Out on a Limb: The Ethical Management of Body Integrity Identity Disorder

  title={Out on a Limb: The Ethical Management of Body Integrity Identity Disorder},
  author={Chris Ryan},
  • C. Ryan
  • Published 1 April 2009
  • Medicine
  • Neuroethics
Body integrity identity disorder (BIID), previously called apotemnophilia, is an extremely rare condition where sufferers desire the amputation of a healthy limb because of distress associated with its presence. This paper reviews the medical and philosophical literature on BIID. It proposes an evidenced based and ethically informed approach to its management. Amputation of a healthy limb is an ethically defensible treatment option in BIID and should be offered in some circumstances, but only… 
Body integrity identity disorder: response to Patrone
Body integrity identity disorder (BIID) is a very rare condition in which people experience long-standing anguish because there is a mismatch between their bodies and their internal image of how
Disfigured anatomies and imperfect analogies: body integrity identity disorder and the supposed right to self-demanded amputation of healthy body parts
This paper criticises the appropriateness of the particular analogies that are thought to shed light on the allegedly unproblematical nature of BIIDs demands and argues that a proper understanding of the respect for autonomy in the medical decision-making context prohibits agreeing to BIID demands for amputation.
Patrone Body integrity identity disorder: response to
2,3Body integrity identity disorder (BIID) is a very rarecondition in which people experience long-standinganguish because there is a mismatch between theirbodies and their internal image of how
[Body Integrity Identity Disorder (BIID): interrogation of patients and theories for explanation].
  • E. Kasten
  • Psychology
    Fortschritte der Neurologie-Psychiatrie
  • 2009
The article disputes the question of matching personality characteristics of these subjects and asks for motives, and investigates whether the concerned limb showed more affections after amputation of a limb.
Body Integrity Identity Disorder Beyond Amputation: Consent and Liberty
  • Amy E. White
  • Medicine
    HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues
  • 2014
It is argued that persons suffering from Body Integrity Identity Disorder (BIID) can give informed consent to surgical measures designed to treat this disorder, even if the surgery seems radical or irrational to most people.
Body Integrity Identity Disorder: The Persistent Desire to Acquire a Physical Disability
BIID is a unique nosological entity with significant consequences for its sufferers and as such may warrant inclusion in some form in the forthcoming DSM-5 and ICD-11.
Body integrity identity disorder using augmented reality: a symptom reduction study
Preliminary results suggest the existence of a possible therapeutic and diagnostic potential that AR possesses, which warrants further consideration within clinical healthcare settings.
No harm, no foul? Body integrity identity disorder and the metaphysics of grievous bodily harm
Three separate contemporary models of harm are sought to clarify: the counter-temporal, the counterfactual, and the non-comparative, which will be applied to the scenario of a BIID-induced, therapeutic, healthy limb amputation and in each, how harm may be understood to have been caused will be explored.
Elective Impairment Minus Elective Disability: The Social Model of Disability and Body Integrity Identity Disorder
  • R. Gibson
  • Medicine
    Journal of Bioethical Inquiry
  • 2019
This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID, using the social model of disability as a means to separate the concept of impairment and disability.
Consent, Autonomy, and the Benefits of Healthy Limb Amputation: Examining the Legality of Surgically Managing Body Integrity Identity Disorder in New Zealand
Upon first consideration, the desire of an individual to amputate a seemingly healthy limb is a foreign, perhaps unsettling, concept. It is, however, a reality faced by those who suffer from body


Amputees by choice: body integrity identity disorder and the ethics of amputation.
It is argued that if patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder, such operations might be permissible, and surgeons ought to be allowed to accede to their requests.
Self-Amputation of a Healthy Hand: A Case of Body Integrity Identity Disorder
Healthy limb amputation: ethical and legal aspects.
Surgeons should exercise great caution before complying with a request to amputate a healthy limb, as long as there is no established body of medical opinion as to the diagnosis and treatment of such a condition.
Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder
  • M. First
  • Medicine, Psychology
    Psychological Medicine
  • 2004
The preliminary results suggest the existence of an extremely unusual clinically distinct condition characterized by a lifelong desire to have an amputation of a particular limb associated with serious negative consequences: amputation attempts, impairment and marked distress.
[Apotemnophilia as a contemporary frame for psychological suffering].
The idea that BIID can be considered as a culture-bound syndrome, a contemporary frame for psychological suffering is supported, despite the fact that it does not have neither intrinsic nor unequivocal psychopathological meaning.
Investigation of the Syndrome of Apotemnophilia and Course of a Cognitive-Behavioural Therapy
The model designed in the current cognitive behavioural approach may serve as a starting point for further development of intervention protocols for this rare disorder.
Clinical and Theoretical Parallels Between Desire for Limb Amputation and Gender Identity Disorder
This model predicts that persons who desire limb amputation would almost always be attracted to amputees and would display an increased prevalence of gender identity problems, both of which have been observed.
Nonpsychotic, nonparaphilic self-amputation and the internet.
Apotemnophilia: Two cases of self‐demand amputation as a paraphilia
The findings in two cases show that self‐demand amputation (apotemnophilia) is related to erotization of the stump and to overachievement despite a handicap. The apotemnophiliac obsession represents