BIID, a term gaining in popularity, describes the extremely rare phenomenon of individuals who desire the amputation of one or more healthy limbs or who desire a paralysis. The first person to use the term BIID was US psychiatrist Michael First, Professor of Clinical Psychiatry at Columbia University. More recently, the term used to describe apotemnophilia is body integrity image disorder (BIID) also known as Amputee Identity Disorder (AID). So what causes some individuals to desire to get rid of a completely healthy limb? Psychological Theories to Explain Desire for Amputation Body Integrity Image Disorder (BIID) Recently there has been a shift away from the long existing theory that this disorder is psychological in origin with some scientists hypothesising a neurological basis. The existence of such fantasies in individuals with apotemnophilia may explain why the patient described above by Bensler and Paauw claimed to be a world-class artist. Individuals with apotemnophilia fantasise about accomplishing great things despite having an amputation. Bensler and Paauw 3 reported the case of a patient in his 20s with apotemnophilia who presented with several conditions mimicking common medical problems and, consistent with previous cases, was secretive about his attempt to self-amputate his legs. Previous case reports have revealed that patients with apotemnophilia are fully aware that people do not approve of their desire for self-amputation. This presents as a diagnostic challenge for the health care provider because of the atypical presentation of self-inflicted injury caused by the disorder. Patients with apotemnophilia secretly harm themselves to necessitate amputation of an injured limb and commonly have a history of repeated, unexplained injuries to the same segment of the body. Even injecting the knee with liquidized fecal matter has been reported. The obsessive need for amputation can even be deadly as those who cannot afford or find a surgeon to carry out the surgery resort to mutilating themselves, for example, by shooting into a leg, sawing off a finger or toe, placing the offensive limb in the way of an oncoming train, or freezing the limb to death by packing it in ice. Recently, the number of self-demand amputations has increased with some amputations of healthy legs being performed in hospital settings 2. Individuals with desire for limb amputation often mimic amputation by bending their limbs out of view, using crutches extensively and wearing prostheses. Apotemnophilia, a disorder that blurs the boundaries between neurology and psychology, describes the rare phenomenon of individuals who desire the amputation of one or more healthy limbs or who desire a paralysis. In one study, an individual was reported as saying “I felt like I was in the wrong body that I am only complete with both my arm and leg off on the right side.” 1. However, to a small minority the idea of ‘getting rid of a limb’ is desirable. Most humans experience considerable distress when faced with the loss of a limb. In the American TV series The Walking Dead, a man cut off his shackled hand to escape from hordes of the undead. Some films have played on this fear, for example in Saw I a man was forced to cut off his own shackled foot in order to escape from death. Even worse is the idea that we would have to self-amputate in order to survive. For most people the idea of losing a limb is horrifying.
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