We talk about having a “broken” heart or “wounded” spirit or “hurt” feelings when we experience a significant rejection in love. Why do we use words that are the same as those that describe physical pain or injury? Is looking at Facebook photos of your ex with his new love equivalent to spilling a scalding hot cup of coffee on your lap?

My inquiring psychologist side decided to research this question, and I came across a study published in 2011 in the Proceedings of the National Academy of Science. A group of investigators compared brain activity generated by intense personal rejection with brain activity caused by intense physical pain.

First they explained that pain is registered in two different areas of the brain. The affective quality of pain (“That’s unpleasant!) is registered in the dorsal anterior cingulate (dACC) and the anterior insula (AI). This area also is activated by a feeling of social rejection. But the real bodily or somatic perception of pain (“Ouch!”—the brain part that makes you wince and reach for the vicodin when you are physically injured) is registered in the secondary somatosensory cortex (S2) and the dorsal posterior insula (dpINS), which we wouldn’t expect to be affected by purely emotional experiences.

Their research method was simple. Take 40 people who felt intensely rejected as a result of recently experiencing an unwanted romantic relationship break-up and give them two tasks. The Social Rejection task was to look at either a head-shot of the ex-lover and think about their specific rejection experience or a head-shot of a friend of the same sex as the lover and think of a recent positive experience with him or her. The Physical Pain task was a Hot trial with a noxious thermal stimulation delivered to their arm or a Warm trial with a non-noxious thermal stimulation on their arm. The subjects rated their “feeling” experience on each task on a scale of 1 to 5, with 1 being the most painful. Their brains responses were studied with a functional MRI to see what brain areas were activated during each of these four trials.

So here is the surprising outcome. The ratings for both the Social Rejection and the Physical Pain tasks were equivalent with severe physical pain and intense rejection rated exactly the same. And, as expected, both the head shot of the ex-lover and the Hot trial produced activity in the affective or “That’s unpleasant!” part of the brain. But, both also produced activity in the “Ouch!” part of the brain. Conclusion: intense rejection is actually perceived as physical pain by our brains.

It is interesting that the “Ouch!” part of the brain is also activated if we observe another person experiencing physical pain. The researchers thought it would be interesting to explore if, for example, a parent watches their child experience rejection if this would also register in the “Ouch!” part of the brain.

So, what does this mean in terms of recovery from a “broken heart”? First, we need to be kind to ourselves and know that our experience is real and, in fact, is equivalent in terms of our brain’s response to a very severe physical injury. And, as the study showed, we can re-experience that level of pain by simply looking at a photo of the ex-lover or thinking about the rejection experience. Intense ongoing physical pain can interrupt sleep, create or worsen depression, and even lead to suicidal thoughts and plans. It can disrupt our relations with our family and co-workers. Chronic pain sufferers tend to reach for the alcoholic drink, the vicodin bottle, illicit drugs, or gallons of ice cream to take the edge off their pain. So do those experiencing intense rejection.

What are the solutions? We can look to how we help chronic pain patients. Part of my current job as the Mental Health Clinical Director for a large health plan is to develop strategies to help our members manage pain safely. We recommend therapists who can teach them how to look at their pain differently. How to think about “managing” their pain instead of getting rid of it. We offer them relaxation and meditation skills to lessen the pain without turning to addictive drugs, even the prescribed ones. Did you know that there is a opioid epidemic in our country—that the death rate from opioid overdoses is skyrocketing even when people are taking correctly prescribed doses? I recently put two and two together and figured out why I headed for the codeine bottle (prescribed to me as a teen for menstrual pain) when I didn’t get asked to a school dance. It actually worked to soften the pain of rejection.

A recent WordPress blog that I follow at thefallingthoughts.com entitled BREAKUP 2 MAKE-UP included many other helpful reframes for those suffering the pain of rejection. I particularly liked the bit about crying your eyes out but the next day don’t repeat the same thing—after all, we don’t laugh at the same joke twice. I also enjoyed the advice that everything has an expiration date—even relationships. I wouldn’t eat a can of spoiled tuna. I look at the expiration date and throw it into the garbage. When life reminds me of a long-expired relationship, why in the world would I want to dig in, thinking it will taste okay? It’s actually going to turn out about the same as holding on to resentments. It’s like taking poison and hoping the other person will die.

Ethan Kross, March G. Berman, Walter Mischel, Edward E. Smith, and Tor D. Wager. Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences, 2011, April 12, Volume 108(15), pps. 6270-6275