fact, some researchers are currently attempting to negotiate these
challenges. However, for the third challenge, reviewing geropsychological
studies and theories are necessary. The first and second inform us that
loneliness studies have inherent methodological problems; however, the
phenomenon that older adults tend to report a lower level of loneliness than
younger adults may be true, nevertheless. Consequently, considering this
third issue, in this chapter the author will review some geropsychological
theories that have been posed as possible explanations for the change in
loneliness with increasing age.
2.3. Aging Paradox in Social Relationships
In this work, the author refers to the phenomenon of the level of

loneliness failing to increase with age, despite the risk factors and triggers
of loneliness concurrently rising, as the “aging paradox of loneliness.”
Previous geropsychological studies have reported on this aging paradox,
wherein older adults’ subjective well-being is sustained despite
experiencing various losses such as a decline in physical functions (Gondo
et al., 2006; Löckenhoff & Carstensen, 2004; Mroczek & Kolarz, 1998).
The effect of aging on the relationship between social activities and
loneliness is paradoxical, as negative life events occur more frequently in
later life (such as the bereavement of close friends, the loss of social rules
with retirement, a reduction in the size of social networks, the limitation of
social activities, and increased difficulty creating new social networks and
social roles), but loneliness does not increase with age.
The aging paradox of loneliness is a framework concerning the
concept of loneliness and how it effects the social aspect of aging
individuals. Specifically, this paradox means that researchers focusing on
48 Aya Toyoshima
the psycho-social aspect of aging have not been able to clearly identify the
negative effects in later life.
A factor of the aging paradox of loneliness is that loneliness has a
stronger association with the quality of social relationships than the
quantity of such relationships (Hawkley et al., 2003; Heinrich & Gullone,
2006). Further, the effect the quantity of social relationships and the
reduction of social networks have on loneliness is not direct (Hawkley,
Burleson, Berntson, & Cacioppo, 2003; Sörensen & Pinquart, 2002). As
mentioned earlier, loneliness is a subjective perception of social isolation
that is distinguished from objective social isolation (Cacioppo & Hawkley,
2009; Cornwell & Waite, 2015); however, social isolation is objective and
can be a trigger for loneliness. The negative impacts that objective triggers
that occur as a result of age have on loneliness and subjective well-being
have been found to be weaker than expected (Figure 1).
Life event
E.g., Bereavement of friends
Undesired retirement
Objective variables
Decreasing social activities
Loneliness
Subjective variables
Subjective well-being
Note: The white arrow signifies that the negative effect of objective triggers on
loneliness is weaker than expected.
Figure 1. Aging paradox of loneliness.

3. THEORETICAL FRAMEWORK OF THE AGING PARADOX
Further discussion and theoretical models are required to explain the

paradoxical phenomenon of loneliness among older adults. One reason for
this is that psychological studies examining psychological concepts of
loneliness and gerontological studies examining the relationship between
social activities and subjective well-being have been conducted
independently of each other. Consequently, in this section, some
psychology and gerontology theories are discussed in an attempt to explain
the effect of age on loneliness and social relationships.
3.1. Attachment Styles of Emotional Loneliness
At an early stage of loneliness research, researchers regarded

attachment style (Bowlby, 1969) to be an important factor in this regard
(e.g., Weiss, 1973). In particular, Weiss (1998) suggested that two kinds of
loneliness exist: social loneliness and emotional loneliness. Social
loneliness is defined as a lack of social relationships in group
environments, such as in work and school, while emotional loneliness
relates to a lack of relationships with caregivers, such as partners or
parents. In other words, the former relates to a person’s social network
(e.g., their number of friends) and the latter is influenced by whether the
person has a partner or is married. Weiss (1973), considering these
attachment styles and loneliness, specifically stated that the development
of relationships between parents and children in childhood influences
loneliness during young adolescence.
Attachment styles are classified using the situation procedures
developed by Ainsworth, Blehar, Waters, and Wall (1978). Some studies
have reported that the attachment style adopted in childhood affects levels
of loneliness in adult life (DiTommaso, Brannen-McNulty, & Best, 2004;
DiTommaso, Brannen-McNulty, Ross, & Burgess, 2003). Secure type
(type B of Ainsworth et al.’s (1978) three main attachment styles) children
who develop stable attachment with their caregivers tend to report lower
50 Aya Toyoshima
levels of loneliness than other types, and to develop social skills and
personalities that allow them to develop close relationships with others
after young adolescence. In particular, emotional loneliness is lower in the
secure type and higher in the avoidant type (type A: children who tend to
avoid interaction with caregivers and strangers). Thus, it can be claimed
that attachment style developed during childhood remains stable
throughout adolescence (Kirkpatrick & Hazan, 1994) and is related to
loneliness (Conger, Cui, Bryant, & Elder, 2000).
Mickelson, Kessler, and Shaver (1997) examined the difference age
makes in regard to attachment style, assessing the attachment styles of
participants using the Adult Attachment Interview (Main, Kaplan, &
Cassidy, 1985). By comparing the association between emotional
loneliness and attachment styles, they found that the prevalence of
avoidant type (dismissing of detached) decreased with age. Further,
Kafetsios and Sideridis (2006) also reported that the association between
loneliness and the tendency to be the avoidant type was weaker in older
adults than in younger adults. Therefore, the reasons older adults report
lower levels of loneliness than younger adults may relate to the scarcity of
the avoidant type among older adults and the weakness of association
between loneliness and attachment style in later life. Thus, there is a
possibility that attachment style relates to the aging paradox of loneliness,
although this cannot be confirmed because the studies mentioned above are
cross-sectional and do not specifically identify the effect of aging on
attachment style.
However, attachment theory cannot explain the developmental change
in loneliness after middle-age. Specifically, differences in attachment
styles and association with loneliness do not explain why older adults
report lower levels of loneliness than expected. For example, the
bereavement of parents, and other persons with whom a close attachment is
formed, tend to occur after middle-age. These life events undoubtedly
enhance emotional loneliness; however, levels of loneliness do not show a
related increase at this point. Attachment theory cannot provide an
explanation for this paradox. Moreover, attachment theory is unable to
explain the social loneliness that occurs as a result of a reduction in social
networks and the loss of social relationships caused by negative life events
such as retirement. Instead, attachment theory focuses on relationships in
childhood and is suitable for providing an understanding of the types of
emotional loneliness that may exist in later life. Thus, to provide an
understanding of social loneliness in later life, other gerontological theories
that focus on related changes in social networks and social activities must
be considered.
3.2. Selective Optimization with Compensation
Selective Optimization with Compensation (SOC; Baltes & Baltes,

1990; Baltes, Dittmann-Kohli, & Dixion, 1984) is a gerontological theory
concerning successful aging. SOC theory relates to a framework of
adaptive development that can be employed in response to the losses that
occur during aging, meaning that people use this to maximize gains and
minimize losses in regard to their aging processes. Specifically, this entails
that, in later life, older adults prioritize certain goals over others (loss-
based selection), perform the most suitable actions for accomplishing each
goal (optimize), and compensate for their loss of resources, such as their
decreasing physical and mental functions, by exploiting other available
resources.
To interpret the aging paradox of loneliness in terms of SOC theory,
this would mean that, in order to maintain their social relationships, older
adults use a strategy of focusing on relationships with closely related and
familiar persons and people with whom they can connect easily with when
they encounter difficulties. For young-elderly who are retired, contact with
people in valued relationships (e.g., contact with children in parental
relationships, and contact with partners in marital relationships) has been
found to enhance subjective well-being and positive self-concepts
(Nakahara, 2013). Meanwhile, older adults, who face limitations on their
social activity, tend to focus on more important relationships; i.e., with
people with whom they are close. Therefore, it is the quality of social
relationships and social activities that influences subjective well-being in
52 Aya Toyoshima
later life, not the size of a person’s social network or the degree of social
activities they engage in. Further, older adults have been found to use SOC
strategies to restrain loneliness triggers, particularly those concerning
social loneliness; social loneliness relates to social networks and social
relationships, and older adults tend to experience changes in this aspect as
a result of negative life events.
Heckhausen and Schulz (1993, 1995) suggested that older adults select
goals, strive to attain those goals, and manage the consequences of failure
and loss as a result of age using two strategies: primary control strategies
and secondary control strategies. Primary control strategies refer to
individuals’ attempts to change the external world to fit their personal
needs and desires; an example would be the investment of time and effort
to maintain a close personal relationship. In contrast, secondary control
strategies target individuals’ inner world and involve their efforts to
influence their own motivations, emotions, and mental representations; an
example of such a strategy would be making efforts to care about the loss
of social relationships. Older adults are more likely to rely on secondary
control strategies because of the limitations they experience in terms of
creating new social relationships. Further, there is also the possibility that
older adults increase their use of secondary control strategies and their
recognition of the merits of solitude during their adaptation to the social
limitations that come with age. Thus, primary control strategies cause a
decrease in social activities, while secondary control strategies influence
the negative impact of decreasing social activities as a result of age
(Figure 2).
4. PREFERENCE FOR SOLITUDE
Preference for solitude (PS), a psychological concept in social

psychology, may be an important factor in regard to the aging paradox of
loneliness. PS refers to the degree to which a person prefers to be alone or
the level of competency in spending time alone (Burger, 1995); those who
have a high PS tend to choose to be alone, which suggests that they regard
the time they spend alone as positive. While SOC theory suggests that a
reason older adults do not report higher levels of loneliness than younger
adults is that they use primary control strategy to adapt to their decreasing
social relationships and activities, on the other hand, PS relates to
secondary control strategy and can be useful for measuring changes in an
individual’s inner perception.
An increase in loneliness is considered an undesirable state of being,
and spending time alone has been raised as one of the causes of this
increase. However, some studies have mentioned some positive aspects to
being alone, such as the fact that solitude increases creativity (Storr, 1988),
or that it is necessary to maintain privacy (Bates, 1964). Further, there are
cases where isolating oneself is used as a coping mechanism for heavy
stress (Heinrich & Gullone, 2006). The main problem relating to solitude is
that it entails a lack of social support, but several studies have found
positive aspects (Burger, 1995; Long & Averill, 2003); Leary, Herbst and
McCrary (2003) found that a group with high PS preferred activities that
could be conducted alone, as spending time alone functioned as a pause in
social activities for them.
Burger (1995) concluded that differences between individuals
regarding PS is an important factor in determining whether solitude is a
positive condition for particular persons. PS is a preference indicator that
shows whether one prefers the condition of being alone, and it can also be
considered as “competency spending time alone” (Long, Seburn, Averill,
& More, 2003). Those who have high PS choose independently to be
alone, they tend to regard time spent alone as positive. Long et al. (2003)
divided solitude into three factors: “Inner-directed” (characterized by self-
discovery and inner peace), “Outer-directed” (characterized by intimacy
and spirituality), and “Loneliness.” In particular, inner-directed solitude is
especially beneficial from an emotional standpoint, as it has been found to
be associated with low depression and high self-esteem.
54 Aya Toyoshima
Time spent alone can be divided into two classes: relational and non-
relational. Relational links to the positive aspects of solitude; specifically,
inner-directed and outer-directed factors. Meanwhile, non-relational links
to the negative aspects; that is, feeling isolated and lonely (Averill &
Sundararajan, 2014). A person with a high PS tends to be active when they
are alone and to feel positive when spending time alone, even though their
social activities are decreased. For such people, being alone allows them to
contemplate and increase their intellectual activities and creativity,
meaning PSS can positively influence one’s subjective well-being (Burger,
1995).
When older adults face a crisis, such as through a negative life event,
loneliness is enhanced, and some people adapt to such an event by
changing their inner perception. For example, older adults tend not to
desire a large-scale social network when they are prevented from going
outside as a result of decreasing physical function. As mentioned above, a
person with a higher PS tends to be “relational” when they spend time
alone and to value staying alone (Long & Averill, 2003); this may
influence certain older adults’ increasing use of secondary control
strategies and their recognition of the merits of solitude during their
adaptation to the social limitations that come with age. Thus, considering
this theoretical background, it can be said that developmental changes
relating to PSS are indicators of changes in the value of social interactions
with others caused as a result of the adoption of secondary control
strategies.
There is a degree of evidence supporting the theory that older adults
tend to have different levels of preference in comparison to younger
generations. For example, Toyoshima and Sato (2017) examined whether
PS promotes emotional well-being in older adults and college students;
their results showed that older adults reported both a higher level of PSS
and a lower level of negative emotion than the college students. Further,
Pauly, Lay, Nater, Scott, and Hoppmann (2016) reported that temporary
solitude is linked to more favorable mental health in older adults. Thus, it
can be concluded that temporarily spending time alone is an experience
that is not necessarily negative and may become more positive with aging.
Life event
E.g., Bereavement of friends
Undesired retirement
Objective variables
Primary control
Decreasing social activities strategy
Secondary control
strategy
Loneliness
Subjective variables
Subjective well-being
Figure 2. The theoretical model of the aging paradox of loneliness.
5. AVENUES OF RESEARCH FOR FUTURE STUDIES

PSS is a psychological factor that explains the aging paradox of
loneliness; however, further study is required on this topic. In this chapter,
the author showed that loneliness among older adults is an important topic
in aging societies, and also discussed an interesting phenomenon, the aging
paradox of loneliness, which concerns the finding that older adults report
lower levels of loneliness than expected. This final section describes
avenues of research for future studies concerning the developmental
changes associated with PSS.
First, a behavioral model is required to differentiate between those who
are at risk of developing loneliness and those who are not. A challenge
here is that it is difficult to identify when a person requires help in regard
to their loneliness, because loneliness is a subjective perception. Further,
socially isolated older adults do not always feel lonely. When such
individuals desire to remain alone and do not wish to receive support, there
56 Aya Toyoshima
is little that a caregiver can do. PS is a preference and psychological factor

and does not relate to whether a person wants to be isolated or if they are
taking risks by isolating themselves. Consequently, to identify whether the
person is unhealthy and exposed to risk, a definition or assessment tool that
measures behavior would be effective. Distinguishing between positive
solitary behavior and negative solitary behavior is important to define the
existence of loneliness. To develop such an assessment tool, examining the
daily activities of older adults with high levels of PS and who maintain
subjective well-being is necessary.
Second, interventions for isolated older adults with high levels of PS
are urgently required. Some social isolated older adults who prefer to be
alone tend to avoid receiving support from others. Some existing
intervention programs for social isolation focus on enhancing social
communication and developing new relationships with others; however,
isolated older adults with higher PS may be passive towards participating
in these interventions and social activities, even though they are exposed to
risk and are the primary targets of the program. It is important to determine
the interest of such people in order to convince them to participate in
intervention programs.
Finally, understanding how older adults overcome loneliness and adapt
to decreasing social relationships would be useful for providing effective
information for younger generations. Intrinsically, many younger adults
report feeling lonely and are exposed to a high risk of loneliness.
Researchers and politicians tend to focus on isolated older adults; however,
younger generations should be set as the main targets in regard to
initiatives that address the problem of loneliness. The strategies and
behaviors that older adults employ to maintain their subjective well-being
may also apply to other age groups who are distressed concerning their
social relationships with others.
ACKNOWLEDGMENTS
The concept of this article is based on the author’s doctoral thesis:
“Toyoshima, A. (2015). Kodoku kan no aging paradox to taisyo horyaku ni
kansuru kenkyu. Doctoral Thesis, Graduate School of Human Sciences,

Osaka University, Japan” (in Japanese).
To conduct this study, I received advice from Professor Shinichi Sato
and Associate Professor Yasuyuki Gondo from Graduate School of Human
Sciences, Osaka University, and I would like to express my sincere
gratitude to them for their assistance. Further, I would like to thank Editage
(www.editage.jp) for English language editing.
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Chapter 3
LONELINESS AND SUICIDE
Rebecca L. Kauten, PhD,

Jessica M. LaCroix, PhD, Amber M. Fox
and Marjan Ghahramanlou-Holloway, PhD
F. Edward Hébert School of Medicine,
Uniformed Services University of the Health Sciences.
Bethesda, Maryland
ABSTRACT
Loneliness has been conceptualized both as an objective state of

physical alienation and a subjective state of distress due to feeling alone.
The construct of loneliness has been empirically linked with a variety of
mental health conditions including depression, hopelessness, suicide
ideation, and/or suicide-related behaviors. This chapter examines

Corresponding Author: Marjan Ghahramanlou-Holloway, Ph.D. Associate Professor,
Department of Medical and Clinical Psychology; Psychiatry. Director, Suicide Care,
Prevention, and Research (CPR) Initiative. F. Edward Hébert School of Medicine.
Uniformed Services University of the Health Sciences. 4301 Jones Bridge Road, Room
B3046. Bethesda, Maryland 20814-4799. Telephone: 301-295-3271. Fax: 301-295-3034.
Email: marjan.holloway@usuhs.edu. Additional email: mholloway@usuhs.edu.
68 Rebecca L. Kauten, Jessica M. LaCroix, Amber M. Fox et al.

More specifically, we review how ambivalence resulting from competing
drives of connectedness, authenticity, and self-protection may contribute
to loneliness and explore manifestations of loneliness and suicidality
during childhood, adolescence, young adulthood, middle adulthood, and
older adulthood. Intervention strategies to address loneliness in the
context of suicide are explored, and recommendations for clinical practice
and future areas of empirical inquiry are presented.
INTRODUCTION
Conceptualizations of loneliness tend to differentiate between

“subjective” and “objective” loneliness. Subjective loneliness relates to
feeling alone and socially isolated (Russell, Peplau, & Cutrona, 1980),
while objective loneliness involves physical alienation such as living alone
or not having friends (Stravynski & Boyer, 2001). Subjective and objective
experiences of loneliness are somewhat analogous to emotional and social
typologies of loneliness, the former associated with lack of intimacy and
attachment and the latter associated with lack of a social network (Russell,
Cutrona, Rose, & Yurko, 1984; Weiss, 1973). Loneliness has also been
defined as the “unpleasant experience that occurs when a person’s network
of social relationships is significantly deficient in either quality or
quantity” (Perlman & Peplau, 1984, p. 15).
Loneliness is thus described as (1) a perceived discrepancy between
one’s needs or desires for social contact and one’s actual social contact, (2)
a subjective rather than objective experience, and (3) as distressing.
Feelings of loneliness may vary over a period of hours as evidenced by a
study capturing one’s experience via ecological momentary assessments
(Kleiman et al., 2017). Furthermore, loneliness may be more or less
distressing at various developmental time points due to differences in
context and desire for social relationships. Distress due to loneliness can
therefore contribute to various mental health issues across the lifespan
including depression, hopelessness, suicide ideation, and/or suicide
behavior (Chang et al., 2017; Kleiman et al., 2017; Lasgaard, Goossens, &
Elkit, 2011; Stravynski & Boyer, 2001).
Loneliness and Suicide 69
THE NEED TO BELONG
Human beings have a fundamental need to belong (Baumeister &

Leary, 1995; Maslow, 1943). Intimacy demands are critical and represent
the layer of essential needs beyond physiological and safety requirements
(Maslow, 1943). Belongingness is more than a desire; it has been presented
as a necessary ingredient for a fulfilling life (Heinrich & Gullone, 2006)
and evolutionarily advantageous (Baumeister & Leary, 1995). It also
demands reciprocal support; providing social support to others is a critical
component of belonging (Cacioppo, Grippo, London, Goossens, &
Cacioppo, 2015). Failure to meet the need to belong can inhibit self-esteem
and self-actualization (Maslow, 1943) and can contribute to loneliness,
which when experienced at intense levels, can lead to depression and
suicidal thoughts (Chang et al., 2017; Kleiman et al., 2017; Lasgaard et al.,
2011).
The interpersonal-psychological theory of suicide highlights the
importance of belongingness in one’s desire to live or die (Joiner, 2005;
2009; Joiner, Brown, & Wingate, 2005). Perceived burdensomeness and
thwarted belongingness are key factors that influence one’s decision to
attempt suicide. Perceived burdensomeness is defined by the belief that
one’s existence is a burden on those around him or her, e.g., “I think my
death would be a relief to the people in my life” (Van Orden, Witte,
Cukrowicz, & Joiner, 2012). This concept is distinct from Perlman and
Peplau’s (1984) conceptualization of loneliness, i.e., a perceived
discrepancy between one’s needs or desires for social contact and one’s
actual social contact. In contrast, thwarted belongingness reflects a sense
of social alienation and a feeling that one does not belong to a larger group,
e.g., “I often feel like an outsider in social gatherings” (Joiner, 2005; Van
Orden et al., 2010), and is more similar to loneliness (Kleiman et al.,
2017). Nonetheless, the link between thwarted belongingness, loneliness,
and suicide is inconsistent, perhaps due to measurement discrepancies (c.f.,
Joiner & Rudd, 1996; Stravynski & Boyer, 2001; Van Orden et al., 2008).
A COGNITIVE BEHAVIORAL CONCEPTUALIZATION

OF LONELINESS
The cognitive behavioral model delineates that thoughts, feelings, and

behaviors are interrelated and influence one another. Any one of the
component facets – cognition, emotion, or action – has the capacity to
influence the others. The cognitive behavioral model is useful in
conceptualizing loneliness (c.f., Heinrich & Gullone, 2006). First, the
definition of loneliness described above depends on the cognitive
perception of a mismatch between the social relationships one has and the
social relationships one needs or wants (Perlman & Peplau, 1984), and
lonely individuals may distort their cognitive perceptions of the world. For
instance, lonely people may view social interactions through a negative
filter (Ernst & Cacioppo, 1999), or perceive the world as more threatening
than people who are not lonely (Hawkley et al., 2003). Lonely people also
often think poorly of themselves (i.e., have low self-esteem) (Peplau,
Miceli, & Morasch, 1982) and may think they are a burden to others, e.g.,
“I think I make things worse for the people in my life” (Van Orden et al.,
2012). Lonely people may employ selective attention and attend
exclusively to evidence that supports a lack of closeness and willingness of
family and friends to provide emotional help. In addition to the inability to
recognize support being offered by others, individuals in a depressive state
may be unable to evoke memories of supportive others while in crisis
(Adler & Buie, 1979).
Loneliness, though distinct from depression, has been shown to
increase the likelihood of depression (Cacioppo et al., 2015). Thus, a
lonely person may have depressive thoughts, characterized by negative
cognitions about the self (e.g., “I am not good company. Who would want
to spend time with me?”), the world (e.g., “No one in the world cares for
me”), and the future (e.g., “I will always be alone”) (Beck, 1970). These
thoughts, in turn, may perpetuate feelings of loneliness.
Affectively, loneliness involves a subjective feeling of distress. Many
lonely people experience feelings associated with desperation (e.g.,
panicked, helpless, hopeless), depression (e.g., sad, empty, alienated),

impatient boredom (e.g., bored, uneasy, angry), and self-depreciation (e.g.,
unattractive, ashamed, insecure) (Rubenstein & Shaver, 1982). Finally, as a
result of negative thoughts and emotions, lonely people may behave in a
passive and ineffective manner (e.g., may be shy, avoid engagement with
others). Lonely people may also be stigmatized, derogated, and avoided,
which in turn may perpetuate their loneliness (Ernst & Cacioppo, 1999).
Loneliness has also been linked with insomnia, though the relation
becomes insignificant when accounting for depression (Hom et al., 2017).
Insomnia, a symptom of depression, may enhance one’s feelings of
loneliness. When someone is awake in the middle of the night, they have
more time to dwell on their state of alone-ness. If the cycle of intrusive
negative thoughts, overwhelming negative feelings, and social withdrawal
continues, an individual’s loneliness may contribute to psychopathology
and beget depression, hopelessness, and thoughts of suicide.
LONELINESS AND SUICIDE ACROSS THE LIFESPAN
Erik Erikson’s (1963) theory of psychosocial development emphasizes

completion of relational milestones in order to successfully and adaptively
progress through life. From developing trust in others to cultivating
intimacy within relationships to fully accepting the people within one’s
life, the focus of Erikson’s psychosocial model of development centers on
overcoming interpersonal challenges. For an individual to successfully
progress through Erikson’s model, the individual must achieve social
effectiveness throughout each developmental stage. Failure to successfully
complete the tasks demanded by each psychosocial stage generally leads to
isolation and, likely, loneliness (e.g., mistrust, shame, guilt, inferiority, role
confusion, isolation, stagnation, and despair). This loneliness manifests
uniquely at various developmental time points and is influenced by age,
maturity, contextual demands, experience, and more. Each stage may thus
give rise to particular manifestations of loneliness that may then be
associated with suicidal thoughts and behaviors within each developmental

stage.
Childhood: Birth to 12 Years
Erikson’s first stage of psychosocial development lasts from birth to

about 18 months. Interpersonal reliance on others begins at birth when the
infant encounters the psychosocial crisis of trust versus mistrust. Here, the
infant learns whether or not he or she can trust others. Infants who are
cared for consistently and reliably will develop a sense of trust that will
form the basis of future relationships. Successful completion of this stage
leads to hope – when additional needs arise, the individual will have hope
that those needs will be met. Conversely, if this stage is not successfully
completed, the individual will move on with the fear that his or her needs
will not be met. Mistrust and fear may contribute to anxiety and insecurity
– and eventually a sense of loneliness.
The second psychosocial stage lasts from about 18 months to 3 years.
Here, the crisis presented is autonomy versus shame and doubt. During this
stage, the child tests his or her limits and develops a sense of autonomy
and confidence, ideally with the support of caregivers who allow the child
to make and learn from mistakes. Successful completion of this stage leads
to individuals who are supported and encouraged – to build confidence.
Conversely, if this second stage is not successfully completed, the
individual will feel ashamed and doubt his or her abilities. Shame and
doubt may contribute to poor self-esteem and heightened dependence.
The crisis of initiative versus guilt characterizes the third stage, which
lasts from ages 3 to 5 years. During this stage, the child experiments with
interpersonal play with peers. The child also begins to take initiative and
ask questions. Success during this stage results in purpose; individuals will
develop a sense of comfort and competence in interpersonal relationships,
while criticism and restriction during this stage leads to guilt and lack of
initiative.
The final stage of childhood stage involves the crisis of industry versus
inferiority and lasts until the child is 12 years old. During this stage, the
child seeks acceptance from authority members (e.g., teachers) and peers
by displaying competency and adhering to societal standards. The child
relies on his or her sense of autonomy and encouragement from others in
order to successfully complete this stage, the result of which is feeling
competent and industrious. When the individual is not encouraged or is
restricted, he or she will feel inferior compared to others. It is evident in
this fourth stage that Erikson meant for the stages to be completed
sequentially; they build upon one another, and failure to successfully
complete an early stage can lead to difficulties in later stages. However,
researchers have also argued that the progression through the stages is not
necessarily linear, and individuals may decompensate backward through
the stages at any time (Whilbourne, Zuschlag, Elliot, & Waterman, 1992).
Research related to loneliness and suicide in childhood is scant, and
there is no available evidence-based treatment that is specifically targeted
at managing suicidal ideation and urges in youth. However, it seems as
though both maternal depression and low perceived parental support
emerge as factors influencing childhood suicidal ideation and urges
(Anderson, Keyes, & Jobes, 2016; Sarkar et al., 2010; Whalen, Dixon-
Gordon, Belden, Barch, & Luby, 2015). Both of these factors are linked to
insecure attachment (Teti, Gelfand, Messinger, & Isabella, 1995; Yan,
Han, Tang, & Zhang, 2017). Insecurely attached children tend to become
upset regardless of whether or not the parent is present in the strange
situation paradigm (Ainsworth & Bowlby, 1991). The fact that these
children are not comforted even when the parent is present suggests a lack
of reliable attachment and could represent that the child’s needs, namely
those for connection, are not being met at home.
Furthermore, insecure attachment patterns tend to extend to peer
relationships, and individuals displaying such patterns are often faced with
peer rejection in early childhood, when these relationships are formative
(Ernst & Cacioppo, 1999). In other words, lonely individuals are often
rejected, which then perpetuates the lonely feelings. Lack of social support
from peers and family lays the foundation for more feelings of loneliness.
The loneliness that manifests in early childhood is related to suicidal

behaviors in middle childhood (Schinka, VanDulmen, Bossarte, & Swahn,
2012). For prepubescent children ages 10 through 14, suicide is the third
leading cause of death (Centers for Disease Control and Prevention, 2016).
Overall, when one’s trust, autonomy, initiative, and industry are being
developed in relation to others, the absence of meaningful social
connection can be devastating.
Adolescence: 12 to 18 Years
The four developmental stages found in childhood provide the

foundation for the fifth stage, characterized by the psychosocial conflict of
identity versus role confusion. This stage lasts through adolescence, from
12 to 18 years. In contrast to the focus of reliance on other people found in
the childhood stages, individuals in the fifth stage are expected to connect
with, rather than rely on others. During adolescence, the individual
develops an identity that is inherently built in relation to other people. This
stage is marked by recognition of one’s sexual orientation, falling in love,
and experimenting with various interpersonal and occupational roles.
Successful completion of this stage leads to fidelity – the individual is able
to accept others and commit to others. Failure to complete this stage results
in identity crisis or role confusion, a vague and shifting chameleon-like
sense of self, and enhanced susceptibility to peer influence.
Peer relationships become even more critical during adolescence, when
teens are developing their identities in relation to others. Whereas
childhood relationships are built on shared activities, adolescent
relationships prioritize intimacy (Heinrich & Gullone, 2006). Lacking
intimacy during adolescence contributes to feelings of loneliness and
hinders identity formation. Additionally, adolescents spend a large portion
of the week in school. Thus, a lack of social support is punctuated by the
necessity of being in an inherently social location without feeling
connected; the adolescent is not physically alone but may experience
subjective feelings of loneliness.
Up to 79% of individuals under 18 years old report occasional to

frequent feelings of loneliness (Parlee, 1979). Although not all of these
individuals later attempt suicide or even have suicidal thoughts, feeling
lonely still has negative implications. Given the emphasis placed on
relational effectiveness during adolescence (Erikson, 1963), a lack of
connection could prime someone for loneliness. During adolescence,
loneliness can be experienced on multiple levels: lack of supportive peer
network, feelings of incongruence with peers, disconnection from parents,
perceptions of being misunderstood, with the added weight of a general
inability to see beyond the present moment. Additionally, chronically
lonely adolescents have been found to be hypersensitive to social exclusion
and hyposensitive to social inclusion. They also tend to attribute social
exclusion to stable, internal factors and social inclusion to external factors,
indicating a tendency to respond to situations in a way that perpetuates
loneliness (Vanhalst et al., 2015).
Minor difficulties often seem to be monumental and insurmountable
during adolescence. Loneliness during this developmental period is
associated with depression, which has been shown to account for the
correlation between loneliness and suicide (Lasgaard et al., 2011; Schinka
et al., 2012). Additionally, to the extent that gender differences exist in
relation to loneliness, adolescent males tend to report greater levels of
loneliness than do females (Heinrich & Gullone, 2006). Although females
are more likely than males to have suicidal thoughts, males die by suicide
almost four times more frequently than females, and suicide is the second
leading cause of death among adolescents and young adults between the
ages of 15 and 34 (Centers for Disease Control and Prevention, 2015;
2016). Further, the suicide rate among teens of both genders has been
rising over the past decade, up 31% for males and doubling for females
(Scutti, 2017). Addressing loneliness and social isolation could be an
avenue of suicide prevention within this particular age group.
Young Adulthood: 18 to 40 Years
The sixth stage of psychosocial development is young adulthood,

lasting from age 18 to 40 years. The conflict for this stage is intimacy
versus isolation. During this period, individuals seek lasting relationships,
including romantic relationships and long-term friendships. Successful
completion of this stage leads to love. Failure to create intimate
connections and fear of commitment leads to isolation, lack of
connectedness, and can contribute to depression at this stage. Here again, it
is apparent that failure to successfully complete previous stages can impact
resolution of the intimacy versus isolation conflict. Mistrust, shame, doubt,
guilt, feelings of inferiority, and identity crises can all negatively affect
intimate relationships during young adulthood and hinder completion of
this stage.
The goals of young adulthood and each subsequent developmental
stage build upon the sense of support and industry that were established
during childhood. During young adulthood, individuals often settle into
intimate romantic relationships, and they sometimes marry and start
families. Additionally, young adulthood marks a period of work
productivity during which networking and making connections is valuable
for later professional growth.
Young adulthood is also a period of significant change. Individuals
enter and graduate from college, experiment with various relationships,
and sample a variety of jobs. Within college, people choose their major,
extracurricular activities, living situation, and friendships. Many young
adults move out of parents’ homes to live on their own, which adds an
element of physical isolation. Similar to adolescence, the social nature of
the systems in which young adults operate almost necessitates
interpersonal interaction. As a result, lacking social interaction is apparent
and can be distressing.
Situational changes, both dramatic and small, can influence one’s
feelings of loneliness (Ernst & Cacioppo, 1999). The overwhelming nature
of the change itself can be magnified when the individual does not have an
adequate support system. Negative life events in particular can interact
with loneliness and contribute to suicide risk above and beyond the
individual effects of negative life events or loneliness (e.g., sexual assault,
Chang et al., 2015). Furthermore, with the explosion of social media,
constant momentary updates, and compulsory comparison through multiple
portals, it is much easier to recognize when one is being excluded. It is not
surprising, then, that when considering college students who reported a
history of suicidal ideation, loneliness was often cited as a cause
(Westefeld & Furr, 1987).
Middle Adulthood: 40 to 65 Years
The seventh stage of psychosocial development, middle adulthood,

lasts from age 40 to 65 years. The conflict inherent in this stage is
generativity versus stagnation. In this stage, the individual strives to
contribute to society in a useful way, and feeling connected to others as
part of the broader society is a key motivator. Successful completion of
this stage results in care for future generations and social institutions.
However, stagnation results from feelings of uselessness and may be
accompanied by social withdrawal as well as a variety of escapist
behaviors including drug and alcohol use and infidelity.
Middle age is characterized by a sense of stability compared with
young adulthood. By middle adulthood, individuals generally have
established social networks and have learned how to meet their needs for
social interaction. Individuals in middle adulthood tend to be settled in
marriages, friend groups, jobs, and have found routine in their daily lives
(Ryff 1989; Tornstam, 1992; Wrzus, C., Hänel, Wagner, & Neyer, 2013).
The stability that often comes with middle age may contribute to the
decreased loneliness reported at this developmental stage (Pinquart &
Sorensen, 2001). Additionally, feeling needed by others is key in this stage
of development, and research has found that individuals who provide
support to friends and family have fewer depressive symptoms and less
stress (Fiori, & Denckla, 2012; Takizawa et al., 2006). In addition,
individuals who feel needed are unlikely to perceive themselves as
burdensome, a key risk factor for suicide ideation (Joiner, 2005). However,
middle aged adults are likely to experience loneliness in the absence of
others (Hawkley & Cacioppo, 2010), especially when stability in their
social networks is disrupted. In situations that force isolation, like being
diagnosed with a physical disability that inhibits social activity, living
alone, going through divorce, or developing a life-threatening illness that
forces unexpected loss of employment, middle aged adults experience
increased loneliness (Lasgaard, Friis, & Shevlin, 2016), and perceived lack
of social support is associated with depressive symptoms among this age
group (Fiori, & Denckla, 2012).
Although suicide is the second leading cause of death for adolescents
and young adults, more people die by suicide in middle or late adulthood
than in adolescence or young adulthood. In the U.S. in 2015, 16,490 people
between the ages of 45 and 64 died by suicide compared with 12,438
people between the ages of 15 and 34 (Centers for Disease Control and
Prevention, 2016). The suicide rate among adults between 45 and 64 years
of age is 19.6 per 100,000 compared with a rate of 12.5 per 100,000 among
adolescents and young adults between 15 and 24 years of age. Further,
suicide rates among middle adults have been increasing, up from 13.5 per
100,000 in 2000 to 19.6 per 100,000 in 2015 (American Foundation for
Suicide Prevention, 2017). Notably, between 1999 and 2015, rural White
Americans between the ages of 45 and 54 had the highest increases in
“despair deaths” (Case & Deaton, 2015), i.e., death due to suicide,
poisoning, and liver disease, than any other group (Stein, Gennuso,
Ugboaja, & Remington, 2017). This group experiences economic stress
and hopelessness (e.g., stagnation) (Erikson, 1963) that contributes to
dysfunction in relationships, poor social support, and escapist use of drugs
and alcohol (Case & Deaton, 2017).
Old Age: 65 Years and Beyond
The eighth and final stage of development is old age and lasts from age
65 to death. Integrity versus despair constitutes the final conflict in
Erikson’s psychosocial development theory. According to Erikson (1980),

integrity is “the acceptance of one’s own and only life cycle and of the
people who have become significant to it as something that had to be and
that, by necessity, permitted of no substitutions” (p. 104). To successfully
complete this stage, the individual must find acceptance of his or her life,
including acceptance and connection with the people in it, and develop a
sense of control over what is to come. Failure to integrate one’s identity
with one’s experiences leads to despair, regret, and contempt for other
people.
Loneliness seems to be felt more acutely in old age. Beyond age 65,
one’s social circle and support system begins to shrink. Older adults are
more likely to lose the close relationships of spouses, friends, and family to
death, leaving older adults with a withering social network and fewer
opportunities for social engagement (Pinquart & Sörensen, 2001). Older
adults whose spouses pass away show some of the greatest increases in
loneliness (Dykstra, van Tilburg, & de Jong-Gierveld, 2005).
As adults continue through older adulthood, they are faced with
declining physical health, death of loved ones, separation from family and
friends, and consequently a degenerating ability to engage in social
activities (Barlow, Liu, & Wrosch, 2015; Dykstra et al., 2005). Being
unable to socialize with friends because either the individual or the
individual’s friends are incapacitated decreases older adults’ ability to
engage in social activity and increases their likelihood to experience more
severe loneliness. In a society lacking significant institutional support and
integrated activities, along with a growing reliance on novel and shifting
technology, older adults may feel increasingly alienated and marginalized.
Consequently, this group is particularly at risk for loneliness (Crocker,
Clare, & Evans, 2006; Victor & Yang, 2012).
During the period of old age, elderly adults may have several rights
revoked. They may have driving privileges removed, could be placed in a
nursing home where they have little opportunity to make their own
decisions, and another person may be given guardianship or power of
attorney over them. Accordingly, older adulthood is associated with
conditions that decrease one’s ability to engage in social activity (Barlow,
Liu, & Wrosch, 2015; Dykstra et al., 2005; Pinquart & Sörensen, 2001).
This decreased social activity may be related to the feelings of loneliness
experienced by older adults. With these circumstances, the older adult
likely perceives little control over his or her own life and may develop a
sense of perceived burdensomeness and/or thwarted belongingness as
though their place in the world is narrowing. These individuals feel
separated not only from individuals but also from the world at large.
Quality of relationships becomes more valuable than quantity (Pinquart &
Sorensen, 2001).
In one particular qualitative investigation, several older adults who had
attempted suicide provided their rationale for their decision (Crocker et al.,
2006). Several themes emerged, including feelings of invisibility and a
struggle to maintain control over their lives. When these individuals felt
separated from and ignored by society and helpless to change their
situation, they attempted suicide as a way of gaining control over some
aspect of their lives. Very old adults have the second highest rate of
suicide; adults aged 85 and older have a rate of 19.4 per 100,000
(American Foundation for Suicide Prevention, 2017).
Ultimately, the sense of losing control is a key contributor to rationale
for attempting suicide in older adults; it is also a factor that influences
feelings of loneliness. Adults that feel they have control over their (social)
lives and can influence their experience with personal effort tend to feel
less lonely than those that believe that only external factors influence their
reality (Newall, Chipperfield, Clifton, Perry, Swift, & Ruthig, 2009).
Unfortunately, this control is often lost with age, and older adults living in
nursing homes tend to be at higher risk for loneliness (Pinquart &
Sorensen, 2001).
LONELINESS ACROSS THE LIFESPAN:

CONTEXT AND CAVEATS
Several factors are important to keep in mind when considering the
manifestation of loneliness across Erikson’s developmental stages. First, it
is helpful to conceptualize the relation between loneliness and suicide as

part of the cognitive behavioral model. As mentioned above, cognitive
behavioral theory posits that thoughts, feelings, and behaviors are
interdependent. These factors can sometimes operate on a feedback loop,
whereby thoughts result in feelings that drive behaviors, which in turn
perpetuate and maintain the valence of the thoughts, feelings, and so on.
For example, an adolescent or young adult may notice that they were not
invited to a party that was photographed and broadcasted on social media
and think, “I am being left out. I have no friends. I don’t fit in.”
Consequently, the individual may feel lonely and isolated. The individual
may shut down and refuse to share his or her thoughts or feelings, even
within their intimate relationships. The individual may be hypervigilant to
negative feedback and may notice that close friends and family did not
acknowledge his or her withdrawal and mood change. As a result, the
individual may think, “No one notices when I’m upset. I guess I really
don’t have anyone that cares about me.” Consequently, the cycle of
loneliness is maintained. Individuals who experience loneliness may then
engage in behaviors that incite further rejection and loneliness per the self-
fulfilling prophecy (Merton, 1968).
The second factor to keep in mind when considering the manifestation
of loneliness across Erikson’s developmental stages is ambivalence toward
other people. By ambivalence, we mean competing desires for (1)
closeness with others, and (2) independence from others. This ambivalence
is a result of competing drives: the drive for connectedness, the drive for
authenticity, and the drive for self-protection. The drive for connectedness
is that from which loneliness originally stems; individuals are compelled
by an innate desire for intimacy, and they feel lonely when that need is not
met. The drive for authenticity stems from Erikson’s sixth stage, identity
versus role confusion. In this stage, individuals want to be accepted, but
the drive for connectedness may be at odds with the drive for authenticity,
and people may hide their true selves in order to be accepted. Alternately,
the individual could prioritize authenticity, seeking the invitation for
intimacy from others but ultimately choosing to be alone if that
connectedness requires inauthenticity. Finally, and potentially most
problematic, the drive for self-protection may serve as a defense

mechanism against loneliness. If an individual perceives rejection from
others, for instance, he or she may respond defensively and conclude that
he or she does not in fact desire connection with others. The individual
may adopt a mentality of rejecting others before they themselves can be
rejected. It is thus possible to simultaneously want to be accepted by others
while spurning advances of those who seek to connect with us.
The third factor to consider while exploring loneliness in the context of
Erikson’s stages is that within cultures that value independence and self-
reliance, it can be difficult to acknowledge that it is sometimes necessary
to rely on other people. When one does inevitably need support or
assistance, he or she may be embarrassed and may perceive themselves as
weak or ineffective, which can lead to self-hatred and suicidal ideation in
extreme circumstances. For instance, one participant in our clinical trial of
Post Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway,
Cox, & Greene, 2012; Ghahramanlou-Holloway, Neely, & Tucker, 2014)
explained their thought processes while considering seeking help for
suicidal thoughts: “They asked me if I wanted to talk on the phone with
them, I really didn’t, because then at that point it’s personal, when you hear
someone’s voice and their inflection and that kind of thing… If I had to
talk to another person at those moments when I’m ready to kill myself, it
would have been too much to emotionally bear.” The participant further
explained that, “the issue that arose that prompted these thoughts alienated
me from my family because I was too embarrassed to tell [them] what
happened. So I think that’s what the difficult thing was in my situation …
who do I turn to when I have something so embarrassing when all I have
are very close peers.” Another participant reported that, “I don’t really
reach out to people because I don’t feel like wanting to be burdensome to
the other people, and I don’t want to disappoint them, and of course, in
committing suicide, [that] would also be very disappointing.” These quotes
illustrate the ambivalence individuals may feel due to simultaneous desires
to connect with others and to remain self-reliant and illustrate the
interconnectivity between loneliness, alienation, and suicidal thoughts.
CLINICAL AND RESEARCH CONSIDERATIONS
Understanding the phenomenon of loneliness as it relates to each of

Erikson’s developmental stages helps to identify opportunities for
intervention. Research shows that increased frequency of contact with
others does not necessarily influence one’s perceptions of loneliness
(Heinrich & Gullone, 2006). Rather, the quality of interactions is the key
factor in ameliorating negative emotions (Ernst & Cacioppo, 1999).
Intimacy is more critical than togetherness in altering one’s sensation of
belonging.
Still, belonging or shared experience can serve in some capacity to
mitigate one’s sense of loneliness, though physical togetherness is merely
the first step. A review of empirical studies evaluating the “Caring Letters
Project,” a program in which brief letters are sent to patients after
discharge from treatment, has shown that follow-up contacts help decrease
repeated suicide attempts (Luxton, June, & Cometois, 2013). Perceiving
that someone cares is a key element in managing loneliness and alleviating
suicide risk.
In clinical practice, it is best to unilaterally assess all patients for the
experience of loneliness as a risk factor for suicide (Tucker, Pak, Neely,
Tylor, Colborn, & Ghahramanlou-Holloway, 2015). Beyond an objective
assessment, genuine interest should be paid to how individuals are coping
with the challenges presented at each developmental stage. Adolescents,
for instance, may be questioned about their peer groups, and young adults
could be asked about the quality of their relationships, while keeping in
mind that quality of these relationships is generally a better indicator of
susceptibility to loneliness than is quantity.
Understanding the experience of loneliness, through clinical dialogue
as well as systematic assessment, is only the first step in the clinical care of
individuals at risk for suicide. Evidence-based cognitive behavioral
interventions for the prevention of suicide (e.g., Brown et al., 2005; Rudd
et al., 2016) highlight the importance of social support in the prevention of
suicide. We recommend that clinicians aim to decipher whether the
individual is experiencing loneliness due to a lack of an existing social
support network, due to a lack of skills in adequately utilizing an existing

social support network, and/or due to beliefs that interfere with the
appropriate usage of an existing social support network.
For those who do not have an existing social support network, the role
of the clinician is to serve as a collaborator in building the structure of a
social support network (e.g., referring the individual for group therapy and
connecting him or her to a peer mentor). For those who do not have the
skills to engage in a social support network, the role of the clinician is to
teach specific social skills (e.g., how to maintain eye-contact and initiate
conversation) to enhance the likelihood of effective social interactions. For
those who have interfering beliefs, the role of the clinician is to
collaboratively, through Socratic questioning and guided discovery, help
the individual restructure his or her cognitions and/or associated images
(e.g., cognitive rehearsal for asking a person to dinner and responding
adaptively to negative self-talk).
In a meta-analysis of randomized control trials to address loneliness,
cognitive-behavioral therapy to decrease negative social cognitions that
perpetuate loneliness was found to have the largest effects, followed by
building social support (Cacioppo et al., 2015). The cognitive approach
allows the lonely person to understand that they can manage their
loneliness. This concept is underscored by more recent research suggesting
that future orientation, namely a perception that circumstances can
improve, mitigates symptoms of depression and suicidal ideation (Chang et
al., 2017).
In terms of clinical research, investigators of randomized controlled
trials on suicide prevention are encouraged to include measures on
loneliness, thwarted belongingness, and social support – and to further
examine these factors in relation to primary and secondary outcomes.
Qualitative research to best understand the thoughts, emotions, and
behaviors of individuals who experience loneliness preceding, during, and
immediately following a suicidal crisis is much needed. For example, how
is the experience of loneliness before attempting suicide different from the
experience of loneliness after a suicide attempt? Finally, clinical

observations indicate that individuals who report a sense of loneliness may
rely on substances (e.g., alcohol) to self-medicate and to even bolster social
confidence. Research on the link between the emotion of loneliness and
various self-destructive behaviors such as excessive drinking is needed to
best understand the trajectory and the mechanisms from suicidal thoughts
to suicidal actions.
CONCLUSION
The subjective and distressing experience of loneliness may manifest

differently across the lifespan depending on psychosocial stage of
development. Success in each of Erikson’s (1963) stages of development
contributes to trust, autonomy, initiative, industry, identity, intimacy,
generativity, and integrity, all of which are required to create and maintain
healthy and fulfilling interpersonal relationships in order to meet the
human need for belonging (Baumeister & Leary, 1995). Nonetheless, when
the need for belonging is unmet or hampered by mistrust, shame, guilt,
inferiority, role confusion, isolation, stagnation, and despair, the loneliness
and alienation felt by individuals can contribute to depression,
hopelessness (Erikson, 1963), thwarted belongingness, perceived
burdensomeness (Joiner, 2005), and may ultimately give rise to suicidal
thoughts and behaviors. Mental health providers are encouraged to assess
individuals’ perceived adequacy of social support and explore the extent to
which loneliness may contribute to feelings of thwarted belongingness and
perceived burdensomeness. Attention should be paid to individuals’
developmental stage and the psychosocial and contextual factors that may
facilitate and/or hinder successful completion of crises within stages. From
this knowledge, clinicians may assess for and identify vulnerabilities in
their clients that may contribute to suicide risk.
Disclaimer: The opinions expressed are those of the authors and do

not necessarily reflect the views of the Uniformed Services University of
the Health Sciences or the Department of Defense.
Disclosure of Funding: Support for writing and research related to

this manuscript has been provided to Principal Investigator, Dr.
Ghahramanlou-Holloway, by the Department of Defense, Congressionally
Directed Medical Research Program (W81XWH-08-2-0172), Military
Operational Medicine Research Program (W81XWH-11-2-0106), and the
National Alliance for Research on Schizophrenia and Depression (15219).
The authors report no financial relationships with commercial interests.
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Chapter 4
SOCIAL, INTERPERSONAL AND EMOTIONAL

ANTECEDENTS OF LONELINESS
Leehu Zysberg, PhD

Research Authority,
Gordon College of Education, Haifa, Israel
ABSTRACT
While the literature is replete with evidence and theory regarding the
emotional consequences of loneliness and the challenges they pose to
individuals, there is still not enough evidence examining the emotional
antecedents of the phenomenon. This chapter reviews the existing
literature on emotional antecedents of loneliness, dwells on recent
evidence linking loneliness and certain underlying emotional mechanisms
and presents an integrative model to guide research and future practice in
diverse settings.
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INTRODUCTION
As our world becomes more densely populated and as global travel,

electronic communication and information become more accessible than
ever, we seem to be lonelier than ever. A paradox, it seems but on a closer
look – not at all. Loneliness, as a psychological and social phenomenon is
not about actual interpersonal connections. Loneliness can be defined as an
on-going, adverse subjective experience of discrepancy between
individuals’ need for socialization and attachment, and their subjective
perception of their actual condition in these respects. All definitions agree
that the experience is inherently unpleasant, adverse and at times
destructive. Most definitions point that the experience has little to do with
a person’s ‘objective’ social standing or associations (Ernst & Cacioppo,
2000; Lasgaard et al., 2016; Peplau & Perlman, 1982).
Loneliness is often related to as ‘the plague of the 21st century’ and is
highly prevalent in western societies (Nyqvist et al., 2017; Ronka et al.,
2013). A surprisingly high rate of individuals report experiencing
loneliness in various stages in life, and though the experience is often
transitory and time dependent numerous authors describe the experience of
‘chronic loneliness’ (Cramer & Barry, 1999) as a growing concern. As new
evidence is slowly accumulating, there is a growing realization that chronic
loneliness may become a new lifestyle or frame of mind that is typical of
current social constructs, culture and social interactions (Pittman and
Reich, 2016).
Loneliness has been studied extensively – especially with respect to its
consequences: the phenomenon has been associated with a broad range of
negative outcomes on the individual and group levels. Thus, loneliness
shows associations with emotional distress, depression, and lower
academic achievement in younger age (Cacioppo et al., 2002; Glaser et al.,
1985; Leary, 1990) as well as reduced immune function, higher risk of
health hazards of opportunistic nature, and even mortality (Richard et al.,
2016; Valtorta, et al., 2016) at older age. Loneliness seems to work its way
to pathology in similar routes as described in the study of the outcomes of
stress: through added burden on the individuals’ (and at times, the groups’)
Social, Interpersonal and Emotional Antecedents of Loneliness 97
coping resources, and reserve capacity thus increasing the chance of

pathology when facing challenge. Unlike stress though, Loneliness seems
to have a two peak risk pattern across the life span: The literature suggests
that individuals are most prone to experience loneliness around
adolescence and around older age (retirement age or older) (Allen et al.,
1993; Nyqvist et al., 2017).
Less studied are the antecedents of psychological loneliness: What
factors predict the subjective experience of loneliness? The literature is
divided into a few domains of such antecedents: 1) “Objective factors”
relating to life changes and choices – such as moving from one community
to another, immigration, etc. that are associated with higher risk of
experiencing loneliness, (2) General social factors associated with shifting
trends in cultures, social norms and lifestyle – that associate with the
experience of being alone and missing others’ company, (3) Aspects of
interpersonal abilities, skills, and the nature of interpersonal interactions
with others, and (4) Aspects of emotional regulation, emotional abilities
and skills associated with increased risk of loneliness (Carr et al., 2017;
Lesgaard et al., 2016).
This chapter will offer an integrative view of the cultural, interpersonal
and emotional antecedents of Loneliness and present emerging conclusions
and trends suggested by the evidence in this field.
LONELINESS – DEFINITIONS AND CONCEPTUALIZATION
Most individuals can understand and relate to the term ‘loneliness’

intuitively, however authors provided formal definitions of loneliness,
relying on varying perspectives and theories. Peplau & Perlman (1982)
provided an overview of common psychological definitions of loneliness.
What does being lonely mean? Some authors believe the experience has an
innate evolutionary function: From an evolutionary point of view being
alone is a disadvantage, and a risk for thriving and survival, therefore we
may be innately wired to feel alarmed, experience pain (if only emotional)
98 Leehu Zysberg
whenever we perceive the lack of adequate social associations and support

from our environment (Bowlby, 1973; Weiss, 1974).
Others maintain that loneliness has a developmental value: Interactions
with others are acknowledged as a key factor in human development. As
such it has drawn a lot of attention from researchers examining the
consequences of rejection, neglect, immigration and other early life
experiences putting individuals at the risk of social confinement (e.g.,
Asher & Wheeler, 1985; Parker & Asher, 1993). Experiencing loneliness,
though often cited as a developmental risk factor has also been mentioned
as a motivational basis, a challenge that if successfully mitigated, serves
future development and learning (Jung, Song and Vorderer, 2012; Moore
& Schultz, 1983; Rokach & Brock, 1998).
Another way to look at loneliness is from the point of view of
motivation, expectancy and frustration: Life in any other field in our lives
we form motivations aimed at achieving certain goals, set expectations and
strive to achieve them – this process takes place in the social and
interpersonal domains as well as any other (Asher Y Wheeler, 1985).
When interpersonal expectations are not met (e.g: having many good
friends, marriage, etc.) individuals experience frustration and stress that
may account for the aversive aspect of feeling alone, or lonely.
Moreover, loneliness, as any psychological experience, is probably
mainly in our head: Studies found evidence that marginalized youths, who
had only one contact they considered a friend, were already quite
‘immune’ to the adverse effects of loneliness (Cassidy & Asher, 1992;
Ernst & Cacioppo, 2000). The way individuals construed, and interpreted
their experiences seems to matter more in predicting adverse effects
associated with loneliness than the actual social network available to them
)e.g., Bogaerts, Vanheule, & Desmet, 2006).
The classic literature on loneliness differentiates between two types of
loneliness: Weiss (1974) defines two types of experiences under the
‘loneliness’ umbrella: 1) Emotional loneliness is the experience of lack of
intimacy and trust in others. A person may be surrounded by others yet feel
they have no one to trust, confide in and share personal experiences. (2)
Social loneliness is the experience of lack of interpersonal associations, or
an insufficient social network in both quantitative and qualitative terms

(Russel, Catrona, Rose & Yurko, 1984). This typology evoked an
impressive wave of empirical research and instrument development efforts,
based on this dual-factor model.
Another model, based on empirical analyses, suggested loneliness
encompasses at least 5 content-realms of perceptions and feelings relating
to: 1) Emotional distress, (2) social alienation, (3) growth and discovery,
(4) isolation, and (5) self-alienation (Rokach, 1997). The model highlights
the multi-tiered complex nature of the experience, including both adverse
and positive, growth-related components (Rokach, 2007).
The above-described models indicate the disagreement on the nature of
the experience and the subjectivity of the psychological components
involved in “what it means and what it feels like to be lonely.” The main
experience acknowledged by all models is that of a psychological
challenge, and at times: crisis.
Antecedents of Loneliness – What the Literature Teaches Us
The study of the antecedents of loneliness is less prolific than in other

aspects of the phenomenon. Studies, however, did attempt to map factors
associated with loneliness and have come up with a broad range of content
areas. Rokach (1997) identified 5 common causes of loneliness he named:
1) Personal inadequacies, (2) developmental challenges, (3) unfulfilling
interpersonal relations, (4) relocation or social separation, and (5) social
marginalization. These causes span the full range from innate, personal to
financial and social factors.
The ‘So-Called-Objective’ Factors of Loneliness: The Role

of Environments and Settings
Despite the emphasis on psychological and social factors, sometimes

the experience of loneliness stems simply from objective realities very
100 Leehu Zysberg
typical of a modern, mobile world: The evidence suggests that separations

from social networks such as family, communities, work organizations and
educational institutions. Societies around the globe are characterized by
increasing mobility: from work and career related shifts to immigration
waves – individuals are torn out of their social networks constantly
(Rokach, 2002; Savikko et al., 2005). living in rural areas as compared to
cities and metropolises also associates with loneliness (in a manner
somewhat contrary to common perception of cities as alienating settings,
rural dwellers experience higher levels of loneliness, see Rokach, 2007;
Savikko et al., 2005). Culture and politics may also play a role, with some
evidence suggesting societies experiencing turmoil and change leave more
room for uncertainty; the breakdown of social structured and hence put
more people at risk of feeling lonely, among other things
(e.g., Huntington, 2006).
Cultural Aspects: Are We Living within a ‘Culture

of Loneliness’?
Culture is a term loosely used in the literature to describe the amalgam

of basic assumptions, ideologies and norms held by a given social group
and guide its function (Lykes and Kemmelmeier, 2014; Rokach, 2007).
Culture guides not only group level outcomes but sets the parameters for
individual behavior, and more importantly in our case – interpersonal
interaction patterns.
Culture often serves practical needs of the community: from survival
to maintaining order, economic viability and prosperity (Fiske and Taylor,
2013). Other factors, however, shape culture too, such as communication
patterns and media, politics and perhaps most of all in recent years -
technology (Murphie and Potts, 2003).
Technology seems to have shaped our world in so many ways and as
technological progress only accelerates, authors can only imagine what
future influences it may have on our society and the way we handle
ourselves and others in interpersonal interaction. Possible scenarios range
from utopian views of a prolific society supported by high technology to

apocalyptic views of human society being ripped apart at the seams
(Muller, 2016). Regardless of future scenarios, a look at how technology
changed and reshaped culture and interpersonal interaction, if only in the
last few decades, reveals an interesting trend that may have relevance to
the subject at hand.
Of special interest to us are advances in IT, communications (cellular
and internet based) and the way they re-shaped social interaction patterns.
The literature seems to agree the recent advances in communication
technology have created a paradox: on one hand, we are more connected
and available to others (and others to us) than ever before, response times
have reached immediacy levels which are unprecedented. Social networks
and bulletin boards connect individuals and groups across geographical
and social borders. Real time technology allows work teams to work on
projects from different corners of the globe. Data, information and
knowledge are transferred faster than we could even imagine and are
accessible, searchable and communicable to almost anyone (Lin and Atkin,
2014). On the other hand we meet face to face, and interact with other less
than ever before. This trend is more noticeable among children and
adolescents, individuals who are ‘technological natives’ and accept CT and
IT more naturally and utilize it more effectively than adults who take more
time to adapt to these changes (Best et al., 2014; Nesi et al., 2017).
Not surprisingly the meager and relatively new evidence regarding the
role of communication technology in loneliness among tech users,
especially adolescents and young adults is painting a grim picture:
Adolescents’ use of smartphone based communication and social apps was
associated with reported loneliness and emotional distress (Bian and
Leung, 2016). Recent studies report an increase in the incidence of
computer addiction, typically bringing the phenomenon of psychological
isolation to an extreme (Muñoz-Miralles, 2016). Additional evidence show
an emerging picture of inverse association between social network and
online communication applications usage and reported sense of loneliness,
emotional distress and even depression (Salmela-Aro et al., 2017).
102 Leehu Zysberg
The trend emerging from the literature is that of resorting to virtual

interaction patterns that do not meet the basic need for direct and
immediate interaction and attachment to and with others. The literature
often mentions that consumers of social networks services see the
interactions with others in such media as impersonal and shallow
(Vaterlaus et al., 2016). Hence the above mentioned paradox: ever-
connected and at the same time, alone, and hungry for direct, more
immediate association with others.
Interpersonal Factors: Interactions That Precede Loneliness
This field of research is one of the least developed in this area of

interest. Still, existing evidence, at times sporadic and imperfect, point in
interesting directions. Morjano and colleagues (2017) for example suggest
that certain relationship patterns with parents and siblings predict self-
reported loneliness in young adults. Other studies link family relationship
patterns in early life with adolescent and young adult loneliness (Johnson,
Lavoie and Mahoney, 2001; Hurt, Hoza and Pelham, 2007). Peer relations
in school age are also a major factor in determining the experience of
loneliness: Parker and Asher (1991) showed how children’s evaluation of
their friendship quality accounts for their self-rated loneliness. Boivin and
colleagues (1995) showed how negative aspects of peer-relations such as
victimization and rejection predict loneliness.
The key here seems to be social support: Although it may be most
visible at early age to adolescence, it is pointed out as an important buffer
and protective factor in a broad range of settings: from social adjustment,
to individual distress and mental health up to coping with chronic health
conditions (Zysberg, 2017). Another recent study shows that along specific
time-points in life the source and arena of interpersonal relationship and
support matter: adolescents, for example, found peer support more
satisfying than family support (Lee and Goldstein, 2016). Gur-Yaish and
colleagues (2013) showed that older adults prefer instrumental support
from professional aides rather than family or close friends, but prefer social
support from family members. In other words – social support matters, but
who provides it is sometimes important too.
To better understand the role of interpersonal relationships and their
protective role we should take a look at personal characteristics often
associated with the above.
Personal Characteristics
Research searches for factors associated with loneliness not only at the
social-cultural level but also on the individual: Demographic
characteristics associate with varying levels of loneliness: gender (being
male), older age and lower socioeconomic status were associated with
increased loneliness. Age, however shows an intriguing ‘anomaly’ whereas
loneliness tends to peak around adolescence and older adulthood, for
different reasons (Yang & Victor, 2011). Family structure also associates
with loneliness. For example, widowed participants reported feeling
lonelier than individuals living with their families (Savikko et al., 2005).
Environment and settings seem to play a major role in triggering
loneliness but given the subjective nature of the experience, the literature
focused on personal attributes associated with it more than external factors.
Rokach, among the more prolific authors on the subject suggested a
5-factor model to account for the subjective experience of loneliness. Out
of these factors, 3 are personal in nature and include: developmental issues,
social inadequacy, and inability to draw upon interpersonal relationships
(e.g., Rokach, 1997). These factors hint at self-perception and personality
as potential structures underlying these experiences. Indeed, the literature
offers a lot of evidence to support the personality-loneliness association:
Studies find relationships between traits under the ‘five factor model’ and
Eysenck’s typology (among the most robust models of personality
assessment) and aspects of loneliness, especially neuroticism and
extraversion (or more accurately – the lack of it) (e.g., Saklofski et al.,
1986). Current studies have linked personality traits to both the extent of
the experience of loneliness and attitudes or judgments of this experience
as more or less acceptable, much in line with the findings reported above
(e.g., Teppers et al., 2013).
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Additional evidence link predispositions and behavioral patterns which

are beyond the scope of personality trait typology but associate with
interpersonal tendencies to interact with others: studies have identified
perspective taking, social and communication skills as well as self-
disclosure, attribution style and even attachment style with the tendency to
feel lonely (e.g., Bogaerts, Vanheule, & Desmet, 2006; Bruch et al., 1988).
The consistent evidence associating personality and loneliness almost
suggest the existence of a ‘lonely personality’ with very specific traits and
predispositions, namely: tendencies toward lesser regulation of reactions,
interpersonal relationships and lower proficiency in reading and processing
information about the self and others. These points lead us to examine the
emotional and emotional regulatory functions and their associations with
loneliness.
Emotions, Emotional Regulation and Loneliness
Is there an emotional code to loneliness? Though there is some work

addressing emotional antecedents of loneliness, it is far less developed than
the literature on the emotional consequences of loneliness. Here I will
attempt to provide an emerging picture of emotional factors that may have
a role in individuals’ likelihood of experiencing loneliness. Let us start
with the building blocks of the model, or the basic psychological functions
closely related with emotional experiences that show evidence of
association with loneliness:
Delay of gratification. The most Basic function of emotional

management and regulation is perhaps the one involving postponing
gratification or need fulfilment (Agarwal, 2014). The most basic of
emotional regulation tasks and the most difficult to manage, it is also
considered by many to be the very foundation upon which interpersonal
associations and relations are built in terms of effective negotiations,
effective conflict management and coping with needs within a complex
interpersonal setting (Agarwal, 2014; Cacioppo et al., 2006; Dill &
Anderson, 1999). Need satisfaction regulation or delay of gratification has

been associated in psychological and educational research with life-long
adjustment, mainly at the social and emotional levels: Mischel’s classic
‘marshmallow study’ exemplified how emotional regulation and delay of
gratification serve as factors in psychological adjustment through the life
cycle (Mischel et al., 2010). It is suggested that such abilities are pivotal in
developing and maintaining meaningful interpersonal relationships, thus
reducing the chance of experiencing loneliness in the long run.
Emotional knowledge. The concept is often associated with two skills:

1) The naming or recognition of emotions in self and others and (2)
Awareness of emotions as they are experienced by self and others (Stein &
Levine, 1989). This concept represents a developmental task beginning at
very early age and often associated with early experiences of deprivation
and frustration (Garner & Power, 1996).
Another developmental aspect associated with this concept is that of
the development of Ego resources or perceptions associated with a sense of
self: Anchored in the grand theories of such luminaries as Kohlberg,
Sullivan and Erikson, the notion of ego development speaks of emerging
selfhood, as a physical, perceptual, emotional and interpersonal anchor of
psychological development (for a thorough review see: Hy Le &
Loevinger, 2014). As individuals learn through on- going experiences
since birth, both physical and interpersonal, they define their own and
others’ boundaries, set perceptual frameworks and rudimentary perceptions
that shape their world, and their relationships with themselves and others
(e.g., Allen et al., 1994). Ample evidence associate Ego development,
emotional reaction patterns and relationship patterns throughout the life-
span (e.g., Smetana et al., 2006).
Though theory associates self and emotional knowledge with the
nature and quality of social associations and studies have associated
emotional knowledge (or the lack of it) with increased risk of loneliness
especially at childhood and adolescence (e.g., Heintz et al., 2014), the
evidence is however still preliminary and rudimentary. Future studies may
106 Leehu Zysberg
further help explore the nature of emotional aspects of self-definition and

self in general and their role in the experience of loneliness.
Self-knowledge, internalizing vs externalizing. A coherent self-

concept as a basis for adept emotional processing and coping is an idea
presented in the early days of psychological reasoning and research
(Hobfoll & London, 1986). The healthy self-concept provides an
infrastructure for better self-knowledge, and the ability to differentiate
between what is “me” or “mine” and “not me or mine.” Such
differentiation is taking place at multiple levels of our psyche, including
perception, and emotional reactions to events (within and around us). Such
structures may account for our tendency toward internalization (less
expression or relief of tensions, attribution of life outcomes so
characteristics of self) or externalization (more expressive style, attribution
of life outcomes to others, or circumstances). These can be conceptualized
as an attribution style or a personality-related pre-disposition, and are
associated with loneliness in children and pre-adolescents (e.g., Heintz et
al., 2014). Such patterns seem to show stability across the life-span
(Fischer et al., 1984).
Emotion-Regulation. Emotion regulation is a concept describing the

extent to which and the strategies by which individuals control (not
suppress!) emotional responses, and attune them to support adaptive
behavior (see: Rubin et al., 1995). This is no mean feat, mind you: research
shows that emotional reactions and experiences are primordial, automatic
in nature and extremely hard to manage. Individuals dramatically vary on
the extent to which they are capable of managing and regulating their
emotions more than almost any other psychological attribute in adulthood
(Gross and John, 2003). The literature is replete with evidence to the
association of emotion regulation (or the lack of it) with a broad range of
psychological and social pathologies ranging from depression to self-
mutilation (Mikolajczak, Petrides, and Hurry, 2009). Less abundant is the
literature on the positive effects of effective emotion regulation, but the
picture painted by the evidence is quite clear and consistent: Emotion
regulation is associated with lower chances of anxiety disorders, more

effective communication and interpersonal relations (Goldin and Gross,
2010; Shiota et al., 2004). The literature positions emotion regulation as a
major function underlying individuals’ social behavior and some of the
basic building blocks of social networking, support and satisfaction with
social relations. Emotion regulation can be addressed as a component of a
larger scale, recent term presented in the literature: emotional intelligence.
Emotional intelligence. Emotional intelligence is a relatively new

concept addressing a century old issue – the role of emotions in reasoning
and problem solving. Various definitions are presented in the current
literature but all share the following assumptions on the concepts’ nature
and significance in our context: 1) Emotions are a major and basic motive
in our behavior, (2) Emotions can be utilized to encode information, better
read situations and effectively manage interpersonal relations, and (3)
Individuals vary extensively in how effective and capable they are in these
fields of intra and inter-personal function (Boyatzis, Goleman, & Rhee,
2000). Emotional intelligence has been related to as an ability, a
personality trait and an eclectic collection of non-cognitive skills and
tendencies (Salovey & Grewal, 2005), and despite the use of various
measures, evidence did show support of the concept’s role in everyday
social and interpersonal settings and challenges. For our purpose here it
does seem like individuals high in EI, manage interpersonal relationships
more effectively, derive more pleasure form them and report less social
distress (e.g., Petrides et al., 2006). A few studies have provided direct
evidence to the role of EI in the experience of loneliness, among them
Zysberg’s (2012, 2017) suggesting that EI provides a protective effect
against feeling lonely, beyond what is accounted for by personal
characteristics and personality traits in a sample of young adults. Austin
and colleagues (2006) showed that EI is associated with a sense of social
and interpersonal well-being (which can be described as the opposite of
loneliness).
108 Leehu Zysberg
From Culture through Society to the Individual Antecedents

of Loneliness: An Emerging Model
The evidence mentioned above provides the basis for an emerging
model describing a functional hierarchy of the social-emotional factors
associated with psychological loneliness. The model also addresses the
intricate interactions between different levels of influence: from the
cultural to the individual.
Culture. The concept to frame the entire process or line of influences

shaping the experience of loneliness start with culture. Cultural
assumptions, values and norms set the stage to what is allowed and what
not. Culture sets the basic parameters within which interpersonal and
personal experiences take place and are interpreted. Characteristics such as
individualism vs. collectivism, cohesiveness, hierarchy, norms of
interpersonal communication, and identity are among the most influential
cultural factors associated in the literature with social interactions.
Social-Interpersonal. Social norms, community structure, the extent to

which technology adoption is acceptable and appreciated, laws and norms
regarding interpersonal communication and interaction, all set the stage
and shape social interaction.
In turn, social and interpersonal interaction, past and present seem to
imprint themselves upon the individual and shape perceptions of quality
and quantity of their associations with others, thus providing all the
‘psychological components’ of the perception of loneliness. A key concept
emerging from the literature that may point to the underlying mechanisms
at work here is that of social support: Helpful, attentive availability of
others seems to have a strong influence on our wellbeing in general. Who
provides that support and how may vary but the extent to which an
individual can be confident in his or her expectation of attentive
availability from others is a major player in this domain.
Emotional. Emotional antecedents of loneliness seem to be the most

confusing and the least studied of the above concepts. Perhaps due to the
potential confusion between the emotional antecedents of loneliness and its

emotional consequences. In other words: is depression (for example) an
antecedent of loneliness or is it its outcome?
Examining what is known in this field, a few concepts and processes
can be identified as potential factors anticipating the emergence of
loneliness in childhood, adolescence and early adulthood. Among those
concepts are emotional temperament, emotion regulation, and emotional
intelligence: these associate closely with individuals’ ability to manage
emotional responses in a manner that is congruent with social demands,
norms and expectations – thus fostering more effective interpersonal
relations.
Figure 1. An emerging model of Social factors of psychological loneliness.
What’s Next?
Recent developments in psychological theory and research provide us

with new insights into the social and emotional antecedents of loneliness.
While the literature provides enough evidence to paint the picture
described above, ALL of the elements in the emerging model are still in
progress in terms of how we understand them or apply them. Of special
110 Leehu Zysberg
interest are those aspects that seem to rise in importance and relevance in
recent years, namely: Cultural aspects, that seem to play a more complex
role than we may think as immigration and global mobility makes almost
any society on earth a mix of cultures, bringing together varying beliefs,
norms and assumptions – how does this meeting of cultures influence
perceived interactions and judgements of loneliness?
Emotional antecedents of loneliness remain elusive, and recent
addition to our tool box in the shape of the concept of emotional
intelligence, among others, add to our ability to re-examine and explore
what we know in this venue. Is emotional intelligence a potential that has a
protective value when it comes to loneliness? And if so – can we intervene
to ‘inoculate’ individuals against the adverse outcomes of being alone?
Practitioners in the fields of education, sports and athletics, social
workers working with immigrants, refugees, with children at risk, with
families experiencing crisis – may embrace some of the insights offered
here. The proposed model may help to both identify individual at high risk
of experiencing loneliness in a manner that may pose risk to their well-
being as well as intervene to ameliorate the adverse effects of the gap
between individuals’ perceptions of the relationships they have and those
they are wishing for.
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120 Leehu Zysberg
BIOGRAPHICAL SKETCH
Leehu Zysberg
Affiliation: Gordon College of Education

Education: PhD in I/O psychology
Business Address: 73 Tchernichowski st. Haifa Israel.
Research and Professional Experience: Prof. Zysberg is interested in

the study of emotions in everyday life, ranging from work, and education
to community and family settings. Published numerous manuscripts and
book chapter in diverse international forums, journals and conferences in
these venues.
Professional Appointments: Associate professor of psychology,

Gordon College of education. Chair of the research authority.
Publications from the Last 3 Years:
1. Zysberg, L. (2014). Emotional intelligence, personality, and

gender as factors in disordered eating patterns. Journal of health
psychology, 19(8), 1035-1042.
2. Zysberg, L., Kimhi, S., & Eshel, Y. (2013) Someone to watch over
me: Exposure to war events and trust in the armed forces in Israel
as factors in war-related stress. Medicine, War and Survival, 29:2,
140–154.
3. Zysberg, L. & Tell, E. (2013) Emotional Intelligence, Perceived
control and eating disorders. SAGE Open July-September, 1–7.
4. Raz, S., Dan, O., Arad, H. & Zysberg, L. (2013) Behavioral and
neural correlates of emotional intelligence: An event-related-
potentials (ERP) Study. Brain Research, 1526, 44–53.
5. Zisberg, A., Van Son, C. R., & Zysberg, L. (2013, November).
Immigrant Acculturation and Culture of Origin in Emotional
Outcomes of Older Patients. In Gerontologist (Vol. 53, pp. 289-

290).
6. Siegel, E. O., Young, H. M., Zysberg, L., & Santillan, V. (2014).
Securing and Managing Nursing Home Resources: Director of
Nursing Tactics. The Gerontologist, gnu003.*
7. Raz, S., Dan,O & Zysberg, L. (2014) Neural correlates of
emotional intelligence in a visual emotional oddball task: An ERP
study. Brain and Cognition, 91, 79–86.*
8. Zysberg, L., Yosel, T. B., & Goldman, M. (2015). Emotional
intelligence and glycemic management among type I diabetes
patients. Journal of health psychology, DOI: 1359105315596373.*
9. Zysberg, L & Lang, T. (2015) Supporting parents of children with
type 1 diabetes mellitus: Review of strategies. Patient Intelligence,
7, 21-31 [An invited review]. *
10. Polischuk, K & Zysberg, L. (2016) Emotional intelligence,
exposure to visual content on Facebook and body image in young
adults. RAV GVANIM [Multi-colors- Hebrew], 15, 194–212. *
11. Siegel, E. O. & Zysberg, L. (2016) Licensed nursing home
administrator preparation and job variations. Annals of Long Term
Care, 24:3, 28-36*
12. Zysberg, L., Orenshtein, C., Gimmon, E., & Robinson, R. (2016).
Emotional Intelligence, Personality, Stress, and Burnout Among
Educators. International Journal of Stress Management. Advance
online publication. http://dx.doi.org/10.1037/str0000028*
13. Siegel, E. O., Zisberg, A., Bakerjian, D., & Zysberg, L. (2016).
Nursing Home Administrator Quality Improvement Self-Efficacy
Scale. Health care management review.*
14. Zysberg, L. (2016) Diabetic management and emotional
intelligence: an emerging direction in current research. Journal of
Endocrinology and Diabetes, 3:1, 1–3. *
15. Zysberg, L., Maskit, D., Reichman, R., & Hecht, A. (2016) Sin and
Punishment on Campus: Ethnic Differences in Academic
Misconduct and Its Treatment by the Academic Disciplinary
122 Leehu Zysberg
Committee. British Journal of Education, Society and behavioral

science, 15:3, 1–11. *
16. Zysberg, L. & Zisberg, A. (2017) Letter to the editor: Regarding
the role of EI in candidate selection in nursing programs. Nursing
Forum, 52:1, 68-69 *
17. Zysberg, L. & Moore, A. (2017). Demographic and personal
correlates of new masculinities: focus on the role of emotional
intelligence. International Journal of Psychology and Counseling,
9:1, 1-9. *
18. Zysberg, L & Guttermn, Y. (2017) Culture, personal
characteristics and academic achievement. Leaves [DAPIM], 64,
[Pagination unavailable yet]. *
19. Zysberg, L & Kasler, J (2017) Learning disabilities and emotional
intelligence. The Journal of Psychology: Interdisciplinary and
Applied, 171, 1-14. *
20. Siegel, E. O., Bakerjian, D. & Zysberg, L. (2017) Quality
Improvement in Nursing Homes: Alignment among Leaders across
the Organizational Chart. The Gerontologist, 57,1-10. *
21. Kasler, J., Zysberg, L., & Harel, N. (2017). Hopes for the future:
demographic and personal resources associated with self-perceived
employability and actual employment among senior year students.
Journal of Education and Work, 13: 1-12. *
22. O. Saad, L. Zysberg, J. Heinik, R. Ben-Itshak, A. Zisberg; The
Right Kind Of Smart? Emotional Intelligence and Cognitive
Impairment in Older Adults. Innov Aging 2017; 1 (suppl_1): 469.
doi: 10.1093/geroni/igx004.1672 *
23. Zysberg, L (2017). Emotional Intelligence Moderates Anxiety
Reactions in Chronic Health Conditions. American Journal of
Applied Psychology. 6: 3, 38-41. doi: 10.11648/j.ajap.
20170603.12 *
24. Zysberg, L and Hemmel, R. (2017) Emotional intelligence and
Physical activity. Journal of Physical Activity and Health, 14:9, 1-
14 (published ahead of print). *
Chapter 5
LONELINESS AMONG ROMANIAN

IMMIGRANTS LIVING IN PORTUGAL
Félix Neto and Maria da Conceição Pinto

Department of Psychology, University of Porto, Portugal
ABSTRACT
This study approaches the determinants of loneliness among

Romanian migrants living in Portugal. Two research questions guided the
study: (1) What influences do acculturation problems have on loneliness?
(2) What influences does adaptation to the society of settlement have on
loneliness? The sample of this research consisted of 181 Romanian
immigrants living in Portugal (49% females). The average duration of
stay in Portugal was 9 years. Loneliness was measured by the ULS-6. In
addition, other scales were used to assess Portuguese language
proficiency, perceived discrimination, sociocultural adaptation,
multicultural ideology, psychological problems and self-esteem. Results
showed that both indicators of acculturation problems and of adaptation
significantly predicted loneliness. Implications of the findings for future
research are discussed.
124 Félix Neto and Maria da Conceição Pinto
Keywords: acculturation, adaptation, immigration, loneliness, Romanian

immigrants
Loneliness is experienced universally, as shown by investigations with

diverse cultural samples, such as Canadians (Rokach & Neto, 2005), Cape
Verdeans (Neto & Barros, 2000b), Filipinos (2012), Koreans (Seeparsad,
Choi, & Shin, 2008), and Portuguese (Neto, 2015). A large corpus of
literature calls our attention to the negative consequences of loneliness
(Masi, Chen, Hawkley, & Cacioppo, 2014; Holt-Lunstad, Smith, Baker,
Harris, & Stephenson, 2015). Specifically, moving to another country
affords a singular opportunity to understand loneliness. Following
Ponizovsky and Ritsner (2004) “newly immigrated persons find
themselves in a drastically different network of social relationships and
experience multiple stressors, including losses” (p. 408). However, the
quantitative investigation of loneliness among migrant people is scarce
(Neto, 2016). The aim of this work is to analyze the level and the
predictors of loneliness among Romanian immigrants residing in Portugal.
According to SEF (Portuguese Immigration Service) in 2014,
Romanians were the fourth largest foreign community in Portugal (after
Brazilians, Ukrainians and Cape Verdeans), with 31 505 registered
citizens. There were more men (54.9%) than women (45.1%). They
represented 8% of the foreign community in Portugal. The Romanian
immigrants who chose Portugal came across several challenges, such as:
the language, housing, the climate, the lack of social support, the
understanding of cultural differences, among other issues.
Many changes may supervene during the acculturation process and
these alterations may impact on loneliness experienced by immigrants. The
great majority of the definitions of loneliness set off the perceived deficits
in relationships. Just to give an example, for Ascher and Paquette (2003, p.
75) loneliness is “the cognitive awareness of a deficiency in one’s social
and personal relationships, and ensuring affective reactions of sadness,
emptiness, or longing.”
Loneliness is a complex issue. It is determined by the interaction of
personal and situational factors (Weiss, 1973). Hence in the current
Loneliness Among Romanian Immigrants Living in Portugal 125
research we are going to examine a range of acculturation and adaptation

factors often mentioned in the culture shock domain (Ward, Bochner, &
Furnham, 2001). Specifically, we will examine whether acculturation
problems (language proficiency and perceived discrimination) and
adaptation outcomes (psychological adaptation, sociocultural adaptation
and intercultural adaptation) predict the level of loneliness.
There exists a large corpus of literature on acculturation and adaptation
in cross-cultural psychology (Ward et al., 2001). Acculturation concerns
the changes resulting from the contact between groups and individuals of
different cultural backgrounds (Redfield, Linton, & Herskovits, 1936;
Berry, 1997). Furthermore, adaptation concerns the long-term outcomes of
acculturation changes (Berry, 1997).
During the acculturation process, migrants may face some difficulties,
such as language proficiency and perceived discrimination. Competency in
the language of the society of settlement is a core indicator of the
acculturation (Phinney, 2003). Indeed, language proficiency constitutes a
first step to learn skills in a new society of settlement. The literature
indicates that host language proficiency predicts psychological
maladjustment (e.g., Zhang & Goodson, 2011).
As well as Portuguese language proficiency, we also examine whether
perceived discrimination predicts loneliness. Previous investigation has
explored whether perceived discrimination was linked to psychological
maladjustment. For instance, a meta-analytic research, including over 100
studies of ethnic or racial discrimination against Latina/os in the U.S.A.,
showed that mental health indicators such as acculturative stress were
mostly strongly linked to discrimination (Lee & Ahn, 2011). Perceived
discrimination was found to be positively related to loneliness (Neto, 2002;
Liu et al., 2014; Neto & Costa, 2015).
Two kinds of adaptation, psychological adaptation and sociocultural
adaptation, have been distinguished (Ward & Kennedy, 1999).
Psychological adaptation “refers to how comfortable and happy a person
feels with respect to being into the new culture, or anxious and out of
place” (Demes & Geeraert, 2014, p. 91). In the current research we are
going to use two indicators of psychological adaptation, in particular, self-
esteem and mental health problems, to examine their relationship with

loneliness.
Self-esteem concerns an individual’s general sense of his or her worth
(Rosenberg, 1979). Research presents a consistent link between loneliness
and poor self-esteem (Heinrich & Gullone, 2006; Ben-Zur, 2012).
Experiencing loneliness and feeling low self-esteem is an everyday
problem (Vanhalst et al., 2013).
Researchers have identified depression, anxiety and psychosomatic
symptoms as the most common mental health consequences of
acculturation (Berry, 1997). Therefore, in this research we consider
depression, anxiety and psychosomatic problems, collectively reported as
mental health problems. Loneliness as a negative experience has been
associated with decrements in mental health problems (Cornwell & Waite,
2009).
Sociocultural adaptation refers to the competence in carrying out the
activities of daily intercultural living (Ward et al., 2001). It is evaluated as
the level of difficulty that migrants face in everyday social situations in
response to cultural differences (Ward & Kennedy, 1999). Past
investigation has shown that greater adaptation difficulties among migrants
were associated with psychological maladjustment (Wilson, Ward, &
Fisher, 2013).
Intercultural adaptation has more recently been identified as a third
form of adaptation, in addition to psychological adaptation and
sociocultural adaptation (Berry, 2015). Intercultural adaptation concerns
the degree to which people are able to establish harmonious intercultural
relations with others, including low prejudice and discrimination. We will
consider multicultural ideology as an indicator of intercultural adaptation.
Multicultural ideology refers to views that cultural diversity is good for a
society (Berry & Kalin, 1995). It includes the core characteristics of
multiculturalism: cultural maintenance, intergroup contact, and willingness
to engage in mutual exchange. We will also examine whether multicultural
ideology is related to loneliness.
According to the aforementioned research two hypotheses on

loneliness were tested:
 Hypothesis 1: It is hypothesized that acculturation problems

(Portuguese language proficiency and perceived discrimination)
will predict positively loneliness.
 Hypothesis 2: It is hypothesized that adaptation (sociocultural,
intercultural, and psychological) will predict negatively loneliness.
METHOD
Participants
The participants were 181 Romanian immigrants (92 men and 89

women) (see Table 1). The immigrants ranged in age from 18 to 57 years
(M = 37.52; SD = 9.5). The average duration of stay was 9 years (SD =
6.25). Married respondents were 62% of the sample. Concerning work, the
modal category was unskilled work (33%). Relatively the instruction level
82% had concluded secondary education or below, and 18% attended
tertiary education. The great majority of the immigrants declared to be
Orthodox Catholics (90.0%).
Measures
For this study, we used the following measures:

Portuguese language proficiency. Four items evaluated the migrants’
self-evaluation proficiency in speaking, reading, writing and understanding
the Portuguese language (Berry et al., 2006; Neto, 2002b) (e.g., “How well
do you speak the Portuguese language?”). Respondents endorsed each item
on a 5-point scale from 1 (not at all) to 5 (very well). The alpha coefficient
in the present study was .97.
Table 1. Demographic characteristics
Variables Romanian Immigrants (N = 181)

Mean age (SD) 37.5 (9.5)
Age
18-35 years 61 (33.7%)
36-57 years 120 (66.3%)
Gender
Male 92 (50.8%)
Female 89 (49.2%)
Place of birth
Romania 181 (100%)
Education
Secondary education or below 148 (81.8%)
Tertiary education 33 (18.2%)
Work
Unskilled work 59 (32.6%)
Skilled work 52 (28.7%)
Managerial work 22 (12.2%)
Professional work 11 (6.1%)
No work 32 (17.7%)
Not answer 5 (2.7%)
Mean duration of sojourn (SD) 9.0 (6.3)
Duration of sojourn
1- 10 years 135 (74.6%)
11-29 years 46 (25.4%)
Perceived discrimination. This scale includes five items (Berry et al.,

2006; Neto, 2006) evaluating the direct experience of discrimination -
negative or unfair treatment from others (e.g., “I have been teased or
insulted because of my Romanian background”). Respondents endorsed
each item on a 5-point scale from 1 (strongly disagree) to 5 (strongly
agree). The alpha coefficient in the present study was .90.
Sociocultural adaptation. The Sociocultural Adaptation Scale (SCAS,
Ward & Kennedy, 1999; Sequeira Neto, 2014) asked immigrants the
degree of difficulty experienced in 20 social situations in the host society.

Migrants indicated how much difficulty (ranging from no difficulty, 1 to
extreme difficulty, 5) they experienced while living in Portugal in each of
20 areas of daily life (e.g., “The pace of life” and “Going to social
gatherings”). Items were recoded positively. Higher scores denoted a lower
amount of difficulty. The alpha coefficient in the present study was .83.
Multicultural ideology. It was previously adapted to the Portuguese
context (Berry & Kalin, 1995; Neto, 2007; 2009b). We used 8 items (e.g.,
“People who come to live in Portugal should change their behaviour to be
more like the Portuguese”). Respondents endorsed each item on a 5-point
scale (where 1 = strongly disagree and 5 = strongly agree). Greater scores
denoted greater levels of multicultural ideology. The alpha coefficient in
the present study was .68.
Mental health problems. This measure included 15 items and was
designed to measure depression, anxiety and psychosomatic symptoms.
Five items measured each of the three areas (Berry et al., 2006; Neto,
2009a). Respondents endorsed each item on a 5-point scale ranging from
“not at all” (1) to “very often” (5). Sample items included “I feel tired”; “I
feel tense and anxious”; and “I feel lonely even if I am with people”
corresponding to psychosomatic complaints, anxiety and depression,
respectively. The alpha coefficient in the present study was .93.
Self-esteem. Self-esteem was measured using the Rosenberg’s (1965)
10-item inventory (e.g., “On the whole I am satisfied with myself” and “I
have a positive attitude toward myself”). Respondents endorsed each item
on a 5-point scale from 1 (totally disagree) to 5 (totally agree). The scale
was previously adapted into Portuguese (Neto, 1996). The alpha
coefficient in the present study was .68.
Loneliness. The brief Portuguese version of the Revised UCLA
Loneliness Scale (Russell, Peplau, & Cutrona, 1980) was used (Neto,
1992; 2014). This is a six-item scale (ULS-6). (e.g., “People are around me
but not with me”). Migrants endorsed each item on a 4-point scale ranging
from 1 (never) to 4 (often). The alpha coefficient in the present study was
.73.
Demographic information. Demographic information was collected on

age, gender, place of birth, time since arrival in Portugal, marital status,
level of education, occupation, and religion.
Procedure
Respondents were recruited by a trained research in the Lisbon

Metropolitan area. The participation rate was high (about 80%).
Participants were informed about the aims of the work. Their consents
were obtained. The participants’ responses were anonymous. The average
time for filling out the questionnaire was 30 minutes to complete. No
rewards were given to the participants for completing the survey.
RESULTS
Before testing the hypotheses of the current study, descriptive statistics

of the measures used are shown in Table 2. One-sample t-test displayed
that the average score of Romanian immigrants on loneliness (M = 1.67;
SD =.57) was significantly lower than the midpoint of the scale (p < .001).
Globally, this finding indicates that Romanian immigrants experienced a
low level of loneliness. Also, one-sample t-tests were conducted for the
other variables of this work. On the one hand, the average scores of
Portuguese language proficiency (M = 4.10; SD =.91), sociocultural
adaptation (M = 4.33; SD =.50), multicultural ideology (M = 4.34; SD
=.72), and self-esteem (M = 4.40; SD =.35) were significantly above the
midpoint (3) of the scales (all ps < .001). On the other hand, the average
scores of perceived discrimination (M = 2.48; SD = 1.31), and
psychological problems (M = 2.06; SD =.79) were significantly lower than
the midpoint (3) of the scales (all ps < .001). Overall, results suggest that
these immigrants presented a positive picture of their process of
acculturation and of adaptation outcomes.
Table 2. Means, standard deviations, and reliability coefficients of the

measures for the Romanian immigrants (N = 181)
M SD Number of items
Cronbach’s α
Portuguese language proficiency 4.10 .91 4 .97
Perceived discrimination 2.48 1.31 5 .90
Sociocultural adaptation 4.33 .50 20 .83
Multicultural ideology 4.34 .72 8 .68
Mental health problems 2.06 .79 15 .93
Self-esteem 4.40 .35 10 .68
Loneliness 1.67 .57 6 .73
To test our first hypothesis, we conducted a hierarchical multiple

regression. Gender, age, level of education and length of residence were
entered in the first block. Portuguese language proficiency and perceived
discrimination were entered in the second block. In the first block no
significant socio-demographic predictor was found. In the second block the
regression displayed that 11% of the total variance in loneliness could be
explained by the independent variables, F(6, 174) = 3.49, p < .01 (see
Table 3). Loneliness was predicted by higher level of perceived
discrimination (β = .31, p <. 001). These findings partially support our first
hypothesis.
To test our second hypothesis, we also conducted a hierarchical
multiple regression. Gender, age, level of education and length of
residence entered in the first block. Sociocultural adaptation, multicultural
ideology, psychological problems, and self-esteem were entered in the
second block. In the first block no significant socio-demographic predictor
was found. In the second block the regression displayed that 26% of the
total variance in loneliness could be explained by the independent
variables, F(8, 166) = 7.46, p < .001 (see Table 4). Loneliness was
predicted by lower multicultural ideology (β = -.14, p <.05), higher
psychological problems (β = .37, p <.001) and lower self-esteem (β = -.21,
p <.01). These findings partially support our second hypothesis.
Table 3. Hierarchical regression models of socio-demographic and

acculturation problems predicting loneliness among immigrants
Variables Block 1, β Block 2, β

Age .01 .06
Gender .05 .06
Level of education .09 -.03
Length of residence -.05 -.07
Portuguese language -.02
proficiency
Perceived discrimination .31***
R2 .01 .11
Adjusted R2 -
.01 .08
F change .57 9.24***
***p <.001.
Table 4. Hierarchical regression models of socio-demographic and

adaptation predicting loneliness among immigrants
Variables Block 1, β Block 2, β

Age .01 .01
Gender .05 .02
Level of education .09 .04
Length of residence -.05 -.05
Sociocultural adaptation .04
Multicultural ideology -.14*
Psychological problems .37***
Self-esteem -.21**
R2 .01 .26
2
Adjusted R .01 .23
F change .57 13.73***
* p < .05; **p<.01; ***p < .001.
DISCUSSION
The current research explored the level and two sets of predictors of
loneliness among Romanian immigrants living in Portugal. Two
hypotheses were tested and they were partially supported by the data.
The literature presents a mixed picture about the level of loneliness
among immigrant people. Some research argues that immigrants may
present proneness to loneliness (King & Merchant, 2008). However, there
are studies which have not found significant differences in loneliness
between immigrants and native population. For example, Portuguese
adolescents living in France and Portuguese adolescents without migratory
experience did not reveal differences in the level of loneliness (Neto,
1999). Identical results were found among Portuguese migrants living in
Switzerland (Neto & Barros, 2000a), and among Angolan, Cape Verdean
and Indian adolescents with an immigrant background residing in Portugal
(Neto, 2002). In a recent study it was even shown that adolescents from
returned migrant families to Portugal displayed lower loneliness than
native adolescents (Neto, 2016). In the current study, the level of loneliness
was not compared with the native population. However, this sample of
Romanian immigrants was experiencing a low level of loneliness.
Our first hypothesis was partially supported. As expected, loneliness
was predicted by greater levels of perceived discrimination. Perceived
discrimination constitutes a potential major stressful factor of the
acculturation process (Jasinskaja-Lahati et al., 2003). Indeed, past research
indicates a strong association between perceived discrimination and poor
mental health associated with feelings of anxiety, psychological distress,
depression and low levels of general well-being (Berry et al., 2006; Pascoe
& Richman 2009). Current findings are consonant with this picture, as
perceiving themselves as being a target of discrimination by members of
the host society predicted loneliness among Romanian immigrants. The
more discrimination immigrants perceived the more loneliness they felt.
However, Portuguese language proficiency did not emerge as a
significant predictor of loneliness. This result can be related to the fact that
the sample had a mean length of residence of 9 years allowing these
migrants to learn adequately the language of the society of settlement.

Globally, this sample evidenced a fairly good competency in Portuguese
language. As Romanian language is also a Romance language, the only
Romance language still spoken in Eastern Europe, obtaining competence in
the Portuguese language may be an easier task than for other Eastern
immigrants.
H2 was also only partially supported. As expected, intercultural
adaptation and psychological adaptation significantly predicted loneliness.
More specifically, lower levels of multicultural ideology and of self-
esteem, and higher levels of psychological problems emerged as significant
predictors of loneliness. The findings concerning the two indicators of
psychological adaptation (self-esteem and psychological problems) are
consonant with past research (e.g., Heinrich & Gullone, 2006; Cornwell &
Waite, 2009; Neto & Costa, 2015). The results concerning the indicator of
intercultural adaptation, that is multicultural ideology, opens a new and
promising avenue, as this kind of adaptation has only been introduced
recently, as has already been remarked. Higher acceptance of cultural
diversity as good for Portuguese society, and willingness to change oneself
in order to accommodate those who are culturally different, lower
loneliness was experienced by Romanian immigrants.
However, sociocultural adaptation did not significantly predict
loneliness. This finding can also reflect the length of residence of the
sample in Portugal. With longer duration of stay the sociocultural
difficulties experienced by migrants may tend to diminish. Indeed,
longitudinal research has shown a positive relationship between duration of
sojourn in a country of settlement and sociocultural adaptation (Ward,
Okura, Kennedy, & Kojima, 1998).
By providing information about acculturation and adaptation predictors
of loneliness among Romanian immigrants, this research makes a
contribution to the literature on migration. However, limitations should be
outlined. First, as the design of this research was cross-sectional,
inferences about the causal impact of the acculturation and adaptation
factors on loneliness cannot be drawn. Additionally, the sample of this
study constitutes a limitation on generalizability. Future studies should
include other immigrant groups in order to know if the current findings can
be generalized. Furthermore, additional predictors of loneliness can be
investigated, such as acculturation orientations, social support, tolerance
and personality.
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INDEX
79, 81, 87, 91, 96, 102, 103, 105, 112,

A
127, 128, 130, 131
aging paradox of loneliness, 47, 48, 50, 51,
academic achievement, 96, 122
52, 55
acculturation, vii, x, 120, 123, 124, 125,
alienation, ix, 7, 16, 17, 18, 19, 22, 67, 68,
126, 127, 130, 132, 133, 134, 135, 136,
70, 83, 86, 99
137, 138
alleviation, 5, 25
adaptation, vii, x, 21, 52, 54, 61, 117, 123,
alone, viii, ix, 2, 3, 10, 12, 13, 14, 17, 20,
124, 125, 126, 127, 128, 130, 131, 132,
21, 22, 23, 25, 26, 27, 28, 34, 37, 38, 39,
134, 135, 139
41, 44, 45, 52, 53, 54, 55, 56, 60, 61, 62,
adjustment, 34, 59, 105, 112, 139
63, 67, 68, 71, 75, 78, 82, 97, 98, 102,
adolescence, ix, 49, 50, 68, 74, 75, 77, 78,
110
89, 91, 97, 102, 103, 105, 109, 114, 115,
in coping, 20, 21, 22
116, 118, 119, 139
aloneness, 4, 61, 114, 118
adolescents, 75, 76, 78, 90, 92, 101, 102,
ambivalence, ix, 68, 82, 83
106, 110, 115, 118, 133, 136, 137
amelioration, viii, 2, 3, 5
adulthood, ix, 34, 46, 57, 62, 68, 76, 77, 78,
American Psychiatric Association, 7, 28
79, 80, 86, 92, 103, 106, 109, 114, 115
American Psychological Association, 138
adults, viii, 29, 30, 37, 38, 39, 40, 41, 42,
annihilation, 5, 21
43, 44, 45, 46, 47, 49, 50, 51, 52, 53, 54,
antecedents, ix, 6, 63, 95, 97, 99, 109, 117,
55, 56, 58, 59, 61, 62, 63, 65, 77, 78, 79,
138
80, 81, 89, 90, 92, 101, 102, 113, 135,
antecedents of loneliness, 6, 63, 99, 109,
137
117, 138
adverse effects, 98, 110
antisocial behavior, 115
affective reactions, 124
antonymic, 6
age, viii, 4, 37, 38, 44, 45, 46, 47, 48, 49,
anxiety, 5, 72, 106, 113, 114, 126, 129, 133
50, 52, 54, 56, 60, 62, 63, 72, 76, 77, 78,
142 Index
assessment, 56, 84, 89, 103, 110, 117, 138 -military gap, 18, 21, 27
attachment, 49, 50, 57, 58, 59, 61, 62, 68, clinical psychology, 111, 117
74, 91, 93, 96, 102, 104, 111, 119 clinicians, 22, 25, 84, 86
styles, 49, 59, 61 close relationships, viii, 37, 45, 50, 61, 79
attachment theory, 50 cognitive, vii, ix, 4, 40, 41, 42, 58, 65, 67,
attitudes, 103, 114, 118, 135, 136, 137 70, 81, 84, 85, 87, 88, 90, 107, 124
attribution, 104, 106 behavioral, vii, ix, 67, 70, 81, 84
authentic expression, 19 function, 41, 42, 58, 65
authenticity, ix, 68, 82 cognitive function, 41, 42, 58, 65
autonomy, 73, 74, 85, 93, 110 cognitive performance, 42
cognitive perspective, 4
cognitive skills, 107
B
cognitive therapy, 88
cognitive-behavioral therapy, 85, 90
behavioral theory, vii, ix, 67, 81
college students, 54, 59, 77, 87, 92
behaviors, ix, 3, 56, 60, 67, 70, 72, 78, 81,
combat stress injuries, 6
85, 86, 88, 92, 119
combat stress reaction (CSR), 7, 21, 28
belong, 17, 28, 31, 69, 70, 87
combat unit, 11
belonging, 16, 21, 69, 83, 86, 114, 136
communication patterns, 100
benefits, 26, 32, 61
communication skills, 104
bond, 10, 11, 12, 23, 90
communicative barrier, 15, 16, 26
breakdown, 7, 12, 30, 100
communicative isolation, 15, 23
brotherhood, 22
community, 30, 91, 97, 100, 108, 120, 124
brutality, 15
compensation, 57, 60
building blocks, 104, 107
computer addiction, 101
burdensomeness, 69, 80, 86, 92
conceptualization, 35, 70
conceptualized, ix, 4, 67, 106
C conflict, 34, 74, 76, 77, 79, 104, 113
consequences, viii, 32, 37, 52, 88, 90, 92,
Canadians, 124 96, 98, 109, 124, 126
care, 4, 21, 30, 31, 32, 34, 52, 77, 84, 121 context, ix, 14, 18, 23, 29, 58, 60, 68, 69,
challenges, ix, 10, 16, 24, 26, 28, 46, 47, 55, 82, 88, 107, 129
72, 84, 95, 97, 98, 99, 107, 124 controlled trials, 85
characteristics, vii, viii, 2, 3, 4, 9, 28, 39, 59, conviction, 20, 21, 23, 24, 26
91, 103, 106, 107, 122, 126, 128 cope, 5, 20, 22, 23, 26
childhood, ix, 34, 46, 49, 51, 61, 62, 68, 72, coping, 20, 21, 53, 84, 97, 102, 104, 106,
73, 74, 75, 76, 86, 88, 91, 93, 105, 109, 115
116, 135 core, 3, 5, 22, 87, 125, 126
children, 11, 44, 46, 49, 51, 74, 86, 90, 92, coronary heart disease, 118
101, 102, 106, 110, 111, 116, 121, 136 crisis, 17, 42, 44, 54, 71, 72, 73, 75, 85, 99,
civilian, 3, 5, 8, 9, 10, 11, 12, 13, 15, 16, 17, 110
18, 19, 21, 23, 24, 26, 27, 28 cultural differences, 124, 126
Index 143
cultural norms, 28 disorder, viii, 1, 6, 29, 31, 32, 113

cultural transition, 135, 139 distress, ix, 34, 67, 71, 99, 101, 102, 107
culture, 25, 46, 63, 96, 100, 101, 108, 115, distrust, 21, 22
117, 120, 122, 125, 138, 139 diversity, 126, 134
DSM, 7
D
E
death, 5, 11, 13, 15, 21, 63, 70, 74, 76, 78,
79, 87, 91 education, 25, 110, 120, 128, 132
decades, vii, 1, 6, 7, 101 educational institutions, 100
deficit, 4, 11, 113 educational research, 105
definition, 4, 40, 41, 56, 70, 106 elderly population, 61
delay of gratification, 104 emotion, 40, 54, 70, 85, 106, 109, 113, 115,
dementia, 41, 43 117, 118
demographic, 91, 103, 122, 128, 130, 131, emotion regulation, 106, 109, 113, 115, 117
132, 137 emotional abilities, 97
demographic characteristics, 91 emotional antecedents of loneliness, ix, 95,
deployment, vii, 1, 9, 10, 28 104, 108, 109, 110
depression, ix, 5, 31, 42, 43, 53, 61, 67, 68, emotional consequences of loneliness, ix,
69, 71, 73, 75, 76, 85, 86, 87, 91, 92, 96, 95, 104
101, 106, 109, 112, 114, 115, 118, 119, emotional distress, 96, 99, 101, 113
126, 129, 133 emotional experience, 39, 104
depressive symptom, 42, 43, 58, 78, 89, 91, emotional health, 91, 138
93, 113, 118 emotional intelligence, 107, 109, 110, 111,
depressive symptomatology, 58, 89 115, 116, 118, 119, 120, 121, 122
depressive symptoms, 42, 43, 78, 91, 93, emotional knowledge, 105
113, 118 emotional reactions, 106
deprivation, 5, 105 emotional regulation, 97, 104
despair, 72, 79, 86, 91 emotional responses, 106, 109
detachment, 7, 11, 22 emotional well-being, 54, 64
developmental change, vii, ix, 38, 44, 50, empathy, 31, 35
54, 55 environment, 10, 11, 20, 98
developmental stage, 72, 74, 76, 78, 81, 82, environmental, 5
83, 84, 86 environmental change, 5
diagnostic, 7, 28 Erikson, Erik, 72
diagnostic and statistical manual of mental evidence, ix, 3, 42, 54, 71, 73, 89, 90, 95,
disorders, 7 96, 97, 98, 100, 101, 102, 103, 104, 105,
disclosure, 26, 27, 33, 104, 112 106, 107, 108, 109, 138
discrepancy, 4, 23, 40, 69, 70, 96 evil, 42
discrimination, x, 123, 125, 126, 127, 128, evolutionary, 5, 11, 97
130, 131, 132, 133, 136, 137, 138 exclusion, 75, 92
144 Index
existential, 5, 21, 22, 30, 36 guilt, 5, 13, 21, 72, 73, 76, 86
existential fear, 21
expectancy, 98
H
expectations, 8, 98, 109
experiential alienation, 17, 18, 22
happiness, 62
experiential isolation, 13, 19, 21, 27
hazards, 96
experiential loneliness, viii, 2, 13, 14, 19,
healing, 5, 25
20, 21, 22, 27, 28
health, ix, 3, 17, 28, 29, 32, 41, 42, 43, 45,
54, 59, 60, 61, 62, 67, 69, 86, 88, 91, 96,
F 102, 111, 113, 116, 119, 120, 121, 125,
126, 129, 131, 133, 135, 137, 138
failed intersubjectivity, 13, 22 health condition, 102
family, 4, 10, 12, 14, 16, 18, 25, 34, 35, 39, health problems, 43, 126, 129, 131
43, 44, 45, 59, 61, 71, 74, 78, 79, 81, 83, health psychology, 120, 121
93, 100, 102, 103, 110, 112, 113, 114, hollowness, 5
120, 137 homecoming, viii, 2, 8, 9, 12, 24, 27, 28, 34
family interactions, 110 homesickness, 5, 10, 11, 30
family members, 14, 25, 39, 45, 103 hopelessness, ix, 67, 69, 71, 79, 86, 89
fear, 19, 26, 72, 76 host, 58, 125, 129, 133
feelings, 7, 14, 16, 17, 19, 43, 57, 70, 71, human actions, 15
74, 75, 76, 77, 80, 81, 86, 99, 116, 133 human behavior, 110
Filipinos, 124 human condition, 23
five factor model’, 103 human development, 59, 98
forsakenness, 5 human existence, 35
friends, 4, 5, 10, 13, 14, 15, 16, 22, 25, 33, human experience, 8
39, 40, 44, 45, 47, 49, 61, 68, 71, 78, 79, human motivation, 28, 87, 89
81, 98, 102 human sciences, 33
friendship, 16, 46, 90, 102, 116
frustration, 98, 105
I
G identity, viii, 2, 10, 16, 18, 23, 24, 29, 34,

74, 75, 76, 79, 82, 85, 88, 108, 135, 138
gender differences, 76 ideology, x, 123, 126, 129, 130, 131, 132,
general social factors, 97 134
generalizability, 134 immigrants, x, 110, 123, 124, 127, 128, 130,
generativity, 77, 85 131, 132, 133, 134, 138
gerontology, 40, 49 immigration, 97, 98, 100, 110, 124, 135,
global mobility, 110 137
graduate students, 139 immune function, 96
group therapy, 84 immune response, 63
growth and discovery, 10, 99 individual differences, 27, 43, 60, 61
Index 145
individuals, viii, ix, 3, 5, 14, 24, 37, 39, 40, isolation, 3, 4, 5, 6, 7, 8, 12, 13, 15, 19, 21,
47, 52, 53, 55, 70, 73, 74, 75, 76, 78, 80, 23, 24, 27, 31, 35, 36, 39, 40, 41, 42, 48,
82, 83, 84, 85, 86, 95, 96, 97, 98, 100, 56, 58, 59, 60, 64, 72, 76, 77, 78, 86, 92,
101, 103, 104, 105, 106, 107, 109, 110, 99, 101, 115, 118, 135, 136, 139
125, 135 Israel, 1, 27, 30, 35, 95, 120, 136
inferiority, 72, 73, 76, 86 issues, 2, 14, 43, 44, 46, 69, 86, 103, 124
influenza, 63
information and communication
K
technologies, 115
infrastructure, vii, viii, 2, 26, 106
kill, 43, 83
inner world, 52
kodoku-shi, 38
insecurity, 72
Koreans, 124
insomnia, 71, 88
institutional betrayals, 22, 28
institutions, 26 L
instrumental support, 102
integrity, 79, 85 language, x, 15, 16, 57
intelligence, 57, 107, 110, 111, 119, 120, proficiency, x, 123, 125, 127, 130, 131,
121, 122 132, 133
intensity, 4, 12, 23 language proficiency, x, 123, 125, 127, 130,
interactions, 98, 102 131, 132, 133
interdependence, 11 later life, viii, 37, 41, 44, 45, 47, 48, 50, 51,
internal-external discrepancy, 19, 23 52, 58, 63, 64, 87
internalization, 106 learning, 25, 26, 98, 139
internalizing, 106, 112 level of education, 130, 131
interpersonal, v, 13, 16, 23, 28, 35, 36, 69, life changes, 97
72, 73, 75, 77, 85, 87, 89, 92, 95, 96, 97, life cycle, 79, 88, 105
98, 99, 100, 102, 103, 104, 105, 107, life experiences, 98
108, 109, 112, 115, 116, 118, 119, 136 life satisfaction, 62, 116
abilities, 97 loneliness, v, vii, viii, ix, x, 1, 2, 3, 4, 5, 6,
associations, 98, 104 7, 8, 9, 10, 11, 12, 13, 14, 16, 18, 19, 20,
interactions, 97 21, 22, 23, 24, 25, 27, 28, 29, 30, 31, 32,
interpersonal communication, 108 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43,
interpersonal factors, 136 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54,
interpersonal interactions, 97 55, 56, 58, 59, 60, 61, 62, 63, 64, 65, 67,
interpersonal relationships, 73, 85, 103, 104, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78,
105, 107, 118, 119 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89,
intervention, v, vii, viii, ix, 1, 2, 22, 24, 27, 90, 91, 92, 95, 96, 97, 98, 99, 100, 101,
56, 68, 83, 88, 89 102,
intimacy, 4, 53, 61, 68, 69, 72, 75, 76, 82, lonely, 3, 4, 5, 7, 9, 10, 14, 15, 17, 18, 19,
83, 85, 98, 114 21, 22, 24, 26, 38, 40, 42, 43, 44, 45, 53,
146 Index
55, 56, 70, 71, 74, 75, 81, 82, 85, 87, 89, misunderstanding, 16
92, 97, 98, 99, 100, 104, 107, 129 mobility, 100, 110
longevity, 60 model, 29, 49, 99, 103, 108
longitudinal study, 88, 89, 139 modern society, 114
longitudinally, 6 mood change, 81
loss, viii, 5, 12, 15, 16, 21, 30, 33, 35, 37, mood disorder, 42
47, 51, 52, 58, 78, 111 mortality, 3, 41, 58, 60, 62, 63, 87, 96, 136
love, 4, 10, 75, 76 motivation, 5, 28, 87, 89, 98, 114
multicultural ideology, x, 123, 126, 129,
130, 131, 134
M
multiculturalism, 126
multidimensional, 88
majority, 124, 127
multiple regression, 131
maladaptive perceptions, 5
maladaptive social cognitions, 24, 26
marshmallow study, 105 N
matter, 2, 35, 98, 102, 114, 135
meanings, 8, 16 narrative, 8, 9, 29, 35, 111
measurement, 28, 70, 138, 139 national academy of sciences, 87
media, 9, 77, 81, 100, 102, 111, 116 native population, 133
memoirs, 6 negative consequences, 124
mental, ix, 3, 12, 17, 20, 21, 28, 29, 30, 31, negative emotions, 41, 42, 43, 83
32, 34, 43, 45, 51, 52, 54, 57, 67, 69, 88, negative outcomes, 96
91, 102, 113, 116, 125, 126, 133, 137 neuroticism, 103
breakdown, 12, 30 nomenclature, 7
health problems, 31, 126 nuclear families, 38
mental disorder, 28, 57 nursing, 80, 81, 121, 122
mental health, ix, 3, 17, 28, 29, 31, 32, 43, nursing home, 80, 81, 121
45, 54, 67, 69, 88, 91, 102, 113, 116,
125, 126, 133, 137
O
mental health problems, 31, 126
mental health professionals, 3
objective, ix, 3, 4, 19, 39, 48, 67, 68, 69, 84,
mental illness, 21
96, 99
mental representation, 52
objective factors, 97
meta-analysis, 31, 33, 41, 46, 47, 63, 85, 90,
old age, 58, 60, 61, 79, 80
93, 118, 136
older adulthood, ix, 68, 79, 80, 86, 103
methodology, 46
older adults, viii, 30, 37, 38, 39, 40, 41, 42,
middle adulthood, 77
43, 44, 45, 46, 47, 49, 50, 51, 52, 53, 54,
migrants, vii, x, 123, 125, 126, 127, 133,
55, 56, 59, 61, 62, 63, 65, 79, 80, 81, 89,
134, 136
90, 102, 113, 135, 137
military, 3, 10, 15, 16, 18, 21, 23, 25, 27,
opportunities, 20, 24, 26, 79, 83
28, 29, 30, 33, 34, 35, 90
ostracized, 5
Index 147
other, 4, 100, 102 Portuguese, x, 123, 124, 125, 127, 129, 130,
131, 132, 133, 134, 136, 137
positive, vii, ix, 4, 26, 38, 45, 51, 53, 54, 56,
P
62, 99, 106, 119, 129, 130, 134
positive emotions, ix, 38, 119
pain, 3, 10, 16, 23, 33, 97
positive relationship, 134
parental influence, 112
posttraumatic stress, viii, 1, 2, 6, 7, 12, 21,
parental relationships, 51
26, 28, 29, 30, 31, 32, 33
parental support, 73
posttraumatic stress disorder (PTSD), viii,
parents, 11, 49, 50, 75, 77, 102, 121
1, 2, 6, 7, 12, 21, 26, 28, 29, 30, 31, 32,
participants, 18, 46, 50, 103, 127, 130
33
peer, 7, 26, 29, 31, 32, 46, 74, 75, 84, 102,
post-war, vii, 6, 7, 8, 9, 12, 14, 22, 23, 25,
111, 113, 116, 135
26
peer group, 84, 116
preference for solitude, vii, ix, 38, 52, 58,
peer influence, 75
64
peer rejection, 74
prevalence, 9, 27, 31, 38, 44, 50, 91, 92, 138
peer relationship, 29, 74
prevention, 76, 84, 85, 86
peer support, 26, 31, 32, 102
primary control strategies, viii, 37, 52
perceived, x, 4, 6, 19, 23, 24, 31, 35, 40, 41,
problem solving, 107
46, 59, 69, 70, 73, 78, 80, 86, 92, 110,
professional growth, 77
117, 122, 123, 124, 125, 127, 130, 131,
protection, ix, 11, 68, 82
133, 135, 137
protective, 6, 86, 102, 103, 107, 110, 115
discrimination, x, 123, 125, 127, 130,
protective role, 103, 115
131, 133, 137
psychiatric, 7, 21, 88, 115
social isolation, 24, 41
psychiatry, 6, 115, 119
social support, 6, 35
psychological, x, 13, 17, 22, 23, 33, 40, 41,
personal relationship, 52, 64, 124
42, 43, 46, 49, 52, 55, 56, 57, 59, 63, 64,
personality, 4, 39, 42, 43, 61, 86, 90, 103,
69, 89, 90, 96, 97, 98, 99, 101, 104, 105,
104, 106, 107, 111, 113, 117, 120, 135,
106, 108, 109, 113, 118, 123, 125, 126,
139
127, 130, 131, 133, 134, 139
phenomenon, ix, 5, 7, 15, 27, 30, 38, 44, 46,
psychological development, 105
47, 49, 55, 83, 95, 96, 99, 101
psychological distress, 133
philosophy, 6, 31, 33
psychological functions, 104
physical, viii, ix, 3, 16, 23, 33, 37, 41, 42,
psychological problems, x, 123, 130, 131,
43, 45, 47, 51, 54, 63, 67, 68, 77, 78, 79,
134
83, 91, 105, 116, 138
psychological processes, 43
health, 41, 42, 79
psychological well-being, 63, 90
physical health, 41, 42, 79
psychologists, 5, 42
polymorphic, 5
psychology, 6, 32, 33, 39, 49, 52, 60, 63, 64,
population, 12, 18, 26, 38, 89, 91, 133, 138
89, 90, 111, 113, 116, 117, 119, 120,
Portugal, v, vii, x, 123, 124, 129, 130, 133,
121, 125, 136, 139
134, 136, 137, 138
psychometric properties, 92
148 Index
psychopathology, 7, 21, 35, 71, 86, 117 retirement, viii, 37, 45, 47, 51, 97
psychosocial, vii, ix, 5, 60, 68, 72, 73, 74, risk factor, 29, 41, 43, 45, 47, 60, 63, 78, 84,
76, 77, 79, 85, 88 89, 91, 98, 118, 136, 138, 139
psychosocial development, vii, ix, 68, 72, Romania, 128
76, 77, 79 Romanian, v, vii, x, 123, 124, 127, 128,
psychosomatic, 126, 129 130, 131, 133, 134
immigrants, x, 123, 124, 127, 130, 131,
133, 134
Q
Romanian immigrants, x, 123, 124, 127,
130, 131, 133, 134
qualitatively, viii, 2, 4, 39
romantic relationship, 46, 59, 76
quantitative, 9, 27, 99, 124
R S
sadness, 124
reactions, 19, 27, 104
school, 49, 75, 102, 116, 118
recognition, 52, 54, 75, 105
second generation, 136
recommendations, vii, ix, 68
secondary control strategies, viii, 37, 52, 54
reconnection, 5, 6, 22, 24, 28
secondary education, 127
recovering, 6
SEF (Portuguese Immigration Service), 124
reintegration, 3, 6, 16, 18, 21, 24, 30
selective attention, 71
rejection, 74, 82, 98, 102, 116
selective optimization with compensation,
relatedness, 4, 110
51
relational deficits, vii, viii, 2, 20, 23
self-actualization, 69, 115
relational expectations, 4
self-alienation, 99
relational needs, 4, 5, 8, 17
self-concept, 51, 106, 113
relationships, viii, 4, 5, 10, 11, 23, 29, 30,
self-consciousness, 112
33, 34, 37, 39, 40, 42, 44, 45, 46, 47, 48,
self-definition, 106
49, 50, 51, 52, 53, 56, 57, 59, 61, 62, 63,
self-destructive behavior, 85
64, 68, 69, 70, 72, 73, 74, 75, 76, 77, 79,
self-discovery, 53
80, 81, 84, 85, 89, 91, 102, 103, 104,
self-esteem, x, 42, 53, 61, 69, 70, 73, 114,
105, 107, 110, 111, 112, 113, 116, 118,
123, 126, 130, 131, 134, 139
119, 124, 126, 134
self-image, 138
relevance, 86, 101, 110
self-knowledge, 106
reliability, 46, 131
self-mutilation, 106
relief, 70, 106
self-rated loneliness, 102
religion, 130
self-regulation, 115
requirements, 69
self-worth, 18, 25
researchers, 11, 17, 39, 40, 42, 46, 47, 49,
severity, 4, 7, 12, 23
73, 98
shared experiences, 11, 12, 26
resources, 51, 97, 105, 122, 136
shared inner realities, 13
response, 8, 51, 101, 126
Index 149
silence, 15, 16, 19 social standing, 96

social acceptance, 139 social structure, 100
social activities, viii, 37, 39, 44, 45, 46, 47, social support, viii, 1, 5, 6, 24, 25, 35, 40,
49, 51, 52, 53, 54, 56, 62, 80 53, 59, 61, 63, 69, 74, 75, 78, 79, 84, 85,
social adjustment, 102 86, 88, 91, 102, 108, 113, 114, 124, 135
social alienation, 70, 99 social support network, viii, 2, 24, 84
social anxiety, 113 social withdrawal, 71, 78, 119
social behavior, 107 social workers, 110
social capital, 111 socialization, 10, 96
social change, 114 society, vii, x, 3, 11, 15, 16, 17, 19, 23, 24,
social circle, 79 25, 33, 34, 35, 42, 58, 62, 64, 65, 77, 80,
social cognition, 24, 26, 85 88, 100, 108, 110, 114, 122, 123, 125,
social construct, 35, 36, 96 126, 129, 133, 134, 138
social context, viii, 2, 8 socioeconomic status, 103
social environment, viii, 24, 37, 45 socioemotional selectivity theory, 44, 61
social events, 19 sociology, 6
social exclusion, 22, 33, 75, 114 soldiers, 5, 10, 11, 12, 21, 29, 32, 34
social factors, 44, 99 solitary, viii, 2, 15, 20, 25, 35, 37, 38, 44,
social group, 42, 44, 100 56, 61
social institutions, 77 death, 38
social interaction(s), 24, 26, 38, 45, 54, 70, solitude, vii, ix, 4, 31, 38, 52, 53, 54, 57, 58,
77, 78, 84, 96, 101, 108 62, 64
social isolation, 5, 36, 39, 40, 41, 48, 56, 58, statistics, 86, 130
59, 64, 76, 92, 118, 136, 139 stigma, 19, 20, 26, 31, 32
social network, 3, 9, 10, 11, 24, 39, 47, 48, stigmatization, 19
49, 51, 52, 54, 57, 58, 63, 68, 78, 79, 98, stories, 13, 25, 26, 29, 35
99, 100, 101, 102, 107 stress, 6, 7, 14, 21, 28, 29, 30, 31, 33, 34,
social psychology, 39, 52, 63, 64, 90, 113, 35, 53, 57, 61, 62, 78, 79, 96, 98, 113,
116, 117 114, 120, 125, 136
social relations, viii, 4, 5, 10, 11, 23, 29, 30, stressful life events, 14
33, 34, 37, 39, 40, 42, 44, 45, 46, 47, 48, stressors, 5, 33, 124
49, 50, 51, 52, 53, 56, 57, 59, 61, 62, 63, stroke, 118
64, 68, 69, 70, 72, 73, 74, 75, 76, 77, 79, structural equation modeling, 136
80, 81, 84, 85, 89, 91, 102, 103, 104, structure, 43, 63, 84, 103, 108, 117
105, 107, 110, 111, 112, 113, 116, 118, subjective, ix, 4, 13, 19, 38, 39, 40, 41, 42,
119, 124, 126, 134 43, 45, 47, 48, 49, 51, 54, 55, 56, 64, 67,
social resilience, 11, 27, 29 68, 69, 71, 75, 85, 96, 97, 103, 111, 137
social resources, 32 experience, 13, 96, 97, 103
social roles, 47 well-being, 38, 42, 43, 45, 47, 48, 49, 51,
social rules, 47 54, 56, 137
social situations, 126, 129 subjective experience, 13, 96, 97, 103
social skills, 24, 26, 50, 59, 84, 118
150 Index
subjective well-being, 38, 42, 43, 45, 47, 48, triggers, 46, 47, 48, 52
49, 51, 54, 56, 137 trust, 21, 22, 26, 32, 34, 72, 74, 85, 98, 120
subjectivity, 99
substitutions, 79
U
successful aging, 42, 51, 57
suicidal behavior, 17, 74, 89, 92
UCLA Loneliness Scale, 39, 61, 63, 64, 90,
suicidal ideation, 43, 73, 77, 82, 85, 89
117, 129, 137, 138
suicide, v, vii, ix, 3, 31, 32, 36, 43, 60, 67,
unique features, viii, 1, 25
69, 71, 72, 73, 74, 75, 76, 77, 78, 80, 81,
unpleasant, 4, 39, 68, 96
83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 136
suicide attempts, 83, 86, 90
suicide rate, 76, 78 V
survival, 11, 97, 100
symptomatology, 7, 27 Veterans, vii, 1, 2, 3, 5, 6, 7, 8, 9, 10, 12, 13,
symptoms, 21, 28, 35, 42, 43, 78, 85, 111, 14, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25,
126, 129 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36
victimization, 102
victims, 23, 32
T Vietnam, 8, 12, 19, 32, 34
technology, 80, 100, 101, 108, 114, 115

teens, 75, 76 W
temperament, 109, 112
therapy, 20, 26, 33, 86, 90, 115, 116 war, vii, 1, 2, 5, 6, 7, 8, 9, 11, 12, 13, 14, 15,
thoughts, 16, 24, 69, 70, 71, 72, 75, 76, 81, 16, 19, 20, 21, 22, 23, 25, 26, 27, 31, 32,
83, 85, 86 33, 34, 35, 113, 120
training, 10, 16, 30 well-being, 3, 22, 29, 38, 42, 43, 51, 54, 61,
traits, 58, 103, 104, 118 63, 64, 90, 107, 110, 111, 113, 114, 119,
trajectory, 22, 85 133, 135
transient, 5 withdrawal, 5, 16, 19, 71, 78, 81, 119
transition, 10, 11, 12, 18, 21, 28, 31, 135, words, 14, 15, 16, 43, 44, 46, 49, 74, 103,
139 109, 116
trauma, 1, 2, 4, 6, 7, 18, 23, 29, 30, 31, 32, work organizations, 100
33, 34, 35 world views, 18
literature, 6
traumatic, vii, 1, 6, 12, 14, 23, 25, 28, 29, Y
30, 32
traumatic experiences, 14, 23, 25 Young Adulthood, 76
traumatizing, 5 young adults, 59, 76, 77, 78, 84, 87, 101,
treatment, 30, 32, 33, 34, 73, 83, 90, 128 102, 107, 119, 121

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PSYCHOLOGY OF EMOTIONS, MOTIVATIONS AND ACTIONS

Additional books in this series can be found on Nova’s website

Additional e-books in this series can be found on Nova’s website

NOTICE TO THE READER

Library of Congress Cataloging-in-Publication Data

ISBN:  H%RRN

Published by Nova Science Publishers, Inc. † New York

In this compilation, the authors begin by discussing veterans'

Indeed, mitigating loneliness via social support may be essential for

needs and desires, while secondary control strategies concern individuals’

Chapter 5 - This study approaches the determinants of loneliness

THE VETERAN'S LONELINESS:

Jacob Y. Stein*, PhD

loneliness vary qualitatively, and these variations may have implications

Keywords: loneliness, veterans, identity, experiential loneliness, trauma

In a recent evocative article that appeared in the veteran-issues online

enigmatic. The enigma is accentuated when this solitary reality is

Loneliness – Its Nature and Relation to Recovery from Trauma

Loneliness may be conceptualized as the epitome of relational deficit

constitutes the experience of loneliness (e.g., depression, hollowness,

Loneliness-Focused Trauma Literature: A Gap Delineated

Trauma has long been recognized as one of many potential antecedents

Gaining Entrance to the Experience

The bulk of the current chapter is an attempt to grant readers an

L.V's account is Starmann's (2015) aforementioned piece, entitled The

THE VETERANS' LONELINESS

In order to gain a fuller understanding of veterans' post-war loneliness

Enlistment, Deployment and Homesickness

As he set out to explain what it is that the veteran's loneliness entails

Being lonely is very difficult for humans; we have always been

complements and amplifies the sense of detachment from one's home,

Homecoming, Experiential Loneliness and

such individuals can do so (e.g., Hodges, Kiel, Kramer, Veach, &

The lonely feelings become enmeshed with feelings of helplessness

In these assertions, L.V practically deemed my current endeavor in this

fail the experiences incorporated in the gestalt we recognize as “war.” This

When the soldier returns and starts to speak – if he starts to speak at

Starmannn (2015) expounds on this communicative barrier:

But it is much more than the technicalities of military routines that is

Civilian Life, the Veteran Identity, and Experiential Alienation

Evidently, the sense of loneliness at hand is rooted in emotional

In an abbreviated sense, being lonely is fighting for acceptance in

Of immense importance here is yet another long standing fundamental

repeatedly noted that it is this alienation, in part, that drives veterans to

Undeniably, the reception of the returning veteran by society may

Ultimately withdrawing into the confinements of the self, and fearing

The Conviction of Being Alone in Coping

Approaching his final conclusion, Starmann (2015) notes the

The veteran's loneliness is a stratified experience in which multiple

Notably, coping alone may refer to coping with anything and

magnified when care systems such as the Veterans Health Administration

Ultimately, understanding the veteran's loneliness may facilitate apt

Implications for Intervention and Reconnection

As clinicians consider implications for intervention, the first aspects to

communicative isolation, the internal-external discrepancy, and the sense

experiential gap and manners in which it may be adaptively approached

So, this Veterans’ Day, if you see a vet sitting by themselves at a

symptomatology remains undetermined and necessitates further research.

Limitations and Future Directions

The developmental course of the veteran's loneliness delineated above

loneliness or otherwise are not bothered by it. Future research should

Adler, A. B., & Castro, C. A. (2013). The occupational mental health

Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of

ISBN: H%RRN