What is loneliness?
Loneliness is a fundamental aspect of life; at some point, everyone will experience it to varying degrees. Even though it is recognized as a public health concern (Office of the Surgeon General, 2023), there is still a need for more discussion about what the experience of loneliness entails and how to recognize it in oneself or others. For starters, loneliness is the distressing feeling you experience when there is a discrepancy between the interpersonal relationships you wish to have and those you currently have (Peplau & Perlman, 1982). It is not the number or frequency of social contacts but your subjective appraisal of the quality of relationships and the satisfaction with the relationships that influences loneliness (Heinrich & Gullone, 2006). Moreover, loneliness is not synonymous with social isolation, nor is it an inevitable consequence of being alone. You can be in the company of others and still experience loneliness, whereas you may not feel lonely when you derive solace and pleasure from solitary pursuits (Brownie & Horstmanshof, 2011).
Loneliness is experienced across all age groups. Twelve percent of kindergartners and first graders, 8.4% of third through sixth graders, and 5-7% of middle-aged and older adults report feeling lonely (Masi et al., 2011). Loneliness tends to increase in older age, and nearly one in five (19.3%) older adults living in the U.S. report experiencing loneliness (Theeke, 2009). These numbers are expected to rise due to the aging U.S. population and increased social isolation after the COVID-19 pandemic. Recent data suggests that half of all adults in the U.S. report feeling lonely (Office of the Surgeon General, 2023). Despite increased digital connectivity, having many "followers" or "friends" on social networking sites does not prevent loneliness.
1. Emotional loneliness: This type of loneliness results from the lack of a close, intimate attachment to another person. It is associated with feelings of emptiness, isolation, and anxiety. Individuals who have recently been divorced, widowed, or ended a relationship may experience this type of loneliness. This type of loneliness is also called intimate loneliness, and marital status is its most vital determinant in middle-aged and older adults.
2. Social loneliness: This type of loneliness results from the lack of a network of social relationships in which the person is part of a group of friends who share common interests and activities. It is associated with feelings of aimlessness, boredom, and exclusion. Individuals who have recently moved to a new social environment (e.g., to a new city, changed jobs, or went to college) may experience this type of loneliness. This type of loneliness is also called relational loneliness, and the frequency of contact with family and friends is its strongest predictor in middle-aged and older adults.
3. Collective loneliness: This type of loneliness results from the lack of connection to people at a distance in the collective space that belongs to the person’s valued social identity or “active network” (e.g., group, school, team, or national identity). The number of voluntary associations an individual belongs to is the strongest predictor of collective loneliness in middle-aged and older adults.
1. Self-alienation: A feeling of separation from self, core, and identity. One of the ways this is experienced is emptiness – a feeling of hollowness and blackness felt by the lonely individual.
2. Interpersonal isolation: This refers to feeling emotionally, geographically, and socially alone. Either absence of intimacy, perceived social isolation, or abandonment characterizes it.
3. Distress: The distress experienced by the lonely individual has four components –
If you are feeling empty and experiencing the above four psychological states, you are likely dealing with loneliness. In this context, loneliness is a sustained state of feeling lonely rather than a temporary mood. Loneliness and depression, despite sharing symptoms, are different. Loneliness involves feeling negatively about oneself in the social aspect of life. At the same time, depression is a broader and more complex condition involving negative self-perception across various areas of life (such as self, work, relationships, environment, and spiritual life). However, loneliness can lead to future depression and maintain depressive symptoms (Duggal, 2016). Besides mental health, chronic and intense loneliness is known to harm physical health. Loneliness increases the risk of premature death by 26%, heart disease by 29%, and stroke by 32% (Thomas, 2024). Despite these health consequences, identifying and addressing loneliness in healthcare settings lags behind other chronic conditions.
Check out Dr. Duggal’s Author Page to learn more about evidence-based self-management techniques that promote mental health and well-being.
Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness: clinical correlates and interventions. Perspectives on Psychological Science, 10(2), 238-249.
Types of loneliness
Loneliness can manifest in the following ways (Cacioppo et al., 2015; Weiss, 1973):1. Emotional loneliness: This type of loneliness results from the lack of a close, intimate attachment to another person. It is associated with feelings of emptiness, isolation, and anxiety. Individuals who have recently been divorced, widowed, or ended a relationship may experience this type of loneliness. This type of loneliness is also called intimate loneliness, and marital status is its most vital determinant in middle-aged and older adults.
2. Social loneliness: This type of loneliness results from the lack of a network of social relationships in which the person is part of a group of friends who share common interests and activities. It is associated with feelings of aimlessness, boredom, and exclusion. Individuals who have recently moved to a new social environment (e.g., to a new city, changed jobs, or went to college) may experience this type of loneliness. This type of loneliness is also called relational loneliness, and the frequency of contact with family and friends is its strongest predictor in middle-aged and older adults.
3. Collective loneliness: This type of loneliness results from the lack of connection to people at a distance in the collective space that belongs to the person’s valued social identity or “active network” (e.g., group, school, team, or national identity). The number of voluntary associations an individual belongs to is the strongest predictor of collective loneliness in middle-aged and older adults.
How do people express loneliness?
It's unlikely that loneliness will be screened for during a medical visit because it is not included in the Diagnostics and Statistical Manual of Mental Disorders (DSM). Loneliness is a subjective experience, so its meaning can vary from person to person. According to a loneliness rating scale, some common expressions of loneliness include (Russell et al., 1978):- “I have nobody to talk to.”
- “I am unhappy doing so many things alone.”
- “I cannot tolerate being so alone."
- “I lack companionship.”
- “I feel as if nobody really understands me.”
- “There is no one I can turn to.”
- “I am no longer close to anyone.”
- “I feel left out.”
- “I feel completely alone.”
- “I am unable to reach out and communicate with those around me.”
- “My social relationships are superficial.”
- “It is difficult for me to make friends.”
- “I feel shut out and excluded by others.”
- “I feel unhappy being so withdrawn.”
1. Self-alienation: A feeling of separation from self, core, and identity. One of the ways this is experienced is emptiness – a feeling of hollowness and blackness felt by the lonely individual.
2. Interpersonal isolation: This refers to feeling emotionally, geographically, and socially alone. Either absence of intimacy, perceived social isolation, or abandonment characterizes it.
3. Distress: The distress experienced by the lonely individual has four components –
- Physiological distress (headaches, nausea, stomach upset, etc.).
- Behavioral distress (crying, anxiety, depression).
- Self-deprecation – generalized negative attitude toward oneself.
- Self-generated social detachment is brought about by either withdrawal or active separation.
If you are feeling empty and experiencing the above four psychological states, you are likely dealing with loneliness. In this context, loneliness is a sustained state of feeling lonely rather than a temporary mood. Loneliness and depression, despite sharing symptoms, are different. Loneliness involves feeling negatively about oneself in the social aspect of life. At the same time, depression is a broader and more complex condition involving negative self-perception across various areas of life (such as self, work, relationships, environment, and spiritual life). However, loneliness can lead to future depression and maintain depressive symptoms (Duggal, 2016). Besides mental health, chronic and intense loneliness is known to harm physical health. Loneliness increases the risk of premature death by 26%, heart disease by 29%, and stroke by 32% (Thomas, 2024). Despite these health consequences, identifying and addressing loneliness in healthcare settings lags behind other chronic conditions.
While chronic loneliness has negative consequences, loneliness experienced as solitude, a chosen state of being alone with others, nature, and the universe, fosters introspection, personal discovery, and growth. This can be an uplifting and exhilarating experience for some individuals, akin to that achieved through solitary meditation or mindful exercises. Additionally, mild and transient loneliness signals us to renew the connections needed to survive and prosper (Duggal, 2016). Thus, loneliness, in small amounts, is not bad.
Check out Dr. Duggal’s Author Page to learn more about evidence-based self-management techniques that promote mental health and well-being.
HARPREET S. DUGGAL, MD, FAPA
REFERENCES
Brownie, S., & Horstmanshof, L. (2011). The management of loneliness in aged care residents: an important gerontological nursing. Geriatric Nursing, 35(5), 318-325.Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness: clinical correlates and interventions. Perspectives on Psychological Science, 10(2), 238-249.
Duggal, H. S. (2016). The complete guide to self-management of depression. Bloomington, IN: Archway Publishing.
Heinrich, L. M., & Gullone, E. (2006). The clinical significance of loneliness: a literature review. Clinical Psychology Review, 26, 695-718.
Masi, C. M., Chen, H. Y., Hawkley, L. C., & Cacioppo, J. T. (2011). A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review, 15(3), 219-266.
Heinrich, L. M., & Gullone, E. (2006). The clinical significance of loneliness: a literature review. Clinical Psychology Review, 26, 695-718.
Masi, C. M., Chen, H. Y., Hawkley, L. C., & Cacioppo, J. T. (2011). A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review, 15(3), 219-266.
Office of the Surgeon General (OSG) (2023). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community. U.S. Department of Health and Human Services.
Peplau, L. A., & Pearlman, D. (1982). Perspectives on loneliness. In L. A. Peplau & D. Pearlman, (Eds.), Loneliness: A sourcebook of current theory, research, and therapy (pp. 1-20). New York, NY: Wiley-Interscience.
Rokach, A. (1988). The experience of loneliness: a tri-level model. Journal of Psychology, 122(6), 531-544.
Russell, D., Peplau, L. A., & Ferguson, M. L. (1978). Developing a measure of loneliness. Journal of Personality Assessment, 42, 290-294.
Theeke, L. A. (2009). Predictors of loneliness in U.S. adults over sixty-five. Archives of Psychiatric Nursing, 23(5), 387-396.
Peplau, L. A., & Pearlman, D. (1982). Perspectives on loneliness. In L. A. Peplau & D. Pearlman, (Eds.), Loneliness: A sourcebook of current theory, research, and therapy (pp. 1-20). New York, NY: Wiley-Interscience.
Rokach, A. (1988). The experience of loneliness: a tri-level model. Journal of Psychology, 122(6), 531-544.
Russell, D., Peplau, L. A., & Ferguson, M. L. (1978). Developing a measure of loneliness. Journal of Personality Assessment, 42, 290-294.
Theeke, L. A. (2009). Predictors of loneliness in U.S. adults over sixty-five. Archives of Psychiatric Nursing, 23(5), 387-396.
Thomas, S. P. (2024). The loneliness epidemic and its health consequences. Issues in Mental Health Nursing, 45(1), 1-2.
Weiss, R .S. (1973). Loneliness: the experience of emotional and social isolation. Cambridge, MA: MIT Press.
Weiss, R .S. (1973). Loneliness: the experience of emotional and social isolation. Cambridge, MA: MIT Press.
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