Introduction:
Body integrity identity disorder is a psychiatric condition in which an individual has a persistent desire to develop a physical disability like amputation. This disorder is also called body integrity dysphoria, xenomelia, or amputee identity disorder. It is an extremely rare disorder in which individuals are inclined to cut off their healthy limbs, like the arm or leg, since they feel a mismatch exists between their physical and mental image. The first case of this disorder was reported in the year 1977, wherein two individuals desired to chop off their healthy limbs.
What Is the History Behind Body Integrity Identity Disorder?
The first surgeon in the world to carry out amputations on healthy individuals was Robert Smith. He carried out elective amputations in otherwise healthy patients in 1997 and 1999. He considered this condition to be a disorder of body identity and claimed that patients craved amputation and felt happy after their transformation. This disorder was initially termed apotemnophilia, and the probable reason was believed to be sexually oriented. However, it was later believed that the patient’s desire for amputations was not linked to sexual reasons but to other various non-sexual reasons as well.
What Is the Link Between Body Integrity Identity Disorder and Other Neurological Conditions?
It is believed by neurologists and psychologists that body integrity identity disorder can occur in individuals whose brain does not map the body correctly. The link between body integrity identity disorder and other neurological conditions was assessed using various neuroimaging techniques. This analysis found that individuals with body integrity identity disorder had brain damage in the right hemisphere.
Why Does Body Integrity Identity Disorder Occur?
The reason for the occurrence of body integrity identity disorder is not clearly understood. There is no single specific reason for the occurrence of this disorder, and many theories have been put forth regarding its origin. It is believed that the following conditions could result in body integrity identity disorder:
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Over-identification with amputees.
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Obsessive-compulsive tendencies.
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Early childhood trauma.
However, the most common reason that is accepted by neurologists and psychologists in unison for the manifestation of this disorder is the inability of the brain to map the body correctly. The brain in these individuals feels that the body should be different than it looks. This disorder usually manifests when one is in the youth phase of life wherein many individuals with this disorder complain about their first feelings of discomfort with their body. Since this is a rare disorder, not much research has been done on this condition.
Is Body Integrity Identity Disorder a Common Condition?
Body integrity identity disorder is a very rare disorder. A certain number of individuals affected by this condition can be difficult to judge and may keep their condition in secrecy. Individuals with this disorder feel disconnected from their physical body parts that they do not identify with and refrain from discussing their issues with others.
What Are the Symptoms of Body Integrity Identity Disorder?
The following are the symptoms of those with body integrity identity disorder:
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Individuals with body integrity identity disorder feel that a specific limb does not belong to them. Though their arms or legs may be healthy, they feel that it is inappropriate for their body and desire to have it amputated.
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Some patients may experience intense emotional pain by retaining the limb that they do not identify with.
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Those with this disorder feel overcomplete concerning their bodies. The desire to have one limb amputated is not just a mere wish of the individuals with body integrity identity disorder but they have the obsessive urge to get rid of the unwanted limb in their bodies.
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Individuals with this disorder have distressing thoughts that could hamper their personal, social, and work life. Those who cannot afford the amputation surgery or could not find a surgeon who will not amputate their limb would try to do it on their own. This kind of self-mutilation could end up with deadly consequences.
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These individuals may also suffer from stress, depression, mood disorders, and anxiety.
How to Diagnose Body Integrity Identity Disorder?
Body integrity identity disorder is challenging to diagnose. Though this condition has been given a name, a diagnosis can only be made if the individuals suffering from this disorder speak out to their physician about their condition. If one feels that there is a mismatch between one's physical and mental image of the body, the physician might analyze the activity of the individual’s brain. They will determine if there are other underlying causes for this condition, like that of a benign (noncancerous) brain tumor.
How Can Body Integrity Identity Disorder Be Treated?
The sad part of this disorder is that there is no cure. However, distress and depression associated with this condition can be treated through cognitive behavioral therapy and selective serotonin reuptake inhibitors (SSRIs-an antidepressant that elevates the levels of serotonin or happy hormone in the brain). Cognitive behavioral therapy is a therapy that focuses on the individual’s behavioral responses to specific stressors or events. Therapists will assist the patients to develop new behavioral habits and techniques for reacting to stressors.
Heavier psychotropic medications such as antipsychotics have not been tested in patients with this disorder. A point to be noted is that there have been reports of individuals with body integrity identity disorder feeling better after amputation of the limb and there has been improvement noted in the quality of their life. Many individuals with this disorder get adapted to living with this disability. These people are referred to as ‘pretenders’. By pretending to live with a disability, these individuals enjoy short-term relief just like the temporary relief that individuals with obsessive-compulsive disorder (a disorder in which a person has excessive thoughts that result in repetitive behaviors) experience after doing a compulsion.
Amputation is carried out by surgeons only when all other therapies have failed and the person still prefers to have amputation done. In a majority of such surgeries, patients were found to be gratified after the completion of the surgery.
What Are the Ways to Keep Body Integrity Identity Disorder From Affecting One’s Health?
The following are some of the ways:
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Body integrity identity disorder manifests in childhood and can cause life-long suffering. Recognizing this condition and seeking help from a mental health professional can help one manage their symptoms at the earliest.
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Sharing one’s condition with a trusted family member or a friend can help one have a better understanding of the condition and can pave ways to find the right treatment option.
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In a few cases, amputation can offer relief from the condition but it has to be done in a safe and legitimate environment by a licensed surgeon after appropriate psychiatric consultation and assessment.
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Body integrity identity disorder has not yet been identified as a mental health condition and is not listed in the Diagnostic and Statistical Manual (DSM). Had it been included in the manual, it would have paved the way for further research, interest, and better treatment options.
Conclusion:
Body integrity identity disorder (BIID) is a rare disorder in which one’s ideal mental body image is in contrast with their actual physical appearance. It makes an individual feel that a part of their body does not belong to them which produces a desire to have the offending limb amputated. These individuals may feel depressed or anxious due to the presence of the offending limb and deem its presence to be unnecessary and feel that the only solution to their problem is to have the limb amputated. Currently, there is no permanent cure for this condition. Early diagnosis can help manage the symptoms. Since body integrity identity disorder is a rare condition, minimal research has been done. Further research is mandatory to have a better understanding of the disorder.
