INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)  
ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue XI November 2025  
Attachment Style and Emotional Regulation in Adolescence: Possible  
Predictive Factors of NSSI Framed According to the Integrated  
Gestalt Perspective. A Scoping Review.  
Simona Durante1, Chiara Scognamiglio1, Valeria Cioffi1, Enrico Moretto1, Raffaele Sperandeo2, Lucia  
Luciana Mosca1*  
1Sipgi, Post Graduate School of Gestalt Psychotherapy, Torre Annunziata, Naples, Italy  
2Department of Neuroscience and Department of Neurosciences Reproductive and Odontostomatologic  
Sciences, University of Naples "Federico II", Italy  
*Corresponding Author  
DOI: https://dx.doi.org/10.47772/IJRISS.2025.91100088  
Received: 20 November 2025; Accepted: 27 November 2025; Published: 29 November 2025  
ABSTRACT  
Background/Objectives: Non-Suicidal Self-Injury (NSSI) refers to any form of intention- ally self-inflicted  
injury aimed at achieving psychological relief. This phenomenon inten- sified following the COVID-19  
pandemic, which saw a rise in new psychopathological onsets, particularly among the adolescent population.  
The objective of this review is to understand to what extent NSSI acts represent, for young individuals, an attempt  
at emo- tional self-regulation and a coping strategy to deal with unpleasant or intolerable emo- tional  
experiences, and how attachment bonds may serve as predictive factors for the on- set of such behaviors  
Methods: a scoping review accordings Preferred Reporting Items for Systematic Reviews and Meta-Analyses  
protocol was conducted Results: Following the analysis of the materials selected in the literature, a strong  
association was found be- tween deficits in emotional regulation and self-injurious behaviors Conclusions: This  
lit- erature review has shown that adolescents’ use of NSSI can be understood as an attempt to contain emotional  
distress when faced with significant difficulties in emotional regulation and coping strategies.  
Keywords: Non-suicidal self-injury; adolescence; emotional regulation; NSSI; attachment style.  
INTRODUCTION  
Understanding the nature of non-suicidal self-injury and its spread among the adolescent population is the  
objective of this scoping review, which is part of a broader re- search project initiated following the observed  
increase in various types of psychopathological onset that have affected this segment of the population in the  
aftermath of the COVID-19 emergency [1].  
The aim is to frame the phenomenon of self-injury within a holistic perspective to understand its situational  
nature and consider how it offers, in the patient's experience, a form of 'relief' from psychological suffering. All  
this is intended to avoid early and thus potentially erroneous diagnoses of borderline personality disorder (BPD),  
a psycho- pathological condition generally characterized by emotional dysregulation and self harming acts [2;  
3].  
The epistemological background of the present review is the integrated Gestalt psycho-therapy model, which  
views the symptom as a behavior aimed at achieving homeostatic equilibrium in the presence of emotional  
tension that cannot be adequately addressed.  
This may occur either due to a lack of affordances (literally 'invitation to use', i.e., the physical quality of an  
object that suggests to a human being the appropriate actions to manipulate it) [4] in the environment to which  
one is exposed or due to other factors, such as genetic predispositions.  
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Non-Suicidal Self-Injury (NSSI) and Self-Mutilation (SM)  
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [5], NSSI refers to 'a  
series of intentionally self-injurious acts towards one's own body carried out on at least five days in the past  
year.' NSSI is included in Section III of the manual, which contains all diagnostic entities that require further  
study and investigation. Thus, non-suicidal self-injury refers to all non-lethal harm inflicted on the body, whether  
superficial or significant, without suicidal intent.  
Socially accepted behaviors such as piercings, tattoos, play piercing, and scarification, religious rituals, or  
accidental and indirect injuries due to substance abuse and behavioral addictions (e.g., eating disorders) are  
excluded. Included, however, are behaviors such as cigarette burns, cutting, and self-mutilation (SM), including  
pinching, scratching, and biting. The most common self-injurious practice is cutting: the act of cutting,  
wounding, and incising the skin, especially on the arms and legs, using razor blades, pencil sharpeners, broken  
cans, or sharp knives.  
Although not among the most common practices, a 2002 study [6] conducted on a school sample of adolescents  
revealed that about 14% of students reported having engaged at some point in self-mutilating behaviors, with a  
higher frequency among females.  
Emotional Regulation and Coping Strategies  
According to Mauss, Bunge, and Gross [7], emotional regulation is defined as 'the individual’s voluntary and  
automatic attempts to influence the emotions they experience, even while experiencing them, by modulating the  
experiential and expressive dimensions.' Therefore, the regulation of emotional experiences may have a dual  
nature: intentional or unintentional. Gross and colleagues’ studies identify two distinct categories in the  
regulatory process of emotional experiences:  
- Cognitive emotion regulation  
This is voluntary and intentional regulation involving various cognitive processes. Gross identifies five  
regulatory strategies that intervene at different phases of the emotional process.  
Stimulus avoidance: the subject avoids situations and/or contacts that may act as triggers for painful emotions.  
Environmental modifications: 'problem-focused coping' [8], involving changes to the environment to reduce  
emotional impact.  
Attention redirection: focusing attention on specific elements of a situation while disregarding others.  
Situation reappraisal: 'emotion-focused coping' [8], involving reevaluating the situation and the demands of the  
environment to alter its emotional meaning.  
Response modulation: acting directly on the emotion while it is occurring, using methods such as suppression,  
inhibition, medication, or sharing. The first three strategies intervene during the construction phase of the  
emotional experience, while the latter two act after the generative process, targeting the components of the  
emotion.  
- Automatic emotion regulation:  
This is triggered by the mere perception of a sensory input and can be defined as the modification of one’s  
emotions without intentional decision-making and without conscious, controlled attention [9].  
Thanks to studies on emotional regulation in children, Nancy Eisenberg et al. [10] proposed a model highlighting  
the strong correlation between emotional regulation and the ability to adaptively or maladaptively control  
emotional processes. Thus, a further distinction can be made between two types of emotional control: effortful  
control (voluntary control), i.e., the ability to inhibit a dominant response in favor of a less dominant one through  
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behavioral inhibition to enable more adaptive reactions; and reactive control, i.e., unintentional and inflexible  
control driven by impulses and automatic responses.  
According to Eisenberg, the relationship between control and regulation forms a continuum: on one end lies  
hyper-reactive control, on the other hypo-reactive control, and in between is true regulation, influenced by high  
or low levels of voluntary control.  
Attachment Theory and Emotional Regulation  
According to Attachment Theory [11], the child initially depends on the caregiver not only for the satisfaction  
of primary needs but also for emotional regulation. Over time, children learn to develop their own regulatory  
abilities through specific caregiver actions, such as validating and encouraging emotional expression,  
communicating affective states, and modeling strategies for managing distressing emotions [12]. At this critical  
stage of development, the parent’s role is to present the external world in a more digestible form so the child can  
acquire adaptive tools to face environmental challenges [13].  
To study Bowlby’s attachment models, Mary Ainsworth developed the Strange Situation experiment [14],  
identifying the following attachment styles: Secure: the child relies on the caregiver and feels safe to explore the  
environment even in threatening situations, expressing joy upon the mother’s return. Insecure-avoidant: the child  
does not rely on the caregiver—who likely has not been responsive to needs—and experiences distress at  
separation but tends to avoid the care- giver upon return. This attachment style often develops in the context of  
a rejecting, unavailable caregiver.  
Insecure-anxious/ambivalent: the child is highly distressed by separation and shows an- ger or hostility upon  
reunion. This often develops when the caregiver’s responsiveness is inconsistent.  
A child’s attachment style originates from the caregiver’s own early attachment experi- ences and, consequently,  
reflects the parent’s adaptive or maladaptive responses to emo- tional distress [15].  
Insecure attachment styles are predictive of difficulties in emotional management, in- cluding avoidance of  
distressing situations or hyper-regulation of internal states—patterns typically associated with insecure-avoidant  
attachment.  
The Adolescent Brain: Between Cutting and Emotional Regulation  
To fully understand the phenomenon of non-suicidal self-injury (NSSI) and its prevalence among adolescents,  
it is necessary to examine the typical features of brain development during this life stage, which help explain  
NSSI as an emotional regulation strategy. Brain development naturally progresses toward increased integration,  
resulting in greater specialization of brain regions and more efficient neural networks. These changes enhance  
the brain’s capacity for complex information processing. During adolescence, major brain changes affect the  
prefrontal cortex and other frontal regions responsible for advanced cognitive functions, including integration,  
synthesis, and behavioral regulation. These changes are not simply additive but are reorganization processes of  
unmatched intensity during the lifespan [16]. This increased integration of the cortex allows for the emergence  
and evolution of com- plex abilities such as cognitive control (reducing impulsivity by increasing awareness of  
consequences), emotional regulation, and the formation of personal and social identity [17].  
The prefrontal cortex acts as a critical hub linking cortical regions with subcortical limbic structures and the  
brainstem. It integrates inputs from internal body signals (interoception) and external stimuli (exteroception),  
making it a vital center for coordination and energy distribution.  
The limbic system, a subcortical region, plays a key role in detecting salient environmental stimuli—sources of  
reward or threat. Its primary function is to generate emotions, which, when well-integrated with the prefrontal  
cortex, enable appropriate responses to environmental demands.  
The brain functions in a 'state-dependent' manner, meaning it is highly influenced by context: environmental  
conditions and emotional states can either interfere with or sup- port integration processes [18]. Integration is a  
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key condition for the development of self- awareness, empathy, emotional balance, and modulation of intense  
emotions or disruptive experiences, which are essential for sound decision-making [19, 20]. When integration is  
lacking, subcortical regions activate without the calming influence of the prefrontal cortex, increasing  
vulnerability to impulsive behaviors such as NSSI.  
The Influence of Attachment on Neurobiological Development  
Looking back to earlier developmental stages, it is important to recognize that brain formation begins in utero  
and continues intensively during the first years of life. In this period, as previously mentioned, the environment  
plays a substantial role in shaping the development and functioning of the central nervous system. This  
environment is primarily defined by the presence—or absence—of an attentive and responsive caregiver. Such  
caregiving helps modulate the development of prefrontal and limbic areas (including the amygdala, a key center  
for threat detection and fear regulation) through the quality of attachment and the experience of relational safety  
[21]. When insecure or disorganized attachment patterns persist into adolescence, there is typically hyperactivity  
of the amygdala in response to perceived threats, resulting in difficulties with emotional inhibition and conscious  
regulation. This impairs the integrated processing of bodily sensations and emotions, leaving the adolescent in  
a state of disconnection or confusion regarding their inner experience [22].  
NSSI from a Gestalt Perspective  
Among the various epistemological frameworks through which the phenomenon of NSSI can be interpreted, this  
review adopts the Gestalt psychotherapy perspective. Gestalt offers a reading of psychopathological experience  
by integrating somatic, experiential, and phenomenological models [23].  
The Gestalt view does not define psychopathology based on the presence, absence, or duration of specific  
symptom patterns, but rather sees symptoms as creative acts of the organism in relation and response to its  
environment. From this perspective, even the most dysfunctional and distressing symptomatic behavior is  
considered a creative function of the organism [24], which attempts to maintain homeostatic equilibrium when  
faced with an environment perceived as unsustainable or lacking in adequate affordances.  
Accordingly, the symptom is understood as the best creative adaptation [note] that the individual has been able  
to devise in response to unmet needs or emotional demands that could not otherwise be integrated. This unique  
manifestation of the phenomenon becomes comprehensible when we recognize that the individual, with their  
experiential history, is in constant interaction with the environment—modifying and being modified by that  
contact [25]. Fritz Perls, one of the founding figures of Gestalt psychotherapy, in his works 'Ego, Hun- ger, and  
Aggression' [26] and 'Gestalt Therapy: Excitement and Growth in the Human Personality' [27], describes a  
theory of encounter with the world that takes place at the 'contact boundary'—represented by the skin, our  
primary sensory organ. For Perls and subsequent Gestalt theorists, experience unfolds in a cyclical process, the  
so-called con- tact cycle [note], beginning from bodily impulses and needs. Neurosis, in this framework, is a  
maladaptive yet creative interruption of this cycle to protect the organism at the cost of its nourishment. The  
symptom, then, is 'the best possible compromise that the organism was able to construct' at the contact boundary  
[27]. From this viewpoint, self-injury represents the only adaptive response available to the adolescent to manage  
intolerable emotional experiences. The interruption of emotional contact occurs through a deflection from  
emotional to physical pain. In some narratives, self-harm is described as a way to interrupt ego-driven  
experiences by breaking through the thickened contact boundary to feel something—anything—again through  
physical injury.  
In Gestalt terms, NSSI is understood as a 'redemptive symptom' [28], a creative act of the organism that, unable  
to access functional self-regulation, resorts to this survival strategy. It is an attempt to reestablish contact with  
the environment, the body, and experience—protecting the individual from the risk of emotional dissolution or  
internal fragmentation.  
Goodman [27] refers to this as a 'protective block,' something that simultaneously obstructs and safeguards  
against full contact with overwhelming experience.  
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MATERIALS AND METHODS  
To examine the most recent scientific findings in the international literature, as well as to identify potential  
directions for future research, was conducted a scoping review following the PRISMA extension for scoping  
reviews (PRISMA-ScR) [29], that provides 20 criteria (plus two optional ones) that the researcher is asked to  
answer in order to identify their work within the Scoping Reviews category.  
The main sources of data and research materials were the following electronic data- bases: Google Scholar and  
PubMed. From these, articles relevant to recent scientific research from the years 2013 to 2023 were selected.  
The selected articles were predominantly in English. A total of 44 articles were identified as suitable for the  
purposes of the review using keywords; a larger number, after reading the abstracts, did not meet the inclusion  
criteria. (See Table 1 and Figure 1).  
The keywords used for the search were: adolescents; self-injurious behavior; self-injury; emotion regulation;  
attachment theory; coping style; attachment bond (see Table 2).  
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The characteristics of the selected studies were summarized in schematic information contained in Table 3,  
relating to the author, title, year of publication, purpose, data collection method and tools used, sample size and  
study design.  
Table 3  
Author  
Title  
Yea Purpose Method  
r
Data  
collection  
Sample size Study  
design  
1 A.  
M. Emotion  
Regulation 201 Understanding  
the ISAS  
436  
Brausch, S. E. Deficits and Nonsuicidal  
relationship  
emotion regulation and NSSI Statements  
behaviors About Self between 11  
between (Inventory of adolescents Longitudina  
8
Woods  
Self - Injury Prospectively  
Predict Suicide Ideation in  
Adolescents  
aged  
l study  
Injury)  
and 16  
2 C.  
L. Deliberate self-harm in 202 To  
adolescents during  
COVID-19: The roles of  
investigate  
the Online  
Qualitative/  
Robillard,  
1
association between stress questionnaire  
related to the Covid-19 s: Statistics  
pandemic emergency and Canada  
quantitative  
Research  
pandemic-related  
emotion  
difficulties, and social  
distancing  
stress,  
regulation  
B. J. Turner,  
M. E. Ames,  
S. G. Craig  
self-harm behaviors (SHD) COVID-19  
and whether difficulties in Stress Scale,  
emotional  
regulation  
this  
moderate/mediate  
relationship  
Emotion  
Regulation  
Scale,  
Ontario Child  
Healthy  
Study Scales  
3 L. Kelada,  
P. Hasking,  
G. Melvin  
Adolescent NSSI and 201 To examine how family Questionnnar 272  
Qaulitative/  
Recovery: The Role of  
Family Functioning and  
Emotion Regulation  
6
functioning and emotion ies  
regulation strategies are  
associated with both NSSI  
and histories of NSSI  
hospitalization.  
adolescent  
students  
aged  
quantitative  
Research  
between 12  
and 18  
4 C. Guèrin – Invalidating  
Caregiving 201 To examine the indirect Questionnari 120  
Qaulitative/  
Marion,  
Martin,  
J. Environments,  
M. Emotion  
Specifc  
Regulation  
9
effects of specific aspects of es  
invalidating family  
environments on NSSI  
through specific difficulties  
in emotion regulation  
adolescents/  
young  
adults aged  
17 to 25  
quantitative  
Research  
Lafontaine, J. Defcits, and Non-suicidal  
Bureau Self-injury  
5 R. Tatnell, P. Attachment,  
Hasking, L. Regulation,  
Emotion 201 To highlight specific risk Questionnari 2637  
Qaulitative/  
Childhood  
and Assault:  
6
factors for NSSI behaviors es  
among adolescents, from a  
prevention and intervention  
perspective  
adolescents  
aged  
Newman, J. Abuse  
quantitative  
Research  
Taffe  
&
G. Examining Predictors of  
between 12  
Martin  
NSSI Among Adolescents  
and 18  
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6 K.  
Glazebrook,  
E. Townsend Between  
Do Coping Strategies 201 Investigating the role of Questionnari 314 students Qaulitative/  
Mediate the Relationship  
Parental  
5
attachment  
on  
NSSI es  
aged  
between 18  
and 20  
behaviors through its effects  
on coping strategies and  
problem-solving skills  
quantitative  
Research  
& K. Sayal  
Attachment and Self-Harm  
in Young People?  
7 A. Gandhi, L. Non-Suicidal Self-Injury 201 Examining  
associations Questionnari 528  
Qaulitative/  
Claes, G. and Adolescents between maternal and peer es  
5
adolescents  
aged  
between 11  
and 19 years  
Bosmans, I. Attachment with Peers and  
Baetens, T. F. Mother: The Mediating  
Wilderjans, S. Role of Identity Synthesis  
attachment,  
formation, and NSSI  
identity  
quantitative  
Research  
Maitra,  
G. and Confusion  
Kiekens, K.  
Luyckx  
8 Y. Tao,  
The Impact of Parent–Child 202 Investigating the relationship Questionnari 662  
Attachment on Self-Injury  
Behavior: Negative  
Emotion and Emotional  
Coping Style as Serial  
Mediators  
0
between attachment style, es  
coping strategies, and NSSI  
among adolescents  
adolescents  
aged  
between 13  
and 18  
X. Bi  
M. Deng  
9 P. Clery A. Is Attachment Style In 202 To identify factors that Questionnari  
Qualitative/  
Rowe  
M. Early  
Childhood  
1
contribute to mental health es/ Clinical  
Munafò  
Mahedy  
L. Associated With Mental  
Health Difficulties In Late  
Adolescence?  
difficulties in adolescents in Interview  
order to evaluate preventive Schedule  
strategies Revised  
quantitative  
Research  
–
1 G. Rogier C. Self  
–
Harm  
and 202 Examining the association Questionnari 740  
Qualitative  
0 Petrocchi M. Attachment in Adolescents:  
0
between attachment style, es  
self-harm, and emotional  
dysregulation in adolescents.  
adolescents Research  
aged  
between 13  
and 19  
D’aguanno P. What Is The Role of  
Velotti  
Emotion Dysregulation?  
1 Y. Wan R. Associations of Coping 202 To  
1 Chen S. Wang Styles with Nonsuicidal  
A. Clifford S. Self Injury in  
identify  
gender Questionnari 9704  
Qaulitative/  
0
differences in the impact of es  
positive coping strategies on  
NSSI and investigate the  
impact of adverse childhood  
experiences  
adolescents  
aged  
between 11  
and 19 years  
–
quantitative  
Research  
Zhang  
S. Adolescents: Do They Vary  
With Gender and Adverse  
Childhood Experiences?  
Orton F. Tao  
1 G.  
2 Hernandez J. dysregulation and coping  
A. Vera strategies in adolescents  
Noriega F. A. with self injurious  
Bautista Depression,  
emotion 202 To  
relationship between self-  
harm and depression,  
determine  
the  
5835  
Quantitative  
2
adolescents Research  
aged  
between 11  
–
emotional dysregulation and  
coping strategies to generate  
an explanatory model of the  
problem under examination  
Machado  
behaviours.  
and 15 years  
Moreno C. K.  
Rodriguez  
Cavajal  
RESULTS  
Following the analysis of the materials selected in the literature, a strong association was found between deficits  
in emotional regulation and self-injurious behaviors [see Tab. 3, nos. 10, 13]. In particular, a study conducted  
on a sample of 436 adolescents [Tab. 3, no. 1], focusing on two aspects of emotional regulation—difficulties in  
dealing with unpleasant emotions and difficulties in recognizing emotional experiences through interoceptive  
awareness—clearly highlighted the psycho-regulatory function of self-injury. The results indicated that NSSI  
acts as a moderator in the relationship between emotional dysregulation and suicidal ideation, suggesting a  
potential amplifying effect on risk  
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The use of NSSI practices as a strategy for emotional regulation was also confirmed in another study [Tab. 3,  
no. 3] involving a sample of 272 students, 48 of whom reported having used cutting as a means of achieving  
psychological relief. This study linked fam- ily functioning and emotional regulation capacity as predictive  
elements for increased engagement in NSSI, finding a positive correlation between poor family functioning and  
greater risk of self-injury, and identifying emotional regulation as a moderating factor in this relationship. The  
study concluded that a central role in adolescents' use of self-injurious strategies is played by living in  
problematic family environments and adopting maladaptive emotional regulation strategies.  
Some findings also support the hypothesis that, under experiential conditions characterized by prolonged  
psychological stress, self-injury emerges as a coping strategy in adolescents. This consideration particularly  
emerged from the analysis of a study [Tab. 3, no. 2] that observed widespread engagement in such behaviors  
during the COVID-19 pandemic—a period of extreme and prolonged emotional distress. The results of this  
research demonstrated that prolonged stress conditions marked by a lack of control— such as those experienced  
during the pandemic—generate complex, poorly tolerable emotional experiences and a perceived inability on  
the part of adolescents to alter these emotions. In addition to difficulties in emotion regulation, other factors  
contributing to the use of this maladaptive coping strategy were found to include self-punishment, sensation-  
seeking, and the need to generate emotional feeling.  
Regarding the hypothesis that attachment bonds may play a role in the incidence of the phenomenon, acting as  
either protective or risk factors, one study included in the review [Tab. 3, no. 8] revealed that poor-quality  
attachment with caregivers is strongly associated with self-injurious behaviors. Negative emotions stemming  
from dysfunctional re- lationships with caregivers may mediate the connection between attachment bonds and  
NSSI: individuals who reported engaging in NSSI exhibited anxious attachment and a tendency to suppress  
emotional expression. Conversely, high-quality attachment, as several studies demonstrate [Tab. 3, nos. 5, 7],  
appears to function as a protective factor against the onset of NSSI behaviors. One study highlighted that the  
mediating model of attachment differs depending on the caregiver figure: attachment to the father is based on  
emotional coping style, while attachment to the mother is associated with emotional experiences and thus  
activates different mechanisms in triggering self- injurious behaviors, consistent with the hypothesis of  
attachment specificity.  
One study contradicts this assumption [Tab. 3, no. 6], favoring instead the hypothesis that the correlation  
between attachment style and increased vulnerability to self-injurious behavior in the context of poor emotional  
coping is indirect. The study suggests that the relationship between attachment and self-injury is mediated by  
coping strategies: a secure attachment may indirectly promote the development of problem-focused coping  
abilities. Paternal attachment has a specific influence on the adolescent’s perceived problem-solving capacity,  
and insecure paternal attachment—being linked to lower self-efficacy—may facilitate involvement in NSSI.  
Lastly, insecure attachment styles tend to hinder the development of effective emotional regulation and may thus  
increase vulnerability to self-injurious behaviors.  
DISCUSSION  
This literature review has shown that adolescents’ use of NSSI can be understood as an attempt to contain  
emotional distress when faced with significant difficulties in emotional regulation and coping strategies.  
The main risk factors include difficulty tolerating negative emotions and limited access to functional regulation  
strategies, exacerbated by vulnerable environmental conditions—such as insecure attachment, low family  
support, and prolonged stress (e.g., the COVID-19 pandemic).  
Although the non-suicidal nature of self-injury might suggest a low level of danger, the scientific literature  
highlights its serious clinical and social relevance.  
These findings are supported by the Gestalt perspective, which views the symptom as meaningful and  
redemptive—an attempt at psychological and emotional survival through creative reorganization of the self.  
Though dysfunctional, self-injury is considered the best available strategy to maintain equilibrium and self-  
contact when other regulation modes have become inaccessible.  
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Neuroscience reminds us that during adolescence, subcortical areas responsible for emotional reactivity mature  
earlier and are more active, while prefrontal areas responsible for regulation, problem-solving, and planning are  
still developing. This neurological imbalance makes adolescents naturally prone to impulsive behavior,  
including self-inury—especially when triggered by dysfunctional relational or environmental factors and lacking  
effective emotional regulation strategies.  
All this evidence suggests the need to move beyond a symptom-based view of the phenomenon and instead  
adopt a bio-psycho-social and phenomenological perspective that considers adolescents within their relational,  
familial, school, and community contexts [30].  
Future therapeutic practice should evolve toward ecological and systemic approaches that integrate bodily,  
relational, and experiential dimensions. This calls for the development of a complex methodology that  
incorporates the adolescent’s context—the system in which they act, live, and build meaning.  
Author Contributions: Conceptualization, Simona Durante. and Lucia Luciana Mosca.; methodology, Lucia  
Luciana Mosca.; validation, Raffaele Sperandeo.; investigation, Simona Durante, Enrico Moretto, Valeria  
Cioffi; data curation, Chiara Scognamiglio; writing—original draft preparation, Simona Durante.; writing—  
review and editing, Lucia Luciana Mosca; visualization, Chiara Scognamiglio; supervision, Raffaele Sperandeo.  
All authors have read and agreed to the published version of the manuscript.  
Funding: This research received no external funding  
Institutional Review Board Statement: the study did not require ethical approval.  
Informed Consent Statement: Not applicable.  
Data Availability Statement: Not applicable.  
ACKNOWLEDGMENTS  
During the preparation of this manuscript/study, the author(s) used ChatGPT free version for the purposes of  
english translation. The authors have reviewed and edited the out- put and take full responsibility for the content  
of this publication  
Conflicts of Interest: The authors declare no conflicts of interest. The funders had no role in the design of the  
study; in the collection, analyses, or interpretation of data; in the writing of the manu- script; or in the decision  
to publish the results.  
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