Body Integrity Identity Disorder (BIID) | Apotemnophilia

Body Integrity Identity Disorder

Body Integrity Identity Disorder (BIID) is a highly secretive and rare condition in which the mental image of the body does not correspond with the physical image. A major limb is frequently amputated or the spinal cord is severed in BIID patients in order to become paralyzed. The study aims to describe all those involved with BIID so that medical professionals have a better understanding of the disease.

The questionnaire was used to collect data on 54 BIID patients’ somatic, psychiatric, and BIID characteristic data. Afterward, we evaluated data of different subtypes of Body Integrity Identity Disorder BIID (i.e. wishing to be amputated or paralyzed). We also compared the impact of BIID on work, social and family life in subjects who had and did not have an amputation.

Everyone is wired a little differently. Some are able to easily cope and adapt to the various challenges life offers, while others face mental health issues that make it difficult to fully live out their lives. Mental health issues are more common than you think. In fact, the National Institute of Mental Health notes that one in five American adults suffers from a mental health issue. Depression, anxiety, and post-traumatic stress disorder (PTSD) are some of the more popular mental health issues that trouble today’s population.

In this post, let’s put the spotlight on a lesser-known mental health condition: body integrity identity disorder.

What is body integrity identity disorder?

Body integrity identity disorder is an extremely rare mental health condition. It is also known as body integrity dysphoria or apotemnophilia. Those who suffer from it strongly desire to cut off their healthy limbs because their physical image does not correspond to how they view themselves. With regards to this, patients who have body integrity identity disorder may seek to amputate their body parts. Failing to fulfill their desire to cut off their healthy body parts can cause significant distress to the patients and further degrade their mental health.

Clinical variables are not different between amputation and paralysis. The effects of surgery were considered to be helpful in all amputation subjects and these subjects are significantly less disabled than BIID subjects without body modification.

Body Integrity Identity Disorder (BIID) is a rare disorder in which individuals feel intensely compelled to either be paralyzed or have one or more of their healthy limbs amputated. It should be noted that BIID is not a paraphilia nor does the desire to amputation the limb indicate psychosis. Rather, BIID is considered to be an identity disorder.

This mismatch between actual and perceived body schema is believed to be the main reason for the preferred body modification. BIID is similar to somatoparphrenia, which occurs after a stroke or a brain tumor damages the right parietal lobe. BIID appears to be a congenital disorder due to the similarity and the early onset.

There is no classification of BIID in the Diagnostic and Statistical Manual of Mental Disorders-IV or the International Statistical Classification of Diseases 11. Therefore, many psychiatrists, neurologists and surgeons haven’t heard of this disorder. The issue is further aggravated by BIIDs’ tendency to avoid healthcare and act out their desires, such as pretending they are disabled or making themselves limbless.

BIID is almost exclusively described from the perspective of the desire for amputation in previous research. Internet-based forums have also reported people describing themselves as having BIID although they do not wish to become amputation-dependent.

Many researchers have therefore suggested that the term BIID should be widened in order to refer to people who have a persistent desire to acquire a physical disability. This other variant of BIID has not been explored so far.

A detailed questionnaire will be administered to a group of BIID individuals in order to provide a detailed phenomenology of BIID. We aim to broaden healthcare professionals’ knowledge of BIID since there is a limited number of studies on BIID. We do this by describing all BIID practitioners and determining whether BIID variants exhibit significant differences.

Read: Split-Brain Syndrome

How does BIID affect your health?

Early childhood is the most common time for body integrity identity disorder to develop. You feel satisfied or complete by altering your body as a result of this condition. 

When something is wrong with your body, you can experience depression and mood disorders. BIID also takes a toll on your mental health because of its stressful and emotional nature. 

Research suggests that BIID could be a congenital disorder, and it is considered an identity disorder.

The desire to be one’s “true self” often leads to amputations and disabilities as ways to feel complete. In recent years, some psychological and neurological factors have been linked to this feeling. Transsexualism and gender identity disorder have many similarities with BIID. 

Dysphoria is often associated with BIID, causing people to feel like they aren’t being treated properly. It is not uncommon for people with BIID to disfigure themselves or perform amputations in severe cases without medical assistance. 

A person with BIID may turn to self-mutilation if they cannot find the proper treatment for their obsessive need to amputate a limb. 

You may notice that someone with BIID is repeatedly injuring the same body part. 


Sophocles reports that Oedipus the King killed his father and had sex with his mother. Oedipus learned that he had committed patricide and incest years after having committed it – initially unaware that his father was his father and his mother was his mother. Oedipus struck out his own eyes after discovering what he had done. Oedipus blinded himself out of guilt and was an allegory for the atrocious acts he committed.  

Ancient Greeks probably would have been unable to comprehend how someone could blind themselves without a tragic reason on the order of Oedipus’s crimes. However, there are several people in modern society who demonstrate “ownership” issues over certain body parts and display an obsessive desire for disability. BIID is a condition that causes them to demand surgeries that often result in amputations, vision loss, hearing loss, or paralysis.  

Most surgeons do not like to intervene with organs or limbs without disease, as you may have guessed. A radical surgical approach is advocated by some doctors for BIID because it is a complex problem.

Read: False Memory Disorder

BIID Examined

French surgeons forced a man’s healthy limb to be amputated at gunpoint in the late 1700s. The patient sent a letter of appreciation and payment to the surgeon after the surgery, thanking the doctor for making him feel better.

Two patients with apparently normal limbs were amputated by a Scottish surgeon named Robert Smith in 2000. Smith was prohibited from performing amputations after the CEO of Smith’s hospital discovered what Smith had done. In the aftermath of these amputations, a debate over healthy amputations and other debilitating surgeries became hotly debated.

An American woman named Jewel Shuping was reported to have poured drain cleaner into her eyes in 2015 in an attempt to realize her lifelong dream of being blind. It is fair to say that Shuping’s claims are disputable; however, reports of this assisted blinding again bring attention to BIID.

In BIID, patients feel that a body part, like an eye or a limb, is “overcomplete” and alienating. There is significant psychic suffering and trauma associated with these feelings.

There is no clear cause for BIID. Body identity disorders can sometimes be traced back to definitive pathologies such as brain tumors. In most cases of BIID, the cause or etiology is not well understood.

Brain changes associated with BIID have been observed in individuals with the disease. It appears that the parietal cortex, premotor cortex, and insula are involved in this process. This brain region may lead to BIID or may appear as a result of BIID, but it’s unclear. 

Read: Capgras Syndrome

What are the symptoms of body integrity identity disorder?

Aside from the overwhelming feeling of wanting to have healthy limbs cut off, patients who have body integrity identity disorder may also exhibit stress, mood disorders, anxiety, and depression. Many actually compare body integrity identity disorder with body dysmorphia, which is a condition where patients constantly view their bodies in a negative life, which subsequently hampers their quality of life.

However, in body integrity identity disorder, patients negatively view their completely healthy bodies and take the extra step of either mutilating themselves or asking surgeons to amputate their limbs or induce paralysis.

What causes body integrity identity disorder?

The cause for body integrity identity disorder is still unknown. Scientists think that this mental illness is caused by several factors such as sexual arousal, early childhood trauma, obsessive-compulsive tendencies, or identifying too much with amputees.

Read: Confabulation

Treatment of BIID

It’s difficult to treat apotemnophilia if you don’t understand what causes it. Psychotherapy and antidepressants don’t help much. Additionally, heavier psychotropics like antipsychotics have not yet been tested with this patient population.

People with apotemnophilia, who wish to have their legs amputated, report improved quality of life after the procedure. It’s worth noting that Robert Smith, the Scottish surgeon who performed the surgery, noted that the two people who had surgery felt exceptionally better afterward and went on to live happily afterward.

Living with a disability is common among people with BIID. These people are labeled “pretenders.” The temporary relief they experience as a result of pretending to live with a disability is similar to that which people who suffer from obsessive-compulsive disorder experience after engaging in a compulsion.

The prospect of performing radical surgery to treat apotemnophilia usually alarms surgeons who encounter the disease. They cite mental illness and limited insight as reasons why an individual who would like to amputate a “healthy” limb can’t give informed consent.

BIID is not psychotic and doesn’t result in delusions. Additionally, people with BIID may experience depression as a result of their illness. This is more likely to be a consequence than a cause.

Author Amy White claims that after a comprehensive screening process, patients with BIID might be eligible for radical surgery if they were diagnosed with a BIID – “Body Integrity Identity Disorder Beyond Amputation: Consent and Liberty.”

In addition to BIID being compared to gender dysphoria, BIID patients undergo radical surgical re-assignment like those undergoing sexual reassignment surgery. Specific to both gender dysphoria and BIID is that the sufferer feels trapped in the wrong body and wants surgery to fix this issue.

As a counterpoint, in “Body Integrity Disorder–Is Amputation of Healthy Limbs Justified?” author Sabina Müller suggests that people who undergo radical surgery for BIID will not be able to work for the rest of their lives and will require rehabilitation and lifetime care.  

Muller is also not sure whether people with BIID who request radical surgery have a good understanding of their illness. He suggests other treatments.

Read: Motor Disorders

How to help someone with body integrity identity disorder

Helping someone with this rare condition is extremely challenging as their inability to correspond with their self-perceived identity can cause feelings of anguish and severe mental distress. In addition, an article on The Lancet suggests that body integrity identity disorder is not recognized in diagnostic manuals as a psychiatric disorder.

Despite this, it’s still important that you encourage a loved one to see a mental health professional to help them with their ordeal. Thankfully, symptoms of body integrity identity disorder such as depression and anxiety are considered as mental illnesses and are covered by most insurance providers. A loved one who is over the age of 65 can also use Medicare to cover the costs of this specific mental health issue.

KelseyCare Advantage states that Medicare Part B covers outpatient mental health services, as well as diagnostic assessments and psychiatric evaluation. With the help of a mental health professional, those who suffer from body integrity identity disorder may be put on various treatment schemes, which may include psychotherapy, SSRIs, vestibular caloric stimulation, cognitive behavioral therapy, and mindfulness techniques.

However, the success rate for available treatment options varies, and a study from the University of Manchester points out that the only method that has been able to produce a continuous therapeutic effect for body integrity identity disorder patients is acquiescing to their request for limb amputation.

Body integrity identity disorder might be an extremely rare mental health disorder, but it still pays to learn about it and how it can possibly be treated. Hopefully in the future, advances in science can figure out what specifically causes this disorder and how to safely treat those who suffer from it. To learn more about other mental health disorders, be sure to read our other posts here on Depressionals.

Read: Hysteria Disorder

To summarize

There is a strong likelihood that BIID is a neurological disturbance that involves hypoawareness of the illness and a lack of autonomy. The best way to integrate the alien limb into the body image is to develop a causal therapy rather than treating the symptom at the expense of irreversible physical damage.

I suspect it will be a long time before we figure out how to exactly help people with BIID. Because BIID is a rare condition, research into it has low power. We know a great deal about BIID from anecdotes. It’s also likely that BIID involves complex neurophysiological processes that have yet to be explained; the brain is, after all, inexplicably complex. The third problem is that radical surgery for BIID is dogged by ethical considerations which further confuse our understanding and appreciation of treatment.