You can sit across the dinner table from someone you love and feel entirely on your own. You can have a full calendar, a group chat that never goes quiet, and still go home with the sense that nobody really knows you. Some people feel ashamed of it, as if loneliness were only allowed to people with no one around.
This article sets out what public health bodies and researchers say about loneliness, including the U.S. Surgeon General's 2023 advisory on social connection. It explains why loneliness can live inside relationships, how common it is, and when it may be part of something a clinician would want to assess.
Can you be lonely when you are not alone?
Yes. The Surgeon General's advisory defines loneliness as "A subjective distressing experience that results from perceived isolation or inadequate meaningful connections," where inadequate means the gap between "an individual's preferred and actual experience." Social isolation is different: "Objectively having few social relationships, social roles, group memberships, and infrequent social interaction."
The National Institute on Aging puts it simply: "You can live alone and not feel lonely or socially isolated, and you can feel lonely while being with other people." The World Health Organization (WHO) describes loneliness as a feeling that "arises when there is a gap between the social connections one has and those one wants or needs." The APA dictionary adds that the gap can be a "deficiency in quantity or quality" of relationships. It can be about how many people you have, or about what you have with them.
What does loneliness inside a relationship look like?
It can look like being together without feeling met. Conversations stay on logistics. You stop mentioning what matters because it does not seem to land. You feel more alone after time with the person than before it. None of this means anyone is doing something wrong. It means the connection you want and the one you have are not the same.
Research on older adults points the same way. In a Chicago study of 225 adults aged 50 to 68, measured at a single point in time, positive marital relationships offered the most protection against loneliness, and the lack of a spouse who is also a confidant was one of the risk factors. In an Irish study of 932 older married couples followed for two years, people who saw their own marriage as more negative reported more loneliness later. Their partners' view of the marriage did not predict it. Both studies are of middle-aged and older adults, each in one place, so they cannot say how common this is in general, and the Chicago study cannot show cause.
Sometimes isolation inside a relationship is not drift but control. The National Domestic Violence Hotline lists "Preventing or discouraging you from spending time with others, particularly friends, family members, or peers" among the warning signs of abuse. If that sounds familiar, The Hotline is at 1-800-799-7233 (or text START to 88788), and in Massachusetts SafeLink is at (877) 785-2020. In immediate danger, call 911.
How common is loneliness?
Very common. The Surgeon General's advisory says that "approximately half of U.S. adults report experiencing loneliness, with some of the highest rates among young adults." That figure rests partly on a 2021 survey by an insurance company, so it is best read as an estimate. Worldwide, the WHO reports that "Approximately 1 in 6 people globally (15.8%) report feeling lonely."
Many people who often feel lonely do not see it as a serious problem. The advisory notes that "less than 20% of individuals who often or always feel lonely or isolated recognize it as a major problem."
Why does loneliness matter for health?
Not all loneliness is a concern. The advisory says that "Transient feelings of loneliness may be less problematic, or even adaptive, because the distressing feeling motivates us to reconnect socially." The concern is loneliness that lasts. In the advisory's words, "chronic loneliness (even if someone is not isolated)" is "a significant health concern."
The advisory reports that loneliness and social isolation "increase the risk for premature death by 26% and 29% respectively," figures drawn from a 2015 meta-analysis of observational studies. Observational studies show links, not proof of cause. The National Institute on Aging adds that the relationship runs both ways: "If you are in poor health, you may be more likely to be socially isolated or lonely."
When is loneliness part of depression?
The two often travel together, and in both directions. The advisory says depression and anxiety "are often characterized by social withdrawal, which increases the risk for both social isolation and loneliness," while loneliness and isolation "also predict increased risk for developing depression and anxiety." It reports that in adults, the odds of developing depression are more than double among people who often feel lonely, compared with those who rarely or never do. That is an association from long-term studies, not a prediction about any one person.
If loneliness comes with persistent low mood or a sense that nothing will change, it is worth talking with a clinician. Only a clinician who has talked with you can say whether it is depression. Dr. Rabin's depression and mood therapy page describes that side of her work.
If loneliness has turned into hopelessness or thoughts of not wanting to be alive, call or text 988, or call 911 in an emergency. The 988 Lifeline lists loneliness and relationships among the reasons to call, and says people do not have to be suicidal to call.
What can help?
The Surgeon General's advisory gives these recommendations to individuals, among others:
- "Invest time in nurturing your relationships through consistent, frequent, and high-quality engagement with others."
- "Minimize distraction during conversation to increase the quality of the time you spend with others."
- "Seek help during times of struggle with loneliness or isolation by reaching out to a family member, friend, counselor, health care provider, or the 988 crisis line."
Research on programs to reduce loneliness has limits. A 2011 meta-analysis found that less rigorous study designs showed larger effects than randomized studies. Among the randomized studies, the most successful programs were those that addressed what the authors called "maladaptive social cognition." Those were programs in general, not one kind of therapy.
When loneliness shows up inside close relationships, it can be worth looking at the patterns behind it. Dr. Rabin's individual therapy for relationship patterns names feeling lonely or disconnected even when others are near among the experiences she works with. It is individual work, not couples counseling, and it traces how early relationships shape present ones.
Keep reading
Sources
- U.S. Surgeon General, Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community (2023), Internet Archive copy of the hhs.gov PDF
- National Institute on Aging, Loneliness and Social Isolation: Tips for Staying Connected (2024)
- World Health Organization, Social connection: questions and answers (2025)
- World Health Organization, Social connection linked to improved health and reduced risk of early death (news release, 2025)
- APA Dictionary of Psychology, loneliness
- Hawkley et al., From social structural factors to perceptions of relationship quality and loneliness: the Chicago health, aging, and social relations study. Journals of Gerontology, Series B (2008)
- Stokes, Two-Wave Dyadic Analysis of Marital Quality and Loneliness in Later Life: Results From the Irish Longitudinal Study on Ageing. Research on Aging (2017)
- Holt-Lunstad et al., Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science (2015)
- Masi et al., A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review (2011)
- 988 Suicide and Crisis Lifeline, Get Help
- National Domestic Violence Hotline, Warning Signs of Abuse
- Casa Myrna, SafeLink
Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in danger, call 911. If you are in crisis or thinking about harming yourself, call or text 988.
