Running head: BODY MODIFICATION AND MENTAL HEALTH

Body Modification and Mental Health

Hannah Harpst
Indiana University Purdue University Fort Wayne

Author Note
Hannah Harpst, Psychology Major, IPFW.

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Abstract

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This paper draws ties from former research done on body modification and mental disorders; its
information is drawn from various internet sources, and scholarly articles. This paper focuses on
connects found between people who have tattoos and piercings that also possess mental disorders
as established by the Diagnostic and Statistical manual of Mental Disorders or DSM-IV and 5.
There are also sections included on what the DSM standard for mental disorders commonly
linked to those possessing body modification in any form.Body Modification and Mental Health
It is not hard to see a possible link between body modification and mental disorders,
especially with body modifications that are permanent. Depression and body dysmorphic
disorder are both common reasons for people to seek out ways to change themselves
permanently. It may also be hard to understand why or how someone could get a face tattoo, or a
body suit; and almost everyone does a double take when they notice a person with a face full of
mental. These radically different but everyday people can be out of the social norm, and possibly
may have severe mental disorders.
Body Modification
Body modification in its current meaning is something done to ones body changing the
natural state of it. This could include everything from tattoos and piercings in the more extreme
stages, to cosmetic surgery in the socially acceptable stages, and haircuts, hair dye, and hair
products in a non-permanent way. 14% or 45 million people in the United States have at least
one tattoo, research also shows that 15.6 million cosmetic procedures were done in 2014 in the
United States alone. Body modification be it a tattoo or a breast implant has become almost an
everyday occurrence in the United States.
Tattoos
Tattoos are a body modification that causes ink to be permanently deposited into the skin.
This is done by opening tiny pinpricks into the epidermis and letting ink fill the space and
allowing it to heal. Tattoos are obtained for many reasons including religion, group affiliation,
rites of passage, purely aesthetic reasons, and medical aesthetic reasons. In 2013, the Pew
Research center sought to find out statistics on tattoos. It was estimated that Americans spends
$1.65 billion on tattoos annually, and 14% or 45 million people in the United States have at least
one tattoo.
Piercings
Piercings, also known as body piercings are taking a needle or dermal punch and creating
an opening wide enough to allow jewelry to occupy space within or through the body flesh. This
jewelry is usually left in long enough to create a fistula of skin where it is not normally, at this
point the piercing is usually considered permanent without the help of corrective surgery and
unlikely to heal on its own.
In 2014 statistics were recorded on body piercings, this includes any piercing on the body
excluding the traditional lower earlobe. Ironically the same percentage of tattooed individuals in
the United States is the same as individuals with body piercings, 14%; the majority of this 14% is

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women, who make up 72% of that number. The most common areas for piercings in women
were belly button (33%) and nose (19%) and for men, nipple (18%) and eyebrow (17.5%).
Plastic Surgery and Cosmetic Augmentation
Though few in todays society believe that plastic surgery and cosmetic augmentation is a
form of body modification, it falls into its definition, and in comparison to tattoos and piercings,
these procedures are more widely used. Research shows that 15.6 million cosmetic procedures
were done in 2014 alone. 286,254 fell into the category of Breast Implants (Korman). Statistics
in 2013 tell that in the United States $12 billion was spent on surgical and non-surgical cosmetic
augmentation, the big five or the five most done procedures included liposuction which
accounted for 16.3% of procedures, Breast augmentation which took up 5.2% of procedures,
eyelid surgery coming in at 5.4%, Tummy tucks 2.3% and Nose surgery with 2.9%.
Mental Illness
General Prevalence
26.2% of adults 18 and older in 2014 suffered from a mental disorder in the United
States, which is approximately one out of every fourth person. Serious mental illness which are
those that cause some sort of disability effect 6% of the population. Mood disorders like major
depression and bipolar have a grasp on 9.5% of Americans. Schizophrenia, a much more rare
disorder only affects 1.1% of the general population, but anxiety disorder knows many more with
it effecting 18.1% of the population in the United States. There are many other disorders, like
obsessive compulsive disorder, post-traumatic stress disorder and eating disorders, but these
stated above are the most prevalent and severe (National Institute of Mental Health, 2014).
Depression
Depression is a mental disorder that effects approximately 9% of the population
(EverydayHealth.com, 2013). Depression can be anything from major depression to bipolar
disorder, once called manic depression. Major depression is categorized by having at least one
episode that causes an effect on ones everyday life, making it impossible to do every day skills.
Persistent depressive disorder or PDD takes place over a long period of time usually being over
two years. It usually consists of feeling low or down but can also effect appetite and sleep,
causing overdoing or underdoing either. Bipolar disorder has a cycle that it shifts between
consisting of highs and lows. The highs are marked by feeling invincible and on top of the world,
while the lows mimic a major depressive episode.
Body Dysmorphic Disorder
Most people have something about their body they do not particularly like, but people
with body dysmorphic disorder have this to an extreme. People with this disorder see flaws that
may or may not be there and obsess over them and usually end up solving the issues they see in
their body with plastic surgery and makeup. In 2001 4% of Americans met the criteria for body
dysmorphic disorder (ieTherapy, 2002).
Generalized Anxiety Disorder

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Anxiety disorders are structured around anxiety coming to a point it interferes with ones
daily life. This disorder has to continue long term. This usually involves physical symptoms of
becoming unable to move or shortness of breath, sometimes even mimicking a heart attack.
Many people with GAD cannot relax, feel restless or keyed up and are regularly irritable. These
people have anxiety about anything and everything, regardless of it is logical or not. With
approximately one out of every fourth person, or 25% of the population suffering from some
type of anxiety disorder, it really makes an impact (Patient.co.uk, 2015).
Studies
Tattoos and Antisocial Personality Disorder
A study was conducted in an inpatient hospital, and used means of interview for data
collection. Antisocial disorder were preexisting in the patients and were diagnosed by using
criteria of the DSM-IV. A measurement of surface area covered by the tattoo and more defined
details about it such as a photograph, the location and how it was obtained. The results found a
trend between tattoos and antisocial personality disorder. Also found was a link between the
higher amounts of surface area covered by tattoos and substance abuse, sexual abuse, and suicide
attempts. Sadly in this study the sample size was low, there were only 36 individuals included in
this study, and all of them were male (Cardasis, W., HuthBocks, A., & Silk, K.). Since
Antisocial personality disorder usually occurs in males, this highly sways their results.
An examination of the psychological role of tattoos in mourning
What makes a person what to get a memorial tattoo? This was the main question asked
for this study. Due to its nature, all the research had to be qualitative rather than the traditional
quantitative found in most scientific inquiries. The researchers compared the psychological
reasoning of those with memorial tattoos to those with tattoos that had no memorial purpose. It
was found that the memorial tattoo did not have one all-encompassing reason behind it for every
single person in the possession of a memorial tattoo. These tattoos regularly functioned as an

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external representation of the internal thoughts still linked to that person, as well as having the
ability to continue to have the lost person be a continual part of the individuals life. The most
common reason for obtaining a memorial tattoo though was that the individuals wanted a way to
express their complex relationship with the lost loved one and the impact it had on them as a
person to lose that loved one from their life. Another regular answer was that it gave the
individual the ability to share their loss with others, regardless of if the person they were sharing
it with knew the lost person or not (Samuel, S.)
Prevalence of tattooing and body piercing in Germany and perception of health, mental
disorders, and sensation seeking among tattooed and body-pierced individuals
Out of all the studies, this one was the best documented and recorded. It had a large
sample size of over 2,000 individuals with even distribution of age and sex. The study tracked
things like education, cohabitated relationships, religious affiliation, and employment rates
between tattooed and pierced and non-tattooed and pierced people. The data showed that the
average age of participant was between 14 and 44 years of age, this was true for both those with
and without body modification. Researchers did discovered that the body modified participants
were more likely to be from urban areas, possibly alluding to more possibilities of social anxiety.
But the psychological results showed that there was no significant difference in regards to
depression and anxiety between those with and without tattoos and piercings. The data did
indeed show however that those with body modifications were more likely to have tested higher
during a questionnaire in sensation seeking behavior. These body modified individuals also
commented on feeling significantly worse in terms of their mental health, regardless of having a
mental disorder or not (Stirn, A., Hinz, A., & Brhler, E.).

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A prospective study of tattoos on appearance anxiety and dissatisfaction, perceptions of

uniqueness, and self-esteem.
Build off of previous research this study wanted to catalog ones physical body image
which had yet to be recorded in information regarding the psychological aspects of tattooing. The
study tried keeping in mind both the sense self and the physical form. This study included 83
British participants obtaining their first tattoo, and it measured their personal beliefs on their
state of appearance anxiety and dissatisfaction of themselves prior to and immediately after
obtaining their tattoo. After obtaining the tattoo the participants would also measure their
appearance investment, self-ascribed uniqueness, social physique anxiety, and their continued
level of satisfaction or dissatisfaction with their tattoo three weeks after obtaining it. Women
after three weeks generally reported to greater social physique anxiety where as men reported
lower. These results are used in accordance to the social standards found about tattooing in the
present western society (Swami, V.)
Depression, anxiety and quality of life: outcome 9 months after facial cosmetic surgery
This study focused on depression before and after facial cosmetic surgeries in women. It found
some interesting results, participants took a questionnaire before their cosmetic surgery and a
follow up survey months after the surgery was over. Although the womens level of good and bad
thoughts hardly changed, what was noticeable change though was their levels of anxiety and
depression. 47% of participants met DSM requirements for depression before the surgery, but
only 27% met the same requirements nine months after the augmentation. Their conclusion
stated that the best reasoning behind facial cosmetic surgery was a lack of self-confidence, the
requests were always on specific features which could possibly be a symptom or red flag for

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body dysmorphic disorder (Meningaud, J., Benadiba, L., Servant, J., Herve, C., Bertrand, J., &
Pelicier, Y, 2002).
Body image, physical attractiveness, and depression.
This study was conducted on women seventeen to sixty three years of age. It first
evaluated what the subject thought of their physical appearance and what others thought about
their own appearance. Results concluded that those diagnosed with depression rated themselves
lower than their non-depressed counterparts.
This study undoubtedly connects depression and body image, since body image is so
heavily influenced by how one looks, it is easy to surmise that they would make steps to change
their body image by body modification.
Summary
Body modification and mental disorders are both prevalent, this alone will allow some
overlap. Following links between the studies, there is even more of an overlap. With studies
showing that women who have low self-esteem in regards to their body more likely had
depression than many of their non-depressed counterparts, and how studies have shown that low
self-esteem was usually cause for some form of cosmetic surgery, one can make the tentative link
between depression inadvertently leading to cosmetic surgery.
There are also studies that show most who go to receive cosmetic surgery have specific
problem areas they want revised, they do not just go in saying they would like to look more
beautiful. Problem areas to the point of going under the knife to correct them may be seen as
obsessive, corresponding to traits of someone possessing body dysmorphic disorder.

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Although at one point it may have been possible for heavily tattooed and pierced people
to be depressed or unhappy with themselves, in todays most recent studies that does not seem to
be the case. In all studies researched in this paper, none of them found any correlation between
DSM IV or 5 standards of mental disorders and heavily or even non-heavily tattooed people
when compared to non-tattooed counterparts. The most correlation found in any of these studies
was that more heavily tattooed people were from more rural areas, which is seen as a trigger for
severe anxiety problems. The comorbidity rate of severe anxiety is between 69% and 81% and
the comorbid issues are usually other anxiety disorders and mood disorders like depression.
Conclusion
When it comes to body modification and its potential ties to mental disorders or illness, it
seems that there is no distinct correlation. And although some can be drawn, there will still have
to be a lot of research done on the subject before anyone is able to give a definitive yes or no
answer concerning the subject. These future studies will have to take into account an individuals
history with mental illness, and their history and details with tattoos and piercings such as how
they were obtained, the tattoo or piercings location and size, as well as in regards to tattoos what
style of art is depicted, and possibly what subject matter the art is of. Like any study there will
always be outliers, either supporting or diminishing the hypothesis, future researchers must take
this into account and ensure that their sample size is large enough

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