Tattoos have evolved from cultural taboo to mainstream fashion over the past century.
As more individuals seek tattoos, understanding motivations and meanings is valuable for mental health providers.
Key Facts:
- Nearly 30% of Americans have at least one tattoo, up from 14% in 2008. Tattooing is especially common among younger adults, with 47% of 18-35 year olds reporting having a tattoo.
- Historically associated with marginalized groups like soldiers, criminals, and gang members, tattooing has become a mainstream phenomenon across Western culture.
- Motivations for tattooing include decoration, expressions of individuality, commemoration of events/relationships, displays of group identity, and affect management. Most report tattoos have significant personal meaning.
- Although some studies suggest mental illness is more common among those with tattoos, recent data indicates few differences in mental health or personality between tattooed and non-tattooed adults.
- Tattoos represent an opportunity for mental health providers to explore identity, emotions, trauma, and relationships. Asking patients about their tattoos provides a window into the psyche.
Source: World J Psychiatry
The History and Evolution of Tattooing in Western Culture
Tattooing has an extensive cross-cultural history spanning over 5000 years.
In Western societies until the mid-20th century, tattoos represented a cultural taboo, associated with marginalized groups like soldiers, criminals, and gang members.
As tattooing techniques improved and risks declined, tattooing became more common across the 1970s and 1980s within niche societal groups.
Over the past two decades, tattooing has emerged into the cultural mainstream, especially among younger generations.
Recent surveys indicate up to 30% of Western adults have tattoos, with nearly 50% of adults under 35 being tattooed.
However, tattoos remain more common in traditionally tattooed groups like military personnel and prison inmates.
As tattoos evolved from symbols of deviance to mainstream fashion, Western militaries have revised strict regulations to allow more tattoos.
The cultural evolution of tattooing provides context for examining motivations and meanings.
Motivations for Getting Tattooed
Individual motivations are diverse, but commonly include:
- Body Decoration – Tattoos as artistic adornment, similar to makeup or jewelry. Provides aesthetically pleasing personal decoration.
- Individuality – Tattoos symbolize uniqueness and convey personal identity. Allow self-expression and assertion of individualism.
- Group Affiliation – Tattoos declare membership in a particular group based on interests, ethnicity, social status, etc. Signify alignment with a collective identity.
- Commemoration – Tattoos memorialize important events, relationships, beliefs. Express an autobiographical narrative on the body.
- Affect Management – Tattoos allow management of difficult emotions and enhancement of self-esteem through permanent bodily display of inner states.
- Impulsiveness – Some report getting tattoos spontaneously without specific meaning. The permanence itself has meaning.
Most obtain tattoos after long consideration rather than impulsively.
Tattoos frequently represent meaningful symbols of self-identity and life events.
Exploring motivation provides insight into patients’ values and inner emotional states.
The Psychology and Psychopathology of Tattooing
Historically, psychoanalytic theory framed tattoos as signs of mental illness or “perversion.”
Tattoos were interpreted as manifestations of traumatic early relationships, masochism, or crippled self-esteem.
However, modern research indicates tattooing has become culturally normative with minimal evidence for psychopathology among tattooed adults.
Some studies report higher rates of mental illness among those with tattoos, especially prisoners and psychiatric inpatients.
However, data suffers from limitations like small sample sizes and inadequate controls.
Associations between tattoos, substance abuse, and risk-taking behaviors are also inconsistently supported.
Overall, there is little recent evidence for personality disorders or deficits among tattooed adults.
Tattoos should not be interpreted as pathological without contextual assessment of an individual.
While links to psychopathology appear unfounded, exploring tattoos in therapy may reveal developmental experiences, identity constructs, and affect management strategies.
As part of the life narrative symbolically illustrated on the body, tattoos represent an opportunity to investigate self-expression and trauma among tattooed individuals.
Self-Perception and Tattoos
Marking the body permanently is expected to impact self-concept.
Research indicates new tattoos reduce body dissatisfaction and increase self-esteem, effects sustained over time.
However, some report increased self-consciousness years later, suggesting shifts in identity.
Motivation affects impact on self-perception.
Tattoos commemorating relationships or beliefs are linked to increases in self-esteem more than aesthetic tattoos.
Over time, additional tattoos are often obtained to represent an evolving identity.
About 20% of individuals regret their tattoos, with 6% opting for removal.
However, most tattooed individuals are satisfied with their tattoos even decades later.
Seeking removal does not indicate global dissatisfaction, as many seek additional tattoos after removing regrettable ones.
Overall, tattoos seem to provide lasting satisfaction and positively impact body image for most wearers.
Tattoos and Suicide Risk
A link between tattoos and suicide has been hypothesized based on regional autopsy studies.
However, evidence for associations with suicide is inconsistent and confounded by links between tattooing and risk-taking behaviors that increase mortality in general.
While some report using tattooing as “therapeutic substitutes” for self-harm, others view tattooing as self-punishment.
Individuals with past self-injury are more likely to have tattoos, but directionality is unclear.
Further research is needed on tattoos as possible signals of suicide risk versus alternative coping outlets.
Either way, assessing self-injury and emotional regulation in patients with extensive symbolic or provocative tattoos can help gauge suicide risk and identify coping deficits.
How Society Perceives Tattooed Individuals
Despite mainstreaming, those with prominent or “tribal” tattoos face negative judgements as less attractive, intelligent, or moral compared to non-tattooed individuals.
However, small, discreet (“cute”) tattoos elicit minimal biases.
Tattooed individuals rate others with tattoos less negatively.
Acceptability varies by occupation, with greater stigma towards tattooed politicians, judges, teachers, and physicians compared to chefs or athletes.
Negative biases likely impact employment opportunities.
Women with tattoos face greater negative judgements than men, rated as less caring, skilled, and professional. Images of tattooed women are perceived as more sexually promiscuous and heavier drinkers.
However, men view tattooed women as more sexually available.
Taken together, women’s tattoos may signal riskier sexual behaviors to potential male partners.
Overall, the theme and placement of a tattoo strongly impacts perceptions.
Asking patients about reactions to their tattoos can reveal experiences of stigma from others.
Tattoos in Adolescents and Young Adults
Tattooing is substantially more common among younger generations, but carries greater stigma in adolescents.
Tattooing under 18 signifies deviance since it is broadly illegal for minors.
Among adolescents, tattoos predict future school dropout, violence, and substance use.
Risk-taking teens likely view tattoos as symbols of independence.
But tattoo motivations differ in adults.
Counselors should avoid assumptions that adolescent tattoos necessarily indicate pathology.
As peer group deviance increases in adolescence, restrictions on tattooing may actually increase risk-taking motivations.
Regulations should balance limiting youth access against potential to increase allure.
Regardless of age, assessing motivations behind tattoos allows individuation beyond stereotypes.
Tattoos in the Military
Soldiers obtain tattoos to display:
- Patriotism and national/ethnic pride
- Unit affiliation and martial themes
- Remembrance of fallen comrades
- Spirituality and nature symbols
Military culture values conformity but also brotherhood; tattoo regulations are increasingly relaxed.
Still, some report regret and stigma over tattoos obtained due to youth or peer pressure.
Exploring tattoo motivations reveals impacts of trauma, camaraderie, and shifting identities from youth into military service.
Especially among veterans, tattoos offer conduits to explore grief, loss, and the self-concept.
Therapeutic Implications of Tattoos
Tattoos represent opportunities for therapists to explore:
- Developmental experiences
- Trauma and affect management
- Relationships
- Belief systems
- Evolving identities
Asking patients about the meaning and motivation for their tattoos often reveals core dimensions of personality, emotional needs, and experiences that facilitate psychotherapy.
Especially for trauma processing, tattoos display outward manifestations of painful memories and inner states.
While tattoos should not be reflexively pathologized, extensively covering the body with provocative imagery warrants assessment of emotional regulation and impulsivity.
For adolescents and those with regrettable or self-harm associated tattoos, discussing motivations can guide interventions.
Overall, the mainstreaming of tattooing necessitates a nuanced approach considering personal context.
By sensitively exploring the “dermal diary” illustrated on a patient’s skin, clinicians gain invaluable access to the psyche.
References
- Study: Tattoos as a window to the psyche: how talking about skin art can inform psychiatric practice
- Authors: Hannah Roggenkamp et al. (2017)
