Pain Expectation in Individuals With High Autistic Traits: Decision–Evaluation Processes and Oxytocin Modulation

Abstract

Pain reflects both sensory input and predictive processes shaped by expectations. Individuals with high autistic traits (HATs) often exhibit atypical pain responses, potentially due to alterations in anticipatory processing. This study investigated pain anticipation in HAT individuals and examined the modulatory effects of oxytocin using behavioral, computational, and pharmacological approaches. In experiment 1, HAT and low autistic trait (LAT) individuals completed a cue-based pain anticipation task. Anticipatory processing was characterized through two components: decision-related processes and evaluative responses. HAT individuals showed altered decision-making, characterized by greater caution under uncertainty and reduced processing efficiency under certain high-pain conditions. They also exhibited more negative evaluative responses, which were associated with poorer psychological health. In experiment 2, HAT participants received intranasal oxytocin or placebo. Oxytocin selectively influenced decision-related processes under uncertainty, increasing evidence accumulation and reducing nondecision time while also increasing the tendency to choose high-pain outcomes under ambiguous conditions. In contrast, oxytocin showed limited effects on evaluative measures. These findings suggest that pain anticipation in HAT individuals involves partially distinct decision-related and evaluative components and that oxytocin exerts process-specific effects on anticipatory processing.