Research explores association between BP and psychopathological symptoms

A paper published in the current issue of Psychotherapy and Psychosomatics addresses the relationship of body piercing with  psychopathology. The term 'body piercing' (BP) refers to the 'insertion of jewellery and other objects into artificially made openings in body parts', while body modifications (BM) encompass BP and tattoos. Recent research has explored the association between BP and psychopathological symptoms with unclear results.

The aim of our study was to investigate this relationship via a systematic review of the literature. The Authors' search (Pubmed, Sciencedirect and Psycinfo) yielded 23 studies. The reported prevalence of BP ranged from 6.8% to 14% in the general population and from 4.3% to 51% among adolescents and young adults. Females were more likely to display BPs than males. BP prevalence also seemed to demonstrate an age effect, with the highest rates between the ages of 14 and 24. BP being associated with dermatological and infectious complications, it could be argued that undergoing BP is itself a high-risk behaviour.

Further studies suggested an association between BP and a large spectrum of high-risk behaviours. It was found to be associated with alcohol use [OR = 5.5 (95% CI = 1.1-11.2)] and smoking [OR = 3.1 (99% CI = 1.6-5.9)] and, despite one study's negative results, was clearly shown to be associated with drug use in different populations [OR = 2.2 (95% CI = 1.3-4.0) in males and OR = 4.1 (95% CI = 2.7-6.2) in females]. A large number of studies reported that individuals with BPs presented increased high-risk sexual behaviours. Reports also suggested a significant relationship between BP and Russian roulette, problem gambling and alcohol-related risky behaviours. Only 2 publications have investigated the relationship between BP and eating disorders, with mixed results.

The findings have also been less consistent with regard to the association between BP and depressive symptoms as well as suicide ideation and suicide attempts. Three large studies found that BP was related to antisocial activity in adolescents [OR = 2.6 (99% CI = 1.3-5.3) for history of truancy]. While angry reactions were found to be a significant predictor of BM, BP was more frequent among women showing low constraint (i.e. being impulsive and thrill seeking) and expressing anger verbally. Contrasting with 1 report, 3 other studies found that sensation-seeking was positively associated with BM and BP. Apart from a study on BM, most research examining the relationship between BP and self-esteem yielded negative results. Self-esteem does not seem to mediate the relationship between BP and high-risk behaviour either. Finally, BP is significantly associated with high negative emotionality and low positive emotionality in young females, while a weak association was described with body dissatisfaction. 

A number of studies provide evidence of an association between BP and high-risk behaviours and point to a possible relationship with certain personality traits and self-reported psychopathological symptoms. However, many of the included studies are based on samples of adolescents or college students, where these behaviours might be more frequent than in other age groups. This age bias might have produced this apparent similarity. Furthermore, although the associations described in the literature are significant, the small effect size in more recent publications  suggests that BP may be becoming an increasingly normal practice and should perhaps not be considered as a marker of deviance.

In most studies reviewed in this paper, psychopathological symptoms as well as BPs were both selfreported, introducing a possible social desirability bias. However, this review of literature indicates that it could be useful for general practitioners to screen for high-risk behaviours in body-pierced subjects and for psychiatric symptoms such as suicidal ideation, and to help patients explore the role of BP in their identity.