Body integrity identity disorder-characteristics and neural correlates

Abstract

Body Integrity Identity Disorder (BIID) describes a pathology which is associated with an overwhelming wish of amputation of one or more healthy body parts. Originally the disease was indicated as “Apotemnophilia”, afterwards as “Amputee-Identity-Disorder”. Patients feel an incompleteness of their body identity. Only the amputation is perceived as solution for the conflict. The wish of amputation often exists since their childhood or adolescence. The persistent wish for amputation is very incriminating for the patients, embarrassing and can have devastating consequences like self-amputation. Little is known about the aetiology and pathogenesis. In the very few described single-cases neither psychotherapy nor psychotropics were efficient.To gain new insights into the aetiology and neural mechanisms of the BIID pathology, we arranged a complex psychometric examination, clinical interviews and functional magnetic resonance imaging (fMRI) measurements with male BIID patients and healthy subjects as control group. In the fMRI- Scanner patients looked to manipulated pictures of themselves, in which they are shown in the actual, real state and the desired state with one/both arms or legs amputated and with prosthesis. The psychometric examination contained different screening instruments for depression, personality, patterns of relationship, attachment etc.Results of our first patient showed that he had superior intelligence, good social abilities, a challenging employment and a longtime relationship. He was inconspicuous in all psychometric measurements.The neuroimaging findings of all patients are evaluated and interpreted in the context of biography and personality features. Our study furnishes new insights into characteristics, brain activity and possible therapeutic implications.

Body Integrity Identity Disorder – a Systematic Record of the Strategies to Reduce the Strain

“…The wish for an amputation can change from one to another body side over the time [8,11,12,22]. Besides the desire for losing a specific limb there exist also wishes for other kinds of disabilities such as loosing senses or becoming paraplegic [9,22]. BIID patients are aware of the absurdity of their desire.…”

“…For example would the loss of the right leg cause problems by driving a car so that the amputation of the left leg is preferred [6,8]. The wish for an amputation can change from one to another body side over the time [8,11,12,22]. Besides the desire for losing a specific limb there exist also wishes for other kinds of disabilities such as loosing senses or becoming paraplegic [9,22].…”

“…People with BIID describe the feeling that specific body parts do not belong to the own self [8,9,22]. Concerned persons cannot identify their selves with their intact body and strive for a condition that is being frightened by most of the people -they wish for a physical disability [8,9,21,22]. The desire for an amputation mostly concerns the left leg, although principally each and every body part can be affected [2,6,9,12].…”

“…Some concerned people imitate the wished physical condition with a behavior called "pretending". Pretenders are tying high one leg or they are using crutches or a wheelchair for coming closer to the felt inner body image [3,9,10,12,16,22].…”

“…BIID patients are aware of the absurdity of their desire. They know that their wish is not "normal", they are ashamed for their thoughts and therefore they often live alone with this deep desire [8,9,22]. The wish for disability is experienced as an imposing thought, which is present in most everyday life situation [10,22].…”