Body Integrity Identity Disorder: Deranged Body Processing, Right Fronto-Parietal Dysfunction, and Phenomenological Experience of Body Incongruity

Giummarra, Melita J.; Bradshaw, John L.; Nicholls, Michael E. R.; Hilti, Leonie; Brugger, Peter

doi:10.1007/s11065-011-9184-8

Cited by 52 publications

(34 citation statements)

References 107 publications

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“…However, differences in body representation are likely to be affected by culture and personal experience in complex ways (Giummarra, Bradshaw, Nicholls, Hilti, & Brugger, 2011). Higher-level differences in gender-identification might lead to an acquired aversion to sex-specific body parts, and over time might modify representation of that body part.…”

Section: Discussionmentioning

confidence: 99%

Altered White Matter and Sensory Response to Bodily Sensation in Female-to-Male Transgender Individuals

et al. 2016

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While most people take identification with their body for granted, conditions like phantom limb pain, alien hand syndrome, and xenomelia suggest that the feeling of bodily congruence is constructed and susceptible to alteration. Individuals with xenomelia typically experience one of their limbs as over-present and aversive, leading to a desire to amputate the limb. Similarly, many transgender individuals describe their untreated sexed body parts as incongruent and aversive, and many experience phantom body parts of the sex they identify with (Ramachandran, 2008). This experience may relate to differences in brain representation of the sexed body part, as suggested in xenomelia (McGeoch et al., 2011). We utilized magnetoencephalography imaging to record brain activity during somatosensory stimulation of the breast – a body part that feels incongruent to most pre-surgical female-to-male (FtM) identified transgender individuals – and the hand, a body part that feels congruent. We measured the sensory evoked response in right hemisphere somatosensory and body-related brain areas and found significantly reduced activation in the supramarginal gyrus and secondary somatosensory cortex but increased activation at the temporal pole for chest sensation in the FtM group (N = 8) relative to non-transgender females (N = 8). In addition, we found increased white matter coherence in the supramarginal gyrus and temporal pole and decreased white matter diffusivity in the anterior insula and temporal pole in the FtM group. These findings suggest that dysphoria related to gender-incongruent body parts in FtM individuals may be tied to differences in neural representation of the body and altered white matter connectivity.

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Section: Discussionmentioning

confidence: 99%

Altered White Matter and Sensory Response to Bodily Sensation in Female-to-Male Transgender Individuals

et al. 2016

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“…Body Integrity Identity Disorder (BIID) is a rare condition in which persons typically report an intense desire either to be paralyzed or to have one or more of their healthy limbs to be amputated [1]–[3]. BIID is not a paraphilia [4] nor does the desire to amputate the limb reflect psychosis amputation [5].…”

Section: Introductionmentioning

confidence: 99%

Body Integrity Identity Disorder

2012

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IntroductionBody Integrity Identity Disorder (BIID) is a rare, infrequently studied and highly secretive condition in which there is a mismatch between the mental body image and the physical body. Subjects suffering from BIID have an intense desire to amputate a major limb or severe the spinal cord in order to become paralyzed. Aim of the study is to broaden the knowledge of BIID amongst medical professionals, by describing all who deal with BIID.MethodsSomatic, psychiatric and BIID characteristic data were collected from 54 BIID individuals using a detailed questionnaire. Subsequently, data of different subtypes of BIID (i.e. wish for amputation or paralyzation) were evaluated. Finally, disruption in work, social and family life due to BIID in subjects with and without amputation were compared.ResultsBased on the subjects' reports we found that BIID has an onset in early childhood. The main rationale given for their desire for body modification is to feel complete or to feel satisfied inside. Somatic and severe psychiatric co-morbidity is unusual, but depressive symptoms and mood disorders can be present, possibly secondary to the enormous distress BIID puts upon a person. Amputation and paralyzation variant do not differ in any clinical variable. Surgery is found helpful in all subjects who underwent amputation and those subjects score significantly lower on a disability scale than BIID subjects without body modification.ConclusionsThe amputation variant and paralyzation variant of BIID are to be considered as one of the same condition. Amputation of the healthy body part appears to result in remission of BIID and an impressive improvement of quality of life. Knowledge of and respect for the desires of BIID individuals are the first steps in providing care and may decrease the huge burden they experience.

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“…Followers of this neurological hypothesis propose to move from BIID to "xenomelia", a Greek word meaning "foreign" and "limb", to parallel somatoparaphrenia (McGeoch et al, 2011). For both these disorders, a common anatomical pattern has been found, involving the right parietal cortex and the right insula (Gandola et al, 2012;Giummarra, Bradshaw, Nicholls, Hilti, & Brugger, 2011). Somatoparaphrenia is a delusion confined to the contralesional paralyzed limb, causing an intense feeling of non-belonging and the ascription of the own arm or leg to family members or caregivers (Gandola et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Is the desire for amputation related to disturbed emotion processing? A multiple case study analysis in BIID

2014

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Body integrity identity disorder (BIID) is characterized by the overwhelming desire to amputate one or more healthy limbs or to be paraplegic. Recently, a neurological explanation of this condition has been proposed, in part on the basis of findings that the insular cortex might present structural anomalies in these individuals. While these studies focused on body representation, much less is known about emotional processing. Importantly, emotional impairments have been found in psychiatric disorders, and a psychiatric etiology is still a valid alternative to purely neurological accounts of BIID. In this study, we explored, by means of a computerized experiment, facial emotion recognition and emotional responses to disgusting images in seven individuals with BIID, taking into account their clinical features and investigating in detail disgust processing, strongly linked to insular functioning. We demonstrate that BIID is not characterized by a general emotional impairment; rather, there is a selectively reduced disgust response to violations of the body envelope. Taken together, our results support the need to explore this condition under an interdisciplinary perspective, taking into account also emotional connotations and the social modulation of body representation.

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Body Integrity Identity Disorder: Deranged Body Processing, Right Fronto-Parietal Dysfunction, and Phenomenological Experience of Body Incongruity

Cited by 52 publications

References 107 publications

Altered White Matter and Sensory Response to Bodily Sensation in Female-to-Male Transgender Individuals

Altered White Matter and Sensory Response to Bodily Sensation in Female-to-Male Transgender Individuals

Body Integrity Identity Disorder

Is the desire for amputation related to disturbed emotion processing? A multiple case study analysis in BIID

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