Psychiatric Politics: Body Integrity Identity Disorder (BIID)

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Psychiatric Politics: Body Integrity Identity Disorder (BIID)

Opinion - Guest Columns

Joanne Proctor

Saturday, 06 December 2008 16:00

Aotearoa (New Zealand). In its most extreme form apotemnophilia is characterized by individuals who experience a strong desire for the removal of healthy limbs. There is also a lesser form of the disorder. With the secondary variety apotemnophiliacs present as 'pretend' amputees, often going to considerable lengths to conceal limbs in attempt to appear as if the appendages had been removed. In BIID jargon the latter group are known as 'wannabes.'

Apotemnophiliacs use the term Amputee Identity Disorder (AID) to describe their fixations. The usage intentionally parallels the GID diagnosis in an apparent attempt to derive legitimacy by association. For example BIID discourse associates the desire for limb removal with male to female genital reconstruction, which is interpreted by BIID proponents as amputation of healthy tissue.

Apotemnophilia is the erotic interest in being or looking like an amputee (not to be confused with acrotomophilia, the erotic interest in having sex with people who are amputees).

In some extreme cases, apotemnophiliacs become so discontented with their bodies that they show a very strong interest in removing an otherwise healthy limb. Individuals can go so far as to seek surgeons to perform an amputation or purposefully injure a limb in order to force emergency medical amputation.

This subject has stimulated a great deal of interest among those with a variety of unrelated birth conditions that require surgical intervention (most prominently, misalignment of

brain and sex organs — alternatively known as HBS or "true" transsexuality).

The historically separate strands of Medicalization, Gender Studies, and Identity Politics have intersected.

For instance, advocates for apotemnophilia (commonly known as Body Integrity Identity Disorder — BIID) have attempted to enlarge the original definition of Gender Identity Disorder (GID) to include paraphiliac behaviors.

Many members of the HBS/TS population express the opinion that some BIID advocates assign apotemnophiliac motives to HBS correction as a way of legitimizing their own paraphilias.

In any case, the advocates of apotemnophilia willfully ignore the growing body of evidence indicating the physiological basis for HBS/"true" transsexualism.

This critique extends to autogynephilia, a term coined by Ray Blanchard that refers to what he considers "a man's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman".

Sharon Gaughan

& Lisa Jain Thompson

… apotemnophiliacs have constructed a comparative rationalization that parodies transgenderism, and associates BIID with primary or true (HBS) transsexualism.But apotemnophilia can extend way past limb removal. Sometimes spinal damage is requested because the BIID patient identifies as a paraplegic.

Castration may be demanded when a male targets his testicles as superfluous. Female apotemnophiliacs may request the removal of one or both breasts for the same reason.

To equate the disorder with GID (Gender Identity Disorder), apotemnophiliacs have constructed a comparative rationalization that parodies transgenderism, and associates BIID with primary or true (HBS) transsexualism. Their arguments do not recognize the pseudo-scientific nature of transgenderism, or that many, if not most, primary transsexuals regard it as irrelevant to their own experience.

As if to complete the parody, parallels are drawn between transsexualism (which they see as a form of BIID) and transvestism (as alike to wannabes). This is a cut from an Apotemnophilia website. (Note the use of "AID" or identity disorder, terminology.)

AID appears to develop in the early years, usually between the ages of 5 and 15. Most sufferers have a well-formed impression of their desired body image by the time they reach their teens.

And just a little further down:

Other groups of patients who may seek amputation include those with factitious disorder (Munchausen’s syndrome) and body dysmorphic disorder (BDD). Those with BDD perceive the limb as being defective in some way, in contrast to patients with AID who see the limb as being normal but extra to their perceived body image. It seems that AID patients are similar to those transsexuals who amputate their genitalia in order to achieve their desired body image. [N1]

The BIID parody has its champions. Self professed autogynephilic, Anne Lawrence, writes:

Body Integrity Identity Disorder (BIID), has sometimes been regarded as a paraphilia (apotemnophilia). BIID appears similar in some ways to gender dysphoria or transsexualism, which is termed Gender Identity Disorder (GID) in the DSM-IV. Persons with BIID and GID both experience a profound sense of wrong embodiment and seek surgical assistance to modify their bodies. [sic] [N2-3]

Both Lawrence and Ray Blanchard take an interest in BIID, which puts them in some fascinating company. An example is Dr Russel Reid. In 2007 Reid, an expatriate New Zealand psychiatrist, was forced to stop treating so-called Gender Identity Disorders at his London practice following a string of misdiagnoses. This is one of several examples reported by England's Guardian newspaper. [N4]

Patient D, who suffers from manic depression, told the GMC [General Medical Council] that Dr Reid failed to recognize that she had manic depression when he treated her.

She became wrongly convinced she needed a sex change after watching a TV documentary. The GMC heard that she eventually became so ill that she thought she needed a sex change in order to fulfill her delusion that she was Jesus.

The patient told the inquiry that she only avoided surgery to remove both her breasts - recommended by Dr Reid - because she was found wandering the streets naked and was sectioned.[Legally Committed].

Once in a psychiatric hospital, she was correctly diagnosed with manic depression and, after treatment, said she had no desire to change sex.

Dr Reid's treatment of her was found to be inappropriate, not in her best interests and contrary to international medical guidance. [N5]

Reid was involved in a BIID controversy in 2000, when he recommended two patients for non-essential amputations. Britain's Sunday Telegraph quotes Reid as saying,

I see transsexuals and they want healthy parts of their body removed in order to adjust to their idealized body image and so I think that was the connection for me. I saw that people wanted to have their limbs off with equally as much degree of obsession and need. [N6]

Clearly, Russel Reid has as much difficulty as Lawrence, Blanchard and the BIID community, in understanding that male to female genital reconstruction actually involves the fashioning of one living, functional, highly sensitive and sexually responsive organ from the tissue of another. Like them, he conveniently omits female to males from the equation. Genetic and neurobiological variation is never mentioned. The life-long commitment to hormones, to maintain the secondary sex characteristics is ignored. Like the others he sees only those few aspects of anatomical sex normalization that support his beliefs. He has been a regular contributor to BIID events, along with Blanchard and Lawrence, since going into semi-retirement. [N7]

Apotemnophilia was not included in the DSM-IV. But with BIID disordered individuals actively lobbying to be in the next version (alongside the other 'identity' disorders) it is probably a safe bet for inclusion this time round.

Its anyones guess what new mental disorders will be invented, or old ones resurrected by Messrs Blanchard and Zucker to explain the classic HBS dissonance between brain and body. But given their obsessive search for new ways to deny the mounting pile of scientific evidence in favor of a biological explanation, and considering the politics involved with DSM inclusion and terminology, primary (HBS) transsexuals have good reason to feel nervous.

Apotemnophiliacs are assured of a more sympathetic ear. The new DSM is due for publication in 2011/2012. APA/DSM politics could easily see primary (HBS) transsexuals misrepresented as an offshoot of BIID. [N8] Much as they have been misrepresented as a gender role transgressive behavioral disorder in past versions.

Notes & Sources[N1] Amputee identity disorder and related paraphilias. Robert Smith. BIID Info. (Online: undated).

Abstract/Overview

Amputee identity disorder (AID) is a condition characterized by an intense desire to be an amputee and a feeling of incompleteness with a full complement of limbs. Sufferers are sometimes driven to seek surgery to remove the unwanted limb(s), although there is an understandable reluctance among clinicians to accede to such demands, and patients may resort to self-injury if surgical treatment is not available. The current management of patients depends on accurate identification of the underlying problem and supportive psychiatric and psychological care. Patients may present with apparent accidental injury and demand amputation. Those who have achieved traumatic amputation may refuse reattachment surgery. Although it is contrary to the normal response of the medical carers it is probably wiser to accede to the patient's request provided a definitive diagnosis of AID has been made. AID appears to be very similar in development, progress and response to treatment as gender identity disorder and could possibly be included in the same diagnostic category.

[N2] Clinical and Theoretical Parallels Between Desire for Limb Amputation and Gender Identity Disorder. Anne A. Lawrence. Archives of Sexual Behavior 35(3): 263-278. Download PDF

Abstract

Desire for amputation of a healthy limb has usually been regarded as a paraphilia (apotemnophilia), but some researchers propose that it may be a disorder of identity, similar to Gender Identity Disorder or transsexualism. Similarities between the desire for limb amputation and nonhomosexual male-to-female (MtF) transsexualism include profound dissatisfaction with embodiment, related paraphilias from which the conditions plausibly derive (apotemnophilia and autogynephilia), sexual arousal from simulation of the sought-after status (pretending to be an amputee and transvestism), attraction to persons with the same body type one wants to acquire, and an elevated prevalence of other paraphilic interests. K. Freund and R. Blanchard (1993) proposed that nonhomosexual MtF transsexualism represents an erotic target location error, in which men whose preferred erotic targets are women also eroticize their own feminized bodies. Desire for limb amputation may also reflect an erotic target location error, occurring in combination with an unusual erotic target preference for amputees. 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. Persons who desire limb amputation and nonhomosexual MtF transsexuals often assert that their motives for wanting to change their bodies reflect issues of identity rather than sexuality, but because erotic/romantic orientations contribute significantly to identity, such distinctions may not be meaningful. Experience with nonhomosexual MtF transsexualism suggests possible directions for research and treatment for persons who desire limb amputation.

[N3] Also see: Blanchard and Lawrence "lump" GID and BIID (a code word for apotemnophilia) Lynn Conway. Third Annual International BIID Meeting (June 6, 2003).

[N4] Russell Reid inquiry: key figures. David Batty. guardian.co.uk (May 25 2007).

[N5] Ibid.

[N6] I changed for all the wrong reasons, and then it was too late … "Claudia", as reported by Julie Bindel. The Sunday Telegraph Magazine (15 November 2003).

[N7] See: Stepping Into The Future. Third Annual International BIID Meeting (Friday, June 6, 2003).

[N8] They are not the only ones to draw a comparison. See A New Way to be Mad: The Gender-Identity Parallel. Carl Elliot. The Atlantic (December 2000).

Ms. Joanne Proctor, deceased, served on the board of Organisation Internationale des Intersexués (OII) and managed the OII New Zealand website. She also maintained Trans Fried Fluff, a blog for and about biological or classical transsexualism.

Jo was a regular columnist for TS-Si. You can see a complete list of Joanne Proctor's articles at TS-Si.org here. [link]

The TS-Si News Service is a collaborative effort by TS-Si.org editors, contributors, and corresponding institutions. Sources can include the cited individuals and organizations, as well as TS-Si.org staff contributions. Articles and news reports do not necessarily convey official positions of TS-Si, its partners, or affiliates. We welcome your comments. Use the form below to leave a public comment or send private correspondence via the TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission.

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..., We all know that Anne Lawrence (a self admitted aut

06 December 2008

Ho hum, fetishists, Thank you Ms. Proctor. Every time

11 December 2008

What if Biid is neurological?, There are studies that sh

19 December 2008

Slipping in through the backdoor with BIID, The broad PH

19 December 2008

The broad PHYSICAL deep neurology of Harry Benjamin Syndrome (HBS or true transsexuality) is becoming more apparent every day. Although the susceptible social studies soft scientist may see surface similarities that traditional psychologists and psychiatrist attribute to a psychological state of mind, the association is only skin deep and ONLY if the shrink or social "scientist" in question is untrained in the hard sciences.

HBS men and women are NOT driven to remove working arms and legs. When an HBS woman or man removes a sexual organ or changes a secondary characteristic, the ultimate goal is to REPLACE that sexual organ with one of the appropriate sex.

A person who has BIID removes healthy body parts and replaces them with nothing.

HBS bring both mind and body into congruence and achieve a healthy physical end state with all body parts working.

A person with BIID do not achieve a healthy physical end state with all body parts working -- their goal is to have a physical end state less whatever healthy parts they believe should be damaged or surgically removed.

Many groups attempt to slip in the back door, yelling We're just HBS! in hope that their particular need follows HBS men and women into mainstream middle America. Many social advocates, not understanding the physical science, get caught up in the latest progressive cause and join the chant We're all like HBS!

No you're not. Wanna Be does not make you HBS; Crossdressing does not make you HBS; transgender does not make you HBS; and, finally, Gender Identity Disorder does not make you HBS Only having HBS makes you HBS.

Sorry, but I can't change the science because a part of society would prefer a simple answer. We've had eight years of a presidency that prefered simple answers. It's time we stop searching for simple answers. Everyone needs to grow up and accept individual responsibity for who they are.

Lisa Thompson

..., A different Sharon said: There are studies that sho

19 December 2008

A different Sharon said:

There are studies that show people with Biid have a smaller than average parietal lobe.

You may be referring to an anatomical fact: the right side of the inferior-parietal lobule is typically smaller in males than females. Where reduced size does occur, the size difference is quantitatively significant.

The external (exteroceptive) senses permit us to perceive the outside world. Our interoceptive senses permit us to perceive pain and the positioning of our internal organs.

Proprioception is altogether different. The inferior-parietal lobule is directly related to proprioreception, the ability of one part of our body to sense the relative position of neighboring parts. Proprioception provides feedback on our body's internal status: Do our various body parts move properly in relation to each other? Is our body is moving with the required effort?

There is research that shows, on average, smaller inferior-parietal lobules in people with BIID. This is no surprise since BIID occurs most frequently among males.

This effects there proprioception.

I suggest you be wary of statements that imply reverse causality. Proprioreception is our sensory capability that provides feedback (as described above). In fact, it is proprioreception that detects and records a disordered expectation. The actual cause of the disorder lies elsewhere.

So its their body telling them their leg should not be there not their mind.

The body doesn't say ... their leg should not be there .... It is more like "the body plan on file from the brain does not account for the presence of this leg". Feedback from the leg and neighboring body parts, via proprioreception, presents a disordered dataset to the brain seeking integration and validation.

Also, most of these people get these felling during puberty and are men.

The sensory disorder has most often been observed in patients following a stroke. There is no quantitative base of sufficient size to support claims of pubertal onset unconnected from other known physical problems. Current reports reman anecdotal.

It is known that those who make such a claim of pubertal onset unconnected from other known physical problems are primarily male.

So my question is, could the desire for a man to be a women be also caused by the parietal lobe? Are there more men becoming women than women becoming men?

The parietal lobe is descriptive and integrative - not prescriptive or proscriptive. This is to be expected, given its superior position to the

occipital lobe and posterior location relative to the

frontal lobe.

The parietal lobe has a complex enough task as it is: to integrate sensory information, determine spatial sense, and provide navigation data. Exploiting the data inputs from our six senses to map objects onto body coordinate positions requires enormous resources, error regulation, and feedback. This data synthesis then becomes available to other parts of our neurobiological system for evaluation, judgement, and possible intervention.

I can't answer your questions about desire and incidence. I never desired to be anything or anyone other than who I am: a woman and a female.

The "desire" you speak of is most often exemplified by cross-dressers and paraphilics.

Sharon S. Gaughan

..., what is it with the bunchesrunning this sight?they

19 December 2008

Dear Me For Real, Science is not hate. You may wish for

19 December 2008

BIID , Well some month before there was a "conference" i

01 July 2009

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Last Updated on Saturday, 06 December 2008 19:25

TS-Siis dedicated to the acceptance, legal protection, and medical treatment of individuals correcting the misalignment of their brains and their anatomical sex, while supporting their transition into society as hormonally reconstituted and surgically corrected citizens.

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