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| '''Apotemnophilia''' is a disorder characterized by the intense and long-standing desire for amputation of a specific limb.<ref>{{Cite web|url = http://cbc.ucsd.edu/pdf/apotem.pdf|title = Apotemnophilia|date = |accessdate = |website = |publisher = |last = |first = }}</ref> In recent years the word apotemnophilia has come to be seen to carry pejorative overtones, meaning as it does "a love of amputation" and implying that the condition is a sexual paraphilia.<ref name="jnnp.bmj.com">McGeoch, Paul, Xenomelia: a new right parietal lobe syndrome, Journal of Neurology, Neurosurgery, and Psychiatry, June 21, 2011 </ref> In an attempt to move towards a more neutral term for desiring an amputation McGeoch, Brang and Ramachandran proposed that the desire for an amputation be renamed "xenomelia", which derives from the Greek to mean foreign limb.<ref name="jnnp.bmj.com"/> Another term for the condition is ] (BIID), but this has come to apply to not only those who desire an amputation but also those who want a range of disabilities including deafness, blindness and a spinal cord injury. | |||
| Apotemnophilia (xenomelia) has features in common with ].<ref name= "Brang" /> Some apotemnophiles seek surgeons to perform an amputation or purposefully injure a limb in order to force emergency medical amputation.<ref>{{cite journal |doi=10.1097/01.SMJ.0000078367.94479.B9 |last1=Bensler |first1=J. M. |last2=Paauw |first2=D. S. |year=2003 |title=Apotemnophilia masquerading as medical morbidity |url= |journal=Southern Medical Journal |volume=96 |issue=7| pages=674–676 |pmid=12940318}}</ref><ref>{{cite journal |doi=10.1016/j.comppsych.2004.12.003 |last1=Berger |first1=B. D. |last2=Lehrmann |first2=J. A. |last3=Larson |first3=G. |last4=Alverno |first4=L. |last5=Tsao |first5=C. I. |year=2005 |title=Nonpsychotic, nonparaphilic self-amputation and the internet |url= |journal=Comprehensive Psychiatry |volume=46 |issue=5| pages=380–383 |pmid=16122539}}</ref> A separate definition of apotemnophilia is ] interest in being or looking like an amputee.<ref>{{cite journal |doi=10.1080/00224497709550967 |last1=Money |first1=J. |last2=Jobaris |first2=R. |last3=Furth |first3=G. |year=1977 |title=Apotemnophilia: Two cases of self demand amputation as a sexual preference |url= |journal=The Journal of Sex Research |volume=13 |issue=2|pages=115–124}}</ref><ref>{{cite journal |last1=Everaerd |first1=W. |year=1983 |title=A case of apotemnophilia: A handicap as sexual preference |url= |journal=American Journal of Psychotherapy |volume=37 |issue=2| pages=285–293 |pmid=6869634}}</ref> This separate definition should not be confused with ], which is the erotic interest in people who ''are'' amputees.<ref>{{cite journal |doi=10.1007/BF01119844 |last1=Dixon |first1=D. |year=1983 |title=An erotic attraction to amputees |url= |journal=Sexuality and Disability |volume=6 |issue=|pages=3–19}}</ref> | |||
| Apotemnophilia (xenomelia) was first described in a 1977 article by psychologists Gregg Furth and ]: "Apotemnophilia: two cases of self-demand amputation as paraphilia." Until recently, the primary explanation for Apotemnophilia was psychological/psychiatric,<ref>Sedda,Anna,Bottini,Gabriella,Apotemnophilia, body integrity identity disorder or xenomelia? Psychiatric and neurologic etiologies face each other,Neuropsychiatric Disease and Treatment, 2014,10:,1255–1265</ref> however recent research suggests that here may be a neurological etiology for this disorder. | |||
| ==Neurological Etiology== | |||
| In 2008, ], David Brang and Paul D. McGeoch conducted research that suggested Apotmenophilia/Xenomilia is a ] caused by an incomplete body image map in the right ].<ref>Brang, David, McGeoch, Paul, Vilayanur, Ramachandran, Apotemnophilia:a neurological disorder, NeuroReport, Vol 19, No 13, 27 August 2008</ref>The study carried out by David Brang, Paul McGeoch and V.S. Ramachandran in 2008 was on two subjects.<ref name="Brang">{{cite journal |authors=Brang, D McGeoch, P & Ramachandran VS |year=2008 |title=Apotemnophilia: A Neurological Disorder |journal=NeuroReport |volume=19 |issue=13 |pages=1305–1306 |doi=10.1097/WNR.0b013e32830abc4d| pmid =18695512 |url=http://cbc.ucsd.edu/pdf/apotem.pdf}}</ref> In 2011 Paul McGeoch et al. published the results of an experiment in which they were able to obtain ] images of the parietal lobes for four ]s, all of whom desired amputation. McGeoch and his co-researchers concluded that the images suggest "that inadequate activation of the right superior parietal lobe (SPL) leads to the unnatural situation in which the sufferers can feel the limb in question being touched without it actually incorporating into their body image, with a resulting desire for amputation".<ref>McGeorch, Paul, Brang, David, Song, Tao, Lee, Roland, Huang, Mingxiong, Xenomelia: anew right parietal lobe syndrome, J Neurol Neurosurg Psychiatry, 22 May 2011</ref> | |||
| In 2011 a group of researchers at the University of Southern California (Brain and Creativity Institute) proposed an alternative neurological hypothesis. These researchers proposed that "individuals with BIID may have a discrepancy between the commands from the ] to the parietal lobe and from the sensory feedback to the same regions in the parietal lobe". This theory was based on the discovery that individuals who desire amputation sometimes experience ]s after amputation.<ref>Demographics, Learning and Imitation, and Body Schema in Body Integrity Disorder, Johnson, A, Liew, S, Aziz-Zadeh, L., Indiana University Undergraduate Journal of Cognitive Science 6 (2011),</ref> | |||
| In 2013, Hilti et al., described structural abnormalities in the superior parietal lobule as well as the right anterior insula of 13 men with xenomelia, supporting parallels between xenomelia and disturbed self-consciousness in disorders like somatoparaphrenia.<ref>Hilti LM, Hänggi J,Vitacco DA, Kraemer B, Palla A, Luechinger R, Jäncke L, Brugger P., The desire for healthy limb amputation: structural brain correlates and clinical features of xenomelia,(2013) Brain Cogn. 136, 318–329</ref> Recent research (2017) suggests that structural hyperconnectivity within the sensormotor system also plays a significant role in xenomelia.<ref>Jürgen Hänggi, Deborah A. Vitacco, Leonie M. Hilti, Roger Luechinger, Bernd Kraemer, Peter Brugger, Structural and functional hyperconnectivity within the sensorimotor system in xenomelia, Brain and Behavior,2017 Mar; 7(3),</ref> | |||
| A number of clinical observations, such as the switching of a longstanding desire from a left-sided to a right-sided leg amputation <ref>Kasten E.,Stirn A. (2009). Body integrity identity disorder (BIID). Z. Psychiatr. Psychol. Psychother. 57, </ref> or the sudden occurrence of new amputation desires after previous ones were satisfied <ref>Sorene E.D.,Heras-Palou C., Burke F.D.,(2006). Self-amputation of a healthy hand: a case of body integrity identity disorder. J. Hand Surg. Br. 31B, 593–595</ref> are not easily explainable by the sole reference to neural mechanisms. Brang et al. suggested that the study of xenomelia “may provide key insights into the question of how neural activity gives rise to mental phenomena”.<ref>Brang D., McGeoch P. D., Ramachandran V. S. (2008). Apotemnophilia: a neurological disorder. Neuroreport 19, 1305–130610.1097/WNR</ref> | |||
| ==Classifications: Body Integrity Identity Disorder (BIID)== | |||
| The term ] was coined in 2005. In a study conducted by Michael First, 52 individuals were administered a structured telephone interview, which helped characterize the altered bodily self-consciousness that culminates in desire for amputation. The use of the term "Body Integrity Identity Disorder" suggests that Apotemnophilia is an identity disorder as defined in the DSM-IV.<ref>Peter Brugger,Bigna Lenggenhager,Melita J. Giummarra,Xenomelia: A Social Neuroscience View of Altered Bodily Self-Consciousness,Front Psychol. 2013; 4: 204. | |||
| Published online 2013 Apr 24. Prepublished online 2013</ref> | |||
| Patients diagnosed with apotemnophilia are sometimes classified as being patients who experience ] (BIID).<ref>Baril, A. and K. Trevenen (2014). "Exploring Ableism and Cisnormativity in the Conceptualization of Identity and Sexuality 'Disorders'", Annual Review of Critical Psychology, 11, p. 389-416 .</ref> In a 2014 review of the psychiatric and neurological literature, Anna Sedda and Gabriella Bottini stated that there is no consensus as to the best way to classify the desire for amputation: | |||
| {{ quote | "In summary, psychological/psychiatric explanations for the desire to amputate a healthy limb include two main hypotheses: a sexual compulsion, belonging to the paraphilic core, and an identity disturbance, paralleling gender identity disorder. At present, no new psychological/psychiatric explanations have been proposed; neither has this condition been included in the DSM-5 classifications."<ref>Sedda,Anna,Bottini,Gabriella,Apotemnophilia, body integrity identity disorder or xenomelia? Psychiatric and neurologic etiologies face each other,Neuropsychiatric Disease and Treatment, 2014,10:,1255–1265</ref> }} | |||
| ==Symptoms and Treatment== | |||
| Apotemnophia / Body Integrity Disorder (BIID) is a is a rare, infrequently studied and highly secretive condition in which there is a mismatch between the mental body image and the physical body. Apotemnomphilia is characterized by an intense desire for amputation of a limb. Currently BIID is not included in the International Statistical Classification of Diseases 11 or the Diagnostic and Statistical Manual of Mental Disorders IV. It is often not known to surgeons, neurologists and psychiatrists. BIID individuals typically avoid healthcare and often act out their desires by pretending they are disabled or perform actual self-amputation. <ref>Rianne Blom,Raoul Hennekam, Damiaan Denys,Body Integrity Identity Disorder,PLoS One. 2012; 7(4): e34702.Published online 2012 Apr 13.</ref> | |||
| A 2012 study concluded, based on interviews with 54 individuals, that the main rationale for their desire for body modification (amputation) was to feel complete or to feel satisfied inside. Based on the results of the survey, researchers concluded that psychotherapy was often supportive, but did not help diminishing BIID symptoms. Individuals reported that antidepressants were helpful in reducing depressive symptoms related to BIID, but that antipsychotics were not. Actual amputation of the limb was effective in all 7 cases who had surgical treatment. <ref>Rianne Blom,Raoul Hennekam, Damiaan Denys,Body Integrity Identity Disorder,PLoS One. 2012; 7(4): e34702.Published online 2012 Apr 13.</ref> | |||
| ==Ethics== | |||
| Surgeons are placed in a difficult situation when apotemnophiles confront them about their situation. A surgeon or a medical professional will have to make the decision between amputating a perfectly normal limb or allowing his or her patients to remain unhappy. Whether the medical professional performs this surgery has not been defined as "allowed" or "disallowed". Although many professionals will agree that a patient's happiness is primarily important, amputating a limb may be out of the question because there is nothing medically wrong with the limb itself.<ref>Mo Costandi,The science and ethics of voluntary amputation,The Guardian,Wed 30 May ‘12</ref><ref>A.Dua,Apotemnophilia: ethical considerations of amputating a healthy limb,J Med Ethics 2010;36:75e78. doi:10.1136/jme.2009.031070 77</ref> | |||
| ==Research directions== | |||
| Apotemnophilia has been studied for a number of years to determine whether this disorder is actually neurological or psychological.<ref name= "Brang" /> However, in-depth research related to apotemnophilia and its correlation to the mind and body are still not clear. Recent research has shown small breakthroughs such that apotemnophiles are three times more likely to want removal of a left limb than right, in accordance with damage to the right parietal lobe, and also in concordance with sufferers of ]; in addition, skin conductance response is significantly different above and below the line of desired amputation, and the line of desired amputation remains stable over time, with the desire often beginning in early childhood.<ref name= "Brang" /> Among a convenience sample of 52 apotemnophiles recruited from internet groups, the great majority wanted a single leg removed, cut above the knee.<ref>{{cite journal |doi=10.1017/S0033291704003320 |last1=First |first1=M. B. |year=2005 |title=Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder |url= |journal=Psychological Medicine |volume=35 |issue=6| pages=919–928 |pmid=15997612}}</ref> There are parallels between apotemnophilia as a motivation for body integrity identity disorder and ] as a motivation for some cases of male-to-female ].<ref>{{cite journal |doi=10.1007/s10508-006-9026-6 |last1=Lawrence |first1=A. A. |year=2006 |title=Clinical and theoretical parallels between desire for limb amputation and gender identity disorder |url= |journal=Archives of Sexual Behavior |volume=35 |issue=3| pages=263–278 |pmid=16799838}}</ref><ref>{{cite journal |last1=Lawrence |first1=A. A. |year=2009 |title=Erotic target location errors: An underappreciated paraphilic dimension |url= |journal=Journal of Sex Research |volume=46 |issue=2–3| pages=194–215 |pmid=19308843 |doi=10.1080/00224490902747727}}</ref> | |||
| A 2014 review <ref>Sedda,Anna,Bottini,Gabriella,Apotemnophilia, body integrity identity disorder or xenomelia? Psychiatric and neurologic etiologies face each other,Neuropsychiatric Disease and Treatment, 2014,10:,1255–1265</ref> concluded that | |||
| {{ quote | "In conclusion, the 37 years of study of this desire to be disabled...appears challenging to understand, even using state-of-the-art technologies. Much more effort is needed to find a solution and, finally, a treatment for the distress these individuals experience. This still-obscure condition needs a multidisciplinary approach to go beyond the “simple” clinical/experimental frame, and requires a much more complex model that also includes social and ethical aspects." }} | |||
| ==See also== | |||
| * ] | |||
| * ], those who behave as if they are disabled | |||
| * ] | |||
| * ] | |||
| ==References== | |||
| {{reflist|33em}} | |||
| ==External links== | |||
| *{{wiktionary-inline}} | |||
| {{Paraphilia}} | |||
| ] | |||
| ] | |||
| ] | |||
| ] | |||
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