Each piece of body art has a backstory. It may have been the result of a desire to get a matching tattoo with a childhood friend or the product of an impulsive decision.

Increasingly, women are using tattoos as reminders and symbols representing how far they have ventured in the quest to reclaim their minds and bodies.

“[Tattoos were] an [artistic] response to something happening in my life… and that helps me cope with a self-esteem issue I’m having because they make me feel beautiful and awesome,” said Alessandra Maiorano, a sophomore fashion studies major. “It reflects this [bad] time but in a positive way.”

Maiorano struggled with emotional issues throughout high school and decided to get a tattoo of a crescent moon on the back of her arm on her 18th birthday to remind her of all she had to offer and her skill in fashion design.

“I can remember feeling so terrible when I was a teenager and being upset and depressed, but I had this talent and thing I loved to do. So, whenever I look at [my moon tattoo], it just makes me feel good,” she said.

Maiorano said her moon tattoo has helped her through rough patches she goes through during the day by reminding her of nighttime, when she feels most comfortable expressing herself through artwork.

Medical researchers are finding that tattoos can give hope to people coping with mental illness, a physical condition or abnormality, as a way to remind them of their strength and self-worth. 

For some, multiple tattoos have deep emotional significance. It has been shown that in some cases, the number of tattoos a woman has can relate to her mental health in both positive and negative respects.

A study published in December 2015 by Jerome Koch, associate chair of Texas Tech University’s Sociology Department, titled “Tattoos, Gender and Well-Being Among American College Students,” polled nearly 2,400 college students between 2010 and 2013 from six universities located around the U.S. The results link women having four or more tattoos to having made previous suicide attempts. 

Koch said earlier studies found that people with at least four tattoos are categorically different than people with one or two, so he wanted to determine the impact of four or more tattoos on students’ well-being and emotions.

“We found this paradox that is kind of puzzling,  that women in the study—and only the women—had about a 10 percent higher level of self-esteem, and that same group [was] as much as four times as likely to have reported a previous suicide attempt,” Koch said.

Koch said the study did not ask students why they got tattoos, but his theory is based on the same reasoning physical illness survivors exhibit when getting tattoos.

“The logic of [the results] follows what we already know from cancer survivors—that people will sometimes replace a physical loss with a tattoo,” Koch said. “What I’m calling [attempted] suicide survivors, might be replacing a kind of emotional loss by getting more tattoos.”

Koch said women typically seem to go through the experience of getting body art differently than men do and are more likely to want their tattoos removed after being less satisfied with the process and outcome.

“[Women] may have a higher expectation of how good it’s going to look and are disappointed when it doesn’t match that expectation,” psychologist Margaret Wehrenberg said.

Wehrenberg said research on the experiences men and women have with body art is limited, but the studies she has encountered show divergences between the sexes.

Women tend to receive more negative feedback about their tattoos than men do, she said.

Going through tattooing is not something to be taken lightly because the process can be expensive and painful. Yet, the possibility of negative feedback does not deter some women from getting their tattoos. Some women view going through tattooing as an artistic form of healing.

“It seems like women, more than men, use body art as a way of reclaiming a sense of self, or even reclaiming a lost part of themselves physically [or] emotionally,” Koch said.

Wehrenberg said she read a study in which the results showed that women get tattoos to take—and visibly show—ownership of their bodies.

Angelica Ferreris, a freshman cinema art + science and interdisciplinary arts double major, said her tattoos remind her not to overthink things.

Ferreris said she got a serotonin molecule tattooed on her foot to represent the time between her eighth grade and freshman year of high school when she was in treatment for an eating disorder. Serotonin is the chemical in the body that contributes to happiness and well-being.

“I needed a kind of symbol to commemorate all I went through without being super cliche about it,” Ferreris said. “The serotonin molecule to me is something that just made sense that I should put it on my body.”

The tattoo Ferreris has on her wrist “BOK,” meaning “be OK,” comes from a time in her sophomore year of high school when her best friend would write the letters on her as a comfort when she was feeling depressed.

“[Tattoos] help keep my mind sane,” Ferreris said. “Before, I used to just have BOK on me, and I think after that I became obsessed with having images to look at. I can look [at] my body and know I have support behind me.”

Body art can also serve as reminders of loved ones and support. Ferreris said she has gotten a majority of her tattoos to represent her friends, who are like her family. However, tattoos can also be used as a way of boosting one’s self-esteem by taking control of one’s body and putting a piece of art on it.

“My self-esteem has only increased with the more tattoos I’ve gotten,” Maiorano said. “You sort of have to feel good enough with yourself in order to permanently put something on your body.”

Maiorano got a Walt Whitman quote tattooed on her ribs that says, “A powerful play goes on, and you may contribute a verse,” to help her cope with self-esteem issues she developed while adjusting to college.

“It’s easy for me to feel [a lack of confidence], especially being surrounded by such talented people at Columbia,” Maiorano said. “[The quote tattoo] reminds me that whatever I have may not be what someone else has, but it’s my own verse; it’s my own contribution.”

Ferreris said having confidence comes from experiencing things that make an individual develop a sense of self and realize their potential.

“When you experience something like [a suicide attempt], you gain this strength inside yourself, and it’s not to say you become egotistical at all,” Ferreris said. “You know who you are; you know what you’ve been through. No one can shut that down.”

Wehrenberg said it is possible for someone to feel a greater ownership of their body after getting a tattoo that improves their feeling of uniqueness and self-esteem.

“One of the major outcomes of getting a tattoo is a feeling of self-expression, like you’ve said something about yourself that feels good to you,” Wehrenberg said. “It also creates a sense of uniqueness. You’ve chosen the symbol or art, [and] you’ve said something.”

Tattoos can also be a response to a physical illness or deformity.

Eric Dean Spruth founded Sacred Transformations about 12 years ago to help people turn their scars, burns or tattoos into empowering works of art.

Sacred Transformations is a federally recognized nonprofit organization in Illinois and Indiana. All of the tattoos done by artists through the company are completely custom and free.

“Even clients who come to us who don’t have a particular idea of what they want; they know what they have is not what they want to continue to live with, be it a self-injurious scar or an existing tattoo,” Spruth said.

Spruth said Sacred Transformations has volunteers who assist clients in the lengthy process of applying for its program. The volunteers go to great lengths to help applicants do research so they can make informed decisions. The organization has even helped them get library cards to support research on what they want for their tattoo.

Spruth said his favorite clients at Sacred Transformations are those who go through the process of applying for the program and use the empowerment it offers them to ultimately decide not to get a tattoo.

“My favorite clients are the ones who ultimately feel more comfortable with their [bodies],” Spruth said. “They internalize the power within themselves to realize how they look at and define themselves is up to them. They have the power not to rely on other people to define them.”

Spruth said tattooing over an existing mark that an individual cannot ignore is like getting a song out of one’s head: They have to empower themselves to listen to it in order to get over it and move on.

“[Tattoos are] a permanent decision, to have your body marked in any kind of way,” Spruth said. “It’s a part of everyone’s life course to have their mind or psyche marked by life experiences, and some of those marks are marks that people wish they could erase, but the reality is, there’s no such thing as erasing the past.”

Spruth said he works with many cancer survivors and for them, tattooing over their scars can be a way to publicly make a statement that their scars are something they should celebrate because they represent their survival.

Pink Ink Fund is a nonprofit organization created in 2011 by tattoo artist Amy Black to help people who have had problems funding their post-mastectomy tattoos. The organization provides small grants funded by donations.

“[Clients] have told us that [post-mastectomy tattoos] help their self-esteem,” Black said. “It helps to return confidence and makes them feel whole again after having gone through the mastectomy.”

Black said the applicants she has spoken to are happy to be going through the process of receiving funding for their post-mastectomy tattoo because they see it as the final step in their recovery process.

“We’re looking at body art as a means of empowerment, taking control of your life again when it’s gotten upset somehow,” Koch said.