"I feel like so much more of myself": The experience of modifying appearance in borderline personality disorder.

Abstract

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).