You can feel terribly alone in a crowd and perfectly content being alone. Loneliness is a subjective emotional state; it is the perception of loneliness that matters. Humans have an instinctive need to belong, this need is as basic to human functioning and survival as the need to obtain food, water and shelter. When this need is not satisfied it impacts not just our psychological health but also our physical health.
The health risks associated with loneliness are comparable with well-established risk factors for disease such as physical inactivity and substance abuse. Loneliness increases mortality to the point that it is similar to smoking 15 cigarettes per day! If that isn’t startling enough, the World Health Organization predicts that loneliness will reach epidemic proportions by 2030.
In 2018, CIGNA surveyed 20,000 US adults using UCLA’s loneliness scale and here is what they found:
1 in 2 reported sometimes or always feeling alone
1 in 4 rarely or never feel as though there are people who really understand them
2 in 5 sometimes or always feel that their relationships are not meaningful
1 in 5 rarely or never feel close to people
Generation Z (18-22) is the loneliest generation
What does this have to do with autoimmune disease? Loneliness actually changes how our immune system is working. Our cellular immunity is impaired, natural killer cells decline, and antibody titers rise. Loneliness triggers our fight/flight/freeze stress response. Humans have spent most of our existence as a species being supported and protected by each other. Loneliness signals to our body that we are in danger, which kicks up our levels of inflammation and changes our immune response.
Inflammation impacts regions of the brain that process fear and anxiety, thereby changing people’s experience of the world. Loneliness may act as a regulatory loop. Lonely individuals have increased sensitivity and surveillance to social threats. They preferentially attend to negative social information while remembering more of the negative aspects of social events. This leads lonely individuals to behave in ways that confirm their negative expectations. These changes in behavior perpetuate loneliness.
The real kicker for me is that folks who have or develop a chronic illness, such as an autoimmune disease, have a higher risk for becoming socially isolated. So not only does loneliness increase the risk of developing an autoimmune disease, having an autoimmune disease increases your risk of becoming lonely. Let’s attend to our social health.
No one has the answers to this problem but what is clear is that loneliness is skyrocketing in developed nations. Moving out and living on your own is a right of passage. We walk around with airpods in our ears and our faces in our phones. These days it is very easy to feel alone in a crowd.
I propose a simple shift in mindset. Instead of the mentality that meeting a friend for coffee is a ‘treat’ let’s put it on par with your morning exercise or your kale salad. I also just want to remind all of us (myself included) in this era of ‘instagram selves’ to not forget who we truly are, and show up with authenticity to our friendships. Nurture your relationships, spend time with the people you care about. Your health depends on it.