4/10/2023 0 Comments Body integrity identity disorderHe currently simulates his ideal self by seating himself in a wheelchair and tying his leg down to the chair in a way where his limb folds, creating the appearance of a stump. His persistent desires to feel complete inside led him to feeling alone and depressed throughout his childhood and into adulthood. Patient 1 reported that the onset of his desires began in early childhood after seeing another child in a wheelchair with a stump amputation. One of the patients desires a single below-the-knee amputation on the right leg (patient 1), while the other desires a double above-the-knee amputation (patient 2). Neither of the patients had any relevant comorbid diagnoses. Both patients were diagnosed with BIID with a primary motivation to feel complete or satisfied inside by a certified psychiatrist working in the outpatient clinic who is specialised in body image-related disorders. Two adult male patients were recruited from a patient group located at the Amsterdam Universitair Medische Centra (location Academic Medical Center (AMC), Amsterdam, Netherlands). 16 17 Other, more common, reported behavioural sequelae include privately simulating their desired appearance, that is, limb binding/limb folding or the use of a wheelchair/crutches/prosthetics, in an attempt to relieve their symptoms. While this approach has not been adopted into any known clinical treatment strategies, it has not deterred these individuals from attempting to perform self-amputations in an effort to rid themselves of their alienated limbs. Though controversial, the only method that has been reported to result in definite symptom improvement is to surgically remove the alienated limbs 11 however, this approach has been ardently contested with arguments being made in favour for 12 13 and against 14 15 doing so. As such, no standard psychopharmacological or psychotherapeutic treatments for this disorder have been devised. The inability to establish a clear consensus on the diagnostic criterion of this disorder ultimately stems from the dearth of studies and diagnostic tools currently available. 1 The aetiological framework of this disorder is as complex as it is unresolved it has been approached from both psychiatric 1–5 and neuroscientific 6–10 standpoints yet still remains unclassified in the Diagnostic and Statistical Manual of Mental Disorders. 1 The onset of these desires is often seen in early childhood, 1 2 with no evidence of them being influenced by perceived ugliness, pain, conversion or psychosis. The primary motivation for these individuals to seek an amputation is to feel complete or to feel satisfied inside, with sexual motivations often being secondary. It is common that patients are very specific regarding the position of the feeling of undesirability of the limb. Individuals with this condition often speak of having an ideal self, which refers to the physical appearance that they feel best reflects their true body schema. This current state of affairs makes it especially difficult to provide an accurate assessment of the prevalence of BIID. Due to the taboo nature surrounding this condition, most individuals do not electively present their symptoms to medical professionals and are instead found on internet forums which are mostly private. Body integrity identity disorder (BIID) is a rare and secretive condition characterised by the feeling of a lack of bodily ownership over a certain healthy limb or limbs, which subsequently causes patients to report a desire to obtain an amputation in order to appear as their ideal self.
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