Self-inflicted Limb Amputation: A Case of Nonparaphilic, Nonpsychotic Xenomelia

Rustad, James K.; Suhail-Sindhu, Timur; Fortney, Thomas A.; Ramkumar, Dipak B.; Warhold, Lance G.; Thakur, Devendra S.; Finn, Christine; Stern, Theodore A.

doi:10.1016/j.psym.2019.03.004

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…Academic literature and 'transableist' message boards contain multiple accounts of people who, having been unable to secure relief from their suffering via mainstream avenues, have either: (i) severely damaged their limb, necessitating a lifesaving amputation; 7,9,12 (ii) amputated the limb themselves; 14,[46][47][48][49] or (iii) enlisted the services of a black market surgeon. j Each method presents significant risks, including, as seen in the Philip Bondy case, the potential for death.…”

Section: Amputationmentioning

confidence: 99%

“…62 While such a conflation might reduce some nuance, this paper contests that the overall purpose remains the same regardless of specificity. c. While BID has been the moniker chosen here because this is the term used in the ICD-11, the disorder has several other names, including apotemnophilia, 24 xenomelia, 16,27,30,46,[63][64][65][66] or amputee identity disorder, 67 and the most common, body integrity identity disorder. 54,68-73 d. While this article focuses on the amputation variation of BID, the arguments contained within could apply to the disorder's other formulations.…”

Section: Orcid Idmentioning

confidence: 99%

“… c. While BID has been the moniker chosen here because this is the term used in the ICD-11, the disorder has several other names, including apotemnophilia, 24 xenomelia, 16,27,30,46,63–66 or amputee identity disorder, 67 and the most common, body integrity identity disorder. 54,68–73 …”

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confidence: 99%

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Body integrity dysphoria and medical necessity: Amputation as a step towards health

Gibson

2023

Clinical Ethics

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Interventions are medically necessary when they are vital in achieving the goal of medicine. However, with varying perspectives comes varying views on what interventions are (un)necessary and, thus, what potential treatment options are available for those suffering from the myriad of conditions, pathologies and disorders afflicting humanity. Medical necessity's teleological nature is perhaps best illustrated in cases where there is debate over using contentious medical interventions as a last resort. For example, whether it is appropriate for those suffering from body integrity dysphoria to receive healthy limb amputations. This paper explores how one's perception of medicine's goal underpins whether interventions are necessary or unnecessary, using the controversial topic of therapeutic amputation as an example. By contrasting ‘classical’ amputations with their more contentious counterparts, it highlights how the idea of medical necessity influences and restrains clinical decision-making. The paper starts by giving an account of body integrity dysphoria, focusing on the debate concerning elective amputation's justifiability. It then introduces Georges Canguilhem's vitalist theory of health, paying particular attention to his emphasis on adaptability. Then, this paper uses his theory as a lens through which to evaluate the appropriateness of therapeutic amputation as a medically necessary procedure. Ultimately, the paper highlights how the label of medical necessity is withheld from potential therapeutic interventions because they fail to conform to pre-established ideas of medicine's purpose and that by doing so, potential harm befalls those who are left with no effective treatments and must look for solutions in the non-clinical world.

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