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Doctor, I am perfectly healthy. Cut my leg off and make me happy.


Mr. Bumble

Well-known member
Joined
Sep 7, 2010
Messages
18,254
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.”

Further reading:
  1. A philophical discussion on the ethics of amputation for BIID patients: http://users.ox.ac.uk/~sfop0174/biid.pdf
  2. 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.

Some questions:

  • 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?
 

NYCKY

Moderator
Joined
Apr 17, 2010
Messages
13,101
I remember reading about the Scottish surgerys some years ago. Thankfully this is a rare disorder.
 

ruserious

Well-known member
Joined
Jan 3, 2011
Messages
29,597
Best to get them to a shrink asap. This is a psycological issue clearly, and cutting off legs and arms to satisfy that need is not solving the problems as it will just inspire more people to do likewise.
If a person gets over their BIID through psycho-treatment, then I'm sure they would be happier than they would if they had their arms taken off whilst suffering the condition.
 

Icemancometh

Well-known member
Joined
May 24, 2007
Messages
335
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.”

Further reading:
  1. A philophical discussion on the ethics of amputation for BIID patients: http://users.ox.ac.uk/~sfop0174/biid.pdf
  2. 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.

Some questions:

  • 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?
I don't think you can offer surgery to prevent people performing their own amputations. It seems too much like blackmail, as though the threat of autoamputation is being held over you. Moreover, we allow elective surgery for cosmetic reasons, why not for psychological ones? Without involving the broader discussion of GID, people have serious procedures every day to improve their quality of life, not their health (if you narrow the definition of health to life expectancy). Provided a complete psychiatric assessment and a complete psychological assessment, I see no reason why this procedure shouldn't be allowed.

With regards to primum non nocere, I think that belongs to an older age. A large proportion of treatments these days have the potential for great harm. Besides which, I always viewed it as quite paternalistic. Given a more patient centred approach, the duty is shifted to giving the patient all the information, and allowing them to make an informed decision. As long as they have capacity, I don't see a problem with that approach.
 

Hitch 22

Well-known member
Joined
Dec 26, 2011
Messages
5,220
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.”

Further reading:
  1. A philophical discussion on the ethics of amputation for BIID patients: http://users.ox.ac.uk/~sfop0174/biid.pdf
  2. 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.

Some questions:

  • 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?
If it makes them happy sure why not?



She's smiling isn't she?:D

STOP BEING BIGOTED AND IGNORANT!

[video=youtube;DA43DS2c12c]http://www.youtube.com/watch?v=DA43DS2c12c&feature=related[/video]
 

Mr. Bumble

Well-known member
Joined
Sep 7, 2010
Messages
18,254
Best to get them to a shrink asap. This is a psycological issue clearly, and cutting off legs and arms to satisfy that need is not solving the problems as it will just inspire more people to do likewise.
If a person gets over their BIID through psycho-treatment, then I'm sure they would be happier than they would if they had their arms taken off whilst suffering the condition.
Psychotherapy is largely ineffective as a treatment.
 

Icemancometh

Well-known member
Joined
May 24, 2007
Messages
335
Psychotherapy is largely ineffective as a treatment.
Not exactly my field, but there are people doing good work with cognitive behavioural therapy. I'm told it gets good results, particularly for anxiety disorders. Not aware of the evidence myself though.
 

Mr. Bumble

Well-known member
Joined
Sep 7, 2010
Messages
18,254
Not exactly my field, but there are people doing good work with cognitive behavioural therapy. I'm told it gets good results, particularly for anxiety disorders. Not aware of the evidence myself though.
Yes, you're right, CBT is very helpful for anxiety disorders, but I don't think that BIID would be classified as an anxiety disorder. The literature and research, such as it is, is clear that therapy has limited impact.
 
D

Dylan2010

Wont these people need more nursing care in their old age, if they pay it fine but the taxpayer should not be responsible. They should probably pay for the operation to boot
 

Mr. Bumble

Well-known member
Joined
Sep 7, 2010
Messages
18,254
Wont these people need more nursing care in their old age, if they pay it fine but the taxpayer should not be responsible. They should probably pay for the operation to boot
Well if it is considered necessary treatment, then one could argue that they are entitled to it as much as a person with diabetes would be entitled to necessary amputation.

"To boot'!!!!
 

Icemancometh

Well-known member
Joined
May 24, 2007
Messages
335
Yes, you're right, CBT is very helpful for anxiety disorders, but I don't think that BIID would be classified as an anxiety disorder. The literature and research, such as it is, is clear that therapy has limited impact.
Agreed.
 

Mr. Bumble

Well-known member
Joined
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Messages
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Mr. Bumble

Well-known member
Joined
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Messages
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Hitch 22

Well-known member
Joined
Dec 26, 2011
Messages
5,220
There was a really weird movie released back in 1993 about a surgeon who falls for a beautiful woman who rejects him. However after she is a victim of a hit and run he hides her in his house and amputates her legs to save her life. He later amputates her healthy arms and keeps her captive as his own living Venus De Milo. Totally f*cked up but worth a look if you like that sort of thing.

[video=youtube;5E25Wk_owBI]http://www.youtube.com/watch?v=5E25Wk_owBI[/video]
 
D

Dylan2010

Well if it is considered necessary treatment, then one could argue that they are entitled to it as much as a person with diabetes would be entitled to necessary amputation.

"To boot'!!!!
"one boot"

I havnt read the details but it is up there with tax funded plastic surgery for cosmetic reasons. Sometimes you need to say no!

Is there any evidence for this in history?
 

Mr. Bumble

Well-known member
Joined
Sep 7, 2010
Messages
18,254
"one boot"

I havnt read the details but it is up there with tax funded plastic surgery for cosmetic reasons. Sometimes you need to say no!

Is there any evidence for this in history?
Yup. If you click on the Plos link in the OP, you'll be able to read research done on BIID. It's very interesting.
 

nakatomi

Well-known member
Joined
Apr 10, 2010
Messages
3,729
Why is there a thread on this?

Seriously...?
I think there are important ethical questions, many people have had surgery for "psychological" reasons and are cured of their ailment once the offending limb has been amputated.
I had a 50+ year old patient stick his leg in dry ice for four hours because he did not want his leg. The problem was that the debris that washed from his thawing leg nearly killed him, trashed his kidneys lungs and brain.

It also seems to me that surgery for BIID seems to be more successful than surgery for transgenderism.
 
Last edited:

bluefirelog

Well-known member
Joined
Jun 28, 2011
Messages
2,772
Never heard about this condition before Bumble and I can't be bothered to read the detail in the article. Instinctively it seems very wrong. Good thing it's rare. In principle, without knowing more, I'd say that if I was a surgeon, I wouldn't perform that surgery. The person needs psychiatric treatment in my opinion, not the removal of healthy limbs. To me, the removal of healthy limbs to treat a psychiatric condition is wrong.
 
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