Tattoos as a method of self-harm to reduce psychological pain in people with borderline personality disorder

Abstract

Introduction: previous studies show how many physical self-injurious practices contribute to reducing psychological pain and anxiety, while also showing that borderline personality disorder (BPD) is the diagnostic orientation that most engages in this practice. The aim of this study is to understand whether tattoos are conceived as a self-injurious method by patients with BPD, in order to guide our clinical practice when carrying out interventions to prevent self-harm and impulsivity, interventions to prevent tattoos as a self-injurious method, and interventions aimed at offering other ways of controlling and channelling impulsivity and expressing anxiety. Material and method: an observational, descriptive and cross-sectional study that included 36 patients diagnosed with BPD who had at least one tattoo. All of them were attended in one of the psychiatry units of the Hospital de la Santa Creu i Sant Pau in Barcelona between January and June 2016. Through an ad hoc questionnaire designed specifically for this study, each tattoo was assessed individually as to: i) whether participants considered that their tattoos had been done as a self-harm method and ii) the characteristics of each tattoo (reason for having it, location, theme, impulsivity). In addition, all participants completed the Barratt Impulsiveness Scale (BIS-11). Results: 36 patients diagnosed with BPD took part (33 women and 3 men), with a mean age of 35 years (standard deviation [SD]: 7.945) and a mean of 3.89 tattoos (SD: 2.816). 140 tattoos were analysed, of which 83 were done for pleasure; 33, for control; 29, for psychological pain; 26, for anger; and 17, for anxiety. The most frequent location was the upper limbs (n = 68) and the most recurrent theme was symbols and logos (n = 51). Of the 140 tattoos, 76 were done as a self-harm method according to participants, the main motivations being pleasure (n = 29), psychological pain (n = 28) and anger (n = 25). Of the tattoos done as a self-harm method, 30 were related to maltreatment/abuse. There were no differences between the number of tattoos as a self-harm method and the degree of impulsivity. Discussion: tattoos were done as a self-harm method in more than half of the cases among patients with BPD, the main motivations being psychological pain, anger and anxiety.