Breakup: How to Tell If You Suffer from Complicated Grief

The emotional responses to a severe breakup can resemble the responses to death.

Posted Apr 16, 2015

Wikimedia Commons
Source: Wikimedia Commons

The emotional responses to a severe breakup can resemble the responses to death. This is no coincidence. When a loved one dies, you grieve. But death is not the only trigger of grief. Grief can occur after any kind of loss: The loss of a job, the loss of a limb, the loss of your home or the loss of a relationship. Grief involves five stages: surprise, denial, anger, sadness and acceptance. These stages do not necessarily occur in this order, and each stage may occur several times.

Sometimes it is impossible to let go of grief. When you continue to grieve a loss, your condition is called complicated grief. Complicated grief is so severe that psychiatrists now consider it for inclusion in the psychiatric manual for diagnosing mental disorders. If you have complicated grief, you have been grieving for six months or more. You furthermore satisfy at least five of the following criteria:

  1. You have obsessive thoughts about aspects of the lost relationship or the person you were with
  2. You spend a significant amount of time every day or almost every day, thinking about your lost relationship or the person you were with
  3. You have intense emotional pain, sorrow, pangs or yearnings related to the lost relationship
  4. You avoid reminders of the loss, because you know that reminders will cause you pain or make you feel uncomfortable
  5. You have problems accepting the loss of the relationship
  6. You have frequent dreams that relate to your lost relationship
  7. You frequently suffer from deep sadness, depression or anxiety because of the loss
  8. You are angry or feel a deep sense of injustice in relation to the lost relationship
  9. You have difficulties trusting others since the relationship ended
  10. The loss of the relationship makes it difficult for you to find pleasure in social and routine activities
  11. Your symptoms make it difficult for you to function optimally on your job, as a parent or in a new relationship

A study published in the May 2008 online version of NeuroImage suggests that complicated grief sometimes occurs because a normal grieving process turns into an addiction. The researchers looked at images of the brains of people who satisfied the criteria for complicated grief and people who were not grieving and found significantly more activity in the nucleus accumbens of the people with complicated grief. Activity in the nucleus accumbens is associated with addiction.

It may seem strange that you could actually become addicted to emotional pain and longing for a person who is no longer with you. The researchers suggest that your yearning and sadness may give you pleasure. This, however, is probably not the right conclusion to draw from the study. Though pleasurable activities normally are necessary to initiate the repetition of addictions, there is reason to believe that it is a reduced pleasure response that causes addiction. If you are addicted to food, for example, the addiction may be caused by an abnormally low response to the pleasure of eating.

Dopamine, a motivator and reward neurotransmitter, is responsible for creating a feeling of pleasure in response to potentially pleasurable activities. Dopamine is also implicated in addiction. But it is a dopamine deficiency, a smaller number of dopamine receptors or an impairment of the function of dopamine that causes addiction, not an increased production of dopamine or increased pleasure in response to pleasurable activities.

So how can grief lead to addiction? Grief occurs only when there was some pleasure involved in spending time with the person. This means that being around the person at least sometimes triggered a dopamine response. The sudden loss of all exposure to the person or the loss of the relationship as it was cuts off this dopamine response. Any reminder or thoughts of the person or the relationship can, however, still trigger a dopamine response. But this response is no longer a pleasurable response because the thoughts or reminders of the loss trigger activity in the amygdala, a brain region that processes negative feelings.

Here is another way to understand how grief can be addictive. Consider obsessive-compulsive disorder. The classical case of this disorder is one in which a person is obsessed with thoughts of disease and germs and compulsively washes his or her hands after being near other people or anything that could possibly carry germs. This disorder is associated with low levels of the mood-enhancing chemical serotonin and fluctuating levels of dopamine. The low levels of serotonin cause obsessive thinking and the dopamine “rewards” motivates the person to behave in compulsive ways.

Complicated grief is similar to obsessive-compulsive disorder. Low levels of serotonin cause the obsessive thinking and yearning for the person or the relationship, and the dopamine responses that this kind of obsessive thinking and yearning give rise to cause the grief to continue.

Reference: Craving Love? Enduring Grief Activates Brain’s Reward Center, NeuroImage, 2008.

Berit "Brit" Brogaard is the author of On Romantic Love