Paralyzed by Desire: A New Type of Body Integrity Identity Disorder

Experimental Neuropsychology Research Unit, School of Psychology and Psychiatry, Monash University, Clayton, Victoria, South Australia, Australia.
Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology (Impact Factor: 0.95). 02/2012; 25(1):34-41. DOI: 10.1097/WNN.0b013e318249865a
Source: PubMed


Body incongruity in body integrity identity disorder (BIID) manifests in the desire to have a healthy limb amputated. We describe a variant of the disorder: the desire to become paralyzed (paralysis-BIID).
Sixteen otherwise healthy participants, recruited through Internet-based forums, websites, or word of mouth, completed questionnaires about details of their desire and accompanying symptoms.
Onset of the desire for paralysis typically preceded puberty. All participants indicated a specific level for desired spinal cord injury. All participants simulated paralysis through mental imagery or physical pretending, and 9 (56%) reported erotic interest in paraplegia and/or disability. Our key new finding was that 37.5% of paralysis-BIID participants were women, compared with 4.4% women in a sample of 68 individuals with amputation-BIID.
BIID reflects a disunity between self and body, usually with a prominent sexual component. Sex-related differences are emerging: unlike men, a higher proportion of women desire paralysis than desire amputation, and, while men typically seek unilateral amputation, women typically seek bilateral amputation. We propose that these sex-related differences in BIID manifestation may relate to sex differences in cerebral lateralization, or to disruption of representation and/or processing of body-related information in right-hemisphere frontoparietal networks.

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    • "individuals who seek a unilateral amputation of the leg versus individuals who seek a unilateral amputation of the arm). Further, knowledge about BIID would greatly profit from the inclusion of variants, in which subjects do not seek amputation of the limb but rather paraplegia (Giummarra et al. 2012). One might reason that this is a different form of body violation, and thus it might induce different responses to disgust related images as well. "
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    ABSTRACT: Body integrity identity disorder (BIID) is characterized by the overwhelming desire to amputate one or more healthy limbs or to be paraplegic. Recently, a neurological explanation of this condition has been proposed, in part on the basis of findings that the insular cortex might present structural anomalies in these individuals. While these studies focused on body representation, much less is known about emotional processing. Importantly, emotional impairments have been found in psychiatric disorders, and a psychiatric etiology is still a valid alternative to purely neurological accounts of BIID. In this study, we explored, by means of a computerized experiment, facial emotion recognition and emotional responses to disgusting images in seven individuals with BIID, taking into account their clinical features and investigating in detail disgust processing, strongly linked to insular functioning. We demonstrate that BIID is not characterized by a general emotional impairment; rather, there is a selectively reduced disgust response to violations of the body envelope. Taken together, our results support the need to explore this condition under an interdisciplinary perspective, taking into account also emotional connotations and the social modulation of body representation.
    Full-text · Article · Mar 2014 · Neurocase
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    • "Relatively large-scale surveys and interview studies (First, 2005, n = 52; Blanke et al., 2009, n = 20; Johnson et al., 2011, n = 97) agree that most subjects with xenomelia are male (90, 85 and 84%, respectively, in the three aforementioned references); the majority desires a leg amputation (73, 80 and 81%, respectively), and the ratio of left-to right-sided target limbs clearly favours the former (55% to 27%, 60% to 20% and 42% to 28%, respectively). A considerable minority of persons with xenomelia desire a bilateral amputation (18, 20 and 30%, respectively), a figure that is probably even higher among affected females (Giummarra et al., 2012). While earlier conceptualizations of xenomelia as a sexual paraphilia (Money et al., 1977) or an erotically motivated urge for amputation (Sue, 1785) appear outdated, we and others have proposed that the condition may be due to an under-representation of the target limb in the right parietal cortex (Hilti and Brugger, 2010; Brang et al., 2008). "
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    ABSTRACT: Xenomelia is the oppressive feeling that one or more limbs of one's body do not belong to one's self. We present the results of a thorough examination of the characteristics of the disorder in 15 males with a strong desire for amputation of one or both legs. The feeling of estrangement had been present since early childhood and was limited to a precisely demarcated part of the leg in all individuals. Neurological status examination and neuropsychological testing were normal in all participants, and psychiatric evaluation ruled out the presence of a psychotic disorder. In 13 individuals and in 13 pair-matched control participants, magnetic resonance imaging was performed, and surface-based morphometry revealed significant group differences in cortical architecture. In the right hemisphere, participants with xenomelia showed reduced cortical thickness in the superior parietal lobule and reduced cortical surface area in the primary and secondary somatosensory cortices, in the inferior parietal lobule, as well as in the anterior insular cortex. A cluster of increased thickness was located in the central sulcus. In the left hemisphere, affected individuals evinced a larger cortical surface area in the inferior parietal lobule and secondary somatosensory cortex. Although of modest size, these structural correlates of xenomelia appear meaningful when discussed against the background of some key clinical features of the disorder. Thus, the predominantly right-sided cortical abnormalities are in line with a strong bias for left-sided limbs as the target of the amputation desire, evident both in our sample and in previously described populations with xenomelia. We also propose that the higher incidence of lower compared with upper limbs (∼80% according to previous investigations) may explain the erotic connotations typically associated with xenomelia, also in the present sample. These may have their roots in the proximity of primary somatosensory cortex for leg representation, whose surface area was reduced in the participants with xenomelia, with that of the genitals. Alternatively, the spatial adjacency of secondary somatosensory cortex for leg representation and the anterior insula, the latter known to mediate sexual arousal beyond that induced by direct tactile stimulation of the genital area, might play a role. Although the right hemisphere regions of significant neuroarchitectural correlates of xenomelia are part of a network reportedly subserving body ownership, it remains unclear whether the structural alterations are the cause or rather the consequence of the long-standing and pervasive mismatch between body and self.
    Full-text · Article · Dec 2012 · Brain
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    • "The recognition that one's limb is " over-present " or " over-able " typically emerges during early childhood or puberty (First 2005). The target limb is usually physically and functionally normal and even attractive (although see: Blanke et al. 2009; Giummarra et al. 2011), and diagnostic criteria have excluded the presence of psychotic disorder (Ryan 2009; Schlozman 1998). A minority of individuals with BIID proceed to the realization of the desire, and isolated reports testify a subjective increase in quality of life (Braam and de Boer-Kreeft 2009; First 2005), although systematic post-amputation investigations are lacking. "
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    ABSTRACT: Body integrity identity disorder (BIID) is characterised by profound experience of incongruity between the biological and desired body structure. The condition manifests in "non-belonging" of body parts, and the subsequent desire to amputate, paralyse or disable a limb. Little is known about BIID; however, a neuropsychological model implicating right fronto-parietal and insular networks is emerging, with potential disruption to body representation. We argue that, as there is scant systematic research on BIID published to date and much of the research is methodologically weak, it is premature to assume that the only process underlying bodily experience that is compromised is body representation. The present review systematically investigates which aspects of neurological processing of the body, and sense of self, may be compromised in BIID. We argue that the disorder most likely reflects dysregulation in multiple levels of body processing. That is, the disunity between self and the body could arguably come about through congenital and/or developmental disruption of body representations, which, together with altered multisensory integration, may preclude the experience of self-attribution and embodiment of affected body parts. Ulimately, there is a need for official diagnostic criteria to facilitate epidemiological characterisation of BIID, and for further research to systematically investigate which aspects of body representation and processing are truly compromised in the disorder.
    Full-text · Article · Nov 2011 · Neuropsychology Review
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