Body Integrity Identity Disorder

Blom, Rianne M.; Hennekam, Raoul C. M.; Denys, Damiaan

doi:10.1371/journal.pone.0034702

Cited by 93 publications

(133 citation statements)

References 25 publications

(45 reference statements)

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“…It might be difficult, however, to recruit enough subjects with a right leg amputation desire due to the preponderance of the left leg as the amputation target. Third, we investigated men only; again, given the rarity of the condition and the fact that an overwhelming majority of persons affected are male (only about 10% of people affected are female; Blom, Hennekam, & Denys, 2012) this gender bias may be excused. Fourth, although we tested the networks across a range of set thresholds and corrected each single threshold for multiple comparisons, we did not additionally adjust the alpha error probability for the number of set thresholds tested.…”

Section: Discussionmentioning

confidence: 99%

Structural and functional hyperconnectivity within the sensorimotor system in xenomelia

et al. 2017

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IntroductionXenomelia is a rare condition characterized by the persistent and compulsive desire for the amputation of one or more physically healthy limbs. We highlight the neurological underpinnings of xenomelia by assessing structural and functional connectivity by means of whole‐brain connectome and network analyses of regions previously implicated in empirical research in this condition.MethodsWe compared structural and functional connectivity between 13 xenomelic men with matched controls using diffusion tensor imaging combined with fiber tractography and resting state functional magnetic resonance imaging. Altered connectivity in xenomelia within the sensorimotor system has been predicted.ResultsWe found subnetworks showing structural and functional hyperconnectivity in xenomelia compared with controls. These subnetworks were lateralized to the right hemisphere and mainly comprised by nodes belonging to the sensorimotor system. In the connectome analyses, the paracentral lobule, supplementary motor area, postcentral gyrus, basal ganglia, and the cerebellum were hyperconnected to each other, whereas in the xenomelia‐specific network analyses, hyperconnected nodes have been found in the superior parietal lobule, primary and secondary somatosensory cortex, premotor cortex, basal ganglia, thalamus, and insula.ConclusionsOur study provides empirical evidence of structural and functional hyperconnectivity within the sensorimotor system including those regions that are core for the reconstruction of a coherent body image. Aberrant connectivity is a common response to focal neurological damage. As exemplified here, it may affect different brain regions differentially. Due to the small sample size, our findings must be interpreted cautiously and future studies are needed to elucidate potential associations between hyperconnectivity and limb disownership reported in xenomelia.

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Section: Discussionmentioning

confidence: 99%

Structural and functional hyperconnectivity within the sensorimotor system in xenomelia

et al. 2017

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“…28 The prevalence of non-heterosexuality among persons with disability desires is controversial (panel 2, table 1); in the largest surveys to date it was found to be 38% (n=52), 1 33% (n=72), 17 and 44·5% (n=54). 8 This is well above the prevalence in the population at large (approx. 2%), 29 but the reasons for the association between disability desires and sexual orientation are unknown.…”

Section: Prevalence and Demographicsmentioning

confidence: 88%

“…More recent surveys produce similar figures; one study recruited 54 persons with a disability desire on the Internet and found the percentage of persons reporting "specific sexual desires" when imagining a disabled state was 90·7%. 8 Even in the desire for hearing loss, the power of the "ear-otic" dimension was emphasized. 28,p.366 In a planned study of the brain morphometric correlates of disability desires we intended to recruit participants with an exclusively asexually based amputation desire, but the recruitment via the Internet revealed comparable ratings of the strengths of sexually neutral versus sexually arousing components of an individual's desires.…”

Section: Proposed Diagnostic Criteria and Differential Diagnosismentioning

confidence: 99%

Limb amputation and other disability desires as a medical condition

Brugger

Christen

Jellestad

et al. 2016

The Lancet Psychiatry

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Some people have a profound dissatisfaction with what is considered an able-bodied state by most others. These individuals desire to be disabled, by conventional standards. In this Review, we integrate research findings about the desire for a major limb amputation or paralysis (xenomelia). Neuropsychological and neuroimaging explorations of xenomelia show functional and structural abnormalities in predominantly right hemisphere cortical circuits of higher-order bodily representation, including affective and sexual aspects of corporeal awareness. These neural underpinnings of xenomelia do not necessarily imply a neurological cause, and a full understanding of the condition requires consideration of the interface between neural and social contributions to the bodily self and the concept of disability. Irrespective of cause, disability desires are accompanied by a disabling bodily dysphoria, in many respects similar to gender dysphoria, and we suggest that they should be considered a mental disorder. SummaryThere are persons who suffer from a profound dissatisfaction with what is considered an ablebodied state by most others. They desire to be "dis-abled" by conventional standards. We integrate recent research findings on the desire for a major limb amputation or paralysis ("xenomelia"). Neuropsychological and neuroimaging explorations of xenomelia revealed functional and structural abnormalities in predominantly right hemisphere cortical circuits of higher-order bodily representation, including affective and sexual aspects of corporeal awareness. These neural underpinnings of xenomelia do not necessarily imply a neurological etiology, and a full understanding of the condition requires consideration of the interface between neural and social contributions to the bodily self and the concept of (dis)ability. Irrespective of etiology, disability desires are accompanied by a disabling bodily dysphoria, in many respects similar to gender dysphoria, and deserve to be considered a mental disorder.3 IntroductionThis review integrates recent research findings concerning a condition that is not yet recognized as a mental disorder, which is still in search of a generally accepted medical label and whose conceptual basis is still "under construction". The condition involves a person's dissatisfaction with an able-bodied state. It is referred to as "body integrity identity disorder" (BIID) in the psychiatric literature, "xenomelia" in neurologically oriented studies, and "transability" ("transableism") in approaches to disability from a primarily sociological perspective (table 1, appendix and figure 1, appendix, for the terminology). In this review we use the term "disability desires" to remain descriptive and avoid controversial concepts of identity and too narrow notions of focal brain damage. Although deafness, blindness or the status of a eunuch can be the target of disability desires, the focus of our review is on the desire for limb amputation or paraplegia. These forms of profound bodily modification are the...

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“…Body integrity identity disorder is characterized by a desire to obtain what most would consider a physical disability, often in the form of limb amputation [1][2][3][4][5][6]. This desire is primarily motivated by a disparity between the individual's biological bodily configuration and their subjective experience of how their body is 'supposed' to be, despite sustained awareness of the biological integrity of their own body.…”

Section: Introductionmentioning

confidence: 99%

“…Concordance amongst these studies suggests that body integrity identity disorder most frequently afflicts males, and typically involves a desire to amputate the leg above the knee [1,5,6]. Individuals report a strong preoccupation with their symptoms and there is often comorbidity, including depression and anxiety [1,2,3,5,7].…”

Section: Introductionmentioning

confidence: 99%

A Neurocognitive Assessment of a Patient with Body Integrity Identity Disorder

Sumner¹,

Castle²,

Kaplan³

et al. 2015

Int J Clin Case Stud

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Objective: Body integrity identity disorder is characterized by a desire to obtain a physical disability, often in the form of amputation. To date, we are aware of no comprehensive investigations of neurocognition in body integrity identity disorder. Method: We report a comprehensive neurocognitive workup of an individual (Mr A), who presented with a longstanding and intense desire to amputate his left leg. Results: In comparison to four demographically matched healthy controls, Mr A exhibited impairment in working memory, with some evidence of additional difficulties with long-term memory. Conclusions: His neurocognitive weaknesses are inline with altered functioning within the superior parietal lobule, which has been implicated in the pathophysiology of body integrity identity disorder.

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Body Integrity Identity Disorder

Cited by 93 publications

References 25 publications

Structural and functional hyperconnectivity within the sensorimotor system in xenomelia

Structural and functional hyperconnectivity within the sensorimotor system in xenomelia

Limb amputation and other disability desires as a medical condition

A Neurocognitive Assessment of a Patient with Body Integrity Identity Disorder

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