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Life Without Limbs: Apotemnophilia

What would life without your limbs? Imagine having an uncontrollable urge to amputate your healthy leg. Imagine having the desire to cut off your hand that does so much for your body. Our hands and legs make every function more efficient and more accessible, from eating to writing and even little things like brushing our teeth. Why would anyone want to do such a thing? This is precisely what people suffering from Apotemnophilia go through. Apotemnophilia is also known as Body Integrity Identity dysphoria (BIID). It is a condition wherein the person has an uncontrollable urge or desire to amputate a healthy limb. An individual suffering from this disorder feels uncomfortable in his or her average body and wants to be disabled. Have you heard of such rare psychological conditions as BIID?

While there aren’t many studies conducted on BIID symptoms, the most common symptom is an uncontrollable urge to amputate a healthy limb that begins manifesting itself in the early teenage years. The patient, in this case, might also face symptoms and other disorders such as extreme stress, depression, or anxiety. In some cases, patients can also have a sense of sexual arousal attached to the loss of a limb. Due to ethical considerations, professionals refuse to amputate a perfectly healthy limb. It makes patients with BIID obligated to try and amputate it themselves. Some patients try to damage an arm or leg to such an extent that the surgeon has no choice but to amputate it. BIID is also compared to body dysmorphia. The subjects think negatively about their bodies as agents that hamper their quality of life. Eating disorders such as Anorexia Nervosa are also linked with BIID showing similar symptoms of starvation or hampering the body’s regular functioning.

Psychologists and neurologists study the underlying cause behind Body Integrity Dysphoria and shed light on the disconnect between the brain and its ability to map the body. Apotemnophilia is a subject of ongoing research. Therefore the reasons are ambiguous. However, a study conducted with a small sample size of participants who had BIID related to their left leg showed through an MRI that they had a decreasing grey matter in the right side of their superior parietal lobule. The amount of missing grey matter was correlated to the strength or desire of the patient to have their leg amputated. Research suggests that the cause behind BIID and this unusual desire is essentially due to the patient’s belief that their target limb may not belong to them. Psychologists also believe that this can stem from childhood trauma, obsessive-compulsive tendencies, sexual arousal, or over-identification.

Treatment for BIID has not been developed. Therefore, standard therapies are not available. However, conventional treatment methods such as selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy is used to treat patients with Apotemnophilia. Antidepressants are also commonly used to reduce the symptoms of depression and stress; however, they do not treat the urge to become an amputee or desire for amputation. Still, there are several debates on the effectiveness of BIID treatment and the ethical considerations regarding surgeons amputating healthy limbs.

As humans, we may experience inevitable disappointment or frustration with their physical appearance from time to time. We may look up to our peers or colleagues and view their bodies as ‘perfect’. Whereas ours may seem ‘imperfect’ or flawed. This feeling of insecurity as humans is expected. However, for individuals with BIID, it goes much deeper. This condition makes those who suffer from it feel as if their limb is disconnected and extraneous. Imagine living with the fear that your arm or leg does not belong to you. Would this cause you anxiety?

Patients with Apotemnophilia have to live with this thought haunting them each day. Ethical considerations surrounding BIID also raise issues regarding personal autonomy and informed consent. Psychologists are working towards incorporating BIID into the Diagnostic and Statistical Manual (DSM) to be recognized as a mental illness, bereft of judgement. Increased awareness about Apotemnophilia is needed for patients diagnosed or those in support of it so that there is development for more effective treatments and possibly a cure.

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