Loneliness and psychosis: an integrative review

PURPOSE OF REVIEW: This review synthesizes emerging research on loneliness in psychosis, integrating neurocognitive, social, developmental, and phenomenological perspectives. We highlight how loneliness operates as both a precipitant and consequence of psychosis symptoms, discuss its manifestations across the psychosis spectrum, and outline conceptual and clinical priorities for advancing person-centered research and clinical care. RECENT FINDINGS: Loneliness is highly prevalent in psychotic disorders and strongly associated with psychiatric symptom severity, instability of self-concept, and overall reduced wellbeing. Neurocognitive models demonstrate that chronic loneliness heightens social threat sensitivity and alters brain networks supporting social cognition and emotion regulation in individuals with psychosis. Longitudinal data show bidirectional relationships between loneliness and paranoia, psychotic-like experiences, and social-cognitive biases. Qualitative work emphasizes loneliness as a profound barrier to recovery across stages of illness. Understudied contributors, including attachment disruptions, social defeat, context, solitude, and disturbances in self and identity, shape subjective experiences of loneliness beyond objective isolation. SUMMARY: Loneliness in psychosis is multidimensional, driven by interacting cognitive, interpersonal, developmental, and contextual processes. Future research should refine definitional distinctions of loneliness in psychosis phenomenology, incorporate dynamic and mixed-methods paradigms, and examine individual-specific and interpersonal mechanisms. Clinically, evidence supports treatments that prioritize meaning making, improving existing relationships, and addressing social biases, integrating cognitive, meta-cognitive, and narrative approaches.