Developing and testing a novel neuroscience hypothesis for the psychogenesis of disordered body image and agency in relationally disordered patients

Patients with severe Personality Disorders (PD) present with co-morbid conditions, eating disorders, psychosomatic disorders, autistic traits and substance misuse. These complex presentations lead to long term hospitalisation. Symptom specific specialist services are ill- equipped to address such trans-diagnostic problems. A new psychotherapeutic approach the Relational Affective Model has been developed for severe PD patients based on a novel psychoanalytic and neuroscientific Relational Affective Hypothesis (RAH). This hypothesis links early relational adversity with narcissistic defences giving rise to disordered interpersonal relating and relating to the body. An associated neural Implicit Psychogenesis Hypothesis (IPH), proposes unconscious narcissistic conflicts lead to adjustments in precision in the Internal Generative Model of the Minimal Self and consequently a disordered sense of body ownership and agency in patients with narcissistic disorders (Personality Disorders). This change at the neural level results in eating disorders and functional motor disorders respectively. Together these two hypotheses explain how psychological defences give rise to somatic symptoms. In this thesis the hypotheses are critically evaluated alongside existing models of eating disorders and functional motor disorders. Study findings are presented in four domains, symptoms, describing the clinical characteristics of participants, developmental trajectories describing predisposing and precipitating factors, disorders in Self Other Distinction investigated using a behavioural Emotional Egocentricity Bias task and finally the fMRI findings which were investigated using the Interpersonal Relations Picture Set paradigm. The findings lend support to the RAH and IPH identifying the role of unconscious psychological conflicts in disrupting Self-Other Distinction and reduced activation in brain region implicated in the sense of body ownership in patients with eating disorders and sense of agency in patients with functional motor disorders. The implications of these findings for our understanding of the relationship between mind and body and the development of new therapeutic interventions for patients with psychosomatic presentations are discussed.