Profile of Mental Functioning in Adolescence - MA Axis

The main innovation of the MA Axis is the introduction of a specific assessment dimension devoted to “Bodily Experiences and Representations.” The reasons are evident, on theoretical as well as clinical grounds. If the child’s psyche emerges and organizes itself around somatic sensations, at puberty the relationship is reversed: it is the body, transformed by sexual maturation and a new physiology, that “imposes itself” on mental functioning. Precisely because of the Winnicottian indissolubility of the psyche–soma dialogue, one cannot overlook how deeply the psyche—between inner and outer worlds, and across past, present and future—is bound up with the experience of the body, especially during the most intense phases of development (Lingiardi, 2024a; Ogden, 2024; Winnicott, 1949). As Boffito and Ferruta (2026, p. XIII) observe, “this is made possible by the ‘imaginative elaboration of all kinds of body functioning’ (Winnicott, 1988, p. 33), a passage that extends the psychosomatic field far beyond the customary reference to the psychological origin of physical ailments, toward a study not so much of the body as of bodily experience, the experience of physical aliveness (soma), which in healthy development goes hand in hand with the experience of imaginative aliveness.” For adolescents, growing up often means learning to recognize and integrate a corporeality they may initially perceive as foreign. This demanding psychic work reawakens memories of primary caregiving, accompanies separation from parental figures, redraws the boundaries between self and other (starting from the surface of the skin; Lemma, 2010) and brings the articulation of gender into play (Lemma, 2018; Lingiardi, 2024b). Where early relationships have left a fragile bodily self as their legacy, anxieties that are hard to contain may be reactivated. At this stage of life, the body is not only a site of transformations to be recomposed into a unified experience; it is also a means through which distress can find expression when words fail. Attacks turned inward, alterations of appearance and high-risk conduct—from self-harm to suicidal behavior, from substance use to feeding and eating disorders—may convey a message, often outside awareness, that the clinician is called upon to hear and decipher. Assessing this capacity means asking how adolescents inhabit their own physicality, what image of themselves they have constructed and to what extent they use it to stage conflicts they are still unable to think and translate into symbolic language.