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Amputate healthy limb? (Apotemnophilia)

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  #1  
Old 23rd June 2005, 08:14 PM
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Default Amputate healthy limb? (Apotemnophilia)

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Sarah Wotherspoon and Janelle Miles
23 Jun 05
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SURGEONS should be allowed to cut off the healthy limbs of people who want to be amputees, a Melbourne researcher says.

Sufferers of the rare body integrity identity disorder say their limbs feel wrong on their bodies and want them amputated.
Melbourne University Centre for Applied Philosophy and Public Ethics researcher Dr Neil Levy and Sydney philosopher Dr Tim Bayne argue sane patients should not be denied the surgery.

"As long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests," the pair wrote in the Journal of Applied Philosophy.

Dr Levy said yesterday: "If it's a long-standing condition then surgery may be a reasonable option.

"One guy I've corresponded with, a New Yorker . . . he's had it for 50 years. He's in his 60s.

"He says it's had a huge impact on his life. It's made him desperately unhappy."

Dr Levy said he had corresponded with at least one Australian, a 29-year-old from Melbourne, who had told him she had always wanted to be an amputee.

To reinforce their case, Dr Levy and Dr Bayne, of Macquarie University's philosophy department, relate the example of a Scottish surgeon's patient who says his life has been transformed for the better by his amputation.

Dr Levy believes such operations are less of a problem than cosmetic surgery such as breast enlargement.

Only about 1000 people worldwide suffer from the disorder, many so severely they have resorted to self-amputation.

"People have used chainsaws or shotguns to try and amputate their limbs or deform them so badly that amputation is the only option," Dr Levy said.
From Herald Sun
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  #2  
Old 23rd June 2005, 11:26 PM
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Very interesting dilemma and I have a paper on the Bioethics of Toe Cutting pending publication in the UK. Apotemnophilia (desire to have an amputation) is not that rare albeit sensational when the person wants a leg or arm removed. A very much neglected aspect of podiatry is the managment of people living with psychological (and often psychosexual) challenges. The rise and popularity of cosmetic surgery has brought the bioethical issues in caring for these patients to the fore which I am sure will interest all practitioners.

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  #3  
Old 24th June 2005, 12:55 AM
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If you consider body modification as an extension of cosmetic surgery then an interesting ethical and medico-legal dilemma presents itself. In the scenario where a patient presents with a request for foot modification like the young lady with the intermetatarsal studs - what should the clinician do. Whilst the first maxim of healthcare should be 'do no harm', it is worthwhile considering what the outcome might be if the patient self-administered insead. Perhaps in cases such as this a more appropriate maxim would be, 'minimise any harm'. In practice, sexual health have been upholding this principle for years when distributing conoms to under-age teens. Shouldn't podiatry do the same? Certainly there is evidence the NHS recognises and addresses these issues with the radical approach to BDS but I wonder how podiatrists would deal with such a dilemma? And the indemnity costs.

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Old 24th June 2005, 01:22 AM
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While I have no problem with the notion of surgery to alleviate psychosocial problems (losing a leg probably has effects of equal magnitute on the individual as some of the psychotropic medications, which essentially amputate personalities....) But I would not be doing surgery of that nature in my role as a Podiatrist, I would leave it to a team approach between therapist and well insured surgeon. Very well insured.....

There was a recent case where a young woman sued the medical team that performed her transgender surgery (she was originally a young man). She argued that she had not be sufficiently screened and counselled, and that she regretted the decision and wanted to go back.... Hmmm, it could be tricky glueing the limb back on (or anything else that had been cut off...)

cheers,

Felicity
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Old 26th June 2005, 03:56 AM
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Default Amputate healthy limb

Have these Melbourne researchers lost touch with reality? An amputation is a risky and very expensive operation, plus all the aftercare and help these people would need to continue with their lives. Who will pay for all of that?
I suppose the amputee would be considered 'disabled' and no longer be expected to work, maybe entitled to benefits as a disabled person. I wonder if that has anything to do with their 'psychological condition'?
Or am I being cynical?!
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Old 4th July 2005, 06:48 AM
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No i do not agree that these researchers have lost touch with reality. Do remember that the article appears to be written by a philosopher and ethicist.

In the 1st post from Admin it highlights that the condition is extremely rare (around 1000 people worldwide) and people with the condition are known to attempt self-amputation; chainsaws and shot-guns are referenced. If we are to focus purely on the financial aspect then i am sure that there is a balance somewhere between long-term pharmacological therapy, psychiatric intervention and managment of botched self-amputation versus amputation.

I am also sure that much ethical debate could be provoked if we were to concern ourselves with the psychological and physical torment that the condition must impose on sufferers.
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Old 4th July 2005, 03:54 PM
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I recall an episode of Law & Order on this .... the plot was based on a "back street" surgeon performing these operation to amputate limbs for those with this condition...but one of them died :(
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  #8  
Old 4th July 2005, 10:47 PM
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Netizens

Trish wrote

>Have these Melbourne researchers lost touch with reality? An amputation is a risky and very expensive operation, plus all the aftercare and help these people would need to continue with their lives. Who will pay for all of that?

The apotemnophiles pay for there hospital expenses and prosthesis by themselves. hat is ofen a stimpualtion and one which overtakes criticism of fairness for all.

I suppose the amputee would be considered 'disabled' and no longer be expected to work, maybe entitled to benefits as a disabled person.

That is not what the person wants and they have live for two years as an amputee and exhaust all forms of other treatment before surgery is even contemplated. These are people living with a preoccupation to have three limbs instead of four. It is not for sympathy nor to become dependent, is it because their ideal body is minus one limb.

I wonder if that has anything to do with their 'psychological condition’.
Or am I being cynical?!

The psychological condition is real and there are no other therapies available. The preoccupation is oppressive and leads apotemnophiles in desperation to cut their limbs off to the danger of their lives.


Stewart wrote

>If we are to focus purely on the financial aspect then I am sure that there is a balance somewhere between long-term pharmacological therapy, psychiatric intervention and management of botched self-amputation versus amputation.

In the treatment of apotemnophilia no pharmaceutical or psychiatric intervention has shown to improve the condition. These folks have a life long obsession relieved only by amputation.

>I am also sure that much ethical debate could be provoked if we were to concern ourselves with the psychological and physical torment that the condition must impose on sufferers.

That is certainly part of the debate.

The key to the bioethical issue is the patient’s right to make the request for “amputation on demand.”, and the physician’s autonomy to grant it or otherwise.

The same debate is related to cosmetic toe surgery, where despite the obvious inclusion of patients with body dimorphic disorders, there is a pattern of “normals” demanding body sculpting which presents the same bioethical dilemmas to podiatrists.


Craig Wrote
>I recall an episode of Law & Order on this .... the plot was based on a "back street" surgeon performing these operation to amputate limbs for those with this condition...but one of them died

It has happen.

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  #9  
Old 5th July 2005, 07:26 AM
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Interesting site for devotees of amputation, calipers, AFOs and orthotics.

http://www.89.com/d/?d=fetishes-amputees

who said this profession ain't sexy!
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  #10  
Old 10th July 2005, 07:33 PM
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Quote:
The psychological condition is real and there are no other therapies available. The preoccupation is oppressive and leads apotemnophiles in desperation to cut their limbs off to the danger of their lives.
Is there much difference to someone with Anorexia whose desperation leads them to starve themselves to the danger of lives?? I'm sure many anorexics would attest the the preoccupation with being thin is oppressive and rules their lives...

However they're "treated"...not allowed to indulge the self-image that their skeletal frames are "fat".

How does this differ?
Why should one be accommodated and the other be treated?
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  #11  
Old 10th July 2005, 11:28 PM
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Quote:
Originally Posted by One Foot In The Grave

However they're "treated"...not allowed to indulge the self-image that their skeletal frames are "fat".
The therapies used in the intervention of eating disorders are much the same as body dysmorphic disorders. The goals are to address underlying psychodynamic issues while instituting behavioural and cognitive changes. In addition, there are a range of medications (mainly the SSRI's) which may have benefit.

However, the use of phrases such as 'indulge the self-image' might not be entirely helpful. The person with an eating/body image disorder has a genuine psychiatric illness, and the notion of 'indulgence' sounds a bit like telling some-one with depression to 'pull up their socks'. The sad fact is that with some body image disorders, it is not possible to achieve the state where the individual can reconcile their internal image with the external reality. The mortality rate for anorexia/bulimia is disturbingly high.

If a person has a psychiatric condition whereby their existence is untenable unless a limb is removed, then ultimately amputation might save their life. Psychiatric treatment is not 100% effective (our suicide rates attest to that), so surgical intervention might be the only option.

cheers,

Felicity

Last edited by Felicity Prentice : 11th July 2005 at 05:58 PM.
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Old 11th July 2005, 03:48 PM
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Quote:
However, the use of phrases such as 'indulge the self-image' might not be entirely helpful. The person with an eating/body image disorder has a genuine psychiatric illness, and the notion of 'indulgence' sounds a bit like telling some-one with depression to 'pull up their socks'.
Fully aware of that...just couldn't think of the right word (still can't!) to use instead of "indulge". I'll consult my trusty thesaurus next time!!
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  #13  
Old 14th July 2005, 06:42 AM
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Felicity is perfectly correct

>If a person has a psychiatric condition whereby their existence is untenable unless a limb is removed, then ultimately amputation might save their life. Psychiatric treatment is not 100% effective (our suicide rates attest to that), so surgical intervention might be the only option.

In apotemnophilia psychiatric treatment ( pharmaceutical and otherwise) has been shown to be completely ineffective. Before surgical treatment is undertaken however the person must first exhaust all other forms of care.

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Old 6th November 2008, 03:49 PM
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Default Apotemnophilia: call for better understanding

netizens

The condition apotemnophilia describes people with a fixation to have a limb amputation (usually healthy). This of course has caused much concern to many in the medial fraternity but a University of Sydney academic has recently brought the subject up again with a call for better understanding

http://au.news.yahoo.com/a/-/latest/...lthy-limbs-ok/

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More on foot sculting and apotemnophilia at:
http://toeslayer-retifismandfetishis...mnophilia.html
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Old 18th December 2011, 11:54 PM
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Default Re: Amputate healthy limb?

The Bizarre Request for Amputation
Rachel Barnes
International Journal of Lower Extremity Wounds December 2011 vol. 10 no. 4 186-189
Quote:
Apotemnophilia is a condition where sufferers wish to be an amputee. Currently, belief in the medical profession is that it is part of the spectrum of body dysmorphic disorder and as such patients are denied surgical correction. This can lead sufferers to extreme lengths. Proponents seek to have the disorder reclassified to a body identity integrity disorder such as gender identity disorder. In this way treatment modalities could be reassessed.
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Old 22nd October 2012, 06:43 PM
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Default Re: Amputate healthy limb?

Apotemnophilia or Body Integrity Identity Disorder: A Case Report Review
Bou Khalil R., Sami Richa
International Journal of Lower Extremity Wounds October 21, 2012
Quote:
Apotemnophilia or body integrity identity disorder (BIID) denotes a syndrome in which a person is preoccupied with the desire to amputate a healthy limb. In this report, we review the available case reports in the literature in order to enhance psychiatrists’ and physicians’ comprehension of this disorder. A search for the case reports available via MEDLINE was done since the first case report published by Money et al in 1977 till May 2011, using the following terms: apotemnophilia, self-demand amputation, body integrity identity disorder, and BIID. In all, 14 case reports were found relevant to our search. The desire to amputate one’s healthy limb seems to be related to a major disturbance in the person’s perception of one’s own identity, where limb amputation can relieve temporarily the patient’s feeling of distress without necessarily and uniformly adjusting the patient’s own identity misperception. More investigations are needed in this domain in order to develop noninvasive treatment strategies that approach this aspect of the patient’s distress within a globalist perspective. In addition, the health professionals’ awareness regarding this disorder is required to ensure professional management of patients’ suffering.
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Old 22nd October 2012, 06:46 PM
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Default Re: Amputate healthy limb? (Apotemnophilia)

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Old 22nd October 2012, 06:56 PM
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Default Re: Amputate healthy limb? (Apotemnophilia)

netizens

I submitted an article on apotmenophilia and BMD to the UK podiatry journal and it took nearly three year to have it published. I was very pleased to see the editorial committee eventually had the courage to do so.

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Old 5th December 2012, 12:00 PM
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Default Re: Amputate healthy limb? (Apotemnophilia)

Apotemnophilia or Body Integrity Identity Disorder
A Case Report Review

Rami Bou Khalil, Sami Richa
International Journal of Lower Extremity Wounds December 2012 vol. 11 no. 4 313-319
Quote:
Apotemnophilia or body integrity identity disorder (BIID) denotes a syndrome in which a person is preoccupied with the desire to amputate a healthy limb. In this report, we review the available case reports in the literature in order to enhance psychiatrists’ and physicians’ comprehension of this disorder. A search for the case reports available via MEDLINE was done since the first case report published by Money et al in 1977 till May 2011, using the following terms: apotemnophilia, self-demand amputation, body integrity identity disorder, and BIID. In all, 14 case reports were found relevant to our search. The desire to amputate one’s healthy limb seems to be related to a major disturbance in the person’s perception of one’s own identity, where limb amputation can relieve temporarily the patient’s feeling of distress without necessarily and uniformly adjusting the patient’s own identity misperception. More investigations are needed in this domain in order to develop noninvasive treatment strategies that approach this aspect of the patient’s distress within a globalist perspective. In addition, the health professionals’ awareness regarding this disorder is required to ensure professional management of patients’ suffering.
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Old 3rd January 2013, 08:25 PM
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Default Re: Amputate healthy limb? (Apotemnophilia)

The desire for healthy limb amputation: structural brain correlates and clinical features of xenomelia
Leonie Maria Hilti, Jürgen Hänggi, Deborah Ann Vitacco, Bernd Kraemer, Antonella Palla, Roger Luechinger, Lutz Jäncke, Peter Brugger
Brain (2012) doi: 10.1093/brain/aws316 First published online
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Xenomelia is the oppressive feeling that one or more limbs of one’s body do not belong to one’s self. We present the results of a thorough examination of the characteristics of the disorder in 15 males with a strong desire for amputation of one or both legs. The feeling of estrangement had been present since early childhood and was limited to a precisely demarcated part of the leg in all individuals. Neurological status examination and neuropsychological testing were normal in all participants, and psychiatric evaluation ruled out the presence of a psychotic disorder. In 13 individuals and in 13 pair-matched control participants, magnetic resonance imaging was performed, and surface-based morphometry revealed significant group differences in cortical architecture. In the right hemisphere, participants with xenomelia showed reduced cortical thickness in the superior parietal lobule and reduced cortical surface area in the primary and secondary somatosensory cortices, in the inferior parietal lobule, as well as in the anterior insular cortex. A cluster of increased thickness was located in the central sulcus. In the left hemisphere, affected individuals evinced a larger cortical surface area in the inferior parietal lobule and secondary somatosensory cortex. Although of modest size, these structural correlates of xenomelia appear meaningful when discussed against the background of some key clinical features of the disorder. Thus, the predominantly right-sided cortical abnormalities are in line with a strong bias for left-sided limbs as the target of the amputation desire, evident both in our sample and in previously described populations with xenomelia. We also propose that the higher incidence of lower compared with upper limbs (∼80% according to previous investigations) may explain the erotic connotations typically associated with xenomelia, also in the present sample. These may have their roots in the proximity of primary somatosensory cortex for leg representation, whose surface area was reduced in the participants with xenomelia, with that of the genitals. Alternatively, the spatial adjacency of secondary somatosensory cortex for leg representation and the anterior insula, the latter known to mediate sexual arousal beyond that induced by direct tactile stimulation of the genital area, might play a role. Although the right hemisphere regions of significant neuroarchitectural correlates of xenomelia are part of a network reportedly subserving body ownership, it remains unclear whether the structural alterations are the cause or rather the consequence of the long-standing and pervasive mismatch between body and self.
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Old 2nd February 2013, 04:52 PM
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Default Re: Amputate healthy limb? (Apotemnophilia)

This limb is mine but I do not want it: from anatomy to body ownership
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Old 26th August 2013, 04:34 PM
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Default Re: Amputate healthy limb? (Apotemnophilia)

Neural Basis of Limb Ownership in Individuals with Body Integrity Identity Disorder
Milenna T. van Dijk, Guido A. van Wingen, Anouk van Lammeren, Rianne M. Blom, Bart P. de Kwaasteniet, H. Steven Scholte, Damiaan Denys
PLoS ONE 8(8): e72212. doi:10.1371/journal.pone.0072212

Quote:
Our body feels like it is ours. However, individuals with body integrity identity disorder (BIID) lack this feeling of ownership for distinct limbs and desire amputation of perfectly healthy body parts. This extremely rare condition provides us with an opportunity to study the neural basis underlying the feeling of limb ownership, since these individuals have a feeling of disownership for a limb in the absence of apparent brain damage. Here we directly compared brain activation between limbs that do and do not feel as part of the body using functional MRI during separate tactile stimulation and motor execution experiments. In comparison to matched controls, individuals with BIID showed heightened responsivity of a large somatosensory network including the parietal cortex and right insula during tactile stimulation, regardless of whether the stimulated leg felt owned or alienated. Importantly, activity in the ventral premotor cortex depended on the feeling of ownership and was reduced during stimulation of the alienated compared to the owned leg. In contrast, no significant differences between groups were observed during the performance of motor actions. These results suggest that altered somatosensory processing in the premotor cortex is associated with the feeling of disownership in BIID, which may be related to altered integration of somatosensory and proprioceptive information.
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Old 27th August 2013, 02:06 PM
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Default Re: Amputate healthy limb? (Apotemnophilia)

Quote:
Originally Posted by Craig Payne View Post
I recall an episode of Law & Order on this .... the plot was based on a "back street" surgeon performing these operation to amputate limbs for those with this condition...but one of them died :(
Finally found more on this episode: http://allisonleotta.com/2012/05/svu...trange-beauty/

Also Apotemnophlilia is more of a sexual disorder; wanting to have a limb removed for psychological/psychiatric reasons is really 'Body Integrity Identity Disorder'

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Old 28th October 2013, 10:04 PM
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Default Re: Amputate healthy limb? (Apotemnophilia)

The Patient Requesting Amputation
Thomas M. Dunn, Ryan M. Moroze
Open Journal of Medical Psychology, 2013, 2, 193-196
Quote:
Although infrequent, there are patients who present themselves to surgeons and ask that a limb be amputated. Generally, such patients fall into one of three categories. The first is those suffering from “Body Integrity Identity Disorder” (BIID), a condition in which individuals feel that one of their limbs is foreign to the rest of their body, and must be re- moved. The second category is Apotemnophilia, a fetishized desire to become an amputee to enhance sexual gratifica- tion. Such drive for sexual gratification may lead to requests for amputation. Finally, the third category is delusional beliefs secondary to severe mental illness that may compel an individual to seek amputation, or even attempt self-amputation. We present a fourth type of patient: the Global War on Terrorism veteran with a severely injured arm demanding amputation to fit in with others who use prosthetic devices. In this instance, the cause of injury was a motor vehicle collision. We speculate that our case is not the only one and that a fourth category of patient demanding ampu- tation is emerging. Further study is needed.
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Old 6th November 2013, 06:56 AM
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Default Re: Amputate healthy limb? (Apotemnophilia)

http://www.abc.net.au/catalyst/stories/2576978.htm

This episode of catalyst gives a good insight into some of the issues. If I recall correctly it also contains an experiment that demonstrates how the brain can be "tricked" about body image, quite simply.

Cheers
Greg
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Old 4th April 2014, 06:05 AM
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Default Re: Amputate healthy limb? (Apotemnophilia)

Is the desire for amputation related to disturbed emotion processing? A multiple case study analysis in BIID
Gabriella Bottinia, Peter Brugger & Anna Sedda
Neurocase: The Neural Basis of Cognition
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Body integrity identity disorder (BIID) is characterized by the overwhelming desire to amputate one or more healthy limbs or to be paraplegic. Recently, a neurological explanation of this condition has been proposed, in part on the basis of findings that the insular cortex might present structural anomalies in these individuals. While these studies focused on body representation, much less is known about emotional processing. Importantly, emotional impairments have been found in psychiatric disorders, and a psychiatric etiology is still a valid alternative to purely neurological accounts of BIID. In this study, we explored, by means of a computerized experiment, facial emotion recognition and emotional responses to disgusting images in seven individuals with BIID, taking into account their clinical features and investigating in detail disgust processing, strongly linked to insular functioning. We demonstrate that BIID is not characterized by a general emotional impairment; rather, there is a selectively reduced disgust response to violations of the body envelope. Taken together, our results support the need to explore this condition under an interdisciplinary perspective, taking into account also emotional connotations and the social modulation of body representation.
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Old 11th July 2014, 10:12 PM
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Default Re: Amputate healthy limb? (Apotemnophilia)

Apotemnophilia, body integrity identity disorder or xenomelia? Psychiatric and neurologic etiologies face each other
Sedda A, Bottini G
Neuropsychiatric Disease and Treatment 2014, 10:1255-1265
Quote:
This review summarizes the available studies of a rare condition in which ­individuals seek the amputation of a healthy limb or desire to be paraplegic. Since 1977, case reports and group studies have been produced, trying to understand the cause of this unusual desire. The main etiological hypotheses are presented, from the psychological/psychiatric to the most recent neurologic explanation. The paradigms adopted and the clinical features are compared across studies and analyzed in detail. Finally, future directions and ethical implications are discussed. A proposal is made to adopt a multidisciplinary approach that comprises state-of-the-art technologies and a variety of theoretical models, including both body representation and psychological and sexual components.
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