Nobody will rush to the hospital after receiving an email saying, ‘we need to talk’. However, most people will tell you that they felt their chest tighten and their stomach drop. Additionally, their body may have felt as though it had been damaged somewhere. We often say our hearts break and that we feel hurt, but for hundreds of years this was just poetic. Over the past two decades, however, scientists have used brain scans to investigate whether it is actually true. A breakup is one of the most difficult situations most people will ever face. It can cause trouble sleeping, overthinking, low moods and even physical illness. Knowing how your brain is working can help you feel less like it is a personal failure.
This article looks at three questions. First, does heartbreak activate the same brain areas as physical pain, and if it does, does that make the two experiences the same? Second, what do reward systems and brain chemistry add to the picture, and how might they relate to the obsessive, craving-like feelings that often follow a breakup? Third, how does all of this compare with ‘broken heart syndrome’, a rare medical condition in which emotional shock affects the heart itself? The research is fascinating but still developing, and much of it is based on small groups of people. It describes patterns in the brain, not a diagnosis or a treatment plan, and it does not show that heartbreak is the same as physical pain or the same as an addiction.
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A Hurting Game
Pain is not a single experience. It has a sensory side, which helps the brain work out where the pain is coming from and how bad it is, and an emotional side, which is how unpleasant and distressing it feels. Researchers wanted to know whether social pain, the hurt of being rejected or left out, makes use of some of the same brain processes. In 2003, psychologists Naomi Eisenberger, Matthew Lieberman and Kipling Williams put 13 volunteers into an fMRI machine.
This measures the amount of blood flow to parts of the brain to show which parts are the most active. The volunteers played an easy game of catch on a computer with two other players. Halfway through the game, the other two players stopped passing the ball. Even though they were just computer programmes, the volunteers’ brains reacted as if they were really being excluded (Eisenberger et al., 2003).
The anterior cingulate cortex became more active when they were excluded. This area is known to be involved in the emotional side of physical pain, and the more upset the volunteers said they were, the more active it became. Another area became less active. This was the anterior region of the right side of the brain. The less active it was, the less distress they felt. It acted like a volume control for the alarm (Eisenberger et al., 2003).
Why would social pain use some of the same processes as physical pain? It is widely believed that evolution is the reason. Humans have relied on a group throughout history to survive. If being excluded from the group feels painful, we are motivated to get back in. This is similar to touching something hot: we feel pain and pull our hand away. The same goes for feeling lonely. We feel a dull pain and try to find other people (Woo et al., 2014).
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A Breaking Heart in the Scanner
Being excluded by a computer is not the same as being dumped. So in 2011, Ethan Kross and his team tried to create a more realistic situation. They asked people who had recently had an unwanted breakup to look at a picture of their ex-partner while in the scanner and think about how they felt about being rejected. They also looked at a picture of a friend and thought about a happy memory they had with them. In another test, painful heat and then gentle heat were applied to their skin (Kross et al., 2011).
The results were surprising. Looking at a picture of an ex-partner activated two areas of the brain that deal with the sensory side of pain. Previous studies had suggested that rejection only activates the emotional side. When the team compared their results with over 500 previous studies, they found that activity in these two areas was a strong indicator that a person was in physical pain, and it allowed them to predict physical pain with up to 88% accuracy (Kross et al., 2011). For a moment it seems as though heartache is not just a metaphor. But activity in the same brain areas does not on its own mean that two experiences are the same, as the next section shows.
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Is it the Same Pain?
Often a good story will not hold up under scientific testing. In 2014, a research group led by Choong-Wan Woo and Tor Wager looked into this question in more detail. Imagine looking out of the window of a plane and seeing the same areas of a city light up in response to two different events. You would probably assume they are the same. But if you zoom in, you may find different buildings lighting up.
This is what this research group did. They scanned 60 people who felt pain from heat and looked at pictures of their ex-partner. They then taught a computer to recognise the detailed fingerprint of each experience. The computer could recognise the pain fingerprint 92% of the time and the rejection fingerprint 80% of the time. However, a computer trained to recognise rejection could not recognise pain, and vice versa. This meant that the fingerprints were different, even in the areas that seemed to be the same (Woo et al., 2014).
Other scientists were also sceptical. Stephanie and John Cacioppo and colleagues (2013) combined data from many previous studies and found that the pain network was not always activated when people felt socially excluded. It also did not show up clearly when people thought about a romantic rejection. However, there is evidence pointing the other way. In research carried out by Nathan DeWall and colleagues in 2010, participants were given acetaminophen (the painkiller in Tylenol) every day for three weeks.
Throughout the day, they reported feeling less hurt. When they were scanned, they had less of a reaction to being excluded than those given a placebo. This suggests that the two types of pain have something in common, since an everyday painkiller can reduce the pain of social exclusion. Overall, the evidence points to overlap, not identity. Emotional heartbreak and physical pain are likely to be on the same street.
They live in different houses, but they may share some neighbourhoods and even plumbing. Activity in the same region tells us the brain may be borrowing similar machinery, not that a breakup hurts in exactly the way a burn does. There is also no consensus in the scientific community, and fMRI is a fairly crude measure. It measures blood flow, not the small signals between individual brain cells.
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The Chemistry of Cravings
Brain scans show where things may be happening. The next studies look at something different from pain: wanting. They suggest a way of understanding why a breakup can leave people feeling stuck, as if part of them is still reaching for the person who left. A research group led by anthropologist Helen Fisher scanned 15 people (10 females and 5 males) who had recently been rejected but were still in love. They looked at a picture of the person who had left them and then a picture of someone they knew (Fisher et al., 2010). Looking at their ex-partner activated reward and craving areas of the brain.
An important area was the ventral tegmental area. This is a small area deep in the brain and is part of the system we use to chase after what we want. Similar areas become active in people who crave cocaine (Fisher et al., 2010). This could help explain why some people become so obsessed after being rejected. Imagine your reward system is a postman. For months, they have been delivering packages to the same address. That address no longer exists, but they still show up. This may be why you look at your ex’s social media at 2 am, write them a message you will never send or keep thinking about your last conversation, hoping it will have a different outcome.
The brain is still seeking something that is no longer available. This does not mean that heartbreak is an addiction. Similar activity in a brain area does not make two experiences the same, and a breakup is a complex emotional event, not a reaction to a substance. There are also important limits to this study. fMRI measures blood flow, not dopamine itself, so the link to dopamine is an inference based on the role of this area in reward. The study also only used 15 people. It is best to think of this as a helpful analogy for why the pull towards an ex can feel so strong, not as a medical diagnosis.
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Natural Painkillers in the Body
One of the most interesting links between heartbreak and withdrawal is the natural painkillers in the body. These are known as opioids. They are the same type of molecule that morphine imitates. Your brain makes its own to help relieve pain. In 2009, Baldwin Way, Shelley Taylor and Naomi Eisenberger looked at a common gene that affects how the opioid system in the brain works. People with one version of this gene tend to feel more physical pain. They found that these people were also more sensitive to rejection and had more activity in the pain areas of the brain (Way et al., 2009).
In everyday terms, this may be one reason why two people can go through a similar breakup and feel it very differently. A few years later, David Hsu and colleagues used a different type of scan, called PET, to look at the opioid system. Researchers found that natural opioids were released in several brain regions when 18 volunteers learnt that others disliked them. People who showed greater resilience had a stronger opioid response in certain brain regions. This shows that the brain’s natural painkillers could help people cope with rejection (Hsu et al., 2013). This suggests that the body may have natural mechanisms that help people recover from emotional pain.
Taken together with the reward studies, this means heartbreak shares some features with withdrawal. Rejection activates reward and craving areas that keep seeking, and it also activates a pain-relief system that tries to cushion the hurt. However, these systems perform different functions, and heartbreak is not equivalent to drug addiction. Scientists have also not followed these systems week by week during an actual breakup. Therefore, we do not yet know how they change over time.
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When the Heart Really Does Hurt
Everything so far concerns the brain. There is one situation where an emotional shock can clearly affect the heart itself. Doctors call this condition Takotsubo cardiomyopathy, also known as ‘broken heart syndrome’. It is important to be clear that this is a distinct medical condition, not simply a more severe form of heartbreak. A sudden emotional shock can trigger this condition, and romantic breakups are not the only possible cause. The person will feel chest pain and have symptoms very similar to a heart attack.
However, doctors find no blockage in their arteries. Instead, part of their heart muscle becomes weak and balloons up into the shape of a Japanese octopus trap (the name of the condition) (Virani et al., 2007). Doctors believe that a rise in stress hormones mainly causes this response, although they do not yet fully understand the exact mechanism. Whilst it is rare, most people make a full recovery.
This condition shows that the brain’s alarm can reach the heart. However, chest tightness during a breakup does not necessarily indicate this rare condition, which only a doctor can diagnose. Its symptoms can resemble those of a heart attack. Therefore, anyone who has chest pain should seek urgent medical help and not assume that it is emotional.
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What May Help?
Whilst this is not a step-by-step guide, it does give us some positive information.
- Your brain has its own volume control: The area of the brain linked to less distress in the first study suggests that the brain can regulate social pain. Talking, journaling, and therapy may be worth trying for their own sake, but this was not looked at in the original experiment, so it is not proven that they work through this area.
- Resilience has a biological side: In a small study, those who coped better had a stronger natural painkiller response (Hsu et al., 2013). This means that getting over a breakup is not just a case of having strong willpower. Your body is helping too.
- Do not take the headlines as medical advice: The painkiller studies were controlled experiments and do not suggest you should take medication for a broken heart.
- Know when to seek help: Romantic rejection can be accompanied by low mood or depression (Fisher et al., 2010). In extreme cases, it can cause suicidal thoughts. If you are feeling hopeless, struggling with everyday life or having thoughts about harming yourself, please speak to a doctor, therapist or crisis line. You do not have to suffer alone. If you have chest pain, seek urgent medical care.
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Conclusion
Although heartbreak leaves no visible wound or trace on an X-ray, the brain responds as though it has lost something important. The best evidence suggests that heartbreak shares some brain areas and some chemistry with physical pain. However, it also has its own signature. Therefore, the two are related but not identical. The reward system keeps seeking someone who is no longer there, in a way that resembles cravings, though heartbreak is not an addiction. Your body also releases natural painkillers to cushion the hurt.
In rare cases, a sudden emotional shock can affect the heart through a separate medical condition called Takotsubo cardiomyopathy. However, this is not what most people experience after a breakup. Scientists are still debating how closely heartbreak resembles physical pain. What nobody can argue is that the pain is real, and that it uses systems that have evolved to keep us connected. A broken heart is nothing to be ashamed of or dramatic. It is a natural response of the social brain when an important relationship ends. Whilst knowing this will not stop you from feeling the pain, it may help you be kinder to yourself whilst it heals.
References +
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- Virani, S. S., Khan, A. N., Mendoza, C. E., Ferreira, A. C., & De Marchena, E. (2007). Takotsubo cardiomyopathy, or broken-heart syndrome. Texas Heart Institute Journal, 34(1), 76–79. https://pmc.ncbi.nlm.nih.gov/articles/PMC1847940
- Way, B. M., Taylor, S. E., & Eisenberger, N. I. (2009). Variation in the mu-opioid receptor gene (OPRM1) is associated with dispositional and neural sensitivity to social rejection. Proceedings of the National Academy of Sciences, 106(35), 15079–15084. https://doi.org/10.1073/pnas.0812612106
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- Fisher, H. E., Brown, L. L., Aron, A., Strong, G., & Mashek, D. (2010). Reward, addiction, and emotion regulation systems associated with rejection in love. Journal of Neurophysiology, 104(1), 51–60. https://doi.org/10.1152/jn.00784.2009
- DeWall, C. N., MacDonald, G., Webster, G. D., Masten, C. L., Baumeister, R. F., Powell, C., Combs, D., Schurtz, D. R., Stillman, T. F., Tice, D. M., & Eisenberger, N. I. (2010). Acetaminophen reduces social pain: Behavioural and neural evidence. Psychological Science, 21(7), 931–937. https://doi.org/10.1177/0956797610374741
- Cacioppo, S., Frum, C., Asp, E., Weiss, R. M., Lewis, J. W., & Cacioppo, J. T. (2013). A quantitative meta-analysis of functional imaging studies of social rejection. Scientific Reports, 3, Article 2027. https://doi.org/10.1038/srep02027
