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A desire for amputation?


While traveling to Disney World the other week, I picked up a copy of Scientific American Mind to keep myself from being too bored on the flight. One by Sabine Miller called "Amputee Envy" concerns what she terms "Body Identity Disorder" (BID). People with this extremely rare disorder desire to have one or more of their appendages removed, and some actually have such discomfort that they request that the appendage be removed. A summary of the article is here.I had heard about this sort of thing and chalked it up to being a sexual fetish. The reality appears to be much more complex. Some appear to be seeking attention rather than any sort of sexual gratification. But most interesting to me is that at about two thirds of the disorder report that amputation will enable them to express their "true" identity. Thus, there may be a parallel between this disorder and Gender Identity Disorder (GID), which is of personal interest to me. Indeed there are some interesting parallels-both disorders arise early in life, and sometimes the discomfort (which can be extreme) is only resolved through surgery.One might think that these sorts of identity statements are merely part of our modern cultures preoccupation with identity or authenticity, but some cases of BID appear to arise from irregularities in how the body is mapped out in the cerebral cortex. Indeed, sometimes temporary cases of body image problems result from brain tumor, injury or disease. When the disease or injury is fixed, the body image problem goes away.The article also address the issue of surgery for BID cases. Some ethicists argue that, as in the case of certain types of GID, if the person is fully informed of the risks and is not psychotic then surgery ethical. Other ethicists consider this wrong headed and that the Doctor must protect the patient from his or her "irrational desires."Again this sort of debate parallels that about Gender Identity Disorder. Since Gender Identity Disorder is much more common, there is actually standard of care called the Benjamin Standard of Care to provide a way to select those most likely to benefit from sexual reassignment surgery. So lots of interesting things in this article to chew on. What makes our identity? Is it merely socially constructed as some would have us believe? How much is changeable about our identity? What are the boundaries of ethically acceptable medical intervention?There are lots of other interesting articles in this magazine...so you might look for it at your newsstand or for purchase online at www.SciAmMind.com.Citation: Sabine Miller(Dec 2007/Jan 2008) Amputee Envy Scientific American Mind 18(6) pp 60-65Other links:BIID-Info.orgWorld Professional Association for Transgender Health


Ronda Miller 10 years, 5 months ago

Fascinating! I will have a look at the magazine you mention. There are truly all types walking among us - and most of the time we never know it, nor does it really matter if it doesn't infringe on another person's right, beliefs, feelings.

Alia Ahmed 10 years, 5 months ago

This reminds me of a book called Phantoms in the Brain by neurologist V.S. Ramachandran. He writes about the very interesting cases of phantom pain in amputees, stroke victims who don't acknowledge or recognize that their limbs are paralyzed and other interesting brain disorders.

wylz 10 years, 5 months ago

First, thank you for the link to my site, http://biid-info.org it is much appreciated.

Sabine Miller didn't term Amputee envy Body Identity Disorder, Dr. Michael First, principal editor of the DSM IV-TR and DSM V offered the term "Body Integrity Identity Disorder". It is worth noting that BIID is not affecting only people who need to be amputees, but also people who need different impairments, such as paralysis, blindness or deafness.

You weren't alone in thinking it was just some sort of sexual fetish. Dr. John Money classified it as a paraphilia over twenty years ago and it is only more recently that the full story has emerged. It is not about sexuality, not for the majority of us.

This is not just a reflection of our modern culture and the "ill-ease" it causes. There are documented cases that can quite obviously be attributed to BIID dating back to the late 1700's.

As for the ethicist quoted so vehemently against surgery as a a treatment option, Arthur Caplan is not known to be particularly disability friendly. So one might have to question motivations to advocate against a solution that would in effect create more disabled people.

Logan72, it is interesting you mention Ramachandran, as he is currently running a study about BIID. He wrote the following paper: http://biid-info.org/Can_vestibular_caloric_stimulation_be_used_to_treat_apotemnophilia%3F



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