P0373 - Body integrity identity disorder-characteristics and neural correlates

Abstract

Body Integrity Identity Disorder (BIID) describes a pathology which is associated with an overwhelming wish of amputation of one or more healthy body parts. Originally the disease was indicated as “Apotemnophilia”, afterwards as “Amputee-Identity-Disorder”. Patients feel an incompleteness of their body identity. Only the amputation is perceived as solution for the conflict. The wish of amputation often exists since their childhood or adolescence. The persistent wish for amputation is very incriminating for the patients, embarrassing and can have devastating consequences like self-amputation. Little is known about the aetiology and pathogenesis. In the very few described single-cases neither psychotherapy nor psychotropics were efficient.

To gain new insights into the aetiology and neural mechanisms of the BIID pathology, we arranged a complex psychometric examination, clinical interviews and functional magnetic resonance imaging (fMRI) measurements with male BIID patients and healthy subjects as control group. In the fMRI- Scanner patients looked to manipulated pictures of themselves, in which they are shown in the actual, real state and the desired state with one/both arms or legs amputated and with prosthesis. The psychometric examination contained different screening instruments for depression, personality, patterns of relationship, attachment etc.

Results of our first patient showed that he had superior intelligence, good social abilities, a challenging employment and a longtime relationship. He was inconspicuous in all psychometric measurements.

The neuroimaging findings of all patients are evaluated and interpreted in the context of biography and personality features. Our study furnishes new insights into characteristics, brain activity and possible therapeutic implications.