Temporary Tattoos: Alternative to Adolescent Self-Harm?

Article excerpt

Although self-harm behaviors such as burning or cutting are common among adolescents, they are a source of concern for parents and friends, and challenging to treat. Treatments have focused on distracting stimuli such as ice or the sting of a rubber band snapped on the wrist. Tattooing may be an alternative somatic strategy that can decrease self-harm and counter negative body image. (1,2)

In a study of 423 individuals with body modification (tattoos and piercings), 27% admitted to cutting themselves during childhood. (3) This study's authors concluded that these practices became a substitute for self-harm, helped patients overcome traumatic experiences, and improved satisfaction with body image.

In line with these observations, we decided to offer temporary tattooing to residents in our 60-bed child and adolescent treatment center. Patients were age 6 to 20 and 70% were female. We received consent from all patients' guardians after explaining the temporary, nontoxic nature of the ink or decals.

Our first trials were with adolescent females with a history of cutting, but we offered temporary tattooing to all patients within a few months. Overall, 7 females and 3 males, all of whom had an axis I mood disorder, participated in temporary tattooing as an alternative to self-harm. We noted borderline personality traits in female patients who engaged in severe self-harm. Patients either drew on themselves or, with therapist supervision, "tattooed" other patients using self-selected designs.

One older teenage girl used cutting to manage flashbacks of sexual abuse from a family member. She had multiple scars from the cutting despite outpatient, hospital, and residential treatment over several years without symptom improvement. After 1 year of tattooing, her cutting episodes decreased from several times per month to once every 3 months. She also reported an improvement in positive perception of her body image from 0 on a l-to-10 scale on admission to 5 at 1 year.

A younger teenage female without visible scars used cutting to manage feelings of being ugly associated with memories of sexual abuse. She reported that over 3 months, drawing tattoos improved her feelings about her body from 0/10 to 4/10, and she no longer reported thoughts of cutting or self-harm. …