On another thread I got involved in an interesting discussion (thanks Nakatomi, Bill, Des Squirrel et al) regarding the similarities and differences between Gender Identification Disorder (GID) which is essentially transexualism, and Body Image Integrity Disorder (BIID).
BIID is a rare mental illness that has no classification in DSM IV (TR) or ICD-10 so there is no standardised diagnostic criteria, yet it is an accepted and recognised mental illness. Little research has been done on the condition but this paper PLOS ONE: Body Integrity Identity Disorder is an excellent attempt to describe and understand the condition. They propose that BIID exists where people "feel their body-image does not match with their body shape. When we use the term “BIID” or “BIID feelings” here we mean to indicate all these different forms of the condition. For example, some people would like to have their leg to be amputated under their knee, whereas others prefer to resemble someone who is paralysed.”
- A philophical discussion on the ethics of amputation for BIID patients: http://users.ox.ac.uk/~sfop0174/biid.pdf
- An online resource for people with BIID: Body Integrity Identity Disorder
Essentially, the person feels that they would be much happier paralysed or as an amputee. While in some cases there is a sexual arousal element to this desire to be paralysed/an amputee, the primary motivation is to feel complete or ‘satisfied inside’. BIID patients have higher levels of anxiety and depression, and functioning is inhibited by obsessive thinking about amputation/paralysis. Medication and therapy can help to ameliorate the symptoms of depression and anxiety but they do not provide long term relief. However, amputation seems to provide long term remission from BIID and significant improvement in quality of life. Essentially, patients are significantly happier.
Some people with BIID will deliberately damage their limb by crushing it under a car or immersing it in dry ice for hours thus necessitating amputation. Some patients have tried using homemade guillotines. In 2000 a Scottish surgeon removed healthy limbs from two people who had BIID. No such elective surgery has been perfomed in Britain since.
- Is it moral and ethical to amputate a healthy limb?
- What of medicine’s prime directive Primum Non Nocere (“first, do no harm”)?
- How do you weigh the pain of surgery and permanent disfigurement and disability against persistent psychological distress?
- Is it better to offer surgery rather than force people to try to amputate a limb themselves?