Body Integrity Identity Disorder (BIID)

by markryanmayo

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Finding a United States doctor to amputate a healthy limb can be exasperating.  In May of 1998, Phillip Bondy paid U.S. doctor, John Brown, ten thousand dollars to amputate his perfectly healthy left leg in Tijuana, Mexico.  According to the LA Times, renegade Brown, had once been a prominent sex reassignment surgeon in Los Angeles.  However, after a series of botched surgeries, he was labeled “Butcher Brown” amongst the transgender community, and he fled to Mexico.  Brown completed the amputation, easing Bondy’s life long anxiety.  Unfortunately, four days later while recovering in a San Diego Hotel, Bondy died from complications caused by unsanitary surgical equipment (Marrison, 2008).   In 2009, Newsweek reported on ‘Josh’, who had tried for many years to destroy his left hand in the hopes of amputation.  Filled with torment, he used a table saw to remove his unwanted hand, which he then mutilated and disposed of to avoid reattachment (Ellison, 2008).  Ashamed, he remained anonymous out of fear as to how his family would respond to what they believed to have been an accident.  A biochemist by the name of ‘Karl’, wanted both of his legs amputated.  After years of suffering in silence, he put a bucket in his car and placed both legs into the bucket filling it with dry ice.  After waiting four hours, he drove himself to the emergency room.  ‘Karl’ had timed it perfectly and three days later the doctors were forced to amputate.  Other forms of self-amputation have occurred that have involved a variety of various tools.

What do these people share in common?  They suffer from Body Integrity Identity disorder (BIID).  BIID is an extremely rare and under diagnosed condition, due to the secretive nature of those afflicted, as well as the lack of research done it this area.  BIID is characterized by an overwhelming desire to amputate one or more healthy limbs (First, 2005).   According to BIID.org (2011), BIID occurs “when a person’s idea of how they should look does not match their actual physical form.”   The disparity between the individual’s psyche and their body leads to a lifetime of significant anxiety and depression (First, 2005).  These symptoms are accompanied by a compulsion to destroy the undesired limb(s), by any means necessary.

Body Integrity Identity Disorder has been known by several names:  In 1977, Dr John Money, an expert on sexuality at John Hopkins University originally named it “apotemnophilia”, which means love of amputation, implying sexual motive (Money, Jobaris, Furth, 1977).  Dr. Richard Bruno of Englewood Hospital in 1997 proposed the name Factitious Disability Disorder, which he grouped into three different categories: 1) devotees – those who are sexually aroused by amputees, 2) pretenders – those who use wheelchairs, crutches and other devices that mimic a disability, and 3) wannabes – those who wanted amputation themselves (Bruno, 1997).   Suffering as a wannabe, Dr. G. Furth and R. Smith published a book on the subject in early 2000, where he introduced the term Amputee Identity Disorder.  Later in August 2000, the BBC produced a documentary titled “Complete Obsession, Body Dysmorphia” which follows Dr. Furth request to have his right leg amputation by Dr. Smith of Scotland, who had previously completed two voluntary amputations.  However, the Scottish medical authorities refused Furth’s request because of public backlash and negative attention concerning Dr. Smith’s prior indiscretions with regards to the Hippocratic oath.

In 2004, Dr. Michael First a professor of Clinical Psychiatry at Columbia University, published a paper in the journal of Psychological Medicine where he first introduced its current name, Body Integrity Identity Disorder (BIID).  In the article, he wrote about the phone interviews conducted with fifty-two people inflicted with this disorder.  First selected the name BIID to distinguish the disorder from paraphilia, psychosis and Body Dysmorphic Disorder, which he stated it more closely correlated with Gender Identity Disorder (GID, a desire for sexual reassignment surgery).

Currently attention regarding BIID has been surfacing within the scientific community. Many psychiatrists and psychologist speculate that BIID is interrelated to other Body Image Disorders, implying a psychological condition (BIID.org, 2014).  However, researchers are currently attempting to prove the reverse of phantom limb syndrome in relationship to BIID, where an abnormality in the brain is the cause (Blanke, et. al. 2009).  This raises many questions: How is Body Integrity Identity Disorder classified and what are its characteristics?  How does it develop?  What are the ethical issues regarding the treatment of BIID?  The next three posts will address such issues, while looking at possible biological and behavioral-cognitive causations of such a disorder.

References:

BIID info website. Available: http://biid-info.org/Main_Page. Accessed 2014, February 12.

Blanke O, Morgenthaler FD, Brugger P, Overney LS (2009).  Preliminary evidence for a fronto-parietal dysfunction in able-bodied participants with a desire for limb amputation.  Journal neuropsychology 3: 181-200.

Bruno, R.L. (1997). Devotees, pretenders and wannabes: Two cases of factitious disability disorder. Journal of sexuality and disability, 15, 243-260.

Ellison J (2009). Cutting desire. Newsweek (http://www.thedailybeat.com/newsweek/2008/05/08  /cutting-desire.html#sthash.gUAsfCCk.dpuf). 2009 May 05.

First MB, Pincus HA, Levine JB, Williams JB, Ustun B, Peele R (2004). Clinical utility as a criterion for revising psychiatric diagnoses. American journal of psychiatry. 2004 Jun; 161(6): 946-54. PMID 15169680

First MB (2005). Desire for Amputation of a Limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological medicine, 2005, 35:919-928. PMID 15997612

Furth, G. & Smith, R (2000). Amputee Identity Disorder: Information, Questions, answers and recommendations about self-demand amputation. 1st Books Library: London.

Marrison J (2008). ‘Butcher brown’ and the deadly doctors. The world’s most bizarre murders; true stories that will shock and amaze you. 1st ed. London, England: John Blake Publishing; 2008. pp. 121-131.

Money, J., Jobaris, R. & Furth, G. (1977). Apotemnophilia: two cases of self-demand amputation as a paraphilia. The journal of sex research, 13 (2), pp. 115-125.

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