How does grief cause physical pain?

Murdered soldier Lee Rigby's mother says she has felt daily chest pains since her son's death. Why does bereavement affect some people this way?

When Shira Schiller suddenly lost her 10-year-old son Max to a heart condition, nothing prepared her for the grief, or its physical symptoms.

"It's like something's sitting on your chest," says Schiller, 47, from London. "It's like there's a hand holding your heart. If I'm having a bad day, it's like being unable to breathe."

She's not alone. Lyn Rigby, 49, whose son Lee was murdered in 2013 in Woolwich, south-east London, told the BBC of a "constant pain in my chest every single day". This pain, she says, "never goes away".

Words like "heartache", "hurt" and "pain" are often used to describe emotional trauma. But people affected by grief often say they experience them as concrete physical sensations.

A churning stomach, a racing heart, shaking, flashbacks and hypersensitivity to noise are all physical by-products of bereavement, according to the British Psychological Society. Yet there's no uniform set of symptoms, just as people react differently in emotional terms to grief and loss.

Broadcaster Barbara Want recalls feeling an acute sensation in her stomach after the death of her husband, BBC presenter Nick Clarke, in 2006. "It was a heavy, heavy weight in there, almost like being ill - like a really bad tummy bug," she says. 

Want says she didn't eat for pleasure for two years, and can't remember feeling hungry in that time. "I got so thin I could see people looking at me with horror," she adds. She developed a croak in her voice, which a surgeon told her was a result of the shock to her system.

Scientists have known for some time that grief can manifest itself physiologically as well as emotionally.

Scans carried out by University of California, Los Angeles (UCLA) scientists showed that the part of the brain that deals with physical pain, the anterior cingulate cortex, processes emotional pain, too.

Chest symptoms are a recurring theme. "I have a number of patients I look after who, after an emotionally stressful episode, are left with heart pain or palpitations," says Alex Lyon, BHF senior lecturer at Imperial College London and honorary consultant cardiologist at Royal Brompton Hospital.

This is commonly known as "broken heart syndrome", also termed stress or takotsubo cardiomyopathy. It usually follows "significant emotional or physical stress", according to the British Heart Foundation. The heart muscle suddenly becomes weakened and one of the heart's chambers changes shape.

It's thought that it affects 100 people per million each year. A study at Imperial College suggested that it might actually be a mechanism for protecting the heart from the surge of adrenaline that often accompanies shock and grief.

The loss of someone close can leave people more vulnerable to infection. A University of Birmingham study found that, especially among the elderly, those who are recently bereaved can suffer from reduced function of neutrophils - the most abundant type of white blood cell, which fight off rapidly dividing bacteria like pneumonia. 

This perhaps goes some way to explaining some of the much-publicised cases of older couples who die within a short space of time of each other.
In 2014 Clifford and Marjorie Hartland of Coventry, Warwickshire, died on their 76th wedding anniversary 14 hours apart. The same year Don and Maxine Simpson from Bakersfield, California, married for 62 years, died on adjoining beds four hours apart, holding hands for some of their final time together.

"People say you die of a broken heart. What we'd say is they are dying of the effect of these factors on their immune system," Anna Phillips, professor of behavioural medicine at the University of Birmingham, who carried out the research into neutrophils and grief.
Another study conducted by Williams and others found that people who have been bereaved in the past year produce fewer antibodies in response to a vaccine.

But despite the weight of scientific knowledge about the relationship between bereavement and physical discomfort, the symptoms are often completely unexpected to people in mourning.
"Sometimes people can be very shocked by how they are feeling physically and worry that there is something wrong with them," says Jessica Mitchell, national helpline manager at the charity Cruse Bereavement Care.