Body Integrity Identity Disorder

DisclaimerThis page is not here to be used as a self-diagnosis, self-identification, or promotion - it's simply here to be informational. Whether or not one self-diagnoses, self-identifies, and/or seeks a professional diagnosis is up to them.Body ImageThe following page includes discussions of body image, including starving oneself, binging and purging, exaggerated self-analysis, and body dysphoria. If you are uncomfortable or get triggered by this topic, it is recommended to not read this page.

**Body Integrity Identity Disorder (BIID)** describes a phenomenon in which an individual desires the amputation of one or more healthy limbs or who desires paralysis. This desire is presumably from experiencing a mismatch between one's perceived mental image of the body and the physical structure and/or functional boundaries of the body. This causes those experiencing it to believe that a part of their body does not actually belong to them.

This is not a paraphilic disorder or paraphilia, though it was once considered to be, there is no sexual motivation for the desire to have a limb amputated.

Some doctors are working to add BIID to the DSM, but others are unsure. Those that argue for its inclusion say that it may lead to further research and possibly lead to further treatment options.

## Causes

The causes of BIID are not well understood. Some speculate early childhood trauma, obsessive-compulsive tendencies, or an over-identification with amputees may contribute to the development of BIID. BIID is not caused by actual physical injuries to the limb, and it is not a paraphilia.

A major theory among psychologists and neurologists is that BIID occurs when the brain has not mapped the body correctly. Individuals with BIID often report a childhood awareness of the condition. Some researchers consider BIID to be a result of the circumstances originally leading to the brain's incorrect mapping of the body, rather than one single condition.

## Treatment

Treatments such as cognitive behavioral therapy and selective serotonin reuptake inhibitors can often reduce the distress and depression associated with BIID, and some find that treating the symptoms exhibited by those with obsessions and compulsions can reduce symptoms.

In one study, two patients with BIID underwent an augmented reality-based simulation that virtually amputated their alienated limbs. During this experiencing, both individuals reported reductions in BIID-related complaints.

Most surgeons will not perform a medically unnecessary amputation.

Some individuals are able to alleviate their desires to some degree, often using canes and prosthetics to simulate an amputated limb, others may attempt self-amputation or damage the limb they wish to remove until amputation becomes necessary.

Amputation has shown to have a 70% success rate of resolving symptoms of BIID. When surgeons do agree to amputation, they do not do so until other treatments have failed.

## References

Müller S. Body integrity identity disorder (BIID)--is the amputation of healthy limbs ethically justified? Am J Bioeth. 2009 Jan;9(1):36-43. doi: 10.1080/15265160802588194. PMID: 19132621.

Turbyne C, Koning P, Zantvoord J, Denys D. Body integrity identity disorder using augmented reality: a symptom reduction study. BMJ Case Rep. 2021 Jan 11;14(1):e238554. doi: 10.1136/bcr-2020-238554. PMID: 33431465; PMCID: PMC7802686.

https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00015/full

https://www.goodtherapy.org/blog/psychpedia/biid