Los Angeles, CA, USA. Research shows that chronic grief activates pleasure areas of the brain, findings that could change how health professionals treat the disorder.

Grief is universal, and most of us will probably experience the pain grief brings at some point in our lives, usually with the death of a loved one or an irreversible change in our personal circumstances.In time, we accept the loss and move on.

But there is a substantial minority of people among us that finds it impossible to let go of old loss.

Even years later, any reminder of their loss — a picture, a memory — brings on a fresh wave of grief and yearning. The question is: why do some grieve and ultimately adapt, while others can't get over the loss of someone — or some thing — held dear? Reporting in the journal NeuroImage, scientists at UCLA suggest that such long-term or "complicated" grief activates neurons in the reward centers of the brain, possibly giving these memories addiction-like properties.

The researchers found that, of 23 women, 11 had complicated grief, and 12 had the more normal, noncomplicated grief.

This study is the first to compare those with complicated and noncomplicated grief, and future research in this area may help psychologists do a better job of treating those with complicated grief.

Mary-Frances O'Connor, UCLA assistant professor of psychiatry and lead author of the study, says "The idea is that when our loved ones are alive, we get a rewarding cue from seeing them or things that remind us of them."

"After the loved one dies, those who adapt to the loss stop getting this neural reward. But those who don't adapt continue to crave it, because each time they do see a cue, they still get that neural reward."

"Of course, all of this is outside of conscious thought, so there isn't an intention about it," she said.

Each of the study participants brought a photograph of their deceased loved one and were shown this picture while undergoing brain scanning by functional magnetic resonance imaging (fMRI). Next, they were scanned while looking at a photograph of a female stranger.

• The authors looked for activity in the nucleus accumbens, a region of the brain most commonly associated with reward and one that has also been shown to play a role in social attachment, such as sibling and maternal affiliation.
  
  
• They also examined activity in the pain network of the brain, including the dorsal anterior cingulate cortex and the insula, which has been implicated in both physical and social pain.

They found that while both groups had activation in the pain network of the brain after viewing a picture of their loved one, only individuals with complicated grief showed significant nucleus accumbens activations.

Complicated grief can be debilitating, involving recurrent pangs of painful emotions, including intense yearning, longing and searching for the deceased, and a preoccupation with thoughts of the loved one.

This syndrome has now been defined by an empirically derived set of criteria and is being considered for inclusion in the DSM-V, the psychiatric manual for diagnosing mental disorders.

O'Connor, who is a member of UCLA's Cousins Center for Psychoneuroimmunology, cautions that she is not suggesting that such reveries about the deceased are emotionally satisfying but rather that they may serve in some people as a type of craving for the reward response that may make adapting to the reality of the loss more difficult.

CitationWhen grief heats up: Pro-inflammatory cytokines predict regional brain activation. Mary-Frances O'Connor, Michael R. Irwin and David K. Wellisch. Neuroimage epub ahead of print. doi: 10.1016/j.neuroimage.2009.05.049

Abstract

Background. Pro-inflammatory cytokines are associated with sickness behaviors, a set of behaviors including low mood, which are orchestrated by the brain and described as shift in motivational state. The present study investigated the hypothesis that local inflammation is associated with greater subgenual anterior cingulate cortex (sACC) activation in persons undergoing chronic stress.

Methods. Women undergoing the emotional stress of bereavement had fMRI scans during a grief elicitation task. Local inflammation was measured by salivary concentrations of two markers of pro-inflammatory cytokine activity (e.g., interleukin-1β and soluble tumor necrosis factor receptor II).

Results. Analyses revealed that both inflammatory markers were positively associated with ventral prefrontal activation (e.g., sACC and orbitofrontal cortex) as well as other regions important in the emotional task such as noun retrieval (e.g., temporal cortex), and visual processing (e.g., cuneus and fusiform gyrus). In separate analyses, the ventral prefrontal activations correlated with free recall of grief-related word stimuli, but not neutral word stimuli.

Conclusions. This is the first study to demonstrate the relationship between emotional processing, regional brain activation and localized inflammation in a chronically stressed population of adults.

Keywords: Grief, Cytokines, Inflammation, Emotion, Neuroscience, Psychoneuroimmunology.

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