Body integrity dysphoria is a psychiatric condition characterized by a persistent desire to acquire physical disability (e.g., amputation, paraplegia). Body integrity dysphoria is also termed as body integrity identity disorder, amputee identity disorder, and xenomelia.
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Body integrity dysphoria is an extremely rare phenomenon, in which patients prefer to cut off their healthy limb (especially one’s arm or leg) because they feel a mismatch between their mental and physical image.
In Body integrity dysphoria, patients decide to go for amputation in search of their true selves. The desire for amputation appears at a very young age between eight to twelve years. Body integrity dysphoria causes significant distress on the patients, and most of them became happy only after the surgery.
Body integrity dysphoria – A brief history
In 1977, the first case of two individuals who desired to cut off their healthy limbs was reported. Earlier Body integrity dysphoria was termed apotemnophilia, and the probable reason for apotemnophilia was said to be sexually oriented.
But, later on, it was found that the patient’s desire for amputations was not only sexually-oriented but was due to several, nonsexual reasons as well.
Robert Smith was the first surgeon in the world to perform amputations on healthy individuals. Robert Smith performed elective amputations in otherwise healthy patients, one in 1997 and one in 1999.
He called this condition a disorder of body identity and reported that patients desperately wanted amputation and were happy after their transformation.
What is the association of body integrity dysphoria with other neurological conditions?
Both psychologists and neurologists believe that Body integrity dysphoria is common in people whose brain fails to map the body correctly. Different neuroimaging techniques were utilized to assess the association of Body integrity dysphoria with other neurological conditions.
Upon analysis, it was found that patients who desire amputation have brain damage in the right hemisphere.
What are the causes of body integrity dysphoria?
The most common reason for amputation in body integrity dysphoria is the patient’s desire to correct the mismatch in their body. This unusual desire is due to the patient’s belief that the target limb does not belong to them.
The underlying cause of Body integrity dysphoria is still unknown, and research is going on to understand the precise cause. Scientists believe that it is mainly due to early childhood trauma, sexual arousal, obsessive-compulsive tendencies, or an over-identification with amputees.
What are the signs and symptoms of body integrity dysphoria?
The common symptoms associated with Body integrity dysphoria are stress, depression, mood disorders, and anxiety.
Body integrity dysphoria is often compared with body dysmorphia. Body dysmorphia is a condition in which subjects keep thinking about their bodies negatively, which hampers their quality of life.
Anorexia nervosa was also found to have links with the Body integrity dysphoria.
What are the treatment options for body integrity dysphoria?
Till now, there is no standard treatment available for body dysmorphia. However, conventional treatment methods are cognitive behavioral therapy and selective serotonin reuptake inhibitors (SSRIs).
Antidepressants help reduce the depressive symptoms related to body dysmorphia. Antidepressants help reduce the stress and depression associated with body dysmorphia; however, antidepressants fail to conquer patients’ desire for amputation.
Studies report that psychosis has led to many cases of self-amputation, self-enucleation, or auto-castration. A 40-year-old French woman with lower-extremity burns; revealed that she wanted her both legs to be amputated for the past 28 years.
Patients intentionally damage their limbs if surgeons refuse to perform the amputation. In one case, a patient performed self-amputation of both legs by freezing them in dry ice.
Surgeons perform amputation only after all the other therapies have failed, and the patient still desperately wants amputation. In most of such surgeries, patients were found to be satisfied after the surgery is done.
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- Ryan, C.J., et al. (2010).Body integrity identity disorder: response to Patrone. Journal of medical ethics. 1;36(3):189-90.