Deepening the desire for disability: A commentary on Saetta et al. (2022)

Capodici, Alessandro; Rizzo, Gaetano; Vicario, Carmelo M.; Pennisi, Antonino

doi:10.1016/j.cortex.2022.06.001

Cited by 4 publications

(4 citation statements)

References 74 publications

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“…For example, pain and pain anticipation (Brang et al, 2008;Romano et al, 2015) as well as disgust responses to violations of the body envelop are differently processed (Bottini et al, 2015). There are also first indications, that interoceptive awareness as assessed via selfreport, is reduced in BID patients (Capodici et al, 2023). Together, these observations fit well to the observation of BID-related structural alterations in the insula, an area that is known to play an important role in the representation of interoceptive signals (McGeoch et al, 2011;Hilti et al, 2013).…”

Section: Body Image Distortions Across the Disorderssupporting

confidence: 58%

A conceptual framework on body representations and their relevance for mental disorders

Möllmann¹,

Heinrichs²,

Herwig³

2023

Preprint

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Many mental disorders are accompanied by distortions in the way the own body is perceived and represented (e.g., eating disorders, body dysmorphic disorder including muscle dysmorphia, or body integrity dysphoria). We are interested in the way these distortions develop and aim at better understanding their role in mental health across the lifespan. For this purpose, we first propose a conceptual framework of body representation that defines this construct and integrates different perspectives (e.g., cognitive neuroscience, clinical psychology) on body representations. The framework consists of a structural and a process model of body representation emphasizing different goals: the structural model aims to support researchers from different disciplines to structure results from studies and help collectively accumulate knowledge about body representations and their role in mental disorders. The process model is reflecting the dynamics during the information processing of body-related stimuli. It aims to serve as a motor for (experimental) study development on how distorted body representations emerge and might be changed. Second, we use this framework to review the normative development of body representations as well as the development of mental disorders that relate to body representations with the aim to further clarify the role of body representations in mental health.

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Section: Body Image Distortions Across the Disorderssupporting

confidence: 58%

A conceptual framework on body representations and their relevance for mental disorders

Möllmann¹,

Heinrichs²,

Herwig³

2023

Preprint

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“…People with BID feel that the focal pivot of desire constantly interpellates their attention and thoughts. Rather than dismissing these thoughts through distraction, many people with BID fuel body dysphoria through a series of recurrent acts [93]. Among these, it is possible to identify disability-simulation behaviors (considered by some authors to be compulsions of control in response to obsessive thoughts about desire [94]), the tendency to engage in imaginative scenarios depicting the self in the desired form of disability, and, last but not least, the time spent on the Internet sharing their experiences in thematically specific online spaces and researching information about the BID, images of disabled bodies, and medical devices.…”

Section: Discussionmentioning

confidence: 99%

Interoceptive and Affective Alterations in Body Integrity Dysphoria: An Online Self-Reporting Study

Capodici,

Pennisi,

Rizzo

et al. 2023

Psychopathology

Self Cite

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Introduction: Body integrity dysphoria (BID) is a rare condition in which individuals experience a long-lasting desire to achieve a specific physical disability. In this study, we tested the hypothesis of interoceptive and affective abnormalities in BID, in line with the evidence of structural and functional alteration of the interoceptive-affective neural system in these individuals. Method: Our study involved 68 participants with BID (mean age: 35.6, SD: 16.4). Among these participants, 47 expressed a desire for amputation, 14 desired paralysis, 3 sought sensory deprivation, and 3 desired a combination of these forms. For comparisons, we recruited a control group of 79 participants (mean age: 35.2, SD: 15.8). We administered assessment measures to investigate alexithymia level (TAS-20), disgust sensitivity (DS-R), interoceptive awareness (MAIA-2), and (affective and cognitive) empathy (QCAE). We also administered the Short Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE) to identify psychiatric comorbidities. Subgroups with low O-LIFE scores (BID = 31; controls = 43) and subgroups with high O-LIFE scores (BID = 37; controls = 36) were derived through a median-split procedure. Results: Within the BID low O-LIFE group, we found reduced interoceptive sensibility, reduced disgust sensitivity, and increased difficulty in identifying feelings, which refers to a dimension of the alexithymia trait. Within the BID high O-LIFE group, we observed a reduced disgust sensitivity and interoceptive sensibility, accompanied by a diminished score in cognitive empathy. Conclusion: Our study suggests that BID can be associated with altered interoceptive and affective processing.

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“…This alteration in emotional processing is exemplified by an excessive identification of individuals with BID’ bodily self with those of individuals with amputations in experimental settings (Ho et al, 2023; Macauda et al, 2017) or through self-reported tests (Hilti et al, 2013). It could potentially lead to an overidentification with amputated bodies (Obernolte et al, 2015), a process possibly mediated by the mirror system (Saetta et al, 2022, see also commentary by Capodici et al, 2022). Aligning with the hyperempathy hypothesis, recent studies suggest that observing amputees triggers substantial resonance in the mirror motor network among healthy individuals, particularly those with heightened empathy (Liew et al, 2013a).…”

Section: Discussionmentioning

confidence: 99%

“…This alteration in emotional processing is exemplified by an excessive identification of individuals with BID' bodily self with those of individuals with amputations in experimental settings (Ho et al, 2023;Macauda et al, 2017) or through self-reported tests (Hilti et al, 2013). It could potentially lead to an overidentification with amputated bodies (Obernolte et al, 2015), a process possibly mediated by the mirror system (Saetta et al, 2022, see also commentary by Capodici et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Feeling at Home in a Virtually Amputated Body; Neural and Phenomenological Effects of Illusory Embodiment in Body Integrity Dysphoria

Saetta,

Peter,

Ruddy

et al. 2024

Preprint

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Body Integrity Dysphoria (BID) is characterized by a profound incongruity between the physical body and a desired, i.e., amputated body, often leading to a desire for limb amputation. Virtual reality (VR) intervention and multisensory stimulation paradigms provide powerful tools to enable transient, illusory embodiment of the desired body, thus experiencing a virtual amputation. This study investigates the impact of VR on neural responses in 18 individuals with BID compared to 18 age and sex matched healthy controls. We used both task-based and resting-state MRI to assess activity when viewing images of the body in the desired versus the undesired state before and after VR, along with functional connectivity measures. In VR, participants played a game with an amputated body, which was adapted for the BID group to simulate their desired bodily shape, seen from a first-person perspective and mimicking the participant's leg movements. Compared to controls, individuals with BID demonstrated a stronger self-reported sense of ownership and control over the virtual body. Task-based fMRI results showed increased activity in the right superior parietal lobule (rSPL), right angular gyrus, and right supplementary motor area pre-VR in the BID group, which normalized post-VR. Resting-state fMRI revealed reduced connectivity in the rSPL, visuo-occipital areas, fronto-parietal, and fronto-striatal mirror and limb system networks pre-VR, also normalising post-VR. Additionally, there was a normalization in the pattern of increased connectivity of dopaminergic cortico-striatal tracts connecting the rSPL and the pars orbitalis of the right inferior frontal gyrus with the nucleus accumbens. Our findings suggest that virtual embodiment effectively modulates BID-related neural networks, potentially providing a controlled, cost-effective, and safe approach to address body dissatisfaction. They also underscore the significance of VR in unravelling the intricate relationship between the body and self, with potential implications for other psychiatric disorders of the bodily self.

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Deepening the desire for disability: A commentary on Saetta et al. (2022)

Cited by 4 publications

References 74 publications

A conceptual framework on body representations and their relevance for mental disorders

A conceptual framework on body representations and their relevance for mental disorders

Interoceptive and Affective Alterations in Body Integrity Dysphoria: An Online Self-Reporting Study

Feeling at Home in a Virtually Amputated Body; Neural and Phenomenological Effects of Illusory Embodiment in Body Integrity Dysphoria

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