In my search for new topics I ran across the obscure “Body Integrity Identity Disorder,” or BIID. This is described as a condition—if, indeed, it is a legitimate diagnosis—in which a person is troubled by the presence of a perfectly healthy body part, nominally a limb, and wants it amputated to restore a sense of personal wholeness. One 2009 review argues that this is a rare but definable illness in which the sufferer makes a reasonable request for “treatment” that ought to be not only taken seriously, but honored, in select cases.
Briefly, the author of the paper in question, one Christopher Ryan, argues that a person with BIID is not necessarily psychotic (BIID is proposed as a diagnosis of exclusion, after the clinician has considered psychosis and other psychiatric conditions), and appears to be normal but has “clinically significant” impairment in personal functioning. Central to the argument is the assertion that the person with putative BIID is not delusional. Delusions rarely arise in otherwise normal people. They are demonstrably false (e.g., “my relatives have been replaced by impostors”) while the BIID claim is inward and subjective (“my personal sense of integrity is violated”), and as such, is unassailable. People with BIID keep it a secret, while delusional people never let you hear the end of it. (Did I mention Area 51?) In short, people with BIID are not crazy, and should not be so labeled.
BIID is not exactly presented as a major public health problem. In his paper, Ryan refers to five reported or known cases.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.