Conversely, some researchers have attempted to show a positive association for body modification. In a study of women with eating disorders, the authors suggested that body piercing could be seen as reflecting a positive attitude towards the body, an expression of self-care [32]. In addition, people with piercings are more likely to give attention to their physical appearance and are less likely to be overweight than people without piercings [33].
Stirn and Hinz [34] concluded that most people who partake in body modification clearly do not do it because they have any psychological problems. However, for a few, modifications may be utilized as a convenient means to either realize psychopathological inclinations, such as self-injury, or to overcome psychological traumas. The prevalence of self-injury is unknown, though it is believed to be a growing problem. While self-injury is believed to be a low-lethality behavior, teens who hurt themselves are at increased risk for suicide related to their underlying anxiety or depression. Moreover, self-harmers report that they often had their skin tattooed or body pierced to help overcome a negative experience, or simply to experience physical pain. Another clue that self-harm and piercing/tattooing might in some cases be linked derives from the fact that many of the self-harmers said they had ceased cutting themselves after obtaining their first piercing or tattoo [35]. The increasing incidence makes deliberate self-harm a problem that all health care providers dealing with adolescents are likely to encounter.
Given the link between body modification and “externalized risk behaviors” in young people, tattooing and body piercing may serve as clinical markers for health care professionals, potentially identifying those who may be involved in activities that hinder their health and development [29]. For example, closer examination of teens who wear long sleeves or clothing inappropriate for weather could reveal cuts, burns, carvings, or bruises that are self-inflicted.
Patients are more likely to discuss the issue of body art if the clinician does not speak or act judgmentally [1]. Practitioners who are concerned that their tattooed patient might be self-injuring or engaging in other risky behaviors should invite a discussion with the patient, perhaps using general terms, such as “Sometimes people may get involved in self-injury and don’t know where to turn for help. I will try to help you if you are ever worried about that.” As always, if the clinician suspects a patient is engaged in self-harming activities, an immediate referral should be made for mental health evaluation and any necessary intervention.
Preventatively, clinicians should provide targeted and repeated education to transmit the message of effective decision-making and evaluation of risks to children in the early elementary grades, since some students start to obtain body art as early as fifth grade.
Regret and Removal
Over time, many individuals regret getting tattoos and wish to have them removed [35]. In some cases, delayed complications, like the development of allergic, hypersensitivity, or granulomatous reactions, require tattoo removal. On average, tattoo regret occurs 14 years after tattooing and by the age of 40 years.