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PHYSIOLOGICAL RESPONSES TO
EXPERIENCES OF SOCIAL PAIN
SALLY S. DICKERSON
Children who are consistently teased or ostracized, or are always the last
ones chosen for the team; people who make fools of themselves in public presentations, or are ridiculed by superiors; and individuals who are put down,
criticized, or rejected by relationship partners or because they possess devalued characteristics or social stigmas often experience social evaluative threat
(SET), which occurs when the self could be negatively judged by others
(Dickerson & Kemeny, 2004). Social evaluative experiences can lead to social
painthe emotional response to the perception that one is being excluded,
rejected, or devalued by a significant individual or group (MacDonald &
Leary, 2005). A growing body of evidence suggests that SET is accompanied
by specific physiological responses, including changes in the cardiovascular,
neuroendocrine, and immune systems (e.g., Dickerson, 2008; Dickerson,
Gruenewald, & Kemeny, 2004). Therefore, social evaluative events that
induce social pain are capable of eliciting not only intense emotional responses
but physiological responses as well. Though the acute experience of social pain
may produce short-term changes in physiological parameters, more chronic or
prolonged experiences could result in dysregulation of physiological systems,
which could lead to negative health outcomes.
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http://dx.doi.org/10.1037/12351-003
Social Pain: Neuropsychological and Health Implications of Loss and Exclusion,
edited by G. MacDonald and L. A. Jensen-Campbell
Copyright 2011 American Psychological Association. All rights reserved.
SALLY S. DICKERSON
are aspects of social pain because they are part of the emotional response to
exclusion or devaluation by others (MacDonald & Leary, 2005); thus, social
evaluative experiences, which induce self-conscious emotional states, are therefore also experiences of social pain. Consequently, the physiological effects of
SET also could be categorized as the physiological effects of social pain.
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conversation period that nobody wants to work with you on a subsequent task
(i.e., rejection condition) showed elevated cortisol levels compared with participants who were told that everyone wanted to work with them (i.e., acceptance
condition). This result is aligned with earlier findings from a Stroud and colleagues (Stroud, Tanofsky-Kraff, Wilfley, & Salovey, 2000) study, in which
women who were increasingly ignored and ostracized by two confederates during a getting to know you discussion task showed increases in cortisol, which
demonstrated that negative interpersonal interactions characterized by rejection
can activate the cortisol system. It is interesting that this cortisol response to
social rejection was observed primarily among women (Stroud, Salovey, & Epel,
2002), with men showing little to no cortisol reactivity. This finding suggests
that women may be particularly sensitive or responsive physiologically to experiences of social pain. However, there were no differences between men and
women in cortisol responses to social rejection in the Blackhart et al. (2007)
study, which indicates that future research on gender differences is warranted.
Other research has looked at cortisol responses to social rejection in
children. Gunnar, Sebanc, Tout, Donzella, and van Dulmen ( 2003) obtained
sociometric assessments of peer rejection by having 3- to 5-year-olds nominate their classmates who they especially liked and did not like at preschool;
salivary cortisol samples were collected during the school day. Those who
were more disliked (e.g., peer rejected) had higher levels of cortisol compared
with the other more socially accepted children, which indicates that rejection is capable of increasing cortisol activity among young children as well.
Social evaluative and hostile communication patterns within the context
of close relationships have also been examined to test the effects of conflict on
physiological parameters. When married couples are asked to discuss a major
problem in their relationship in the laboratory, wives who are on the receiving
end of criticism, disapproval, and other social evaluative and rejecting behaviors show increases in HPA activity, including elevations in ACTH and cortisol levels (Kiecolt-Glaser et al., 1997; Malarkey, Kiecolt-Glaser, Pearl, &
Glaser, 1994). This effect has been observed among both newlywed samples
(Malarkey et al., 1994) and older adults who have been married on average
more than 40 years (Kiecolt-Glaser et al., 1997). It is interesting that in both
samples of married couples, the effect of abrasive communication styles during
conflict emerged only among women, mirroring the gender differences in the
physiological effects of social rejection reviewed earlier, which again suggests
women may be more physiologically vulnerable under conditions of social pain.
Summary and Future Directions: Cortisol and Social Pain
A body of evidence now demonstrates that social evaluative and rejecting contexts provide one set of conditions capable of eliciting cortisol responses.
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This has been shown using a variety of different paradigms, ranging from social
evaluative laboratory performance tasks to incidents of rejection, ostracism, or
conflict. In addition, cortisol responses to SET and rejection have been documented across the life span, from preschool-age children (e.g., Gunnar et al.,
2003) to older adults (e.g., Kiecolt-Glaser et al., 1997). However, the vast
majority of these studies have been conducted in the laboratory (cf. Gunner
et al., 2003; Rohleder et al., 2007); future research should examine how SET
and rejection influence cortisol reactivity in more naturally occurring situations. Studies that use daily diary methodology and salivary cortisol assessment
could examine these important questions of generalizability. In addition, few
studies have examined SET within ongoing interpersonal relationships (cf.
Kiecolt-Glaser et al., 1997) but instead have used strangers or new acquaintances to induce evaluation or rejection in the participants. It will also be
important to continue to examine these processes as they unfold in developing
and established interpersonal relationships.
Furthermore, studies should continue to explore the affective correlates
of cortisol reactivity. The self-conscious emotions associated with social pain,
which are elicited under SET, may be linked to cortisol responses; a growing
number of studies have reported a correlation between self-conscious cognitive and emotional responses and cortisol activity (Dickerson, Mycek, &
Zaldivar, 2008; Gruenewald et al., 2004; Lewis & Ramsay, 2002). In addition,
more general measures of distress or negative emotion have not been associated with cortisol responses (e.g., Dickerson & Kemeny, 2004), which suggests
a specific association between the self-conscious emotions and cortisol under
SET. Taken together, these studies provide evidence that the conditions that
trigger social pain trigger increases in cortisol, and the emotions associated
with social pain are linked with this physiological response.
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1993). These changes are typically observed rapidly (e.g., upon initiation of
the stressor) and tend to dissipate quickly after the threat is removed (e.g.,
fast recovery), especially when compared with cortisol trajectories in similar
situations. Besides social evaluative performance stressors, other types of
social threats can elicit cardiovascular reactivity as well; social rejection or
hostile social conflict can also lead to elevations in heart rate and blood pressure (e.g., Kiecolt-Glaser et al., 1993; Stroud et al., 2000).
Although SET can certainly increase cardiovascular parameters, the
effects appear to not be as specific to SET compared with cortisol. In the
Gruenewald et al. (2004) study, there were increases in heart rate, SBP, and
DBP under both SET and non-SET conditions; in other words, participants
showed cardiovascular reactivity regardless of whether they were alone in a
room or in front of an evaluative audience. This effect was recently replicated
in a study using similar methodology (Dickerson, Gable, Irwin, Aziz, &
Kemeny, 2009). However, the Gruenewald et al. (2004) study found that cortisol was elicited only under the SET condition. This suggests that the cardiovascular system may be responsive to a wide variety of different stressful
situations, whereas other parameters, such as cortisol, may be more sensitive
to the social milieu of the threat. Nevertheless, it is clear that experiences of
social pain often elicit increases in heart rate and blood pressure along with
activation of the HPA axis.
Although both social and nonsocial stressors may elicit increases in cardiovascular markers, the magnitude of the experience of social pain may moderate responses to social threat. For example, the Gruenewald et al. (2004)
study found marginally greater increases in heart rate and blood pressure
among those in the SET condition (although both conditions showed
increases), which suggests that greater social pain translated into a stronger
cardiovascular response. This finding is similar to findings of greater increases
in cardiovascular reactivity under conditions in which the evaluative nature
of the task is emphasized (T. W. Smith, Nealy, Kircher, & Limon, 1997) or
when others act in nonsupportive ways (e.g., conveying boredom or disinterest, directly disagreeing, or undermining the participant; Gerin, Pieper, Levy,
& Pickering, 1992; Lepore, Allen, & Evans, 1993; Sheffield & Carroll, 1994).
In addition, when couples engage in a problem discussion task, the more hostile, socially painful interactions result in greater blood pressure reactivity
(Kiecolt-Glaser et al., 1993), and hostile verbal exchanges have been linked
with increases in blood pressure among female hypertension patients (Ewart,
Taylor, Kraemer, & Agras, 1991).
Taken together, this research demonstrates that cardiovascular parameters such as heart rate and blood pressure often increase with experiences of
social pain, and the severity or gravity of the experience may be related to the
magnitude of these responses. Future research should continue to examine
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