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A broken heart (also known as heartbreak or heartache) is a metaphor for the intense emotional stress or pain one feels at experiencing great loss or deep longing. The concept is cross-cultural, often cited with reference to unreciprocated or lost love. [1]
Failed romantic love can be extremely painful; people with a broken heart may succumb to depression, anxiety and, in more extreme cases, post-traumatic stress disorder. [2] [3]
The intense pain of a broken heart is believed to be part of the survival instinct. The "social-attachment system" uses the "pain system" to encourage humans to maintain their close social relationships by causing pain when those relationships are lost. [1] Psychologists Geoff MacDonald of the University of Queensland and Mark Leary of Wake Forest University proposed in 2005 the evolution of common mechanisms for both physical and emotional pain responses and argue that such expressions are "more than just a metaphor". [4] [5] The concept is believed to be universal, with many cultures using the same words to describe both physical pain and the feelings associated with relationship loss. [4] [5]
The neurological process involved in the perception of heartache is not known, but is thought to involve the anterior cingulate cortex of the brain, which during stress may overstimulate the vagus nerve causing pain, nausea or muscle tightness in the chest. [6] Research by Naomi Eisenberger and Matthew Lieberman of the University of California from 2008 showed that rejection is associated with activation of the dorsal anterior cingulate cortex and right-ventral pre-frontal cortex, areas established as being involved in processing of pain, including empathizing with pain experienced by others. [6] The same researchers mention effect of social stressors on the heart, and personality on perception of pain. [7]
A 2011 study showed that the same regions of the brain that become active in response to painful sensory experiences are activated during intense social rejection or social loss in general. [5] [8] Social psychologist Ethan Kross from University of Michigan, who was heavily involved in the study, said, "These results give new meaning to the idea that social rejection hurts". [5] The research implicates the secondary somatosensory cortex and the dorsal posterior insula. [5]
For most bereaved individuals, the journey through grief will ultimately culminate in an acceptable level of adjustment to a life without their loved one. [9] The Kübler-Ross model postulates that there are five stages of grief after the loss of a loved-one: denial, anger, bargaining, depression and acceptance. [1] [10] And while it is recognized that mourners go through initial period of numbness leading to depression and finally to reorganization and recovery, most modern grief specialists recognize the variations and fluidity of grief experiences differ considerably in intensity and length among cultural groups, individually from person to person [9] as well as depending on the amount of investment put into the relationship.
Ruminating, or having intrusive thoughts that are continuous, uncontrollable, and distressing, [11] is often a component of grieving. John Bowlby's concept of "searching for the lost object" is about the anxiety and mounting frustration as the mourner remains lost, frequently sifting through memories of the departed, and perhaps fleeting perceptions of spectral visitations by the lost individual. When the loss involves 'being left' or 'unrequited love', [12] in addition to the above, this mental searching is accompanied by obsessive thoughts about factors leading to the breakup, and possibilities for reuniting with the lost individual. [13] When rejection is involved, shame may also be involved – the painful feeling of being inherently unacceptable, disposable, unworthy. [14]
The physical signs of grieving include: [15]
A broken heart is a major stressor and has been found to precipitate episodes of major depression. In one study (death of a spouse), 24% of mourners were depressed at two months, 23% at seven months, 16% at 13 months and 14% at 25 months. [2]
Although there are overlapping symptoms, uncomplicated grief can be distinguished from a full depressive episode. [16] Major depression tends to be more pervasive and is characterized by significant difficulty in experiencing self-validating and positive feelings. Major depression is composed of a recognizable and stable cluster of debilitating symptoms, accompanied by a protracted, enduring low mood. It tends to be persistent and associated with poor work and social functioning, pathological immunological function, and other neurobiological changes unless treated. [9]
In relationship breakups, mourners may turn their anger over the rejection toward themselves. [17] This can deepen their depression [18] and cause narcissistic wounding. [19] The process of self-attack can range from mild self-doubt to scathing self-recrimination which leaves a lasting imprint on an individual's self-worth and causes them to doubt their lovability, personality-efficacy, and attachment worthiness going forward. [20]
In severe cases, the depression of a broken heart can create a sustained type of stress that constitutes an emotional trauma which can be severe enough to leave an emotional imprint on individuals' psychobiological functioning, affecting future choices and responses to rejection, loss, or disconnection. [21] A contributing factor to the trauma-producing event is that 'being left' can trigger primal separation fear – the fear of being left with no one to take care of one's vital needs.
Mourners may also experience the intense stress of helplessness. [22] If they make repeated attempts to compel their loved one to return and are unsuccessful, they will feel helpless and inadequate to the task. Feeling one's 'limited capacity' can produce a fault line in the psyche which renders the person prone to heightened emotional responses within primary relationships. [23]
Another factor contributing to the traumatic conditions is the stress of losing someone with whom the mourner has come to rely in ways they did not realize. [24] For instance, in time, couples can become external regulators for one another, attuned on many levels: pupils dilated in synchrony, echoing one another's speech patterns, movements, and even cardiac and EEG rhythms. [25] Couples can function like a mutual bio-feedback system, stimulating and modulating each other's bio rhythms, responding to one another's pheromones, [26] and be addicted due to the steady trickle of endogenous opiates induced by the relationship. [27]
Research has shown that in extreme cases, some who experience a broken heart go on to develop post-traumatic stress disorder (PTSD). [3]
There are various predisposing psycho-biological and environmental factors that determine whether one's earlier emotional trauma might lead to the development of a true clinical picture of posttraumatic stress disorder. [21] This would lower their threshold for becoming aroused and make them more likely to become anxious when they encounter stresses in life that are reminiscent of childhood separations and fears, hence more prone to becoming posttraumatic.
Another factor is that insecure attachments in childhood have shown to predispose the individuals to difficulties in forming secure attachments in adulthood and to having heightened responses to rejection and loss. [28]
There is also variation in individuals' neurochemical systems that govern the stress regulation. Depending on the severity of the stress response induced in an individual by an event (i.e. a romantic breakup), certain concentrations of stress hormones including CRF, ACTH, and cortisol work to intensify the imprinting of an emotional memory of the event, indelibly inscribing its fears and other sensations in the amygdala (to serve as a warning for future events), [29] while the same stress hormones can act to impede. [3]
In many legends and fictional tales, characters die after suffering a devastating loss; however, even in reality people die from what appears to be a broken heart. Takotsubo cardiomyopathy or Broken heart syndrome is commonly described as a physical pain in the chest or heart or stomach area, which is due to the emotional stress caused by a traumatic breakup or the death of a loved one.
Broken heart syndrome mimics symptoms of a heart attack, but it is clinically different from a heart attack because the patients have few risk factors for heart disease and were previously healthy prior to the heart muscles weakening. [30] Some echocardiograms expressed how the left ventricle, of people with the broken heart syndrome, was contracting normally but the middle and upper sides of the heart muscle had weaker contractions due to inverted T waves and longer Q-T intervals that are associated with stress. [31] Magnetic resonance images suggested that the recovery rates for those with broken heart syndrome are faster than those who had heart attacks and complete recovery to the heart is achieved within two months. [30]
Physiological and biochemical changes that contribute to higher physical illnesses and heart disease have been found in individuals that have high levels of anxiety and depression. Some individuals who have divorced have compromised immune systems because of inflammatory cytokines followed by a state of depression. [32]
The sentiment is expressed in a collection of Sumerian proverbs: [33]
May Inana pour oil on my heart that aches.
Biblical references to the pain of a broken heart date back to 1015 BC. [34]
Insults have broken my heart and left me weak, I looked for sympathy but there was none; I found no one to comfort me
— Psalm 69:20
Rudaki, regarded as the first great genius of Persian poetry, used broken heart imagery in his writing.
Look at the cloud, how it cries like a grieving man
Thunder moans like a lover with a broken heart.
Shakespeare's play Antony and Cleopatra features a character, Enobarbus, who dies of a broken heart after betraying a friend. Lady Montague dies of a broken heart after the banishment of her son in Romeo and Juliet . [35]
Frida Kahlo's 1937 painting Memory, the Heart portrays the artist's heartbreak during and after an affair between her husband and her sister.
A mental disorder is an impairment of the mind disrupting normal thinking, feeling, mood, behavior, or social interactions, and accompanied by significant distress or dysfunction. The causes of mental disorders are very complex and vary depending on the particular disorder and the individual. Although the causes of most mental disorders are not fully understood, researchers have identified a variety of biological, psychological, and environmental factors that can contribute to the development or progression of mental disorders. Most mental disorders result in a combination of several different factors rather than just a single factor.
Grief is the response to loss, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, while grief is the reaction to that loss.
In the human brain, the anterior cingulate cortex (ACC) is the frontal part of the cingulate cortex that resembles a "collar" surrounding the frontal part of the corpus callosum. It consists of Brodmann areas 24, 32, and 33.
Psychological pain, mental pain, or emotional pain is an unpleasant feeling of a psychological, non-physical origin. A pioneer in the field of suicidology, Edwin S. Shneidman, described it as "how much you hurt as a human being. It is mental suffering; mental torment." There is no shortage in the many ways psychological pain is referred to, and using a different word usually reflects an emphasis on a particular aspect of mind life. Technical terms include algopsychalia and psychalgia, but it may also be called mental pain, emotional pain, psychic pain, social pain, spiritual or soul pain, or suffering. While these clearly are not equivalent terms, one systematic comparison of theories and models of psychological pain, psychic pain, emotional pain, and suffering concluded that each describe the same profoundly unpleasant feeling. Psychological pain is widely believed to be an inescapable aspect of human existence.
A relationship breakup, breakup, or break-up is the termination of a relationship. The act is commonly termed "dumping [someone]" in slang when it is initiated by one partner. The term is less likely to be applied to a married couple, where a breakup is typically called a separation or divorce. When a couple engaged to be married breaks up, it is typically called a "broken engagement". People commonly think of breakups in a romantic aspect, however, there are also non-romantic and platonic breakups, and this type of relationship dissolution is usually caused by failure to maintain a friendship.
Acute stress disorder is a psychological response to a terrifying, traumatic or surprising experience. It may bring about delayed stress reactions if not correctly addressed. Acute stress may present in reactions which include but are not limited to: intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. Reactions may be exhibited for days or weeks post the traumatic event.
Social rejection occurs when an individual is deliberately excluded from a social relationship or social interaction. The topic includes interpersonal rejection, romantic rejection and familial estrangement. A person can be rejected or shunned by individuals or an entire group of people. Furthermore, rejection can be either active, by bullying, teasing, or ridiculing, or passive, by ignoring a person, or giving the "silent treatment". The experience of being rejected is subjective for the recipient, and it can be perceived when it is not actually present. The word "ostracism" is also commonly used to denote a process of social exclusion.
Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally happening in response to complex traumas, i.e. commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive few or no chance to escape.
Human bonding is the process of development of a close, interpersonal relationship between two or more people. It most commonly takes place between family members or friends, but can also develop among groups, such as sporting teams and whenever people spend time together. Bonding is a mutual, interactive process, and is different from simple liking. It is the process of nurturing social connection.
Social connection is the experience of feeling close and connected to others. It involves feeling loved, cared for, and valued, and forms the basis of interpersonal relationships.
"Connection is the energy that exists between people when they feel seen, heard and valued; when they can give and receive without judgement; and when they derive sustenance and strength from the relationship." —Brené Brown, Professor of social work at the University of Houston
Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children with mothers who have experienced traumatic or stressful events during pregnancy can increase the child's risk of mental health disorders and other neurodevelopmental disorders. Kaiser Permanente and the Centers for Disease Control and Prevention's 1998 study on adverse childhood experiences determined that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments that lead to increased risk of unhealthy self-destructive behaviors, risk of violence or re-victimization, chronic health conditions, low life potential and premature mortality. As the number of adverse experiences increases, the risk of problems from childhood through adulthood also rises. Nearly 30 years of study following the initial study has confirmed this. Many states, health providers, and other groups now routinely screen parents and children for ACEs.
Stress-related disorders constitute a category of mental disorders. They are maladaptive, biological and psychological responses to short- or long-term exposures to physical or emotional stressors. The National Institute of Environmental Health Sciences categories Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) as stress-related disorders. However, the World Health Organization's ICD-11 excludes OCD but categories PTSD, Complex Post-Traumatic Stress Disorder (CPTSD), adjustment disorder as stress-related disorders.
Grief counseling is a form of psychotherapy that aims to help people cope with the physical, emotional, social, spiritual, and cognitive responses to loss. These experiences are commonly thought to be brought on by a loved person's death, but may more broadly be understood as shaped by any significant life-altering loss.
Trauma bonds is a term developed by Patrick Carnes to describe emotional bonds with an individual that arise from a recurring, cyclical pattern of abuse perpetuated by intermittent reinforcement through rewards and punishments. The process of forming trauma bonds is referred to as trauma bonding or traumatic bonding. A trauma bond usually involves a victim and a perpetrator in a uni-directional relationship wherein the victim forms an emotional bond with the perpetrator. This can also be conceptualized as a dominated-dominator or an abused-abuser dynamic. Two main factors are involved in the establishment of a trauma bond: a power imbalance and intermittent reinforcement of good and bad treatment, or reward and punishment. Trauma bonding can occur in the realms of romantic relationships, platonic friendships, parent-child relationships, incestuous relationships, cults, hostage situations, manager vs their direct reports, sex trafficking, or tours of duty among military personnel.
Prolonged grief disorder (PGD), also known as complicated grief (CG), traumatic grief (TG) and persistent complex bereavement disorder (PCBD) in the DSM-5, is a mental disorder consisting of a distinct set of symptoms following the death of a family member or close friend. People with PGD are preoccupied by grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance and difficulty in managing interpersonal relationships. Difficulty accepting the loss is also common, which can present as rumination about the death, a strong desire for reunion with the departed, or disbelief that the death occurred. PGD is estimated to be experienced by about 10 percent of bereaved survivors, although rates vary substantially depending on populations sampled and definitions used.
Even though intimacy has been broadly defined in terms of romantic love and sexual desire, the neuroanatomy of intimacy needs further explanation in order to fully understand their neurological functions in different components within intimate relationships, which are romantic love, lust, attachment, and rejection in love. Also, known functions of the neuroanatomy involved can be applied to observations seen in people who are experiencing any of the stages in intimacy. Research analysis of these systems provide insight on the biological basis of intimacy, but the neurological aspect must be considered as well in areas that require special attention to mitigate issues in intimacy, such as violence against a beloved partner or problems with social bonding.
Emotional abandonment is a subjective emotional state in which people feel undesired, left behind, insecure, or discarded. People experiencing emotional abandonment may feel at a loss. They may feel like they have been cut off from a crucial source of sustenance or feel withdrawn, either suddenly or through a process of erosion. Emotional abandonment can manifest through loss or separation from a loved one.
Family estrangement is the loss of a previously existing relationship between family members, through physical and/or emotional distancing, often to the extent that there is negligible or no communication between the individuals involved for a prolonged period.
Ulysses syndrome is an atypical set of depressive, anxious, dissociative, and somatoform symptoms that results from being exposed to extreme levels of stress unique to the process of modern migration. Rather than a mental disorder, this syndrome is a natural reaction to toxic levels of stress seen in migrants who are otherwise in normal mental health.
Naomi I. Eisenberger is a social psychologist known for her research on the neural basis of social pain and social connection. She is professor of social psychology at the University of California, Los Angeles (UCLA) where she directs the Social and Affective Neuroscience Laboratory and co-directs the Social Cognitive Science laboratory.