Loneliness is a cognitive discomfort or uneasiness from perceiving oneself to be alone, according to the American Psychological Association (APA). It is a universal emotion of feeling empty and unwanted, making it more difficult to connect with other people.
Even those people surrounded by others or those in a stable relationship can still experience deep and pervasive loneliness. The Attachment Theory emphasizes the importance of a strong emotional bond between infant and caregiver, insecure attachment patterns increase distrust and hinder the development of social skills.
This led to the foundation of the psychological theory of loneliness with six identified social needs that contribute to the feelings of loneliness such as attachment, social integration, nurturance, reliable alliance, reassurance of worth, and guidance in stressful situations.
Signs and Symptoms of Loneliness
Loneliness is a subjective feeling of isolation with varying degrees of presentation such as:
- feeling of sadness, emptiness, or disconnectedness
- decreased energy
- feeling foggy or unable to concentrate
- sleeping issues such as insomnia or interrupted sleep
- decreased appetite or sudden binge eating
- feelings of worthlessness, hopelessness, or self-doubt
- body aches and pains
- anxious, restless, or paranoia
- feeling left out or isolated from others even when surrounded by others
- feeling exhausted by social interactions or withdrawal from social events
- unusual spending or shopping
- substance misuse
- hostile and delinquent behavior
Causes of Loneliness
Loneliness can be a symptom of a psychological disorder and can be caused by situational, internal, and personality factors such as:
- Existential. Loneliness is often a result of circumstances or life changes which is inevitable and even beneficial, as it can help satisfy the need for connection and appreciate the joy of being alive.
- Physical isolation. Living alone, a change in living situation, or relocating to a new neighborhood can cause loneliness.
- Lack of close confidants. Fewer social ties from family or friends whom they can rely on for support, confide in and spend time with.
- Personality factors. People who lack confidence or have low self-esteem often believe they are unworthy of others’ attention. Introverts who are less likely to seek social connections contribute to feelings of isolation and loneliness.
- Psychological disorders. Depression often causes people to withdraw socially.
- Cultural factors. Migrants can experience loneliness due to culture shock and homesickness. Rebuilding social networks in a new state, country, workplace, or environment can be difficult and cause loneliness.
- Relationship loss. The ending of any relationship, divorce, or death of a loved one can make people more susceptible to loneliness. Although this is common and often temporary, the loss of a significant person will initiate a grief response and feel loneliness from time to time.
- Financial problems. Financial struggles can lead to shame and stress, whether it is due to unemployment, working multiple jobs, or low-income households.
- Situational factors. All sorts of sudden or unexpected situations can cause significant loneliness. Childbirth, postpartum blues, or even getting married are all life-changing events.
Risk Factors to Loneliness
Various factors related to an increased risk for loneliness are:
- Age. People 50 years and older are more likely to experience loneliness from the death of loved ones, worsening health conditions, sensory impairment, retirement, or income changes. Risk increases with women as they get older.
- Chronic disease and conditions. Patients with lasting symptoms from chronic disease tend to have reduced physical and social activity. People with HIV face greater social isolation and loneliness due to the stigma.
- Geriatric syndromes and impairments. Deficits in communication or comprehension, limited functional abilities, or impaired mobility may result in loneliness due to embarrassment or stigma.
- Immigrants. First-generation immigrants experience social isolation including language barriers and establishing new relationships.
- Gay, lesbian, and bisexual population. An individual’s sexual orientation can cause loneliness due to perceived discrimination and negative social reactions.
- Psychological factors. Depression is accompanied by deficits in social function and high levels of loneliness. Social withdrawal is the recognized feature of dementia and other neurodegenerative disorders.
- Social factors. Individuals with unfulfilling or conflict relationships increase self-reported loneliness. Spousal relationships can either be beneficial or detrimental depending on the amount of support and divorce rates increase with age. Single adults can have more prevalent feelings of loneliness because of the lack of a trusted confidant.
- Disruptive life events. Bereavement results in a critical loss of intimacy and support. Retirement and unemployment can affect an individual’s social interactions and financial stability.
- Religious and spiritual factors. The intensity of one’s faith may affect an individual’s feeling of loneliness. Active involvement in religious organizations can be a source of social support and coping skills.
Complications of Loneliness
Chronic loneliness may cause or aggravate problems in one’s health and well-being, including the following:
- High blood pressure. Increased incidence of high blood pressure has been strongly associated with loneliness.
- Heart disease. Loneliness was linked to the increased risk of stroke and coronary heart disease development.
- Obesity. Lonely individuals tend to binge-eat resulting in digestion problems or obesity.
- Weakened immune function. Upon examining the gene expressions in leukocytes of lonely individuals they found an increased gene involved in inflammation and decreased genes involved in antiviral responses.
- Psychological effects. Loneliness increases the concentration of cortisol level which weakens the effects of dopamine (the happy hormone). Prolonged elevated cortisol level causes sleeping problems, depression, or anxiety. Social alienation or schizoid character type has also been linked with loneliness. Long-term effects of loneliness result in an “ontological crisis” or “ontological insecurity” where they are not sure of reality and its existence.
- Dementia. There is a 40% increase in cases of dementia associated with loneliness. Loneliness has also been linked with Alzheimer’s disease
- Suicidal ideation. Chronic loneliness triggers suicidal tendencies or self-harm. In children, hostile and delinquent behaviors can be seen, leading to several forms of antisocial and self-destructive behaviors.
- Premature mortality. Research says that feelings of loneliness increase the risk of premature death by 26%. This is due to the constant state of heightened alert of the brain dealing with everything on their own. People with good social relationships tend to have a 50% chance of survival than lonely people.
Diagnosis of Loneliness
Loneliness is a universal emotion that we may experience from time to time. However, experiencing the signs and symptoms above is not a normal response and that is the time to consider professional help. Even though there is no definite diagnosis for loneliness, there are some assessment tools that can be used such as:
- Medical history. A complete medical history including the past and present health conditions, unexplained physical symptoms, lack of energy, change in eating pattern, sleeping disturbances, extreme mood swings, major or sudden life changes, social withdrawal, or substance abuse must be disclosed to have a clear picture of what’s causing the loneliness.
- Physical exam. A complete physical exam will be done including the vital signs, weight, sensory functions, and assessment of the area with reported pain.
- Psychological assessment. Assessment of the patient’s risk for loneliness is important to determine the underlying cause. It is important to establish rapport so that the patient will be open and honest. Ask the patient to describe how they feel physically, emotionally, and mentally.
- UCLA Loneliness Scale. The University of California, Los Angeles loneliness scale is an assessment tool designed to measure the subjective feelings of loneliness and isolation. Results were found to be highly reliable in terms of consistency and re-test after a year.
- De Jong Gierveld Loneliness Scale. It is a reliable measurement tool for overall emotional and social loneliness. This tool measures the feelings of missing a reliable relationship and social network.
Treatment for Loneliness
Finding solutions to chronic loneliness is more challenging given its complexity and harmful effects. Some interventions can help patients combat loneliness such as:
- Medications. Used to relieve signs and symptoms associated with loneliness.
- Analgesics. This is given for physical pain as temporary relief.
- Antidepressants. Prescribe to patients with depression as a stand-alone treatment or used in conjunction with therapy until a suitable medication is found.
- Support system. The most available cure for loneliness is human connection. It is important to determine the patient’s available support system such as family and friends and nurture their relationships to counteract loneliness.
- Therapy. Commonly used intervention for lonely or depressed patients.
- Counseling. Speaking to a counselor can greatly help patients to connect. Validating patients’ feelings of loneliness and lifting the burden off of their shoulders as to who’s at fault can help them recognize the support available.
- Cognitive behavioral therapy. CBT programs were proven to be effective in reducing loneliness due to shared cognitive and behavioral presentations between loneliness, depression, and anxiety. This helps individuals recognize misperceptions and be aware of negative thoughts that affect their behavior.
- Group therapy. This helps the patient connect with other people and establish a support system. They gain a sense of belongingness and acceptance with other people who have the same experiences.
- Pet therapy. Animal-assisted therapy can ease the feelings of loneliness with the companionship the animals provide.
Prevention for Loneliness
To help patients protect themselves from the negative effects of loneliness, the following can be recommended:
- Be mindful of one’s health. It is important to be as physically and mentally healthy as possible. Eat healthy food, get enough sleep, exercise regularly, and be active.
- Connect with others. It is important to have some contact with other people and improve one’s existing relationships with family or friends. Having someone to trust and talk to about personal things is important.
- Choose fulfilling and rewarding activities. Be active and do things that may have a positive impact on one’s mood. Spending time in nature or outdoors can help improve the mood and meet other people at the same time.
- Join a group or community association. Finding a group of people with the same interest is a great opportunity to make new friends and interact with others.
Risk for Loneliness Nursing Diagnosis
Risk for Loneliness Nursing Care Plan 1
Nursing Diagnosis: Risk for Loneliness related to anxiety secondary to panic disorder.
Desired Outcomes:
- The patient will be able to discuss feelings and concerns.
- The patient will be able to demonstrate relaxation techniques to prevent anxiety attacks.
| Risk for Loneliness Nursing Interventions | Rationale |
| Establish rapport and maintain a calm, non-judgmental, and non-threatening approach to the patient. | Gaining the patient’s trust will result in open and honest discussion. Being calm can also be reflected in the patient and develop a sense of calmness, security, and control of the situation. |
| Provide a small room with a quiet and peaceful environment with minimal stimuli as possible. | A small room can provide a sense of comfort and prevent panic attacks by being secured in a small area. External stimuli can cause anxiousness and panic attacks. |
| Remain with the patient and reassure his/her safety and security. | The patient’s loneliness may increase if left alone. Ensure the patient’s safety and security to prevent anxiety and panic attacks. |
| Provide reassurance and comfort measures such as giving a warm blanket, listening to music, taking a bath, etc. | Making patients comfortable helps the patient relive anxiety and recover quickly. |
| Educate the patient about relaxation techniques and diversional activities such as deep breathing, meditation, guided imagery, etc. | This helps the patient establish a sense of control over the situation. |
| Educate the patient and significant others about the situation, signs and symptoms, and interventions that may help. | The patient may have all the help that he/she may need if the people around are aware of the situation. The patient will develop a sense of security and minimize anxiety. |
| Secure consent before referring the patient to cognitive-behavioral therapy. | This prevents future anxiety and panic attacks by strengthening the patient’s mind over his/her condition with the help and guidance of professionals. |
Risk for Loneliness Nursing Care Plan 2
Nursing Diagnosis: Risk for Loneliness related to social isolation secondary to anxiety attacks.
Desired Outcomes:
- The patient will be able to recognize activities that lead to the lack of social interactions.
- The patient will be able to interact with others starting with family members, then trusted friends to a group of people.
| Risk for Loneliness Nursing Interventions | Rationale |
| Assess the patient’s understanding and perception of his/her situation. | Lonely individuals experience social isolation due to anxiety and fear of being rejected by other people. |
| Initiate contact with the patient’s existing support system. | It is important to determine the patient’s available support system such as family and friends and nurture their relationships. There is no other person that can fully understand the patient other than the family members. |
| Educate the patient and significant others about social isolation and anxiety. | Recognizing early signs of anxiety and isolation will help the patient gain a sense of control over his/her situation while the significant others can give appropriate support and encouragement during those times. |
| Provide a one-on-one activity with the patient and a family member or trusted friend in a calm and quiet environment. | This will help prevent anxiety attacks while initiating social contact gradually through a familiar and trusted support system. |
| Encourage the patient to participate in a small group with the same interest or hobbies to participate in. | Interaction with people of the same interest can help the patient gain a sense of belongingness while engaging with other people. |
| Engage the patient in a more social setting with a large number of people. Progressively introduce the patient from one person to another and encourage the patient to be more involved with other people. | Social interaction and engagement can boost the patient’s self-esteem and divert his/her attention from negative thoughts. |
| Educate the patient about support groups and organizations that may help the patient and significant others. | They can learn many things from those individuals who have been through the same experiences and struggles. |
| Recognize and encourage the patient’s willingness to socialize by appreciating and giving praise. | Boosting confidence through positive reinforcement will help the patient be motivated and repeat those behaviors. |
Risk for Loneliness Nursing Care Plan 3
Nursing Diagnosis: Risk for Loneliness related to impaired family process secondary to substance abuse.
Desired Outcomes:
- The patient will be able to recognize behaviors that contribute to the problem of the family.
- The patient will be able to identify coping behaviors and lifestyle changes to minimize damage among family members.
| Risk for Loneliness Nursing Interventions | Rationale |
| Review the family history by identifying individual roles, strengths, and circumstances involving substance misuse. | This will help the nurse recognize each member of the family and identify factors that may cause the problem among family members. |
| Assess the patient’s perception of the current situation. | Provides information to plan appropriate approaches and plan of care. |
| Assess the patient’s method of coping with problems and current level of functioning among family members. | Determine individual coping mechanisms skills in dealing with situations and plan an effective way of correcting them. |
| Assess the extent of enabling behaviors of the patient and family members. | Substance abusers often rely on others to cover their own inability to cope. Enabling is rescuing the patient from destructive behaviors. |
| Involve the family in the treatment plan. | Substance abuse is a family illness and recovery is evident when the family is involved and treated as well. Each member is dealing with substance abuse behavior dragging everyone to being lonely. |
| Provide support during substance withdrawal and abstinence. | Many patients are not aware of the nature of addiction and abuse. Explaining the consequences and their behaviors will help them get better. |
| Encourage involvement with self-help groups, addiction groups, and professional family therapy. | Support the patient and significant others while recovering and maintaining sobriety. |
Risk for Loneliness Nursing Care Plan 4
Nursing Diagnosis: Risk for Loneliness related to required isolation secondary to herpes zoster infection.
Desired Outcomes:
- The patient will be able to establish interaction through other forms of communication.
- The patient will be able to perform infection control measures to improve quality of life.
Risk for Loneliness Nursing Care Plan 5
Impaired Social Interaction
Nursing Diagnosis: Risk for Loneliness related to impaired social interaction secondary to personality disorder.
Desired Outcomes:
- The patient will be able to recognize personal behaviors that cause relationship difficulties among others.
- The patient will be able to collaborate with the nurse on substituting unacceptable behaviors for positive behaviors.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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