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The pain of social disconnection: examining the shared neural underpinnings of physical and social pain

Key Points

  • Observational evidence has highlighted similarities between physical pain and 'social pain' — the painful feelings associated with actual or potential damage to social bonds. Thus, experiences of social rejection or loss are often described with physical pain words ('hurt feelings' and 'broken heart'), and both physical and social pain are highly noxious experiences.

  • Research on the neurochemical substrates of physical and social pain has demonstrated that both rely on opioid processes. Thus, opiates, which are potent analgesics, have also been shown to reduce separation distress behaviours in animals.

  • Neuroimaging research has demonstrated that experiences of social exclusion predominantly activate the dorsal anterior cingulate cortex (dACC) and anterior insula (AI) — regions known to have a role in the distressing experience of physical pain.

  • In addition, several lines of research have shown that experiences of negative social evaluation, rejection from a romantic partner and bereavement also lead to activity in the dACC and AI. A few studies have also shown neural activity in regions associated with the sensory component of pain (posterior insula); additional research will be needed to determine the types of social pain that elicit sensory-related processing.

  • On the basis of the shared neural circuitry associated with physical and social pain, research has shown that individuals who are more sensitive to one kind of pain are also more sensitive to the other. Thus, greater physical pain experience or sensitivity is associated with greater social pain sensitivity (rejection sensitivity or anxious attachment).

  • Another consequence of a physical–social pain overlap is that factors that alter one type of pain have a similar effect on the other. For example, social support, which is known to reduce social pain, can also reduce physical pain, and Tylenol (paracetamol; Johnson and Johnson), which is known to reduce physical pain, can also reduce social pain.

  • On the basis of the role of the dACC and AI in responding to socially painful experience, these regions may be crucial for translating experiences of social disconnection into downstream physiological responses, which have implications for health. Indeed, the dACC and AI may have a mediating role in the links between social rejection and both inflammatory activity and depression.

Abstract

Experiences of social rejection, exclusion or loss are generally considered to be some of the most 'painful' experiences that we endure. Indeed, many of us go to great lengths to avoid situations that may engender these experiences (such as public speaking). Why is it that these negative social experiences have such a profound effect on our emotional well-being? Emerging evidence suggests that experiences of social pain — the painful feelings associated with social disconnection — rely on some of the same neurobiological substrates that underlie experiences of physical pain. Understanding the ways in which physical and social pain overlap may provide new insights into the surprising relationship between these two types of experiences.

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Figure 1: Cortical substrates of the affective and sensory components of physical pain.
Figure 2: Neural responses to social exclusion.
Figure 3: Model depicting the functional consequences of a physical–social pain overlap.

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Acknowledgements

I am grateful to M. Lieberman, S. Taylor, M. Irwin and the members of the Social and Affective Neuroscience Laboratory for their helpful comments on earlier versions of this review.

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Correspondence to Naomi I. Eisenberger.

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Glossary

Isolation calls

A type of distress vocalization produced by infant mammals in response to separation from a caregiver. These vocalizations function to facilitate reunion with the caregiver.

Cyberball

A virtual ball-tossing game that can be used to induce social inclusion or exclusion, depending on the behaviour of the other virtual players (whether they toss the ball to the participant).

Anxious attachment

A style of relating to close others characterized by a heightened concern about being abandoned by close others and therefore an exaggerated sensitivity to signs of acceptance or rejection by others.

Avoidant attachment

A style of relating to close others characterized by an avoidance of seeking out support or closeness from others.

Rejection sensitivity

The tendency to anxiously expect, readily perceive and intensely react to experiences of social rejection.

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Eisenberger, N. The pain of social disconnection: examining the shared neural underpinnings of physical and social pain. Nat Rev Neurosci 13, 421–434 (2012). https://doi.org/10.1038/nrn3231

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