Special Issue: Experiencing Well-Being
Modeling and controlling the body in maladaptive ways: 
an active inference perspective on non-suicidal 
self-injury behaviors
Barca Laura *, Domenico Maisto, Giovani Pezzulo
Institute of Cognitive Sciences and Technologies, National Research Council, Via San Martino della Battaglia 44, Rome 00185, Italy
*Corresponding author. Institute of Cognitive Sciences and Technologies, National Research Council, Via San Martino della Battaglia 44, Rome 00185, Italy.
E-mail: laura.barca@istc.cnr.it
Abstract 
A significant number of persons engage in paradoxical behaviors, such as extreme food restriction (up to starvation) and non-suicidal 
self-injuries, especially during periods of rapid changes, such as adolescence. Here, we contextualize these and related paradoxical 
behavior within an active inference view of brain functions, which assumes that the brain forms predictive models of bodily variables, 
emotional experiences, and the embodied self and continuously strives to reduce the uncertainty of such models. We propose that not 
only in conditions of excessive or prolonged uncertainty, such as in clinical conditions, but also during pivotal periods of developmental 
transition, paradoxical behaviors might emerge as maladaptive strategies to reduce uncertainty—by “acting on the body”— soliciting 
salient perceptual and interoceptive sensations, such as pain or excessive levels of hunger. Although such strategies are maladaptive 
and run against our basic homeostatic imperatives, they might be functional not only to provide some short-term reward (e.g. relief 
from emotional distress)—as previously proposed—but also to reduce uncertainty and possibly to restore a coherent model of one’s 
bodily experience and the self, affording greater confidence in who we are and what course of actions we should pursue.
Keywords: non-suicidal self-injuries; intolerance of uncertainty; interoception; adolescence; active inference
© The Author(s) 2023. Published by Oxford University Press.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which 
permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction
Why do some persons engage in paradoxical behaviors, such 
as extreme food restriction (up to starvation) and non-suicidal 
self-injuries (NSSIs)? These and other pathological behaviors 
are transversal to various psychopathological conditions. Self-
destructive actions including self-harm have been associated 
with post-traumatic stress disorder (Moeller et al. 2001, Yehuda 
2002, Weiss et  al. 2015 , Zelkowitz et  al. 2023 ), eating disor-
ders (Sagiv and Gvion 2020 ), and borderline personality disorder 
(
Reichl and Kaesset, 2021). Whether paradoxical behaviors as NSSI 
have a common origin across such and other conditions remains 
to be systematically tested, which is particularly challenging 
as—in most cases—they can only be assessed using retrospec-
tive measures, rather than measured during their occurrence or 
induced experimentally. Although they are typically associated 
with some form of psychopathology, they are not exclusive to
clinical conditions but might also be transiently acted by non-
clinical individuals. For example, self-injury behaviors are not 
uncommon during adolescence and progressively decrease in 
adulthood (
Laugesen et al. 2003, Nock et al. 2009, Thielsch et al. 
2015, Osmanagaoglu et al. 2018).
Scholars from a variety of disciplines have questioned why peo-
ple intentionally harm themselves (either by starving or cutting), 
proposing various theoretical models empirically tested over time 
(Chapman et al. 2006, Nock and Mendes 2008a, Nock et
 al. 2009, 
Wolff et al. 2019), but we still lack a mechanistic understanding 
of such behaviors. Here, we propose that despite starvation and