Body integrity identity disorder

Body Integrity Identity Disorder (BIID), formerly known as Amputee Identity Disorder, is a psychological disorder wherein sufferers feel they would be happier living as an amputee. It is typically accompanied by the desire to amputate one or more healthy limbs to achieve that end.

The most widely accepted current theory on the origin of BIID is that it is a neurological failing of the brain's inner body mapping function (located in the right parietal lobe). According to this theory, the brain mapping does not incorporate the affected limb in its understanding of the body's physical form. (Mysteries of the Mind, Secret Life of the Brain E2, TVO documentary)

Description

A person with BIID typically wants one or more limbs (sometimes just hands) amputated. While the official definition of BIID includes only a desire for amputation, Dr. Michael B. First, an author of the upcoming DSM-V who first defined BIID, has agreed in principle that BIID could include a need for other impairments, such as paraplegia or partial paralysis of a limb.

Symptoms of BIID sufferers are often keenly felt. The sufferer feels incomplete with four limbs, but is confident amputation will fix this. The sufferer knows exactly what part of which limb should be amputated to relieve the suffering. The sufferer has intense feelings of envy toward amputees. They often pretend, both in private and in public, that they are an amputee. The sufferer recognizes the above symptoms as being strange and unnatural. They feel alone in having these thoughts, and don't believe anyone could ever understand their urges. They may try to injure themselves to require the amputation of that limb. They generally are ashamed of their thoughts and try to hide them from others, including therapists and health care professionals.

The majority of BIID sufferers are white middle-aged males, although this discrepancy may not be nearly as large as previously thought. ^[1] The most common request is an above-the-knee amputation of the left leg.

A sexual motivation for being or looking like an amputee is called apotemnophilia.^[2][3] Most people with BIID don't report a sexual motivation. In addition, apotemnophilia should not be mistaken for acrotomophilia, which describes a person who is sexually attracted to other people who are already missing limbs. However, there does seem to be some relationship between the disorders, with some individuals exhibiting both conditions.

Today, no surgeons will treat BIID patients by performing the desired amputations. Some act out their desires, pretending they are amputees using prostheses and other tools to ease their desire to be one. Some sufferers have reported to the media or by interview over the telephone with researchers that they have resorted to self-amputation of a "superfluous" limb, for example by allowing a train to run over it, or by damaging the limb so badly that surgeons will have to amputate it. However, the medical literature records few, if any, cases of actual self amputation.^[4] Often the obsession is with one specific limb. A patient might say, for example, that they "do not feel complete" while they still have a left leg. However, BIID does not simply involve amputation. It involves any wish to significantly alter body integrity. Some people suffer from the desire to become paralyzed, blind, deaf, use orthopaedic appliances such as leg-braces, etc. Some people spend time pretending they are an amputee by using crutches and wheelchairs at home or in public; in the BIID community, this is called a "pretender." The condition is usually treated as a psychiatric disorder.

Exact causes for BIID are unknown. One theory states that the psyche of a child seeing an amputee, may imprint on this body image as an "ideal." Another popular theory suggests that a child who feels unloved may believe that becoming an amputee will attract sympathy and love. The biological theory is that BIID is a neuro-psychological condition in which there is an anomaly in the cerebral cortex relating to the limbs; cf. Proprioception. If the condition is neurological, it could be conceptualized as a congenital form of somatoparaphrenia, a condition that often follows a stroke that affects the parietal lobe. Since the right side of the inferior-parietal lobule—which is directly related with proprioception—is significantly smaller in men than women, a malfunction of this area could potentially explain not only why men are much more likely to have BIID, but also why requests for amputations most often concern left-side limbs. (The right side of the brain controls the left side of the body and vice versa.) If the condition is similar to somatophrenia, it could have the same "cure"—vestibular caloric stimulation. In simple terms it involves squirting cold water in the patient's right ear.

Ethical considerations

The idea of medically amputating a BIID sufferer's undesired limb is highly controversial. Some support amputation for patients with BIID that cannot be treated through psychotherapy or medication. Others emphasize the irreversibility of amputation, and promote the study of phantom limbs to treat the patient from a psychological perspective instead.^[5]

Books

• Stirn, A., Thiel, A., Oddo, S. (2009). Body Integrity Identity Disorder: Psychological, Neurobiological, Ethical and Legal Aspects. Pabst Science Publishers. ISBN 978-3-89967-592-4. 
• Furth, Gregg M., Smith, Robert (2000). Amputee Identity Disorder: Information, questions answers, and recommendations about self-demand amputation. Authorhouse. ISBN 978-1588203908. 
• Sacks, Oliver W. (1998). A Leg To Stand On. Touchstone Books. ISBN 978-0684853956. 

Movies

• Whole, a documentary about people with B.I.I.D., was broadcast in 2004
• [1] a report about people with BIID in Australia on the ABC

BIID in popular culture

• Armless (2010), a film in which the protagonist John leaves his wife and goes to New York City to find a doctor to amputate his arms.
• Quid Pro Quo (2008 film)
• In the Mental episode "Life and Limb," the patient Brian Jennings self amputates his healthy left hand and says he feels, "...better than I've ever felt—like a great weight has been lifted. My body is finally right...complete. I'm whole."
• In the Nip/Tuck episode "Ben White," the title character wants a healthy leg amputated so he will feel whole.
• In the CSI: NY episode "Outside Man," the detectives discover the world of BIID when a person with the disorder dies from an illegal amputation.
• In the book Geek Love a cult called Arturism involves members having their limbs amputated so they can be like Arty, the cult leader.
• In the book Last Days by Brian Evenson a cult of self amputees makes a messiah out of a detective who amputates his own hand without anesthetic.
• In the Grey's Anatomy episode "Haunt You Every Day," a former patient of Christina's claims his foot "isn't his," and wants a doctor to amputate it. He amputates it himself using a chainsaw. In the episode, the condition is incorrectly referred to as Body Dysmorphic Disorder.
• In an episode of Casualty, a woman's leg is destroyed by a train. She is suspiciously unfazed by what has happened and she is later diagnosed with BIID.
• A patient who self-amputated his leg was featured in an episode of Taboo.

See also

• Apotemnophilia
• Body dysmorphic disorder
• Body image
• Body modification
• Alien hand syndrome
• Attraction to disability
• Deformity
• Acrotomophilia

References

1. ^ Ellison, Jesse (28 May 2008). "Cutting Desire". MSNBC. http://www.newsweek.com/id/138932. Retrieved 2008-05-28. 
2. ^ Money J, Jobaris R, Furth G (1977). "Apotemnophilia: Two cases of self demand amputation as a sexual preference". The Journal of Sex Research 13 (2): 115–124. doi:10.1080/00224497709550967. 
3. ^ Everaerd W (April 1983). "A case of apotemnophilia: a handicap as sexual preference". Am J Psychother 37 (2): 285–93. PMID 6869634. 
4. ^ Large MM (October 2007). "Body identity disorder". Psychol Med 37 (10): 1513; author reply 1513–4. PMID 18293510. 
5. ^ Levy, Neil (2007). Neuroethics — Challenges for the 21st Century. Cambridge University Press. ISBN 0521687268. 

External links

• ABC News article: What Drives People to Want to Be Amputees?
• Bensler JM, Paauw DS (July 2003). "Apotemnophilia masquerading as medical morbidity". South. Med. J. 96 (7): 674–6. doi:10.1097/01.SMJ.0000078367.94479.B9. PMID 12940318. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0038-4348&volume=96&issue=7&spage=674. 
• Bridy A (2004). "Confounding extremities: surgery at the medico-ethical limits of self-modification" (PDF). J Law Med Ethics 32 (1): 148–58. doi:10.1111/j.1748-720X.2004.tb00460.x. PMID 15152438. http://futurefeedforward.com/confounding_extremities.pdf. 
• Bruno, Richard L. (Winter 1997). "Devotees, Pretenders, and Wannabes: Two Cases of Factitious Disability Disorder". Sexuality and Disability 15 (4): 243–60. doi:10.1023/A:1024769330761. 
• First MB (June 2005). "Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder". Psychol Med 35 (6): 919–28. doi:10.1017/S0033291704003320. PMID 15997612. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=306492. 
• Bayne T, Levy N (2005). "Amputees by choice: body integrity identity disorder and the ethics of amputation". J Appl Philos 22 (1): 75–86. doi:10.1111/j.1468-5930.2005.00293.x. PMID 15948330. http://www.blackwell-synergy.com/links/doi/10.1111/j.1468-5930.2005.00293.x/abs/. 
• slate.com article: "Costing an arm and a leg"
• Wise TN, Kalyanam RC (2000). "Amputee fetishism and genital mutilation: case report and literature review". J Sex Marital Ther 26 (4): 339–44. doi:10.1080/009262300438742. PMID 11056898. 
• Elliott, Carl (December 2000). "A New Way to Be Mad". The Atlantic. http://www.theatlantic.com/doc/200012/madness.