06/08/2026
Lately, I have increasingly heard colleagues arguing that loneliness should be included in the DSM as a separate diagnosis.
I believe an important clarification is needed, with both rigor and respect for the complexity of this human experience: loneliness is not, in itself, a mental disorder.
It is, however, a major clinical indicator.
Loneliness frequently appears in depression, anxiety, complicated grief, relational trauma, personality disorders, addictions, existential suffering, and attachment difficulties. It may function as a risk factor, a symptom, a consequence, or a maintaining mechanism within a psychopathological picture.
DSM-5-TR already includes loneliness in the context of prolonged grief disorder, which shows that the phenomenon is clinically recognized, even though it is not defined as an autonomous diagnosis.
The World Health Organization has also identified loneliness and social isolation as an important public health issue and has launched a commission dedicated to social connection. The U.S. Surgeon General’s report has likewise emphasized that loneliness affects mental, physical, and social health, not only affective mood.
So the question is not whether loneliness matters clinically.
It matters profoundly.
The question is different: should it be turned into a separate psychiatric diagnosis?
Answer: NO.
Because loneliness is a fundamental human experience, not automatically a pathology. It may appear in grief, separation, migration, motherhood, illness, aging, adolescence, existential crises, identity transformations, or periods of withdrawal necessary for reflection and creativity.
Not every loneliness is a disorder.
Sometimes it is a signal.
Sometimes it is a transition.
Sometimes it is grief.
Sometimes it is a need for meaning.
Sometimes it is the effect of a culture that fragments relationships.
Sometimes it is the absence of community.
Sometimes it is an old wound of belonging.
If we were to transform loneliness into an autonomous diagnosis, we would risk pathologizing normal life experiences. By the same logic, we would have to ask whether the DSM should also include happiness, normality, longing, ordinary sadness, doubt, the need for meaning, or creative solitude.
The role of the DSM is not to catalogue all human experiences, but to define mental disorders in which there is clinically significant suffering, functional impairment, and clear diagnostic criteria.
Another important risk is the loss of context.
Loneliness cannot be understood outside the person’s history: family, attachment, trauma, community, social exclusion, migration, grief, illness, digitalization, age, shame, relational status, place in the family, and sense of belonging.
The same experience can carry very different meanings: for an adolescent, loneliness may mean exclusion, shame, or the absence of a group of belonging; for an adult, it may be the effect of a cold relationship, a divorce, or a life lived more through performance than connection; for a grieving person, it may express the absence of the one who has been lost; for someone in a creative or spiritual process, it may be a fertile form of solitude, not a symptom.
The DSM requires relatively stable criteria. Loneliness, however, is fluid, relational, cultural, and deeply contextual.
There is also a risk of diagnostic overlap. Loneliness already appears in depression, social anxiety, trauma, prolonged grief, attachment disorders, personality disorders, addictions, or suicidal ideation. If we were to make it a separate diagnosis, we could end up with diagnostic duplication or clinical confusion: treating loneliness as the main diagnosis when it may, in fact, be part of a depressive, traumatic, relational, or grief-related picture.
Moreover, including loneliness as a psychiatric diagnosis could individualize a problem that is often also social. The implicit message could become: “the problem is in the individual.” But sometimes the problem is also in the fragmentation of community, the precarity of relationships, digitalization, the loss of rituals, social mobility, shame, exclusion, or the absence of real spaces of belonging.
Nor should the systematic assessment of loneliness be applied mechanically, exclusively through standardized tools. Assessment is useful, but when it becomes rigid, it can reduce the clinical encounter to questionnaires.
Loneliness is often hidden beneath shame, defensive autonomy, performance, emotional withdrawal, or the apparently functional phrase: “I manage on my own.”
It does not always appear as a direct answer to the question: “Do you feel lonely?” Sometimes it appears in the way a person tells the story of relationships, absences, silences, loyalties, ruptures, losses, and their place in the family.
That is why loneliness needs careful clinical formulation, not only coding. It needs to be explored through relational history, belonging, attachment, losses, trauma, family context, social context, and resources for reconnection.
Loneliness should not be ignored, but neither should it be diagnosed too quickly. It requires listening, differentiation, and contextual understanding.
Before saying that loneliness should be “introduced into the DSM,” perhaps we need to understand more deeply what loneliness is, how many forms it can take, and what it tells us about the person, relationships, family, community, and the culture in which we live.
Loneliness is not something to be simply fought against; loneliness is to be understood, listened to, contextualized, and, at times, transformed through relationships that can become alive again.
P.S. In Romania, we have an accredited course dedicated to the Psychotherapy of Loneliness.
