Neuroethics

, Volume 2, Issue 1, pp 21–33

Out on a Limb: The Ethical Management of Body Integrity Identity Disorder

Original Paper

Abstract

Body integrity identity disorder (BIID), previously called apotemnophilia, is an extremely rare condition where sufferers desire the amputation of a healthy limb because of distress associated with its presence. This paper reviews the medical and philosophical literature on BIID. It proposes an evidenced based and ethically informed approach to its management. Amputation of a healthy limb is an ethically defensible treatment option in BIID and should be offered in some circumstances, but only after clarification of the diagnosis and consideration of other treatment options.

Keywords

Body integrity identity disorder Apotemnophilia Ethics Therapy Amputation 

References

  1. 1.
    Dotinga, R. 2000. Out on a limb. Salon [August 29].Google Scholar
  2. 2.
    Dyer, C. 2000. Surgeon amputated healthy legs. British Medical Journal 320: 322.CrossRefGoogle Scholar
  3. 3.
    Johnston, J., and C. Elliott. 2002. Healthy limb amputation: Ethical and legal aspects. Clinical Medicine 2: 431–435.Google Scholar
  4. 4.
    Bayne, T., and N. Levy. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy 22: 75–86.CrossRefGoogle Scholar
  5. 5.
    Savulescu, J. 2006. Autonomy, the good life and controversial choices. In The Blackwell guide to medical ethics, eds. R. Rhodes, L. Francis, and A. Silvers. New York: Blackwell.Google Scholar
  6. 6.
    First, M.B. 2005. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine 35: 919–928.CrossRefGoogle Scholar
  7. 7.
    Berger, B.D., J.A. Lehrmann, G. Larson, L. Alverno, and C.I. Tsao. 2005. Nonpsychotic, nonparaphilic self-amputation and the internet. Comprehensive Psychiatry 46: 380–383.CrossRefGoogle Scholar
  8. 8.
    Sorene, E.D., C. Heras-Palou, and F.D. Burke. 2006. Self-amputation of a healthy hand: A case of body integrity identity disorder. Journal of Hand Surgery 31B: 593–595.Google Scholar
  9. 9.
    Braam, A.W., S. Visser, D.C. Cath, and W.J.G. Hoogendijk. 2006. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology 39: 32–37.CrossRefGoogle Scholar
  10. 10.
    Baubet, T., B. Gal, S. Dendoncker-Viry, A.C. Masquelet, M.T. Gatt, and M.R. Moro. 2007. Apotemnophilia as a contemporary frame for psychological suffering. Encephale 33: 609–615.CrossRefGoogle Scholar
  11. 11.
    Bensler, J.M., and D.S. Paauw. 2003. Apotemnophilia masquerading as medical morbidity. Southern Medical Journal 96: 674–676.CrossRefGoogle Scholar
  12. 12.
    Money, J., R. Jobaris, and G. Furth. 1977. Apotemnophilia: Two cases of self-demand amputation as a paraphilia. Journal of Sex Research 13: 115–125.CrossRefGoogle Scholar
  13. 13.
    Everaerd, W. 1983. A case of apotemnophilia: a handicap as sexual preference. American Journal of Psychotherapy 37: 285–293.Google Scholar
  14. 14.
    Bruno, R.I. 1997. Devotees, pretenders and wannabes: Two cases of factitious disability disorder. Sexuality and Disability 15: 243–260.CrossRefGoogle Scholar
  15. 15.
    Wise, T.N., and R.C. Kalyanam. 2000. Amputee fetishism and genital mutilation: Case report and literature review. Journal of Sex & Marital Therapy 26: 339–344.CrossRefGoogle Scholar
  16. 16.
    Storm, S., and M.D. Weiss. 2003. Self-inflicted tourniquet paralysis mimicking acute demyelinating polyneuropathy. Muscle & Nerve 27: 631–635.CrossRefGoogle Scholar
  17. 17.
    Elliott, C. 2000. A new way to be mad. Amputations sought by healthy people. The Atlantic Monthly 2866: 73–84.Google Scholar
  18. 18.
    British Broadcasting Corporation. Complete Obsession. 2000. Horizon. 17-2-2000.Google Scholar
  19. 19.
    Australian Broadcasting Corporation. Enough rope: Three amputees. 2006. Enough Rope. 28-8-2006.Google Scholar
  20. 20.
    Furth, G., and R. Smith. 2000. Apotemnophilia: Information, questions, answers and recommendations about self-demand amputation. Bloomington: 1st Books.Google Scholar
  21. 21.
    Smith, W.J. 2005. Should doctors be allowed to amputate healthy limbs? Newsletter of the Center for Bioethics and Culture Network.Google Scholar
  22. 22.
    Large, M.M. 2007. Body identity disorder. Psychological Medicine 37: 1513–1514.CrossRefGoogle Scholar
  23. 23.
    Schlozman, S.C. 1998. Upper-extremity self-amputation and replantation: 2 case reports and review of the literature. Journal of Clinical Psychiatry 59: 681–686.Google Scholar
  24. 24.
    Sadock, B.J., and V.A. Sadock. 2007. Kaplan and Sadock’s synopsis of psychiatry, 505. Baltimore: Lippincott Williams & Wilkins.Google Scholar
  25. 25.
    Feinberg, T.E., and D.M. Roane. 2005. Delusional misidentification. Psychiatric Clinics of North America 28: 665–683.CrossRefGoogle Scholar
  26. 26.
    Gardener-Thorpe, C., and J. Pearn. 2004. The Cotard syndrome. Report of two patients: With a review of the extended spectrum of ‘délire des négations’. European Journal of Neurology 11: 563–566.CrossRefGoogle Scholar
  27. 27.
    Lepping, P., I. Russell, and R.W. Freudenmann. 2007. Antipsychotic treatment of primary delusional parasitosis. British Journal of Psychiatry 191: 198–205.CrossRefGoogle Scholar
  28. 28.
    Berrios, G.E., and R. Laque. 1995. Cotard’s syndrome: Analysis of 100 cases. Acta Psychiatrica Scandinavica 91: 185–188.CrossRefGoogle Scholar
  29. 29.
    Grant, J.E., and K.A. Phillips. 2005. Recognizing and treating body dysmorphic disorder. Annals of Clinical Psychiatry 17: 205–210.CrossRefGoogle Scholar
  30. 30.
    Crerand, C.E., M.E. Franklin, and D.B. Sarwer. 2006. Body dysmorphic disorder and cosmetic surgery. Plastic and Reconstructive Surgery 118: 167e.CrossRefGoogle Scholar
  31. 31.
    Phillips, K.A. 2002. Pharmacologic treatment of body dysmorphic disorder: Review of the evidence and recommended treatment approach. CNS Spectrums 7: 453–460.Google Scholar
  32. 32.
    Koran, L.M., E. Hollander, G. Nestadt, H.B. Simpson, and American Psychiatric Association. 2007. Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Journal of Psychiatry 164: 5–53.Google Scholar
  33. 33.
    Krahn, L.E., H. Li, and M.K. O’Connor. 2003. Patients who strive to be ill: Factitious disorder with physical symptoms. American Journal of Psychiatry 160: 1163–1168.CrossRefGoogle Scholar
  34. 34.
    Lawrence, A.A. 2006. Clinical and theoretical parallels between desire for limb amputation and gender identity disorder. Archives of Sexual Behavior 35: 263–278.CrossRefGoogle Scholar
  35. 35.
    Bottini, G., E. Bisiach, R. Sterzi, and G. Vallar. 2002. Feeling touches in someone else’s hand. Neuroreport 13: 249–252.CrossRefGoogle Scholar
  36. 36.
    Ramachandran, V.S., and P. McGeoch. 2008. Can vestibular caloric stimulation be used to treat apotemnophilia? Medical Hypotheses 69: 250–252.CrossRefGoogle Scholar
  37. 37.
    Edgerton, M.T. 1973. Transsexualism—A surgical problem? Plastic and Reconstructive Surgery 52: 74–76.CrossRefGoogle Scholar
  38. 38.
    Centers for Disease Control and Prevention. Unexplained dermopahty (aka “Morgellons”). http://www.cdc.gov/unexplaineddermopathy/general_info.html. 2008.
  39. 39.
    Koblenzer, C.S. 2006. The challenge of Morgellons disease. Journal of the American Academy of Dermatology 55: 920–922.CrossRefGoogle Scholar
  40. 40.
    Murase, J.E., J.J. Wu, and J. Koo. 2006. Morgellons disease: A rapport enhancing term for delusions of parasitosis. Journal of the American Academy of Dermatology 55: 913–914.CrossRefGoogle Scholar
  41. 41.
    British Broadcasting Corporation. The Goodies—Punky business. 1977.Google Scholar
  42. 42.
    Smith R. Body integrity identity disorder: Advice of surgeons. http://www.biid.org/advice.php?page=06&lan=en. 2008. www.biid.org.
  43. 43.
    Law, S.A. 1995. Silent no more: physicians’ legal and ethical obligation to patients seeking abortions. Review of Law and Social Change 21: 279–321.Google Scholar
  44. 44.
    Lanzetta, M., P. Petruzzo, R. Margreiter, J.M. Dubernard, F. Schuind, W. Breidenbach, S. Lucchina, S. Schneeberger, C. van Holder, D. Granger, G. Pei, J. Zhao, and X. Zhang. 2005. The international registry on hand and composite tissue transplantation. Transplantation 79: 1210–1214.CrossRefGoogle Scholar
  45. 45.
    Australia and New Zealand Dialysis and Transplant Registry. 2006. Australia and New Zealand Dialysis and Transplant Registry Report 2006. Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of Sydney, Westmead HospitalWestmeadAustralia

Personalised recommendations