Social functioning, loneliness, and psychosis phenotype in the general population: a network analysis perspective

Psychotic experiences (PEs) occur across a continuum from subclinical phenomena in the general population to clinical disorders and are consistently associated with impaired social functioning. The present study aimed to investigate the network structure linking PEs, social functioning, and loneliness, and to identify central elements within this network.

We analyzed data from a representative sample of Slovak adults (N = 1200) who completed validated measures of PEs, loneliness, social functioning, emotional distress, social motivation, and mentalizing. A regularized partial correlation network was estimated using EBICglasso, comprising 17 nodes. Centrality indices and edge weights were used to determine the most influential nodes and connections.

The network revealed 40 non-zero edges. Friendship approach, bizarre experiences, social withdrawal, paranoia, and avolition emerged as the most interconnected nodes. Paranoia was strongly associated with loneliness and social withdrawal, while avolition was linked to loneliness and reduced social participation. Negative affect showed associations with loneliness and diminished participation. Social withdrawal linked negative symptoms to diminished social engagement and interpersonal communication. In contrast, hallucinations and grandiosity showed no notable direct associations with social functioning or loneliness.

These findings highlight paranoia, social withdrawal, and avolition as central mechanisms connecting PEs with social functioning and loneliness, while social approach motivation may serve as a protective factor. The results support a dimensional model of psychosis and point to early social and motivational targets for intervention.