Amputee identity disorder and related paraphilias

## Abstract

Amputee identity disorder (AID) is a condition characterized by an intense desire to be an amputee and a feeling of incompleteness with a full complement of limbs. Sufferers are sometimes driven to seek surgery to remove the unwanted limb(s), although there is an understandable reluctance among clinicians to accede to such demands, and patients may resort to self-injury if surgical treatment is not available. The current management of patients depends on accurate identification of the underlying problem and supportive psychiatric and psychological care. Patients may present with apparent accidental injury and demand amputation. Those who have achieved traumatic amputation may refuse
reattachment surgery. Although it is contrary to the normal response of the medical carers it is probably wiser to accede to the patient's request provided a definitive diagnosis of AID has been made. AID appears to be very similar in development, progress and response to treatment as gender identity disorder and could possibly be included in the same diagnostic category.

## Analysis

This article targets solely on those of us requiring amputations, doing away with anyone else, except in a short footnot, as an after thought.

> Some patients seek treatment for associated psychiatric conditions but do not discuss the AID problem with their therapist, either because they are too ashamed of their feelings or because they feel the therapist will have no understanding of those feelings.
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It is with reason that we feel that therapists or other medical professionals will not understand the BIID feelings. Person after person reporting their experiences with therapy reports that their therapist did not get it, or did not want to get it. In the cases where therapists are friendly to the concept, they tend to need to be educated about the condition to start with.

> AID appears to develop in the early years, usually between the ages of 5 and 15. Most sufferers have a well-formed impression of their desired body image by the time they reach their teens.
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Often well before puberty/sexuality develops.

> In assessing AID patients it is important to eliminate other potential reasons to seek amputation. Stewart and Lowrie (1980) believe that self-mutilation, including amputation, chiefly occurs in five distinct groups of patients:
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> * transsexuals, who usually mutilate only the genitals in order to assume the physical appearance of the opposite sex
> * schizophrenics who may self-mutilate in response to voices ordering them to do so or in response to a delusional belief that the body part is defective or 'bad'
> * patients with a personality disorder, who appear to mutilate to relieve tension or gain secondary advancement
> * confused patients, who may injure themselves due to disinhibition, poor judgement or perceptual difficulties
> * depressed patients, who may mutilate themselves in a failedsuicide attempt or as atonement for perceived sins.
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> Other groups of patients who may seek amputation include those with factitious disorder (Munchausen’s syndrome) and body dysmorphic disorder (BDD). Those with BDD perceive the limb as being defective in some way, in contrast to patients with AID who see the limb as being normal but extra to their perceived body image. It seems that AID patients are similar to those transsexuals who amputate their genitalia in order to achieve their desired body image.
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There are many reasons why individuals may seek amputation, paraplegia or other impairments, not all related to BIID. It is important to make the distinction between those who do have BIID and those who do not.

Of note here is that Dr. Smith clearly outlines that BIID is not related to neither Munchausen nor BDD.

> Antidepressants (including selective serotonin reuptake inhibitors, SSRIs), psychotherapy, cognitive–behavioural therapy (CBT), hypnotherapy and electroconvulsive therapy (ECT) have all been tried with limited success.
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Therapy and medication just plain does not work.

> AID is a condition that appears never to be resolved by non-surgical therapy and the symptoms can only be suppressed.
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The only way to resolve this fully is through surgery or self-injury.

> Many sufferers have resorted to self-injury to achieve amputation: methods have included the use of chainsaws, shotguns, train wheels, a home-made guillotine and cold injury with dry ice (solid CO2). Clearly these are dangerous activities and a number of patients have died as a result.
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We are desperate and if the medical community does not assist us, we will be forced to cause more damage than necessary.

Interestingly, those of us requiring amputations have a wider range of "solutions" for self-injury, which are not necessarily available to those of us requiring spinal cord injuries.

> The follow-up of these patients is clearly short, but all patients seem to be satisfied with the results. They feel 'enabled', their all-consuming desire is resolved, and they find they are leading more stable and more productive lives.
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So people who have become amputees report being happier after the fact! Surgery does work.

> An interesting additional point is that most are no longer interested in associating with or communicating with the 'wannabe' or 'needtobe' communities.
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It's one of the things that we find frustrating, most "realised wannabes" disappear and it's hard to get consistent feedback and proof that surgery works.

> The deliberate mutilation by amputation appears to run contrary to the stricture that doctors should first do no harm. However, it may be more harmful to refuse operation in patients at risk of self-injury.
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A doctor recognises that the "do no harm" idea is not as straightforward as first appearance would suggest.

> The extensive and adverse publicity associated with the release of details about the patients on whom the current author operated has made surgeons and institutions wary of any involvement.
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And here is a clear statement that one of the major block to surgery is negative publicity, and the media! What a piss poor excuse to withhold medical treatment from people.

> There is no long-term follow-up studies of patients who have succeeded in achieving amputation. The only long-term evidence is from self-injured amputees who certainly seem to have long-term successful outcomes.
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Ah, yes, this is an argument often heard. It doesn't stand to reason though. "We can't offer you surgery because there's no proof that surgery works." How can anyone be expected to prove surgery works if they aren't going to do surgery to prove (or disprove) it works?

Someone must offer such a study. I'm sure there would be no shortage of participants.

> We do not know how the patient’s quality of life with an amputation will be as they grow older and have increasing problems with mobility and cardiorespiratory reserve.
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OTOH, there are multiple studies showing that the medical community has an erroneous perception of quality of life post-impairement, especially several years post injury.

> At present, it is unlikely that surgical treatment will be carried out until formal approval of a research project has been obtained.
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And such a research project is highly unlikely because of previously stated medical bias against impairment, (wrongly placed) ethical concerns, fears of public backlash, etc.