{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:12:04Z","timestamp":1778825524728,"version":"3.51.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Child Adolesc. Psychiatry"],"abstract":"<jats:p>Over the past two decades, adolescent psychological distress has increased markedly, with a growing number of young people experiencing intense suffering that cannot be verbalised and is instead expressed through the body, including self-harming behaviours and social withdrawal. These manifestations are frequently associated with poor therapeutic engagement and complex family dynamics characterised by emotional intrusion, overprotection, or relational absence. From a systemic and narrative perspective, symptoms are understood as meaningful communications embedded within family systems, transgenerational histories, and contemporary socio-cultural transformations. Social changes related to digital hyperconnection, altered parenting practices, and performance-oriented cultural models have reshaped adolescent subjectivity, privileging action and bodily expression over narration and mentalisation. This paper explores \u201cshown pain\u201d as a primary mode of communication in adolescence and examines the clinical transition from bodily enactment to narrated experience. Drawing on systemic theory, narrative psychotherapy, and neurobiological insights, the article analyses the emotional dimensions underlying self-harm and withdrawal, as well as the ambivalent regulatory functions of symptoms. A clinical case is presented to illustrate how an integrated therapeutic approach, combining individual and family therapy, can facilitate alternative narratives, support differentiation processes, and promote individual and relational change. The paper highlights the relevance of systemic psychotherapy in restoring meaning, voice, and relational listening in severe adolescent distress.<\/jats:p>","DOI":"10.3389\/frcha.2026.1829312","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:43:15Z","timestamp":1778823795000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: When pain is shown and silenced. adolescents looking for a voice"],"prefix":"10.3389","volume":"5","author":[{"given":"Daniela","family":"Tortorelli","sequence":"first","affiliation":[{"name":"Psychoterapy School, Centro Studi e Applicazione Della Psicologia Relazionale (C.S.A.P.R.)","place":["Prato, Italy"]},{"name":"Societ\u00e0 Italiana di Psicologia e Psicoterapia Relazionale (S.I.P.P.R.)","place":["Arezzo, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"B1","article-title":"Adolescent mental health","year":"2021"},{"key":"B2","year":"2025"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1606370","DOI":"10.3389\/ijph.2023.1606370","article-title":"Gender and age influence on emergency department visits for non-suicidal self-injuries in school-aged children in Italy: an 11-years retrospective cross-sectional study","volume":"68","author":"Paladini","year":"2023","journal-title":"Int J Public Health"},{"key":"B4","first-page":"1945","article-title":"A call to action: the second Lancet Commission on adolescent healt and wellbeing","volume-title":"Lancet","author":"Baird","year":"2025"},{"key":"B5","volume-title":"The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness","author":"Haidt","year":"2024"},{"key":"B6","author":"Twenge","year":"2023","journal-title":"Generations: The Real Differences between Gen Z, Millennials, Gen X, Boomers, and Silents-and What They Mean for America's Future"},{"key":"B7","volume-title":"Rapporto sulla Salute Mentale dei Giovani in Italia 2018\u20132022","year":"2022"},{"key":"B8","year":"2025"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1038\/s41598-024-84187-5","article-title":"Self-isolation of adolescents after COVID-19 pandemic between social withdrawal and hikikomori risk in Italy","volume":"15","author":"Cerbara","year":"2025","journal-title":"Sci Rep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.3390\/children10101669","article-title":"Hikikomori (severe social withdrawal)","volume":"10","author":"Tolomei","year":"2023","journal-title":"in Italian Adolescents. 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