Could Brain–Computer Interface Be a New Therapeutic Approach for Body Integrity Dysphoria?

Abstract

Patients suffering from body integrity dysphoria (BID) desire to become disabled, arising from a mismatch between the desired body and the physical body. We focus here on the most common variant, characterized by the desire for amputation of a healthy limb. In most reported cases, amputation of the rejected limb entirely alleviates the distress of the condition and engenders substantial improvement in quality of life. Since BID can lead to life-long suffering, it is essential to identify an effective form of treatment that causes the least amount of alteration to the person’s anatomical structure and functionality. Treatment methods involving medications, psychotherapy, and vestibular stimulation have proven largely ineffective. In this hypothesis article, we briefly discuss the characteristics, etiology, and current treatment options available for BID before highlighting the need for new, theory driven approaches. Drawing on recent findings relating to functional and structural brain correlates of BID, we introduce the idea of brain–computer interface (BCI)/neurofeedback approaches to target altered patterns of brain activity, promote re-ownership of the limb, and/or attenuate stress and negativity associated with the altered body representation.

Brain Abnormalities in Individuals with a Desire for a Healthy Limb Amputation: Somatosensory, Motoric or Both? A Task-Based fMRI Verdict

“…It may be worth further experimenting with a more systematic approach, with the neuromodulation of these regions. Techniques such as, for example, transcranial magnetic stimulation (TMS, see [ 72 ]) or transcranial direct current stimulation (tDCS) may be prime candidates to be exploited for the alleviation of the dysphoria associated with amputation desires or their variants.…”

Successful treatment of body integrity dysphoria with amputation: A case report

“…3 Not enough evidence and long-term efficacy studies currently exist to make surgery a first-line treatment option, but it has been considered effective for treating BID, with high satisfaction rates in reported cases. [4][5][6] Patients aren't delusional and can make their own decisions. They recognize the limb as theirs, but feel it does not align with their body schema or identity since childhood.…”

“…Amputating a healthy limb for psychological distress is uncommon 4 . The Hippocratic principle of “First, do no harm” is sometimes cited due to concerns about regret, disability, or financial burden 7 .…”

“…Patients aren't delusional and can make their own decisions. They recognize the limb as theirs, but feel it does not align with their body schema or identity since childhood 3,4,6–8 . A variety of presentations has been reported in the literature which could be categorized as cases of BID, a variant or a subset of it, or an entirely distinct entity.…”

“…Gray matter atrophy correlates with compensatory behaviors, but it's unclear if it's a cause or effect of symptom intensity 4,9 . The dysphoria‐causing region's boundaries are clear, 8 with reduced skin conductance responses under the desired amputation site 9,10 .…”