A qualitative investigation of tattooing as an adaptive appearance investment: positive body image and eating disorder recovery in a predominantly transgender and gender expansive sample.

Tattooed individuals often express the positive effects of wearing body art toward improved self-image and confidence. This research builds on prior data exploring the positive effects of tattooing and investigates how tattoos impact one's relationship to eating disorder (ED) recovery and body image. We held three focus groups lasting 60 minutes each, recruiting participants via purposive snowball sampling (n = 15), with additional opportunities to respond to focus group prompts asynchronously. Eligible participants were individuals with lived experience of an ED, self-identified as being in recovery, had three or more tattoos, and spoke English. Participants predominantly held gender-expansive (n = 4 Non-Binary, n = 3 Genderqueer, n = 3 Cisgender Women, n = 3 Transgender, n = 2 Transmasculine, n = 2 Gender Non-Conforming, n = 2 Intersex, n = 1 Cisgender Man) and non-heterosexual identities. Focus groups were held between April 2021 and July 2023 and followed a semi-structured interview format. Primary analyses focused on participants' responses to open-ended prompts regarding how they understood the relationships between tattooing, body image, and ED recovery. Thematic analysis identified four core themes: Tattooing allowing for embodiment, tattooing allowing for recovery-oriented behaviors, tattooing enabling positive body image, and tattooing facilitating empowerment. An overarching message was that tattooing is a therapeutic and transformative process, allowing for self-determination. Participants indicated that tattooing can be experienced as a powerful mechanism for behavioral change and shifts in relationship to one's body. Participants expressed that tattooing can be an effective route towards both gender euphoria and body liberation, enhancing one's ability to maintain ED recovery.