Personality Disorders: Theory, Research, and Treatment, Vol 17(5), Sep 2026, 319-328; doi:10.1037/per0000765
Body modifications such as tattoos and piercings have known identity-affirming functions. Despite this, as a subject of psychological research, they are mainly studied in relation to self-injurious behavior. Given the frequency of both self-damaging behavior and unstable identity in borderline personality disorder (BPD), and informed by a sample of 17 pilot interviews, we hypothesized that for people with BPD, body modifications provide relief from internal and aversive identity-related concerns. The present study takes a qualitative approach to examine body modification and related emotional and intrapersonal experiences in BPD. Participants with BPD (N = 47) participated in a semistructured interview targeting appearance-modification experiences. Rapid qualitative analysis methods were used to sort interview content into five domains of interest: physical sensations, affect regulation, sense of self, emptiness and identity disturbance, and impulsivity. Participants described a wide range of body modifications and associated experiences. Results substantiated the potential for appearance modifications to positively impact sense of self in BPD—mitigating identity disturbance and emptiness—and revealed complex emotional consequences when these modifications do not “work.” The results also challenge inferred causal relationships between nonsuicidal self-injury history and appearance modification: Although participants reported sensory similarities between the behaviors, appearance modifications carried specific positive connotations and consequences that nonsuicidal self-injury did not. This study reveals a complex and nuanced picture of appearance modification in BPD, with particular implications for identity affirmation and mood induction. The results identify common themes across highly variable and personal narratives, opening a window into BPD lived experience. (PsycInfo Database Record (c) 2026 APA, all rights reserved)