Why Love Literally Hurts

Psychologists have discovered the neural link between social and physical pain

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.

References and Further Reading:

Wittstein, I. S., Thiemann, D. R., Lima, J. A., Baughman, K. L., Schulman, S. P., Gerstenblith, G., Wu, K. C., Rae, J. J., Bivalacqua, T. J., & Champion, H. C. (2005). Neurohumoral features of myocardial stunning due to sudden emotional stress. New England Journal of Medicine, 352, 539–548.

Kross, E., Berman, M. G., Mischel, W., Smith, E. E., & Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences, USA, 108, 6270–6275.

Master, S. L., Eisenberger, N. I., Taylor, S. E., Naliboff, B. D., Shirinyan, D., & Lieberman, M. D. (2009). A picture’s worth: Partner photographs reduce experimentally induced pain. Psychological Science, 20, 1316–1318.

Eisenberger, N. I., Lieberman, M. D., & Williams, K. D. (2003). Does rejection hurt: An fMRI study of social exclusion. Science, 302, 290–292.

Panksepp, J., Herman, B., Conner, R., Bishop, P., & Scott, J. P. (1978). The biology of social attachments: opiates alleviate separation distress. Biological Psychiatry, 13(5), 607–618.

Chen, Z., Williams, K. D., Fitness, J., & Newton, N. (2008). When hurt will not heal: Exploring the capacity to relive social and physical pain. Psychological Science, 19, 789–795.

DeWall, C. N., MacDonald, G., Webster, G. D., Masten, C. L., Baumeister, R. F., Powell, C., . . . Eisenberger, N. I. (2010). Tylenol reduces social pain: Behavioral and neural evidence. Psychological Science, 21, 931–937.

Eisenberger, N. I. (2012). Broken hearts and broken bones: A neural perspective on the similarities between social and physical pain. Current Directions in Psychological Science 21, 42–47.

Observer Vol.26, No.2 February, 2013

Leave a comment below and continue the conversation.

Comments

This is fascinating, but, as a bereaved mother, I wonder if they would be interested in expanding the study to bereaved parents. Whereas the kinds of relationships discussed in this article are implied to be those dissolved by a break-up, I would want to know if the brain/body react differently when the relationship ties are more permanently severed, because of a death (either of a child or a spouse/significant other).

I would think the same would be trueof abandoned and/or neglected children. The scientific impact could speak volumes on the lasting impact such rejection could have on children in abuse cases.

My early years were spend being ignored, left behind, and for the most part chasing love. My parents were divoring at a very early age. Both too busy trying to find love again to share love with their children, I was the youngest. Age 1. Even to this day its so painful to think about. Plus, this feeling resurfaces when things occur once triggered. I’d love it, if you wanted to study me ~ I’d like better, a cure.

If this is done to a still developing child are there long term impacts?

We were raised at a time when it was acceptable for parents to essentially abandon their babies in play pens, swings, so on until they were 2. Was also normal for children to be potty trained in seats that had trays that locked on so the parent could force the child to sit until they did their business.

I do not raise my children this way (ages 2 & 4) refuse to. They appear to be developing beautifully.

Where as my siblings & myself had to attend “special” classes in school because we had learning difficulties.

It hurts the heart, to see a child hurt in any way.

Very interesting read. I am an ACOA with PTSD. Abdonment, neglect and abuse issues. I have spent my entire life alone. I just don’t know how to interact with people. I enjoyed this. And i enjoyed the comments.

“Our findings confirmed that social pain is easily relived, whereas physical pain is not,” the researchers reported in a 2008 issue of Psychological Science.
This is the opposite of what all the leading info says… A mis-type perhaps??

As a child, I was left for long periods of time alone in a crib and a playpen, with only a doll for company. When my father understood why that doll was so important to me, he would give me extra attention when he returned from work. I was reading by the time I was 4, because of that attention when he read to me.
I was found to be highly intelligent when I entered school, but my mother and my sister contributed to a situation where I was “beaten down” to emotional rubble. I was molested by a brother, and both of them lied, hid it, and vilified me. Dad never knew until near his death, many years later.
I always thought that people exaggerated the “Mom” connection – it was a sentimental thing they did to make *her* feel better. I never felt that connection to my mother. After her death, I have come to understand it better, and realize that her actions favoring 3 siblings and ignoring her two “unwanted” children are the reason. For my brother and I, our ONLY value to her were in what we would do FOR her. And both of us are socially “awkward”… we never quite feel like we fit in. At least I was blessed to find a good husband who loves me, and I *created* the family I should have had.

I agree with Andrea in that the study should expand the area of bereavement to widowhood as well. What I experienced after the loss of my husband was a true physical agony that I can only describe as like being run through with a spear. It would slice through me and was unrelenting and truly disabling for hours or even days, persisting until I literally collapsed from exhaustion. I was unable to cry enough, running dry all the time although it did no good at all. Nothing–NOTHING helped. Even now, almost five years later it returns, doubling me over with tears that bring no relief.

Carly, I had the same issue had first. Then I realized that I had read it as “relieved”, but it says “relived”, as in social hurt comes back more easily.

My two sons have autism. I & there Dad love them so much!Yet cause nonverbal and have social problems if they feel pain more?? Or if reason for ton of sensory issues??

This is very true. I was a neglected spouse for years. The divorce was and has been traumatic. My spouse would not speak to me for days or weeks but would walk past me. This reaction is real. Frustration sets in and a form of PTSD sets in. This is an amazing social and physical recognition of a persons requirements for stability.

This is a true thing, I had heart problems and the nurse said she had seen it quite a bit, but the Dr. would not confirm, “broken heart syndrome” I was totally exhausted and traumatized by my narcissistic ex husband, he would punish me with ignoring me or my accomplishments and with silence. To this day I have a had a hard time with silence from someone. I needed counseling for PTSD to deal with my new spouse who is so good to me, but he will some times do things that trigger me and it freaks me out. I have had to learn how to deal with the PTSD. And he has had to learn how to change a couple of little things so when we disagree it did not turn ugly. Because people do is agree, but they can work it out. We just needed to understand where we each came from to get past it. I hope there is more research about this. So people won’t think we are so crazy for having a hard time “moving on” it is a real issue. Not just in our heads.

I have chronic major depression stemming from a childhood of serious abuse – sexual, physical and emotional. In my early 20s, as a virtual teetotaller, I discovered that opiates significantly improved things for me. If I took heroin, I could do the housework, leave the house to do errands and face situations that usually daunted me. For me it acted like a stimulant rather than a depressant. I felt “normal” in a way that I usually did not. Of course, after 10 years, the consequences of “self-medicating” with an illicit substance meant I needed to stop, and I went to rehab. I don’t recall meeting any other patient who did not have some kind of significant trauma in their past. I’ve been drug free for well more than a decade now, but the depression is as bad as ever. I’m currently battling suicidal thoughts and am literally only still on the planet because of my responsibility for a darling little girl. I never committed crimes to fund my use, apart from the crime of purchasing the substance, but I did lose every asset I had. However, rarely does a day go by that I don’t wish that I could have the pain relief again.

Fascinating. Certainly rings true for me. I’d be interested in a study that replaced the Tylenol with 10 minutes of meditation or yoga. I think it might have the same preventative effect.

I have an extremely high threshold for physical pain, especially for a female. I’ve pulled my own broken molar, and have duct-taped a broken ankle (after the swelling subsided, of course.) I’m what most of my male friends consider to be a tough b%tch. In the past few years, my boyfriend has been suffering from many ailments that can be contributed to stress caused by his ex. We’re close enough romantically that I’ve been making myself physically sick with migraines and stomach problems. He & I both suffer from PTSD, for different reasons (his is because of his ex’ verbal, emotional, & financial abuse towards him). When he hurts, I literally hurt as well.

Is this saying that a light smack for a child might actually be a better discipline that ignoring or time-out, or that time-out might be possibly more traumatic?

The last paragraph of ‘Physical Pain Dies, Lost Love Doesn’t’ states that emotional pain is easily relieved – but physical pain is not. This is backwards from the preceding paragraph stating people more easily recalled the details of a betrayal over physical pain. It is the only incongruent statement and should be corrected.

Thanks for the comment, Tim. The last paragraph actually states that “emotional pain is easily *relived* — but physical pain is not.” “Relive,” as in to mentally re-experience something–not “relieve” as in to alleviate.

I’m the mom of a child labelled as multiply-disabled and always have to deal with NYS social services reps or medical providers. I also battle fibromyalgia. Sometimes I have to call bureaucrats and paper pushers in social services or in legal services. When the providers are kind, I feel so happy. But when they are uncaring, I often get off the phone feeling a fibro-flare up. I’d like to see a study done on the effects of dealing with indifferent uncaring caregivers, offices, and bureaucrats, especially in the healthcare system. Sometimes the effect of dealing with certain people who have legal, medical, or official power over us and feeling as if one is unheard or is being delegated to some legal slushpile can be very disheartening. I think these legal and medical providers who feel they can be cruel to health “consumers” are more destructive than we know. I wonder if most people are like me and have to psyche themselves up to be brave enough to call certain types. Or if fibrofolks and those with immune system overloads are the only ones who freak out at making officia calls.

These studies should be presented within the legal system as support for spouse and children suffering from neglect and mental and emotional abuse. The lawyers, judges and public professionals (such as schools) place very minute regard, if any at all, to those who have been in this situation. When applying to limit the contact with the abusive person, one is told that unless it is serious physical abuse the children must remain with that parent. They show symptoms of distress and lasting brokenness the same as physically abused children and spouses; yet no one listens. No validation. And the abusive person gets to continue.

I have a good amount of friends, several who I would consider “close” but my problem is that I have chosen people who are very distant, and have very rejecting behavior. They do not express anger so I cannot tell if they are upset with me or are just busy and I become paranoid that I did something to make them ignore me or that there is something wrong with me. It is very painful for me to experience this type of feeling, I am a very sensitive person and I feel that for my own sanity I have to give up the friendships in order to save my own feelings. I am tired of being made to feel worthless and I cant even reveal my depression because one of friends in particular will say all the right things, and then go on with the behavior. I am very lost and alone. I am somewhat of an introvert but realize how badly I need to socialize with my friends and it is a hard pill to swallow to know that they don’t look at me as a priority. It is my fault for choosing distant people to be my “best friends” and allowing them to treat me this way.

I think Love is life . No one can live without love. A man can die for his love . But Love is not support to them who is love by life. why it be impossible?

A great deal of attention is currently being paid to mental illness, but it is focused mainly on the person with the illness. I know from personal experience that the pain extends to the families who very often feel rejected, isolated and afraid, with little opportunity to share these problems. And the children can suffer at least as much, although differently.

This is an excellent article, but I think the issue it is examining includes more then the physical and social pain dichotomy. I believe part of what is being explored here is what Charles Darwin saw in many different species, which is the instinct of shame vital to the child’s survival. The terror of a child fearing abandonment is legitimate. Without the caregiver or community help, the child may die. So it makes sense, that evolution would provide infants and many species what a powerful drive to stay bonded or included. Shame in a child is the fear that they have done something wrong which they must correct in order to alleviate a shame and improve their chances of survival. I am currently working on a diagnostics concept for this shame challenge. When the child managers to resolve the fear and pain , the shame is resolved. When the child is left in jeopardy, instead of rationalizing as an older child might, the younger child is left feeling they are at fault for the failure, and the normal shame becomes toxic. I call this lasting damage childhood post traumatic shame. I believe C.P.T.S as I call it, is distinct from PTSD and in fact is a major contributing factor increasing the likelihood of contracting PTSD. I also believe there is an endemic that may well be millions of children, victims of war, drought, and social conflicts, who are silently suffering C.P.T.S., and are neither diagnosed nor treated, to the detriment of their lives, their families and their communities.

STICKS and stones may break my bones, but words will never hurt me. We’ve all heard this. But it is not true. This.article is RIGHT ON.

Thank you for this article that touched me in many ways. You have confirmed to me further what my therapist worked me through from living in an emotionally abusive marriage for 21 years. After reading this wonderful article I can see even more clearly than before the trap I was caught in, the painful cycle of being shut out by an abusive husband for weeks, feeling isolated & lost in a dark hole of depression,demeaned & pulled back & forth in a horrible cycle. Yes, these findings should be shared in tge courts because we suffer as painfully as those physically abused.

Thank you so much, to all the researchers and authors. As an Emotional Freedom Technique practitioner I’ve become convinced that our old hind brain programming (pain avoid, pleasure-seek) extended to emotional pain but until now I didn’t have any literature to point the link out to my clients. Somehow it helps when we recognize that our emotional pain and reactions are coming from a very primitive place of needing to feel included. That instinct and the pain that results are “tappable issues”. That’s a term we use in EFT. I’d encourage anyone here that is dealing with intense emotional pain to google EFT. You can find thousands of videos and information and the basics of the technique can be learned in five minutes. Given what this article teaches us it may be a life-saver!

We’ll..I was talking to my uncle last night and told him how I felt about a boy.. When I see the boy my heart pounds so hard I can physically feel it.. My stomach knots. My uncle told me that was love and I didn’t know what to do.. This helped me understand why I felt pain so much when I think, see or speak to the boy
.. I told him how I felt.. I told him that it hurt so much I just felt like stabbing
him because I did… This is my first
experience of this..
I just thought I would say this here :)

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