Can vestibular caloric stimulation be used to treat apotemnophilia?


[edit] Original article

Can vestibular caloric stimulation be used to treat apotemnophilia?

[edit] Author(s)

Ramachandran, V.S. and McGeoch, Paul

[edit] Source

Medical Hypotheses, Volume 69, Issue 2, Pages 250-252. Available on PubMed

[edit] Abstract/Overview

Apotemnophilia, or body integrity image disorder (BIID), is characterised by a feeling of mismatch between the internal feeling of how one's body should be and the physical reality of how it actually is. Patients with this condition have an often overwhelming desire for an amputation- of a specific limb at a specific level. Such patients are not psychotic or delusional, however, they do express an inexplicable emotional abhorrence to the limb they wish removed. It is also known that such patients show a left-sided preponderance for their desired amputation. Often they take drastic action to be rid of the offending limb. Given the left-sided bias, emotional rejection and specificity of desired amputation, we suggest that there are clear similarities to be drawn between BIID and somatoparaphrenia. In this rare condition, which follows a right parietal stroke, the patient rejects (usually) his left arm as "alien". We go on to hypothesis that a dysfunction of the right parietal lobe is also the cause of BIID. We suggest that this leads to an uncoupling of the construct of one's body image in the right parietal lobe from how one's body physically is. This hypothesis would be amenable to testing by response to cold-water vestibular caloric stimulation, which is known to temporarily treat somatoparaphrenia. It could also be investigated using functional brain imaging and skin conductance response. If correct our hypothesis not only suggests why BIID arises, but also, in caloric stimulation a therapeutic avenue for this chronic and essentially untreatable condition.

[edit] Comments/Analysis

"Apotemnophilia, or body integrity image disorder(BIID)"

Unfortunately, like many other people, the author appears to be confusing the conditions. We agree with Dr First's opinion that there is a difference between apotemnophilia (arousal at the idea of being an amputee), and BIID, which is a body image issue and doesn't have a sexual component as a prime factor.

"These individuals are neither psychotic nor delusional"

Another considered opinion stating transabled individuals are not psychotic nor delusional.

"It is noteworth that it has been shown that most patients with BIID desire amputation of either a left-sided limb (55%) or bilaterally (18%). it is the minority (27%) who solely want removal of a right sided limb.

Given the highly specific level of the desired amputation, the left sided preponderance and the emotion tinged description of a feeling that the limb simply does not belong;"

How do non-amputee transabled individuals factor in this suggestion?

"We postulate that a functional disturbance of the right parietal cortex lies at the root of BIID"

Does this hypothesis still stands when taking into account those who need to be paraplegic, blind, deaf, or have other non-amputee related impairments?

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