Body Integrity Identity Disorder

Body integrity identity disorder is one of the most surprising conditions. In fact, it causes the sufferer to endanger their health. In this article, we explain its characteristics, implications, and the most frequent types of intervention.

Written and verified by the psychologist Elena Sanz.

Last update: 13 December, 2023

The thought of losing one of your limbs or a functional part of your body is usually terrifying. However, a psychiatric disorder exists that’s characterized by this bizarre desire, which can become an obsession. It’s known as body integrity identity disorder.

Imagine a person pouring corrosive substances into their eyes to blind themselves, or deliberately mutilating their arms or legs to get rid of them. These dramatically striking and seemingly meaningless actions are motivated by intense psychological processes that we explain below.

Body integrity identity disorder

Body integrity identity disorder (BIID) is considered to be an identity disorder. It can be traced in the ICD-11, one of the main diagnostic manuals of psychiatry and psychology. On the other hand, it’s included in clinical literature and its presence is notable both in the healthcare and scientific fields.

Throughout history, different experts have made proposals and contributions to the universal understanding of this disorder. It’s been called apotemnophilia (love for amputation), factitious disability disorder, and amputee identity disorder.

Three types of the disorder have been established. The first type involves those individuals who only feel sexually attracted to amputees. The second concerns those who act and present themselves as disabled (without really being so). While the third type includes those who want to be disabled and do everything possible to achieve it.

Today, it’s understood that in this disorder, there’s an alteration or dysfunction in the development of anatomical identity. Consequently, the individual doesn’t feel satisfied with a certain part of their body and wants to eliminate it. This is the main symptom of BIID: an intense desire or an urgent need to mutilate or amputate a healthy part of the body.

These thoughts (irrational and repetitive) become obsessive and generate great discomfort, anxiety, and changes in mood in the sufferer. In addition, due to misunderstandings on the part of the environment, they tend to isolate themselves socially.

The origin of the desire for amputation

The fact that these people want and seek to be disabled isn’t related to economic benefit. It’s usually linked to the following ideas:

• They seek to achieve a physical aspect that’s particularly pleasing to them which entails the amputation of a part of their body. In effect, it’s an attempt to reach a personal ideal.
• They consider this part of the body to be foreign as if it doesn’t belong to them. In fact, they consider it incongruous with their body image.
• They consider the relevant limb or part of the body to be useless, defective, or a burden.

As we mentioned earlier, these ideas generate a great deal of discomfort in the sufferer. However, they can also lead to self-mutilation attempts. Research has found that this is more frequent when the BIID has a component of comorbid sexual arousal.

Depending on the individual, the fixations can be focused on different areas of the body. Therefore, each patient clearly knows which part of the body causes them anguish and which they wish to eliminate. Moreover, if they achieve it, they experience relief and satisfaction. They no longer feel invalid, but satisfied with their new state.

Causes of body integrity identity disorder

The disorder usually begins to take shape during childhood and adolescence, moments at which irrational and compulsive ideas regarding amputation are already present. However, these ideas aren’t usually externalized until adulthood. Despite this, due to fear of social stigma, sufferers rarely seek professional treatment or support.

It’s been observed that this disorder occurs more frequently in men (approximately 30 percent more incidence). It usually mainly affects the extremities like the arms, legs, and hands. To date, the causes of the condition aren’t entirely clear.

Some of the theories suggest that, during childhood, the sufferer may have been  exposed to a person with a disability. Thus, somehow, they started to view disability as an aspirational ideal, perhaps due to the treatment they observed the person receiving from their own parents and others. This meant they inferred that disability was a way of obtaining appreciation and empathy. They may even have seen it as linked with an aesthetic ideal, considering it to be more attractive.

Some research has led to the proposal that the disorder may be related to a lesion or damage to the right parietal lobe of the brain. Differences in the size of certain brain structures, as well as hyperreactivity of specific areas related to proprioception, have also been observed in those suffering from the disorder.

Is there treatment?

At the moment, there’s no definitive and universally accepted cure. Generally, drugs (such as antidepressants or antipsychotics) and psychotherapy are used as interventions.  It’s also essential that the individual is aware that they’re suffering from a disorder and recognize that they need help.

In most cases, people with BIID desire limb paralysis or amputation, and request medical help to complete the surgery. However, even if it alleviates their discomfort and finally makes them feel complete and satisfied with their physique, it’s a decision that’s fraught with moral dilemmas. After all, it involves eliminating (either physically or functionally) a healthy limb.

Whatever the individual circumstances may be, professional assistance and intervention are essential to help the sufferer of bodily integrity identity disorder recover their well-being.