(CNN) - For Olivia Adamson, her body art "is a visual reminder I am still alive. And still OK." What she particularly likes is the ability to touch it: the words "unbreakable" on the right side of her left foot and "survivor" in her aunt's handwriting on the inside of her left wrist. "If I am having a hard time, as soon as I touch my wrist and I run my finger over my word 'survivor,' it helps."
Adamson, 24, of Austin, Texas, was sexually assaulted in November 2015 and in January 2016. In both cases, she knew the perpetrator.
Her only support network was her aunt, she says, and she got the "survivor" tattoo as part of the healing process. "Once I got the tattoo, I knew that it was going to help in ways that I couldn't help myself heal," she said.
Like many other sexual assault survivors, Adamson found getting tattooed to be a therapeutic experience. Without her tattoos symbolizing her experiences, "I really don't know where I would be."
December Maxwell, 38, knows this feeling well. She is a survivor of childhood sexual assault and published a paper in January on the phenomenon of survivors getting tattoos as a way to heal from trauma.
Maxwell, a Ph.D. student at the University of Texas in Arlington, spoke to 10 sexual assault survivors about the motivations behind their tattoos and found that they have "very different" reasons than the general population.
Previous research shows that in different cultures, tattoos symbolize membership in a group, signify status or commemorate a major life event. For the people in Maxwell's study, "getting tattoos was very therapeutic."
The participants got their first tattoos between the ages of 11 and 29 and had three each, on average. Some acquired their first body art after their assault.
"A sexual assault is an infringement on your body," Maxwell said. But by marking their skin in their own way, people are able to redefine their relationship with their bodies.
This is a "cathartic experience," she said, and some people in her study didn't realize how much they were holding on to their pain until they went through the process of selecting art that carries meaning for them and was designed to symbolize their experience.
Reclaiming their bodies also allows people to "shed the identity as a victim and move toward being a survivor," Maxwell explained.
Cierra Barefoot, who was sexually assaulted at 13, has the Fire Rose Unity Survivor Tattoo, resembling the outlines of a rose and the shape of fire. She was inspired by American pop star Lady Gaga to tattoo this design beneath her collarbone.
Lady Gaga has publicly discussed her sexual assault in the past, revealing she was raped at 19 and was diagnosed with post-traumatic stress disorder. During her 2016 Oscar performance, she asked 50 sexual assault survivors to join her on stage, and some had gotten the geometric rose tattoos as a sign of unity. Since then, the design has become a symbol for sexual assault survivors.
Barefoot was inspired by Lady Gaga's 2016 performance, and said the fire rose tattoo gives her "power" over her own story. "I'm proud of being a survivor," said the 22-year-old from Pittsburgh.
Shifting perceptions away from victim to survivor is important for processing the event and moving on or becoming sexually involved again, Maxwell added.
Many survivors look to tattoos to help them overcome the trauma because they view it as an alternative healing method.
Maxwell likens this to traditional art therapy, in which people have to draw something related to how they feel and engage with their experiences in that way.
But unlike art therapy, "a lot of participants talked about how the pain was part of the [healing] process," Maxwell said. Similar to meditation, the physical pain of the needle will force people to be "present in the moment; they can't avoid their thoughts." People also have to focus on their breathing, as with a marathon or exercise class -- both methods often used to deal with trauma, she added. This helps people slow down and think about their pain and how to cope with it.
Adamson, who has the "unbreakable" and "survivor" tattoos, agreed: "Therapy, sometimes it helps, and sometimes it doesn't." It depends largely on the therapist and how understanding they are. In her case, she felt like therapy was not helpful. Instead, she focused on accepting the experience in her own way. To "put it in ink, on your body, for me, is the best way to let some of it go," she said.
Last year, Adamson was in a physically and sexually abusive relationship, after which she got a bow tattoo on her right wrist to symbolize "being held together."
Adamson added that she believes it is important for people to not hide behind what has happened to them. She decided to share her story wanting people to know "it's OK for others to know what has happened."
Feeling that therapy isn't helping isn't uncommon, according to Maxwell. It can be difficult to find a therapist who specializes in sexual assault treatment, especially if you're looking for a female therapist.
The women in her study felt stigmatized because they're survivors of sexual assault, and because of their body art. Some felt uncomfortable going to a traditional therapist because of those stigmas.
That made some sexual assault survivors look for alternative healing methods -- like tattoo, writes Maxwell's study.
Coping methods are 'tools in a toolbox'
According to the Rape, Abuse, and Incest National Network, on average, there are 321,500 victims of rape and sexual assault every year in the United States. A 2013 report by the World Health Organization found that 35% of women across the globe have experienced "either physical and/or sexual intimate partner violence or non- partner sexual violence."
During an assault, the fight, flight or freeze instinct takes over, explained Anne McKechnie, a consultant forensic clinical psychologist based in Glasgow, Scotland. Once the immediate threat is gone, the "information has to be assimilated into the memory banks," said McKechnie.
During this assimilation period, it is normal to feel distressed or agitated, to have trouble sleeping and experience intrusive thoughts or to completely avoid the incident, she said. "The brain is just essentially accommodating that new information and beginning to understand it," according to McKechnie, who was not involved in Maxwell's research.
A person's reaction to assault may also depend on whether they have been repeatedly assaulted or by things like childhood adversity, she added.
"When we make sense of something that's happened to us, we are able to move on and create a memory. That might hurt a little bit when we go there, but actually, it's something that we can largely live with," McKechnie explained.
This is where tattoos come in. If they are a way for survivors to take back control and accept that what has happened is not their fault, they can be beneficial, she said.
Barefoot said her "survivor" tattoo has helped her not feel shame. "It's a reminder that I am not broken or tainted from the abuse."
Alongside therapy, her body art was one of the coping mechanisms. Barefoot was also motivated to get her tattoo in order to start a conversation. "'I want to educate people on sexual assault," she said, "how it changes people's lives and pretty much can almost destroy them."
Barefoot explained that she was comfortable telling her story because "if just one victim sees this and is able to start their own healing process and gets help" then she knows that she has made "the right decision."
But in the absence of other coping mechanisms, a tattoo will not solve the problem, McKechnie said. "We should never, ever aim to have just one way of coping. We need to see coping as a variety of tools in a toolbox."
Another concern is that people might see tattooing as a distraction. "While you're coping with physical pain, your brain isn't doing that processing of the memory that it needs to do" to be able to move on, she said.
Maxwell agrees that processing trauma through tattoos needs to happen in line with other therapy. She added that tattoos have the potential to become maladaptive: unhelpful behaviors that hinder people from adjusting healthily. "You can't get a tattoo every time you process something," she added.
Barefoot likes that her body art gives her the chance to educate people. When someone's gaze lands on her tattoo, it opens a conversation about the meaning and allows her to "open people's eyes" to the topic of sexual assault.
"I'm proud of being a survivor, and I'm proud of being able to educate others and open a conversation with this tattoo."