Social connectedness is fundamentally important for human development, health and survival (Gilbert, 2016). Common experience in everyday life shows how events such as losing close relationships (e.g., breakup), and being devalued by, or excluded from desired relationships can trigger distressing and challenging emotional responses. Universally, such negative social experiences, or socially disconnecting events, are often described as being “painful” and as resulting in “emotional scars”, “hurt feelings”, “broken hearts” and “injury” (Eisenberger, 2015; MacDonald & Leary, 2005). These subjective descriptions were confirmed by accumulating evidence showing that when social connectedness is threatened, a pain-like experience may occur, which is designated as social pain. The concept of social pain refers to the affective response (that is, painful feelings) triggered by social exclusion, rejection or loss; it has therefore been often used to characterize the reactions to threats for the need to belong (Baumeister & Leary, 2017). On the other hand, the social-physical pain overlap theory (Eisenberger et al., 2003) stipulates that being socially rejected or excluded poses similar serious threats to survival as being physically injured. This theory has found empirical support in several neuroscientific studies, which showed that the same biological systems and neural circuits that process physical pain also underlies the distressing experience of social pain (Eisenberger, 2012, 2015; Rotge et al., 2015).
Social disconnection and subsequent pain can have profound repercussions on human health and behaviour throughout the lifespan (DeWall & Baumeister, 2006). Indeed, a body of evidence has shown that experiences of social pain could lead to physiological dysregulations, including alterations in the functioning of the immune system and heightened levels of hypothalamic-pituitary-adrenal axis activation; this, in turn, could lead to adverse health outcomes (Dickerson, 2011). In particular, social pain is linked to elevated rates of physical and mental health problems (DeWall & Baumeister, 2006), as well as increased money spending (Baumeister et al., 2008). Social pain was also found to increase sensitivity to physical pain (Eisenberger et al., 2006). The pain that comes with the actuality or possibility of losing social bonds and relationships seems to increase the likelihood of depression in adolescents (Slavich et al., 2014), and to precipitate the onset of major depression (Slavich et al., 2009) and social anxiety (Fung & Alden, 2017) in adults. Additionally, socially rejected or excluded individuals display a decrease in self-regulatory ability and overall cognitive functioning, an increase in aggressive and self-destructive behaviours (such as procrastination and risk-taking) (DeWall & Baumeister, 2006; Mendes & Jamieson, 2012), and lower levels of self-esteem (Sepehrinia et al., 2024; Yanagisawa et al., 2011). Finally, previous research indicated that social rejection/exclusion is significantly associated with a greater increase in paranoid beliefs and psychotic-like symptoms in both clinical and non-clinical populations (Lincoln et al., 2018; Pillny & Lincoln, 2020; Sundag et al., 2018). In light of these findings, it can be assumed that investigating social pain may aid in the detection and management of its multiple closely related clinical conditions. It is therefore crucial to measure the social pain construct using robust tools that enable mental health professionals and researchers to better identify and understand them.
Studies on the relationship between social pain and psychopathology have mostly adopted either the experimental cyberball paradigm or self-report measures. The cyberball task assesses social pain based on the needs-threat model (Williams et al., 2000; Zadro et al., 2004), which proposes that social exclusion is a threat to four fundamental needs, i.e. meaningful existence, control, self-esteem, and belonging. However, this approach has methodological problems that limit the validity of its findings, including a questionable construct validity and inconsistent correlations with other measures evaluating diverging needs (Gerber et al., 2017). Besides, the need-threat scale reflects a short-term emotional response to experiencing exclusion in the cyberball game, which is a particular situation that does not necessarily mirror a consistent response tendency to feel social pain in various situations. As for self-report measures, they encompass the Interpersonal Sensitivity Measure (IPSM; (Boyce & Parker, 1989)), the Adult Rejection Sensitivity Questionnaire (ARSQ; (Berenson et al., 2009)), and the Hurt Feelings Scale (HFS; (Leary et al., 1998)). The IPSM does not focus specifically on emotional reactions to social rejection, but also covers a wide range of other interpersonal situations, including dependency, shyness, anxiety, self-criticism, and susceptibility to critique (Boyce & Parker, 1989). The ARSQ reflects negative emotional reactions towards anticipated, rather than actually experienced, social rejection situations (Berenson et al., 2009). In addition to these limitations, the theoretical relationship of the IPSM or the ARSQ to social pain has proven to be unclear, and their original dimensional structure was not supported in later studies (Harb et al., 2002; Innamorati et al., 2014). Unlike the IPSM and the ARSQ, HFS’s items were designed to specifically cover emotional components of social pain; however, its psychometric characteristics have not been systematically tested and remain unknown (Stangier et al., 2021).
To bridge these gaps, Stangier et al. (Stangier et al., 2021) have recently developed and validated a self-report instrument, i.e. the Social Pain Questionnaire (SPQ), to specifically assess the construct of perceived social pain. The scale’s items were created based on the background of both the belongingness theory (Baumeister & Leary, 2017) and the social-physical pain overlap theory (Eisenberger et al., 2003). The SPQ is composed of 10 items loading on a single factor, and scored on a five-point Likert type scale ranging from 0 (“Applies not at all to me”) to 4 (“Applies exactly to me”). A sample item is “It hurts my feelings if somebody denies a request of me”. In the original validation study, the SPQ demonstrated solid psychometric properties in German outpatients seeking psychotherapy and healthy individuals, including good factorial structure and excellent reliability (Stangier et al., 2021). Convergent validity was supported by significant positive moderate correlations with interpersonal sensitivity, ambivalent-worry attachment, depression, general psychopathological symptoms and paranoid ideation. The SPQ also showed good discriminant validity as evidenced by higher levels of social pain exhibited by patients with depression, social anxiety disorder and personality disorders as compared to patients with other diagnoses (other anxiety disorders and trauma-related disorders) (Stangier et al., 2021). More recently, the SPQ was translated to the Persian language and validated in a sample of Iranian adults from the general population, where it showed a one-dimensional construct, excellent internal consistency, divergent and convergent validity as revealed through correlations between the SPQ and measures of self-esteem, perceived social support, and interpersonal sensitivity (Sepehrinia et al., 2024). The psychometric properties of the SPQ have also been examined in German adolescents aged 14 to 20 years, where it showed a unidimensional factor structure and high internal consistency (Schwarz et al., 2021). To date, there is no validated version of the SPQ suitable for use in Arabic-speaking populations.
Rationale
To our knowledge, there is currently no valid instrument available in the Arabic language to measure the social pain construct. In addition, we could find no previous studies that evaluated social pain in Arabic-speaking individuals of Arab origin. This is a clear gap, especially given the evidence that emotional responses to social rejection vary across cultures, with people from individualistic societies (i.e. UK) being more capable of regulating the negative emotional reactions elicited by social exclusion than those from collectivistic, group-oriented cultural backgrounds (i.e. China) (He et al., 2021). One plausible explanation is that collectivistic cultures value groups over individuals, and put more emphasis on the relationships and social connection in the group (Cho & Yoon, 2001). In such cultural contexts, social exclusion may be experienced with greater difficulty and distress to the individual (Kanetsuna et al., 2006). Therefore, it is of utmost importance to consider the role of culture in how people react emotionally to social exclusion when developing prevention and intervention strategies across diverse populations. To this end, the use of culturally tailored measurement tools is essential. The present study proposes to examine the psychometric properties of an Arabic translation of the SPQ in Arabic-speaking adults from the general population of different Arab countries. By exploring the validity, reliability, and factor structure of the SPQ in Arab countries from the Middle East-North Africa (MENA) region, it is possible to determine whether any changes are required to enhance the scale’s psychometric properties before it can be used in these different cultural contexts. It is expected that the Arabic version of the SPQ will replicate the originally proposed single-factor structure in both sexes and all countries, and will have good internal consistency reliability as well as adequate convergent and divergent validity. Depression, anxiety, psychotic experiences, and self-esteem were chosen for the establishment of convergent and divergent validity on the basis of their close theoretical relationship to social pain.