Body integrity dysphoria

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"Self-amputation" redirects here. See also Autotomy and Amputation § Self-amputation.
"BIID" redirects here. For the organisation, see British Institute of Interior Design.

Body integrity dysphoria
Other namesBody integrity identity disorder
Clinical Psychology
SymptomsDesire to have a sensory or physical disability, discomfort with being able-bodied
ComplicationsSelf-amputation
Usual onset8–12 years old
Risk factorsKnowing an amputee as a child
TreatmentCognitive behavioral therapy
MedicationAntidepressants

Body integrity dysphoria (BID), also referred to as body integrity identity disorder (BIID), amputee identity disorder or xenomelia, and formerly called apotemnophilia, is a rare

sensory or physical disability or feeling discomfort with being able-bodied, beginning in early adolescence and resulting in harmful consequences.[1] BID appears to be related to somatoparaphrenia.[2] People with this condition may refer to themselves as transabled.[3][4][5]

Signs and symptoms

BID is a rare, infrequently studied condition in which there is a mismatch between the mental body image and the physical body, characterized by an intense desire for amputation or paralysis of a limb, usually a leg, or to become blind or deaf.[2] The person sometimes has a sense of sexual arousal connected with the desire for loss of a limb, movement, or sense.[2]

Some become somewhat more comfortable with their own bodies by pretending they are amputees using

prostheses and other tools to help their dysphoria, by using a wheelchair or by blocking their vision or hearing. Some people with BID have reported to the media or by interview with researchers that they have resorted to self-amputation of a "superfluous" limb by, for example, allowing a train to run over it or otherwise damaging it so severely that surgeons will have to amputate it. However, the medical literature records few cases of self-amputation[6][7] apart from that of cricket historian Rowland Bowen, who self-amputated one of his legs below the knee in 1968.[8]

To the extent that generalizations can be made, people with BID appear to start to wish for amputation when they are young, between eight and twelve years of age, and often knew a person with an amputated limb when they were children; however, people with BID tend to seek treatment only when they are much older.

personality disorders.[7] Family psychiatric history does not appear to be relevant, and there does not appear to be any strong correlation with the site of the limb or limbs that the person wishes they did not have, nor with any past trauma to the undesired limb.[7]

Causes

As of 2014 the cause was not clear and was a subject of ongoing research.[9] However a small sample of people with body integrity dysphoria connected to their left leg have had MRI scans that showed less gray matter in the right side of their superior parietal lobule. The amount of gray matter missing was correlated to the strength of the patients' desire to remove their leg.[10]

Diagnosis

In the

behavioural or neurodevelopmental disorder, by a Disease of the Nervous System or by another medical condition, or by Malingering." A diagnosis of gender dysphoria must be ruled out.[11]

Classification

Prior to the release of the ICD-11, the diagnosis of BID as a mental disorder was controversial. There was debate about including it in the DSM-5, and it was not included; it was also not included in the ICD-10.[2][9] It has been included in the ICD-11, which reached a stable version in June 2018, as 'Body integrity dysphoria' with code 6C21.[1]

Treatment

There is no

antidepressants.[7]

The ethics of surgically amputating the undesired limb of a person with BID are difficult and controversial.[6][12][13]

Prognosis

Outcomes of treated and untreated BID are not known; there are numerous case reports that amputation permanently resolves the desire in affected individuals.[7][14]

Transability

Transability (which can also be referred to as being trans-able) is the term used to describe an able-bodied person's need to alter his or her body in order to develop a physical impairment or disability. This is influenced by personal decision and desire.[15] According to ISH News, transable people go through the process by physically injuring themselves in a way that causes lifelong disabilities, satisfying their aspiration to be disabled. The transable person could want to become

amputee, paraplegic or anything else.[16]

History

Apotemnophilia was first described in a 1977 article by psychologists Gregg Furth and John Money as primarily sexually oriented. In 1986 Money described a similar condition he called acrotomophilia; namely, sexual arousal in response to a partner's amputation. Publications before 2004 were generally case studies.[17] The condition received public attention in the late 1990s after Scottish surgeon Robert Smith amputated limbs of two otherwise healthy people who were desperate to have this done.[17]

In 2004 Michael First published the first

psychosexual research has been ongoing as well.[17][18][19]

See also

References

  1. ^ a b "ICD-11 – Mortality and Morbidity Statistics". icd.who.int. Archived from the original on 1 August 2018. Retrieved 6 July 2018.
  2. ^
    S2CID 3335803. Archived
    from the original on 14 January 2018. Retrieved 13 January 2018.
  3. doi:10.17157/mat.3.1.388. Open access icon
  4. ^ Shad (11 June 2015). "Desiring disability: What does it mean to be transabled?". CBC Radio. Archived from the original on 11 June 2015. Retrieved 11 June 2015.
  5. S2CID 144412724
    .
  6. ^
    ISBN 978-0-521-68726-3
    .
  7. ^
    S2CID 30991969
    .
  8. ^ "Cricket historian, writer, surgeon, spy: the mad world of Major Rowland Bowen". the Guardian. 21 July 2017. Archived from the original on 29 December 2021. Retrieved 29 December 2021.
  9. ^
    PMID 25045269
    .
  10. S2CID 219544915
    .
  11. ^ "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Archived from the original on 1 August 2018. Retrieved 19 December 2021.
  12. ^ Costandi, Mo (30 May 2012). "The science and ethics of voluntary amputation | Mo Costandi". The Guardian. Archived from the original on 2 January 2018. Retrieved 13 January 2018.
  13. S2CID 23988376
    .
  14. PMID 22514657
    .
  15. ^ "Becoming disabled by choice, not chance: 'Transabled' people feel like impostors in their fully working bodies". nationalpost. 3 June 2015. Retrieved 19 January 2023.
  16. ^ "Transability Makes People Get Disabled by Choice - ISH News". YouTube. 16 December 2022. Archived from the original on 19 January 2023. Retrieved 19 January 2023.
  17. ^
    S2CID 144072976
    .
  18. S2CID 17528273. Archived
    (PDF) from the original on 9 October 2018. Retrieved 24 September 2019.
  19. S2CID 10105602
    .

Further reading

External links
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