Loneliness and susceptibility to social pain mediate the association between autistic traits and psychotic experiences in young non-clinical adults

Understanding of the mechanisms involved in the occurrence of psychotic experiences (PEs) in highly autistic individuals is crucial for identifying appropriate prevention and intervention strategies. This study aimed to investigate the mediating role of susceptibility to social pain and loneliness in the relationship between autistic traits (ATs) and PEs in adults from the general population of 12 Arab countries. This cross-sectional study is part of a large-scale multi-country research project. A total of 7646 young adults (age range 18-35 years, mean age of 22.55 ± 4.00 years and 75.5% females) from twelve Arab countries (i.e., Algeria, Bahrain, Egypt, Iraq, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Oman, Palestine, and Tunisia) were included. Mediation analyses showed that, after adjusting over confounding variables, both loneliness (indirect effect: Beta = 0.18; Boot SE = 0.02; Boot CI 0.14; 0.21) and social pain (indirect effect: Beta = 0.03; Boot SE = 0.01; Boot CI 0.001; 0.05) partially mediated the association between ATs and PEs. Higher ATs were significantly associated with more loneliness and susceptibility to social pain, and directly associated with more severe PEs. Finally, higher loneliness and susceptibility to social pain were significantly associated with greater PEs scores. Findings indicated that individuals with higher ATs tend to experience greater loneliness and feel more pain from rejection, which can in turn be associated with higher levels of PEs. Interventions targeting susceptibility to social pain and loneliness as a means of mitigating PEs among highly autistic adults should be considered.