title: Pain Processing after Social Exclusion and Its Relation to Rejection Sensitivity in Borderline Personality Disorder.
abstract: OBJECTIVE
  There is a general agreement that physical pain serves as an alarm signal for the prevention of and reaction to physical harm. It has recently been hypothesized that "social pain," as induced by social rejection or abandonment, may rely on comparable, phylogenetically old brain structures. As plausible as this theory may sound, scientific evidence for this idea is sparse. This study therefore attempts to link both types of pain directly. We studied patients with borderline personality disorder (BPD) because BPD is characterized by opposing alterations in physical and social pain; hyposensitivity to physical pain is associated with hypersensitivity to social pain, as indicated by an enhanced rejection sensitivity.
  
  
  METHODS
  Twenty unmedicated female BPD patients and 20 healthy participants (HC, matched for age and education) played a virtual ball-tossing game (cyberball), with the conditions for exclusion, inclusion, and a control condition with predefined game rules. Each cyberball block was followed by a temperature stimulus (with a subjective pain intensity of 60% in half the cases). The cerebral responses were measured by functional magnetic resonance imaging. The Adult Rejection Sensitivity Questionnaire was used to assess rejection sensitivity.
  
  
  RESULTS
  Higher temperature heat stimuli had to be applied to BPD patients relative to HCs to reach a comparable subjective experience of painfulness in both groups, which suggested a general hyposensitivity to pain in BPD patients. Social exclusion led to a subjectively reported hypersensitivity to physical pain in both groups that was accompanied by an enhanced activation in the anterior insula and the thalamus. In BPD, physical pain processing after exclusion was additionally linked to enhanced posterior insula activation. After inclusion, BPD patients showed reduced amygdala activation during pain in comparison with HC. In BPD patients, higher rejection sensitivity was associated with lower activation differences during pain processing following social exclusion and inclusion in the insula and in the amygdala.
  
  
  CONCLUSIONS
  Despite the similar behavioral effects in both groups, BPD patients differed from HC in their neural processing of physical pain depending on the preceding social situation. Rejection sensitivity further modulated the impact of social exclusion on neural pain processing in BPD, but not in healthy controls.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Bungert
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Georgia
authors.initials: G
authors.lastname: Koppe
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Niedtfeld
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Vollstädt-Klein
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schmahl
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Lis
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bohus
mesh_terms: D000328:Adult; D000679:Amygdala / Q000503:physiopathology*; D001883:Borderline Personality Disorder / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology*; D005260:Female; D005717:Games, Experimental; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D008279:Magnetic Resonance Imaging; D010146:Pain / Q000503:physiopathology*; D058748:Pain Perception / Q000502:physiology*; D017288:Pain Threshold; D012929:Psychological Distance; D020886:Somatosensory Disorders / Q000209:etiology / Q000503:physiopathology; D013315:Stress, Psychological / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013788:Thalamus / Q000503:physiopathology*; D018910:Video Games; D055815:Young Adult