June 23, 2023 – Susan Whitmore lost her daughter Erika 20 years ago to a rare sinus cancer.
And even though she is a grief counselor in Pacific Palisades, CA, “I thought the grief would literally kill me,” she said. “People often don’t talk about how physical grief is, but it’s a shock to your entire being. When this grief came flooding in, I didn’t know what to do with it.”
Whitmore remembers thinking, “I don’t know how anyone can survive this.” Then she began to contemplate her situation. “Maybe I will survive, but this type of grief has to be doing something to my body — to my bones, creating gut-wrenching, unrelenting pain that goes on day after day, week after week, month after month.”
The grief indeed took a physical toll. Whitmore began having chest pain that turned out to be a symptom of anxiety attacks. “But I had other physical experiences as well,” she said. She eventually developed an autoimmune disease and, now in her 70s, has high blood pressure, too.
“In my work as a grief counselor, I’ve learned that many people experience the pain of grief in their chest or stomach or both, and some people describe it as an ‘elephant standing on the chest.’”
‘Grief Pangs’ and Blood Pressure
Whitmore’s experience, and that of her patients, now has science behind it. A new study has found that severe grief can cause a significant increase in blood pressure, suggesting that grief can be a risk factor for future heart problems.
Researchers at the University of Arizona studied 59 people who had lost someone close to them in the past year. Participants focused on feelings of separation and attachment through “grief recall,” a 10-minute process in which they were asked to share a moment when they felt very much alone after the death of their loved one.
Lead author Roman Palitsky said the study “used an interview that got bereaved people to focus directly on their loss, simulating in a controlled laboratory environment what might happen when someone has a ‘grief pang’” – meaning distress related to bereavement.
Palitsky was a doctoral student at University of Arizona at the time the study was done and is now the director of research projects in spiritual health at Emory University Woodruff Health Sciences Center in Atlanta.
The researchers measured blood pressure at the start of the experiment and then after the 10-minute grief recall interview and found that patients’ blood pressure increased significantly after the interview.
“People’s blood pressure went up during this interview, suggesting that these moments of intense sadness have observable cardiovascular impacts,” Palitsky said. “We also found that those with the most severe grief had the greatest increase in blood pressure.”
He and his colleagues wanted to do the study because grief is not just emotional but also “has striking impacts on physical health.” They wanted to “see if the emotions of grief are responsible for some of these health impacts” and hoped the results “would help bereaved people stay physically healthy by better understanding the higher-risk period of bereavement.”
A heart condition linked to grief is takotsubo cardiomyopathy – sometimes called “broken heart syndrome” – which is a “stress response that balloons the heart.” But the researchers wanted to study something different: high blood pressure, which is more common and may contribute to the increased risk of heart attack and stroke, seen after loss, Palitsky said.
Why Does Grief Affect the Heart?
Several mechanisms might explain why grief affects the heart, Palitsky said, and “probably different mechanisms for different people, and it’s important to remember that many people experience grief in unique ways.”
People “sometimes take less care of themselves, they might exercise less or consume more alcohol. They might experience isolation and loneliness, or they may become depressed, which are all risk factors,” he said.
There is also an immune response in some people that contributes to greater inflammation and poorer regulation of the endocrine system. “But our study also points to the immediate acute impacts of grief, which can be emotionally very intense and which might play a role in acute cardiac events that happen at greater rates after the death of a loved one,” Palitsky said.
Glenn Levine, MD, a professor of medicine at Baylor College of Medicine and chief of the cardiology section at Michael E. DeBakey VA Medical Center in Houston, says grief is a “state of severe mental distress” that can “lead to higher adrenaline type hormone levels, leading to elevated blood pressure and faster heart rate.”
Grief also may have “indirect effects, such as patients not taking their medications regularly during period of distress and mourning,” said Levine, who was not involved in the study.
When Grief and Trauma Intersect
An important part of grief is the trauma that surrounds it, Whitmore said; not only the trauma of losing a loved one, but also the trauma of the events that may have come before the loss. Trauma causes a physical stress response that can be triggered even long after the event, leading to posttraumatic stress disorder (PTSD).
“I have major PTSD from having watching Erika die, and at first, I didn’t know what it was. It was haunting me, and I was reliving my daughter’s illness again and again, which make the physical part so much more taxing and debilitating,” she said.
Not every death of a loved one is traumatic, even though it can be extremely painful and devastating, Whitmore said. “My mother died about 8 years ago at the age of 90. She had lived a full life, and at the end, she was miserable and it was a blessing when she died. I didn’t need to see a therapist to help me heal.” This was quite different from the loss of her daughter.
“So find out if you have some trauma surrounding your loss and find somebody who can help you work with that trauma,” Whitmore said.
Whitmore is the founder and CEO of griefHaven, a nonprofit dedicated to providing grief support and education. Among the many services they offer are private support groups that are specific to different types of loss – for example, loss of a parent, a child, or a sibling – and are geared toward different ages and circumstances of death.
Managing the Physical Impact of Grief
Palitsky said that experiencing a loss doesn’t necessarily lead to heart problems for most people. “But we suggest that people not skip the regular doctor’s visit after a loved one dies, even though it can be an overwhelming time in many ways.”
And be sure you protect your mental and emotional health after the loss, “and if you find you’re having a lot of trouble coping, it could help to find a little bit of extra support, whether it’s being around loved ones or maybe seeing a therapist,” Palitsky said. “Protecting your mental health may also help to protect your heart.”