Pain-provoking behaviour as a driven reaction to psychological distress: the bio-psycho-social neurotic loop model

In clinical psychology and psychiatry, different complaints are generally perceived as problems with a different ethiology, despite the fact that it can also be hypothesised that they share the same dimension. We believe that many clinicians share the heuristic insight that a pure categorical approach to psychopathology underscores the potential value of a dimensional approach. The neurotic loop model attempts to explain how pain-provoking behaviour develops and how it persists, increases and expands in spite of continuing negative consequences. Pain-producing behaviour is postulated as a neurobiologically rooted reaction to the activation of distressing representations. In biologically vulnerable people, pain-provoking behaviour channels stress resulting from disturbing emotions. This behaviour will initially be very rudimentary and may become more sophisticated according to the operant history. In this way, the neurotic loop model postulates pain-provoking behaviour on a continuum from simple muscle contractions to more complex self-injurious behaviour. Negative consequences of pain-provoking behaviour will reactivate the distressing representations, resulting in a driven vicious circle: the neurotic loop. The model integrates the most influential models of learning theory with neurobiology and developmental aspects. The neurotic loop model attempts to provide insight into the dynamics of dysfunctional pain-provoking behaviour and yields implications for therapy.