Body integrity identity disorder (BIID, also referred to as amputee identity disorder) is a psychological disorder in which an otherwise healthy individual feels that they are meant to be disabled. BIID is related to xenomelia, "the dysphoric feeling that one or more limbs of one's body do not belong to one's self".
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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, or individuals who have themselves surgically or chemically sterilized. 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.
Description
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.
The majority of BIID sufferers are white middle-aged males, although this discrepancy may not be nearly as large as previously thought. Most commonly an above-the-knee amputation of the left leg is desired, but amputations may also involve the arms, or instead manifest itself as a need for paralysis, or involve the senses, such as hearing or vision.
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.
Up until recently, the BIID has led to the desire to become disabled on organs other than limbs. Events of BIID causing a desire to become disabled in organs such as eyes have been reported.
Ethical considerations
The idea of medically amputating a BIID sufferer's undesired limb is highly controversial. Since amputation is irreversible one alternative might be within the study of phantom limbs to treat the patient from a psychological perspective.
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. 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.