Tattoos: Demographics, Motivations, and Regret in Dermatology Patients (2024)

Abstract

Keywords: Psychodermatology, tattoo motivations, tattoo regret, tattoos

Introduction

Tattoos can be seen in all cultures around the world. They date back thousands of years as an ancient art form and have recently become increasingly popular and common. The tattooing process or technique involves the insertion of coloured pigments into the deep layers of the skin using a tattooing machine that contains needles that punch through the epidermis. Tattoos are usually performed by a professional tattoo artist in a tattoo studio, although some people have their tattoos performed by themselves or their friends in places such as a home or prison.

The etymological origin of the word tattoo is believed to have two major derivations: the first is from the Polynesian word ‘ta’, which means ‘striking something’, and the second is the Tahitian word ‘tatau’, which means ‘to mark something’.[1] The skin is the largest and most visible organ of the human body; thus, tattooing is a good way for individuals to express themselves and their thoughts, feelings and beliefs. In this context, tattooing practices vary according to culture, society and even era, and the reasons for obtaining tattoos are highly variable. They include religious factors, showing one's status and position in society or group membership, therapeutic reasons or merely for decorative purposes.[2] Motivations or reasons also differ among genders, age groups and other demographic characteristics, such as educational levels and professions. A recent study, which was designed as an international online survey among a representative sample of the general population from five major countries, found that the motivations for obtaining tattoos mostly included celebrating a milestone, embellishment of the body and expressing individuality, and that motivations differed between genders and countries.[3]

There is also the issue of tattoo regret. Tattoo regret means that a person feels regret and is dissatisfied with at least one of their tattoos after obtaining them. Studies have shown that tattoo regret rates have increased in recent years as tattoos have become more popular and common; tattoo regret is also correlated with acquiring one's first tattoo at a younger age.[4,5]

Both motivations and regret for tattooing, in fact, address some psychological and psychiatric aspects of individuals or psychocultural features. A visible figure or mark on the skin can expose an individual's feelings and thoughts through the personal meaning of the skin art and the underlying reason for obtaining the tattoo.[6] The deepest unconscious conflicts may be expressed via tattoos.[7] Tattoos can help psychodermatologists understand their patients via the symbols on the skin.

This study was done to reveal demographic features, as well as smoking, alcohol consumption and/or substance use, motivations and tattoo regret in dermatology patients.

Materials and Methods

A multi-centre cross-sectional study was conducted. Patients who applied to dermatology outpatient clinics for any skin disorder in a total of 10 centres in different cities in Turkey between November 2019 and November 2020 and had at least one tattoo were included in the study. There were no exclusion criteria except for refusing to participate in the study.

A 16-question survey that included basic demographic characteristics, including tobacco, alcohol and substance use of study participants, morphological characteristics and types of tattoos, and questions to assess tattoo regret or removal, as well as tattooing practices, was designed. While some of the survey questions were self-structured by the authors, some were based on similar previous studies.[4,8,9] A semi-structured questionnaire which was originally developed by Tiggemann and Golder (2006) for understanding motivations for obtaining body art such as tattoos and piercings was performed for all participants.[8] Participants were asked to give points from 1 (not a reason) to 5 (very strong reason) regarding 19 possible reasons for having acquired their tattoos.

SPSS 15.0 for Windows was used for the statistical analysis. Descriptive statistics are given as numbers and percentages for categorical variables and given as mean, standard deviation, minimum, maximum, median and interquartile range for numerical variables. Two independent group comparisons of ordinal variables were made with the Mann–Whitney U-test. The relationships between numerical variables were analyzed with Spearman's correlation analysis since the parametric test condition was not met. The statistical alpha significance level was accepted as P < 0.05.

Approval from ethics committee was obtained and it was writtenly approved on 10.03.2020. Due to the intensity of ethics committee of Seyrantepe Etfal Training and Research Hospital, verbal approval was obtained earlier.

Results

Discussion

There are many studies on tattooing in the medical field, particularly in psychology and psychiatry, but studies in dermatology on the demographic characteristics of people who have tattoos, their tattooing practices and their motivations for having tattoos are limited. Tattoos and tattooing practices are directly related to the skin; therefore, it is important to examine the issue from a dermatological/psychodermatological viewpoint. Dermatological patients may have visible signs of disease on their skin. The visibility of any diseased skin or obvious symptoms in public can be associated with stigmatization, discrimination and low self-esteem in these patients.[7] On the other hand, tattoos are commonly visible and have some inherent emotional foundation. They are applied on the skin to express feelings, commitment, beliefs and so on. Tattooing carries a meaning, a story, which is unique and very individualistic.[10] Thus, any tattoo bearer has her/his own reasons for having been tattooed. Motivations may be generally classified into religious, cultural or emotional categories, as well as celebration or decoration, or the motivation may be more individualistic.[10,11,12]

In our cohort group, men, singles, younger persons and those with more education were greater in number than women, married persons, older persons and those with less education. In a review of epidemiologic studies by Kluger, it was noted that older populations are generally less tattooed than the young; tattooing is definitely more common in those born after the 1980s.[3] In the same study, it was emphasized that men are typically more inclined to have tattoos. In a Polish study, men were significantly more likely to have their bodies tattooed.[13] However, this trend seems to be changing: women are now more likely to have tattoos than men in some countries, such as the USA and Australia. Additionally, Heywood et al. conducted a survey in Australia and found that men and women aged between 20 and 39 were most likely to have been tattooed, as were men with lower levels of education, tradesmen and women with live-out partners.[14] Roberts and Ryan conducted a survey on 4,595 people with an age range of 11–21 and stated that there was a correlation between possessing a tattoo and being brought up in a broken family or one with low parental income or education.[15] Our results regarding educational level in tattooed study participants were different. However, our study is not a large-scale study, having only been performed in a sample of dermatology outpatients. Nevertheless, sociocultural variations should be considered in evaluations of the link between sociodemographic factors and tattooing, as stated by Antoszewski et al.[13]

Although most of the participants had their tattoos performed professionally in tattoo studios, 24.5% of the participants disclosed that they had received their tattoos in a house or a prison instead of in a tattoo studio. Liszewski et al. found that 17.5% of the total 501 participants in their study had received their tattoos somewhere besides a tattoo studio.[4]

Considering the reasons for having tattoos, the most frequent tattoo motivations we found were similar to the results of previous studies.[8,9,13,16,17,18,19] The leading motivations in our study were ‘to feel independent’, ‘to be an individual’, ‘to feel better about myself’, ‘because they look good’ and ‘to have a beauty mark’. While the first three motivations express an augmentation of self-expression and self-identity, the other two can be considered artistic or decorative aims. Other studies have confirmed these results. A review study by Wolhrab et al. found a total of 10 motivations. A vast majority of studies in this review mentioned the expression of individuality and the beautification of one's own body as predominant motivations for obtaining body modifications.[16] Forbes noted that most tattooed persons view tattoos and other forms of body art as a way of expressing themselves and as an attractive method of body adornment.

Motivations for having tattoos can vary between genders. Women had significantly higher scores than men for obtaining a tattoo ‘to be an individual’, ‘to have a beauty mark’ and ‘to feel better about themselves’. A study conducted by Grumet et al. reported that women are more likely to have tattoos for body decoration, while men are more likely to have an image or symbol representing group identity.[20] Swami found that men had higher scores on obtaining a tattoo to celebrate an occasion or a person, while women had higher scores on obtaining a tattoo to be fashionable.[9] A survey from Greece demonstrated that 77% of all subjects had motives of ideology, message or fashion.[21] Tiggemann and Golder found that men had higher scores regarding tattoo motivations of ‘to show commitment to a group’.[8] Weiler et al. revealed that self-expression and a sense of identity and uniqueness are among the most widespread and primary motives for having tattoos.[22]

Another point is that participants who had their tattoos applied by an amateur had higher scores regarding tattoo motivation of ‘because my friends are tattooed’. In addition, substance use among the participants was relatively high, and 24.5% of the participants got their tattoos somewhere other than a tattoo studio, such as a house or prison. These results may be correlated with a tendency to engage in risky behaviours. This correlation with a tendency to engage in risky behaviours such as smoking, alcohol and drug abuse, or engaging in illegal behaviour and activities has been previously pointed out by many studies.[23,24,25,26,27]

Almost one-quarter of the participants regretted at least one of their tattoos. In previous studies, it has been estimated that 16%–44% of people with tattoos later regret at least one of their tattoos.[4,28,29,30,31,32] Aslam and Owen indicated that current fashions and changing social attitudes towards tattoos may be primary reasons for tattoo regret.[32] The main reasons for tattoo regret have been noted as family or partner pressure, personality change, employment, change of lifestyle or partner or poorly done tattoos.[5] In our study, the fact that participants expressing tattoo regret had the most statistically significant response for ‘to be fashionable’ in terms of tattoo motivation may elucidate the most common reason for tattoo regret, which was described by participants as ‘not liking the tattoo anymore’. On the other hand, people satisfied with their tattoos felt that they were more unique, creative and beautiful due to their tattoos. Additionally, we found that tattoo regret is related to getting the first tattoo at an earlier age, as well as to male gender, lower education level, and having the tattoo performed by an amateur or oneself. These results are consistent with those of previous studies.[4,5] A study performed among college students by Armstrong et al. revealed that 13% of them did not like their first tattoo, and 18% stated that their tattoo artist did not meet their expectations.[33] However, Kluger noted that the rate of tattoo regret may change in accordance with gender, age, interests and even nationality.[34] Moreover, persons who had tattoos on their upper extremities and faces had higher regret rates compared to those with tattoos in other areas. It is likely that having tattoos on visible areas provides a greater inclination to regret.

Conclusions

This study of dermatology outpatients with tattoos found that feeling independent and free, feeling better about one's self and beauty were the most common reasons for obtaining tattoos. Thus, uniqueness, self-identity, beauty and fashion were important concepts in this study. The finding of an association between tattooing and risky behaviour was in line with findings from other studies. Also, this study showed that tattoo regret was associated with having the first tattoo at an earlier age, male gender, low education level, being tattooed by an amateur or self and having a tattoo on a visible area of the body.

In the light of the foregoing results, tattoos should not only be considered artwork on the body, but also as a tool for individuals to express themselves and construct their self-identity. Tattoos have deep symbolic meanings rooted in emotion and may offer clues to the behavioural patterns of individuals. Consequently, tattooing is a complex practice and a relevant subject for psychodermatology.

References