Tattoos: Demographics, Motivations, and Regret in Dermatology Patients

Abstract

Background:

Tattoos are very popular in today's world. Objectives: The aim of this study was to determine the demographics, the characteristics of tattoos, motivations for getting tattoos, tattooing practices and tattoo regret.

Materials and Method:

This multi-centre, cross-sectional study was conducted among. 302 patients attending to the dermatology outpatient clinics and having at least one tattoo. A questionnaire form including all needed data about patients, tattoo characteristics and possible reasons for obtaining tattoos was designed and applied to all participants.

Results:

Of 302 patients, 140 (46,4%) were females and 162 (53,6%) were men. The mean age was28,3 ± 8,1 years (min-max, 16–62) for all study group, 53% of participants (n = 160) had at least one tattoo involving letters or number, 80 participants (26%) stated regret for at least one of their tattoos, and 34 of them (42,5%) had their unwanted tattoo removed or camouflaged with a new tattoo. The most common reason for regret was ‘not liking the tattoo anymore’. The most common motivations for having tattoos were ‘to feel independent’, ‘to feel better about himself/herself’ and ‘to look good’. Women had higher scores than men regarding tattoo motivations of ‘to be an individual’ and ‘to have a beauty mark’.

Conclusion:

Given the rates, tattoo regret is a significant issue and as motivations differ between genders, age groups and other demographic characteristics; tattoos are not just an ink or drawing on the body, but a tool for individuals to express themselves and to construct self-identity. Tattoos have deep symbolic meanings for emotions, and they may be a clue for behavioural patterns of individuals.

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

Demographic characteristics of study participants

A total of 302 patients participated in the study; 140 (46.4%) were female and 162 (53.6%) were male. The mean age was 28.3 ± 8.1 years (min–max: 16–62 years) for the entire study group. The demographic characteristics of the participants and their alcohol, tobacco and substance use habits are listed in Table 1.

Table 1.

Demographics and habits of participants

	n	%
Gender
Female	140	46.4%
Male	162	53.6%
Age Mean±SD (Min-Max)	28.3±8.1 (16-62)
Education level
Primary school	21	7.0%
Middle school	35	11.6%
High school	94	31.1%
University	152	50.3%
Marital status
Single	206	68.2%
Married/Cohabitating	76	25.2%
Widowed/Divorced	20	6.6%
Tobacco use
No	94	31.1%
Yes	170	56.3%
Quit	38	12.6%
Alcohol use
No	116	38.4%
Occasionally	162	53.6%
Regularly	24	7.9%
Substance use
No	260	86.1%
Yes	9	3.0%
Previous use	33	10.9%

Half of the participants (n = 152; 50.3%) had a university or postgraduate degree. Among the 302 participants, 206 (68.2%) participants stated their marital status as single, 76 (25.2%) participants were married or cohabitating, and 20 (6.6%) participants were widowed or divorced. Ninety-four participants (31.1%) had never used tobacco, while 38 patients (12.6%) had previously used tobacco and had quit. More than half of the participants (n = 170; 56.3%) reported regular tobacco use. A total of 186 patients (61.5%) reported regular or occasional alcohol use. Thirty-three participants (10.9) reported previous substance use, and nine participants (3%) reported active substance use.

Tattoo characteristics and tattooing practices

The characteristics of the participants’ tattoos, such as colour, total number of tattoos, location on the body and tattoo content, were recorded; participants were asked questions about their tattooing practices. The results for the tattoo characteristics and tattooing practices are shown in Table 2. The mean age at getting a first tattoo was 21.8 ± 6.8 years (min–max: 12–56 years). One hundred and twenty patients (39.7%) stated that they were considering getting a new tattoo in the next 12 months. Ninety patients (29.8%) had applied their own tattoos or had them applied by an amateur who was not considered a professional tattoo artist. Furthermore, 74 patients (24.5%) stated that they acquired their tattoos in a house or a prison instead of in a tattoo studio.

Table 2.

Tattoo characteristics and tattooing practices

	n	%
Colour of tattoo
Monochromic	222	73.5%
Polychromic	80	26.5%
Age at first tattooing Mean±SD (Min-Max)	21.8±6.8 (12-56)
Considering getting a new tattoo in the next 12 months
No	182	60.3%
Yes	120	39.7%
Regretting any tattoo
No	222	73.5%
Yes	80	26.5%
Removed or camouflaged unwanted tattoo
No	268	88.7%
Yes	34	11.3%
Total number of tattoos Median (Min-Max)	2 (1-60)
Total number of tattoo sessions Median (Min-Max)	2 (1-62)
Tattooing practice
Amateur/self	90	29.8%
Professional	212	70.2%
Where did you get your tattoo?
House, prison, etc.	74	24.5%
Tattoo studio	228	75.5%
Tattoo location on the body
Upper extremities	259	85.8%
Back	63	20.9%
Front trunk	83	27.5%
Lower extremities	51	16.9%
Other	34	11.3%
Tattoo content
Alphanumeric	160	53.0%
Figural: Animal	90	29.8%
Mystical	76	25.2%
Nature	85	28.1%
Emblem	101	33.4%
Tattoo categorization
Cosmetic	293	97.0%
Medical	11	3.6%
Traumatic	2	0.7%

As for tattoo content, 160 participants (53%) had at least one tattoo involving letters or numbers. Most of these tattoos were names, initial letters or meaningful dates referring to a loved one, or motivational quotes such as ‘carpe diem’. Religious tattoos, which were included in the mystical tattoo category, were the least common tattoos in the study group (n = 76, 25.2%). For colour, 222 participants (73.5%) had monochromatic tattoos, most of which were coloured black, while 80 participants (26.5%) had polychromatic tattoos. The tattoos of the participants were also categorized as cosmetic, medical or traumatic; 293 participants (97%) had cosmetic tattoos, 11 participants (3.6%) had medical tattoos, and 2 participants (0.7%) had traumatic tattoos. Most of the participants (n = 259; 85.8%) had tattoos on their upper extremities. Furthermore, 61 patients (20.2%) had piercings on their bodies in addition to tattoos.

Motivations for obtaining tattoos

The mean scores for the reasons for obtaining tattoos were compared according to demographic characteristics such as gender, age and education level, as well as the common evaluation of all participants. The most common motivations for getting tattoos for the entire study group were ‘to be an individual’, ‘to feel better about myself’ and ‘because they look good’, followed by ‘to express myself’, ‘to feel independent’ and ‘to have a beauty mark’. However, the most common motivations for getting tattoos differed between genders, age groups and educational levels, which are listed in Tables 3, 4 and 5, respectively. As can be seen in Table 3, women had higher scores than men regarding tattoo motivations of ‘to be an individual’, ‘to have a beauty mark’ and ‘to feel better about myself’.

Table 3.

Reasons for obtaining tattoos in all study groups and genders

	Total	Gender		P
		Women	Men
To celebrate an occasion/person	1 (1-5)	1 (1-5)	1 (1-4)	0.303
To feel independent	3 (1-4)	3 (1-4)	2.5 (1-4)	0.819
To look attractive	2 (1-4)	2 (1-4)	2.5 (1-3)	0.550
To express myself	3 (1-4)	3 (1-5)	3 (1-4)	0.087
To be an individual	3 (1-5)	4 (1-5)	3 (1-5)	0.009
To be unique	1 (1-3)	2 (1-3.75)	1 (1-3)	0.074
To control my body	1 (1-4)	2 (1-4)	1 (1-3)	0.105
To be fashionable	1 (1-3)	1 (1-3)	1.5 (1-3)	0.536
To be creative	2 (1-4)	3 (1-4)	2 (1-4)	0.378
Because they look good	3 (1-5)	3 (1-5)	3 (1-5)	0.746
Because my friends are tattooed	1 (1-2)	1 (1-2)	1 (1-3)	0.462
To rebel	1 (1-1)	1 (1-1)	1 (1-1)	0.659
Because I want it to be seen	2 (1-4)	2 (1-4)	2 (1-3)	0.296
To feel better about myself	3 (1-5)	4 (2-5)	3 (1-4)	0.011
To stand out in a crowd	1 (1-2)	1 (1-2)	1 (1-2)	0.884
Because I like to take risks	1 (1-3)	1 (1-4)	1 (1-3)	0.194
To feel mature	1 (1-2)	1 (1-3)	1 (1-2)	0.096
To have a beauty mark	3 (1-4)	1 (3-5)	1 (2-4)	0.028
To show commitment to a group	1 (1-1)	1 (1-1)	1 (1-2)	0.800

*Statistical alpha significance level was accepted as P<0.05. *The most common motivations are in bold

Table 4.

Reasons for obtaining tattoos in relation to age

	Age
	r	P
To celebrate an occasion/person	0.005	0.936
To feel independent	0.021	0.722
To look attractive	-0.045	0.438
To express myself	-0.091	0.114
To be an individual	-0.090	0.118
To be unique	-0.159	0.006
To control my body	-0.208	<0.001
To be fashionable	-0.188	0.001
To be creative	-0.272	<0.001
Because they look good	-0.146	0.011
Because my friends are tattooed	-0.026	0.654
To rebel	-0.009	0.875
Because I want it to be seen	-0.105	0.068
To feel better about myself	0.032	0.575
To stand out in a crowd	-0.068	0.241
Because I like to take risks	-0.113	0.049
To feel mature	-0.148	0.010
To have a beauty mark	-0.022	0.698
To show commitment to a group	-0.021	0.715

*r shows inverse correlation

Table 5.

Reasons for obtaining tattoos and educational levels

	Educational Level				P
	Primary School	Junior High School	High School	University
To celebrate an occasion/person	2 (1-3.5)	3 (1-5)	1 (1-3)	1 (1-5)	0.200
To feel independent	3 (1.5-4)	3 (1-5)	2 (1-4)	3 (1-4)	0.741
To look attractive	2 (1-3)	1 (1-3)	2 (1-4)	3 (1-4)	0.061
To express myself	2 (1-3)	3 (1-3)	2 (1-4)	3 (1-5)	0.022
To be an individual	1 (1-2)	2 (1-5)	3 (1-5)	4 (1.25-5)	<0.001
To be unique	1 (1-2)	2 (1-4)	1 (1-3.25)	1 (1-3)	0.332
To control my body	1 (1-3.5)	1 (1-4)	2 (1-4)	1 (1-3)	0.848
To be fashionable	2 (1-3.5)	3 (1-5)	1.5 (1-3)	1 (1-3)	0.003
To be creative	1 (1-2.5)	3 (1-4)	2 (1-4.25)	3 (1-4)	0.291
Because they look good	3 (1-4)	3 (2-5)	3 (1-5)	3 (1-5)	0.660
Because my friends are tattooed	1 (1-3)	2 (1-4)	1 (1-2)	1 (1-2)	0.012
To rebel	1 (1-1.5)	1 (1-1)	1 (1-2)	1 (1-1)	0.324
Because I want it to be seen	2 (1-5)	2 (1-3)	2 (1-4.25)	2 (1-3)	0.293
To feel better about myself	2 (1-5)	3 (1-4)	3 (1-5)	4 (1-5)	0.401
To stand out in a crowd	1 (1-2.5)	1 (1-2)	1 (1-3)	1 (1-2)	0.164
Because I like to take risks	1 (1-2.5)	1 (1-3)	2 (1-3)	1 (1-3)	0.167
To feel mature	1 (1-2)	1 (1-3)	1 (1-3)	1 (1-2)	0.529
To have a beauty mark	1 (1-3)	2 (1-3)	2 (1-4.25)	3 (1-5)	0.039
To show commitment to a group	1 (1-1)	1 (1-2)	1 (1-2)	1 (1-1)	0.371

The scores given as ‘being unique, controlling my body, fashion, being creative, looking good, feeling mature, I like to take risks’ among the reasons for wanting to have a tattoo with age were found to be negatively and weakly statistically significant (p = 0,006 P < 0,001 P = 0,001 P < 0,001 P = 0,011 P = 0,049 P = 0,010). The scores given as ‘creative’ among the reasons for wanting to have a tattoo with age had the highest correlation coefficient (r:-0.272 P < 0.001). Participants who had a university-level degree had significantly higher scores for the motivation of ‘to be an individual’.

Participants were also grouped as those with and without tattoo regret; motivations for having tattoos were also compared between these two groups [Table 6]. Participants who did not regret any of their tattoos had higher scores for having a tattoo to be an individual, to be unique, to be creative or to have a beauty mark. Participants who expressed regret for at least one of their tattoos had higher scores for obtaining a tattoo to be fashionable.

Table 6.

Reasons given for groups with and without tattoo regret

	Tattoo Regret		P
	No	Yes
To celebrate an occasion/person	1 (1-4.25)	1 (1-5)	0.569
To feel independent	2 (1-4)	3 (1-4.75)	0.138
To look attractive	2 (1-4)	3 (1-3.75)	0.384
To express myself	3 (1-5)	3 (1-3.75)	0.246
To be an individual	4 (1-5)	1.5 (1-4.75)	0.002
To be unique	2 (1-3)	1 (1-2)	0.017
To control my body	1 (1-4)	1 (1-3)	0.388
To be fashionable	1 (1-3)	2 (1-4)	0.045
To be creative	3 (1-4)	2 (1-3)	0.039
Because they look good	3 (1-5)	3 (1-5)	0.278
Because my friends are tattooed	1 (1-2)	1 (1-3)	0.107
To rebel	1 (1-1)	1 (1-1)	0.946
Because I want it to be seen	2 (1-4)	2.5 (1-4)	0.285
To feel better about myself	3 (1-5)	3 (1-4.75)	0.975
To stand out in a crowd	1 (1-2)	1 (1-2.75)	0.413
Because I like to take risks	1 (1-3)	1 (1-4)	0.802
To feel mature	1 (1-2)	1 (1-3)	0.584
To have a beauty mark	3 (1-5)	2 (1-3.75)	0.033
To show commitment to a group	1 (1-1)	1 (1-1.75)	0.950

The last comparison in motivations was made between those who had tattooed themselves/had been tattooed by an amateur and those who had been tattooed by a professional tattoo artist [Table 7]. Participants who had their tattoo applied by a professional tattoo artist had higher scores regarding the tattooing motivation of ‘to be an individual’. Participants who had tattooed themselves or had been tattooed by an amateur had higher scores for the tattoo motivation of ‘because my friends are tattooed’.

Table 7.

Reasons for amateur/self and professional tattoos

	Tattooing practice		P
	Amateur/self	Professional
To celebrate an occasion/person	1 (1-3)	1 (1-5)	0.265
To feel independent	3 (1-4)	2 (1-5)	0.549
To look attractive	2 (1-3)	2 (1-4)	0.285
To express myself	3 (1-4)	3 (1-5)	0.764
To be an individual	2 (1-4)	3 (1-5)	0.010
To be unique	1 (1-3)	1 (1-3)	0.422
To control my body	1 (1-3)	2 (1-4)	0.198
To be fashionable	2 (1-4)	1 (1-3)	0.097
To be creative	2 (1-4)	3 (1-4)	0.493
Because they look good	3 (1-5)	3 (1-5)	0.254
Because my friends are tattooed	1 (1-3)	1 (1-2)	0.003
To rebel	1 (1-2)	1 (1-1)	0.133
Because I want it to be seen	2 (1-4)	2 (1-4)	0.401
To feel better about myself	3 (1-4.25)	3 (1-5)	0.158
To stand out in a crowd	1 (1-2)	1 (1-2)	0.607
Because I like to take risks	1 (1-3)	1 (1-3)	0.203
To feel mature	1 (1-3)	1 (1-2)	0.542
To have a beauty mark	2 (1-4)	3 (1-5)	0.134
To show commitment to a group	1 (1-3)	1 (1-5)	0.265

Tattoo regret

As can be seen in Table 2, 80 participants (26%) expressed regret for at least one of their tattoos; 34 of these (42.5%) had their unwanted tattoo removed or camouflaged with a new tattoo. Participants were also asked about their reasons for regret. The most common reason for regret was ‘not liking the tattoo anymore’. In addition, tattoo regret was compared according to age, gender, educational status and tattooing practices; these results are shown in Table 8. There was no significant difference between the mean ages of the participants in both groups. On the other hand, the mean age of getting the first tattoo was lower in the regretful group. The mean age of first tattooing was 19.3 years for those who expressed regret for at least one of their tattoos, while the mean age of first tattooing for those who did not express regret was 22.7 years. The tattoo regret rate was also higher in males than in females as 66.3% of the regretful group was male.

Table 8.

Tattoo regret rates

	Regretting any tattoo				P
	Mean±SD Min-Max/Median
	No		Yes
Age	28.1±8.3		29.0±7.3		0.187
	16-62/26		18-51/28
Age at getting first tattoo	22.7±7.2		19.3±5.1		<0.001
	13-56/20		12-38/18
	n	%	n	%	P
Gender
Female	113	50.9%	27	33.8%	0.008
Male	109	49.1%	53	66.3%
Education level
Primary school	12	5.4%	9	11.3%	0.004
Middle school	18	8.1%	17	21.3%
High school	72	32.4%	22	27.5%
University	120	54.1%	32	40.0%
Marital status
Single	156	70.3%	50	62.5%	0.268
Married/Cohabitant	54	24.3%	22	27.5%
Widowed/Divorced	12	5.4%	8	10.0%
Tattooing practice
Amateur/self	51	23.0%	39	48.8%	<0.001
Professional	171	77.0%	41	51.3%
Tattoo location
Upper extremities	183	82.4%	76	95.0%	0.004
Back	45	20.3%	18	22.5%	0.748
Front trunk	57	25.7%	26	32.5%	0.241
Lower extremities	35	15.8%	16	20.0%	0.386
Other	19	8.6%	15	18.8%	0.013

It was found that there was a statistically significant difference in the educational levels of the participants in the regretful and non-regretful groups. While more than half of the non-regretful group had a university-level degree (n: 120; 54.1%), less than half of the regretful group had a university-level degree (n: 32; 40%). Moreover, the percentages of primary school graduates in the non-regretful and regretful groups were 5.4% and 11.3%, respectively. As a result, the percentage of participants with a lower educational level was higher in the regretful group.

Tattoo regret was also found to be related to the choice of amateur or professional tattooing. While the amateur rate was 48.8% and the professional rate was 51.3% in the regretful group, the amateur rate was 23% and the professional rate was 77% in the non-regretful group; this difference was statistically significant. In other words, among the 90 participants who had their tattoos performed by an amateur, 43.3% (n: 39) stated that they regretted at least one tattoo. However, only 19.3% (n: 41) of the 212 participants who had their tattoos performed by a professional tattoo artist expressed regret. This shows that those who choose to have their tattoos professionally done experience less tattoo regret.

Moreover, participants who had their tattoos applied on their upper extremities and face had higher regret rates of 29.3% and 44.1%, respectively.

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.