The bitter pain of a betrayal, especially the end of a close friendship, often brings deep emotional pain and trauma. Indeed, losing a good friend is sometimes described as ‘having the heart broken’. To be accurate, emerging research suggests the pain which results from a betrayal or social rejection is indistinguishable from actual physical pain. The agony of losing a trusted friend is not just an emotional wound but a mental one as well.
This complex relationship between social bonds and human biology is spine chilling, to say the least. In this article, we do a deep dive into the breakups of friendships and attempt to understand the pain it brings on a neurobiological level. When betrayal happens, certain systems and regions in the brain get active, and the breakup of the friendship has far reaching ramifications on the body.
Combining these findings from neuroscience, psychology and physiology, we try to understand the severity of pain caused due to friendship ruptures and whether there are ways to treat such a distressing issue.
Understanding Betrayal: A Psychological and Social Perspective
When trust is broken within a relationship, betrayal happens, which leads to emotional damage. Different psychologists view it as a multi-layered construct, where its readers feel shock, sadness, anger and loss (Jones & Burdette, 1997). Betrayal is one type of rejection that is exceptionally harsh, as it stems from an act that was committed by a trusted individual.
Friendships are very important socially as they foster a great source of support as well as a sense of identity. With the separation of friends, a person could be put in a place where their self-worth and security is compromised (Baumeister & Leary, 1995). Trust that has been broken countered with emotional intimidation makes break up of friendships powerful stressors.
The Neurobiology of Social Pain
The Anterior Cingulate Cortex and Insula: Neural Correlates of Hurt Feelings
According to fMRI results, social exclusion leads to the activation of the anterior cingulate cortex (ACC), as well as the insula, both of which have been associated with the processing of physical pain. In a landmark study, Eisenberger et al (2003) revealed participants experiencing social exclusion while playing Cyberball showed greater activity in ACC which correlated with greater reported distress (https://doi.org/10.1126/science.1089134).
The elicits pain or distress to the ACC which reconciles the emotional component of pain along with the isula which is responsible for visceral sensations, it creates the ‘Somatic marker’ of emotional pain or “pose” itself within.
The Opioid System: Bridging Physical and Emotional Pain
Common neural pathways that support social and physical pain which are stemmed from the neurological components add further support. The opioid system, which modulates the degree of physical pain experienced, has shown research that it also plays a role in carving out social pain, The opioid analgesic acetaminophen has been shown to lessen the only and hurt feelings that arise from rejection.
DeWall et al. (2010) demonstrated self-reported levels of hurt to be reduced after the intake of acetaminophen, these results revealing a suggestive overlapping in pharmacological efficacy (https://doi.org/10.1177/0956797610374741). On the other, social pain seemed to worsen following opioid withdrawal demonstrating greater sensitivity indicating a more complex interacting system.
Regulatory Role of the Prefrontal Cortex
Social pain, or pain from the breakdown of personal relationships, can, however, be controlled by the structures of the inner prefrontal cortex such as the dorsolateral prefrontal cortex (DLPFC) which integrates the emotional responses.
Kross et al. (2011) reported that individuals who underwent self-distance reflection, a DLPFC mediated process, were more likely to have lower anxiety levels when reliving moments of rejection (https://doi.org/10.1177/0956797611400748).
This indicates that the range of self-control tactics available can lower the intensity of pain generated from one’s neural mechanisms.
Friendship Breakups: A Unique Neural Signature
The phenomena of friendship violation is however much less understood even though it is often accompanied by equally distressing emotional pain. Romantic breakups lend themselves to the most research, yet friendship breakups have their own set of characteristics. Typically, breakups of friendships have no formal mechanisms for dissolution, which can result into vague loss.
Meyer et al. (2015) utilized MRI to corroborate the findings of past studies that reported the temporoparietal junction (TPJ), associated with social cognition and moral intuition, was engaged when friends were asked to picture a friendship breakup alongside the activation of the ACC and insula (https://doi.org/10.1093/scan/nsv009).
This means that betrayal is more painful than endorsed actions done without malice due to the deeper pain incurred by first evaluating the intention behind the betrayer’s actions.
Neurochemical Responses to Betrayal
Cortisol and the Stress Response
Betrayals cause the hypothalamic-pituitary-adrenal (HPA) axis activity which is associated with the release of cortisol. Social-evaluative threats like betrayal pr provocation of non-social stresses had been shown to elicit stronger cortisol responses. Chronic cortisol suppression may lead to mental health disorders due to the dsregulation of stress responses (Dickerson et al, 2004).
Oxytocin: The Double-Edged Sword of Trust
Although oxytocin is termed the love hormone due to its role in trust and bond development within a person, it has been shown to heighten agony at the moment of betrayal. In a study conducted by my colleagues, intranasal oxytocin raised distress while people without strong social support were asked to remember betrayal (Tabak et al., 2019). This indicates there is a paradoxical role of oxytocin and hence, it necessitates further exploration and consideration.
Dopamine Withdrawal and Reward Pathways
Dopamine-centered reward pathways become active during friendships and when they are severed, one may experience something akin to addiction withdrawal. Fisher et al. (2010) conducted a study and subjects who had gone through rejection reported additional activity in their ventral tegmental area, a part strongly linked to craving (https://doi.org/10.1093/scan/nsp037). This concept of “neural addiction” explains why people obsess over exes after looking for closure.
Long-Term Consequences: When Social Pain Becomes Chronic
Chronic Pain and Inflammation
Prolonged social pain can sensitize neural pathways, just like prolonged physical pain can. Recurrent social rejection, as tracked by Slavich et al. (2010), was associated with inflammatory activity enabled by the tela sensorimotor cortical area (https://doi.org/10.1073/pnas.1002614107). And again, depression and autoimmune disorders stem from chronic inflammation.
Mental Health Implications
Break-ups with friends significantly increase the likelihood of falling into depression, having anxiety or even PTSD. As per the findings of Teo et al. (2013), people who had unresolved issues regarding friendship loss had bouts of major depressive episodes (https://doi.org/10.1016/j.jad.2012.11.006). This may be due the changes in the ACC and amygdala that make them vulnerable.
Coping Mechanisms and Interventions
Cognitive-Behavioral Therapy (CBT)
Following betrayal, CBT focuses on a person’s dysfunctional cognitions. A meta-analysis done by Coventry et al., (2021) found that CBT was efficacious in reducing pain-related distress by enhancing DLPFC-mediated regulation (https://doi.org/10.1016/j.cpr.2020.101927).
Mindfulness and Self-Compassion
Creswell, et al, 2016 (https://doi.org/10.1177/2167702615616346) noted that mindfulness reduces the activity of the anterior cingulate cortex which could enhance coping during social stress. Self-compassion interventions also aid in emotional resilience by reducing cortisol.
Social Support and Reconnection
Rebuilding social connections activates the ventral striatum which may compensate for the dopamine deficit caused by rejection (Hsu et al., 2015) (https://doi.org/10.1093/scan/nsv009). Support groups can increase trust which promotes oxytocin release.
Pharmacological Approaches
As promising as SSRIs and oxytocin may be, results can differ greatly. According to a study by Schneiderman et al. , an intranasal type of oxytocin was in fact ineffective for chronic social pain in a 2020 trial which further emphasizes the necessities of personal approaches (https://doi.org/10.1038/s41386-020-0657-4).
Ethical Considerations in Research
Inducing social pain in studies raises ethical concerns. Researchers must ensure informed consent and provide debriefing to mitigate distress (American Psychological Association, 2017) (https://www.apa.org/ethics/code). Longitudinal monitoring is critical to address potential long-term effects.
Conclusion
The neurobiological mechanisms of betrayal indicate an intriguing relationship between social and physical pain and it is argued that these two are linked through common neural and chemical system pathways.
These attempts to understand these mechanisms puts us in a better place to structure interventions to healing emotional wounds. Efforts must be made to investigate individualized therapy as well as the impact culture has on the experience of social pain.
Psychology combined with neuroscience helps us get closer to dealing with the unexpressed pain suffered because of a broken heart.
