Body integrity identity disorder

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"Self-amputation" redirects here. See also Autotomy.

Body integrity identity disorder (BIID, also referred to as amputee identity disorder)[1] is a psychological disorder in which an otherwise healthy individual feels that they are meant to be disabled.[2][3][4][5] It is not medically recognized by the American Psychiatric Association's DSM-5. BIID is related to xenomelia, "the oppressive feeling that one or more limbs of one's body do not belong to one's self".[6]

BIID is typically accompanied by the desire to amputate one or more healthy limbs. It also includes the desire for other forms of disability, as in the case of a woman who intentionally blinded herself.[2] 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 hypothesis states that it results from a neurological failing of the brain's inner body mapping function (located in the right parietal lobe) to incorporate the affected limb in its understanding of the body's physical form.[citation needed]


Sufferers of BIID are uncomfortable with a part of their body, such as a limb, and feel confident that removing or disabling this part of their body will relieve their discomfort. Sufferers may have intense feelings of envy toward amputees. They may pretend that they are an amputee, both in public and in private. Sufferers experience the above symptoms as being strange and unnatural. They may try to injure themselves to require the amputation of that limb. They are generally ashamed of their thoughts and may try to hide them from others, including therapists and health care professionals.[citation needed]

The majority of BIID sufferers are white middle-aged males, although this discrepancy may not be nearly as large as previously thought.[7] The most common[clarification needed] request is an above-the-knee amputation of the left leg, but it may also involve the arms, manifest itself as a need for paralysis, or even involve the senses, such as hearing or vision. In the United States, the most frequent manifestation of this disorder is the desire to disable the sexual organs, either through contraception, tubal ligation or vasectomy.[citation needed]

A sexual motivation for being or looking like an amputee is called apotemnophilia.[8][9] 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.[10] However, many of the people who experience one also experience the other.[11]

Ethical considerations[edit]

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.[12]

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.[13] 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".[14] The condition is usually treated as a psychiatric disorder.

In popular culture[edit]

See also[edit]


  1. ^ Smith, R. C. (2004). "Amputee identity disorder and related paraphilias". Psychiatry 3 (8): 27–30. doi:10.1383/psyt. 
  2. ^ a b "Woman desperate to be blind had drain cleaner poured in eyes, now happier than ever". Tribune Media Wire. 1 October 2015. Retrieved 2 October 2015. 
  3. ^ Davis J. L. (2012). "Narrative construction of a ruptured self: Stories of transability on". Sociological Perspectives 55 (2): 319–340. doi:10.1525/sop.2012.55.2.319. 
  4. ^ Boesvel, S. (2015, June 3). "Becoming disabled by choice, not chance: ‘Transabled’ people feel like impostors in their fully working bodies." The National Post.
  5. ^ Shad (11 June 2015). "Desiring disability: What does it mean to be transabled?". CBC Radio. Retrieved 11 June 2015. 
  6. ^ 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 136: 318–329. doi:10.1093/brain/aws316. 
  7. ^ Ellison, Jesse (28 Oct 2011). "Cutting Desire". MSNBC. Retrieved 2015-05-28. 
  8. ^ Money, J.; Jobaris, R.; Furth, G. (1977). "Apotemnophilia: Two cases of self‐demand amputation as a paraphilia". Journal of Sex Research 13 (2): 115–125. doi:10.1080/00224497709550967. 
  9. ^ Everaerd, W. (1983). "A case of apotemnophilia: A handicap as sexual preference". American journal of psychotherapy 37 (2): 285–293. PMID 6869634. 
  10. ^ Elliott, Carl (December 2000). "A New Way to Be Mad". The Atlantic. Retrieved 7 August 2012. [Psychologist John Money, author of the first medical case study,] distinguished apotemnophilia from "acrotomophilia"—a sexual attraction to amputees. 
  11. ^ Elliott, Carl (December 2000). "A New Way to Be Mad". The Atlantic. Retrieved 7 August 2012. Some wannabes are also devotees. 
  12. ^ Levy, Neil (2007). Neuroethics — Challenges for the 21st Century. Cambridge University Press. pp. 3–5. ISBN 0-521-68726-8. 
  13. ^ Large, M. M. (2007). "Body identity disorder". Psychological Medicine 37 (10): 1513; author reply 1513–4. PMID 18293510. 
  14. ^ Elliott, Carl (December 2000). "A New Way to Be Mad". The Atlantic. 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. 

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