A romantic breakup can be devastating and traumatic during emerging adulthood (between 18 and 25), a critical stage in the life course, especially for identity development – a time when brains are still developing, particularly in areas associated with higher cognitive and emotional functioning.
Alberta van der Watt writes in the The Conversation:
After a breakup, young people may experience poorer academic performance, intrusive thoughts of the ex-partner and intense grief.
They can even attempt suicide – and yet, breakups among emerging adults are often dismissed or trivialised as a rite of passage. A trauma response is shrugged off as exaggerated or overblown.
Added to this, the psychiatric literature does not see breakups as potentially traumatic events.
As a mental health researcher with experience in romantic attachment and trauma research, I co-authored a paper exploring romantic relationship breakups as potentially traumatic events among university students. The research aimed to investigate whether their experiences fitted the official psychiatric diagnosis of post-traumatic stress.
Identifying potential trauma after a breakup could help young adults get appropriate treatment and support.
In several studies we tested the idea that breakups can be deemed a potentially traumatic event based on the Diagnostic and Statistical Manual 5th Edition (DSM-5) definition. Mental healthcare providers use the Diagnostic and Statistical Manual as a guide to diagnose patients with, for example, post-traumatic stress disorder.
A diagnosis of post-traumatic stress disorder is based on various criteria, including Criterion A: exposure to actual or threatened death, serious injury, or sexual violence. Criterion A acts as the “gatekeeper” to this diagnosis.
Asking the questions
Based on their self-reported responses on the Post-traumatic Stress Checklist for DSM-5, our participants fell into three groups:
Group one (breakup group): 886 participants who endorsed post-traumatic stress symptoms based on their most traumatic breakup.
Group two (trauma group): 592 participants who endorsed post-traumatic stress symptoms based on a DSM-5-defined traumatic event (for example physical and sexual assault).
Group three (control group): 544 participants who endorsed post-traumatic stress symptoms based on their most stressful experience (for example relocating homes or a parental divorce).
We found breakup participants, those in Group One, reported significantly more post-traumatic stress symptoms, such as flashbacks, recurring memories, and nightmares about their former partner, than both the other two groups.
Looking at the brain
After the questionnaire, a subset of students from each of the three groups completed brain scans so we could see which brain areas were activated in response to specific stimuli.
During the scans, they rated images as positive, negative or neutral.
• 36 participants from Group One (breakup group) rated photos of their ex-partners;
• 15 participants from Group Two (trauma group), who specifically indicated physical or sexual assault as their most traumatic event, rated photos of physical or sexual assault;
• 28 participants from Group Three (control group) rated general negative images (like children playing in polluted water). These photographs were part of the International Affective Picture system, widely used in studies of human emotion.
We analysed the brain activation (increased blood flow) of the amygdala and hippocampus within the temporal lobe. These regions of the brain are associated with post-traumatic stress disorder and form part of the fear-based limbic system that is part of our “fight or flight” system.
They have also been linked to real and imagined romantic attachment rejection.
We found similar activation levels in the amygdala and hippocampus when breakup group participants rated images of their ex-partners to when trauma group participants rated images of physical and sexual assault.
Sex, religion, and other factors
Third, we focused on the breakup participants only, and found their emotional response to the breakup was influenced by:
• demographic characteristics likes sex, sexual orientation and religion. Specifically, participants with a minority sexual orientation and who reported not being religious reported higher levels of breakup distress;
• characteristics of the breakup such as the perceived closeness of the relationship and reasons for the breakup.
Moving forward
The combined results support our hypothesis that romantic breakups can be potentially traumatic events for emerging adults and may be experienced as life-threatening.
Validating experiences of breakups as potentially traumatic may cushion their negative impacts, encourage emerging adults to seek help, and promote mental health.
Mental healthcare providers and student counselling services should recognise the possible intensity of breakups and consider screening for post-traumatic stress symptoms after a breakup.
Trauma-focused treatment, such as prolonged exposure therapy, may help students, especially those who cannot avoid breakup-related cues such as seeing their former partners in class or on social media.
Since romantic breakups are not considered traumatic events within the psychiatric literature, our findings are controversial, and we do not claim that all breakups are necessarily traumatic.
More research must be done, especially with a more diverse set of students and a larger sample size for the brain scans.
Alberta SJ van der Watt – Researcher, Stellenbosch University.
Study details
An attachment theory approach to reframing romantic relationship breakups in university students: a narrative review of attachment, neural circuitry, and post-traumatic stress symptoms
Alberta SJ Van der Watt, Annerine Roos, Stefan Du Plessis, Eric Bui, Elmien Lesch, Soraya Seedat.
Published in Journal of Couple & Relationship Therapy on 3 May 2021
Abstract
Background
Non-marital romantic relationship breakups (RRBs) frequently occur among university students. These RRBs constitute stressful events but are conventionally not thought of as traumatic. Current research on RRBs has mainly focused on their association with grief and depression.
Aim
Using attachment theory, we argue that reframing RRBs as potentially traumatic events that can result in post-traumatic stress symptoms (PTSS) is scientifically justifiable, and that further investigation of the relationship of RRBs to post-traumatic stress disorder (PTSD) phenomenology and pathobiology is warranted.
Methods
To inform our argument, this narrative review draws on the theoretical approach of attachment theory and its nexus with neuroscience.
Results
Individuals who experience RRBs report a range of negative psychological consequences including severe distress. RRBs remain one of the primary reasons that university students seek campus counselling services. Among university students, relationship problems also have a strong association with completed suicide. Additionally, functional neuroimaging (fMRI) studies document brain changes in the amygdala and hippocampus in individuals with RRBs (brain changes that are also implicated in PTSD). Last, the controversy and debate around what constitutes a traumatic event, especially in terms of Criterion A for a PTSD diagnosis according to the Diagnostic and Statistical Manual 5th edition (DSM-5), remains prevalent.
Conclusion
Reframing RRBs as possible traumatic events may open the door to treatments that are currently effective for PTSD. Further research on RRBs needs to be holistic within an attachment-neural-behavioural system framework to better understand how RRBs can induce long-lasting negative effects.
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