Body integrity dysphoria

Body integrity dysphoria (BID, also referred to as body integrity identity disorder, amputee identity disorder and xenomelia, formerly called apotemnophilia) is a disorder characterized by a desire to be disabled or having discomfort with being able-bodied beginning in early adolescence and resulting in harmful consequences.[1] BID appears to be related to somatoparaphrenia.[2] People with this condition may refer to themselves as "transabled".[3][4][5]

Body integrity dysphoria
SymptomsDesire to become disabled, discomfort with being able-bodied
Usual onset8–12 years old
Risk factorsKnowing an amputee as a child
TreatmentCognitive behavioral therapy

Signs and symptoms

BID is a rare, infrequently studied condition in which there is a mismatch between the mental body image and the physical body, characterized by an intense desire for amputation of a limb, usually a leg, or to become blind or deaf.[2] The person sometimes has a sense of sexual arousal connected with the desire for loss of a limb or sense.[2]

Some act out their desires, pretending they are amputees using prostheses and other tools to ease their desire to be one. Some people with BID have reported to the media or by interview over the telephone with researchers that they have resorted to self-amputation of a "superfluous" limb; for example, by allowing a train to run over it, or by damaging the limb so badly that surgeons will have to amputate it. However, the medical literature records few, if any, cases of actual self amputation.[6][7]

To the extent that generalizations can be made, people with BID appear to start to wish for amputation when they are young, between 8 and 12 years old, and often knew a person with an amputated limb when they were children; however, people with BIID tend to seek treatment only when they are much older.[7] People with BIID seem to be predominantly male, and while there is no evidence that sexual preference is relevant, there does seem to be a correlation with BIID and a person having gender dysphoria or a paraphilia; there appears to be a weak correlation with personality disorders.[7] Family psychiatric history does not appear to be relevant, there does not appear to be any strong correlation with the site of the limb or limbs that the person wishes they did not have, nor with any past trauma to the undesired limb.[7]


As of 2014 the cause was not clear and was a subject of ongoing research.[8]


As of 2014 there were no formal diagnostic criteria.[2]


As of 2014 it remained unclear whether BID is a form of human diversity or a mental disorder, similar to the development of the concept of gender dysphoria. There was debate about including it in the DSM-5 and it was not included; it was also not included in the ICD-10.[2][8] It has been included in the ICD-11, which reached a stable version in June 2018, as 'Body integrity dysphoria' with code 6C21.[1] The ethics of surgically amputating the undesired limb of a person with BID are difficult and controversial.[6][9][10]


There is no evidence-based treatment for BID; there are reports of the use of cognitive behavioral therapy and antidepressants[7]


Outcomes of treated and untreated BID are not known; there are numerous case reports that amputations permanently resolves the desire in affected individuals.[7][11]


Apotemnophilia was first described in a 1977 article by psychologists Gregg Furth and John Money as primarily sexually oriented. In 1986 Money described a similar condition he called "acromotophile", namely sexual arousal over a partner's amputation. Publications before 2004 were generally case studies.[12] The condition received public attention in the late 1990s after a Scottish surgeon, Robert Smith, amputated limbs of two people who were desperate to have this done and were otherwise healthy.[12]

In 2004 Michael First published the first clinical research in which he surveyed 52 people with the condition, a quarter of whom have had an amputation. Based on that work, First coined the term "body integrity identity disorder" to express what he saw as more of an identity disorder than a paraphilia.[8] After First's work, efforts to study BID as a neurological condition looked for possible causes in the brains of people with BID using neuroimaging and other techniques.[2][12] Research provisionally found that people with BID were more likely to want removal of a left limb than right, in accordance with damage to the right parietal lobe; in addition, skin conductance response is significantly different above and below the line of desired amputation, and the line of desired amputation remains stable over time, with the desire often beginning in early childhood.[12] This work did not completely explain the condition, and psychosexual research has been ongoing as well.[12][13][14]

See also


  1. "ICD-11 - Mortality and Morbidity Statistics". Archived from the original on 1 August 2018. Retrieved 6 July 2018.
  2. Brugger, P; Lenggenhager, B (December 2014). "The bodily self and its disorders: neurological, psychological and social aspects". Current Opinion in Neurology. 27 (6): 644–52. doi:10.1097/WCO.0000000000000151. PMID 25333602. Archived from the original on 14 January 2018. Retrieved 13 January 2018.
  3. Baril, Alexandre; Trevenen, Kathryn (14 April 2016). "Transabled women lost in translation? An introduction to: '"Extreme" transformations: (Re)Thinking solidarities among social movements through the case of voluntary disability acquisition'". Medicine Anthropology Theory. 3 (1): 136. doi:10.17157/mat.3.1.388.
  4. Shad (11 June 2015). "Desiring disability: What does it mean to be transabled?". CBC Radio. Archived from the original on 11 June 2015. Retrieved 11 June 2015.
  5. Davis, Jenny L. (1 June 2014). "Morality Work among the Transabled". Deviant Behavior. 35 (6): 433–455. doi:10.1080/01639625.2014.855103. ISSN 0163-9625.
  6. Levy, Neil (2007). Neuroethics — Challenges for the 21st Century. Cambridge University Press. pp. 3–5. ISBN 978-0-521-68726-3.
  7. Bou Khalil, R; Richa, S (December 2012). "Apotemnophilia or body integrity identity disorder: a case report review". The International Journal of Lower Extremity Wounds. 11 (4): 313–9. doi:10.1177/1534734612464714. PMID 23089967.
  8. Sedda, A; Bottini, G (2014). "Apotemnophilia, body integrity identity disorder or xenomelia? Psychiatric and neurologic etiologies face each other". Neuropsychiatric Disease and Treatment. 10: 1255–65. doi:10.2147/NDT.S53385. PMC 4094630. PMID 25045269.
  9. Costandi, Mo (30 May 2012). "The science and ethics of voluntary amputation | Mo Costandi". The Guardian. Archived from the original on 2 January 2018. Retrieved 13 January 2018.
  10. Dua, A (February 2010). "Apotemnophilia: ethical considerations of amputating a healthy limb". Journal of Medical Ethics. 36 (2): 75–8. doi:10.1136/jme.2009.031070. PMID 20133399.
  11. Blom, RM; Hennekam, RC; Denys, D (2012). "Body integrity identity disorder". PLOS ONE. 7 (4): e34702. Bibcode:2012PLoSO...734702B. doi:10.1371/journal.pone.0034702. PMC 3326051. PMID 22514657.
  12. De Preester, H (May 2013). "Merleau-Ponty's sexual schema and the sexual component of body integrity identity disorder". Medicine, Health Care and Philosophy. 16 (2): 171–84. doi:10.1007/s11019-011-9367-3. PMID 22139385.
  13. Lawrence, A. A. (2006). "Clinical and theoretical parallels between desire for limb amputation and gender identity disorder" (PDF). Archives of Sexual Behavior. 35 (3): 263–278. doi:10.1007/s10508-006-9026-6. PMID 16799838.
  14. Lawrence, A. A. (2009). "Erotic target location errors: An underappreciated paraphilic dimension". Journal of Sex Research. 46 (2–3): 194–215. doi:10.1080/00224490902747727. PMID 19308843.

Further reading

  • Davis, Jenny L. (2012). "Narrative Construction of a Ruptured Self: Stories of Transability on". Sociological Perspectives. 55 (2): 319–340. doi:10.1525/sop.2012.55.2.319. JSTOR 10.1525/sop.2012.55.2.319.
  • First, MB; Fisher, CE (2012). "Body integrity identity disorder: the persistent desire to acquire a physical disability". Psychopathology. 45 (1): 3–14. doi:10.1159/000330503. PMID 22123511.
  • Furth, Gregg M.; Smith, Robert (2000). Apotemnophilia : information, questions, answers, and recommendations about self-demand amputation (Rev. (05/15/2002). ed.). Bloomington, IN: 1stBooks. ISBN 978-1588203908.
  • Sacks, Oliver W. (1998). A Leg To Stand On. Touchstone Books. ISBN 978-0-684-85395-6.
  • Stirn, A.; Thiel, A.; Oddo, S. (2009). Body Integrity Identity Disorder: Psychological, Neurobiological, Ethical and Legal Aspects. Pabst Science Publishers. ISBN 978-3-89967-592-4.
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