Modeling and controlling the body in maladaptive ways  3
the affectivity attributed to the others might also be perceived 
as vague and misinterpreted (e.g. “Is he/she interested in me or 
not?” “Am I a person worthy of attention and love from oth-
ers?”). Bodily illusions, such as the “rubber hand illusion” (Suzuki 
et al. 2013, Crucianelli et al. 2018) and the “enfacement illu-
sion” (Sforza et al. 2010, Tajadura-Jiménez et al. 2012), provide 
compelling evidence for the malleability of self-other bound-
aries as a function of bodily information and of interoceptive
sensibility.
Dealing with these ambiguous situations could be particu-
larly challenging and distressing for a person with no adaptive 
strategies to reduce uncertainty. Therefore, in these (admittedly 
extreme) conditions, even maladaptive strategies such as star-
vation that reduce uncertainty and render bodily and interocep-
tive stimuli more salient might become more appealing (see also
Linson et al. 2020). In other words, while starvation would still be 
considered paradoxical—in the sense that it runs against the “util-
itarian” imperative of ensuring well-being and survival—it might 
play a functional role for an organism that simultaneously tries 
to “maximize utility and minimize uncertainty,” as assumed by 
active inference.
In this article, we propose that NSSI and other kinds of paradox-
ical behaviors might also be conceptualized in similar ways, i.e. as 
other cases in which a person intentionally changes her bodily 
and interoceptive sensations, in order to reduce excessive bodily 
and interoceptive uncertainty (but also more broadly to modulate 
affective and physiological states that are otherwise dysregulated, 
e.g. to decrease the excessive intensity of bodily sensations in 
hyperarousal).
In the next sections, we first discuss NSSI behaviors by focusing 
on the fact that they might occur in non-clinical individuals. We 
will highlight that this could be not only especially the case dur-
ing adolescence—a period of life during which people experience 
various kinds of uncertainties (e.g. their bodies, the self, their 
social status, and interpersonal relationships), but also more spec-
ulatively during other periods of life associated with substantial 
changes and uncertainty, such as the perimenopause–menopause 
transition period in women. Then, in the subsequent section, 
we introduce the main tenets of active inference by focusing on 
its proposed mechanisms for interoceptive processing and uncer-
tainty reduction. Finally, we discuss how the active inference 
framework might help conceptualize NSSI as a possible strategy 
to reduce uncertainty; for example, the uncertainty that some 
(non-clinical populations of) adolescents might strive to cope with 
during their transition to adulthood.
Paradoxical behaviors: the case of NSSI
“Self-injury behaviors” is an umbrella term that includes a wide 
range of behaviors (and intentions), including suicide attempts, 
superficial cuts, and medication withdrawals (Skegg 2005, Nock 
2010). We focus on NSSI behaviors as the direct, deliberate 
destruction 
of body tissue without lethal intent (e.g. cutting one-
self). A distinction is also made between NSSI performed stereo-
typically in the context of developmental disabilities (e.g. head 
banging) and major injuries often observed in psychotic disorders. 
The most frequent examples of NSSI include cutting the skin with 
a sharp object (e.g. a knife, razor blade, or needle) and skin burn, 
usually with a cigarette (Khanipour et  al. 2016). Patients often 
injure themselves, in a single act, by inflicting multiple injuries 
at the same body site, usually in areas that are easily hidden 
but accessible (e.g. forearms and anterior thighs). The behavior 
is often repeated, resulting in extensive scarring patterns. The age 
of onset of NSSI tends to be early adolescence, between 12 and 
14 years of age, and the behavior appears to decline after young