Broken heart

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1938 poster for an adaptation of Avery Hopwood's Why Men Leave Home, showing a physically cracked heart symbol as a metaphor for unhappiness in love "Why men leave home" by Avery Hopwood LCCN98516874.jpg
1938 poster for an adaptation of Avery Hopwood's Why Men Leave Home, showing a physically cracked heart symbol as a metaphor for unhappiness in love

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]

Contents

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]

Physiology

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]

Psychology

Uncomplicated grief

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]

  1. Exhaustion, muscle tightness or weakness, body pains, fidgety restlessness, lack of energy
  2. Insomnia, sleeping too much, disturbing dreams
  3. Loss of appetite, overeating, nausea, "hollow stomach", indigestion, intestinal disorders like diarrhea, excessive weight gain or loss
  4. Headaches, short of breath, chest pressure, tightness or heaviness in the throat

Depression

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]

Psychological trauma

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]

Post-traumatic stress disorder

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]

Medical complications

Broken heart syndrome

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]

Endocrine and immune dysfunction

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]

Cultural references

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.

See also

Related Research Articles

<span class="mw-page-title-main">Grief</span> Response to loss in humans and other animals

Grief is the response to the loss of something deemed important, 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.

<span class="mw-page-title-main">Anterior cingulate cortex</span> Brain region

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.

<span class="mw-page-title-main">Psychological pain</span> Unpleasant feeling of a psychological nature

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.

<span class="mw-page-title-main">Breakup</span> Termination of an intimate relationship

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.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

<span class="mw-page-title-main">Social rejection</span> Deliberate exclusion of an individual from social relationship or social interaction

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 is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

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 whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

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 categorizes 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 categorizes PTSD, Complex Post-Traumatic Stress Disorder (CPTSD), adjustment disorder as stress-related disorders.

<span class="mw-page-title-main">Grief counseling</span> Therapy for responses to loss

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 are emotional bonds that arise from a cyclical pattern of abuse. A trauma bond occurs in an abusive relationship, wherein the victim forms an emotional bond with the perpetrator. The concept was developed by psychologists Donald Dutton and Susan Painter.

<span class="mw-page-title-main">Prolonged grief disorder</span> Medical condition

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.

<span class="mw-page-title-main">Ulysses syndrome</span> Medical condition

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.

<span class="mw-page-title-main">Miscarriage and grief</span>

Miscarriage and grief are both an event and subsequent process of grieving that develops in response to a miscarriage. Almost all those experiencing a miscarriage experience grief. This event is often considered to be identical to the death of a child and has been described as traumatic. "Devastation" is another descriptor of miscarriage. Grief is a profound, intensely personal sadness stemming from irreplaceable loss, often associated with sorrow, heartache, anguish, and heartbreak. Sadness is an emotion along with grief, on the other hand, is a response to the loss of the bond or affection was formed and is a process rather than one single emotional response. Grief is not equivalent to depression. Grief also has physical, cognitive, behavioral, social, cultural, and philosophical dimensions. Bereavement and mourning refer to the ongoing state of loss, and grief is the reaction to that loss. Emotional responses may be bitterness, anxiety, anger, surprise, fear, and disgust and blaming others; these responses may persist for months. Self-esteem can be diminished as another response to miscarriage. Not only does miscarriage tend to be a traumatic event, women describe their treatment afterwards to be worse than the miscarriage itself.

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