By Dina Weinstein and Sara McCloskey

Feeling lonely and socially isolated are more common than ever, studies have found.

This has been a cause for concern because having a social connection positively impacts individual health and well-being. But lacking those connections, federal health experts say, is as harmful as smoking 15 cigarettes a day.

In fact, an advisory from the U.S. Surgeon General reveals how loneliness can be connected to a raft of medical conditions, including cardiovascular disease, infectious diseases, depression, anxiety and premature death.

“Humans are wired to be together, to work together to solve problems for survival,” said Rachel Wood, Ph.D., R.N., NPD-BC, CEN, CPEN, affiliate faculty at Virginia Commonwealth University's School of Nursing. “Feeling isolated from the group that keeps us safe could trigger a fight or flight response. And we know very well that chronic triggering of that fight or flight response can lead to negative health outcomes.”

Wood is one of several VCU faculty who focuses their research on social isolation. She specifically studies loneliness and burnout in acute care nurses. Jane Chung Ph.D., RN, is an associate professor at the School of Nursing’s Department of Family and Community Health. She conducts research on aging populations and technology, with an interest in developing, applying and evaluating tech solutions to help older adults age in place.

“We live in an extroverted society. Being an introvert or liking “me time” is not desired in society overall," Chung said. "If you say you are lonely there might be a social stigma. People may be reluctant to admit, ‘I don't have social connections that are meeting my emotional needs."

Wood and Chung spoke with VCU Health news about what loneliness may feel like, how to reengage people who feel lonely and what type of clinical expertise may be helpful. 

Are loneliness and social isolation really linked to other health problems?

Yes, recent studies have connected loneliness and social isolation to an elevated risk for developing various health conditions.

While health experts say it is hard to measure this precisely, research has linked loneliness and social isolation to health problems in adults aged 50 and older. These health concerns include a 50% increased risk of developing dementia, 29% increased risk for heart disease and 50% increased risk of experiencing a stroke. Higher rates of depression, anxiety and incidents of suicide were also associated with loneliness.

What are the signs and symptoms of loneliness?

It can be tough to tell if someone is experiencing loneliness because some signs and symptoms overlap with depression, which is described as a sad mood that can interfere with your daily activities for a long period of time.

"There are associated emotions that come along with loneliness, like sadness or despair... Dehumanization can be something that people experience as well, because as they feel isolated, they start to lose that sense of holistic self,” Wood said.

Some other loneliness symptoms include:

• Fatigue
• Detachment from activities and others
• Withdrawing from friends and family
• Changes in sleep patterns and energy levels, especially for children

What can loneliness feel like for people at different stages of their lives?

Everyone is a little different, Chung says, when it comes to how they experience their social networks and the impact those networks have on them. Some of this relates to societal changes in roles and expectations as we age and our cognitive development.

"Kids and adolescents’ brains are still developing, so their response might be different from the responses of older adults, and their symptoms or behaviors might be different,” Chung explained. “As children are coming up, they're still trying to learn their sense of self and trying to find their way and their position in their network of friends. Whereas in the older adults, they often have established a network or a set of social norms and expectations, and when those shift and change, it almost feels more like a loss, whereas for children it's not. It's something that they just haven't yet attained. And so that can lead to different experiences."

What are the biggest misconceptions about loneliness and social isolation?

According to the Centers for Disease Control and Prevention, being socially isolated means someone doesn't have as many social connections, while loneliness is the feeling of being alone even if someone has social connections.

Wood says one misconception is that social isolation and loneliness are separate things. In her experience, social isolation can be a component of one’s feelings of loneliness.

"Some people like to be isolated for a time. It's almost an escape for them, and that's okay if that's something that's affirming to them. That doesn't necessarily mean that they're a lonely person, but some people can be in a room full of people or have a lot of friends, not isolated at all and still feel profoundly lonely,” Wood said. “It's not necessarily just about the number of people that you see or interact with daily. It's more about the depth and the meaning in those relationships and whether those are meeting the needs that you have.”

What advice do you give to people who are suffering from social isolation?

Both Chung and Wood say spending time with others is the first step, but those interactions are only the start. Connections to others who you can really be yourself around are crucial.

"Seeking help is important. Recognizing your loneliness is okay,” Chung said. "There are a lot of people who feel the same way, but they just don't feel comfortable sharing their state or status with others. If you feel okay being vulnerable, you can find a lot of allies."

“Try to put yourself in situations where you can connect, whether that's a civic organization, a church or religious group, joining a club or exploring a new hobby. But it goes beyond that,” Wood said. "The most important piece is to find a space where you can make more than just a superficial connection, where there is openness, vulnerability, the ability to be more authentic – in a way that others will respond to and validate the authenticity of who you are and what you bring to the situation.”

Some characteristics of strong social connections include:

• Feeling cared for, valued and appreciated by others;
• Having meaningful and regular conversations or social exchanges;
• Availability to public resources and spaces, such as parks or public transportation;
• Having someone who can help when you’re feeling down and/or when you need assistance with a physical task, such as a ride to the grocery store or doctor’s office.

How can a loved one or friend best support someone who is experiencing loneliness?

If you’re concerned about the mental health and well-being of someone you’re close to, Chung and Wood say reassuring them that you are here to support them may help them open up.
“It's important to have a sense of community, to give each other a feeling or assurance that, ‘I am here for you so you can reach out to me anytime.’ Being available for someone else is important. Family and friends should consider making more frequent contact with your loved ones,” Chung said.

“Support a friend or loved one by being the one to be vulnerable first. When someone does open up, even in any small way to say, ‘I see you and I believe you,’ those are powerful words, not to try to fix it, not to try to tell them what they think or feel is wrong, but just to say, ‘I hear what you're saying. I want to be on this team with you,’ and then create that space for vulnerability, authenticity and affirmation,” Wood said.

What should someone do if they are struggling with loneliness and want professional help?

Chung and Wood say finding a mental health professional is helpful for people struggling with loneliness or other mental health concerns. Counselors, therapists, psychologists and psychiatrists are all clinical experts who can help someone if they are having thoughts of self-harm, experiencing anxiety or depression, or want to talk about ways to cope with feelings of loneliness.

If you or a loved one are in distress, the National Suicide and Crisis Lifeline is available 24/7 for free and confident support. The phone number is 988.