Abstract Background Tattoos and piercings are becoming increasingly popular in many countries around the world. Individuals seeking such body modifications have reported diverse psychological motives. Besides purely superficial considerations, tattoos and piercings can also have a deep, personal meaning. For example, they can mark and support the emotional processing of significant life events, including formative experiences from early childhood. However, there is a lack of studies that examine the links of tattoos and piercings with experiences of childhood abuse and neglect in large, population-based samples. Methods We investigated the association of reports of childhood abuse and neglect with the acquisition of body modifications (tattoos and piercings) within a representative German community sample. Survey participants (N = 1060; ages 14–44 years) were questioned whether they had tattoos and piercings and filled out the 28-item Childhood Trauma Questionnaire Short Form (CTQ-SF). Results Tattoos and piercings were more common among individuals who reported childhood abuse and neglect. The proportion of participants with tattoos and piercings increased as a function of the severity of all assessed types of abuse and neglect (emotional, physical, and sexual abuse; emotional and physical neglect). In logistic regression analyses which included the covariates age, gender, education, and income, the sum of significant kinds of childhood abuse and neglect was positively related to having tattoos and/or piercings (OR = 1.37 [95% CI 1.19–1.58]). Conclusions The results corroborate previous research indicating that body modifications could have special significance for individuals who have survived adversity, in particular interpersonal trauma at the hands of caregivers. These findings could inform screening procedures and low-threshold access to psychotherapeutic care.