Many people are unhappy with aspects their appearance or parts of their body. For people with Body Integrity Identity Disorder their distress is much more serious, as they believe that parts of their body literally do not belong to them – and may see amputation as the only cure.
Body Integrity Identity Disorder is perhaps most commonly seen as the persistent feeling that a limb is an alien or foreign part of the body, and the belief that only the removal of the limb will relieve the psychological discomfort. However it is not just restricted to a desire to amputate limbs, but can also encompass other drives to permanently alter the integrity of the physical body, including the wish to become deaf, blind, or paralysed.
Understandably Body Integrity Identity Disorder can be extremely difficult to live with. Sufferers may cope through pretending to be an amputee – they may use a wheelchair or crutches, and may even use tourniquets or contort their body in order to lose sensation in the affected part of the body. A more drastic step is the use of self-harm to remove parts of the body, or to damage them to the extent that they require amputation or removal on medical grounds.
Ethical considerations prevent amputation on purely elective grounds, and so the only option for someone with Body Integrity Identity Disorder is psychological treatment. But what are the causes of such a fundamental break between the mental image and the physical reality of the body?
Firstly the cause isn’t sexual in origin. Whilst there is a paraphilia (the need for an unusual condition to be met in order to achieve sexual arousal) based on being or resembling an amputee, called apotemnophilia, it isn’t commonly seen in people with Body Integrity Identity Disorder.
One theory sees it as having psychological origins. For instance the person with Body Integrity Identity Disorder may have met or seen an amputee at an early age, and have incorporated the idea of them as an ideal person. Whether this is because of the amputee’s personal qualities, or because of the extra attention and care they might receive, remains a moot point.
Other explanations are based on psychological delusions about limbs – somatoparaphrenia and asomatognosia. Somatoparaphrenia is the delusion that a limb, or even an entire side of the body, does not belong to the person affected. Even when faced with proof that the limb is their own those affected will construct elaborate explanations to maintain their delusion. Asomatognosia, which more usually follows paralysis, is similar in the person’s non-acceptance of the limb or side of the body, but sees them accept the reality of the situation when presented with proof.
Both of these delusions also point to a neurological explanation of Body Integrity Identity Disorder. In this the brain’s body mapping ability, located in the right parietal lobe, is incomplete, and so fails to recognise the affected limb or body part. Whatever the cause, research into Body Integrity Identity Disorder and its treatment is starting to lead not just to a better understanding of the brain’s body mapping, but is also adding to the understanding of phantom limb pain.
Between two thirds and three quarters of all amputees experience phantom sensations seemingly originating in the absent body part. The vast majority of these sensations are reported as being painful, but fortunately the pain is normally intermittent, and reduces in intensity and frequency over time. No single treatment has emerged as particularly effective for phantom limb pain but two of the latest techniques, based around the understanding of the brain’s body mapping, seem to be promising.
The first is the use of visualisation to learn to move the phantom limb into impossible positions, and the second involves the use of a mirror box, with the reflection replacing the missing limb. Both of these use re-learning the control and feedback signals from the missing body part to repair the body map and remove the anomalies that are experienced as pain.
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