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Body Integrity Identity Disorder (BIID), also known as Amputee Identity Disorder is the overwhelming desire to amputate one or more healthy limbs or other parts of the body. Sometimes its sufferers take it upon themselves to amputate their own limbs. Although it most commonly refers to people who wish to amputate limbs, the term BIID also applies to those who wish to alter their bodily integrity in general.

Overview

A person with BIID typically wants one or more of his or her limbs cut off. A sexual motivation for being or looking like an amputee is called apotemnophilia. The condition should not be mistaken for a person with acrotomophilia, who is sexually attracted to other people who are already missing limbs. In the BIID community, these people are referred to as 'devotees'. However, there does seem to be some relationship between the two disorders, with some individuals exhibiting both conditions. Experiencing an erotic interest in being an amputee has several parallels with those who identify as transgender or transsexual, specifically those men who have an erotic interest in being female.

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 on principle that BIID could include a need for other impairments, such as paraplegia. Anecdotal evidence shows that a large percentage of people who have BIID require different impairments. To confirm this, he is undertaking a new study (as of April 2007), as a follow up to his original study. If it is found the principal motivation of patients with BIID is to have a disability, BIID might be considered to be a form of Munchausen syndrome.

Today, very few surgeons will treat BIID patients by giving them what they want. 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, there are few if any cases of actual self amputation of a lower limb recorded in the medical literature. Often the obsession is with one specific limb, and with patients "not feeling complete while they still have a left leg", for example. 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 the 'pretender'. The condition is usually treated as a psychiatric disorder.

The exact causes for BIID are unknown. However, some experts have put forward theories as to why some people suffer from this illness. One theory states that a child, upon seeing an amputee, may imprint his or her psyche, and the child adopts this body image as an "ideal". Another popular theory suggests that a child who feels unloved may believe that becoming an amputee will attract the sympathy and love he or she needs. 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 was neurological, it could be conceptualized as a congenital form of somatoparaphrenia, a condition that often follows a stroke afflicting 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 the requests for amputations are most often of the 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.

While people with BIID are commonly thought of as "psychos," a diagnosis of psychosis excludes a diagnosis of BIID. The vast majority of BIID sufferers are white middle-aged males, although there are some female sufferers as well.

Symptoms of BIID sufferers are often keenly felt. The sufferer feels incomplete with four limbs, but is confident that he or she will feel better about this post-amputation. The sufferer knows exactly what part of which limb should be amputated to relieve the suffering. The most common request is an above-the-knee amputation of the left leg. 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.

Ethical Ramifications

The decision of a doctor to amputate the troublesome limb of someone who suffers from BIID 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

• Amputee Identity Disorder: Information, questions answers, and recommendations about self-demand amputation by Gregg M. Furth & Robert Smith (1stBooks)

Movies

• The documentary Whole
• Quid Pro Quo (2008 film)

BIID in popular culture

• In the Nip/Tuck episode "Ben White," the title character wants a healthy leg amputated in order to feel whole.
• In the CSI: New York episode "Outside Man", the detectives discover the world of BIID when one such person with the disorder dies as a result of an illegal surgical procedure.
• In the book Geek Love a cult called Arturism involves members having their limbs amputated so that they can end up like Arty, the cult leader.
• 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.

References

1. Money, J., Jobaris, R., & Furth, G. (1977). Apotemnophilia: Two cases of self demand amputation as a sexual preference. The Journal of Sex Research, 13, 115–124.
2. Everaerd, W. (1983). A case of apotemnophilia: A handicap as sexual preference. American Journal of Psychotherapy, 37, 285–293.
3. Lawrence, A. A. (2006). Clinical and theoretical parallels between desire for limb amputation and gender identity disorder. Archives of Sexual Behavior, 25, 263–278.
4. Large MM. Body identity disorder. Psychol Med. 2007 Oct;37(10):1513
5. Ellison, Jesse (May 28, 2008). "Cutting Desire". MSNBC. Retrieved May 28, 2008. {{cite news}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
6. Levy, Neil (2007): Neuroethics- Challenges for the 21st Century. Cambridge University Press

See also

• Apotemnophilia
• Body dysmorphic disorder
• Gender identity disorder
• Body image
• Body modification
• Alien hand syndrome
• Attraction to disability

External links

• Los Angeles Body Dysmorphic Disorder & Body Image Clinic
• BIID.org
• BIID Info - The most comprehensive source of information about BIID.
• The Apotemnophile
• Leg-brace Abasiophilia
• Transabled.org
• ABC News article: What Drives People to Want to Be Amputees?
• Bensler JM, Paauw DS. Apotemnophilia masquerading as medical morbidity. South Med J. 2003 Jul;96(7):674-6.
• Bridy, Annemarie. Confounding Extremities: Surgery at the Medico-ethical Limits of Self-Modification Journal of Law, Medicine & Ethics, 32 (2004): 148–158.
• Bruno, Richard L. "Devotees, Pretenders, and Wannabes: Two Cases of Factitious Disability Disorder." Sexuality and Disability. 15.4 (Winter 1997): 243-260.
• First, Michael B. Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder Psychological Medicine (2005), 35: 919-928 Cambridge University Press.
• Bayne, Tim & Levy, Neil. Amputees By Choice: Body Integrity Identity Disorder and the Ethics of Amputation Journal of Applied Philosophy 22(1) (2005): 75–86.
• slate.com article: "Costing an arm and a leg"
• Wise TN, Kalyanam RC. Amputee fetishism and genital mutilation: case report and literature review. J Sex Marital Ther. 2000 Oct-Dec;26(4):339-44.

• Abnormal psychology