2 Barca et al.
Highlights
• Predictive processing theories assume that the brain 
forms internal body and self-models at multiple levels 
of detail and strives to reduce their uncertainty.
• High levels of uncertainty in internal models of the body 
and the self are common across several clinical condi-
tions.
• Excessive levels of uncertainty might also be experienced 
in the typical population during development transitions.
• This excessive uncertainty might hinder the mainte-
nance of a coherent model of the  embodied self and 
confidently engage in adaptive courses of actions.
• Maladaptive behaviors, such as non-suicidal self-injury, 
might emerge as paradoxical but effective strategies to 
“act on the body” to reduce uncertainty
similar because they explicitly target the body, with self-induced 
hunger or painful sensations, to modify bodily and interocep-
tive experiences. This perspective helps contextualize harmful 
behaviors within an “interoceptive inference” framework, which 
assumes that (interoceptive) bodily sensations and their regula-
tion are key for affectivity, mental health, conscious processes, 
and the self (Craig 2002, Seth et al. 2012 , Barrett and Simmons 
2015, P
ezzulo et al. 2015, Paulus et al. 2019, Quigley et al. 2021), 
which could provide novel insights on why people do things to 
harm themselves intentionally.
A central theme of inferential models of cognition, like active 
inference, is that actions are motivated by both “utilitarian” imper-
atives, such as reward achievement, and the “epistemic” impera-
tive to reduce uncertainty about one’s state (intended in a broad 
sense, from bodily state to one’s identity and self-models). Var-
ious researchers proposed that paradoxical behaviors could be 
motivated by reward achievement since they have (paradoxically) 
positive effects, such as relief from emotional distress and nega-
tive affect (Nock and Prinstein 2004, Chapman et al. 2006, Bresin 
and Gordon 2013 , Selby et al. 2019). Here, we advance a com-
plementary perspective by suggesting that these behaviors might 
appear less paradoxical when considering that they could serve 
uncertainty minimization imperatives. For example, we recently 
suggested that the starvation observed in restrictive anorexia 
nervosa could serve the imperative of minimizing “interoceptive 
uncertainty” or the uncertainty about one’s interoceptive state—
stretched up to the uncertainty of the self—which might be partic-
ularly severe when people receive ambiguous interoceptive signals 
from the body, when they have poor models of their bodily or emo-
tional state, or when they are particularly intolerant to high levels 
of uncertainty (Barca and Pezzulo 2020).
What are the possible causes of interoceptive uncertainty? 
Consider, e.g. a person with physiological deficits in interocep-
tive pathways that do not allow her to clearly sense interoceptive 
streams and identify her emotional states and embodied self. 
These deficits might prevent the person from developing an appro-
priate model of her emotions (e.g. a model that clearly specifies 
what emotion she feels and in which conditions) and a good 
understanding of the emotions and the affective states of others 
and hence be constantly uncertain about them (see also Smith 
and Lane 2015, Smith et al. 2018, 2019). Such detachment from 
one’
s body and bodily information might result from adverse 
experiences during infancy and childhood, such as emotional 
and physical neglect (Schmitz et al. 2023 ), or—in less dramatic 
situations—from reduced affective reciprocity during parental 
interactions (Conradt and Ablow 2010). Development theories 
underscore the role of parental care in shaping the experience of 
self and others and integrative processes of consciousness (Bowlby 
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