Apotemnophilia – Everything You Need to Know

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Body Integrity Identity Disorder has been known by many different names over the years. This disorder has been known as “Apotemnophilia” and Amputee Identity Disorder. Although it has been known by many other names, professionals working in the field today know this particular disorder as Body Integrity Identity Disorder. Body Integrity Identity Disorder is a psychologically based condition in which an individual has a fantasy of having a missing limb. Because of this fantasy, an individual may opt to have a voluntary amputation in order to achieve this ideal image of themselves. This idealized notion of having a missing limb is persistent and often times will preoccupy the individual seeking the amputation.

There have been some occasions in which an individual will harm themselves or the limb that they seek to have amputated in order to hide the fact that they have this disorder. Harming themselves to the point in which an amputation is necessary and saying that it was an accident will conceal the fact that they have been suffering from this psychological disorder from the physician performing the amputation. It is said that this particular disorder is a result of a misfiring in the mapping coming from the brain to the various parts of the body. Therefore, not only is it deemed as a psychological disorder but a neurological disorder as well. Some may feel as though an individual is doing this for attention, but it is sincerely not deliberate.

Often times, an individual suffering from this disorder is sexually motivated for the amputation that they are seeking; however this is one of the rarest motivations that is reported. Today, no physicians or surgeons will treat this disorder by actually performing the amputation. Sufferers of this disorder sometimes use various prosthesis to mimic the amputations and fulfill their desires in this way.

Apotemnophilia is the uncontrollable yearning to amputate one or more healthy limbs or where a person wishes to become paraplegic. The disorder also referred to as Body Integrity Identity Disorder (BIID) blurs the distinction between psychiatry and neurology.

The condition is characterized by the longstanding or intense desire for someone to amputate their limbs. Apotemnophilia patients feel the desire to be discomfort or to get disabled. It’s a phenomenon that commonly starts during early adolescence and ends up causing harmful consequences.

Apotemnophilia is associated with somatoparaphrenia – a kind of monothematic delusion where an individual denies a limb or part of their body is theirs. Individuals suffering from this disorder may well regard themselves as “transabled.”

Apotemnophilia – Signs and Symptoms

Apotemnophilia starts as Body integrity dysphoria (BID) in the early adolescence stages. It’s a rare disorder mismatch between the physical body and mental body image. It’s characterized by a great craving for limb amputation, particularly a leg, or for someone to become deaf or blind. At times, the individual has the sexual arousal sense linked to the yearning to lose their sense or limb.

Some of the affected people act as amputees and start using prostheses, among other tools as they try to make their desire and feelings practical. Other individuals suffering BID have been interviewed or reported to the media or dialogue to over the telephone about their condition.

Research show they end up doing self-amputation of their “superfluous” limb or limbs. For instance, they may permit a train to run over their body parts or serious damage their limbs – whereby surgeons only end up amputating their limbs.

To the degree that they make generalizations, BID patients begin wishing for amputation when they’re between 8 and 12 years. They often knew an amputee during their childhood. But those with BIID seek treatment at just older age. 

BIID patients are predominantly those of male gender, but there isn’t any proof that sexual preference is critical. Even though there seems to be a BIID association and individual suffering from gender paraphilia or dysphoria, there appears to be a feeble connection with personality disorders. 

The history of family psychiatric doesn’t look significant. But there isn’t any sturdy linkage with the limb or limbs’ site that the individual wishes to remove or any precedent trauma to the unneeded limb.

Apotemnophilia – Causes

The causes of BIID were still not clear and are a matter of ongoing research. 

Apotemnophilia – Diagnosis

To date, there isn’t any formal diagnostic criterion. 

Apotemnophilia – Classification

It is still not clear whether BIID is a kind of mental disorder or human diversity as the same with gender dysphoria concept development. Its debate was neither included in the DSM-5 or the ICD-10. But having attained a stable edition in June 2018, it was comprised in the ICD-11 as ‘Body integrity dysphoria’ using code 6C21.

The surgical ethics of amputating an unneeded body part for a BID patient are controversial and difficult. 

Apotemnophilia – Treatment

BID has no proof-based treatment. But there are reports of using antidepressants, cognitive behavioral therapy, and surgery to amputate the non-required body part. 

Apotemnophilia – Prognosis

The results of treated or untreated BID aren’t known. But various case reports portray that amputation enduringly resolves the need in affected people. 

Apotemnophilia – History

Apotemnophilia was initially discussed by psychologists John Money and Gregg Furth in the 1977 article. They termed the condition as mainly sexually oriented. In 1986, John Money explained a similar disorder, which he termed as “acromotophile.” Before 2004, the publications were generally case studies. 

During the late 1990s, it’s when Apotemnophilia received public attention. Robert Smith, Scottish surgeon, amputated limbs of two healthy individuals but those who were desperate for it.

The first clinical research was published in 2004 by Michael First, after examining 52 people suffering from the condition. A quarter of the number has had the amputation done. Based on the review, Michael First regarded the condition as “body integrity identity disorder.”

That was to express his views for more of an identity disorder rather than a paraphilia. Following Michael First work, there were efforts to study Apotemnophilia as a neurological condition. That’s by looking for possible causes in the brain using to neuroimage among other methods.

Studies also reviewed that BID sufferers wanted their left limbs removed more than the right. That’s following the right parietal lobe damage. More so, the skin conductance response is greatly different below and above the desired amputation line. 

The desired amputation line remains stable after a while with the need usually starting in early childhood. Michael’s work, however, didn’t fully elaborate the condition, while the psychosexual study has been continuing over time. 

Apotemnophilia – Desire for Amputation

For the majority of people, it’s horrifying to losing a limb. Even worse, is envisioning of self-amputation to survive. Despite the number of films and TV series portraying this desire and fear, in reality, it doesn’t add up.

Most people suffer from distress when they lose a limb. But that’s not the case to a small number of BIID patients who desire to get amputated. Other people portrayed the feelings that their body parts are in the wrong body. 

Some of the people with this desire usually mimic amputation by bending their limbs, wearing prostheses, and using crutches. Recently, there has been an increase in self-demand amputations with a number of them carried out on healthy limbs.

The obsessive is even deadly as some of Apotemnophilia patients do it themselves. That’s more in cases whether the individual can’t afford the surgery costs. They can shoot their leg, or saw off a toe or finger. Well, others have been known to place the offensive limb ahead of an oncoming train or freezing their limb to death in the ice. 

There’ve also been reports of using liquidized fecal matter to inject the limb. Apotemnophilia patients secretly endanger themselves to carry out the amputation. Most of the BIID patients are known to have a repeated history of injuring the body segment they want to be removed. 

It’s a health diagnostic challenge due to the self-inflicted atypical presentation caused by the disorder.  

Recent case reports showed that Apotemnophilia patients fully understand that people oppose their amputation actions. That’s particularly when done to a healthy body part. But patients of this disorder fantasize of achieving great things despite having to undergo the odd practice.

Other fantasies claim that such people achieve great things, such as being world-class artists. There has been a new change from the traditional theory that BIID is psychological, and some scientists hypothesized for neurological treatment. 

But the need to fully eradicate someone’s limb remained unsolved myth. 

Apotemnophilia – Psychological Theories for Amputation

Recently, a number of terms are utilized in describing Apotemnophilia depending on various researchers who carry out studies. The condition has been called Body Integrity Image Disorder (BIID) or Amputee Identity Disorder (AID).

Michael First was the first person to utilize the term BIID. He is a US-based psychiatrist and also the Clinical Psychiatry Professor at Columbia University. 

Most of the BIID patients are known to experience everyday disruption. They also encounter distress due to their obsession to remove the “alien appendage.” However, BIID shows there’s a mismatch between the people’s subjective of their body’s actual structure and their body. 

Fascinatingly, despite BIID being some identity disorder, it’s contrasted to Gender Identity Disorder (GID). Psychological journal indicates some similarities between GID and BIID. With the latter, individuals are distressed in their anatomy since they feel odd with their internal self-sense. 

Both disorders are said to originate in childhood. They’re usually expressed by the desired identity imitation such as transvestism or pretending. They also entail a paraphiliac sexual arousal. Paraphiliac is regarded as the condition where individuals gain sexual gratification and arousal from situations, individuals, or objects that are extreme and atypical. 

To answer the myth question on what encourages an individual need for amputation of their ideal healthy limbs studies have got different revelations. Some researchers portray that the affected people suffer from Body Dysmorphic Disorder (BDD). It’s a circumstance in which individuals wrongly believe that one or more parts of their body are profoundly ugly or diseased. 

Such a belief generates intense worry by the sufferer. The patient maintains it even when faced with the contrary proof. There are two significant distinctions between BIID and BDD patients. However, Apotemnophilia OR BIID patients don’t view their body parts as ugly. 

Secondly, instead of swishing to get more beautiful, they have an interest in becoming “more authentic” and disabled. 

Apotemnophilia – Sexual Attraction

Another explanation for the amputation desire is amputees’ sexual attraction or sexual arousal. They have the idea to become amputees. Thus, Apotemnophilia is viewed as a form of the psychosexual disorder. Strangely, it’s observed that the fundamental amputation reason need is the supposed phallic resemblance by an amputee’s stump. 

Apotemnophilia – Neurological Theories Explaining Amputation

BIID disorder has long been termed as wholly psychological in original. There’s enhancing notion popularity that the condition has a neurological basis. Can the former instances of brain tumors send some light towards this disorder? 

Strokes and tumors are found to cause body-image distortions in the parietal lobe. The part has the body image drawn from sensory inputs. Pötzl syndrome patients suddenly ignore body parts or get convinced of them being unreal, alien, or parts of other people and not themselves. 

The BIID symptoms onset often dates to childhood. The early onset presumes theirs is a brain defect at birth. For example, abnormal blood vessel, early brain trauma, such as shaken baby syndrome were shaking the baby may lead to brain swelling.

Other associated causes of Apotemnophilia are retinas damage, tearing of veins causing blood to drain or incomplete nerve development. That’s in either (sensorimotor cortex) motor or sensory function parts. Likewise, the big bundle of nerve fibers links our left brain hemisphere with the right one – the corpus callosum.

Early-onset BIID patients on the body image disturbance can’t recall a life where the distressed limb got integrated into the image of their body. Some neuroscientists propose that the right parietal dysfunction offers rise to BIID. That results in the body’s image uncoupling construct offering rise to BIID. 

The defect leads to an uncoupling body image construct in the right parietal lobe regarding the physical body of a person. Other arguments suggest that physical limbs of Apotemnophilia patients developed devoid of sensory consciousness. There is also the BIIB similarity which happens following a stroke within the right parietal lobe. 

Somatoparaphrenia patients have persuaded their limbs, particularly the left arms belong to other people. At times, they develop the aversion to offend the limb, stating negatively about the body part. They may term as being hideous or communist. 

The tendency of the right parietal lobe dysfunction arguments is for those people who want their body put away from the body.

The idea is said to support the right hemisphere (right parietal lobe) since it’s the brain side that manages the left side of the body movements. Somatoparaphrenia is linked, although not essential, which is perhaps the outcome of the right parietal lobe harm.

In somatoparaphrenia, the affected people deny the ownership of the limbs. In most cases, they’re convinced of having nothing wrong with the feeling where their left side is paralyzed. 

Fascinatingly, there has been some achievement in treating these disorders. For instance, cold-water vestibular caloric stimulation is a method which has been temporarily used in treating them. The process entails cold-water infusion into the patient’s ear external canal.

As a result of the similarly between BIID and these disorders, this treatment can likewise equally avert the Apotemnophilia symptoms. The treatment generates right parietal lobe activation in addition to several other body parts. 

Some earlier examinations involving twenty participants with the thirsty for Apotemnophilia found – the body left side is what affects the limbs. There are also revelations that the desire to get rid of the left leg is three times higher than the right one. 

It’s uncommon that such an asymmetry would be actual if BIID were purely psychological. More investigations were carried out by taking the Skin Conductance Response (SCR) on the below and above part of the desired amputation. 

The right forebrain parts influence skin conductance. It’s the change measure in the skin’s conductivity to a weak electric current. The more someone sweat’s, that’s to a threatening or arousing stimulus, the higher the influence in skin conductivity. 

Findings portray, heightened skin conductance reaction to pinprick under the desired amputation line – offers proof that’s consistent with the hypothesis from a right parietal lobe dysfunction. It incorporates input from different sensory parts and the insula to generate a body image coherent sense. 

If the neurological basis theory is right, perhaps it shows why Apotemnophilia arises and portrays that caloric stimulation is a therapeutic avenue for the present untreatable and chronic condition. 

Apotemnophilia – Conceptual between Psychologists and Physicians

The desire for BIID patients is analyzed differently by physicians and psychologists. But there’s no known successful psychotherapeutic or pharmaceutical therapy. Lobbies of individuals suffering from Apotemnophilia elaborate the analogy amputation desire to the level of surgical sex reassignment transsexuals. 

But medical ethicists talk about the controversy regarding healthy limbs elective amputations. One way, the autonomy principle is applied to minimize the right for body modifications. While on the other, Apotemnophilia autonomy is doubted.

As per neurological outcomes, BIID is a brain disorder that generates a body image disruption for which stroke patients’ parallels are known. 

If Apotemnophilia were a neuropsychological disturbance incorporating the missing illness insight and particular autonomy; thus, amputations would be contraindicated. They should also be categorized as bodily injuries involving mentally disordered patients. 

Rather than curing just the symptoms, causal therapies might be developed to incorporate the alien limbs in the person’s body image. 

Psychology

Paraphilia – Apotemnophilia

From late 1800, there’ve been various cases of people associated with Apotemnophilia. John Money, the late sex researcher, described conditions of the two individuals seeking amputation in 1977 as apotemnophilia. The paraphilia or sexual deviation entails eroticizing a wheelchair, a pair of crutches or stump. 

In some circumstances, Apotemnophilia is revealed to view rejected homosexuality compensation. It’s assumed that the limb amputation averts amputating the transsexual’s penis. Amputation fetishism and desire are strongly correlated. 

The above theory is backed by Michael First’s findings from Colombia University. In 2004, he stated that 87% of 52 individuals suffering from Apotemnophilia felt sexually attracted to. Nearly one-third suffered from pedophilia, masochism, fetishism, and transvestism. 

Psychiatry

Obsessive-compulsive Disorder & Body Dysmorphic Disorder (BDD)

Individuals suffering from BDD exhibit a preoccupation with a slight or imagined defect in marked and appearance social areas impairment. That resulted in appearance preoccupation, which is occasionally inclined with delusional intensity. 

Frequently, BDD happens with other psychiatric disorders, whereby the most ordinary comorbid diagnoses include anxiety and mood disorders, substance use disorders, obsessive-compulsive disorders, personality disorders, and eating disorders. 

Cosmetic medical treatments ordinarily generate no change or even inferior, body’s exacerbation of dysmorphic disorder symptoms. 

Identity Disorder

Several analyses exhibit Apotemnophilia as an identity disorder rather than the desire to get disabled. During the survey, most of the interviewed BIIM candidates portrayed their desire for Apotemnophilia as a way to gain “real identity.”

Some of the disorder patients say they’re in the wrong body and they’re complete only when their left arm and leg are cut. Despite several similarities to Gender Identity Disorder (GID), however, Apotemnophilia differs in a number of areas.

BIID support groups utilize the analogy “transabled” neologism in their successful term transgender. They elaborate the need for analogy amputation in the longing of transsexuals to reassign sex surgically. 

But the BIID definition is just a descriptive categorizing without clear explanation. Identify component emphasizes may propose a causal elaboration, but isn’t proven either biologically or psychologically. 

Peripheral Disturbances

In some cases, BIID is presumed to come out of peripheral injury. It was an instance with Oliver Sacks whom in 1974 got a severe injury on his left thigh after being hit by a bull in the Norway Mountains.

After healing of the wound, he felt no connection with his thigh and infrequently wished was leg was amputated. 

Other BIID patients recall childhood damages that involved their limbs. Afterward, they started getting obsessed with amputation wishes. In about one-fifth of the study conducted, disabilities such as those involving broken legs and limps offered the impetus with amputation desire. 

Apotemnophilia – Wrapping Ups

BIID or formerly Apotemnophilia is a neuropsychological disturbance that incorporates missing insight, illness, and the specific lack of autonomy. Rather than curing the price symptom of irreparable bodily damage, a causal therapy can be established to integrate the body image with the alien limb.

But is the patient’s desire for amputation an obsessive desire or an autonomous decision? The response remains unclear considering it’s not a pain-free or cost-free process. Elective amputations can thus be regarded as severe injuring of the body due to substantial loss of autonomy.

That follows investigations from hundreds of psychiatrists who found BIID patients desire is either based on monothematic or obsessive delusion. Besides, neurological studies maintain with the brain disorder hypothesis. It’s also backed by most of the elective amputations’ influential advocates.

Treatment associated with irreversible damages shouldn’t be carried out. That’s as long as accessible diagnostic techniques such as positron emission tomography and fMRI haven’t been fully explored.

Still, the argument that amputation is the sole effective Apotemnophilia therapy doesn’t count up. To start with, its success hasn’t been proved scientifically but just anecdotally. Secondly, its achievements aren’t even sustainable as some amputees develop more amputation desires.

Thirdly, efficient therapies and less invasive techniques can be applied. For instance, Apotemnophilia patients can undergo electrical stimulation in the affected brain part, transcranial magnetic stimulation, or neuropsychological rehabilitation.

For the former, it would be vital for patients to undergo a participative decision making and careful benefit-risk-analysis.

Lastly, there’s an ethical question on whether a certain brain therapy or amputation is more problematic. In divergent to the amputation, a suitable brain therapy would be a fundamental rather than a symptom cure.

That could cure an alien limb suffering but also prevent further disability. Thus a better comprehending of this disorder would be contributory for effective treatment development.

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