Thirty percent of U.S. adults in a 2019 survey of 2,008 people had received a mental health diagnosis. Of those, 42.3 percent had a tattoo. Of those who had never received a diagnosis, only 28 percent did. That gap is real — and it is also almost certainly not the whole story.
The relationship between tattooing and mental health is one of the most consistently misread areas in the research. Correlation studies find elevated rates of psychiatric history among tattooed people. Controlled clinical studies often find those differences disappear. Prospective studies — the kind that actually follow people through the experience — find measurable psychological benefits. And specific populations, from cancer survivors to combat veterans, show strong evidence that tattooing can function as genuine therapy. None of that cancels the darker correlations out. All of it needs to be held at once.
The Population Picture: Correlation Is Not Pathology
The foundational epidemiological work comes from Dr. Aglaja Stirn and colleagues at JW Goethe University Hospital, Frankfurt, whose 2006 study of 2,043 German citizens found tattooing significantly correlated with sensation-seeking and, within the 14–44 age group, with a perception of reduced mental health. A 1990 paper by Dr. R.F. Raspa and Dr. J. Cusack in American Family Physician went further, arguing that finding a tattoo on physical examination should alert a physician to possible underlying psychiatric conditions. That paper shaped clinical attitudes for a generation.
More recent controlled research has substantially revised that picture. A 2015 study by Anna J. Pajor, Grażyna Broniarczyk-Dył, and Julita Świtalska, published in Psychiatria Polska, surveyed 449 people and found no significant differences in life satisfaction between modified and non-modified groups — and actually found higher self-esteem regarding competence and leadership among those with body modifications. A 2022 replication by Mateusz J. Lammek, also in Psychiatria Polska, surveyed 557 people during the COVID-19 pandemic and reached the same conclusion: body modifications should not be considered a risk factor for poor mental health outcomes. The Raspa and Cusack framing reflects a cultural moment when tattoos were concentrated among marginalized populations. As tattooing has entered the mainstream, the blanket clinical alarm has not held up.
What Getting a Tattoo Actually Does to You
The most methodologically rigorous answer to that question comes from Prof. Viren Swami of Anglia Ruskin University, whose 2011 prospective study in Body Image recruited 82 people about to get their first tattoo and measured them before, immediately after, and three weeks later. Both men and women showed significantly lower appearance anxiety and body dissatisfaction immediately after getting tattooed, and significantly higher body appreciation, self-ascribed uniqueness, and self-esteem at the three-week mark.
The gendered finding within that study matters for anyone working in a studio. Swami found that women experienced higher social anxiety surrounding their appearance three weeks after the procedure — an effect men did not show. Research reviewed in Body Image confirms why: non-tattooed adults perceive tattooed individuals as more neurotic and less conscientious, and those negative attributions are more readily applied to women with visible tattoos than to tattooed men. The psychological lift from getting tattooed is real. The social cost that follows, for women especially, is also real.
When Tattooing Functions as Therapy
The strongest evidence for tattooing as a genuinely therapeutic act comes from specific clinical populations. A 2024 study by Dr. Miranda Proctor, Dr. Jeffrey E. Cassisi, Dr. Robert D. Dvorak, and Veronica Decker at the University of Central Florida, published in Supportive Care in Cancer, examined 330 post-surgical breast cancer survivors. Those with medical tattoos reported significantly lower body-image distress, depression and anxiety symptoms, and perceived stress than those without. Lisa Franczak, owner of Rose Red Tattoo and Permanent Makeup in Ellicott City, Maryland, writing in the AMA Journal of Ethics in 2018, described how breast tattoos can embolden a woman’s sexuality, self-confidence, and sense of body reclamation after surgery.
A 2025 study by Keren Cohen-Louck and Yakov Iluz at Ariel University, Israel, published in Stress and Health, used semi-structured interviews with eight former combat soldiers and identified two adaptive coping mechanisms in their tattooing: emotional-relief coping — processing and expressing emotions tied to military events — and positive-productive coping that enhanced positive feelings and expressed a transformative process of change. A 2024 study by Scout Silverstein and Tamara Santibañez, published in Eating Disorders, found that tattooing enabled embodiment, recovery-oriented behaviors, positive body image, and empowerment among 15 individuals in eating disorder recovery. The common thread across all three populations is intentional agency over a body that has felt alien or harmed.
The Harder Correlations: BPD, Impulsivity, and Manic Tattooing
A 2018 study by Dr. Alexandra Vizgaitis and Prof. Mark F. Lenzenweger, published in Personality Disorders, found that borderline personality disorder features were positively correlated with total number of body modifications, including tattoos, and specifically with identity diffusion and low self-concept clarity. A 2013 German study by Gesche Höhner, Tobias Teismann, and Ulrike Willutzki at Ruhr University Bochum found that women with borderline symptomatology considered individuality, coping, and management of negative life events significantly more crucial reasons for getting modified — suggesting body modification may serve as a coping strategy similar to self-injury for people with borderline tendency.
More recent work complicates that picture. A 2025 study by Victoria Avon, Nathalie Gullo, and Dr. D. Catherine Walker at Union College, published in the International Journal of Environmental Research and Public Health, found that the extent of tattooing — number of tattoos and body surface covered — was not significantly associated with BPD symptomatology. Non-suicidal self-injury craving scores were significantly correlated with body modification craving scores, suggesting that for some people with high BPD symptomatology, tattooing may function as an alternative to self-harm rather than an expression of the same impulse.
On the specific question of tattooing during mania: the honest answer is that the formal peer-reviewed evidence is thin. A direct search of PubMed for studies on tattoos and bipolar disorder or mania yields no results. What the broader behavioral literature does confirm is the mechanism that makes manic tattooing plausible — bipolar disorder involves episodes of elevated impulsivity, reduced inhibition, and decisions that feel deeply meaningful in the moment but may not reflect baseline values. Impulsive decision-making is the single strongest predictor of tattoo regret across the literature, with one analysis finding it accounts for 35 percent of regret cases. For anyone with bipolar disorder, the research does not say never get a tattoo. It says be honest about your current state — and the impulsivity and regret data supports that caution directly.
Tattoo Regret: The Numbers
Regret is measurable, and the numbers have grown. A multi-center dermatological study by Altunay (2022) found 26.5 percent of tattooed adults regret at least one tattoo, with 42.5 percent of that group pursuing removal. A 2023 Pew Research survey of 8,480 adults found a 24 percent regret rate — nearly double the 14 percent recorded in 2012. Research by Liszewski and colleagues found that 35.1 percent of people who got their first tattoo before age 18 express regret, compared to 12.8 percent of those who waited until 18 or older. Age at first tattoo is the strongest individual predictor of regret in the literature. Impulsive decision-making is the strongest situational one. Those two facts together are the most practical thing this research has to offer anyone sitting in a chair or standing behind one.
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