Broken heart (also known as a heartbreak or heartache) is a

metaphor A metaphor is a figure of speech that, for rhetorical effect, directly refers to one thing by mentioning another. It may provide (or obscure) clarity or identify hidden similarities between two different ideas. Metaphors are often compared wi ...

for the intense emotional stress or pain one feels at experiencing great and deep longing. The concept is cross-cultural, often cited with reference to unreciprocated or lost love. Failed romantic love can be extremely painful; people with a broken heart may succumb to depression,

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...

and, in more extreme cases,

post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats o ...

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. Psychologists Geoff MacDonald of the

University of Queensland , mottoeng = By means of knowledge and hard work , established = , endowment = A$224.3 million , budget = A$2.1 billion , type = Public research university , chancellor = Peter Varghese , vice_chancellor = Deborah Terry , city = B ...

and Mark Leary of

Wake Forest University Wake Forest University is a private research university in Winston-Salem, North Carolina. Founded in 1834, the university received its name from its original location in Wake Forest, north of Raleigh, North Carolina. The Reynolda Campus, the un ...

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". 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. The neurological process involved in the perception of heartache is not known, but is thought to involve the

anterior cingulate cortex In the human brain The human brain is the central organ (anatomy), organ of the human nervous system, and with the spinal cord makes up the central nervous system. The brain consists of the cerebrum, the brainstem and the cerebellum. It c ...

of the brain, which during stress may overstimulate the

vagus nerve The vagus nerve, also known as the tenth cranial nerve, cranial nerve X, or simply CN X, is a cranial nerve that interfaces with the parasympathetic control of the heart, lungs, and digestive tract. It comprises two nerves—the left and righ ...

causing pain, nausea or muscle tightness in the chest. Research by

Naomi Eisenberger Naomi I. Eisenberger (born in San Francisco) 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 ...

and

Matthew Lieberman Matthew Dylan Lieberman is a Professor and Social Cognitive Neuroscience Lab Director at UCLA Department of Psychology, Psychiatry and Biobehavioral Sciences. Personal life and education Lieberman was born on May 5, 1970 in Atlantic City, New Jer ...

of the

University of California The University of California (UC) is a public land-grant research university system in the U.S. state of California. The system is composed of the campuses at Berkeley, Davis, Irvine, Los Angeles, Merced, Riverside, San Diego, San Franci ...

from 2008 showed that rejection is associated with activation of the dorsal

and right-ventral

pre-frontal cortex In mammalian brain anatomy, the prefrontal cortex (PFC) covers the front part of the frontal lobe of the cerebral cortex. The PFC contains the Brodmann areas BA8, BA9, BA10, BA11, BA12, BA13, BA14, BA24, BA25, BA32, BA44, BA45, BA46 ...

, areas established as being involved in processing of pain, including empathizing with pain experienced by others. The same researchers mention effect of social stressors on the heart, and personality on perception of pain. 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. Social psychologist

Ethan Kross Ethan Kross is an American experimental psychologist, neuroscientist and writer, who specializes in emotion regulation. He is a professor of psychology and management at the University of Michigan and director of the Emotion & Self Control Laborato ...

from

University of Michigan , mottoeng = "Arts, Knowledge, Truth" , former_names = Catholepistemiad, or University of Michigania (1817–1821) , budget = $10.3 billion (2021) , endowment = $17 billion (2021)As o ...

, who was heavily involved in the study, said, "These results give new meaning to the idea that social rejection hurts". The research implicates the

secondary somatosensory cortex The human secondary somatosensory cortex (S2, SII) is a region of cortex in the parietal operculum on the ceiling of the lateral sulcus. Region S2 was first described by Adrian in 1940, who found that feeling in cats' feet was not only represe ...

and the dorsal posterior insula.

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. The

Kübler-Ross model The five stages of grief model (or the Kübler-Ross model) is popularly known as a model that describes a series of emotions experienced by people who are grieving: denial, anger, bargaining, depression and acceptance. In actuality, the Kübler- ...

postulates that there are five stages of grief after the loss of a loved-one: denial, anger, bargaining, depression and acceptance. 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 as well as depending on the amount of investment put into the relationship. Ruminating, or having intrusive thoughts that are continuous, uncontrollable, and distressing, is often a component of grieving.

John Bowlby Edward John Mostyn Bowlby, CBE, FBA, FRCP, FRCPsych (; 26 February 1907 – 2 September 1990) was a British psychologist, psychiatrist, and psychoanalyst, notable for his interest in child development and for his pioneering work in attach ...

'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', 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. When rejection is involved,

shame Shame is an unpleasant self-conscious emotion often associated with negative self-evaluation; motivation to quit; and feelings of pain, exposure, distrust, powerlessness, and worthlessness. Definition Shame is a discrete, basic emotion, d ...

may also be involved – the painful feeling of being inherently unacceptable, disposable, unworthy. The physical signs of grieving include: # Exhaustion, muscle tightness or weakness, body pains, fidgety restlessness, lack of energy # Insomnia, sleeping too much, disturbing dreams # Loss of appetite, overeating, nausea, "hollow stomach", indigestion, intestinal disorders like diarrhea, excessive weight gain or loss # Headaches, short of breath, chest pressure, tightness or heaviness in the throat

Depression

A broken heart is a major

stressor A stressor is a chemical or biological agent, environmental condition, external stimulus or an event seen as causing stress to an organism. Psychologically speaking, a stressor can be events or environments that individuals might consider demandin ...

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. Although there are overlapping symptoms, uncomplicated grief can be distinguished from a full depressive episode. 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. In relationship breakups, mourners may turn their anger over the rejection toward themselves. This can deepen their depression and cause narcissistic wounding. 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.

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. 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. 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.Balint, Michael. The Basic Fault: Therapeutic Aspects of Regression. Evanston: North Western University Press, 1992. 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. 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. Couples can function like a mutual bio-feedback system, stimulating and modulating each other's bio rhythms, responding to one another's pheromones, and be addicted due to the steady trickle of endogenous opiates induced by the relationship.

Post-traumatic stress disorder

Research has shown that in extreme cases, some who experience a broken heart go on to develop

posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats ...

(PTSD).Goleman, Daniel. The Emotional Brain and Emotional Intelligence: New Insights. North Hampton, Mass, 2011. 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. 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. 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), while the same stress hormones can act to impede.

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. Some

echocardiogram An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound of the heart. It is a type of medical imaging of the heart, using standard ultrasound or Doppler ultrasound. Echocardiography has become routinely used in th ...

s 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 wave In electrocardiography, the T wave represents the repolarization of the ventricles. The interval from the beginning of the QRS complex to the apex of the T wave is referred to as the ''absolute refractory period''. The last half of the T wave ...

s and longer Q-T intervals that are associated with

stress Stress may refer to: Science and medicine * Stress (biology), an organism's response to a stressor such as an environmental condition * Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...

. 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.

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.

Cultural references

The sentiment is expressed in a collection of Sumerian proverbs: Biblical references to the pain of a broken heart date back to 1015 BC.

Rudaki Rudaki (also spelled Rodaki; fa, رودکی; 858 – 940/41) was a Persian poet, singer and musician, who served as a court poet under the Samanids. He is regarded as the first major poet to write in New Persian. Said to have composed more tha ...

, regarded as the first great genius of Persian poetry, used broken heart imagery in his writing.

Shakespeare William Shakespeare ( 26 April 1564 – 23 April 1616) was an English playwright, poet and actor. He is widely regarded as the greatest writer in the English language and the world's pre-eminent dramatist. He is often called England's natio ...

'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''."Romeo and Juliet, Act V Scene III"
Shakespeare Literature. Retrieved 5 August 2015. Frida Kahlo's 1937 painting '' Memory, the Heart'' portrays the artist's heartbreak during and after an affair between her husband and her sister.

References

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External links

* * * * {{Wiktionary-inline, broken heart Love Metaphors referring to body parts Emotions Suffering