In this report, we describe the case of a 19-year-old male who acutely used the process of tattooing, and its associated physical pain, to regulate negative affective states. While tattooing has been described in the literature as serving individuals in a variety of ways (e.g. establishing a sense of individuality, externalizing important feelings), we are unaware of any prior case reports describing this affective function. Indeed, in this case, tattooing may have functioned more like self-harm behaviour, and we discuss this potential implication. Copyright © 2003 John Wiley & Sons, Ltd.