The Role of Romantic Breakup in Increasing Vulnerability to Emotional Disorders: A Systematic Review

Received: 28-Aug-2021 Accepted Date: Sep 08, 2021 ; Published: 15-Sep-2021

Introduction

In recent years, several models, especially cognitive and behavioral models, have developed to identify the underlying processes of disorders in the Diagnostic and Statistical Manual of Mental Disorders [1]. However, some researchers have criticized such approaches, offering research- based classifications of mental disorders that are more empirical, one of which is the model of emotional disorders. The term "emotional disorders" refers to symptoms and disorders classified into the diagnostic categories of mood and anxiety disorders [2]. Accordingly, Watson introduced a category of emotional disorders for mood and anxiety disorders, which includes three subcategories: (i) turbulence and anxiety disorders (generalized anxiety disorder, general distress, post-traumatic stress disorder, and depressive mood), (ii) Bipolar disorder (cyclothymic, bipolar I and II), and (iii) panic disorders (panic, social phobias, specific phobias and transphobia). One of the reasons for using the concept of emotional disorders was the significant overlap between anxiety and mood disorders [3]. In this regard, integrative approaches consider emotional disorders as a continuum of psychiatric disorders caused by emotional dysregulation and dysfunction. Among their common features are coexistence [4,5], transdiagnostic causative factors and their effect on academic, occupational, and social functions [6,7]. Although unipolar mood and anxiety disorders are included in the continuum of emotional disorders [8], there was already evidence of classifying quasiphysical, dissociative and borderline personality disorders in the emotional disorders category in addition to mood and anxiety disorders [9]. Several studies have reported that failure in adaptive emotional experience is often attributed to psychological problems [10,11], which indicates the need for emotion regulation of individuals because it can play a protective role against emotional disorders [12].

Due to the high prevalence of emotional disorders, understanding the etiological factors of these disorders is of particular clinical importance. A number of causal factors have been suggested for these disorders, Including biological, genetic and environmental factors psychological factors, such as personality traits and sensitivity to anxiety and emotions and other factors including poverty, death or divorce of parents, a history of psychological illness in parents, low self-esteem, and chaotic family environment [13-18]. There is empirical evidence emphasizing the common features of major emotional disorders and many studies have indicated the overlap of these disorders throughout life [19-21]. On the other hand, due to the coexistence of a large number of emotional disorders and their consequences on individual and social functions, such disorders have received more and more attention. Considering the commonalities of such disorders and their affecting factors, it is possible to reduce costs and save time spent in the recovery process by facilitating the process of prevention, intervention and treatment [3].

One of the main consequences of mood disorders is affecting a person's relationship with others and consequently reducing the quality of communication argued in their research, such people complain of poor communication skills, because they receive lower acceptance from people around them and experience a variety of short-term and longlasting problems [22,23]. According to the related research [24,25], Some of the most important consequences of such relationships are academic, family, and job problems, psychological stress, etc. The importance of communication becomes clearer when considering the fact that one of the most important tasks of adulthood is choosing a spouse and establishing a pleasant and lasting relationship with the opposite sex. The ability to establish a lasting and meaningful relationship is regarded as one of the key social capacities of human beings because the need for love, affection and belonging are the most important human needs after physiological needs and security [26, 27]. In every period of life, a person is involved in special relationships with others that can promote his/her personal and social health or vice versa. Romantic relationships, especially in youth, are among important aspects of identity, social status, intimacy, and emotional security [28], so that the termination of such a relationship is an unpleasant event that anyone may experience in his/her life, because it’s negative consequences and feelings are inevitable. Due to the failure in love, the person experiences sadness, grief and isolation, called the state of frustration, which occurs after rejection by the beloved after intimacy [29]. Romantic breakup refers to a situation occurred after separation or failure of romantic relationships [30], which includes a set of severe signs and symptoms that appear after a breakup in a long-term romantic relationship and cause maladaptive reactions as well as dysfunction in various social, occupational and educational areas. Romantic breakup is experienced as severe and traumatic stress and causes psychological, emotional and physical distress in the person. Symptoms of romantic breakup increase after experiencing a love trauma because it violates the person’s favorable assumptions and expectations of the relationship and the presuppositions of his/her security in the relationship [31]. Thus, the person experiences it as a shocking event, which is often accompanied by feelings of panic, fear, and helplessness, which are similar to the situation that people experience in relation to death or threat of death [32]. This causes stress and a feeling of inability to control and prevent events [33]. In this regard, Saylor found that breakup of a relationship and romantic breakup are important life events with several negative consequences, including the occurrence of mood disorders and symptoms of complicated grief and sadness. Based on the theoretical hypothesis regarding the effect of romantic breakup on emotional disorders, we reviewed two perspectives and models on the effect of romantic breakup on vulnerability to emotional disorders.

A) Triple Vulnerability Model: It is one of the comprehensive models to explain the etiological factors of psychological disorders, which includes three types vulnerabilities: 1) general biological vulnerability, 2) general psychological vulnerability (perception of having low control over events, and 3) disorder-specific psychological vulnerability (derived from individual learning experiences) [34, 35]. The interaction between general biological and psychological vulnerabilities contributes to moods that are likely to lead to emotional disorders [36]. In addition, a specific type of disorder-specific psychological vulnerability is related to disorders such as thought-action fusion in obsessive-compulsive patients [37], low anxiety control in patients with generalized anxiety disorder, major depression, and obsessive- compulsive disorder [38]. There are also relations between dysfunctional attitudes with depression, thought-action fusion with obsession, and intolerance of uncertainty with widespread anxiety [39-42]. Based on this model, the desire to underestimate capabilities and react to intense emotions, self-criticism in stressful situations, and the desire to experience less positive emotions, causes people to react more negatively to unpleasant stimuli. As a result, the susceptibility to unpleasant experiences increases, which in turn increases their psychological problems. In this model, it is believed that there is a pronounced feeling of uncontrollability, especially when people face tasks or challenges that may be threatening [9], thus, feeling of failure or weakness is a sign of chronic disability while dealing with negative events that are unpredictable and uncontrollable, leading to a feeling of uncontrollability and negative emotions [11]. Feeling of uncontrollability is widely associated with negative emotional response capacity. Low perception and unpredictability have a direct impact on bio-vulnerability and especially play an important role in increasing HPA- based activity which is considered as a key factor in reacting to stressful events. In addition, it involves different parts of the brain associated with emotional disorders. Thus, it is conceivable how interactions between general biological and psychological factors make individuals vulnerable to emotional disorders. In this sense, the experience of romantic breakup can cause feelings of uncontrollability and the spread of negative emotions, and as a result, make a person vulnerable to emotional disorders. In the case of disorder-specific psychological vulnerability, it can be argued that dysfunctional attitudes acquired by experiencing romantic breakup in the vulnerable person towards themselves and the world, causing the person to interpret specific facts too negatively and inefficiently, and this contributes to emotional disorders, especially depression. In other words, the presence of negative, inflexible, perfectionist and inefficient attitudes towards self/ others and the future, as they are non-standard and unrealistic, causes negative mood, reduced pleasure and interest and at last, depression in these people, thus, make them more vulnerable to other emotional disorders. On the other hand, it has been argued that by creating a state of uncertainty, romantic breakup causes a person to have a strong tendency to threateningly interpret vague information, which may increase anxiety and worry about the interpretation of concepts arising from emotional situations, and by increasing negative emotional experiences, provide the ground for psychological disorders.

B) Diathesis- Stress Model: This model describes the complex interaction between genes and the environment of psychological vulnerability in detail and shows the important role of this relationship in the development of mental disorders [43]. Emphasizing the interaction between disease preparedness and environmental disturbances, this model states that those who are genetically vulnerable to physical and mental problems are more vulnerable to psychological disorders when placing in stressful situations. Vulnerability is a predisposing factor for the emergence of disorders and incompatibilities, having a number of symptoms including situational symptoms, personality traits, or external sources such as poor social support [44]. In addition to innate readiness for disease, disease preparedness includes other characteristics that increase the risk of a disorder in the individual. Stress, on the other hand, refers to major traumatic events and increased chronic events [45]. Generally, this model states that having preparedness disease to a disorder alone does not necessarily lead to a disorder; however, it increases the risk of developing the disorder. In other words, the presence of a specific vulnerability does not necessarily mean the occurrence of a disorder, but requires a larger stressful event in the life of a person with minor vulnerability. Conversely, in the case of high vulnerability, even a minor stress can lead to the disorder. Therefore, this model considers the stress and disease preparedness as harmful or unpleasant environmental stimuli that trigger the psychological damage. According to this model, romantic breakup is a traumatic event that significantly increases the incidence of psychological and emotional disorders by increasing the individual's vulnerability to emotional disorders.

Methodology

This study is a systematic review of articles examining the impact of romantic breakup on vulnerability to emotional disorders, which were published from 2004 to 2021. In order to collect data, international databases such as Google Scholar, Science Direct, Web of Science and Pubmed, and Iranian databases including SID, Magiran and Ensani were employed and English keywords of love trauma, vulnerability and emotional disorders were used to access the related articles (Figure 1).

Figure 1. Flowchart of selecting articles to systematic review.

Article selection and data extraction: First, articles and researches related to the subject were explored using the above-mentioned keywords and then, a list of articles on romantic breakup and vulnerability to emotional disorders along with their abstracts was prepared and added to the initial list. Next, a checklist of information required in the study including research location, year of publication, methodology, number of samples, sampling method and data collection tool was prepared and after reviewing by the researcher, related articles were selected and included in the review. The initial search using the above-mentioned keywords resulted in 91 articles, of which 69 records remained after the necessary screening and excluding unrelated articles. In the next step, the abstracts of the selected articles were studied and 53 articles were selected, all of which were exclusively related to the subject of the study. Finally, after excluding duplicated and similar studies and considering the priority of publication year, 18 articles were included in the study in line with the purpose of the research. Inclusion criteria were research-related studies, newly released studies and nonduplicated studies, while exclusion criteria were unrelated or less relevant studies, studies published outside the specified range, and studies with duplicated topics.

Results

After screening and evaluating the explored articles, 18 articles were finally selected for the review. These studies were conducted in the United States, Canada, the Netherlands, Australia, Austria, Italy, and Iran, and include the following topics: the phenomenological study of romantic breakup, the role of protective and traumatic factors, its relationship with suicide and exacerbation of other disorders, its effects on other mental health variables, its relationship with influential variables during the treatment process, and other disorders such as bipolar disorder, depression, anxiety, and obsessive-compulsive disorder. The total number of participants in the study was 20,251. A summary of the systematic review findings is provided in Table 1.

Discussion

The aim of the present study was to investigate the role of romantic breakup in increasing vulnerability to emotional disorders. For this purpose, 18 scientific articles related to the research topic were selected and separately reviewed. The following is the summary of the study.

According to the triple vulnerability model, the occurrence of disturbing thoughts, doubts, emotions and feelings are considered as threatening when they lead to the emergence of metacognitive beliefs about their importance and meaning. These beliefs include thought-event fusion and thought-action fusion [46]. Such metacognitive processes may be perceived as a sign of danger by the individual. In addition, a negative evaluation of such thoughts causes a person to experience intense negative emotions, especially anxiety, anger, and guilt, causing him/her to experience more disturbing thoughts and feelings in a vicious cycle. As a result, special strategies such as ritual beliefs, neutralization, thought suppression, mental arguing, verification, etc. might be employed to deal with the perceived danger. Since such rules are unrealistic and psychologically require a lot of energy to be achieved, they cause stress and tension, preventing the realistic evaluation of these disturbing thoughts and feelings in the mind. As a result, perceptions of danger and negative emotions persist. In other words, such metacognitive and ritual beliefs lead to the formation of dysfunctional behaviors that may last for hours and, thus, deprive a person of the possibility to perform a realistic evaluation of intellectual content and ritual behaviors, causing intensified and perpetuated negative moods and obsessive-compulsive symptoms, which may eventually lead to emotional disorders. As romantic breakups are stressor events, they increase anxiety in the individual. Based on the anxiety tolerance model, such people perceive romantic breakup as turmoil events and will ultimately experience chronic anxiety in response to such situations. Based on the anxiety tolerance model, being anxiety will help such people to deal effectively with ambiguous frightening situations, thereby preventing the occurrence of adverse events. Self-concern leads to negative bias and cognitive avoidance toward emotional trauma, causes persistent anxiety in a vicious cycle. While rejecting the existence of possible ambiguous situations, they use anxiety as the main strategy to reduce their levels of intolerance when facing such situations, indicating that there is a strong relationship between anxiety and intolerance. In the above process, therefore, the person is more vulnerable to emotional disorders due to the experience of chronic anxiety and intolerance of uncertainty.

The vulnerability-stress model states that high levels of anxiety are a risk factor for extreme reactions to stress as well as vulnerability to mental disorders, especially emotional disorders [47]. People with high levels of anxiety overreact to threatening romantic breakups and ambiguous stimuli [48-53]. Therefore, such people are more vulnerable to stress-induced changes. On the other hand, increased sensitivity to threats combined with annoying and negative thoughts neutralizes people's responses to major stressors in their lives. Finally, negative emotions reinforce the main features of emotional disorders such as emotional dysregulation, mood swings, frustration, helplessness, worthlessness, and lack of pleasure, and contribute to the occurrence and progression of such disorders in other words, increased sensitivity to threats combined with annoying and negative thoughts neutralizes people's responses to major stressors in a vicious cycle, which ultimately reinforce the main features of emotional disorders and contribute to the occurrence and progression of emotional disorders. Although emotions help us to provide an adaptive respond to opportunities and threats, their deviation from original path can increase our vulnerability to emotional disorders. In this regard, romantic breakup or love trauma syndrome has four basic characteristics, including "arousal, avoidance, automatic remembering and emotional anaesthesia" [54-60], which can cause emotions to deviate from their original path by interfering with the process of emotional regulation. Thus, it is more likely to use ineffective coping strategies when facing stressful events after a romantic breakup. On the other hand, since love trauma syndrome are divided into two categories, including type I (sudden and unexpected events, during which the person feels completely defeated) and type II (repetitive and chronic events, during which a person's desirable expectations of the relationship are constantly shattered) it can be found that both types can reduce the coping ability and increase avoidance strategies of a person that prevent correctional learning in him/her. Such people may also complain of chronic feelings of emptiness, impatience, and lack of perceived identity, and when pressured, complain of being very depressed most of the times despite the intense expression of emotional states. On the other hand, they may often try to compensate for the love trauma with an alternative and avoid the resulting emotional pain [61-65].They may be relatively successful in the short term, but they are always at risk of suppressing consequences of love trauma syndrome, in which case a more complicated syndrome is more likely. Manifestations of such an event can be in the form of changing attitudes, especially towards the opposite sex with hatred, avoidance of communication, aggression, and childish and immature personality behaviors, which ultimately lead to self-destructive behaviors in such people. This paves the way for greater vulnerability to other emotional disorders by reducing psychological and behavioral capacity of the individual to cope with stressful situations [66-72].

Conclusion

Romantic breakup refers to a situation occurred after separation or failure of romantic relationships, which includes a set of severe signs and symptoms that appear after a breakup in a long-term romantic relationship and cause maladaptive reactions as well as dysfunction in various social, occupational and educational areas. Romantic breakup is experienced as severe and traumatic stress and causes psychological, emotional and physical distress in the person. Symptoms of romantic breakup increase after experiencing a love trauma because it violates the person’s favorable assumptions and expectations of the relationship and the presuppositions of his/her security in the relationship. Thus, it is more likely to use ineffective coping strategies when facing stressful events after a romantic breakup.

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Citation: Rezapour, Roya, Shahram Vaziri and Farah Lotfi Kashani. “The Role of Romantic Breakup in Increasing Vulnerability to Emotional Disorders: A Systematic Review.” Clin Schizophr Relat Psychoses 15(2021). Doi: 10.3371/CSRP.RRSV.091521.

Copyright: © 2021 Rezapour R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.