Self-amputation Research Articles

Paralyzed by Desire

Body incongruity in body integrity identity disorder (BIID) manifests in the desire to have a healthy limb amputated. We describe a variant of the disorder: the desire to become paralyzed (paralysis-BIID). Sixteen otherwise healthy participants, recruited through Internet-based forums, websites, or word of mouth, completed questionnaires about details of their desire and accompanying symptoms. Onset of the desire for paralysis typically preceded puberty. All participants indicated a specific level for desired spinal cord injury. All participants simulated paralysis through mental imagery or physical pretending, and 9 (56%) reported erotic interest in paraplegia and/or disability. Our key new finding was that 37.5% of paralysis-BIID participants were women, compared with 4.4% women in a sample of 68 individuals with amputation-BIID. BIID reflects a disunity between self and body, usually with a prominent sexual component. Sex-related differences are emerging: unlike men, a higher proportion of women desire paralysis than desire amputation, and, while men typically seek unilateral amputation, women typically seek bilateral amputation. We propose that these sex-related differences in BIID manifestation may relate to sex differences in cerebral lateralization, or to disruption of representation and/or processing of body-related information in right-hemisphere frontoparietal networks.

Merleau-Ponty’s sexual schema and the sexual component of body integrity identity disorder

Body integrity identity disorder (BIID), formerly also known as apotemnophilia, is characterized by a desire for amputation of a healthy limb and is claimed to straddle or to even blur the boundary between psychiatry and neurology. The neurological line of approach, however, is a recent one, and is accompanied or preceded by psychodynamical, behavioural, philosophical, and psychiatric approaches and hypotheses. Next to its confusing history in which the disorder itself has no fixed identity and could not be classified under a specific discipline, its sexual component has been an issue of unclarity and controversy, and its assessment a criterion for distinguishing BIID from apotemnophilia, a paraphilia. Scholars referring to the lived body-a phenomenon primarily discussed in the phenomenological tradition in philosophy-seem willing to exclude the sexual component as inessential, whereas other authors notice important similarities with gender identity disorder or transsexualism, and thus precisely focus attention on the sexual component. This contribution outlines the history of BIID highlighting the vicissitudes of its sexual component, and questions the justification for distinguishing BIID from apotemnophilia and thus for omitting the sexual component as essential. Second, we explain a hardly discussed concept from Maurice Merleau-Ponty's Phenomenology of Perception (1945a), the sexual schema, and investigate how the sexual schema could function in interaction with the body image in an interpretation of BIID which starts from the lived body while giving the sexual component its due.

Body Integrity Identity Disorder: Deranged Body Processing, Right Fronto-Parietal Dysfunction, and Phenomenological Experience of Body Incongruity

Body integrity identity disorder (BIID) is characterised by profound experience of incongruity between the biological and desired body structure. The condition manifests in "non-belonging" of body parts, and the subsequent desire to amputate, paralyse or disable a limb. Little is known about BIID; however, a neuropsychological model implicating right fronto-parietal and insular networks is emerging, with potential disruption to body representation. We argue that, as there is scant systematic research on BIID published to date and much of the research is methodologically weak, it is premature to assume that the only process underlying bodily experience that is compromised is body representation. The present review systematically investigates which aspects of neurological processing of the body, and sense of self, may be compromised in BIID. We argue that the disorder most likely reflects dysregulation in multiple levels of body processing. That is, the disunity between self and the body could arguably come about through congenital and/or developmental disruption of body representations, which, together with altered multisensory integration, may preclude the experience of self-attribution and embodiment of affected body parts. Ulimately, there is a need for official diagnostic criteria to facilitate epidemiological characterisation of BIID, and for further research to systematically investigate which aspects of body representation and processing are truly compromised in the disorder.

Body Integrity Identity Disorder: From A Psychological to A Neurological Syndrome

Body Integrity Identity Disorder (BIID) is a condition in which individuals experience an intense desire for amputation of an healthy limb. Recently, McGeoch and colleagues provided the first direct evidence that this syndrome may be neurological rather than psychological in its origin. However, before including BIID in body ownership disorders, several concerns should be clarified, exploring other components of body representation and not only somatosensory perception.

Diabetic Foot Ulcer: Amputation on Request?

In 2000, a Scottish surgeon received significant publicity for amputating lower limbs from healthy patients who were thought to have a Body Integrity Identity Disorder (1). We present a type 1 diabetic patient with a recurrent foot ulcer who requested a lower-limb amputation. Although very different, this situation also created difficult ethical issues that we have attempted to address. Peter C. Brown (aged 54 years) was diagnosed as having type 1 diabetes at age 21 years. Between early 2006 and November 2008, he had several admissions with a diabetic foot ulcer that partly resolved but never fully healed (2). By early November 2008 and after discussions with his family, he decided that he …

Examining the “Neuro-” in Neurodiversity: Lessons from Body Integrity Identity Disorder

Mackenzie and Watts briefly mention body integrity identity disorder (BIID) as a condition that could be described in terms of “neurodivergence rather than pathology,” and they draw a distinction b...

Xenomelia: a new right parietal lobe syndrome

BackgroundDamage to the right parietal lobe has long been associated with various disorders of body image. The authors have recently suggested that an unusual behavioural condition in which otherwise rational...

Consent, Autonomy, and the Benefits of Healthy Limb Amputation: Examining the Legality of Surgically Managing Body Integrity Identity Disorder in New Zealand

Upon first consideration, the desire of an individual to amputate a seemingly healthy limb is a foreign, perhaps unsettling, concept. It is, however, a reality faced by those who suffer from body integrity identity disorder (BIID). In seeking treatment, these individuals request surgery that challenges both the statutory provisions that sanction surgical operations and the limits of consent as a defence in New Zealand. In doing so, questions as to the influence of public policy and the extent of personal autonomy become important. Beyond legal issues, BIID confronts dominant conceptions of bodily integrity, medical treatment, and ethical obligations. This paper seeks to identify the relevant public policy concerns raised by BIID in New Zealand and the limits of autonomy, before moving on to consider how BIID sufferers may legally seek the treatment they require and how a doctor might be protected from criminal proceedings for assault for performing this treatment. It will be argued that it is possible to legally consent to the amputation of a healthy limb as medical treatment and that public perception should not be allowed to take precedence over this right.

Body Integrity Identity Disorder: Erste Erfolge in der Langzeitpsychotherapie

The Body Integrity Identity Disorder (BIID) is a fairly unknown and unexplored psychic illness. Very little cases underwent a psychotherapeutic treatment. We report on the two-and-a-half year psychotherapy with a 37 years old man, who wants an amputation of his two legs. Origin and meaning of the amputation desire were uncovered in psychotherapy. The psychodynamic oriented therapy with cognitive-behavioral elements can be used to develop further treatment approaches.

Limb amputations in fixed dystonia: A form of body integrity identity disorder?

Fixed dystonia is a disabling disorder mainly affecting young women who develop fixed abnormal limb postures and pain after apparently minor peripheral injury. There is continued debate regarding its pathophysiology and management. We report 5 cases of fixed dystonia in patients who sought amputation of the affected limb. We place these cases in the context of previous reports of patients with healthy limbs and patients with chronic regional pain syndrome who have sought amputation. Our cases, combined with recent data regarding disorders of mental rotation in patients with fixed dystonia, as well as previous data regarding body integrity identity disorder and amputations sought by patients with chronic regional pain syndrome, raise the possibility that patients with fixed dystonia might have a deficit in body schema that predisposes them to developing fixed dystonia and drives some to seek amputation. The outcome of amputation in fixed dystonia is invariably unfavorable. © 2011 Movement Disorder Society

BIID is not BDD – comment on Kwok-Kwan Chan et al

BIID is not BDD – comment on Kwok-Kwan Chan et al

Body Integrity Identity Disorder (BIID): What do health care professionals know?

Body Integrity Identity Disorder (BIID) is a syndrome in which people have the intense feeling their body will be complete after the amputation of a limb. In spite of the broad reporting in the yellow press, most of the BIID affected patients we have investigated in the last few years told us they were nearly always confronted with a lack of professional knowledge when they sought the advice of health care professionals. A typical example of a BIID patient (Mr. R), and an 11-item “BIID Questionnaire” were drafted by the authors and were used to assess the degree to which British (n=25) and German (n=58) health care professionals are informed about causes and symptoms of BIID sufferers. Results of the present study revealed that 41% of the participants correctly diagnosed BIID or Apotemnophilia. Yet, almost 30% misdiagnosed the case as Body-Dysmorphic or as Somatisation disorder. More than 85% of the participants tended not to contact the medical officer to affect the hospitalisation of the patient in a mental institution. 12% of the therapists answered with “rather/definitely yes”. Almost 70% of the therapists answered that they would try to convince the patient to go voluntarily to a psychosomatic institution. When asked whether they would support the patient to satisfy his wish for amputation, more than 91% denied, 7% of the participants answered with “rather yes”, and only one out of 83 therapists with “definitely yes”. We found only small differences between therapists from UK and Germany. Professionals in Germany more often tended to recommend psychosomatic clinics, therapists from Great Britain more European Journal of Counselling Psychology 2009, Vol. 1, No. 2 17 frequently suggested treatment with psychotropic medications. Female professionals voted more often for supporting the patient to fulfil his wish for amputation.

Response to Müller

To the Editors: I write in response to Sabine Muller's Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified? (2009). In her article, Ms. Muller attributes ...

Disfigured anatomies and imperfect analogies: body integrity identity disorder and the supposed right to self-demanded amputation of healthy body parts

Patients with the controversial diagnosis of body integrity identity disorder (BIID) report an emotional discomfort with having a body part (usually a limb) that they feel should not be there....

The Ethical Management of Body Integrity Identity Disorder: Reply to Pies

The Ethical Management of Body Integrity Identity Disorder: Reply to Pies

The Ethics of Limb Amputation and Locus of Disease

The ethics of medically-authorized limb amputation in individuals with Body integrity identity disorder (BIID) remains extremely controversial. One factor to consider is the putative locus of a disease process, and whether the proposed treatment--in this case, limb amputation—reasonably addresses the issue of what organ is mediating the patient’s complaint.

Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified?

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image.

Body Integrity Identity Disorder (BIID) and the Limits of Autonomy

Muller (2009) in her fine review of the current clinical and scientific knowledge of body integrity identity disorder (BIID) and the ethical acceptability of therapeutic amputation maintains that “...

Whose Identity Is It Anyway?

In the target article, Sabine Muller (2009) argues that Body Integrity Identity Disorder (BIID) is a brain disorder, and as a result, such patients do not have insight into their illness. Although ...

Two Types of Autonomy

Although I agree with Sabine Muller's (2009) conclusion that we should first seek to find alternatives to amputation for patients suffering from Body Integrity Identity Disorder (BIID), I disagree ...