Ho, Yingying; (2024) A mentalizing-based approach to the understanding of functional somatic disorders in the context of romantic relationships. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The term Functional Somatic Disorders (FSD) is often used to describe persistent, somatic symptoms in which patients show dysregulation in neurobiological systems and neural circuits related to fatigue and pain processing. These heterogeneous symptoms significantly impact personal well-being and public health due to their association with high levels of disability. This thesis investigates, from an interpersonal-systemic perspective, the interplay between attachment styles, mentalizing capacities, and FSD symptom severity within romantic relationships using a mixed-methods approach. A quantitative study involving 74 Taiwanese couples examined associations between attachment styles, mentalizing impairments, and FSD severity. Within each couple, the individual reporting a higher level of FSD symptoms was considered the 'index person', and the other individual was referred to as the 'partner'. The findings revealed significant associations between insecure attachment, mentalizing impairments, and the severity of FSD symptoms. Importantly, the index person's mentalizing impairments mediated the association between both partners’ attachment anxiety and the index person's FSD symptom severity. The index person's mentalizing impairments also mediated the association between their own attachment avoidance and FSD symptom severity. Moreover, from a person-centered perspective, distinct subgroups characterized by specific attachment and mentalizing patterns were identified, highlighting the complex interplay between these variables and FSD severity in romantic couples. Complementing the quantitative findings, qualitative interviews with nine couples in which the index person experienced elevated FSD symptoms, provided important new insights into the lived experiences of couple dynamics associated with FSD symptoms within couples. In particular, findings further emphasized the importance of understanding FSD symptoms within the context of romantic relationships, as evidenced by findings concerning the dyadic nature of mentalizing and the reciprocal influence of each partner's attachment style and mentalizing capacity in shaping their symptom-related experiences. Overall, the studies reported in this PhD thesis suggest a key role for reciprocal interactions between attachment and mentalizing within couples and the significant impact these dynamics may have on FSD symptoms. These findings suggest that therapeutic interventions targeting interpersonal aspects could enhance treatment outcomes for individuals with FSDs. Directions for future research are discussed together with the limitations of the studies reported in this PhD thesis.

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