Antecedents and consequences of social and physical pain

Pain overlap theories (Eisenberger & Lieberman, 2004; MacDonald & Leary, 2005) suggest that the detection of social threats has mapped onto the pre-existing neurological circuitry used to signal physical pain. Supporting this assumption, several studies have found that social pain activates brain regions known for their role in processing the unpleasantness of physical pain (e.g., Eisenberger, Lieberman & Williams, 2003). In this dissertation, considering the amount of physiological evidence for common brain responses to social and physical pain, I examine whether and how social and physical pain overlap in their psychological antecedents and consequences. I first consider fear of pain as a common antecedent. In the medical literature on physical pain, the fear of pain—compared with other potential variables—emerges as one of the most relevant predictors of the perception of pain. Study 1a assesses whether fear of social and physical pain reflect unitary psychological dimensions related to, but still distinct from, each other. Study 1b investigates whether both fear of social and physical pain are associated with measures conceptually related to one of them. The findings show that fears of social and physical pain are two related—yet distinct—psychological dimensions. Likewise, I show that dimensions traditionally associated with fear of one type of pain have some degree of overlap with fear of the other type of pain. Then, to test a common antecedents hypothesis, Study 1c replicates previous findings, showing that the fear of physical pain can enhance the perception of physical pain. Likewise, I examine whether fear of social pain can enhance the perception of social pain. Study 1d shows that individuals with higher fear of social pain perceive social threats as more painful. Aside from supporting the common antecedents hypothesis, the present results also suggest a specificity effect in that each fear is able to predict its associated type of pain. Indeed, it emerges that fear of social and physical pain uniquely predict the perception of their associated pain. Taken together, these studies suggest that fear of pain play a significant role in accounting for why individuals vary in pain perception of social and physical threats. Second, I examine whether social and physical pain overlap in the psychological consequences, specifically the threat of basic human needs (i.e., belonging, control, meaningful existence, self-esteem). Study 2a shows that recalling a past physical pain episode can be associated with memories of low self-esteem, poor control, and greater aggressive temptations, similar to recalling a socially painful episode. In Study 2b, a currently inflicted experience of pain results in lowering satisfaction on all the four needs tested for both physical and social pain and worsening affect, besides confirming the increase in aggressive temptations. It also emerges that both social and physical pain lead to feeling ignored and excluded. I also test a differential strength hypothesis which argues a greater need threat effect of social versus physical pain on the basic needs tested. In Study 2a, the intensity of pain associated with episodes of social and physical pain does not differ; nevertheless, social pain is associated with lower need satisfaction than physical pain. In Study 2b, even though participants in the physical pain condition report higher pain scores than those in the social pain condition, social pain still has a greater impact on need satisfaction. Moreover—providing convergent evidence of the specific tenacity of social pain—participants assigned to the social pain conditions not only report higher feeling of needs frustration, but they are also more tempted to act in ways to restore their frustrated needs. These results add evidence to the pain overlap theories, and suggest new ways to understand and manage pain. Finally, moving from the empirical evidence provided across these six studies, I contend the overlap between social and physical pain extends beyond acute episodes, by proposing an integrative theoretical model that outlines the most relevant antecedents and consequences of the experiences of chronic social and physical pain. In terms of antecedents, my model suggests that both frequent and/or intense past painful events and insecure attachment styles are associated with the insurgence of persistent social and physical pain. Then, I propose that the same pattern of overlapping cognitive, affective and behavioral processes is involved in the maintenance of both types of pain. Specifically, I show how—at both the social and physical level—catastrophic appraisals of pain can give rise to pain-related fears that may in turn be associated with avoidance and disuse. In terms of consequences, the model focuses on the detrimental effect chronic pain has on individuals’ ability to self-regulate. Both forms of pain impair self-regulation on four fundamental domains: cognition, emotion, motivation, and interpersonal regulation. Additionally, both forms of pain persistently threaten four fundamental human needs: belonging, control, self-esteem, and meaningful existence. Implications for chronic pain conditions, as well as for the social psychological research and theories on pain are discussed.