Feeling unsafe in one's own body : the impact of illness on psychological safety and social engagement

The concept of neuroception of psychological safety, rooted in Polyvagal Theory, offers a framework for understanding how individuals perceive safety at a physiological and psychological level. Illness may disrupt this perception, affecting bodily regulation, emotional resilience, social connection, and self-compassion. This study aimed to ex-plore how experiences of being unwell, across both acute and chronic contexts, affect individuals’ neuroception of psychological safety. Semi-structured interviews were conducted with eleven adult participants aged 20–79, including individuals with both acute and chronic illness experiences. Interview questions were informed by the Neu-roception of Psychological Safety and Polyvagal Theory. Data were analysed using re-flexive thematic analysis, following Braun and Clarke’s six-step process. Four key themes were identified: dysregulation and the narrowing window of tolerance (re-duced emotional resilience and heightened bodily sensitivity); distrust and disap-pointment (a rupture in bodily and self-trust); responsibility and internalised guilt (moral and emotional burdens around illness and recovery); and illness demands at-tention and disrupts social connection (withdrawal, emotional depletion, and com-promised compassion). Across themes, participants described a diminished sense of psychological safety when unwell, shaped by both internal physiological changes and altered social dynamics. Illness can profoundly undermine psychological safety by disrupting neurobiological regulation, altering relational engagement, and eroding trust in one’s body and self. These findings highlight the importance of integrating psychological safety principles into models of care, particularly in how individuals experience and recover from illness.