SummaryBackgroundThe experience of social exclusion represents an extremely aversive and threatening situation in daily life. The present study examined the impact of social exclusion compared to inclusion on steroid hormone concentrations as well as on subjective affect ratings.MethodsEighty subjects (40 females) participated in two independent behavioral experiments. They engaged in a computerized ball tossing game in which they ostensibly played with two other players who deliberately excluded or included them, respectively. Hormone samples as well as mood ratings were taken before and after the game.ResultsSocial exclusion led to a decrease in positive mood ratings and increased anger ratings. In contrast, social inclusion did not affect positive mood ratings, but decreased sadness ratings. Both conditions did not affect cortisol levels. Testosterone significantly decreased after being excluded in both genders, and increased after inclusion, but only in males. Interestingly, progesterone showed an increase after both conditions only in females.DiscussionOur results suggest that social exclusion does not trigger a classical stress response but gender-specific changes in sex hormone levels. The testosterone decrease after being excluded in both genders, as well as the increase after inclusion in males can be interpreted within the framework of the biosocial status hypothesis. The progesterone increase might reflect a generalized affiliative response during social interaction in females.

Positive self-evaluation is a major psychological resource modulating stress coping behavior. Sex differences have been reported in self-esteem as well as stress reactions, but so far their interactions have not been investigated. Therefore, we investigated sex-specific associations of self-esteem and stress reaction on behavioral, hormonal and neural levels. We applied a commonly used fMRI-stress task in 80 healthy participants. Men compared to women showed higher activation during stress in hippocampus, precuneus, superior temporal gyrus (STG) and insula. Furthermore, men outperformed women in the stress task and had higher cortisol and testosterone levels than women after stress. Self-esteem had an impact on precuneus, insula and STG activation during stress across the whole group. During stress, men recruit regions associated with emotion and stress regulation, self-referential processing and cognitive control more strongly than women. Self-esteem affects stress processing, however in a sex-independent fashion: participants with lower self-esteem show higher activation of regions involved in emotion and stress regulation, self-referential processing and cognitive control. Taken together, our data suggest that men are more engaged during the applied stress task. Across women and men, lower self-esteem increases the effort in emotion and stress processing and cognitive control, possibly leading to self-related thoughts in stressful situations.

High alexithymic traits and psychiatric comorbidities such as depression and social phobia are frequently observed among adults with autism spectrum disorder. In this study, we tested whether alexithymic and/or autistic traits are risk factors for depressive and social phobic symptoms in adults with autism spectrum disorder ( n = 122), patients with social interaction difficulties other than autism ( n = 62), and neurotypical participants ( n = 261). Multiple regression analyses of these three groups demonstrated that both traits explained considerable variance of depressive and social phobic symptoms. In adults with autism spectrum disorder, alexithymic traits were predictive of depressive symptoms, while autistic traits predicted social phobic symptoms. In patients with social interaction difficulties other than autism, alexithymic and autistic traits were identified as predictors of social phobic symptoms, while no variable predicted depressive symptoms. In neurotypicals, both alexithymic and autistic traits were predictive of depressive and social phobic symptoms. Our results, therefore, highlight the importance of assessing both alexithymic and autistic traits in patients with and without autism spectrum disorder for identifying comorbid psychopathology. Depending on the underlying core symptomatology, alexithymic and/or autistic traits increase the risk of depressive and social phobic symptoms calling for therapeutic strategies to prevent or at least reduce comorbid psychopathology. Lay abstract Adults with autism often develop mental health problems such as depression and social phobia. The reasons for this are still unclear. Many studies found that alexithymia plays an important role in mental health problems like depression. People with alexithymia have difficulties identifying and describing their emotions. Almost every second person with autism has alexithymia. Therefore, we explored in this study whether alexithymia is linked to worse mental health in autistic people. We looked at two common diagnoses, depression and social phobia. We found that alexithymia increased symptoms of depression, while autistic traits increased symptoms of social phobia. Our results suggest that alexithymia and autistic traits can increase the risk of mental health problems. An early assessment could help prevent mental health problems and improve quality of life.

Difficulties in emotion perception are commonly observed in autism spectrum disorder. However, it is unclear whether these difficulties can be attributed to a general problem of relating to emotional states, or whether they specifically concern the perception of others' expressions. This study addressed this question in the context of pain, a sensory and emotional state with strong social relevance. We investigated pain evaluation in self and others in 16 male individuals with autism spectrum disorder and 16 age- and gender-matched individuals without autism spectrum disorder. Both groups had at least average intelligence and comparable levels of alexithymia and pain catastrophizing. We assessed pain reactivity by administering suprathreshold electrical pain stimulation at four intensity levels. Pain evaluation in others was investigated using dynamic facial expressions of shoulder patients experiencing pain at the same four intensity levels. Participants with autism spectrum disorder evaluated their own pain as being more intense than the pain of others, showing an underestimation bias for others' pain at all intensity levels. Conversely, in the control group, self- and other evaluations of pain intensity were comparable and positively associated. Results indicate that emotion perception difficulties in autism spectrum disorder concern the evaluation of others' emotional expressions, with no evidence for atypical experience of own emotional states.