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Apotemnophilia is a neurological disorder in which otherwise sane and rational individuals express a strong and specific desire for the amputation of a healthy limb or limbs It is due to hpothesised damage to the right parietal lobe, as the disorder has features in common with somatoparaphrenia . When experienced very strongly, some people with apotemnophilia come to feel discontented with their bodies and want to actually remove an otherwise healthy limb, a condition called body integrity identity disorder. Some apotemnophiles seek surgeons to perform an amputation or purposefully injure a limb in order to force emergency medical amputation. A separate, though occasionally comorbid, definition of Apotemnophilia is erotic interest in being or looking like an amputee. This separate definition should not be confused with acrotomophilia, which is the erotic interest in people who are amputees.

Research studies

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 somatoparaphrenia; 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 . Among a convenience sample of 52 apotemnophiles recruited from internet groups, the great majority wanted a single leg removed, cut above the knee. There are parallels between apotemnophilia as a motivation for body integrity identity disorder and autogynephilia as a motivation for some cases of male-to-female gender identity disorder. Apotemnophilia has been studied for a number of years to determine whether this disorder is actually neurological or psychological. Recent studies such as the one written in the paper "Apotemnophilia: a neurological disorder" tests whether Apotemnophilia is neurological or psychological. The research consisted of two different test subjects of two different ages: 29years old and 63years old. Both test subjects were right handed, showed competent neurological abilities along with consistent emotional and intellectual abilities. Testing subjects with Apotemnophilia was done through skin conductance response (SCR) to pinprick above and below the line of desired amputation on each leg. Response to pinpricking was recorded at four different sites: both feet, and both upper thighs above the desired line of amputation.

Definition

A paraphilia of the stigmatic/eligibilic type in which sexuerotic arousal and facilitation or attainment of orgasm and dependent upon oneself being an amputee . In this disorder, otherwise sane and rational individuals express a strong and specific desire for the amputation of a healthy limb or limbs. Most date this desire to their childhood and not uncommonly the sufferer will attempt to obtain amputation of the specific limb. As few surgeons are willing to amputate healthy limbs, this often means that the patient themselves will attempt to irrevocably damage the limb in question, thus necessitating formal amputation. After amputation most report to being happy with their decision and often state, paradoxically, that they are ‘complete’ at last

Classifications: What is it?

Patients diagnosed with Apotemnophilia is sometimes classified as being patients of Body Integrity Identity Disorder (BIID). Apotemnophilia is usually classified under BIID becuase patients feel discontented with their bodies and want to actually remove an otherwise healthy limb.

Sexual Desires

Apotemnophilia has frequently been connected to sexual desires.

Neurological vs. Psychological

There have been a number of studies to determine whether Apotemnophilia is a form of neurological disorder or a psychological disorder. It has been connected to activity in the prefrontal cortex while also being connected to the same concept of a person wanting to become a transvestite. Whether it is neurological or psychological, there will always be questions from both sides.

Neurological

Many scientists and researchers have been connecting apotemnophilia to neurological brain misfunctions. Researchers have specifically pinpointed the damage to be particularly in the prefrontal cortex - the area where body image is made and developed. One study by Brang and his team helped scientifically back his hypothesis that apotemnophilia is a neurological disorder. His findings provide psychophysiological evidence to support our hypothesis that apotemnophilia arises from a congenital dysfunction of the right parietal lobe and, in particular the right superior parietal lobule, which receives and integrates input from various sensory areas and the insula to form a coherent sense of body image.

The study that Brang performed consisted of a skin conductance test on two apotemnophiles both of which want amputation. The reason why skin conductance was used in this test was because it is a good indicator of general sympathetic arousal.

Brang proposed that the failure of a congenitally dysfunctional right superior parietal lobule to form an unified body image leading to changes in skin conductance readings. When this dysfunction is acquired, as in somatoparaphrenia,the brain seems sometimes to rationalize the discrepancy by denying ownership of the limb. When the dysfunction is congenital it leads to a feeling that affected area should not be there to begin with and a desire for an amputation.

Psychological

Apotemnophilia has also been related to psychological characteristics. For example, apotemnophilia has been frequently compared to transvestitism along with the desire for sex changes or people with different sexual preferences. Although psychological classification has not been scientifically tested, it has been compared to the confusion a patient may experience while being diagnosed and treated with apotemnophilia. This confusion is similar to the confusion people may feel when they develop the desire to become one sex over another or change their preference in sexual attraction. Whether apotemnophilia is neurological or psychological, is still a debate in the medical and psychology community.

Symptoms

Depression

Apotemnophiles will become prone to extreme levels of depression caused by isolation, confusion and the inability to determine what they're supposed to be like physically and emotionally. Patients with apotemnophilia will feel that they are apart from the norm and will isolate themselves from socializing.

Intentional Injuries

Caused by desperate attempts to get the unwanted limbs to be amputated. People with apotemnophilia have a longterm vision of their body as missing limbs. Originally developed at a young age, apotemnophiles will go through drastic measures to ensure that their lifelong dream of being an amputee is fulfilled. Mentioned below, apotemnophiles will purposely induce infections into limbs or even harm themselves by going as far as sawing off limbs half way so medical professionals do not have a choice other than to remove the limb.

Sexual Motivation

Apotemnophilia has been connected to sexual desire for a number of years, but it is important not to confuse apotemnophilia with acrotomophilia. One excerpt from a case study from the American Journal of Psychotherapy by titled A case of apotemnophilia: a handicap as sexual preference by Dr. Walter Everaerd, PhD. from Utrecht, The Netherlands interviews an apotemnophile who describes his development of sexual preference:

" He became attracted to amputation in his 10th year. An amputated boy is according to him happier than he himself... When he was about 11 year old, he thought that he would be happier with an amputated leg. He therefore tried to infect sores on his leg. No infections developed at the time. After that he did not make any more attempts. He feels the he would not be able to bear the pain resulting from it... In addition he has photos and drawings of amputated boys and men, war victims, at his disposal. He fantasizes a lot about these photos. The image of amputation takes on erotic importance. When masturbating, amputated boys and men play at the role of partner in his fantasies. He is often occupied with self-amputation or the amputation of possible partners. He fantasizes for example, that a group of young boys who were playing together erected a guillotine. They chopped off each others legs. He does not find his desire for amputated partners and his fantasies about amputation sadistic. He often reacts astonished when I ask him that. It is not the amputation itself that is important but rather the result of it. In the development of this preference alloapotemnophilia and autoapotemnophilia were established. Now amputation of his own leg has no longer an sexual meaning. He says now that he only could feel complete once his leg has been amputated. Wanting to be amputated plays an important role in his sense of identity."

Acrotomophilia

Acrotomophilia (from the Greek akron , tomein and philein ), refers to a paraphilia in which an individual expresses strong sexual interest in amputees. It is a counterpart to apotemnophilia, the sexual interest in being an amputee.

Amputee fetishism has been described as a form of abuse levelled at the relative vulnerability and dependence of disabled women.

Treatment

Apotemnophiles are usually normal psychologically and have been proven to be emotionally healthy . However, due to its connections to being neurological, treatments are available to apotemnophiles. The major problem in providing treatment is that most apotemnophiles do not seek professional treatment for their condition. They are more likely to be found in the act of self amputation before actively seeking medical attention themselves. As mentioned in the article "I am in Depression", "One of the most prominent problems in the treatment of this disorder is that most apotemnophiles do not seek professional treatment for the condition, but rather receive it only when they have been caught in the act, referred by a surgeon they approached for getting an amputation or on the request of their sexual partner. Thus, their motivations for change may often stem from a desire to do it for someone else rather than from a genuine desire to change". Treatments for apotemnophiles have been studied; however, the two main forms of treatment seem to be a combination of cognitive and behavior elements that have been scientifically modified to change patterns of behavior and fetishes. These combinational therapy have significantly shown that there are reduced rates of recidivism than seen in untreated individuals . Along with a combinational treatment of cognitive and behavioral focuses, another element that has been studied is something known as aversion therapy. The therapy provides aversive conditioning to deviant sexual fantasies. Therapies are provided by medical attention and have shown to reduce the effects of apotemnophiles. Along with therapy, apotemnophiles will be exposed to treatment that focuses on cognitive behavioral programs that include training in social skills that may help maintain the deviant sexual arousal and behavioral patterns.

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 making his or her patients happy. 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.

See also

• Disability pretenders, those who behave as if they are disabled
• Attraction to disability
• Acrotomophilia
• Transvestitism

References

1. ^ , Brang,G. (2008). Apotemnophilia: A Neurological Disorder. Cognitive Neuroscience and Neuropsychology, 19 1305-1306.
2. Bensler, J. M., & Paauw, D. S. (2003). Apotemnophilia masquerading as medical morbidity. Southern Medical Journal, 96, 674–676.
3. Berger, B. D., Lehrmann, J. A., Larson, G., Alverno, L., & Tsao, C. I. (2005). Nonpsychotic, nonparaphilic self-amputation and the internet. Comprehensive Psychiatry, 46, 380–383.
4. Money, J., Jobaris, R., & Furth, G. (1977). Apotemnophilia: Two cases of self demand amputation as a sexual preference. The Journal of Sex Research, 13, 115–124.
5. Everaerd, W. (1983). A case of apotemnophilia: A handicap as sexual preference. American Journal of Psychotherapy, 37, 285–293.
6. Dixon, D. (1983). An erotic attraction to amputees. Sexuality and Disability, 6, 3–19.
7. First, M. B. (2005). Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 35, 919–928.
8. Lawrence, A. A. (2006). Clinical and theoretical parallels between desire for limb amputation and gender identity disorder. Archives of Sexual Behavior, 35, 263–278.
9. Lawrence, A. A. (2009). Erotic target location errors: An underappreciated paraphilic dimension. Journal of Sex Research, 46, 194-215.
10. First M. (2005). Desire for an amputation of a limb: paraphilia, psychosis, or a new type of identity disorder. Psychol Med, 35 919-923.
11. Bayne T, Levy N. (2005). Amputees by choice: body integrity identity disorder and the ethics of amputation. J Appl Philos, 22 75-86.
12. ^ , Everaerd,W. (1983). A Case of Apotemnophilia: A Handicap as Sexual Preference. American Journal of Psychotherapy, 37 285-293.
13. , Critchley M. (1953). The parietal lobes. 225–255.
14. , Har R, Forss N. (1999). Magnetoencephalography in the study of human somatosensory cortical processing. Phil Trans R Soc Lond B, 354 1145–1154.
15. , Felleman DJ. (1991). Van Essen DC. Distributed hierarchical processing in the primate cerebral cortex. Cereb Cortex, 1 1–47.
16. , Critcheley HD. (2002). Electrodermal responses: what happens in the brain. Neuroscientist, 8 132–142.
17. Elman, R.Amy (2001). "Mainstreaming immobility". Sourcebook on violence against women. SAGE. pp. 193–208. ISBN 0761920056. {{cite book}}: Unknown parameter |editors= ignored (|editor= suggested) (help)
18. ^ , Apotemnophilia Treatment.

• Neurological disorders
• Paraphilias