(Vienna, 17 June 2026) A recent study by the Medical University of Vienna shows that social exclusion has measurable effects on stress regulation and attentional processes in adolescents with nonsuicidal self-injurious behaviour. Following experimentally induced rejection, the adolescents exhibited persistently reduced heart rate variability – indicating a diminished ability of the autonomic nervous system to regulate stress responses. At the same time, the way in which images relating to self-injury on social media were perceived by the affected adolescents changed. The findings, published in the journal Translational Psychiatry, once again underscore the importance of protective measures in the digital space.
Researchers led by Oswald Kothgassner from the Department of Child and Adolescent Psychiatry at MedUni Vienna have already demonstrated in earlier studies that digital content can trigger or provoke the urge to self-injure in affected adolescents. It was previously unclear what role social stressors such as exclusion, rejection or bullying play in this context. To investigate this question, the research team studied 50 adolescents exhibiting nonsuicidal self-injury (NSSI).
As part of an experiment, participants were randomly assigned either to take part in a realistic ball game or to be deliberately excluded from it. The subsequent comprehensive measurements and surveys show that social exclusion did not directly lead to a stronger subjective urge to self-injury. At a physiological level, however, a clear effect was observed immediately: socially excluded adolescents exhibited persistently lower heart rate variability – an indication of the autonomic nervous system’s reduced ability to regulate its response to stressors.
16 to 22 per cent of adolescents affected
The consequences of impaired stress regulation became apparent when confronted with self-injury-related content: after viewing relevant images, stress and the urge to self-injure increased more sharply among socially excluded adolescents than among included study participants. Attention processes also changed: following social exclusion, adolescents were less likely to focus their initial attention on images related to self-injury. However, in a subsequent reaction time task, it became apparent that they found it more difficult to shift their attention away from these images.
"Our study shows that social rejection does not always have to be immediately and consciously experienced as increased stress. However, it measurably alters physical stress regulation and can contribute to later triggers – such as images of self-injury on social media – having a stronger effect," says lead author Andreas Goreis from the Department of Child and Adolescent Psychiatry at MedUni Vienna, summarising the findings.
"Particularly following conflicts, exclusion or rejection, distressing online content can become especially problematic for young people with self-injurious behaviour," says study leader Oswald Kothgassner. "Prevention and therapy should therefore take into account both social stressors and how to deal with self-injury-related content on social media." Furthermore, the findings once again underscore the importance of protective measures in the digital space.
According to international studies, 16 to 22 per cent of adolescents are affected by nonsuicidal self-injurious behaviour. The most common methods include cutting, scratching, hitting, burning the skin and biting. Participants in the current study reported an average of 115 episodes within a year, with the average age at first occurrence being around 12 years.
Publication: Translational Psychiatry
Social Exclusion Alters Attention and Autonomic Regulation in Adolescents with Nonsuicidal Self-Injury.
Andreas Goreis, Annika Lozar, Rosa List, Sofia-Marie Oehlke, Bettina Pfeffer, Karin Prillinger, Diana Klinger, Heidi Zesch, Peter B. Marschik, Laurence Claes, Paul L. Plener, Oswald D. Kothgassner.
doi:10.1038/s41398-026-04136-w
https://www.nature.com/articles/s41398-026-04136-w
The study was conducted as part of the TORN project and funded by the Austrian Science Fund (FWF): 10.55776/KLI963.