Being belittled, ignored or emotionally neglected as a child can leave marks that last well into adulthood, shaping how people feel about themselves and how they connect with others. New research from India suggests that loneliness plays a central part in this process, and that it may be a key target for helping those affected.
The study, published in the International Journal on Child Maltreatment: Research, Policy and Practice, examined 465 trauma-exposed adults who sought help at a private wellness centre in Ahmedabad. Participants completed questionnaires on adverse childhood experiences, loneliness and depression. They then took part in interviews of at least an hour, during which researchers assessed childhood emotional maltreatment and symptoms of complex posttraumatic stress disorder.
Complex PTSD, recognised in the World Health Organization’s ICD-11 since 2018, includes what are known as disturbances in self-organisation. These cover difficulty managing emotions, a persistently negative view of oneself and troubled relationships. Researchers have long linked such symptoms to repeated trauma, but little was known about them in India or the wider Global South.
Dr Gunjan Y Trivedi, co-founder of Wellness Space in Ahmedabad, said: “Initially, I started with PTSD assessment, around 2019. Results were good, but something was missing in the recovery. It appeared that the clients were not recovering fully. I could not pinpoint what was not happening and what else could be done. This is what led to a review of the literature, where I found CPTSD. It was too early, but the initial research was encouraging. The fact that we were working with ACEs (adverse childhood experiences), which are mostly repeated exposure to trauma, also helped. (Repeated exposure to trauma, where an individual may not be able to escape, is one core criterion for CPTSD.)”
Using structural equation modelling, the team found that childhood emotional maltreatment was significantly associated with both adult loneliness and disturbances in self-organisation. It was not directly linked to adult depression. Instead, loneliness appeared to connect the two, as lonelier participants were more likely to report depressive symptoms.
Depression itself was associated with greater disturbances in self-organisation. Together, childhood emotional maltreatment, loneliness and depression accounted for around half of the variation in these symptoms, which the authors describe as a notable result.
The findings also revealed a difference between the sexes. Among women, loneliness was linked both directly and indirectly, through depression, to disturbances in self-organisation. Among men, the link was indirect only, running through depression. The authors say existing research is not sufficient to explain this, and suggest it needs further investigation.
The sample was largely female, at around 74%, and the average age was about 31. Participants were English-speaking and urban, and all had sought help at a wellness centre, so the results may not apply to the wider Indian population.
The authors stress that the study is cross-sectional, meaning it shows associations rather than cause and effect. The relationship between loneliness and complex PTSD may even run both ways, they note, since distressing symptoms could lead people to withdraw socially and feel more isolated.
Even so, the researchers argue that clinicians should routinely screen for childhood emotional maltreatment, loneliness and depression in people seeking mental health support. They describe loneliness and depression as modifiable risk factors, which could be addressed as part of trauma-informed care. They also call for greater awareness among parents, teachers and community workers of the long-term impact of emotional harm that leaves no physical sign.
Trivedi said: “Diagnosis in mental health has some element of subjectivity. Metaphorically, the title of our book is the important message that I would like people who are suffering with mental health issues to internalise: What Happened to Me? vs What’s Wrong with Me? Mental health outcomes are predictable if we look back at what happened to these individuals.”
Longitudinal research and studies across wider populations are needed to clarify how these pathways develop over time. For now, the work adds to growing evidence that early emotional wounds and adult loneliness are closely intertwined.
Looking ahead, Trivedi said: “We have written a few case studies (focused on recovery) and have assessed psychometric properties for CPTSD assessment with Indian data, so more individuals could benefit. We have also been studying the risk factors and consequences of loneliness.”
