Differential neural processing of social exclusion in adolescents with non-suicidal self-injury: An fMRI study

Abstract

Non-suicidal self-injury (NSSI) is highly prevalent in adolescence and has been suggested as an autonomous diagnosis in the Diagnostic and Statistical Manual (DSM-5). Social rejection is as potential risk-factor for NSSI and depression in adolescence. Objectives of this study were to identify differences in neural processing of social rejection in depressed adolescents with and without co-morbid NSSI and healthy controls. Participants were 28 depressed adolescents (14 with co-morbid NSSI, 79% females) and 15 healthy controls, with an average age of 15.2 years (SD=1.8). Social exclusion was implemented using the Cyberball paradigm 'Cyberball' during functional magnetic resonance imaging (fMRI). All participants reported feelings of social exclusion after fMRI scanning. Investigating the effects of NSSI, we found that depressed adolescents with NSSI showed relatively enhanced activation of the medial prefrontal cortex (mPFC) and the ventrolateral prefrontal cortex (vlPFC) compared to depressed adolescents without NSSI and also compared to healthy controls. Results point towards divergent processing of social exclusion in depressed adolescents with NSSI as compared to adolescents with mere depression in brain regions previously related to the processing of social exclusion. This finding of distinct neurophysiological responses may stimulate further research on individual treatment approaches.

I Want You to Want Me: Interpersonal Stress and Affective Experiences as Within‐Person Predictors of Nonsuicidal Self‐Injury and Suicide Urges in Daily Life

“…Our results also indicate that feeling rejected, excluded, abandoned, or left out is more strongly predictive of subsequent NSSI urges than feeling insulted or criticized and that this relationship is at least partially mediated by changes in internalizing negative affect. Previous research at the between‐persons level has yielded mixed results with respect to whether individuals with a history of NSSI are, on average, more sensitive to rejection than individuals with no such history (Groschwitz, Plener, Groen, Bonenberger, & Abler, ; Schatten, Andover, & Armey, ); our findings suggest that regardless of one's overall propensity to experience negative affect following rejection, increases in perceived rejection at the within‐person level are associated with increased odds of NSSI urges among high‐risk individuals. This finding is consistent with prior work suggesting that having fewer close relationships predicts worse SITB outcomes, such as moving from NSSI to suicidal behaviors (Whitlock et al., ), and suggests that identifying strategies to cope with or prevent experiences of rejection or exclusion may be important tools for those at high risk of NSSI.…”

Non-suicidal Self-Injury in Adolescence

“…Another study focusing on socially stressful situations investigated differences in the neural processing of social exclusion using functional magnetic resonance imaging (fMRI). In this study, Groschwitz et al [49•] found differentiated processing of social exclusion in depressed adolescents with NSSI as compared to adolescents with mere major depression and healthy controls. Those differences were mainly prevalent in the medial prefrontal cortex (mPFC) and the ventrolateral prefrontal cortex (vlPFC), which might point towards adolescents with NSSI being more affected by social exclusion.…”

“I just finally wanted to belong somewhere”—Qualitative Analysis of Experiences With Posting Pictures of Self-Injury on Instagram

“…On the other hand, the role of peer-and family related loneliness in association with NSSI has been described in several studies (22,23). Furthermore, social exclusion and bullying have shown to be riskfactors for NSSI (24,25), with emerging neurobiological evidence of adolescents with NSSI to be more sensitive to social exclusion than their peers (26). The need to belong might therefore be one keyfactor for adolescents posting NSSI content online.…”