Body Integrity Identity Disorder, or BIID, is a term used to describe a mental health issue. It's like that neglected book on your shelf—not talked about often.

Even though researchers are constantly learning new things about the mind, BIID is still somewhat of a mystery. It's similar to attempting to solve a riddle without all the answers.

People's perceptions of their bodies and self are affected by BIID, leaving people perplexed. Attempting to fit a square peg into a circular hole is analogous.

BIID serves as a reminder that despite the rapid advancements in our understanding of the mind, much remains to be discovered.

What is BIID?

Body Integrity Identity Disorder (BIID), also known as Apotemnophilia or Xenomelia or Body integrity dysphoria.

It is a psychiatric condition characterized by an intense and persistent desire for the amputation of one or more healthy limbs or the desire for other forms of physical impairment.

Individuals with BIID often experience significant distress and impairment in social and occupational functioning due to their incongruent body image.

It seems that somatoparaphrenia and BIID are connected. Individuals who have this illness may identify as transabled.

Clinical Characteristics

A strong and ongoing desire for limb amputation or other types of physical disability are common clinical presentations of BIID.

Major symptoms include:

• Strong desire for limb removal or physical disability

• Severe pain or sensation of bodily misalignment

• Exhaustion from concealing true emotions

• Acting disabled, potentially leading to self-harm or self amputation

• Varied symptom severity for each individual

• Feeling unfulfilled with current physical state

• Anxiety from appearance-self-image mismatch

• Depression due to inability to live authentically without alteration

• Obsession with desires hindering enjoyment and relationships

What is the etiology?

Several theories have been put out to explain the genesis of BIID, but its etiology is still poorly understood.

According to some experts, BIID could be caused by disruptions in the brain's representation of the body, which would result in a mismatch between the person's perceived and actual physical bodies.

BIID is thought to be associated with early childhood trauma, obsessive-compulsive behaviors, and an excessive identification with amputees. According to professionals.

Some suggest psychological elements as possible causes of BIID, such as identity problems or early trauma. To clarify the underlying mechanics of this illness, more research is necessary.

How it is diagnosed?

Psychiatric classification systems like the DSM-5 and ICD-10 do not clearly define the diagnostic criteria for BIID.

But to diagnose BIID, medical professionals may use on psychiatric testing, clinical interviews, and observation of behaviors and suffering associated with the urge to amputate a leg.

Body integrity identity disorder is diagnosed and classified under "body integrity dysphoria" in the International Classification of Diseases (ICD-11). In medical practice, the ICD is a useful tool for physicians to recognize and categorize a range of illnesses.

Therapeutic Strategies

Since there is no proven cure for BIID, managing the illness presents considerable difficulties.

Psychotherapy, in particular acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT), may be helpful in assisting people in managing their wants in a more healthy way and coping with the discomfort associated with BIID.

Surgical therapies, including elective amputation, on the other hand, have no scientific evidence to support their effectiveness and are contentious and ethically challenging.

Using a wheelchair or crutches, or donning a prosthesis may help.
living as though you were missing a physical part by using virtual reality. Sometimes SSRIs are prescribed in medications to treat the symptoms of depression.

Recent Findings

BIID usually appears in childhood, motivated by a need for fulfillment or wholeness.

Even though serious mental illnesses are uncommon, the distress that BIID produces can lead to depressive symptoms. The clinical aspects of the paralysis and amputation variations are similar.

In affected patients, surgery greatly improves quality of life and reduces impairment, indicating that both variations are expressions of the same illness.

In order to provide BIID patients with appropriate care and reduce their difficulties, it is imperative to comprehend and honor their desires.

According to the study, in contrast to controls, people with BIID had bigger volumes in the cerebellum (lobule VIIa) and smaller volumes in particular regions of the left premotor cortex.

These areas are critical for the experience of multisensory integration and bodily ownership.

According to this research, BIID may result from structural brain abnormalities and a breakdown in multisensory integration, which could explain why people perceive a discordance between their physical and mental body shapes.

Although it's unclear if it occurs before symptom intensity, gray matter atrophy in BIID is correlated with compensatory actions. 

Clear boundaries are seen in specific brain areas associated with dysphoria, where lower skin conductance responses are observed under the intended amputation location.

Amputation desire is not primarily motivated by concerns about appearance, unlike body dysmorphic disorder.

One patient reinforced their sense of acceptance by others by prioritizing conforming to their perceived body image over any barriers in relationships and day-to-day living.

According to research, BIID may result from changes in brain anatomy, specifically in the right superior parietal lobule (rSPL), which is linked to a greater desire for amputation. 

Virtual reality and other experimental methods, such as the disappearing limb trick, provide momentary respite from this craving and point to possible non-invasive treatment paths.

Moreover, abnormalities in brain connections, such as those involving the mirror system and limbic regions, could be a factor in the over-identification with amputees.

When analyzing self-reported childhood recollections, care might need to be used. Furthermore, a potential advancement of obsessive features in BIID is suggested by increased fractional anisotropy (FA) in areas associated with reward processing and obsessive-compulsive tendencies.

Similarities have been noted between BIID and disorders such as anorexia, gender dysphoria, and schizophrenia, for which surgery is not recommended because of possible risks, according to Edwards et al.

The patient in this study saw parallels between his experience and those of those having surgery for gender dysphoria, recognizing characteristics similar to PTSD.

Ethical Issues to Take Into Account

The process of deciding whether to undergo elective amputation and other surgical procedures is at the center of the ethical issues surrounding BIID.

Healthcare professionals must carefully balance the beneficence and nonmaleficence principles with the autonomy of the person with BIID, taking into account the possible dangers and advantages of such operations.

Informed permission, capacity evaluation, and the long-term effects of surgical treatments are additional concerns that need to be carefully considered when making ethical decisions.

In Summary

A recurrent desire for limb amputation or other physical harm is a hallmark of Body Integrity Identity Disorder, an uncommon and complex psychiatric state.

Healthcare professionals must work to offer compassionate and comprehensive care for people with BIID, taking into account both their psychological discomfort and the ethical ramifications of proposed interventions, despite the paucity of knowledge regarding its genesis and treatment obstacles.