Brown (
2004) presents another multicomponent model for the development and maintenance of MUS. He proposes that MUS constitute an alteration in body image generated by “rogue representations” in the cognitive system. This model is based on a hierarchical cognitive model of attentional control proposed by Norman and Shallice (
1986). Norman and Shallice described a higher level executive control system, the supervisory attentional system that, for the greater part, is localised in the prefrontal cortex. This system monitors ongoing activity and modulates behaviour when established automatic routines are not sufficient, for instance, in novel situations. Automatic routines are in their turn controlled by a hierarchical lower level control process, involving a series of well-learned behavioural units or schemata that can be activated by environmental and contextual stimuli through a decentralised and semi-autonomous process called “contention scheduling”.
In Brown’s integrated model, MUS arise when the lower level attentional process of contention scheduling selects rogue representations, which can be any kind of information concerning the nature of physical symptoms. These rogue representations can be acquired from many different sources, including personal exposure to a serious physical state (e.g. during periods of physical illness, or through traumatic experiences), exposure to physical states in others (e.g. abnormal levels of illness in the family environment), but also through sociocultural transmission or verbal suggestion. These experiences create memory traces that are functionally similar to those generated when the same symptoms are experienced in the self. The rogue representation selected by the primary attention system leads to the activation of the secondary attention system which involves selective attention to physical sensations, disease-confirming information and negative affect. These secondary attention processes facilitate reactivation of the rogue representation in the memory system (see also Rief & Broadbent,
2007).
