Body Integrity Identity Disorder Beyond Amputation: Consent and Liberty

White, Amy E.

doi:10.1007/s10730-014-9246-4

Cited by 17 publications

(5 citation statements)

References 21 publications

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“…Because of self-reported improved symptoms, many ethicists support elective amputation as a potential therapy [13][14][15][16] . In fact, in 1997 and 1999, Robert Smith, a Scottish surgeon, performed 2 elective amputations before his methods were revealed and the ensuing public outcry led to him being prohibited from performing further amputations by his hospital 14,17 .…”

Section: Discussionmentioning

confidence: 99%

Self-Inflicted Hand Amputation without Replantation in a Patient with Body Integrity Identity Disorder

Ramkumar

Brown

Lewis

et al. 2021

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Case: We describe a patient who self-amputated his hand using a log splitter, because of a long-standing belief that the limb “did not belong to him.” On admission, he refused replantation and was found to be nonpsychotic. He was diagnosed with body integrity identity disorder (BIID) and declared competent to make his own medical decisions. A revision amputation was performed. Conclusion: BIID is a challenging diagnosis that physicians treating traumatic injuries should be aware of. Many ethicists support elective amputation as a definitive treatment, because of potential harm reduction and because BIID does not respond to conservative modalities such as pharmacotherapy.

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Section: Discussionmentioning

confidence: 99%

Self-Inflicted Hand Amputation without Replantation in a Patient with Body Integrity Identity Disorder

Ramkumar

Brown

Lewis

et al. 2021

JBJS Case Connector

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“…76,90,91 Detractors agree that patients can refer on the principle of respecting autonomy if the conditions on the left side are met -but they question fulfillment of the conditions:…”

Section: Characteristic Features Of Disability Desires and The Personmentioning

confidence: 99%

Limb amputation and other disability desires as a medical condition

Brugger

Christen

Jellestad

et al. 2016

The Lancet Psychiatry

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Some people have a profound dissatisfaction with what is considered an able-bodied state by most others. These individuals desire to be disabled, by conventional standards. In this Review, we integrate research findings about the desire for a major limb amputation or paralysis (xenomelia). Neuropsychological and neuroimaging explorations of xenomelia show functional and structural abnormalities in predominantly right hemisphere cortical circuits of higher-order bodily representation, including affective and sexual aspects of corporeal awareness. These neural underpinnings of xenomelia do not necessarily imply a neurological cause, and a full understanding of the condition requires consideration of the interface between neural and social contributions to the bodily self and the concept of disability. Irrespective of cause, disability desires are accompanied by a disabling bodily dysphoria, in many respects similar to gender dysphoria, and we suggest that they should be considered a mental disorder. SummaryThere are persons who suffer from a profound dissatisfaction with what is considered an ablebodied state by most others. They desire to be "dis-abled" by conventional standards. We integrate recent research findings on the desire for a major limb amputation or paralysis ("xenomelia"). Neuropsychological and neuroimaging explorations of xenomelia revealed functional and structural abnormalities in predominantly right hemisphere cortical circuits of higher-order bodily representation, including affective and sexual aspects of corporeal awareness. These neural underpinnings of xenomelia do not necessarily imply a neurological etiology, and a full understanding of the condition requires consideration of the interface between neural and social contributions to the bodily self and the concept of (dis)ability. Irrespective of etiology, disability desires are accompanied by a disabling bodily dysphoria, in many respects similar to gender dysphoria, and deserve to be considered a mental disorder.3 IntroductionThis review integrates recent research findings concerning a condition that is not yet recognized as a mental disorder, which is still in search of a generally accepted medical label and whose conceptual basis is still "under construction". The condition involves a person's dissatisfaction with an able-bodied state. It is referred to as "body integrity identity disorder" (BIID) in the psychiatric literature, "xenomelia" in neurologically oriented studies, and "transability" ("transableism") in approaches to disability from a primarily sociological perspective (table 1, appendix and figure 1, appendix, for the terminology). In this review we use the term "disability desires" to remain descriptive and avoid controversial concepts of identity and too narrow notions of focal brain damage. Although deafness, blindness or the status of a eunuch can be the target of disability desires, the focus of our review is on the desire for limb amputation or paraplegia. These forms of profound bodily modification are the...

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“…In its most common variant, i.e., the desire for amputation, on which we focus here, the defining features include an intense feeling of inappropriateness concerning their current body configuration. BID patients desire to become physically disabled in order to feel “complete” and become the person they envisage themselves to be ( First, 2005 ; White, 2014 ). Ironically, achieving this completeness often involves desiring to amputate an otherwise healthy and fully functioning limb, raising many ethical and medical considerations.…”

Section: Introductionmentioning

confidence: 99%

Could Brain–Computer Interface Be a New Therapeutic Approach for Body Integrity Dysphoria?

Chakraborty

Saetta

Simon

et al. 2021

Front. Hum. Neurosci.

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Patients suffering from body integrity dysphoria (BID) desire to become disabled, arising from a mismatch between the desired body and the physical body. We focus here on the most common variant, characterized by the desire for amputation of a healthy limb. In most reported cases, amputation of the rejected limb entirely alleviates the distress of the condition and engenders substantial improvement in quality of life. Since BID can lead to life-long suffering, it is essential to identify an effective form of treatment that causes the least amount of alteration to the person’s anatomical structure and functionality. Treatment methods involving medications, psychotherapy, and vestibular stimulation have proven largely ineffective. In this hypothesis article, we briefly discuss the characteristics, etiology, and current treatment options available for BID before highlighting the need for new, theory driven approaches. Drawing on recent findings relating to functional and structural brain correlates of BID, we introduce the idea of brain–computer interface (BCI)/neurofeedback approaches to target altered patterns of brain activity, promote re-ownership of the limb, and/or attenuate stress and negativity associated with the altered body representation.

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Body Integrity Identity Disorder Beyond Amputation: Consent and Liberty

Cited by 17 publications

References 21 publications

Self-Inflicted Hand Amputation without Replantation in a Patient with Body Integrity Identity Disorder

Self-Inflicted Hand Amputation without Replantation in a Patient with Body Integrity Identity Disorder

Limb amputation and other disability desires as a medical condition

Could Brain–Computer Interface Be a New Therapeutic Approach for Body Integrity Dysphoria?

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