The vicious circle of social exclusion and psychopathology: a systematic review of experimental ostracism research in psychiatric disorders

The effects of acute social ostracism on subsequent snacking behavior and future body mass index in children

BACKGROUND/OBJECTIVES

Ostracism may lead to increased food intake, yet it is unclear whether greater reactivity to ostracism contributes to higher body mass index (BMI). We investigated whether children who exhibited greater stress to social exclusion subsequently consume more energy and whether this predicts BMI 6- and 18-months later.

SUBJECTS/METHODS

Children (8.5 years-old) (N = 262, males = 50.4%; Chinese = 58.4%) completed a laboratory-based manipulation of social exclusion (the Cyberball task) prior to an ad-libitum snack. Heart rate variability (HRV) was measured during the inclusion and exclusion conditions and proportionate changes were calculated as a physiological measure of exclusion-related stress. Social anxiety and social-emotional assets were also measured as moderators.

RESULTS

Greater stress (as measured physiologically or by self-report) did not directly, or indirectly via energy intake, predict later BMI (at 9- and 10-years). However, among children reporting higher social anxiety, greater stress as measured by proportionate changes in HRV was associated with increased energy intake (B = 532.88, SE = 226.49, t(255) = 2.35, [CI95 = 86.85,978.92]). A significant moderated mediation was also observed (index: (b = 0.01, bootSE = 0.01, [CI95 = 0.001, 0.036]), such that among children reporting higher social anxiety, greater stress from social exclusion predicted increased energy intake from a subsequent snack, which in turn predicted higher BMI 1.5 years later.

CONCLUSION

This prospective study suggests that a pattern of greater snack intake in response to heightened vulnerability to the effects of ostracism may contribute to increases in child BMI scores.

"A 'Cool' Kid Wears a Brand, and Everyone's following Him" Hierarchal Social Status in Preadolescence: A New Developmental Perspective

Inequality in hierarchical social status, especially among socially excluded children, profoundly affects preadolescents. Historically viewed through a lens of psychopathology and moral deficiencies, it challenges the education system's approaches and interventions. This article introduces a developmental perspective, highlighting the hierarchical social status' role in shaping classroom cohesion, strength, and distinctiveness. This study's phenomenological, qualitative methodology aimed to gain preliminary insight into the children's perspectives. Drawing from 12 focus group discussions involving 140 latency-age (grade 5) children in Israel, it uniquely reveals the dynamic nature of hierarchical social status influenced by children's connections with the group. This dynamism promotes group unity, strengthens bonds, and prioritizes collective concerns, contributing to the development of a "social self" in the latency phase. Beyond theory, this study proposes innovative interventions to address social status disparities.

School bullying and peer relationships in children with chronic pain

ABSTRACT

Preliminary evidence suggests that there are significant associations between bullying and chronic pain, as well as between the quality of peer relationships and psychological function in youth with chronic pain. However, these findings have yet to be replicated, and the role that bullying plays in anxiety in children and adolescents with chronic pain has not yet been examined. This study sought to expand our understanding of the associations between measures of bullying and quality of peer relationships and pain-related function domains in a community sample of schoolchildren with chronic pain. One thousand one hundred fifteen schoolchildren participated in this study; 57% were girls, the mean age of the study sample was 11.67 years (SD = 2.47), and 46% reported having chronic pain. Participants completed measures of pain characteristics, pain interference, anxiety, and depressive symptoms, bullying (past and current), and quality of peer relationships. Youth with chronic pain reported a significantly higher percentage of being bullied in the past compared with youth without chronic pain. In the group of youth with chronic pain, the measures of past and current bullying, and quality of peer relationships, were not significantly associated with pain intensity, pain interference, or anxiety. However, having a history of being bullied and the quality of peer relationships were significantly associated with depressive symptom severity. The findings indicate that research to evaluate the potential causal role of bullying and the quality of peer relationships on pain-related function domains in youth with chronic pain is warranted.

Distinct neural dynamics of the observed ostracism effect in decision-making under risk and ambiguity

Observational ostracism, as a form of social exclusion, can significantly affect human behavior. However, the effects of observed ostracism on risky and ambiguous decision-making and the underlying neural mechanisms remain unclear. This event-related potential study investigated these issues by involving participants in a wheel-of- fortune task, considering observed ostracism and inclusion contexts. The results showed that the cue-P3 component was more enhanced during the choice phase for risky decisions than for ambiguous decisions in the observed inclusion contexts but not in the observed ostracism contexts. During the outcome evaluation phase, feedback-related negativity amplitudes following both risky and ambiguous decisions were higher in the no-gain condition than in the gain condition in the observed inclusion context. In contrast, this effect was only observed following risky decisions in the observed ostracism context. The feedback-P3 component did not exhibit an observed ostracism effect in risky and ambiguous decision-making tasks. Risk levels further modulated the cue-P3 and feedback-related negativity components, while ambiguity levels further modulated the feedback-P3 components. These findings demonstrate a neural dissociation between risk and ambiguity decision-making during observed ostracism that unfolds from the choice phase to the outcome evaluation phase.

Childhood emotional maltreatment and sensitivity to social rejection in emerging adults

BACKGROUND

Enhanced responsiveness to social rejection may be a transdiagnostic mechanism through which childhood emotional maltreatment predisposes individuals to interpersonal and mental health problems. To investigate this mechanism, as a first step, more detailed investigations are needed regarding the assumed association of childhood emotional maltreatment with rejection sensitivity in later life.

OBJECTIVE

The present work examines the hypothesis that among different subtypes of childhood maltreatment, in particular forms of emotional maltreatment (emotional abuse and neglect) relate to rejection sensitivity in emerging adults.

PARTICIPANTS AND SETTING

In study 1, 311 emerging adults (18-25 years) participated in a retrospective cross-sectional assessment. In study 2, 78 emerging adults (18-25 years) were included in an experiment (O-Cam paradigm) which involved the experience of social rejection (vs. inclusion).

METHODS

Study 1 investigates whether intensities of childhood emotional abuse and neglect have unique associations with trait rejection sensitivity, when considering all maltreatment subtypes (emotional abuse, sexual abuse, physical abuse, emotional neglect, physical neglect) simultaneously. Study 2 examined whether childhood emotional abuse and neglect moderate the experience of social rejection in terms of need depletion, sadness and anger after social rejection (vs. inclusion).

RESULTS

Study 1 indicates that emotional abuse and neglect have unique associations with rejection sensitivity. Study 2 results show that only a higher intensity of emotional abuse has extensive effects on need depletion and sadness after social rejection (vs. inclusion).

CONCLUSIONS

In particular, experiences of childhood emotional abuse may relate to rejection sensitivity in young adulthood.

Polygenic risk for major depression, attention deficit hyperactivity disorder, neuroticism, and schizophrenia are correlated with experience of intimate partner violence

Research has suggested that mental illness may be a risk factor for, as well as a sequela of, experiencing intimate partner violence (IPV). The association between IPV and mental illness may also be due in part to gene-environment correlations. Using polygenic risk scores for six psychiatric disorders - attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BPD), major depressive disorder (MDD), neuroticism, and schizophrenia-and a combined measure of overall genetic risk for mental illness, we tested whether women's genetic risk for mental illness was associated with the experience of three types of intimate partner violence. In this cohort of women of European ancestry (N = 11,095), participants in the highest quintile of genetic risk for ADHD (OR range: 1.38-1.49), MDD (OR range: 1.28-1.43), neuroticism (OR range: (1.18-1.25), schizophrenia (OR range: 1.30-1.34), and overall genetic risk (OR range: 1.30-1.41) were at higher risk for experiencing more severe emotional and physical abuse, and, except schizophrenia, more severe sexual abuse, as well as more types of abuse and chronic abuse. In addition, participants in the highest quintile of genetic risk for neuroticism (OR = 1.43 95% CI: 1.18, 1.72), schizophrenia (OR = 1.33 95% CI: 1.10, 1.62), and the overall genetic risk (OR = 1.40 95% CI: 1.15, 1.71) were at higher risk for experiencing intimate partner intimidation and control. Participants in the highest quintile of genetic risk for ADHD, ASD, MDD, schizophrenia, and overall genetic risk, compared to the lowest quintile, were at increased risk for experiencing harassment from a partner (OR range: 1.22-1.92). No associations were found between genetic risk for BPD with IPV. A better understanding of the salience of the multiple possible pathways linking genetic risk for mental illness with risk for IPV may aid in preventing IPV victimization or re-victimization.

Involvement in cyberbullying events and empathy are related to emotional responses to simulated social pain tasks

Introduction

This study aims to explore the relationship between cyberbullying involvement either as a perpetrator or a victim and emotional responses to virtual social exclusion and inclusion. Previous research has predominantly focused on the impacts of in-person bullying. Our study shifts this focus to the cyber realm.

Methods

A total of 156 adolescents living in northern Italy were recruited (Mage: 12.26; SD = 0.87; 43% female). After completing measures of empathy and involvement in cyberbullying, adolescents participated in the cyberball tasks. Latent profile analysis was used to identify subgroups.

Results

We found three groups: Class 3, reporting negative responses to the social exclusion tasks and positive responses to the social inclusion tasks; Class 1, reporting neutral emotional responses to social inclusion and negative emotional responses to social exclusion; and Class 2, showing neutral responses to 'social exclusion' tasks and strongly positive responses to 'social inclusion' tasks. Linear regression revealed that cyberbullies report a typical emotional response to exclusion and inclusion tasks (Class 3), whereas cybervictims are more likely to report negative responses to both exclusion and inclusion events (Class 1). High levels of empathy are associated with the manifestation of a typical emotional response (Class 3), in contrast to an impaired emotional response characterized by neutral or positive responses to conditions of 'social exclusion' and positive responses to conditions of 'social inclusion' (Class 2).

Conclusion

Results underscore the complex interplay between cyberbullying roles and emotional responses to virtual social experiences. Theoretical implications and limitations of the research are discussed.

Towards identifying the characteristics of youth with severe and enduring mental health problems in practice: a qualitative study

A group of youth with severe and enduring mental health problems (SEMHP) falls between the cracks of the child-and-adolescent psychiatry (CAP) system. An insufficient understanding of these youth's mental health problems results in a failure to accurately identify and provide support to these youth. To gain a deeper understanding, the aim of this study is to explore characteristics of youth with SEMHP in clinical practice based on the experiences of youth and clinicians in CAP. This qualitative study consisted of 20 semi-structured interviews with 10 youth with lived experience and 10 specialized clinicians in CAP. Both a thematic and content analysis was conducted to identify, assess, and report themes associated with youth with SEMHP. Themes were individual characteristics such as trauma, masking, self-destructive behavior, interpersonal distrust as well as environmental and systematic characteristics including parental stressors, social isolation and societal stressors, which go beyond the existing classifications. These characteristics profoundly impact youth's daily functioning across various life domains, creating an interactive process, ultimately leading to elusive mental health problems and overwhelming feelings of hopelessness. The authors recommend proper assessment of characteristics in all life domains affected and their perpetuating effect on SEMHP during diagnostics in CAP. Engaging in a dialogue with youth themselves is crucial due to the nature of youth's characteristics, which frequently transcend traditional classifications and may not be immediately discernible. It also requires an integrated care approach, entailing collaborations between educational institutions and mental healthcare providers, and attention to potential indicators of deficits in the healthcare system and society.

Neural correlates of social exclusion and overinclusion in patients with borderline personality disorder: an fMRI study

BACKGROUND

Interpersonal difficulties of patients with borderline personality disorder (BPD) are closely related to rejection sensitivity. The aim of the present study was to gain further insight into the experience and cerebral processing of social interactions in patients with BPD by using fMRI during experimentally induced experiences of social exclusion, inclusion, and overinclusion.

METHODS

The study involved 30 participants diagnosed with BPD (29 female and 1 male; age: M = 24.22, SD = 5.22) and 30 healthy controls (29 female and 1 male; age: M = 24.66, SD = 5.28) with no current or lifetime psychiatric diagnoses. In the fMRI session, all participants were asked to complete a Cyberball task that consisted of an alternating sequence of inclusion, exclusion, and overinclusion conditions.

RESULTS

Compared to healthy controls, participants with BPD reported higher levels of inner tension and more unpleasant emotions across all experimental conditions. At the neural level, the participants with BPD showed lower recruitment of the left hippocampus in response to social exclusion (relative to the inclusion condition) than the healthy controls did. Lower recruitment of the left hippocampus in this contrast was associated with childhood maltreatment in patients with BPD. However, this difference was no longer significant when we added the covariate of hippocampal volume to the analysis. During social overinclusion (relative to the inclusion condition), we observed no significant differences in a group comparison of neural activation.

CONCLUSIONS

The results of our study suggest that patients with BPD experience more discomfort than do healthy controls during social interactions. Compared to healthy participants, patients with BPD reported more inner tension and unpleasant emotions, irrespective of the extent to which others included them in social interactions. At a neural level, the participants with BPD showed a lower recruitment of the left hippocampus in response to social exclusion than the healthy controls did. The reduced activation of this neural structure could be related to a history of childhood maltreatment and smaller hippocampal volume in patients with BPD.

Divergent emotional and autonomic responses to Cyberball in patients with opioid use disorder on opioid agonist treatment

The perception of social exclusion among patients with opioid use disorder (OUD) could be affected by long-term opioid use. This study explores the emotional and cardiac autonomic responses to an experience of ostracism in a sample of participants with OUD on opioid agonist treatment (OAT). Twenty patients with OUD and twenty healthy controls (HC) performed a ball-tossing game (Cyberball) with two conditions: Inclusion and Ostracism. We measured self-reported ratings of perceived threat towards one's fundamental needs and respiratory sinus arrhythmia (RSA) immediately after the game and 10 min after Ostracism (Reflective stage). Following ostracism, participants with OUD self-reported blunted feelings of threat to the fundamental need to belong. RSA levels were significantly suppressed immediately after ostracism and during the Reflective stage in comparison with HC, indicating an autonomic alteration in response to threatening social situations. Finally, only among HC higher perceived threats towards fundamental needs predicted increases in RSA levels, suggesting an adaptive vagal regulation in response to a perceived threat. Conversely, among patients with OUD the subjective response to ostracism was not associated with the autonomic reaction. OAT may have a protective effect against negative feelings of ostracism. However patients with OUD on OAT present poor autonomic regulation in response to social threats, which could reflect their trait hypersensitivity to social rejection.

Effects of an open-label placebo intervention on reactions to social exclusion in healthy adults: a randomized controlled trial

Social exclusion, that is being left out by others, can have adverse consequences for individuals' psychological well-being. Even short-term experiences of social exclusion strongly threaten basic psychological needs and cause so-called social pain. Prior research suggests an overlap between the experience of social and physical pain that, amongst others, is reflected by the effectiveness of physical pain treatments in alleviating social pain. Drawing upon these prior findings, we here explore whether open-label placebos, which have previously been found to be effective in reducing physical pain, can alleviate social pain following social exclusion. Seventy-four healthy participants were randomly assigned to one of four conditions in a 2 × 2 between-subjects design: First, they either received an open-label placebo intervention or no treatment. Second, they either experienced inclusion or exclusion by their co-players in the interactive ball-tossing game Cyberball. We find that excluded participants in the open-label placebo condition experienced significantly less hurt feelings compared to those in the control condition (Cohen's d = 0.77). There was no effect of treatment for need threat. The findings suggest new possibilities to alleviate social pain, which is of particular interest in the context of preventing destructive and maladaptive behaviors in situations where functional coping strategies are unavailable.

Criminal thinking and psychosocial characteristics among young adults entering residential substance use treatment

Background and aim: Young adults with substance use (SU) problems face a high risk of co-occurring problems, including criminality. The aim of the present study was to assess the psychosocial characteristics, SU problems, and criminal thinking young adults entering SU treatment have, and whether the SU characteristics, sex and age are associated with criminal thinking scores. Methods: The sample was 407 young adults aged 16-29 years who underwent an entry assessment between January 2011 and December 2016 at a residential SU treatment institution in Norway. All study data were extracted from electronic health records, including survey information from the Achenbach System of Empirically Based Assessment and the Psychological Inventory of Criminal Thinking Styles. Results: In the present sample, severe SU, high rates of psychosocial problems, and criminal thinking were reported. Almost three-quarters (72.67%) of young adults reported high levels of criminal thinking (≥60). However, male participants were more likely to report high levels of criminal thinking compared to female participants (p=0.031). In bivariate regression models, only sex and having stimulants/opioids as primary drug were associated with mean levels of criminal thinking. The same was true in the multiple regression model. Conclusion: Young adults in residential SU treatment are a multi-problem high-risk/high-need group of people. Due to the elevated levels of criminal thinking, we recommend that young adults in SU treatment should be screened for criminogenic treatment needs, such as criminal thinking, regardless of justice involvement.

Electrophysiological evidence for sensitization effects elicited by concurrent social threats

Experiencing a social threat, such as social exclusion, is a painful event. In contrast to previous studies providing insight into the processing of a single short-termed threat, we exposed healthy individuals to the simultaneous onset of different social threats. This approach allowed us to track whether these threats are processed independently-or whether they interact in a common system. Using a virtual ball-throwing game (Cyberball), electrophysiological (event-related brain potentials, ERPs) and behavioral (self-reports) responses were collected. We assigned undergraduates to three experimental groups: single threat exclusion (n = 24), single threat loss of control (n = 26), and joint onset of both threats (dual-threat, n = 25). Self-reports indicated an increase in threats (i.e., in perceived exclusion and loss-of-control) in the latter group. The ERPs disentangled the neural responses to each threat: In the dual-threat group, the amplitudes of the P3 responses to exclusionary and intervention events were enhanced. This indicates that individuals are sensitized to each of the threats when the other threat is present simultaneously. Our findings support the theoretical notion of a common cognitive system responding to violations in subjective expectations.

Sensitivity to ostracism is blunted in suicide attempters only when they report suicidal ideation

BACKGROUND

Modified pain perception is at the core of many theories on suicide; however, studies on the relationship between pain perception and suicidal behavior (attempt) have produced contradictory results. In this experimental study, we investigated whether physical pain and social pain are concomitantly influenced by suicidal ideation (SI) and past suicidal behavior.

METHODS

155 inpatients with depression (90 with and 65 without past history of suicide attempt) were included. They underwent thermal stimulation of the skin to assess physical pain tolerance and played the Cyberball game to assess their sensitivity to ostracism (social pain). Participants self-assessed current SI through the specific item in the Beck Depression Inventory.

RESULTS

Pain tolerance was not associated with history of suicide attempt, current SI, and their interaction. Social pain was associated with the interaction between history of suicide attempt and current SI. Social pain was decreased in suicide attempters, compared with non-attempters, only when they reported current SI.

LIMITATIONS

Cyberball game may not be representative of everyday stress and ecological social context.

CONCLUSIONS

Unlike what suggested by many theories, pain tolerance does not seem to be necessary to attempt suicide. Suicide attempters with current SI displayed blunted sensitivity to ostracism and could be less willing to restore social affiliation compared with non-attempters.

Exploring Intergroup Peer Exclusion: Validation of the Latency Social-Psychological Developmental Questionnaire (LSPD)

Intergroup peer exclusion has been studied mainly from a pathological aspect. Currently, methods of diagnosis and treatment focus on this pathological point of view. Qualitative research has revealed that social intergroup peer exclusion has a role in the developmental task of the latency stage. The study’s main aim was to develop and validate a quick and easy quantitative questionnaire for use in a school setting that reflects the social developmental variables exposed in previous qualitative research. The 32-item Latency Social-Psychological Developmental questionnaire (LSPD) and the Loneliness and Social Dissatisfaction Questionnaire were administered to 20 Grade 4 and Grade 5 classes at four co-ed public elementary schools (N = 373 participants). Factor analysis revealed six developmental factors, and correlations were found between these factors and loneliness. The LSPD is a tool for assessing latency stage development among children who experienced exclusion as well as the developmental status of the entire class. The LSPD can assist in identifying specific development areas to focus on in treatment and intervention.

Virtual Rejection and Overinclusion in Eating Disorders: An Experimental Investigation of the Impact on Emotions, Stress Perception, and Food Attitudes

(1) Background: the investigation of how interpersonal functioning affects eating psychopathology has been receiving increasing attention in the last decade. This study evaluates the impact of virtual social inclusion or ostracism on emotions, perceived stress, eating psychopathology, and the drive to binge or restrict in patients across the eating disorder spectrum. (2) Methods: a group of 122 adolescent and adult females with different eating disorder diagnoses were compared to 50 healthy peers with regards to their performance on, and responses to the Cyberball task, a virtual ball-tossing game. Each participant was randomly assigned to playing a social inclusion or a social exclusion block of the Cyberball task and completed self-report assessments of emotions, perceived stress and urge to restrict/binge before and after the task. (3) Results: patients with anorexia nervosa showed a more negative impact on psychological well-being evaluated with the need threat scale after the excluding block, while patients with bulimia nervosa reported more negative effects after the overincluding condition. Patients with binge eating disorder showed a reduction in specific negative emotions after the overincluding block, unlike all other participants. (4) Conclusions: findings show significant correlations between restraint thoughts in patients with bulimia nervosa and binge thoughts in patients with binge eating disorder after being exposed to the inclusion condition. Different reactions in cognitive and emotional states of patients with eating disorders after different interpersonal scenarios confirm the impact of inclusive or exclusive relationships on eating psychopathology, with specific and different responses across the eating disorder spectrum, that have been discussed, linked to their eating behavioral cognition.

Association between the behavioral response during social exclusion and recalled childhood maltreatment

Social exclusion is a critical event for mental health. Patients with interpersonal dysfunction, e.g., with borderline personality disorder (BPD) or persistent depressive disorder (PDD), are particularly vulnerable, often based on their experiences of early adversity in life. The etiological pathways from childhood maltreatment (CM) to current behavior during social exclusion are still underexplored. This cross-diagnostic study investigated the relationship between self-reported CM and behavioral reaction to social exclusion in an experimental paradigm (Cyberball). Data from 140 subjects including patients with BPD and PDD as well as healthy controls were analyzed. The effect of CM (Childhood Trauma Questionnaire, CTQ) on behavior to social exclusion during Cyberball (ball tossing behavior) was analyzed including rejection sensitivity (RS) as a mediator. In the whole sample, the CTQ score (B = -.004, p < .05) as well as the emotional neglect subscore (B = -.016, p < .01) were associated with a reduced ball tossing behavior towards the excluder. There were no significant indirect effects involving RS. These current findings support the relationship between CM and an altered interpersonal response in critical interpersonal situations. Larger cohorts with multidimensional data in social domains are warranted to further investigate the link between CM and current interpersonal dysfunction.

Aggressive intentions after social exclusion and their association with loneliness

Both social exclusion and loneliness are aversive experiences that can lead to hostile behavioral reactions, including aggressive behavior. This study aimed to assess whether a social exclusion scenario in the subject's imagination elicits aggressive reactions towards an excluding person as measured with the hot sauce paradigm. Furthermore, we studied the effect of loneliness on such reactions. In total, 251 subjects (67.7% female; mean age 27.3 ± 9.3 years) participated in this study which was based on an online survey. After trait loneliness was assessed with the UCLA Loneliness scale at baseline, two imaginary scenarios were presented in randomized order, i.e., an exclusion condition (with one of two working colleagues excluding the participant from a social activity) and an inclusion condition (without exclusion). Following each scenario, participants had the task to allocate the amount of hot sauce to each colleague that they find appropriate. Participants distributed significantly more hot sauce to the excluder than to the includers. The amount of hot sauce was significantly correlated with loneliness for all includer interactions (i.e., after the inclusion as well as the exclusion scenario), but not for the interaction with the excluder. Our results support the hypothesis that social exclusion elicits aggressive behavior. Interestingly, the experience of loneliness seems to be associated with an increase in aggressive behavioral tendencies or a lack of their inhibition. The cognitive and/or emotional processes underlying the interplay between social exclusion, loneliness and aggression should be a focus of future research.

How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder

Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.

Aberrant social feedback processing and its impact on memory, social evaluation, and decision-making among individuals with depressive symptoms

BACKGROUND

Depression is associated with aberrant social feedback processing. However, little is known about the impact of these deficits on individuals' memory, social evaluation, and social decision-making.

METHODS

We examined event-related potentials (ERPs) during the processing of social feedback with different emotional valences and intensities, among individuals with high and low depressive symptoms. After three days, participants performed a recall test, along with social evaluation and money allocation.

RESULTS

Compared with the control group, participants with depressive symptoms showed larger occipital P1 and parietal P3 amplitudes to negative social feedback, as well as larger frontal feedback-related negativity toward highly positive social feedback; this indicates toward altered attentional allocation, encoding, and anticipation in social feedback processing. After three days of social feedback processing, individuals in the depressive symptom group recalled negative social feedback better and gave less positive evaluations and allocated less money to the senders of highly negative social feedback compared with control group participants. Notably, ERPs predicted subsequent memory, social evaluation, and decision-making, suggesting a significant impact of aberrant social feedback processing on social cognition and behaviors in depression.

LIMITATIONS

Individuals with depressive symptoms rather than patients with depressive disorders were recruited and therefore caution is needed in applying the findings to clinical populations.

CONCLUSIONS

Individuals with depressive symptoms exhibit negative bias in anticipation, attentional allocation, and encoding processes during social feedback processing, which further influences their memory, social evaluation, and social decision-making in the long run. These aberrant biases should be targeted to prevent the development of major depressive disorders.

Sequential Social Exclusion in a Novel Cyberball Paradigm Leads to Reduced Behavioral Repair and Plasma Oxytocin in Borderline Personality Disorder

Patients with borderline personality disorder (BPD) show interpersonal deficits, and altered emotional and oxytocin (OT) responses to social exclusion (Cyberball). In order to extend previous findings, this study applies a novel Cyberball variant. Nineteen BPD patients and 56 healthy controls (HC) played Cyberball for 2 minutes of inclusion, 5 minutes of partial exclusion by one of two co-players, and 2 minutes total exclusion by both. Plasma OT levels at baseline and after 7, 9, 15, and 40 minutes were measured with radioimmunoassay. BPD patients showed a greater aversive reaction and a trend for greater OT reduction after social exclusion than HC. BPD patients also tended to play less frequently with the excluder. Though limited by our sample size, we partially replicate previous findings. Our preliminary behavioral data support the notion of an altered OT regulation and reduced capacity for social cooperation in BPD.

Autonomic changes as reaction to experimental social stress in an inpatient psychosomatic cohort

OBJECTIVES

Patients with psychosomatic disorders suffer from social isolation that might further lead to destabilization and exacerbation of bodily symptoms via autonomic pathways. We aimed to investigate the influence of controlled social stress (model of social ostracism) on the autonomic nerve system (ANS) in an inpatient cohort with psychosomatic disorders.

METHODS

We examined heart rate variability (HRV), skin conductance (SC) and skin temperature (ST) as well as ECG-derived respiration rate (EDR) and subjective reports on stress during exposure to experimental social stress (cyberball game). Data were collected from 123 participants (f:m = 88:35, 42.01 ± 13.54 years) on admission and upon discharge from the university psychosomatic clinic. All data were recorded during baseline, inclusion and exclusion phases of the cyberball game as well as during the recovery phase.

RESULTS

We found significant changes between admission and discharge with a decline in parasympathetic-related HRV parameters (SDRR -3.20 ± 1.30 ms, p = 0.026; RMSSD: -3.77 ± 1.28 ms, p = 0.007) as well as a decrease in SC (-0.04 ± 0.17 μS, p = 0.019) and EDR (-0.01 ± 0.01 Hz, p = 0.007), suggesting a drop in sympathetic tonus, with no changes in ST (p = 0.089) and subjective stress levels (p = 0.322). HRV parameters decreased during the cyberball game (SDRR p = 0.026; RMSSD p = 0.002; lnHF p < 0.001). In contrast, both SC (p < 0.001) and EDR (p < 0.001) increased during the game with SC being slightly lower during the exclusion phase. This can point toward a stimulation of sympathetic nervous system during game participation, which was concordant with the rise in subjective stress values (p < 0.001). ST showed a continuous, unspecific rise over time (p < 0.001).

CONCLUSION

Our data demonstrate the decrease of ANS parameters during experimental social stress when data upon discharge were compared to those upon admission. These results are partially contradictory to previous studies that showed a rise in HRV in a psychiatric cohort over the course of (outpatient) treatment. Further research is required to help attributing these differences to effects of treatment or acute states relating to admission to or discharge from a psychosomatic department.

Altered immediate behavioral response to partial social exclusion: A cross-diagnostic study in patients with borderline personality disorder and persistent depressive disorder

Borderline personality disorder (BPD) and persistent depressive disorder (PDD) are related to interpersonal dysfunction which might become particularly apparent in situations of social exclusion (SE). While emotional responses to SE have been widely explored, behavioral data in clinical samples are lacking. In this cross-diagnostic study, we applied a variant of the Cyberball paradigm to investigate the dynamic behavioral response to partial SE in BPD and PDD. BPD patients (n = 36), PDD patients (n = 34) and age and gender matched healthy controls (HC) (total n = 70) played experimental (i.e. partial SE Cyberball) and control (i.e. inclusion only) conditions in randomized order. While all groups tended to increase ball tosses towards the excluder in response to SE, this behavioral turn was significantly lower in PDD (p = .03, d = -.30) and trendwise in BPD patients (p = .06, d = -.28). Thus, an altered immediate response to partial SE was observed in BPD and PDD, in addition to the emotional reactions. This study supports the hypothesis of a behavioral coping with SE in BPD and PDD that might be problematic in the long run and provides an experimental paradigm for future research on interpersonal dysfunction.

Autonomic vulnerability to biased perception of social inclusion in borderline personality disorder

BACKGROUND

Individuals with Borderline Personality Disorder (BPD) feel rejected even when socially included. The pathophysiological mechanisms of this rejection bias are still unknown. Using the Cyberball paradigm, we investigated whether patients with BPD, display altered physiological responses to social inclusion and ostracism, as assessed by changes in Respiratory Sinus Arrhythmia (RSA).

METHODS

The sample comprised 30 patients with BPD, 30 with remitted Major Depressive Disorder (rMDD) and 30 Healthy Controls (HC). Self-report ratings of threats toward one's fundamental need to belong and RSA reactivity were measured immediately after each Cyberball condition.

RESULTS

Participants with BPD showed lower RSA at rest than HC. Only patients with BPD, reported higher threats to fundamental needs and exhibited a further decline in RSA after the Inclusion condition.

CONCLUSIONS

Individuals with BPD experience a biased appraisal of social inclusion both at the subjective and physiological level, showing higher feelings of ostracism and a breakdown of autonomic regulation to including social scenarios.

Depressed and excluded: Do depressive symptoms moderate recovery from ostracism?

BACKGROUND

Prior studies show that depressed individuals react with more immediate reflexive need threat to ostracism than healthy controls. However, it remains unclear whether the observed difference between depressed individuals and healthy controls is caused by ostracism. To find out, the exclusion condition needs to be compared to a baseline condition: inclusion.

METHODS

We assessed depressive symptoms in N = 426 participants in an experimental study. Participants were included or excluded in Cyberball and indicated both their immediate reflexive need satisfaction level and their reflective need satisfaction level several minutes later to assess recovery.

RESULTS

Being excluded decreased reflexive need satisfaction levels for all participants. At the same time, the strength of depressive symptoms negatively predicted reflexive and reflective need satisfaction and was associated with slower recovery. Importantly, no moderation was observed: individuals with more depressive symptoms reported reduced need satisfaction levels regardless of being included or excluded in Cyberball.

LIMITATIONS

The present findings were obtained with one paradigm only, albeit the most commonly used one: Cyberball. Depressive symptoms were assessed as self-report; future studies may wish to replicate the effects using structured clinical interviews.

CONCLUSIONS

Depressive symptoms come with lowered need satisfaction levels, irrespective of whether individuals are socially excluded or included. Clinical practitioners should be aware of the relationship between chronic need threat and depression in order to help their patients overcome it.

Ostracism, Psychological Capital, Perceived Social Support and Depression among Economically Disadvantaged Youths: A Moderated Mediation Model

Mental health promotion of economically disadvantaged youths is a popular issue in current China. Economically disadvantaged youths are at greater risk of depression. Ostracism may be an important predictor of depression for them. However, no consensus has been reached on the underlying mechanism between ostracism and depression. A total of 1207 economically disadvantaged youths were recruited from six universities in China. These youths were asked to complete questionnaires measuring depression, ostracism, psychological capital, and perceived social support. A moderated mediation model was examined by using IBM SPSS STATISTICS 27macro program PROCESS version 3.5, in which psychological capital was a mediating variable, and perceived social support was a moderating variable. Lack of causal inferences and self-report bias due to the cross-sectional and self-report survey need to be considered when interpreting results. The results revealed that ostracism was positively associated with depression among economically disadvantaged youths. Psychological capital partially mediated the association. Perceived social support moderated the indirect association between ostracism and depression via psychological capital among economically disadvantaged females. Training and intentional practice of psychological capital could be the core to develop the depression interventions targeting economically disadvantaged youths with experience of ostracism. Gender and perceived social support need to be considered in developing the interventions.

Psychological Maltreatment and Loneliness in Adolescents: Social Ostracism and Affective Experiences

Psychological maltreatment is an important public health concern that has been linked with a variety of negative psychosocial consequences and adjustment problems in childhood to adulthood. The purpose of the current study sought to explore the direct and indirect associations between psychological maltreatment, social ostracism, affective experiences, and loneliness among high school Turkish adolescents. Participants were comprised of 791 adolescents attending three public high schools in Turkey. Students were mostly male with a mean age of 16.35 (SD = 1.09) years. Findings from the analyses indicated that social ostracism mediated the relationship between psychological maltreatment and both positive and negative affective experiences. Social ostracism and affective experiences mediated the effect of psychological maltreatment on adolescent feelings of loneliness. Results of the present study suggest that social ostracism and affective experiences are important mechanisms that may help to understand the impacts of psychological maltreatment on adolescent feelings of loneliness.

Treatment patterns and appropriateness of antipsychotic prescriptions in patients with schizophrenia

Schizophrenia is a chronic mental condition presenting a wide range of symptoms. Although it has a low prevalence compared to other mental conditions, it has a negative impact on social and occupational functions. This study aimed to assess the appropriateness of antipsychotic medications administered to schizophrenic patients and describe current treatment patterns for schizophrenia. A retrospective cohort study was conducted in all patients over the age of 15 with an active diagnosis of schizophrenia and treated with antipsychotics between 2008 and 2013 in the Valencia region. A total of 19,718 patients were eligible for inclusion. The main outcome assessed was inappropriateness of the pharmacotherapeutic management, including polypharmacy use. Altogether, 30.4% of patients received antipsychotic polypharmacy, and 6.8% were prescribed three or more antipsychotics. Overdosage affected 318 individuals (1.6%), and 21.5% used concomitant psychotropics without an associated psychiatric diagnosis. Women and people with a comorbid condition like anxiety or depression were less likely to receive antipsychotic polypharmacy. In contrast, increased polypharmacy was associated with concomitant treatment with other psychoactive drugs, and only in user on maintenance therapy, with more visits to the mental health hospital. Overall, we observed a high level of inappropriateness in antipsychotic prescriptions. Greater adherence to guidelines could maximize the benefits of antipsychotic medications while minimizing risk of adverse effects.

Stress-responses to ostracism: Examining cortisol and affective reactivity to in-person and online exclusion

Ostracism is associated with poor outcomes, but it is unclear if online versus in-person ostracism elicits divergent psychological and physiological responses. Participants (N = 54) were randomly assigned to online or in-person ostracism, and provided pre- and post-ostracism measures of affect, self-esteem, self-feelings, and salivary cortisol. No significant changes in negative affect, self-esteem, or self-feelings emerged, nor were there differences by ostracism condition. Both ostracism conditions decreased positive affect (stronger online) and lowered cortisol. Extending prior work, ostracism appears to reliably decrease positive affect (especially online) but may not be threatening to the self; moreover, ostracism may reliably elicit acute cortisol declines.

Development and validation of a new instrument to measure social pain

Social pain is an emotional reaction to social exclusion which has been widely investigated in experimental settings. We developed the Social Pain Questionnaire (SPQ) and examined its factor structure, reliability, and construct validity. We constructed a 46-item pool that covered a broad range of situations related to social pain. Using three different subsamples (Online convenience sample: n = 623, Representative sample: n = 2531, Clinical sample of outpatients seeking psychotherapy: n = 270) we reduced the item pool to 10 items for the final SPQ scale, paying particular attention to content validity and factorial structure. Convergent, divergent and discriminant validity were assessed using standardized measures of related constructs and group differences. For the final 10-item version, a good factorial structure and reliability were found. Convergent validity was supported by correlations with related instruments of interpersonal sensitivity, attachment styles, depression and social anxiety. The representative and clinical sample differed significantly in social pain. The SPQ is an economic self-report measure with solid psychometric properties. Our data support the factorial, construct and convergent validity. The SPQ can be used to clarify the role of social pain in mental disorders and to incorporate interventions targeted towards social pain in psychotherapeutic settings.

Processing of increased frequency of social interaction in social anxiety disorder and borderline personality disorder

We investigated how patients with social anxiety disorder (SAD) and patients with borderline personality disorder (BPD) process an increase in the frequency of social interaction. We used an EEG-compatible version of the online ball-tossing game Cyberball to induce an increase in the frequency of social interaction. In the first condition, each player received the ball equally often (inclusion: 33% ball reception). In the following condition, the frequency of the ball reception was increased (overinclusion: 45% ball reception). The main outcome variable was the event-related potential P2, an indicator for social reward processing. Moreover, positive emotions were assessed. Twenty-eight patients with SAD, 29 patients with BPD and 28 healthy controls (HCs) participated. As expected, HCs and patients with BPD, but not patients with SAD, showed an increase in the P2 amplitude from the inclusion to the overinclusion condition. Contrary to our expectations, positive emotions did not change from the inclusion to the overinclusion condition. EEG results provide preliminary evidence that patients with BPD and HCs, but not patients with SAD, process an increase in the frequency of social interaction as rewarding.

High Rejection Sensitivity in Patients With Somatoform Pain Disorder

Objective: Rejection sensitivity (RS) is often associated with mental disorders but as yet has not been investigated in patients with somatoform pain disorder (SPD). The aim of the study was to explore the degree of RS in patients with SPD compared to healthy controls. In addition, we examined factors associated with RS and the moderator effect of SPD. Methods: A total of 65 patients with SPD (confirmed by Structured Clinical Interview, SCID-I) and 65 age- and gender-matched healthy controls participated. Rejection Sensitivity Questionnaire (RSQ), Patient Health Questionnaire (PHQ-9, PHQ-15), Relationship Scale (ReSQ), Essen Trauma Inventory (ETI) and the Childhood Trauma Questionnaire (CTQ) were applied. Multiple linear regression analysis was performed. Results: The level of RS was significantly higher in patients with SPD compared to healthy controls (M = 10.30, SD = 5.64; M = 6.13, SD = 2.50; p < 0.001; d = 0.95). Higher levels of depressive symptoms (p < 0.001), childhood adversities (p < 0.001) and the insecure attachment style (p = 0.007) were related to higher levels of RS. No significant moderation effect was detected. Conclusions: Patients with SPD are highly sensitive to social rejection. In addition, insecure attachment styles as well as depressive symptoms and childhood adversities are strongly associated with RS. Further studies are needed to figure out how RS is connected to SPD over lifetime.

Brain responses to social feedback in internalizing disorders: A comprehensive review

Problems with interpersonal relationships are often a chief complaint among those seeking psychiatric treatment; yet heterogeneity and homogeneity across disorders suggests both common and unique mechanisms of impaired interpersonal relationships. Basic science research has begun yielding insights into how the brain responds to social feedback. Understanding how these processes differ as a function of psychopathology can begin to inform the mechanisms that give rise to such interpersonal dysfunction, potentially helping to identify differential treatment targets. We reviewed 46 studies that measured the relationship between brain responses to social feedback and internalizing psychopathology. We found that socially relevant anxiety was associated with amygdala hyperactivity to the anticipation of social feedback. Depression was related to hyperreactivity of regions in the cingulo-opercular network to negative social feedback. Borderline personality disorder (BPD) was associated with hyperactivity of regions in the default mode network to negative social feedback. The review also identified key insights into methodological limitations and potential future directions for the field.

Socio-affective processing biases in severe alcohol use disorders: Experimental and therapeutic perspectives

Previous literature has consistently reported socio-affective information processing impairments in patients with severe alcohol use disorder (SAUD). Some recent studies have also suggested that these patients might exhibit biases toward stimuli indicating social threat, such as angry or disgusted faces. Such biases have been largely documented in other psychopathological disorders like anxiety, where they play a critical role in the emergence and maintenance of the disorder. A comprehensive understanding of these biases in SAUD would thus deepen the understanding of interpersonal difficulties and relapse-related factors. However, to date, no study has directly explored these biases in SAUD. In order to initiate efforts to address this issue, we first review preliminary evidence supporting the hypothesis of biased processing of social threat in SAUD. Then, we identify possible pathways through which such biases might negatively impact the course of the disorder. Finally, we provide precise recommendations and available materials to develop research in this promising field, and underline the related theoretical and clinical perspectives.