1997, Liotti 2004
 , 2006, F onagy et al. 2023).
During infancy, a child starts making sense of her internal 
experiences through the information she gets from the external 
world, most notably from caregivers whose behavior has a fun-
damental regulatory function shaping emotional development, 
stress physiology, and refinement of limbic circuitry (Gee 2016). 
In addition to the quality of caregivers’ response to the infant’s 
need for proximity, its “predictability” supports the development 
of emotions’ regulatory capacity (Gee and Cohodes 2021; Wu and 
Feng 2020) and a cohesive sense of self (Arciero and Bondolfi 
2009), increases prosociality (Deneault 
 et al. 2023), and influ-
ences the development of social brain structure (see Ilyka et al. 
2021 for a review). Self-report assessment of exposure to unpre-
dictability 
during early life appears to predict symptoms of anx-
iety, depression, and anhedonia in adulthood (Glynn et al. 2019). 
Evidence from cross-species studies indicates that the predictabil-
ity of caregivers’ behavior in rodents may specifically influence 
the offspring’s development of corticolimbic circuitry involved in 
emotion-related functioning (Glynn and Baram 2019). Rodents 
exposed to unpredictable maternal care exhibit atypical amygdala 
functioning (Malter Cohen et  al. 2013) and weaker connectivity 
with the medial prefrontal cortex (Guadagno et al. 2018).
Abraham et al. (2019) evaluated a number of features of the 
neurobiological interoceptive circuit (e.g. the functionality of the 
amygdala, insula, and oxytocinergic system) in parents and chil-
dren over the first 6 years of parenthood. Results revealed a critical 
association between parental interoceptive sensitivity—indexed, 
e.g. by increased bilateral activation of the anterior insula in 
response to a video of his/her interacting with his/her infant—
the consolidation of the child’s interoceptive circuit and mental 
health. Taken together, thus, consistent evidence indicates that 
parental ability to respond appropriately to the children’s needs 
and bodily signals supports the child’s ability to adequately repre-
sent his/her internal bodily states, concurring in the development 
of self-processes (Fotopoulou and Tsakiris 2017 , Ciaunica et al. 
2021a, 2021b). The degree of predictability of caregivers’ response 
appears to be critical for the development of affect regulation 
and a cohesive sense of the self (Ilyka et  al. 2021). When care-
givers’ behavior is less reliable, children have more difficulties in 
distinguishing their own internal states, making self-other dis-
tinctions (Ogawa et al. 1997, Dutra et al. 2009), and—in the most 
severe cases—developing an integrated sense of the self (Liotti 
2004, 2006).
As 
a consequence of these or other deficits in developing 
appropriate models of emotional and self-models, a person might 
experience significant interoceptive uncertainty and perceive her 
own internal states in confused and uncomfortable ways later 
in life. Suppose that the interoceptive channels are unreliable 
and the internal models rooted in bodily experiences are poor. 
In that case, a person might construe a sense of personal stabil-
ity through external, non-interoceptive signals, such as feedback 
from others and from the world, rather than via interoceptive 
signals. Engaging in social interactions, in which we experience 
affective states relevant to our self-confirmation (e.g. a sense 
of acceptance and kindness), might be particularly challenging 
for this person ( Guidano 1987, Arciero and Bondolfi 2009 ). While 
interacting with others, she might experience ambiguous bodily 
and emotional states. She might be unable to reduce this uncer-
tainty using the other as an external point of reference since