Friday, December 28, 2007

Body Identity Disorder

While traveling to Disney World the other week, I picked up a copy of Scientific American Mind to keep myself from being too bored on the flight. One by Sabine Miller called "Amputee Envy" concerns what she terms "Body Identity Disorder" (BID). People with this extremely rare disorder desire to have one or more of their appendages removed, and some actually have such discomfort that they request that the appendage be removed. A summary of the article is here.

A clarification: "Body Identity Disorder" is a term proposed by Dr. Michael First. See this link:
http://biid-info.org/First%2C_Michael

I had heard about this sort of thing and chalked it up to being a sexual fetish. The reality appears to be much more complex. Some appear to be seeking attention rather than any sort of sexual gratification. But most interesting to me is that at about two thirds of the disorder report that amputation will enable them to express their "true" identity. Thus, there may be a parallel between this disorder and Gender Identity Disorder (GID), which is of personal interest to me. Indeed there are some interesting parallels-both disorders arise early in life, and sometimes the discomfort (which can be extreme) is only resolved through surgery.

One might think that these sorts of identity statements are merely part of our modern cultures preoccupation with identity or authenticity, but some cases of BID appear to arise from irregularities in how the body is mapped out in the cerebral cortex. Indeed, sometimes temporary cases of body image problems result from brain tumor, injury or disease. When the disease or injury is fixed, the body image problem goes away.

The article also address the issue of surgery for BID cases. Some ethicists argue that, as in the case of certain types of GID, if the person is fully informed of the risks and is not psychotic then surgery ethical. Other ethicists consider this wrong headed and that the Doctor must protect the patient from his or her "irrational desires."

Again this sort of debate parallels that about Gender Identity Disorder. Since Gender Identity Disorder is much more common, there is actually standard of care called the Benjamin Standard of Care to provide a way to select those most likely to benefit from sexual reassignment surgery. So lots of interesting things in this article to chew on. What makes our identity? Is it merely socially constructed as some would have us believe? How much is changeable about our identity? What are the boundaries of ethically acceptable medical intervention?

There are lots of other interesting articles in this magazine...so you might look for it at your newsstand or for purchase online at www.SciAmMind.com.

Citation: Sabine Miller(Dec 2007/Jan 2008) Amputee Envy Scientific American Mind 18(6) pp 60-65

Other links:

BIID-Info.org

World Professional Association for Transgender Health
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