Body Integrity Identity Disorder

Assessment | Biopsychology | Comparative | Cognitive | Developmental | Language | Individual differences | Personality | Philosophy | Social |
Methods | Statistics | Clinical | Educational | Industrial | Professional items | World psychology |

Clinical: Approaches · Group therapy · Techniques · Types of problem · Areas of specialism · Taxonomies · Therapeutic issues · Modes of delivery · Model translation project · Personal experiences ·

---

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. 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. 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. 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.

Books

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

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

See also

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

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.
• Bridy A (2004). Confounding extremities: surgery at the medico-ethical limits of self-modification. J Law Med Ethics 32 (1): 148–58.
• Bruno, Richard L. (Winter 1997). Devotees, Pretenders, and Wannabes: Two Cases of Factitious Disability Disorder. Sexuality and Disability 15 (4): 243–60.
• 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.
• Bayne T, Levy N (2005). Amputees by choice: body integrity identity disorder and the ethics of amputation. J Appl Philos 22 (1): 75–86.
• 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.
• Elliott, Carl. A New Way to Be Mad. The Atlantic.

Template:Use dmy dates