Effects of social exclusion on dissociative states and pain perception in university students at suicide risk: A virtual reality study

Introduction: Most recent theories of suicide view increased pain tolerance as a key risk factor for suicidal behavior. In recent work, we integrated these models with meta-analyses on pain hypersensitivity in suicide, neuropsychoanalytic studies on hypo- and hyperarousal responses to early relational trauma, and evidence of dissociative vs. hypervigilant subtypes in PTSD. Hence, we hypothesized the existence of two profiles in suicide risk: a dissociative vs. a pain hypersensitive profile. This study aims to examine dissociative and non-dissociative responses, as well as changes in pain perception, face to interpersonal stress (i.e. social exclusion) and their relationships with suicide-related history, trait dissociation and trauma. Methods: University students are being recruited to participate in a VR version of the Cyberball Game, a validated social exclusion paradigm. Inclusion and exclusion conditions are presented on different days to each participant, in counterbalanced order. On the first day, students complete a self-report adaptation of the Columbia-Suicide Severity Rating Scale (C-SSRS), the Dissociative Experiences Scale (DES-II), and the Traumatic Experiences Checklist (TEC). Before and after each condition, state dissociation, heat-pain threshold and subjective heatpain ratings are assessed, respectively, through the Cambridge Depersonalization Scale – state version (CDS-S) and a computer-controlled thermal stimulator. Results (expected): Individuals with suicide-related history (i.e. recent SI, or lifetime SP, NSSI or SA) are expected to exhibit greater increases in state dissociation following the exclusion condition compared with individuals without such a history. Higher DES and TEC scores are expected to associate with greater increases in state dissociation after exclusion. Patterns of hypo- or hypersensitivity to pain in response to social exclusion will also be explored in relation to suicide-related history, dissociative traits and traumatic experiences. Conclusions: Findings could inform person-centered approaches to suicide-risk prevention by accounting for individual differences in dissociative and pain perception patterns of response face to interpersonal stress.