BIID as a mental illness

There is a lot of debate within the so-called BIID community about just what Body Integrity Identity Disorder really is. Here are some of the suggestions:

  • Mental illness
  • Lifestyle choice
  • Just a difference
  • Neurological condition
  • Neuropsychological condition


[edit] The case against "Lifestyle choice" and "difference"

If we are to accept the label of Body Integrity Identity Disorder, then, we must also accept that BIID is not just a difference, nor a lifestyle choice. One of the problems we see with stating that BIID is a lifestyle choice is that such a concept implies that transabled individual actually have a choice in feeling the way they do. This is not the case. The vast majority of people who have BIID feelings will agree that there is no choice, nor control, on feeling the way they do about acquiring an impairment.

The concept of lifestyle choice, or difference, also makes the condition appear much more benign than it really is. BIID has a significant, and often destructive, impact in people's lives. Lifestyle choices don't usualy have the negative impact BIID can have on people's lives.

[edit] Neurological / neuropsychological conditions

The thing is, we don't have enough evidence to support this suggestion. One might argue that there is not enough evidence to categorically classify BIID one way or the other. But the evidence pointing to a neurological condition is much weaker than that pointing towards a mental illness.

[edit] The case for "Mental Illness"

To begin with, the term Body Integrity Identity Disorder was coined by Dr. First, a psychiatrist deeply involved with the next edition of the DSM.

Wikipedia defines mental illness as:

"A mental illness as defined in psychiatry and other mental health professions, is abnormal mental condition or disorder expressing symptoms that cause significant distress and/or dysfunction."

Let's look at this definition in depth.

Abnormal mental condition. Abnormal, what does that mean? As Wikipedia points out, there are many ways to look at it, but perhaps a safe, non-controversial way is to look at it in terms of statistical infrequency. If the norm is what is found more often, abnormal is something that doesn’t happen very often. Mental condition. There are no (known/proven) physiological reasons for us to feel the way we do. There is not a "disability gene" (even though some disabilities are congenital). It *is* happening in our mind. Therefore, we feel confident to state that BIID is an abnormal mental condition.

Disorder. Expanding the acronym BIID, we arrive at Body Integrity Identity Disorder. Need we say more?

Expressing symptoms. Hmm, ok, in other words, how do we see it’s there? We probably don’t need to decorticate it that far down, but heck, why not?

'Significant distress. It should be fair to say that our BIID is causing the majority of us significant distress. Over the last 12 years, we have been in contact with hundreds of transabled individuals. We have exchanged emails or IM’ed with dozens of transabled individuals. All of them, all of *us*, have stated that they’ve experienced distress at not having their physical body conform to their mental image of it. Then, we’ve experienced shame, and guilt, and disgust. We’ve experienced being ostrarcised by family, friends, and perfect strangers. We most certainly experience significant distress, even though some of us claim they are perfectly happy to be transabled. We only hope for them that they aren’t just experiencing wishful thinking and trying to convince themselves by stating something to us.

Dysfunction. Does not function properly, or as well as possible. It is also fair to say that our transabled thoughts have impaired our functioning at some point or another along the line. They may have in fact chronically affected everything we do.

[edit] Frowning on the "Mental Illness" label

So, why is it so distasteful for some of us to be labelled as mentally ill? Could it be perhaps that society as a whole views mental illness as something ubber negative? Even in the disability sector, mental illnesses are at the bottom of the totem pole. How many times have we heard (or said) negatively charged expression relating to mental illnesses? Expressions such as "Chill, take a pill", or "She must be off her meds today", or "Don’t pay attention to him, he’s just crazy". How many of us have been uncomfortable when in the presence of someone we know to have been diagnosed as schizophrenic, or as having bi-polar disorder? Why? Just because of the name of the condition they have, or perhaps because of a tic they have.

We’re all guilty at some level of buying into society’s message and perception that a mental illness is something negative, something to be shunned. But society is also under the impression that *any* disability is something to be shunned. One might think that attitudes are changing, but they aren’t, not really. Otherwise there wouldn’t be so many people with disabilities stuck in nursing homes for the sole reason that they have a disability. Otherwise, there would not be so many places that aren’t accessible. Otherwise, there would not be so much unemployment among the disability population. Otherwise there wouldn’t be so many doctors saying it’s ok to kill disabled infants. Otherwise… Well, we could go on and on. Fact is, having a disability is viewed really negatively in the world at large.

But in and of itself, a disability is neutral. And by the same token, in and of itself, a mental illness is also neutral. It’s not always pleasant, and it often causes distress, but it isn’t negative in and of itself. It only becomes a problem when a non-inclusive society creates barriers (for example, always having jokes at the expense of people with mental illnesses).

Why are you so desperate NOT to be labelled as mentally ill? Don’t you see the advantages of such a label?

People call us "sick". They don’t realise how true to the mark they are. Yes, we’re sick. Mentally ill. And if it’s a mental illness, we have no more control over our condition than we would be if we had cancer, asthma or the common cold. Why are people with a cold not shunned the way people with mental illnesses are? (that was a rethorical question…)

We have a mental illness, it is out of our control. We can’t be made to be ashamed of being transabled, because shame (should) derive only from things we have control over. Instead of shaming us for something we have no control over, help us get better!

And if BIID does become a recognised form of mental illness, then we are more likely to be better accepted by the medical community. Just as transsexuals started to see accepted avenues of treatment when their condition was accepted as a mental illness, we believe that it will take us being formally labelled as mentally ill before we see treatment options open to us. And we don’t necessarily mean to have a "cure" for BIID. See Treatment Protocol to know how we feel about treatment optons.

The concept of BIID as a mental illness explains many things. But it is also a means to an end. we should accepte just about any label anyone wants to apply to us, as long as it leads to us getting what we need, whether a spinal cord injury, an amputation, or deafness or blindness. Because, you see, if the label of mental illness is neutral, then there’s nothing wrong with being mentally ill. And there’s nothing wrong with BIID being a mental illness. And there’s nothing wrong with having BIID.

By Webmaster. Adapted from

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