Breakup distress in university students may take the form of complicated grief, an intense and prolonged period of grief following a loss (Horowitz, Siegel, Holen, Bonanno, Milbrath, & Stinson, 1997). Typically complicated grief is associated with a death, although many of the complicated grief symptoms are similar to those of heartbreak following a romantic relationship breakup. The criteria for complicated grief have been defined as intensive intrusive thoughts, pangs of severe emotion, distressing yearnings, feeling excessively alone and empty, unusual sleep disturbances, and loss of interest in personal activities (Horowitz et al., 1997). The term "complicated" reflects the unresolved complications of normal functioning as assessed by the Inventory of Complicated Grief (Prigerson, Maciejewski, Reynolds, Bierhals, Newsom, Fasiczka, et al., 1995).
In a study that measured both uncomplicated grief (based on the Texas Revised Inventory of Grief by Faschingbauer, 1981) and complicated grief (based on the Inventory of Complicated Grief by Prigerson et al., 1985), complicated grief scores were more related to anxiety, depression, social functioning, and general health than symptoms of uncomplicated grief (Boelen & van den Bout, 2008). In another study on complicated grief, 55% of the sample were depressed (Simon, Shear, Thompson, Zalta, Perlman, Reynolds, et al., 2007). Those who had comorbid complicated grief and depression reported higher levels of grief and more sleep disturbances and anxiety symptoms.
In a study on college students, complicated grief symptoms were assessed by the Inventory of Complicated Grief, and insomnia and associated sleep behaviors were also self-reported (Hardison, Neimeyer, & Lichstein, 2005). The rate of insomnia was significantly higher in the complicated versus the uncomplicated grief samples (22% versus 17%), and sleep disturbances were related to intrusive thoughts about the loss as well as images of the deceased in their dreams. In a study on insomnia itself, the insomnia group experienced more images regarding "intimate relationships" as compared to the good sleeper group (Nelson & Harvey, 2003). Some have suggested that controlled intrusive thoughts prior to sleep become intrusive images during sleep, ultimately leading to insomnia.
Many of the complicated grief symptoms were reported in at least one study on romantic relationship breakups, although it was a study on adult women, not university students (Najib, Lorberbaum, Kose, Bohning, & George, 2004). For this study, women who were grieving over the loss of a romantic relationship and were experiencing intrusive thoughts showed brain activity in different regions during intrusive versus neutral thoughts. They also rated their mood states including sadness and anxiety and their intrusive thoughts as being excessive.
Background literature on the variables that appeared to be affected by romantic breakups suggested the following: Gender differences in breakup distress have rarely been reported. But, in one study on university students, men reported more difficulty than women in recovering from broken relationships (Knox, Zusman, Kaluzny, & Cooper, 2000). In another study, women were more distressed (Fisher, 2004). The latter finding would be expected given that women are more readily depressed by stressful events (Nolen-Hoeksema, 2000).
Research on the initiator status (i.e., who ended the relationship) also yielded mixed results. While one researcher reported that the level of distress was unrelated to who ended the relationship (self or other) (Waller, 2008), another group suggested that both men and women who were rejected experienced more depression, loss of self-esteem and intrusive thoughts than those who did the rejecting (Perilloux & Bus, 2008). In another study, depression occurred in only those individuals who had been rejected, not in those who initiated the rejection (Ayduk, Downey, Testa, & Yen, 1991). …