Alessandra (Tavistock and Portman NHS Foundation Trust, London, UK) Lemma 
Under the Skin [PDF ebook] 
A Psychoanalytic Study of Body Modification

Alessandra Lemma – Winner of the Levy-Goldfarb Award for Child Psychoanalysis!

Under the Skin considers the motivation behind why people pierce, tattoo, cosmetically enhance, or otherwise modify their body, from a psychoanalytic perspective. It discusses how the therapist can understand and help individuals for whom the manipulation of the body is felt to be psychically necessary, regardless of whether the process of modification causes pain.

In this book, psychoanalyst Alessandra Lemma draws on her work in the consulting room, as well as films, fiction, art and clinical research to suggest that the motivation for extensively modifying the surface of the body, and being excessively preoccupied with its appearance, comes from the person’s internal world – under their skin. Topics covered include:

• body image disturbance


• appearance anxiety


• body dysmorphic disorder


• the psychological function of cosmetic surgery, tattooing, piercing, and scarification.

Under the Skin provides a detailed study of the challenges posed by our embodied nature through an exploration of the unconscious phantasies that underlie the need for body modification, making it essential reading for all clinicians working with those who are preoccupied with their appearance and modify their bodies including psychotherapists, counsellors, psychiatrists and psychologists.