Gender Dysphoria and Body Integrity Identity Disorder: Similarities and Differences

Endocrine care of transpeople part I. A review of cross‐sex hormonal treatments, outcomes and adverse effects in transmen

“…Gender dysphoria (GD) refers to the distress that may accompany the incongruence between this experienced dichotomy with its most extreme expression as transsexualism . The current diagnostic term may also protect persons with GD ensuring their access to care and guaranteeing that their condition will not be used against them in social, occupational or legal areas . Current diagnosis and care of transgender individuals is provided according to the Standard of Care provided by the World Professional Association for Transgender Health (WPATH), Endocrine Society guidelines, Good Practice Guidelines by Royal College of Psychiatrists and the DSM‐V .…”

“…1 The current diagnostic term may also protect persons with GD ensuring their access to care and guaranteeing that their condition will not be used against them in social, occupational or legal areas. 3 Current diagnosis and care of transgender individuals is provided according to the Standard of Care provided by the World Professional Association for Transgender Health (WPATH), 4 Endocrine Society guidelines, 5 Good Practice Guidelines by Royal College of Psychiatrists 6 and the DSM-V. 1 The final goal of medical and possibly surgical treatment is to improve the well-being and quality of life of gender dysphoric individuals.…”

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

“…The groups differed, however, in the intensity of their aversion toward the unwanted body parts, with Gender Dysphoric individuals expressing an intense rejection or hatred, whereas BID individuals exhibited an indifference toward the limb. Remarkably, in both BID and GID individuals, the examination of reality is preserved in that the discomfort sensations are “illusions, not delusions” ( Garcia-Falgueras, 2014 ; p. 161), and do not typically persist after surgical intervention ( Garcia-Falgueras, 2014 ).…”

“…Characterized by delusional misattribution of the paralyzed limb to someone else (Gerstmann, 1942;Romano and Maravita, 2019) -Right hemisphere subcortical white matter (Gandola et al, 2012;Moro et al, 2016) -Middle and inferior right frontal gyrus (Gandola et al, 2012) -Right hippocampus and amygdala (Gandola et al, 2012;Romano et al, 2014) Asomatognosia Disruption to right hemisphere influencing limb awareness Phenomenological similarities in 23% of the cases (Blanke and Metzinger, 2009) Feeling that parts of the body are missing or have disappeared from corporal awareness (Arzy et al, 2006;Saetta et al, 2021) Right temporo-parietal lobe, including the right superior parietal lobule (Saetta et al, 2021) Alien hand syndrome Disownership of the limb No traceable underlying cause for the perceived "disembodiment" of the limb (Müller, 2009) Motor control of the affected limb is disinhibited and moves non-volitionally -Primary motor cortex, premotor cortex, precuneus, and right inferior frontal gyrus (Schaefer et al, 2010) -Supplementary motor area, anterior cingulate gyrus, medial prefrontal cortex, and anterior corpus callosum (Feinberg et al, 1992) Anarchic -Anterior corpus callosum (Feinberg et al, 1992) Gender incongruity Conflict between aspects of the physical body (sex) and the desired body. Onset (early childhood or adolescence), discontent in the individual with their identity, perceived reduction of desire post-surgical intervention or through mimicking of desired identity Comorbidity of BID with GID has been described in 19% of the cases (First, 2005;Lawrence, 2010) Preserved rationality and distress disappears after surgical intervention (Garcia-Falgueras, 2014) Focus upon gender rather than upon a limb Intensity of rejection of body parts. Intense hatred in Gender incongruity vs. indifference in BID (Ostgathe et al, 2014) -Bilateral superior parietal lobule and the primary somatosensory cortex (Lin et al, 2014) -Right insula (Nawata et al, 2010) Apotemnophilia (from ancient Greek "love for amputation") proposes psychological or psychiatric features related to sexual disturbances to be the centerpiece of the disorder, whereas Xenomelia (from ancient Greek "foreign limb") put the disorder in the context of a neurological syndrome originating from alterations of the right parietal lobe (McGeoch et al, 2011).…”

Personality Dimensions and Attributional Styles in Individuals with and without Gender Dysphoria

“…Gender dysphoria is related to a marked incongruence between one's experienced/ expressed gender and his/her assigned gender, and is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning (4)(5)(6). In practice, gender dysphoria is a diagnostic term that allows individuals access to care and helps to minimize jeopardy in social, occupational, or legal areas; furthermore, gender dysphoria is distinguished from sexual orientation (7,8). Overall, contemporary studies have shown an increasing incidence of referrals for gender dysphoria diagnosis and a higher rate of psychiatric and developmental problems in those individuals with gender dysphoria (9).…”