poor models in which precision parameters are incorrectly set). 
We next turned to active inference and discussed how reduc-
ing uncertainty (not just maximizing utility) is a key imperative 
in this framework. This implies that an active inference agent 
can sometimes privilege uncertainty minimization over utility 
maximization. In extreme conditions, such as when interocep-
tive uncertainty is excessive or difficult to reduce, a person could 
develop maladaptive strategies to deal with it, such as acting on 
the body to produce interoceptive sensations of pain or starvation 
that reduce interoceptive uncertainty.
The centrality of physiological processes and bodily informa-
tion for the sense of self has been widely discussed by intero-
ceptive research (Seth et al. 2012, Quigley et al. 2021 ). Here, in 
continuity with previous works (Barca and Pezzulo 2020), we sug-
gest that (i) some pathological behaviors—that “act on the body” 
in maladaptive ways—might be considered as strategies for mod-
ifying internal models and the sense of self when it is deficient, 
through bodily sensations and (ii) the sense of self can be defi-
cient when bodily information is uncertain, and this can happen 
not only in clinical conditions but also during pivotal periods of 
developmental transition, e.g. in adolescence.
The theoretical perspective offered here leaves several impor-
tant questions unaddressed. First, even if uncertainty reduction 
might be a central drive in self-injury behaviors, it is unclear what 
kinds of uncertainty (if any) specifically trigger the paradoxical 
behaviors. It may be only the uncertainty at deep hierarchical 
levels (e.g. at the level of self-models) that promotes paradoxi-
cal behaviors. Alternatively, it could be possible that it is not so 
much the kind of uncertainty that matters but somewhat its asso-
ciated distress, which in turn could be amplified by conditions 
like the intolerance of uncertainty. While these and alternative 
hypotheses remain to be tested in future research, they might in 
the future lead to novel tailored interventions. Current reviews of 
NSSI interventions (see, e.g. Turner et al. 2014, Witt et al. 2021) out-
line the various treatments currently available (e.g. psychological 
and psychosocial interventions, pharmacological treatments, and 
a combination of both), but underline the need for further data 
on their effectiveness. The use of formal models of brain function 
to characterize the mechanisms of psychopathology (Friston et al. 
2014, Ste
phan and Mathys 2014) might help conceptualize dys-
functional behaviors in operationalizable terms. In this vein, one 
might delineate interventions aimed at reducing the uncertainty 
of self-models by starting from the bodily self and the definition 
of self-other boundaries (if these turn out to be the critical aspects 
for the patient). In this endeavor, techniques such as virtual reality 
and robotics might help elucidate which levels of the multisen-
sory integration process of the bodily self might be compromised 
(Dieguez and Lopez 2017, Tsakiris 2017, Serino et al. 2018). Virtual 
reality along with role-playing sessions and the use of avatars are 
increasingly considered effective tools for the training of clinicians 
who deal with individuals engaging in NSSI (Taliaferro et al. 2023). 
It remains to be tested whether the use of virtual reality or similar 
interventions—and the definition of contexts and tasks aimed at 
reducing the uncertainty of the bodily self—might also be viable 
for individuals engaging in NSSI.
Second, in this paper, we have mainly focused on uncertainty 
reduction, but as we reviewed earlier, there are other alterna-
tive (or complementary) perspectives on the genesis of NSSI that 
considers elements such as affective regulation. In addition to 
the studies discussed earlier, other insights into the pathologi-
cal mechanisms that might underlie NSSI come from the anal-