Body integrity identity disorder

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Body Integrity Identity Disorder (BIID), also known as Amputee Identity Disorder or Apotemnophilia (from Greek αποτέμνειν "to cut off", and φιλία "love of") 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 and/or penis. Although it most commonly refers to people who wish to amputate limbs, the term BIID, or 'wannabe' also applies to those who wish to alter their bodily integrity.

The more recent names have generally replaced the name "apotemnophilia" because the identification of this disorder simply as a paraphilia is now increasingly believed to be incorrect.

A person with BIID typically wants one or more of his or her limbs cut off. The condition should not be mistaken for a person with acrotomophilia, who is sexually attracted to other persons 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.

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. There are hence several recorded cases of sufferers resorting 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. Often the obsession is with one specific limb, 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, unsuccessfully, as a psychiatric disorder.

Persons suffering from BIID can be as young as four or five years old when they first discover their condition, for example by feeling jealous of an amputee. Some BIID patients compare the evaluation of BIID as a psychiatric illness to the historical classification of homosexuality as a mental illness. Like transgender people, someone suffering from BIID feels that he or she is "meant" to live with an altered body. They consider this to be an unconscious genetic decision, much like sexual orientation. The same argument -- no one would choose to have something this difficult -- is applied. Some BIID-rights advocates suggest that as little as 30 years ago, being transgender, gay, bisexual or anything relating to that was considered just as "wrong" as BIID is today, and that this should change in the future.

The exact causes for BIID are currently 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 their psyche, and the child adopts this body image as their "ideal." Another popular theory suggests that a child who feels unloved may believe that becoming an amputee will attract the sympathy and love they need. 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. The feelings and urges to have an amputated limb begin in almost all sufferers before they reach adolesence. Many sufferers can recall the first amputee they saw, which resulted in a kind of "recognition response" in regards to their previously vague feelings of discomfort.

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 male, 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 they will feel better about this post-amputation. The sufferer knows exactly what part of which limb should be amputated to relieve their suffering. This is commonly an above-the-knee amputation. The sufferer has intense feelings of jealousy towards other 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.

More research needs to be done about BIID and apotemnophilia - only a few studies have been done on the subject; but as research gains ground, more and more hospitals recognize the condition.

Contents 1 Books 2 Movies 3 BIID in popular culture 4 See also 5 External links

[edit] Books

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

[edit] Movies

• The documentary Whole

[edit] 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.

[edit] See also

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

[edit] External links

• BIID.org
• The Apotemnophile
• Leg-brace Abasiophilia
• slate.com article: "Costing an arm and a leg"
• Bensler JM, Paauw DS. Apotemnophilia masquerading as medical morbidity. South Med J. 2003 Jul;96(7):674-6.
• 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.
• Bruno, Richard L. "Devotees, Pretenders, and Wannabes: Two Cases of Factitious Disability Disorder." Sexuality and Disability. 15.4 (Winter 1997): 243-260.