Social Pain Sensitivity in Autistic Adults: Associations With Gender, Self-Esteem, Cognitive Empathy, and Sensory Sensitivity.

Social pain sensitivity refers to the tendency to detect and react strongly to cues of social exclusion. Frequent social adversities and specific characteristics may make individuals with autism more sensitive to social pain, yet evidence remains inconsistent. To enhance our understanding, autistic adults aged ≥ 16 years (n = 1425; Mage = 47.3, SD = 14.2) and allistic adults (n = 187; Mage = 51.4, SD = 14.6) enrolled in the Netherlands Autism Register (NAR) completed the Social Pain Questionnaire (SPQ). A two-way ANOVA demonstrated that autistic adults reported significantly higher social pain sensitivity than allistic adults, with a small effect size (η2 p = 0.02). Women reported higher social pain sensitivity than men across both groups (η2 p = 0.01), and this gender difference was comparable for autistic and allistic adults. Within the autistic group, in a subset of participants with complete data (n = 234), a hierarchical multiple regression analysis showed that social pain sensitivity was moderately associated with lower self-esteem (β = -0.47), but not with cognitive empathy or sensory sensitivity. Exploratory analyses further indicated that self-esteem fully accounted for the association between autism diagnosis and social pain sensitivity. Consistent with sociometer theory, these results suggest that heightened social pain sensitivity in autistic adults may reflect reduced perceived social acceptance. Our findings highlight the relevance of social adversities for autistic adults and underscore the need for supports that strengthen belonging and reduce socially painful experiences.