Why does my heart hurt when im sad?

When people have their feelings hurt, what is actually happening inside the body to cause the physical pain in the chest?
—Josh Ceddia, Melbourne, Australia

Robert Emery and Jim Coan, professors of psychology at the University of Virginia, reply:

terms such as “heartache” and “gut wrenching” are more than mere metaphors: they describe the experience of both physical and emotional pain. When we feel heartache, for example, we are experiencing a blend of emotional stress and the stress-induced sensations in our chest—muscle tightness, increased heart rate, abnormal stomach activity and shortness of breath. In fact, emotional pain involves the same brain regions as physical pain, suggesting the two are inextricably connected.

But how do emotions trigger physical sensations? Scientists do not know, but recently pain researchers uncovered a possible pathway from mind to body. According to a 2009 study from the University of Arizona and the University of Maryland, activity in a brain region that regulates emotional reactions called the anterior cingulate cortex helps to explain how an emotional insult can trigger a biological cascade. During a particularly stressful experience, the anterior cingulate cortex may respond by increasing the activity of the vagus nerve—the nerve that starts in the brain stem and connects to the neck, chest and abdomen. When the vagus nerve is overstimulated, it can cause pain and nausea.

Heartache is not the only way emotional and physical pain intersect in our brain. Reent studies show that even experiencing emotional pain on behalf of another person—that is, empathy—can influence our pain perception. And this empathy effect is not restricted to humans. In 2006 a paper published in Science revealed that when a mouse observes its cage mate in agony, its sensitivity to physical pain increases. And when it comes into close contact with a friendly, unharmed mouse, its sensitivity to pain diminishes.

Soon after, one of us (Coan) published a functional MRI study in humans that supported the finding in mice, showing that simple acts of social kindness, such as holding hands, can blunt the brain’s response to threats of physical pain and thus lessen the experience of pain. Coan implicated several brain regions involved in both anticipating pain and regulating negative emotions, including the right anterior insula (which helps to regulate motor control and cognitive functioning), the superior frontal gyrus (which is involved in self-awareness and sensory processing) and the hypothalamus (which links the nervous system to the endocrine system).

Although the biological pathways underlying these connections between physical and mental pain are not well understood, studies such as these are revealing how intricate the connection is and how very real the pain of heartache can be.

After a major break up or a death of a loved one, you may feel so upset that it hurts. You experience gut-wrenching heartache and pain as you try to work through your feelings. There are many descriptions in literature and popular culture about the pain in your heart or chest when you are sad. This is not just a coincidence. When you are emotionally sad or upset, it can actually cause you physical pain. It is not just in your mind. Your feelings are actually causing physical changes in your body.

Terms like heartache are not just a metaphor. People actually feel physical pain when they feel emotional pain. Your body is designed to handle stress in certain ways. When you are engaged in a stressful situation, it causes physical changes. Your heart rate increases, your stomach churns, you become short of breath and your muscles tighten.

When scientists look at MRIs of people in emotional or physical pain, they see something interesting. Emotional pain causes the same brain regions to light up as physical pain does. This seems to show that your body connects emotional and physical pain. When you are upset or sad, you actually feel physical pain because of the strength of your feelings.

Why Does This Happen?

In New Age literature, you always read about the mind-body connection. This is not just some made-up, New Age topic. There really is a distinct connection between your mind and body. In 2009, the University of Maryland and the University of Arizona conducted a study on this topic. They decided to look at changes to brain activity in the anterior cingulate cortex. This part of the brain is designed to handle emotional reactions. During a stressful experience, your anterior cingulate cortex reacts by increasing the vagus nerve’s activity. This nerve is connected to your chest, brain stem, abdomen and neck. If your vagus nerve is stimulated excessively, it can cause you to experience nausea and pain.

In another 2006 study, emotional pain was found to influence your perception of pain. In the study published in Science, a mouse watched a fellow mouse that was in agony. Even though the first mouse was not harmed, it had a changed sensitivity to pain because of its empathy for the harmed mouse. Another MRI study on humans found that social kindness could change how the brain responds to pain. For example, holding hands could reduce how sensitive you are to pain. Different regions of the brain like the superior frontal gyrus, the anterior insula and the hypothalamus were found to play roles in regulating negative emotions and blunting the feeling of pain.

The experience of heartache seems to be caused by the anterior cingulate cortex. This part of the brain regulates emotional reactions, and it becomes active during stressful situations. Your heartache is not just in your mind. You are actually experiencing increased pain because of the emotional stress that you are under.

Your Mind and Body

This type of mind-body reaction is not just related to your recent heartache. Different emotions can cause different physical reactions. When you are afraid, it feels like your stomach drops. Anxiety, anger and fear were also found to cause strong reactions in your chest area. Meanwhile, seeing a crush can give you goosebumps. When study volunteers felt love and happiness, sensations started to spark all over their bodies.

What Happens When You Experience a Break Up?

For most people, a break up is one of the most emotionally devastating things that can happen. Other than losing a loved one, there are few events that are as emotionally difficult and challenging to go through. Unfortunately, your break up is taking its toll on your body. There are a few different physical changes that happen following a break up, and these changes are not in your head. A break up is actually genuinely bad for your health.

1. Your Stress Hormones Go Nuts

As you might expect, the constant stress of a break up causes your stress hormones to spiral out of control. When you first fell in love, you experienced a boost in oxytocin and dopamine. These neurochemicals induced feelings of pleasure and happiness. If you have ever researched addictions, you may have noticed that dopamine is one of the chemicals involved in an addiction as well. This is not just chance; you basically become addicted to love.

Unfortunately, a break up is a devastating end to your love addiction. All of those positive neurochemicals stop flooding your body, and your brain fills with epinephrine and cortisol. Known as the stress hormones, these neurochemicals cause blood to flow to your muscles and your heart to beat faster. Your body basically goes into flight or fight mode as it experiences this stress. This can lead to a stiff neck, swollen muscles, headaches and a tight sensation in your chest.

2. You May Gain or Lose Weight

For many people, a break up results in a changed attitude toward food. Some people begin binge-eating as a way to distract themselves, comfort their broken heart and heal. Other people are so consumed by stress and anxiety that they cannot even contemplate eating. Either option can lead to a rapid change in your weight as you try to get over your loss.

3. You Will Question Yourself

When you fall in love with someone, your personal identity starts to change. Before long, you are thinking of yourself as an “us” instead of just an “I.” Once the break up occurs, you lose this “us” identity. Instead of being someone’s partner, you are just yourself again. This can cause you to have an existential crisis as you try to figure out who you are again. You may also question your personal qualities as you try to figure out if it is something that you did or said that caused the break up.

3. You Will Feel Depressed

Now that the happiness hormones are gone you are probably going to experience depression. When you experience trauma or loss, you may experience a drop in your self-esteem. Your heartache and lower self-esteem can fuel a sense of depression. Researchers have also found that a loss that caused reduced self-esteem was twice as likely to cause depression.

4. You May Go Through Withdrawal

As we mentioned before, you have basically developed an addiction to the positive hormones that happen when you fall in love. When you are suddenly out of love, your mind and body go through withdrawal. In MRI studies, the brain areas that activate when seeing a picture of an ex are the same ones that light up when someone goes through cocaine withdrawal. Luckily, the withdrawal symptoms have something else in common with cocaine withdrawal. If you give it long enough, the withdrawal symptoms and stress will gradually go away.

While you may want to isolate yourself and binge-watch Netflix, that is one of the worst things that you can do. Whether you lost a loved one or experienced a break up, the best thing that you can do is to be around people. You need to boost your dopamine levels again, so start doing activities that you enjoy. Exercise, being around friends and doing activities that you love can help increase your dopamine levels.

The Pain Is Real: 8 Scientific Effects Heartbreak Has On The Body

When your heart is broken, it can feel like the end of the world. No amount of pain has ever felt so agonizing or concentrated. It’s like a giant hole was pummeled into your chest, with no hope of repair.

You cry, you scream, you watch Netflix until you’ve seen every documentary your subscription has to offer and yet nothing seems to smooth your heartbreak or soothe the longing you feel.

True Story: Breakups are a bitch, and heartbreak is a bigger bitch than f*cking karma.

I think I can say with pretty solid confidence, most people would rather get smacked in the face with a metal pole than get their hearts broken. It’s why we try to avoid it.

Our bodies literally repel being dumped because there’s no greater pain than heartbreak. The struggle is just so real, and the risks we take by falling in love are innumerable and terrifying.

The thing is, a breakup is really, really f*cking bad for your health. You might think it’s all in your head, but it’s not. You truly are experiencing an illness.

Here are eight scientific things that happen to your body when you have a broken heart, proving it’s just about the worst thing in world.

Your brain thinks you’re physically hurt.

When you get viciously dumped, it can feel like someone has punched you in the stomach, knocking all the wind out of you.

It can be consuming, as if your entire body were suddenly in Rigamortis. Guess what? While nothing has physically been done to you, your brain literally is telling your body the pain is real.

As Naomi Eisenbuerger, Ph.D., and assistant professor of psychology at the University of California at Los Angels told Women’s Health Magazine, the area of your brain that lights up when you’re hurt physically is the same area that lights up when you suffer “social rejection.”

So, when we say heartbreak “hurts like hell,” you know it actually hurts.

You either get really heavy or really thin.

Having your heart broken can go one of two ways: you either binge-eat or eat nothing.

It’s all about how you cope with sadness. Some people eat their feelings, using food as a distraction and a comfort while they cry their hearts out, watching an endless stream of Lifetime movies. Others are so racked with anxiety, they can’t even think about eating; food becomes disgusting and indigestible.

For some, heartbreak can be the most fabulously unhealthy diet known to man.

You’re swimming in stress hormones.

As Women’s Health Magazine explains, when you’re in love, your brain is inundated with the neurochemicals dopamine and oxytocin, making you experience feelings of happiness and pleasure. After all, love is more addicting than drugs, according to science.

When you get your heart broken, though, all those lovey-dovey chemicals wash right out of your system, leaving you victim to stress hormones. Your brain pumps your body full of cortisol and epinephrine.

An overabundance of cortisol tells your brain to send too much blood to your muscles, causing them to tense up, ostensibly for swift action. But you’re not leaping anywhere, and as a result you’re plagued with swollen muscles causing headaches, a stiff neck and an awful squeezing sensation in your chest.

The verdict? Heartbreak is really f*cking bad for you.

You’ll be depressed.

Though this one might be obvious, but studies have actually proven heartbreak does cause depression. According to Psychology Today, researchers at Virginia Commonwealth University studied 7,000 male and female twins and analyzed their levels of depression and anxiety based on traumatic experiences in their lives.

The research found “losses that involved lower self-esteem were twice as likely to trigger depression as ones that involved loss alone.” Read: Getting rejected by your boyfriend or girlfriend is the greatest self-esteem hit of them all.

Withdrawal is real.

As I mentioned before, love is just as addicting as drugs, specifically cocaine. When you’re a cocaine addict cut off from the drug, your body goes through withdrawal. The same thing happens when you’re addicted to love and suddenly find yourself without it.

According to The Frisky, “areas of the brain are much more active after seeing the image of the ex. These same active areas are also afire in cocaine addicts who are experiencing physical pain while going through withdrawal.”

Luckily, like the withdrawal you experience from drugs, eventually the symptoms will subside and you can get on with your new, single life. It’ll be better, I promise.

You’ll wonder who you are.

Doctors say after a terrible breakup, you can question your identity. According to Erica Slotter, a psychology Ph.D. candidate at Northwestern University, “We know that relationships change the way we think about ourselves. When a relationship ends, that sense of self ends.”

Breakups can provoke existential crises. When we’re brutally broken up with, we’re left questioning who we are because we’re not sure how this could have happened to us. Aren’t I lovable? Wasn’t that person The One? Now you’re forced into a new phase of life, you’ll have to figure out just what kind of person you want to be moving forward.

This won’t be the last time heartbreak hits.

Sorry to be the bearer of possibly the worst news known to man, but research from Brown University has found if you experience a breakup, the likeliness of a second breakup increases by 75 percent. I know this is the last thing you want to hear right now, but it’s the truth.

You’ll want to be alone, but you’ll need to avoid it.

When you go through a breakup, the only thing you want to do is be alone. Instead, you need to get those dopamine levels up, stat. The best way to do this is by going out and doing some of the activities you love to do, like activities that bring you joy.

It may seem like the most unappealing thing in the world when you’re miserable and just want to cuddle up to a pint of Ben and Jerry’s and finish off your pathetic list of ways to get him back, but if you want your body to heal, you need to GTFO of the house and do sh*t.

Even if you choose to go on a bender, it can be good for the soul. Becoming a hermit crab is only going to prolong and agitate your broken-heart syndrome.

Depression is associated with recurrent chest pain in adults regardless of the presence of coronary artery disease, according to the results of a study published in the American Heart Journal.

In this prospective cohort study, researchers evaluated 365 patients with acute chest pain and low-to moderate-cardiac risk who were admitted to the emergency department. Once infarction was ruled out, participants underwent cardiac stress testing. To determine the association between psychiatric conditions and recurrent chest pain at 30 days post-discharge, participants completed the Patient Health Questionnaire (PHQ8), Clinical Anxiety Scale (CAS), and Perceived Stress Scale (PSS).

A total of 36% of participants (n=131) reported recurrent chest pain within 30 days. Compared with participants who did not report recurrent chest pain, those who did had higher mean scores of depression (evaluated by PHQ8; 6.78 vs 4.61), anxiety (evaluated by CAS; 46.3 vs 41.3), and perceived stress (evaluated by PSS; 17.4 vs 16.1).

Depression, anxiety, and perceived stress scores were all positively correlated with increasing chest pain frequency, and the relationship was significant for depression (P <.001). The researchers noted that patients with chest pain 1 to 3 times daily had average PHQ8 scores twice those of patients without recurrent chest pain.

Although baseline antidepressant use increased the risk for recurrent chest pain (OR 2.82), patients taking antidepressants with controlled depression (defined as PHQ8 <10) did not have a significantly increased risk for chest pain (OR 1.89).

The study authors concluded that the study “underscores the impact of depression in patients who present with chest pain with and without history of …. Approaches to screen and manage depression early in the chest pain center may have significant implications in curtailing recidivism and quality of life for these patients.”


Kim Y, Soffler M, Paradise S, et al. Depression is associated with recurrent chest pain with or without coronary artery disease: A prospective cohort study in the emergency department. Am Heart J. 2017;191:47-54.

Chest pain and rapid heartbeat. These symptoms can be related to lung or heart problems, even serious ones like a heart attack. But they also can be symptoms of depression and anxiety, what doctors call “anxious depression.” These chest pains can often be chronic in those suffering from depression, but may be felt suddenly in those suffering from anxiety. If you are having these symptoms, see a doctor right away to rule out serious heart, gastrointestinal, or lung problems.

If your heart is fine, you may be suffering from another problem such as heartburn, depression, or anxiety.

There is a complex and close biological relationship between depression, anxiety, and the heart, research shows. Depression has been linked to heart disease. When you are under stress or having a panic attack, the body releases stress hormones like cortisol as part of our natural “fight or flight” response. These hormones can trigger physical symptoms like chest pain and a rapid heartbeat that may feel like a heart attack.

Could your chest pain and rapid heartbeat be related to depression? One way to find out is to keep a symptom diary. Print out this symptom diary, and fill it out. Then take it to your doctor to discuss what may be causing your symptoms.

How to stay heart healthy — even when you’re down.

Ever drown your sorrows in a big bowl of ice cream? When you’re feeling down, it’s easy to reach for your favorite comfort food. But thinking about your heart health is important, even when you’re not feeling too chipper.

That’s often easier said than done, said Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center in New York. But it’s also important, because heart disease is the No. 1 killer of all Americans.

“When people are stressed, anxious or feeling down, they’re not apt to make the healthy choice because they’re so overwhelmed by their situation,” Dr. Goldberg said. “A person’s mental health, in terms of their general health, is underestimated.”

Depression is reported in an estimated 1 in 10 of Americans ages 18 and older, and the figure can be as high as 33 percent for heart attack patients. But just feeling down can lead to changes that can affect your health, and not just because you may fall into habits that are bad for your heart, Dr. Goldberg said.

“Other physiological things are happening in the body, including increased stress hormones, higher levels of cortisol and higher glucose levels,” she said. “Taking care of your overall outlook and well-being is as important as taking care of your blood pressure and cholesterol.”

It’s not surprising if you find it hard to get plenty of exercise, eat heart-healthy foods, limit alcohol or kick a smoking habit. All those things can seem like “just one more thing to add to their list of things that is already causing stress,” Dr. Goldberg said. “People turn to things that give them comfort and aren’t thinking about whether those things are healthy or not.”

Out With the Bad, In With the Good

If you’re struggling with stress or anxiety, Dr. Goldberg said that taking three key steps can help.

  1. Identify the cause of your stress or anxiety and address it. Seek therapy if necessary.

    “If you’re feeling down for a couple days, that’s OK, but if it goes on for weeks, you need to seek help,” Dr. Goldberg said.

  2. Choose healthy habits and don’t rush it. If you aren’t in the habit of exercising, start gradually rather than putting pressure on yourself to get back to a rigorous routine.

    “Something as simple as taking a walk, 30 minutes a day, even if you do only 10 minutes at a time, can help your heart,” Dr. Goldberg said. “Exercise improves your mood while you’re doing it, but long-term studies show that people who exercise report better quality of life overall.”

    Exercise is especially important when you’re struggling with work, family and other life stresses, Dr. Goldberg said. In addition to being good for your heart health, “exercise can be a means to making you feel better,” she said.

    “Some people respond to stressful situations by eating because they’re so stressed out and that’s something that gives them pleasure and relaxes them,” Dr. Goldberg said.

    If reaching for unhealthy foods has become a habit, try using healthier cooking techniques or substituting ingredients to cut down on fat, added sugar, sodium and calories. Try reaching for healthy snacks, or choose undressed salads and other healthy dishes when dining out. Fresh fruits and vegetables are a nutritious and satisfying snack.

    “Focus on eating from all four food groups,” Dr. Goldberg said. “Many people say they have to eat on the go, but you can really find healthy items on the salad bar instead of getting a burger, fries and milkshake.”

  3. Incorporate other unhealthy lifestyle habits one a time instead of trying to “fix” everything at once. That’s especially true if one of the habits you want to break is a smoking habit.

    “Quitting smoking is a big deal and difficult to break,” Dr. Goldberg said. Learn about Life’s Simple 7 keys to prevention and how to get heart healthy one step at a time.

    Ultimately, you have to take care of yourself to break the cycle of feeling down. That could be doing something structured, like a yoga class or tai chi practice, or something you can do anywhere, such as a few minutes of meditation, listening to music or reading a book.

    “Even taking a bath can help,” Dr. Goldberg said. “Just take some time and relax.”

Last reviewed 6/2014

Most of us see the connection between social and physical pain as a figurative one. We agree that “love hurts,” but we don’t think it hurts the way that, say, being kicked in the shin hurts. At the same time, life often presents a compelling argument that the two types of pain share a common source. Old couples frequently make the news because they can’t physically survive without one another. In one example from early 2012, Marjorie and James Landis of Johnstown, Pennsylvania, who’d been married for 65 years, died just 88 minutes apart.

Truth is you don’t have to be a sentimentalist to believe in broken hearts — being a subscriber to the New England Journal of Medicine will do. A few years ago a group of doctors at Johns Hopkins University reported a rare but lethal heart condition caused by acute emotional distress. The problem is technically known as “stress cardiomyopathy,” but the press likes to call it “broken heart syndrome,” and medical professionals don’t object to the nickname.

Behavioral science is catching up with the anecdotes, too. In the past few years, psychology researchers have found a good deal of literal truth embedded in the metaphorical phrases comparing love to pain. Neuroimaging studies have shown that brain regions involved in processing physical pain overlap considerably with those tied to social anguish. The connection is so strong that traditional bodily painkillers seem capable of relieving our emotional wounds. Love may actually hurt, like hurt hurt, after all.

A Neural Couple

Hints of a neural tie between social and physical pain emerged, quite unexpectedly, in the late 1970s. APS Fellow Jaak Panksepp, an animal researcher, was studying social attachment in puppies. The infant dogs cried when they were separated from their mothers, but these distress calls were much less intense in those that had been given a low dose of morphine, Panksepp reported in Biological Psychiatry. The study’s implication was profound: If an opiate could dull emotional angst, perhaps the brain processed social and physical pain in similar ways.

Panksepp’s findings on social distress were replicated in a number of other species — monkeys, guinea pigs, rats, chickens. The concept was hard to test in people, however, until the rise of neuroimaging decades later.

A breakthrough occurred in an fMRI study led by APS Fellow Naomi Eisenberger of University of California, Los Angeles. The researchers knew which areas of the brain became active during physical pain: the anterior cingulate cortex (ACC), which serves as an alarm for distress, and the right ventral prefrontal cortex (RVPFC), which regulates it. They decided to induce social pain in test participants to see how those areas responded.

Eisenberger and colleagues fed participants into a brain imaging machine and hooked them into a game called Cyberball — essentially a game of virtual catch. Participants were under the impression that two other people would be playing as well. In actuality, the other players were computer presets controlled by the researchers.

Some test participants experienced “implicit” exclusion during the game. They watched as the other two players tossed the virtual ball, but were told that technical difficulties had prevented them from joining the fun. Others experienced “explicit” exclusion. In these cases, the computer players included the participant for seven tosses, then kept the ball away for the next 45 throws.

When Eisenberger and colleagues analyzed the neural images of exclusion, they discovered “a pattern of activations very similar to those found in studies of physical pain.” During implicit exclusion, the ACC acted up while the RVPFC stayed at normal levels. (The brain might have recognized this exclusion as accidental, and therefore not painful enough to merit corrective measures.) During explicit social exclusion, however, both ACC and RVPFC activity increased in participants.

The study inspired a new line of research on neural similarities between social and physical pain. “Understanding the underlying commonalities between physical and social pain unearths new perspectives on issues such as … why it ‘hurts’ to lose someone we love,” the researchers concluded in a 2003 issue of Science.

In a review of studies conducted since this seminal work, published in the February 2012 issue of Current Directions in Psychological Science, Eisenberger offered a potential evolutionary reason for the relationship. Early humans needed social bonds to survive: things like acquiring food, eluding predators, and nursing offspring are all easier done in partnership with others. Maybe over time this social alert system piggybacked onto the physical pain system so people could recognize social distress and quickly correct it.

“In other words,” wrote Eisenberger, “to the extent that being separated from a caregiver or from the social group is detrimental to survival, feeling ‘hurt’ by this separation may have been an adaptive way to prevent it.”

Physical Pain Dies, Lost Love Doesn’t

Psychologists believe that physical pain has two separate components. There is the sensory component, which gives basic information about the damage, such as its intensity and location. There’s also an affective component, which is a more qualitative interpretation of the injury, such as how distressing it is.

Initial studies that followed Eisenberger’s pioneering work focused on the affective component. (The ACC, for instance, is closely related to affective pain — so much so that animals without that part of their brain can feel pain but aren’t bothered by it.) As a result, researchers began to think that while the qualitative aspects of social and physical pain might overlap, the sensory components might not.

Recently that thinking has changed. A group of researchers, led by Ethan Kross of the University of Michigan, believed that social pain might have a hidden sensory component that hadn’t been found because games like Cyberball just weren’t painful enough. So instead they recruited 40 test participants and subjected them to a far more intense social injury: the sight of an ex-lover who’d broken up with them.

Kross and colleagues brought test participants into a brain imaging machine and had them complete two multi-part tasks. One was a social task: Participants viewed pictures of the former romantic partner while thinking about the breakup, then viewed pictures of a good friend. The other was a physical task: Participants felt a very hot stimulation on their forearm, and also felt another that was just warm.

As expected from prior research, activity in areas associated with affective pain (such as the ACC) increased during the more intense tasks (seeing the “ex” and feeling the strong heat). But activity in areas linked with physical pain, such as the somatosensory cortex and the dorsal posterior insula, also increased during these tasks. The results suggested that social and physical pain have more in common than merely causing distress — they share sensory brain regions too.

“These results give new meaning to the idea that rejection ‘hurts,’” the researchers concluded in a 2011 issue of Proceedings of the National Academy of Sciences.

Still it’s not quite accurate to say that physical and social pain are exactly the same. As other research suggests, social pain may actually be much worse in the long run. A kick to the groin might feel just as bad as a breakup in the moment, but while the physical aching goes away, the memory of lost love can linger forever.

A research group led by Zhansheng Chen at Purdue University recently demonstrated this difference in a series of experiments. During two self-reports, people recalled more details of a past betrayal than a past physical injury and also felt more pain in the present, even though both events had been equally painful when they first occurred. During two cognitive tests, people performed a tough word association task significantly more slowly when recalling emotional pain than when recalling physical pain.

“Our findings confirmed that social pain is easily relived, whereas physical pain is not,” the researchers reported in a 2008 issue of Psychological Science.

Heart-Shaped Box (of Tylenol)

There is a bright side to the new line of research linking social and physical pain: Remedies for one may well double as therapy for the other. A group of psychological researchers, led by C. Nathan DeWall of the University of Kentucky, recently tested whether acetaminophen — the main ingredient in Tylenol — could relieve the pain of emotional distress as effectively as it relieves bodily aches.

In one experiment, some test participants took a 500-mg dose of acetaminophen twice a day for three weeks, while others took a placebo. All 62 participants provided self-reports on a “hurt feelings” scale designed to measure social exclusion. After Day 9, people who took the pain pill reported significantly lower levels of hurt feelings than those who took a placebo.

As a follow-up study, DeWall and colleagues gave either acetaminophen or a placebo to 25 test participants for three weeks, then brought them into the lab to play Cyberball. When participants were excluded from the game, those in the acetaminophen group showed significantly lower activity in their ACC than those in the placebo group — a sign that the painkiller was relieving social pain just as it normally did physical pain.

“For some, social exclusion is an inescapable and frequent experience,” the authors conclude in a 2010 issue of Psychological Science. “Our findings suggest that an over-the-counter painkiller normally used to relieve physical aches and pains can also at least temporarily mitigate social-pain-related distress.”

The effect breaks both ways. In another report from Psychological Science, published in 2009, a research group led by Sarah Master of University of California, Los Angeles, found that social support could relieve the intensity of physical pain — and that the supportive person didn’t even have to be present for the soothing to occur.

Master and colleagues recruited 25 women who’d been in relationships for at least six months and brought them into the lab with their romantic partner. They determined each woman’s pain threshold, then subjected her to a series of six-second heat stimulations. Half of the stimulations were given at the threshold pain level, half were given one degree (Celsius) higher.

Meanwhile the woman took part in a series of tasks to measure which had a mitigating effect on the pain. Some involved direct contact (holding the partner’s hand, a stranger’s hand, or an object) while others involved visual contact (viewing the partner’s photo, a stranger’s photo, or an object). In the end, contact involving a romantic partner — both direct and visual alike — led to significantly lower pain ratings compared to the other tasks. In fact, looking at a partner’s picture led to slightly lower pain ratings than actually holding his hand.

At least for all the hurt love causes, it has an equally powerful ability to heal.

Why we need to take emotional pain as seriously as physical pain


If we did, we’d all be kinder and more compassionate, both to each other and to ourselves when our hearts get broken, says psychologist Guy Winch.

I have worked with scores of heartbroken people over the past twenty years, and I remember many of them vividly. This is not surprising, as the ease with which we recall events is heavily influenced by their intensity, and the raw emotion and terrible anguish of a person whose heart just got broken is hard to forget. This is especially true when the patient sitting across from me is a teenager.

One teenage patient stands out in my mind because his story encapsulated almost everything that is wrong with how we currently regard heartbreak. Greg was a highly intelligent, gay seventeen-year-old junior who had recently come out at school — thankfully, to relatively little fanfare. Greg spent two years nursing a crush on Devon, a senior and one of only two other out gay kids in his school. A month after coming out, Greg finally gathered the courage to walk up to Devon during lunch and suggest they hang out. As happens far too often with teenagers, Devon’s rejection was both swift and unnecessarily cruel. Feeling humiliated and absolutely gutted, Greg made his way to his history class, in which he was scheduled to have a big exam. Greg’s best friend (who was straight) always sat next to Greg in history, and Greg hoped to have a few moments to talk with him and get support before the exam began.

But when Greg arrived in class, his friend was not there. As he later found out, his friend had twisted his ankle while shooting hoops during the lunch break. When the history teacher saw the swollen ankle, she excused him from the test and sent him to the nurse’s office. Alone and with no support, Greg spent the hour fighting tears while struggling to focus on his exam. Knowing he had done poorly, Greg approached the history teacher after class to explain why he had trouble concentrating. But instead of responding with empathy or compassion, Greg’s teacher chastised him for “making excuses.”

We desperately need a more open dialogue about how severely heartbreak impacts our emotions and functioning.

This is the message we’re sending high school kids about emotional versus physical pain. If your ankle swells even slightly, your physical discomfort will be noticed and you will be afforded both compassion and consideration. But if your heart gets ripped out of your chest and the emotional pain you feel is so severe you can’t even concentrate, you will be given neither. If this is how we educate our youth, is it any surprise that heartbreak is so poorly understood and that emotional pain is so often ignored? And if nothing in her schooling or training gave her any tools to deal with students whose heart just got broken, should we be surprised by Greg’s teacher responding as she did?

I am not advocating we excuse every teenager who claims to have a broken heart from taking exams. Given how frequently teenagers get their hearts broken, we would end up with more students sitting out exams than taking them. Yes, separating the normative psychological and emotional distress adolescents experience on a daily basis from an exceptional, urgent or acute situation is by no means an easy call. But Greg was not someone nursing his hurt feelings from a rejection or breakup that happened days or weeks previously. He was an A student, blinking back tears in obvious emotional pain.

We desperately need a more open dialogue about how severely heartbreak impacts our emotions and functioning. And for such discussions to be productive, we have to disavow ourselves of the notion that there is something childish, embarrassing or inappropriate about feeling severe emotional anguish when our heart is broken, because heartbreak is devastating, at any age. We suffer emotional pain that is nearly “unbearable” for days, weeks and even months on end. Our body experiences stresses that can damage both our short-term and long-term health. Our grief activates circuitry in our brain that causes withdrawal symptoms similar to those experienced by people who are addicted to cocaine or heroin. Our ability to focus and concentrate, think creatively, problem-solve and generally function at our regular capacity becomes significantly impaired. Our lives are thrown upside down, leaving us questioning who we are and how to define ourselves going forward.

Studies have found that when societies do not sanction grief, we internalize these standards and regard our emotions and reactions as less legitimate.

The fact that all this goes virtually unrecognized, if not entirely ignored by society, makes our ordeal far more challenging than it already is. Our friends and loved ones might offer us comfort and support but only for a limited time. Our schools, institutions, workplaces, and even our healthcare system fail to do even that (the kind actions of some individual bosses or employers notwithstanding).

What makes this state of affairs so unfortunate and truly unacceptable is that we are not fundamentally blind to grief. When a first-degree relative dies, especially if it is a spouse, parent or child, we are usually afforded time off, sympathy, compassion and a tacit understanding that we will not be functioning at our best as we grieve. Similarly, employers are likely to be at least supportive and sympathetic when we let them know we’re going through a rough divorce. Our grief, in such cases, is both recognized and sanctioned, regardless of its magnitude.

But other kinds of grief, such as the kinds of heartbreak we’ve explored here, are neither recognized nor sanctioned. They’re disenfranchised, regardless of how emotionally devastated we are. Not only are we robbed of support and compassion, we are forced to expend our dwindling emotional reserves to hide how bereft we feel, lest we be judged for being overly emotional, immature or weak of character.

By not affording employees the time they need to heal from emotional pain, companies are left carrying the burden of less productive workers.

My concern about how we marginalize these kinds of grief is not just a reflection of my work with heartbroken patients. Studies of disenfranchised grief — and there are many of them — have found that when societies do not sanction grief, we internalize these standards and regard our own emotions and reactions as less legitimate. This lack of external and internal validation has also been found to negatively impact our psychosocial health and increase our risk for developing clinical depression.

If emotional pain were visible, heartbreak and the suffering it caused would not remain disenfranchised for long. When we show up to work or school with a broken leg, arm, even a broken finger, we often garner more attention, concern and consideration, because people can see the splints or bandages, than we are likely to when our heart is broken. They are there as evidence that we hurt. And yet, broken bones inflict none of the profound cognitive, emotional and psychological impairments heartbreak does.

Most companies are hesitant to institutionalize allowances for “emotional health reasons,” short of major mental diagnoses, because they fear employees will unfairly take advantage of them. However, their assumptions are both short-sighted and misguided. By not affording employees the time and support they need to heal, companies are left carrying the burden of less productive workers who are functioning below their capacity for extended durations of time.

If schools accepted that emotional pain is just as important as physical pain, they could train educators to be more compassionate toward suffering students.

If companies recognized the debilitating impact of heartbreak and gave their employees time to grieve, get support and recover, it would allow employees to return to full productivity sooner than they might otherwise. Rather than hide our emotional pain from our fellow students and colleagues, teachers and employers, we could heal it more quickly and minimize our periods of compromised productivity. And if schools accepted the basic fact that emotional pain is just as important, legitimate and debilitating as physical pain, they could train their educators to be more supportive of and compassionate toward students suffering from heartbreak. There is no reason why we do not teach our captive audience of middle and high school students how to avoid the mistakes that make our emotional pain worse and how to adopt the habits that promote emotional health and healing. But we do not.

If emotional pain were visible we would all conduct ourselves very differently. We would find kinder ways to break up with the person we were dating, and we would be less cruel when rejecting people who expressed interest in us. We would show more concern when we saw someone sitting alone, an anguished look on their face. We would be more patient and less judgmental when a friend or loved one fails to get over a broken heart in what we consider a timely manner. And when our own heart gets broken, we would be more self-compassionate, feel less shameful about our distress, and be more open to asking for the help we need.

For now, though, we must remind ourselves that despite a lack of institutional support, we are not entirely defenseless against the assaults of heartbreak. There are things we can do –and things we should avoid doing — to ease our emotional pain, speed up our recovery, and heal the emotional and psychological wounds we suffered. Understanding what kinds of mistakes we must avoid and how to avoid getting stuck, and knowing what actions we should take and which habits to adopt in order to heal, means we are no longer at the mercy of the one curative ingredient over which we have no control: time.

We can help our hearts heal, and we can be more proactive and supportive in helping other broken hearts heal as well. Heartbreak is all around us. It’s time we open our eyes and see it, for only then can we truly heal it and move on.

Excerpted from the new book How to Fix a Broken Heart by Guy Winch. Reprinted with permission from TED Books/Simon & Schuster. © 2018 Guy Winch.

About the author

Guy Winch is a licensed psychologist who is a leading advocate for integrating the science of emotional health into our daily lives. His two TED Talks have been viewed over 20 million times, and his science-based self-help books have been translated into 26 languages. He also writes the Squeaky Wheel blog for PsychologyToday.com and has a private practice in New York City.

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University Emory University

Depressed patients tend to have more frequent chest pain, even in the absence of coronary artery disease, report cardiologists.

The findings suggest pain and depression may share a common neurochemical pathway, says Salim Hayek, a cardiology research fellow with Emory Clinical Cardiovascular Research Institute.

“Depression is a common and well-recognized risk factor for the development of heart disease,” Hayek says. “Patients with known heart disease and depression tend to experience chest pain more frequently.

“However until now, it was not known whether that association was dependent on underlying coronary artery disease. Although our findings do not establish causality, they do suggest that depression is an important confounder of the relationship between chest pain and heart disease.”

More depression, more frequent chest pain

The study included 5,825 adults enrolled in the Emory Cardiovascular Biobank between 2004 and 2013. The biobank is a prospective registry of patients undergoing cardiac catheterization at three Emory Healthcare sites in Atlanta. Biobank patients had an average age of 63 years, with 65 percent male and 22 percent African-American.

Prior to cardiac catheterization, patients completed the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms and the Seattle Angina Questionnaire to assess chest pain frequency in the past month. The presence and severity of coronary artery disease was determined by angiogram. Patients completed the same questionnaires at one and five years post-procedure.

The researchers found that depression severity as measured by the PHQ-9 was independently associated with the frequency of chest pain, indicating that patients with more severe depression had more frequent chest pain.

Even patients with mild depression had more frequent chest pain than patients with no depressive symptoms. The findings remained after adjusting for coronary artery disease severity, age, gender, race, and traditional cardiovascular risk factors, including smoking status, body mass index, blood pressure, and blood lipid levels.

Patients with depression, whether women or men, were three times more likely to experience more frequent chest pain than those without depression. This was found to be true in patients with and without obstructive coronary artery disease.

Depression screenings?

A reduction in the severity of depression symptoms was associated with a decrease in the frequency of chest pain at follow-up. Notably, patients with depression who underwent revascularization did not have an improvement in chest pain frequency at one-year follow-up.

“We found that depression is strongly associated with the frequency of chest pain in adults, with and without underlying coronary artery disease, and that patients with depression and heart disease did not have an improvement in their chest pain frequency even after coronary intervention,” Hayek says.

“One possible explanation for our findings is that pain and depression share a common neurochemical pathway.”

Hayek adds: “Although depression is established as a risk factor for heart disease, there are no clear recommendations in the US for depression screening in patients with cardiovascular disease. ESC prevention guidelines recommend assessing patients for depression to prevent cardiovascular disease.

“Screening for depression in patients presenting with chest pain should be considered, and studies examining the effect of appropriate anti-depressive therapy on chest pain are needed.

“The fact that chest pain frequency at follow-up was decreased in patients whose depressive symptoms improved indicates that treating depression may help alleviate chest pain, after obstructive coronary artery disease as a cause of chest pain has been ruled out. This needs to be confirmed in randomized controlled trials.”

Hayek presented the results at the European Society of Cardiology Congress in London today.

The Katz Family Foundation Preventive Cardiology Grant supports Hayek.

Source: Emory University

Depression and heart disease: A two-way street

Watch for the warning signs of depression, which is often missed in people with heart disease.

Published: November, 2016

Image: gpointstudio/Thinkstock

All people have days when they feel sad, gloomy, or down in the dumps. But if those feelings last for weeks and you gradually stop feeling hopeful or happy about anything in your life, you may have depression. Like heart disease, depression is common, so it’s not unusual to have both conditions together. In fact, depression is about twice as likely to occur in people with heart disease compared with the general population. And people with depression face a heightened risk of heart disease.

“It’s really important for people to be aware of this link and to get treatment for depression, because it can be very debilitating,” says Dr. Christopher Celano, a psychiatrist at the Cardiac Psychiatry Research Program at Harvard-affiliated Massachusetts General Hospital.

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Depression Can Break Your Heart


Research over the past two decades has shown that depression and heart disease are common companions and, what is worse, each can lead to the other. It appears now that depression is an important risk factor for heart disease along with high blood cholesterol and high blood pressure. A study conducted in Baltimore, MD found that of 1,551 people who were free of heart disease, those who had a history of depression were 4 times more likely than those who did not to suffer a heart attack in the next 14 years. In addition, researchers in Montreal, Canada found that heart patients who were depressed were 4 times as likely to die in the next 6 months as those who were not depressed.

Depression may make it harder to take the medications needed and to carry out the treatment for heart disease. Depression also may result in chronically elevated levels of stress hormones, such as cortisol and adrenaline, and the activation of the sympathetic nervous system (part of the “fight or flight” response), which can have deleterious effects on the heart.

The first studies of heart disease and depression found that people with heart disease were more likely to suffer from depression than otherwise healthy people. While about 1 in 20 American adults experience major depression in a given year, the number goes to about 1 in 3 for people who have survived a heart attack. Furthermore, other researchers have found that most heart patients with depression do not receive appropriate treatment. Cardiologists and primary care physicians tend to miss the diagnosis of depression; and even when they do recognize it, they often do not treat it adequately.

The public health impact of depression and heart disease, both separately and together, is enormous. Depression is the estimated leading cause of disability worldwide, and heart disease is by far the leading cause of death in the United States. Approximately 1 in 3 Americans will die of some form of heart disease.

Studies indicate that depression can appear after heart disease and/or heart disease surgery. In one investigation, nearly half of the patients studied one week after cardiopulmonary bypass surgery experienced serious cognitive problems, which may contribute to clinical depression in some individuals.

There are also multiple studies indicating that heart disease can follow depression. Psychological distress may cause rapid heartbeat, high blood pressure, and faster blood clotting. It can also lead to elevated insulin and cholesterol levels. These risk factors, with obesity, form a constellation of symptoms and often serve as a predictor of and a response to heart disease. People with depression may feel slowed down and still have high levels of stress hormones. This can increase the work of the heart. As high levels of stress hormones are signaling a “fight or flight” reaction, the body’s metabolism is diverted away from the type of tissue repair needed in heart disease.

Regardless of cause, the combination of depression and heart disease is associated with increased sickness and death, making effective treatment of depression imperative. Pharmacological and cognitive-behavioral therapy treatments for depression are relatively well developed and play an important role in reducing the adverse impact of depression. With the advent of the selective serotonin reuptake inhibitors to treat depression, more medically ill patients can be treated without the complicating cardiovascular side effects of the previous drugs available. Ongoing research is investigating whether these treatments also reduce the associated risk of a second heart attack. Furthermore, preventive interventions based on cognitive-behavior theories of depression also merit attention as approaches for avoiding adverse outcomes associated with both disorders. These interventions may help promote adherence and behavior change that may increase the impact of available pharmacological and behavioral approaches to both diseases.

Exercise is another potential pathway to reducing both depression and risk of heart disease. A recent study found that participation in an exercise training program was comparable to treatment with an antidepressant medication (a selective serotonin reuptake inhibitor) for improving depressive symptoms in older adults diagnosed with major depression. Exercise, of course, is a major protective factor against heart disease as well.

The NIMH and the National Heart, Lung and Blood Institute are invested in uncovering the complicated relationship between depression and heart disease. They support research on the basic mechanisms and processes linking co-occurring mental and medical disorders to identify potent, modifiable risk factors and protective processes amenable to medical and behavioral interventions that will reduce the adverse outcomes associated with both types of disorders.

Portions of the above information have been provided with the kind permission of the National Institute of Mental Health (www.nimh.nih.gov)

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