Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder
 Original article
Background. The objective of this paper is to describe and conceptualize an unusual and probably rare condition: the intense longstanding desire to have an amputation.
Method. Structured interviews were conducted by telephone of 52 subjects (mean age: 48[middot]6, range 23[ndash ]77 years; 47 male, 4 female, 1 intersexed) self-identified as having had a desire to have an amputation.
Results. Seventeen per cent (n=9) had an arm or leg amputated with two-thirds using methods that put the subject at risk of death and one-third enlisting a surgeon to amputate their healthy limb. The most common reported reason for wanting an amputation was the subject[apos ]s feeling that it would correct a mismatch between the person[apos ]s anatomy and sense of his or her [lsquo ]true[rsquo ] self (identity). None were delusional. For all but one subject age at onset was during childhood or early adolescence. For those who had psychotherapy or medication there was no change in the intensity of the desire for amputation. The six subjects who had an amputation at their desired site reported that following the amputation they felt better than they ever had and no longer had a desire for an amputation.
Conclusions. These preliminary results suggest the existence of an extremely unusual clinically distinct condition characterized by a lifelong desire to have an amputation of a particular limb. The condition is associated with serious negative consequences: amputation attempts, impairment and marked distress. Reflecting similarities between Gender Identity Disorder and this condition, the author suggests that it may be conceptualized as an unusual dysfunction in the development one[apos ]s fundamental sense of anatomical (body) identity.
For some reason this study shows an overwhelming preponderance of people who require amputation as opposed to other conditions. This may be due to the way survey respondent were recruited, or to the fact that at the time of the survey, the existance of BIID was not well known outside of certain circles. In fact, from 1995 until about 2001, I knew of only one other non-amputee transabled individual. Yet in the years since, literally dozens have contacted me.
"The most common reported reason for wanting an amputation was the subject's feeling thatit would correct a mismatch between the person's anatomy and sense of his or her 'true' self (identity)"
Body Image - a definite split between psyche and body.
"None were delusional"
People with BIID are not delusional! We are quite lucid and aware of the enormity of what we need.
"For those who had psychotherapy or medication there was no change in the intensity of the desire for amputation."
Not only does anecdotal evidence shows that medication or therapy doesn't work, but formal studies conducted by no less than the editor of the DSM says the same!
"The six subjects who had an amputation at their desired site reported that following the amputation they felt better than they ever had and no longer had a desire for an amputation."
A proof that surgery does work! We know that, why doesn't the medical community follow up?
"He reports that prior to amputation his left leg did not feel any different from his other limbs nor did he perceive it to be ugly or deformed."
This shows this isn't about body dysmorphia, and that comparisons to anorexia are innacurate.
"He denies that a desire for attention was a motivation for the amputation."
BIID is not generally about attention
"He began weekly insight-oriented psychotherapy (which he experienced as useless) and also was prescribed trials of a vaeiety of antidepressants, anti-OCD medications and antipsychotic medications. He reported that they did not reduce his desire in any way and only made him feel worse."
Another affirmation that drugs don't work, and that therapy isn't helpful.
"Four years after the amputation, Tom reports no regrests whatsoever about having had the surgery: ' My only regret is that I did not have it done sooner'."
Another statement going towards surgery as a viable treatment option for people who have Body Integrity Identity Disorder.
"Sometimes amputation attemps can be understood as manifestations of another mental disorder, such as severe mood or psychotic disorder. For example, amputation was reported as a method of suicide in a 37-year-old female with severe depression who amputated both hands with a power saw hoping to bleed to death (Stewart & Lowrey, 1980), and hand amputation (accompanied by self-inflicted amputation of the penis) was reported in a 22-year-old male who was responding to command auditory hallucinations and delusions of guilt over perceived sexual transgressions (Hall et al. 1981)"
These other conditions that make people seek amputation make diagnosing BIID more difficult. This is why it is so important that Body Integrity Identity Disorder be included in the DSM.