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Pain lies at the interface of sensory and cognitive\u2013affective processing, encompassing both perceptual sensitivity and appraisal of pain\u2010related experiences. Yet, how pain catastrophizing, a pain\u2010specific cognitive\u2013affective pattern characterized by rumination, magnification, and helplessness, relates to depressive severity and neurophysiological dynamics during adolescence remains poorly understood. In this cross\u2010sectional case\u2013control study, we recruited 140 participants aged 12\u201323 years with and without MDD and investigated behavioral and electrophysiological correlates of pain\u2010related cognitive\u2013affective dysregulation using clinical assessments and resting\u2010state electroencephalography (EEG). Structural equation modeling revealed a significant indirect association between pain catastrophizing and depressive severity through anxiety, highlighting anxiety\u2010related processes within this relationship. Compared with healthy controls, adolescents with MDD exhibited increased \u03b4\u2010 and \u03b8\u2010band power and altered EEG microstate dynamics, characterized by greater temporal involvement of microstate B, reduced temporal persistence of microstate D, and increased bidirectional B\u2013C transitions. EEG\u2010informed path models further linked microstate features to the indirect relationship between pain catastrophizing, anxiety, and depressive severity. Together, these findings identify convergent behavioral and neurophysiological correlates of pain\u2010related cognitive\u2013affective dysregulation and highlight dynamic EEG features for further investigation in adolescent MDD.<\/jats:p>","DOI":"10.1111\/nyas.70421","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:16:00Z","timestamp":1791479760000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neurophysiological Correlates of Pain\u2010Related Cognitive\u2013Affective Dysregulation in Adolescent Depression"],"prefix":"10.1111","volume":"1564","author":[{"given":"Hong","family":"Li","sequence":"first","affiliation":[{"name":"Department of Psychiatry First Hospital\/First Clinical Medical College of Shanxi Medical University  Taiyuan Shanxi China"},{"name":"Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder First Hospital 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