Body integrity identity disorder
Body integrity identity disorder (BIID, also referred to as amputee identity disorder) is a psychological disorder wherein sufferers feel they would be happier living as an amputee. It is related to xenomelia, "the oppressive feeling that one or more limbs of one's body do not belong to one's self".
BIID is typically accompanied by the desire to amputate one or more healthy limbs to achieve that end. BIID can be associated with apotemnophilia, sexual arousal based on the image of one's self as an amputee. The cause of BIID is unknown. One theory states that the origin of BIID is that it is a neurological failing of the brain's inner body mapping function (located in the right parietal lobe). According to this theory, the brain mapping does not incorporate the affected limb in its understanding of the body's physical form.
Symptoms of BIID sufferers are often keenly felt. The sufferer feels incomplete with four limbs, but is confident amputation will fix this. The sufferer knows exactly what part of which limb should be amputated to relieve the suffering. The sufferer has intense feelings of envy toward amputees. They often pretend, both in private and in public, that they are an amputee. The sufferer recognizes the above symptoms as being strange and unnatural. They feel alone in having these thoughts, and don't believe anyone could ever understand their urges. They may try to injure themselves to require the amputation of that limb. They generally are ashamed of their thoughts and try to hide them from others, including therapists and health care professionals.
The majority of BIID sufferers are white middle-aged males, although this discrepancy may not be nearly as large as previously thought. The most common request is an above-the-knee amputation of the left leg.
A sexual motivation for being or looking like an amputee is called apotemnophilia. In addition, apotemnophilia should not be mistaken for acrotomophilia, which describes a person who is sexually attracted to other people who are already missing limbs. However, many of the people who experience one also experience the other.
Ethical considerations 
The idea of medically amputating a BIID sufferer's undesired limb is highly controversial. Some support amputation for patients with BIID that cannot be treated through psychotherapy or medication. Others emphasize the irreversibility of amputation, and promote the study of phantom limbs to treat the patient from a psychological perspective instead.
Some act out their desires, pretending they are amputees using prostheses and other tools to ease their desire to be one. Some sufferers have reported to the media or by interview over the telephone with researchers that they have resorted to self-amputation of a "superfluous" limb, for example by allowing a train to run over it, or by damaging the limb so badly that surgeons will have to amputate it. However, the medical literature records few, if any, cases of actual self amputation. Often the obsession is with one specific limb. A patient might say, for example, that they "do not feel complete" while they still have a left leg. However, BIID does not simply involve amputation. It involves any wish to significantly alter body integrity. Some people suffer from the desire to become paralyzed, blind, deaf, use orthopedic appliances such as leg-braces, etc. Some people spend time pretending they are an amputee by using crutches and wheelchairs at home or in public; in the BIID community, this is called a "pretender". The condition is usually treated as a psychiatric disorder.
In film 
- Whole, a documentary about people with BIID broadcast in 2004
- Quid Pro Quo (2008), a semi-paralyzed radio reporter is sent out to investigate a story that leads him into an odd subculture and on a journey of disturbing self-realization.
- Armless (2010), a film in which the protagonist John leaves his wife and goes to New York City to find a doctor to amputate his arms.
See also 
- Attraction to disability
- Body image
- Body dysmorphic disorder
- Body modification
- Erotic target location error
- Gender identity disorder
- Obsessive-compulsive disorder
- Smith, R. C. (2004). "Amputee identity disorder and related paraphilias". Psychiatry 3 (8): 27–30. doi:10.1383/psyt.220.127.116.11394.
- Hilti, L. M.; Hanggi, J.; Vitacco, D. A.; Kraemer, B.; Palla, A.; Luechinger, R.; Jancke, L.; Brugger, P. (2012). "The desire for healthy limb amputation: Structural brain correlates and clinical features of xenomelia". Brain. doi:10.1093/brain/aws316.
- Ellison, Jesse (28 May 2008). "Cutting Desire". MSNBC. Retrieved 2008-05-28.
- Money, J.; Jobaris, R.; Furth, G. (1977). "Apotemnophilia: Two cases of self‐demand amputation as a paraphilia". Journal of Sex Research 13 (2): 115. doi:10.1080/00224497709550967.
- Everaerd, W. (1983). "A case of apotemnophilia: A handicap as sexual preference". American journal of psychotherapy 37 (2): 285–293. PMID 6869634.
- Elliott, Carl (December 2000). "A New Way to Be Mad". Atlantic Magazine. Retrieved 7 August 2012. "[Psychologist John Money, author of the first medical case study,] distinguished apotemnophilia from "acrotomophilia"—a sexual attraction to amputees."
- Elliott, Carl (December 2000). "A New Way to Be Mad". Atlantic Magazine. Retrieved 7 August 2012. "Some wannabes are also devotees."
- Levy, Neil (2007). Neuroethics — Challenges for the 21st Century. Cambridge University Press. pp. 3–5. ISBN 0-521-68726-8.
- Large, M. M. (2007). "Body identity disorder". Psychological medicine 37 (10): 1513; author reply 1513–4. PMID 18293510.
- Elliott, Carl (December 2000). "A New Way to Be Mad". Atlantic Magazine. Retrieved 7 August 2012. "'Pretenders' are people who are not disabled but use crutches, wheelchairs, or braces, often in public, in order to feel disabled."
Further reading 
- Stirn, A., Thiel, A., Oddo, S. (2009). Body Integrity Identity Disorder: Psychological, Neurobiological, Ethical and Legal Aspects. Pabst Science Publishers. ISBN 978-3-89967-592-4.
- Sacks, Oliver W. (1998). A Leg To Stand On. Touchstone Books. ISBN 978-0-684-85395-6.
- Elliott, Carl (July 10, 2003). "Costing an Arm and a Leg: The victims of a growing mental disorder are obsessed with amputation.". Slate.com. Retrieved 7 August 2012.
- "Complete Obsession". Horizon. 17 February 2000. BBC2. http://www.bbc.co.uk/science/horizon/1999/obsession.shtml.
Davis, Jenny L. 2012. Narrative Construction of a Ruptured Self: Stories of Transability on Transabled.org. Sociological Perspectives. 55(2):319-340 http://www.jstor.org/discover/10.1525/sop.2012.55.2.319?uid=3739920&uid=2129&uid=2&uid=70&uid=4&uid=3739256&sid=21102218078801
Davis, Jenny L. 2012. Prosuming Identity: The Production and Consumption of Transableism on Transabled.org. American Behavioral Scientist 56 no. 4 596-617 http://abs.sagepub.com/content/56/4/596
- Complete Obsession, a Horizon episode on BIID (transcript)
- Do No Harm: Why do some people want to cut off a perfectly healthy limb? article by Anil Ananthaswamy on medical and ethical considerations in BIID