Treatment Approach for BIID

by markryanmayo

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There is currently no known treatment for Body Integrity Identity Disorder (BIID).  Unlike most, this disorder goes medically unrecognized by many doctors and psychotherapists, thus there is no presently known protocol for treatment.  In a study conducted in 2012, only forty percent of health care professionals were able to correctly identify and diagnose BIID (Khalil & Richa, 2012).  Consequently, the medical community often handles those with BIID inappropriately.  Therefore, sufferers often go untreated, and in addition, sufferers fear hospitalization due to the ethical code of conduct in regards to reporting a self-harming desire (APA.org, 2010).  Due to this institutional inaction, treatment becomes self-administered, while suffering in silence, those with BIID self seek alternative ways to cope with their distress.   This self-treatment (i.e., self-medication) forms a maladaptive coping mechanism, that seeks to lessen the symptoms of depression and anxiety, which is caused by the shame that is experienced when a desire for self-amputation is greatly stigmatized by others (First, 2005).

There have been no systematic studies concerning medication when treating Body Integrity Identity Disorder and its underlying symptoms.  However, a number of medications have been tried, which include those used in the treatment for depression, Obsessive-Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), and psychosis (BIID.org, 2012).   With similarities between BIID and Obsessive-Compulsive Disorder (i.e., repetitive and intrusive thoughts), treatment with medication are used to alleviate the symptoms of OCD, which are namely selective serotonin reuptake inhibitors (such as Prozac, Paxil, Zoloft, Luvox, Celexa, and Lexapro) would make sense, but the effectiveness of such medications to treat BIID is unknown (Jenike, 2012).   In First’s (2005) survey of fifty-two patients with a desire for amputation, sixteen reported having taken one of these medications, however none reported any decrease in their desire for amputation.  According to Jenike (2012) the combination of medication in conjunction with Cognitive Behavioral Therapy (CBT), which involves retraining thought patterns and routines, can reduce the obsessive-compulsive component and diminish the need for self-amputation.

Other medications considered helpful, include second generation antipsychotics, such as Risperidal, Seroquel, and Abilify (Blom, et al, 2012).  These medications have been known to be helpful with symptoms of OCD and Major Depressive Disorder.   Although individuals with BIID are not psychotic, these medications appear to be helpful in treating a number of conditions (i.e., Bipolar Disorder, treatment-resistant depression, and Schizophrenia), which can reduce BIID symptoms such as agitation, anxiety, and aggression (First, 2005).  However, there is only one reported case, where a sufferer took Risperidal and showed significant improvements in the desire for amputation (Khalil & Richa, 2012).  It is also worth noting, that positive correlation between BIID and ADHD is hypothesized (Berger, Lehrmann, Larson, Alverno, Tsao, 2005), because of the impulsivity that is involved with self-amputation.  This suggests that treating the ADHD symptoms would results in a secondary improvement in the BIID sufferer.  However, in research conducted by First, he found no known relationship between ADHD and BIID (First, 2005).

Such medications can be beneficial in the changes of mood and improve the quality of life for a BIID sufferer.  Conversely, those who have had psychotherapy and or have used medication(s) reported no change in the desire for amputation (Khalil et al., 2012).  A common form of treatment used by psychotherapists is referred to as “pretend-therapy”.  BIID sufferers are encouraged to function as if the limb was no longer there, this is used as outlet to release frustrations and reduce anxiety.  The idea behind this method of treatment is to offer an alternative to amputation, by having the sufferer experience the disability as near as possible (Khalil et al., 2012).  This type of exposure therapy is used to give insight into the anticipated change, in hope that a new perspective regarding a concept of wholeness will take place.  Nonetheless, most sufferers reported that pretending only leads to further frustration, because it simply reinforced the desire and anxiety for limb removal (Blom, et al, 2012).   Blom’s report revealed that only those who had amputation reported a feeling of wholeness without regret.

While the medical community’s awareness of this disorder is not common place, a greater understanding and dialogue is needed so effective treatment can be developed to prevent these sufferers from inflicting self-harm at the risk of death.  Next to surgery, there is no effective management strategy at present that acknowledges and respects the desires of BIID sufferers. 

References:

APA.org, (2013). Ethical principles of psychologists and code of conduct including 2010 amendments.  American Psychological Associations.  Available: http://www.apa.org/ethics/code/index.aspx. Accessed 2014, April 10.

Berger, B. D.,  Lehrmann, J. A., Larson, G., Alverno, L., Tsao, C. (2005).  Nonpsychotic, nonparaphilic, self-amputation and the internet.  Comprehensive psychiatry 46(5). 350-383. doi:10/016/j.comppsych.2004.12.0003.

BIID.org (2012). Available: http://biid-info.org/Main_Page. Accessed 2014, February 12.

Blom, R. M., Denys, D., Hennekam, R. C., (2012).  Body integrity identity disorder.  PloS One, 7(4): e34702. doi:10.1371/journal.pone.00034702.

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

Khalil, B. R., Richa, S. (2012).  Apotemnophilia or body integrity identity disorder: A case report review.  The International Journal of Lower Extremity Wounds, 1-7.

Jenike, M., (2012).  Medication for obsessive compulsive disorder. International OCD Foundation.  Available: http://www.ocfoundation.org/MedSummary.aspx.  Accessed 2014, April 9.

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