Are Tattoos an Indicator of Severity of Non-Suicidal Self-Injury Behavior in Adolescents?

Abstract

Objective To compare adolescents with non-suicidal self-injury behavior and tattoos [NSSI (T+)] with another group with non-suicidal self-injury behavior without tattoos [NSSI (T-)]. Methods Adolescents (n=438) 42.6% males from the community (M=12.3, SD=1.3), completed the Self-Injury Schedule. Results The lifetime prevalence of tattoos performed with the purpose to feel pain was 1.8%. Compared to the NSSI (T-) group, the NSSI (T+) group was significantly more likely to meet the DSM-5 frequency criteria of 5 self-injury events in 1 year, practice more than one method of self-injury, and topography, more suicidal intentionality, more negative thoughts and affective emotions before, during, and after self-injury and more academic and social dysfunction. Conclusion Adolescents from the community who practice tattooing to feel pain, show a distinct phenotype of NSSI. Health professionals and pediatricians should assess tattooing characteristics such as intention (to feel pain), frequency, and presence of non-suicidal self-injury behavior and suicide intentionality.

Hiding in the open: Consideration of nonsuicidal self‐injury by proxy as a clinically meaningful construct

“…Specifically, studies have found that a majority of individuals with a history of NSSI reported cessation of or decreases in NSSI following initiation of tattooing and body‐piercing (Stirn & Hinz, 2008; Wessel & Kasten, 2014). Likewise, Solís‐Bravo et al (2019) found that individuals with NSSI and tattoos reported greater severity of NSSI and had greater endorsement of all NSSID criteria (including past‐year NSSI frequency, negative emotional antecedents, NSSI‐related cognitions, and resultant distress/impairment) when compared to individuals with NSSI but no tattoos. Although preliminary, these findings suggest that tattooing and piercing may function in the same way as NSSI and be associated with increased NSSI severity and related impairment among individuals with a history of this behavior, supporting the conceptualization of a subset of these behaviors as NSSI by proxy.…”

“…Although there have been no systematic investigations of NSSI by proxy to date, key NSSI by proxy behaviors have received preliminary attention from researchers in the context of traditional NSSI research, with studies examining behaviors such as tattooing and piercing (Solís‐Bravo et al, 2019; Wessel & Kasten, 2014), initiating a pet to inflict injury (Mann et al, 2020), initiating sex as self‐injury (Fredlund et al, 2020; Jonsson et al, 2019; Zetterqvist et al, 2018), and initiating a fight (Green et al, 2017). However, current investigations have not delineated the critical facets of these behaviors, most notably that they are other‐caused yet self‐driven.…”

“…Historically, consideration of tattooing and body piercing as forms of NSSI has been a controversial topic within the NSSI literature, both because these behaviors generally involve another person inflicting the bodily tissue damage and because tattooing and body piercing are often engaged in for aesthetic or artistic expression purposes (Aizenman & Jensen, 2007; Claes & Vandereycken, 2007; Wessel & Kasten, 2014; Wohlrab et al, 2007). Yet, despite the fact that these behaviors may commonly serve socially sanctioned purposes, there are notable examples of individuals seeking out tattooing and body piercing for the explicit purpose of self‐injury (Anderson & Sansone, 2003; Mann et al, 2020; Solís‐Bravo et al, 2019; Wessel & Kasten, 2014). These latter examples complicate the established distinction between conventional tattooing and body piercing and NSSI (Aizenman & Jensen, 2007; Claes & Vandereycken, 2007) and suggest that there may be times when these behaviors are better considered as a form of NSSI by proxy.…”

Tattoos in Psychodermatology

“…However, there are some conflicting results on this point. While some research proposes that teens and young adults with tattoos are at increased risk of suicide attempts and unhealthy practices, some claim that tattoos could be a protective or mitigating factor for suicidal ideation and attempts [63,64]. One study in particular noted that expletive tattoos in a forensic context may be associated with unnatural and violent deaths, and that the study of certain subgroups of tattooed individuals may be useful in discerning specific trends that are unclear if "tattoos" are treated as a homogeneous phenomenon [65].…”

Modified body – symbol of risk or resources?

“…Nowadays, the approach of psychologists to the function and nature of body modifications has become heterogeneous. By some researchers they are considered as non-suicidal self-injuries (NSSI) [3], direct self-destructive behaviors related to psychopathology: mental illness [4], personality disorders [5], including identity prob-lems [6]. Other scientists perceive them as normative or semi-normative behaviors, methods of expression one's personal identity (often depicting the feeling of belonging to a group), an intentional form of transforming the concept of self [7,8].…”