Health effects of loneliness

The American Psychological Association defines loneliness as “affective and cognitive discomfort or uneasiness from being or perceiving oneself to be alone or otherwise solitary”. 

Loneliness is perceived social isolation—the idea that you are alone or without close friends. The person who suffers from loneliness feels there’s a gap between their current social life and what they want their social life and social connections to be like. This gap could arise from several factors; for example, unrealistic expectations set by viewing other people’s social media lives.

Loneliness is different from solitude in that loneliness is unwanted alone-time that is painful or causes suffering. For someone who is lonely, it is possible to experience isolation amid a crowd, or while surrounded by well-wishers. In that sense, loneliness is a feeling. It is typically associated with negative emotions which can have a cascading effect on our health.

Research shows that loneliness may cause and be caused by chronic conditions such as heart disease, lung disease, hypertension, atherosclerosis, stroke, and metabolic disorders like obesity and metabolic diseases such as diabetes.

Loneliness is also a “major predictor of psychological problems, such as depression, psychological stress, and anxiety... (and) linked to overall morbidity and mortality in adult populations.” (“The complexity of loneliness” in Acta Biomedica)

The ongoing Harvard Study of Adult Development—it was started in 1939, and is perhaps the longest-running study on what makes people happy and contented with their lives—shows that people who are involved in the community and have close-knit ties with family, friends, their spouse are more likely to be healthy and happy in old age.

The opposite is also true: people who are lonely or in bad relationships, where there is a lot of conflict or where they feel they can’t trust their partner or rely on them completely, experience earlier decline in mental and physical health

In the 1970s, sociologist Robert S. Weiss of the University of Massachusetts wrote about emotional loneliness and social loneliness.

• Emotional loneliness comes from thinking there's no one in your life who "serves as a nurturing confidant, someone who affirms your existence". ("The Phenotype of Loneliness" by John T. Cacioppo and Stephanie Cacioppo, in The European Journal of Developmental Psychology, 2013). It may also arise from losing someone you love or are emotionally attached to.
• Social loneliness is all about the quality of one's relationships. How often you meet your close friends and family and what is your relationship with them like can be indicators of whether you feel lonely or not.
  Social loneliness is relational—in relation to others. Some situations like moving to a new city or school or even a neighbourhood where you don’t have a support system yet can give rise to social loneliness for short periods.

In the case of transitional loneliness, the symptoms (like sadness) might pass in a few days without having a lasting impact on health. However, if the condition turns into chronic loneliness, it can open you up to health problems.

For example, lonely people, tend to have higher levels of cortisol hormone in their blood in early mornings. To be sure, cortisol is normally high when you wake up (unless you have a night-time job, in which case the day-night cycle is reversed). But loneliness causes an abnormal increase in cortisol (stress hormone) that can affect your blood pressure, pulse, metabolism and overall health.

Everyone feels lonely at one time or another. However, long-term loneliness or the feeling of being cut-off from everyone—chronic loneliness—can impact our mental and physical health. Though loneliness is not characterised as a mental illness, it does have some common signs and symptoms you could look out for:

• Feeling alone in a crowd or while surrounded by friends, family or colleagues.
• Inability to engage with people on a deeper level or feeling exhausted when you try to connect with others.
• Feelings of self-doubt and worthlessness
• Feelings of anxiety or restlessness
• Sleeping too little or too much or having interrupted sleep
• Low energy and enthusiasm
• Poor appetite
• Body pain
• Increased shopping or binge-watching shows or movies
• Feeling like you don’t belong

Older people tend to be at high risk for loneliness. That said, it is wrong to assume that only the elderly suffer from loneliness.

Newborns need to be held and comforted and develop a bond of trust (attachment security) with a parent to have a healthier outlook on isolation as they grow older.

Children and young adults can feel lonely, too. Life events like bullying, not fitting in at school or family discord can cause children to feel isolated. Research shows that adverse childhood events can have very long term effects on overall well-being throughout life.

Factors like a being in a bad relationship, a bad breakup or the death of a partner can also make people across age groups feel lonely.

Socio-economic factors that have a bearing on mental health can also make one more susceptible to feeling lonely. These factors include low income or financial difficulties, being unemployed or having lower levels of education. 

Additionally, having a chronic illness or condition that prevents one from going out or eating out or doing the things their friends want to do can also make them feel lonely. Caregivers of people with chronic or progressive illnesses like multiple sclerosis may also be at high risk of being lonely.

Research has shown that people who spend a lot of time online rather than mingling with people IRL (in real life), may be at risk of loneliness and other mental health problems.

According to research, some potential causes of loneliness* are:

• Genetics or a heritable sensitivity to loneliness
• Childhood environment
• Cultural norms
• Social needs
• Physical disabilities
• Discrepancies between actual and desired relationships

*Source: “Perceived social isolation and cognition” by J.T. Cacioppo and Louise C. Hawkley, published in Trends in Cognitive Sciences, 2009; 13(10): 447-54.

People who feel lonely are prone to take a more negative view of their circumstances. For example, they might perceive a situation to be more stressful than someone who has a strong support mechanism and social connections. Stress, as we know, has many implications for mental and physical health.

Loneliness is linked to poorer lifestyle choices though it’s not always clear whether loneliness leads to the poorer choices (like smoking and low levels of physical activity) or if the poorer choices lead to loneliness.

Here’s a look at the science-backed effects of loneliness:

• Worsening of symptoms in patients: In people with chronic health problems, loneliness can increase the existing symptoms. For example, chronic pain patients may experience an increase in pain because of loneliness. In a vicious circle, the pain may increase their loneliness, as they may become more reluctant to socialise or go out if they are in pain.
• Worsening of pain and fatigue in caregivers: Caregivers of people with a progressive illness like dementia, or a stressful diagnosis like cancer, may experience greater fatigue, pain and even depression as a result of loneliness.
• Poorer motor function, especially in older people: Lonely People are less likely to have the motivation to go out or workout alone. Over time, lack of physical activity could result in more aches and pains and less motor ability. (Read more: How to reduce the risk of falling in older people). Studies have linked loneliness to decline in motor function that makes day-to-day activities like bathing and dressing oneself difficult for older people.
• Effects on brain function and mental well-being: Loneliness affects brain function and mental health across age groups.
  • In children and adolescents, it may present as poor attention, poor sleep quality, and difficulty in regulating themselves—loneliness can become a link between emotional dysregulation and eating disorders like binge eating and bulimia nervosa.
  • In older people, loneliness has been linked with Alzheimer’s disease and cognitive decline. (What compounds the problem is that a significant decline in cognitive ability may lead to greater loneliness, as the person may shun social contact if they feel embarrassed or unable to participate.)
  • Loneliness can be a red flag for psychological problems like depression, stress and anxiety. Indeed, loneliness and depression are interlinked: while people with depressive conditions, mood disorders and psychotic disorders are likely to feel lonely, those who are lonely are at greater risk for depression.
  • Studies show that lonely people are also more likely than non-lonely people to use psychoactive substances which in turn are a risk factor for poor mental health.
  • Research shows that lonely people also tend to expect things to go wrong in relationships compared with non-lonely people. This negative outlook can also affect their ability to sustain relationships or be happy in them. “Indeed, loneliness is related to stronger expectations of and motivations to avoid bad social outcomes and weaker expectations of and motivations to approach good social outcomes,” wrote John T. Cacioppo and Louise C. Hawkley in “Perceived Social Isolation and Cognition” (published in Trends in Cognitive Sciences in 2009).
• Effects on physical health: Research has linked loneliness to a higher incidence of many health conditions like:
  • Heart disease
  • Lung disease
  • High blood pressure (hypertension)
  • Atherosclerosis, or cholesterol plaque build-up in blood vessels
  • Stroke
  • Metabolic disorders like obesity
  • Metabolic disease like diabetes
  • Overall morbidity
  • Death

The treatment depends on the underlying cause of loneliness. That said, some approaches used to address this condition are:

• Cognitive behavioural therapy: This is a type of talk therapy in which a trained psychologist tries to help change the patient’s outlook to help them see themselves, their relationships and their lives in a more positive light. Cognitive behavioural therapy can have a huge impact on people of all ages.
• Drug therapy: If the cause of your loneliness is a medical condition like depression, the doctor may prescribe medicines like antidepressants or antipsychotic medicine.
• Lifestyle changes: Your doctor may also advise making changes to your diet and workout routine. Research shows that lonely people tend to work out less. Exercising releases feel-good hormones (endorphins), so building exercise into their routine can help some people.

Certain interventions can also be geared toward specific age groups:

• For children: Research shows that children fail to thrive in environments where they lack attachment security with a parent, even if all their other needs like food and warmth are met. That's why it is important to be predictable and responsive to our children in the early years of their life, so they can have a healthy outlook on relationships rather than seeing them with mistrust.
  As children grow older, parents should explain to them why alone-time is not the same as loneliness.
  Social acceptance by peers has a huge part to play in preventing loneliness in schoolgoing kids. Schools should encourage positive behaviours in terms of involving new kids and looking out for children who seem like they are having difficulty making friends.
• For teenagers: The teen years are a period of great change in the body and mind. This is also the age when many young people try to experiment with smoking, alcohol, drugs and sex. A break-up in the teen years can be devastating. Betrayals in friendship can seem very final. The stress of important schoolyears—like writing the boards—can compound the feelings of frustration and loneliness. And social media can be an added stressor. Research shows loneliness can be a factor linking social anxiety to suicidality in this age group.
  It is important to build proper support systems for youths that involve parents, school counsellors and community members. Research shows that there are some signs parents, siblings, teachers and friends could look out for such as impaired control over eating and poor sleep quality, which could signal a mental health issue like loneliness in teens.
• For older people: Community and social activities can reduce loneliness among the elderly. Research shows that interacting with people builds up “cognitive reserve” which slows down the effects of ageing on the brain.
  The Harvard Adult Development Study showed that octagenarians who had close-knit friendships and could trust their partner to have their back experienced a slower decline in memory and brain function as they aged.

Loneliness is perceived social isolation. It may arise from a gap in how many connections we would like to have and how many we have in real life (our ideal versus actual social life).

Loneliness can be a useful impetus that makes us go out and seek more connections, but it can also be a negative emotion with far-reaching consequences for our health.

Loneliness is not exactly a disease, but it can lead to multiple health problems. Loneliness is linked to:

Mental health problems:

• Poor attention and memory
• Sleeping problems
• Depression
• Eating disorders
• Psychosis
• Can be the bridge between social anxiety and suicidality

Physical health problems:

• High blood pressure
• Heart disease
• Lung disease
• Atherosclerosis and stroke risk
• Early death

It is important to keep a lookout for signs of loneliness in ourselves and loved ones and reach out for help when it is needed. Cognitive behavioural therapy can help people of every age and in every stage of life. Depending on the underlying cause of loneliness, there are drug therapies and other treatments to prevent the health effects of loneliness from spiralling out of control.