Is Social Pain Real Pain?

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Does being burned by negative feedback physically hurt? Do broken hearts actually feel broken? Do actions that hurt our feelings cause real pain, or is psychological pain just an analogy? Is it a linguistic coincidence that when our psyche hurts, we use "pain" words to describe how we feel?

These questions are no longer just for philosophers and poets to entertain. Scientists now have some answers, thanks to new technology. We know that rejection and isolation are painful to our social brains. In fact, compromising any valuable social connection feels “painful.” Naomi Eisenberger of UCLA found that the neural circuitry for physical and social pain overlap (1). Her lab demonstrated this overlap from a variety of converging methodologies — behavioral, genetic, and neuroimaging.

A physical pain experience has two components (2). The first is a sensory component — for example, “having throbbing pain in lower right leg that lasts for a few minutes.” So, it includes location, intensity, and duration. The other component is affective — the emotional side of pain. Being in pain does not "feel" good and evokes emotions that reflect that inner state, such as sadness, anger, or fear. It is not surprising that a person suffering from chronic pain might also develop depression and/or anxiety. These secondary conditions can intensify and prolong physical pain. But depression can also induce its own pain. In other words, depression hurts, even in the absence of any preceding physical pain, and has been associated with somatic symptoms such as general body pain (3).

One way to demonstrate that the body and mind feel pain the same way is to look for shared activation in the brain. Of particular interest is the second component, the emotional aspect of physical pain. Many fMRI studies have shown that the distressing unpleasant feelings of physical pain are processed in the dorsal anterior cingulate cortex (dACC) and the anterior insula (AI) (4).

The important question here is: Does social/psychological pain activate these same areas, dACC and AI? That is exactly what Eisenberger’s lab found over a series of studies (5). To induce social pain in participants as they remained still in the fMRI scanner, the researchers had them play a “Cyberball” computer game, tossing a virtual ball to other players. The participant was sometimes included in the Cyberball game and other times excluded — similar to being rejected from a social group. And in fact, being excluded from the game was associated with increased activation in the dACC and the AI, the very same areas involved in physical pain. Similar results have since been shown in other studies conducted in different labs (6).

How did the researchers know that participants felt rejected when they did not get the virtual ball? They asked them; and the stronger a participant felt social pain (e.g., "I felt meaningless"), the greater the activity in the brain areas associated with the affective component of physical pain. This positive correlation between greater activity in the dACC and/or anterior insula and greater self-reported social distress in response to social exclusion was also found in subsequent studies (7).

Do different people react differently to social pain? Are some more sensitive?

Absolutely. The amount of social support available during a socially painful event reduces activity in these brain pain-related areas (8). Another study showed an increased sensitivity in dACC and AI to social distress in people who crave acceptance and who look out for cues that signal any possible chance of rejection (also known as the anxious attachment style) (9).

There are also individual differences that stem from genetic variations in processing physical pain. For example, a polymorphism in an opioid receptor gene has been shown to be associated with physical pain sensitivity. Individuals who carry the rare G allele have a higher sensitivity to physical pain and require more pain medication to deal with pain (10).

Are carriers of the G allele also more sensitive to social pain?

That is exactly what a study found: Participants who carried the G allele scored higher on a measure of sensitivity to rejection and showed greater activation in the dACC and AI during the social exclusion game compared to those who did not carry the G allele (11).

Yes, social pain is real pain.

This explains why people under social distress might self-medicate with alcohol, prescription medications, illicit drugs, or even unhealthy relationships. In fact, in one study, researchers found that when participants took Tylenol over a three-week period, they reported less hurt over that period compared to those who took a placebo. Moreover, participants who took Tylenol showed less activation in the dACC and AI to social rejection in an fMRI study compared to those who took a placebo (12).

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This shared brain circuitry for social and physical pain has implications for education, work, and relationships. When children are bullied by exclusion and rejection, they are truly in pain. When co-workers frequently exclude colleagues from lunch invitations, it does hurt. Receiving rejection feedback at work, school, or from parents really hurts. Children might medicate by the natural reaction to protect themselves, aggression against attacker. And of course, the aggression might be turned inward and manifest as a mental illness. Some minority groups may find themselves excluded from mainstream society; others may share the same experience as a byproduct or belonging to a low socioeconomic class. And they remain in pain...