We live in a culture that increasingly medicalizes solitude while structurally producing it at scale. In the span of a single generation, community ties have frayed, religious and civic participation has declined, and digital life – though full of “connections” – has failed to satisfy our need to feel belonging. Unfortunately, loneliness is not a marginal experience anymore. It’s ambient.

And yet, in the therapy room, clients may arrive not necessarily saying “I’m lonely,” but “I feel off,” “I think I have social anxiety,” or some version of  “I’m anxious around people.” And often, they do. But sometimes, and especially lately, it’s worth pausing before coding that discomfort as pathology. Because for many clients, their withdrawal from others isn’t the result of anxiety alone. It’s also the result of too few safe spaces, too few chances to be known, too little practice being in community.

In a dominant culture where disconnection is so common it’s almost invisible, how do we distinguish between social anxiety and what might better be described as social starvation? When the symptoms are overlapping, but the cause, and the clinical need, may be fundamentally different?

The Landscape of Disconnection

In May 2023, U.S. Surgeon General Dr. Vivek Murthy released an advisory calling attention to what he labeled a public health crisis: the epidemic of loneliness and isolation. According to the report, nearly 1 in 2 adults in the U.S. report experiencing measurable levels of loneliness, with the highest rates found among young adults aged 18 to 24.

The health risks are profound: lack of social connection and feelings of isolation increase the risk of premature death by 29%, a risk comparable to smoking 15 cigarettes a day. It’s also linked to heightened risk of anxiety, depression, cardiovascular disease, and dementia. But loneliness doesn’t strike evenly. It disproportionately affects people already pushed to the margins:

• Single parents are more likely to report feeling isolated.
• BIPOC and LGBTQ+ individuals often experience exclusion from traditional support systems.
• Young adults, navigating a world of fractured institutions and expensive housing, are often left without stable peer networks.
  
  

For many clients, this isn’t a temporary dip in connection. It’s the air they’ve been breathing for years.

When Social Starvation Looks Like Anxiety

In this context, it's no surprise that a growing number of clients arrive in therapy reporting what looks like social anxiety. They avoid parties, dread phone calls, and fear being judged. But when clinicians probe deeper, a different picture sometimes emerges – not of fear, but of loss.

The symptoms of social anxiety and social starvation often mimic each other:

• Emotional shutdown
• Low self-esteem
• Hypervigilance to rejection
• Withdrawal and isolation
• Negative self-narratives

But research suggests there may be crucial differences in what underlies these experiences. A report published in the Annals of Behavioral Medicine found that chronic loneliness increases perceived social threat, creating a mental landscape where connection feels risky even when desired. Another study published in Molecular Psychiatry (2023) showed that prolonged social isolation alters the brain’s reward pathways, making social interaction feel less satisfying and harder to initiate, even when the need for connection remains intact.

This is what makes social starvation so tricky to identify. Clients may describe their withdrawal in the language of avoidance. But clinically, what we’re seeing is often a wound, not a phobia. Not a fear of people necessarily, but an ache for people who aren’t there.

In the Therapy Room: Differentiation and Clinical Inquiry

So how do we distinguish between a client who fears social situations, and one who is simply socially malnourished by prolonged disconnection? Start by listening for longing. Many clients, whether navigating social anxiety or acute social isolation, carry a deep desire for connection. Longing paired with sadness may signal a readiness to engage, even when the fear to engage with others remains strong.

Some useful clinical questions might include:

• Is this isolation new, or has it been a long-standing coping strategy?
• What’s the client’s history with connection – in family, school, or community?
• What is their relationship to trust, vulnerability, and belonging?
• Is it fear that holds them back, or something else - like exhaustion, discouragement, or lack of opportunity?

It’s important, too, to consider the context. A client recently moved to a new city, left their faith community, or transitioned to remote work might not be “socially anxious,” they might be relationally unmoored. A young adult who’s never had a close friend may not be avoiding intimacy out of fear, but because they’ve never experienced safe connection in the first place.

Clinical Implications: Relationship as Intervention

The distinction matters between social anxiety and social starvation, because it changes the intervention. With clients who experience social anxiety, traditional CBT interventions like exposure, skills practice, and cognitive restructuring can be helpful. The therapeutic task is to reduce anticipatory fear and increase tolerance of vulnerability.

But with socially starved clients, the work often begins with naming the loss. Grieving missed friendships. Acknowledging years of under-touch, under-seen, under-held existence. Helping them notice that they want connection and community not because they’re needy, but because they’re human. 

A 2025 study published in BMC Primary Care highlighted the potential of “social prescribing,” linking people to local cultural and community resources, to support health and wellbeing. The study found that successful implementation depends on clear language, community outreach, and inclusive infrastructure. For clients facing social isolation, connection isn’t optional, it’s therapeutic. Therapy here may involve:

• Exploring barriers to engagement, including trust, access, and cultural fit
• Supporting gradual reconnection through community roles like volunteering, student placements, or buddy systems
• Reviewing and role-playing communication skills to help clients practice initiating conversations or navigating social situations with more confidence and clarity
• Processing the emotional experience of re-entering communal spaces; like hope, fear, and ambivalence
• Helping clients reimagine belonging on their own terms

Treat the Wound, Not Just the Reflex

It can be tempting to see every withdrawal as avoidance. But in a culture that chronically underfeeds our need for one another, we must be careful not to mislabel starvation as fear.

Clients who present with social anxiety-like symptoms may in fact be suffering from prolonged disconnection. Their symptoms aren’t false, but their cause may be misunderstood. For them, the path forward isn’t just about exposure: it’s about restoration. Rebuilding relationships as a vital source of regulation, identity, and safety.

When connection is both the symptom and the cure, our role is not to fix: it’s to witness, honor, and build a bridge back. Sometimes that starts with helping a client name their loneliness not as pathology, but as a natural response to unnatural conditions.