Apotemnophilia: Psychiatric disorder, neurological disorder or not a disease at all?

Abstract

Introduction

Apotemnophilia or body integrity identity disorder (BIID) is defined by the uncontrollable desire to amputate one or more healthy limbs or to be paraplegic.

Objectives/aims

We reviewed the available studies of this condition in order to enhance the comprehension of this disorder and the possible need of a multidisciplinary assessment.

Methods

Relevant papers from 2000 were identified using PubMed database, with the terms apotemnophilia, BIID and self-demand amputation.

Results

Reports of the phenomenon of amputee attraction trace back to 1933 in a series of letters and articles published in journals and magazines by erotically-obsessed persons who wanted to become amputees themselves. The first scientific report of this issue only appeared in 1977, when John Money described two cases that requested an amputation of a healthy limb, a condition he named apotemnophilia. Would-be amputees – or “wannabes” – may appear in thousands and they have their own websites. Until now, the explanation of this phenomenon has been in favor of a psychiatric etiology: a pathological desire driven by a sexual compulsion. Recently, a neurological explanation has been proposed and defends that might exist a dysfunction of the right parietal lobe, leading to a distorted body image and a desire for an amputation.

Conclusions

Apotemnophilia is a rare, uncommonly studied condition, which blurs the limits between psychiatry and neurology. We must be aware that this disorder is more frequent in unusual places like websites and others. A better understanding of this condition is crucial for the development of effective treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.