Body integrity identity disorder
Encyclopedia
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)
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 surgeon
s 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.
s to treat the patient from a psychological perspective instead.
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 paraplegiaParaplegia
Paraplegia is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek: παραπληγίη "half-striking". It is usually the result of spinal cord injury or a congenital condition such as spina bifida that affects the neural elements of the spinal canal...
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
White people
White people is a term which usually refers to human beings characterized, at least in part, by the light pigmentation of their skin...
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
Apotemnophilia
Apotemnophilia is a neurological disorder in which otherwise sane and rational individuals express a strong and specific desire for the amputation of a healthy limb or limbs. It is due to hypothesized damage to the right parietal lobe, as the disorder has features in common with somatoparaphrenia...
. 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 surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
s 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
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
disorder.
Exact causes for BIID are unknown. One theory states that the psyche of a child seeing an amputee, may imprint
Imprinting (psychology)
Imprinting is the term used in psychology and ethology to describe any kind of phase-sensitive learning that is rapid and apparently independent of the consequences of behavior...
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
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
. If the condition is neurological, it could be conceptualized as a congenital form of somatoparaphrenia
Somatoparaphrenia
Somatoparaphrenia is a type of monothematic delusion where one denies ownership of a limb or an entire side of one's body. As an example, a patient would believe that her or his own arm would belong to the doctor, or that another patient left it behind....
, 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 limbPhantom limb
A phantom limb is the sensation that an amputated or missing limb is still attached to the body and is moving appropriately with other body parts. 2 out of 3 combat veterans report this feeling. Approximately 60 to 80% of individuals with an amputation experience phantom sensations in their...
s to treat the patient from a psychological perspective instead.
Books
Movies
- WholeWhole (film)Whole is a documentary about people with body integrity identity disorder. It first was broadcast on the Sundance Channel in 2004....
, a documentary about people with B.I.I.D., was broadcast in 2004 - http://www.abc.net.au/catalyst/stories/2576978.htm a report about people with BIID in Australia on the ABC
BIID in popular culture
- ArmlessArmless (2010 film)Armless is a 2010 comedy film directed by Habib Azar and written by Kyle Jarrow, starring Daniel London, Janel Moloney, Matt Walton, Zoe Lister-Jones and Laurie Kennedy....
(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 QuoQuid Pro QuoQuid Pro Quo is a film written and directed by Carlos Brooks, starring Nick Stahl, Vera Farmiga, Pablo Schreiber, and Kate Burton. The film was released at the 2008 Sundance Film Festival and scheduled for release on 13 June 2008....
(2008 film) - In the MentalMental (TV series)Mental is a television series produced by Fox's subsidiary Fox Telecolombia, which aired in the summer and fall of 2009 on FOX international channels for Latin America, Europe and Asia, starring Chris Vance and Annabella Sciorra...
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/TuckNip/TuckNip/Tuck is an American drama series created by Ryan Murphy, which aired on FX in the United States. The series focuses on McNamara/Troy, a plastic surgery practice, and follows its founders, Sean McNamara and Christian Troy...
episode "Ben White," the title character wants a healthy leg amputated so he will feel whole. - In the CSI: NYCSI: NYCSI: NY is an American police procedural television series that premiered on September 22, 2004, on CBS. The show follows the investigations of a team of NYPD forensic scientists and police officers as they unveil the circumstances behind mysterious and unusual deaths as well as other crimes...
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 LoveGeek LoveGeek Love is a novel by Katherine Dunn, published completely by Alfred A. Knopf in 1989. Dunn published parts of the novel in Mississippi Mud Book of Days and Looking Glass Bookstore Review...
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 EvensonBrian EvensonBrian Evenson is an American academic and writer of both literary fiction and popular fiction. He has received degrees from Brigham Young University and the University of Washington . After leaving a teaching position at BYU, he held positions at Oklahoma State University, Syracuse University...
a cult of self amputees makes a messiah out of a detective who amputates his own hand without anesthetic. - In the Grey's AnatomyGrey's AnatomyGrey's Anatomy is an American medical drama television series created by Shonda Rhimes. The series premiered on March 27, 2005 on ABC; since then, seven seasons have aired. The series follows the lives of interns, residents and their mentors in the fictional Seattle Grace Mercy West Hospital in...
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 DisorderBody dysmorphic disorderBody Dysmorphic Disorder is a type of mental illness, a somatoform disorder, wherein the affected person is exclusively concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features...
. - In an episode of CasualtyCasualty (TV series)Casualty, stylised as Casual+y, is a British weekly television show broadcast on BBC One, and the longest-running emergency medical drama television series in the world. Created by Jeremy Brock and Paul Unwin, it was first broadcast on 6 September 1986, and transmitted in the UK on BBC One. The...
, 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 TabooTaboo (TV series)Taboo is a documentary television series that premiered in 2002 on the National Geographic Channel. The program is an educational look into "taboo" rituals and traditions practiced in some societies, yet forbidden and illegal in others....
.
See also
- ApotemnophiliaApotemnophiliaApotemnophilia is a neurological disorder in which otherwise sane and rational individuals express a strong and specific desire for the amputation of a healthy limb or limbs. It is due to hypothesized damage to the right parietal lobe, as the disorder has features in common with somatoparaphrenia...
- Body dysmorphic disorderBody dysmorphic disorderBody Dysmorphic Disorder is a type of mental illness, a somatoform disorder, wherein the affected person is exclusively concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features...
- Body imageBody imageBody image refers to a person's perception of the aesthetics and sexual attractiveness of their own body. The phrase body image was first coined by the Austrian neurologist and psychoanalyst Paul Schilder in his masterpiece The Image and Appearance of the Human Body...
- Body modificationBody modificationBody modification is the deliberate altering of the human body for any non-medical reason, such as aesthetics, sexual enhancement, a rite of passage, religious reasons, to display group membership or affiliation, to create body art, shock value, or self expression...
- Alien hand syndromeAlien hand syndromeAlien hand syndrome is a neurological disorder in which the afflicted person's hand appears to take on a mind of its own...
- Attraction to disabilityAttraction to disabilityAttraction to disability is a sexualised interest of people in the appearance, sensation and experience of disability. It may extend from normal human sexuality into a type of sexual fetishism...
- DeformityDeformityA deformity, dysmorphism, or dysmorphic feature is a major difference in the shape of body part or organ compared to the average shape of that part.Deformity may arise from numerous causes:*A Genetic mutation*Damage to the fetus or uterus...
- Acrotomophilia
External links
- ABC News article: What Drives People to Want to Be Amputees?
- slate.com article: "Costing an arm and a leg"