A note before starting
Living with a mental health condition does not stop anyone from having tattoos, piercings or other modifications, and having them does not mean a person is ill. This article looks at how certain conditions can intersect with decisions about the body, in general terms. It is not diagnostic, and only a qualified professional who knows you can say what applies in your case.
Mental illness is a broad category
“Mental illness” covers a wide range of conditions, from anxiety and depression to eating disorders, trauma-related conditions, bipolar disorder, psychosis and personality-related conditions, among others. They differ in symptoms, causes and treatments, and many people experience them at some point in life. Some are episodic; some are longer term; many respond well to treatment.
Because of that variety, no single statement describes how they relate to body modification. A better approach is to look at a few ways in which particular conditions can matter to decisions about changing the body.
Body dysmorphic disorder
Body dysmorphic disorder, often shortened to BDD, is one of the best-known conditions connected with appearance. It involves a persistent preoccupation with perceived flaws, often minor or not noticeable to others, that causes significant distress and interferes with daily life. People with BDD commonly spend long periods checking, comparing, concealing or researching the feature that worries them, and they may seek cosmetic procedures or other changes hoping to relieve the distress.
Clinicians report that changes made for BDD (sometimes called body dysmorphia in everyday speech) often do not bring lasting relief, and that dissatisfaction can persist or shift to another feature. For that reason, professionals who offer cosmetic procedures are often encouraged to be alert to signs of BDD and to refer people for assessment. BDD is treatable, commonly with specific forms of talking therapy and sometimes medication, so getting evaluated is worth it.
Not every dislike of a feature is BDD. Many people dislike something about their appearance without the intense preoccupation, time cost and impairment that define the disorder. The distinction is for a clinician to assess.
Eating disorders and body-related distress
Eating disorders involve complicated relationships with food, weight and body shape, and body dissatisfaction is often central. Decisions about changing the body can be fraught for someone in this situation, because the thoughts driving the decision may be part of the illness. If you have an eating disorder or suspect you do, it is wise to involve a healthcare professional before any major body-related decision, and to prioritize treatment. This site does not offer advice on weight change or procedures.
Anxiety and depression
Anxiety and depression are among the most common conditions, and they can color decisions in understandable ways. Low mood can bring on hopelessness about appearance or a wish for a dramatic fresh start. Anxiety can make decisions feel urgent or, conversely, can make a person freeze. Neither condition rules out a thoughtful choice, but both can make it harder to judge how a decision will feel later. Waiting until a period of lower distress, and talking with someone who knows you, tends to be wise. People with significant needle fear or panic responses may also want to discuss that with a professional, since a bad experience can be distressing.
Trauma-related conditions
For people who have experienced trauma, including those living with trauma and PTSD, the body can carry complicated meanings. Some find that choosing a tattoo or marking gives a sense of reclaiming their body; others find that being touched, held still or experiencing pain triggers difficult memories. Both reactions occur. A trauma-informed approach, in which the professional communicates clearly, asks for consent at each step and allows breaks, can help, and a therapist can help someone consider whether and when a modification suits them.
Self-harm and suicidal thoughts
Any condition can sometimes involve urges to hurt oneself. Because that topic needs its own careful treatment, it is covered separately in this cluster. If you are thinking about harming yourself or ending your life, please contact a crisis line or your local emergency number. In the United States, call or text 988.
Medication and physical health
Practical medical matters also interact with mental health care. Medication interactions are a reason to ask a doctor first: some medications can affect bleeding, healing or skin reactions, and some people take medication that changes how they feel physically or emotionally during a stressful procedure. It is reasonable to tell your doctor about any planned modification and to ask whether your medications or health conditions call for any precautions. Professionals who do tattoos and piercings typically ask about health history on a consent form, and honest answers help them keep you safe. The decision about disclosure is yours, but the information is protective.
Why talk to a doctor or therapist first
For a minor piercing, a conversation with a professional may not be necessary. For a major or irreversible change, it is worth considering, particularly if you have a mental health condition or are unsure about your motives. A good conversation can cover:
- what you hope the change will do and whether that is realistic
- whether your current mood or symptoms might be influencing the timing
- whether you are being treated for a condition and how stable you are
- what to do if you feel differently afterward
- whether there are physical health considerations
A clinician is not there to forbid anything. The aim is to make sure the decision is yours, made with clear eyes. If a doctor or therapist dismisses you because of your appearance, you can look for another who listens.
Choosing carefully and having a plan
Some further steps can support wellbeing:
- Take your time, and revisit the idea after a break.
- Choose a licensed professional who answers questions patiently.
- Tell someone you trust about your plans.
- Prepare a plan for the days afterward, including aftercare and who to contact if you feel low.
- Keep up with any ongoing treatment, since a modification does not replace it.
The takeaway
Mental illness and body modification can intersect in many ways, some neutral, some beneficial, some difficult. Conditions that distort how the body is seen or that make impulsive decisions more likely call for extra care and professional input. Most of all, mental illness is not a character flaw, and body art is not a symptom. If you are struggling, reaching out to a doctor, therapist or crisis service is a sign of strength, and it can be the most valuable step you take.