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Hello.
Hi.
Hello.
Welcome back to another episode of Diagnosing a Killer.
I'm Kenna.
And I'm Koelle.
How's it going?
Pretty good.
I feel like my throat's already a problem.
Yeah.
That vocal arrest for vocal fry.
For vocal fry.
Soup's excited.
I am off of work for the next few days, so I get to focus on cleaning, and it's kind
of therapeutic.
Yeah.
That is nice to have that extra time.
I got up for work this morning, and then I was told that there was a change of plans
in my schedule, so I actually only ended up working for like three hours today.
And it was pretty nice too.
Do you see I cleaned the corner of the bathroom?
I did.
Oh my gosh, that's so funny that you say that, because I walked in and I was like, ooh, the
floors look nice.
And I remembered that I saw it earlier today that the floor was kind of gross, and I was
like, oh, it's like pleasant surprise that it was clean.
I cleaned the baseboards in the bathroom too.
Just getting like full on Cinderella over here.
Cinderella.
Do the dishes, Cinderella.
Well, I have a mental breakdown today that is actually not even in the DSM.
Really?
But it is a disorder, so we're going to talk about that.
But before we get into that, would you like to give everyone our social media?
Sure.
You can check us out on social media anywhere at Diagnosia Killer, other than ex formerly
known as Twitter, which is at Killer Diagnosis.
We also have a cache app, PayPal Venmo.
We also got that Patreon going.
We got four tiers.
Tier number one is, never remember, tier number one, you get ad free mental breakdown episodes,
tiers two, three and four, get ad free every episode, and tiers three and four get that
added bonus episode at the end of every month.
Yeah, definitely.
I think I was mistaken the last time we talked about it.
I thought we had like 12 out.
We have 15.
Nice.
So, if you're interested in those bonus episodes, if you'd like to join those peeps that have
access to them, go over to patreon.com, slash Diagnosis at Killer, and sign up.
It actually really helps us out and it helps us create more content for you guys.
Like, share, subscribe, and don't forget to add automatic downloads so that you don't
miss a single one of our episodes.
Right, right, right.
And thank you so much to our existing Patreons as well.
We always want to make sure we're thinking them because y'all are the best and I love
all your comments and everything.
Best comments.
So, today, we are going to be talking about body integrity dysphoria.
Interesting.
And, as you may know, we wait till the end to record the content warning for each other,
but you guys won't hear anything different, so you are going to hear your content warning
right about now.
Content warning.
This episode includes conversation about self-mutilation and self-harm.
If this episode is not for you, we encourage you to find another one of our episodes.
Remember your mental health is very important and we love you.
We love you.
Bye.
I'm just going to love that for the rest of room.
I know, it's like movie magic.
Okay, let's get into this.
Body integrity dysphoria is also referred to as body integrity identity disorder, amputee
identity disorder, or Xenomelia.
Body integrity dysphoria, or BID, is a rare mental disorder that is characterized by a
desire to have a sensory or physical disability or feeling discomfort with being able-bodied.
Okay.
It's very different than anything we've really talked about.
People essentially think that they are over-compensated with what they have and maybe a piece of
them does not belong to themselves and they don't want it anymore.
It's like the opposite of phantom limb?
I wouldn't say it's the opposite.
I would say it's almost phantom limb when the limb is still attached.
Right.
Yeah.
Well, yeah.
You feel that you have, like you said, an overabundance of something that you don't feel is, but
it's the way that they identify.
They identify as amputee or they identify as someone who shouldn't have an arm or a leg.
So another thing that we're going to notice about this is that there is little to no research
about this disorder and that being the case, there's a lot of what-ifs and maybes when
it comes to how people think and feel and how people should be treated and things like
that, but we'll get into it.
That's very interesting and I bet there's very few cases as well.
Yeah, of course.
In individuals with BID, there is often a mismatch between the mental body image and
the physical body and this often results in an intense desire for amputation or complete
paralysis of a limb.
This desire for amputation typically focuses on the leg or the desire to become blind or
deaf can also be part of this disorder.
So the reason I say it typically focuses on the leg is because while there are minimal
cases, most of them are about the leg.
But yeah, so it can even go into-
Senses.
So you're wanting to become blind or feeling like you need to become blind or deaf.
Wow.
In even rarer cases, a person will express a sexual arousal connected with the desire
for loss of a limb, movement, or sense.
Okay, Beine.
Yeah, I mean, yeah, a dexter.
Oh yeah.
Brian was really into that.
True.
But he was into it from a paraffillic standpoint, like a fetish almost.
This is like a personal, like internal thing for yourself.
I guess it's like your own foot fetish.
While the diagnosis of body integrity dysphoria did not make it into the DSM-5 or the DSM-5
TR, it is mentioned within the newest version relating to body dysmorphic disorder.
So it's like a side note of body dysmorphic disorder.
What do they call that?
They call that a-
I don't know, like a subset?
Yeah.
Also, by the way, I ordered the DSM-5 TR today.
The newest one that came out in 2023.
Well, that's a read from it for sure.
Yeah.
BID was mentioned in the International Classification of Diseases 11 or the ICD, and it is included
under the category of, quote, disorders of bodily distress, of bodily experience, end
quote.
I was going to ask if it was part of the ICD-10, but I guess they have 11.
They do have the 11 though, yeah.
The ICD explains BID as being, quote, characterized by an intense and persistent desire to be
become physically disabled in a significant way, with onset by early adolescents, accompanied
by persistent discomfort or intense feelings of inappropriateness concerning current, non-disabled
body configuration.
Good job.
Thank you.
The desire to become physically disabled results in harmful consequences, as manifested
by either the preoccupation with the desire significantly interfering with productivity,
with leisure activities, or with social functioning, or by attempts to actually become disabled,
have resulted in the person putting his or her health or life in significant jeopardy.
The disturbance is not better accounted for by another mental, behavioral, or neurodevelopment
disorder, by a disease of the nervous system, or by another medical condition, or by malingering,
end quote.
So pretty much what the DSM-5 would say or 5TR would say, but essentially, yeah, just
kind of like dotting all their eyes and crossing their T's like it's not caused by anything
else, like this is its own thing.
Right.
So, like stated, this type of disorder typically begins showing signs in early adolescents,
and actually said anywhere from the ages of 5 to 8, just really early.
You start identifying being, having essentially a disability.
Right.
And unfortunately, sometimes this can result in harmful consequences, because you are so
young when you experience it, you might try to take matters into your own hands, so to
speak.
Like harm yourself or yeah.
So a term known as apatamnophilia was first described in a 1977 article by psychologists
Greg Firth and John Money as being primarily sexually oriented.
This word apatamnophilia was the previously known term for BID.
Okay.
It's just no longer used.
So, anophilia being apocalyptic.
In 1986, John Money would further describe a similar condition he called octo-mophilia,
which is the sexual arousal in response to a partner's amputation.
Could you imagine growing up and your name was John Money?
Yeah.
What a John Money.
It's because of John Money in the house.
Oh, I'd call him Jay Money for sure.
Jay Money.
Yeah.
Jay Money.
The condition would receive public attention in the late 1990s after a Scottish surgeon
called Robert Smith amputated limbs of two otherwise healthy people who were desperate
to have them done.
This was where?
This was in Scotland.
Well, I don't know if it was in Scotland, but it was a Scottish surgeon.
I mean, in the late 90s.
The checks.
That, yeah, they said, I don't want these limbs, but they essentially do like a doctor-assisted
amputation.
Yeah.
But they were otherwise perfectly healthy.
I feel like I've heard, either I've heard a case that's similar to that where somebody's
like, yeah, just cut off my finger or my ear or essentially they were an otherwise healthy,
perfectly healthy individual like you have said.
That's my third time saying that.
But yeah, it was either that or it was American Horror Story, I can't remember.
It was Grey's Anatomy as well.
They have like three cases where like one of the times this hockey player gets like his
finger broken or it's like rugby or something and he has to play.
And so he's like, can you just cut it off?
Like I don't want to wait for it to heal.
Just cut it off.
Like I just amputated it.
And they're like, no, you can't do that.
And then he cuts it off himself or he tries to.
And then there's this other one that is truly like this where this guy comes in and he's
like, hey, yeah, my foot, like my left foot, it's just, it's not mine.
And they're like, what?
He's like, it's just not mine.
Like it needs to go.
Like he's like shaking it, like hitting it on the floor and stuff.
He's like, yeah, it's just not mine.
Could you just remove it?
And they're like, sir, we can't remove like a perfectly healthy limb.
Like there's nothing wrong with you physically.
He's like, just donate it.
Yeah, but it's not mine.
Yeah, seriously.
And he ends up grabbing a saw from somewhere and starting to cut his own leg off.
Like it's pretty impressive.
I can't remember that.
Is that like in the first intro?
And then it's like, maybe.
Yeah, yeah.
It's the beginning of the like the first couple of seasons for sure.
So back to history of BID in 2004, a man named Michael first would publish the first clinical
research in which he surveyed 52 people with BID.
These names are just great.
I know they are.
They're great.
Out of these 52, a quarter of these people had undergone amputation for this disorder.
Based on this survey, Michael would coin the term body integrity identity disorder to express
what he saw as more of an identity disorder than a paraffilia, just like you were saying.
Yeah.
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After this discovery, minimal research was done to fully understand where the disorder
comes from and there are still questions surrounding it today.
Due to the fact that it's so rare, BID is a very misunderstood disorder and because
of this, it can be extremely difficult to diagnose and to treat.
Furthermore, there are still differing opinions and thoughts about what causes it.
Some people who have seldom studied the disorder suggest that BID can be linked to early childhood
trauma, obsessive compulsive tendencies, or over-identification with amputees, which
I think is interesting.
It's like essentially what they're trying to say is, if you have a lot of amputees in
your life from a young age, you may be inclined to try to become part of that group.
But I don't think that makes sense.
Like if your mom's blind, you wish you were blind or something.
Yeah, or something.
But childhood trauma, we can always explain that.
That's always an explanation.
And then obsessive compulsive tendencies also make sense to me because they become obsessed
with the fact that that's not something they want on their body.
Do you think it's a reincarnation thing where somebody is a war-torn soldier and they're
reincarnated and they believe that they don't deserve all these limbs?
I don't know.
It's like reincarnation, limb guilt?
Maybe.
However, while some people may not fully agree with these theories, psychologists and neurologists
tend to agree that BID may be caused by the brain not mapping the body correctly.
Which makes a little more sense to me.
If this is the case, rather than being a mental disturbance, BID could very likely be a neurological
disorder that occurs in childhood.
So the brain will begin mapping the body when the person is first born, but it will continue
to do so while into the person's childhood, when people with BID typically begin reporting
their discomfort with their bodies.
That makes sense.
Because babies go through stages where they recognize that their hands are theirs, their
feet are theirs.
Holy shit, I got two of these.
And so when kids start to begin to walk and then eventually run, that is part of that
development as well.
Like you said, brain mapping those motor skills and recognizing those motor skills, how fast
you can run, when to stop, when to keep going, when to pivot, all that.
And then also when the external trauma enters the environment that you're in, that brain
mapping can be disrupted.
And that would make sense to me.
And then also in the same vein, what if there's a physical thing that happens with the development
of the frontal lobe or did this child accidentally get hit on the head?
Things like that where it's kind of disrupted, like you said.
But it's more of a neurological or medical thing than it is a psychological thing.
And that's where the disagreement is.
Again, there is so little to go off of when it comes to BID, and much more extensive research
needs to be done to fully understand the disorder.
When someone is experiencing symptoms of BID, they may have strong emotional disturbances
due to a healthy limb or other part of their body they simply do not connect with.
When it comes to this desire to get rid of a particular part of the body, it is not
simply just the desire of wanting the limb gone, but the all over consuming urge to actually
take the steps to get rid of the body part.
This becomes an obsessive need in some cases, and people will and often do go to great lengths
to make this happen.
If a person who is struggling with BID does not seek professional help, they will often
attempt to do this amputation or removal themselves, and this can cause major trauma, infection,
and more.
Furthermore, these obsessive thoughts about removing a part of their body can really affect
someone's personal, professional, and social lives as well.
Obviously, if you're experiencing this obsessive thought, you might not want to tell someone
else about it, because in their mind it's like, how do I say that to someone else?
I'm kind of thinking as well as you're explaining it, just people that suffer from body dysmorphia
as well, and how this must be linked in some way.
Yeah, and I think that's why it falls under the whole body integrity disorders category
in the DSM.
The fact that BID is extremely hard to diagnose is another potential dangerous side effect
of the disorder.
Typically, when or if a person decides to seek out help for these feelings, they will
be referred to a neurologist in order to undergo a brain scan.
Doctors will first look for any type of brain tumor that may be causing the interference
with the body.
This can be extremely expensive, and some people will not want to go through the trouble
for a disorder that may make them feel like they can't talk about it in the first place.
When a person has BID, they may have several different symptoms that pile on the desire
to lose a limb or body part.
They may feel a sense of overcompletion, exhaustion from trying to hide their feelings
from others, obsessive thoughts about their bodies, extreme stress or anxiety about how
they present themselves to the world, and depression due to the fact that they can't
be their true self.
Many people who seek treatment for the symptoms of BID will not receive an accurate diagnosis,
and this can even further encourage them to attempt self-mutilation.
However, most of the time, the person experiencing BID will not think of this as self-harm, and
rather what they have to do.
Either way, attempting self-mutilation can lead to things like uncontrollable bleeding,
infection, nerve damage, severe pain, and or phantom limb pain.
On top of this, it is extremely dangerous to attempt self-mutilation, and it can be
life-threatening.
Although it is likely to get misdiagnosed when seeking help from BID, that should not
discourage people from speaking with a professional.
The best thing to do is to educate oneself about their symptoms and speak with a psychology
professional to get assistance.
Once somebody becomes diagnosed with BID, treatment will need to begin immediately.
Although it is also a difficult disorder to treat, BID does have a few treatment options
that have been utilized in the past.
These include cognitive behavioral therapy and medications to treat anxiety and nor depression.
On top of these, other types of treatment have been utilized to treat BID, such as having
the client wear a prosthetic or even using a wheelchair or crutches, and also using virtual
reality to simulate living without parts of your body.
That makes me think of VR for agoraphobia.
If you're afraid to go outside, you do like Sheila and Shameless when she goes to the grocery
store VR because it's getting over her fear.
I've never seen Shameless.
Oh, well, she does.
But when we got back from Manhattan and we didn't see the Twin Tower Memorial, what
do you call that?
What's it called?
Ground Zero.
Yeah, Ground Zero.
When we got back home, I did the VR of Ground Zero.
Oh, did you?
Because I was like, and there's just people walking around and like, yeah, but it really
felt like you were there.
Right, and VR can definitely make you so enveloped in that and it can feel so real that it might
be a good treatment, almost like your exposure therapy almost, but the reverse.
I wonder if that does more, I don't know.
I mean, I'm sure it does good for overall serotonin and stuff like that, but when you
come back to reality, is it just going to exasperate?
Yeah, it's a bleak.
I know.
I'm not sure.
That's why I said these had been utilized, but these are just things that have been tried.
Fair, yeah.
While treatment is not known to get rid of the desire to relieve oneself of a body part,
it can reduce the amount of stress one feels surrounding the feelings.
There are some people who believe that the successful removal of the body part that is
causing the pain may be a way to treat BID, but this has not been proven.
In fact, there is research to suggest that the removal may increase the amount of stress
and anxiety due to the challenges that come with it and may lead to regretful feelings.
This is kind of a weird, I don't think it's a far-fetched thought, but I just feel like
do you think in certain cases if people were allowed to, let's say, amputate a foot or
an arm or a hand that it would actually be life-saving?
I can see where that would be something that could be seen as a benefit, especially in
this mindset of I need to do this to feel better.
But as far as research goes with this specific disorder, I'm just not sure, just because
again it's so, there's so little that has been studied about it.
I couldn't tell you either way if it would really truly help or if it would make things
worse.
Because I was also going to say that there's also the risk of, let's say someone does go
and they do a successful treatment or amputation with a professional that could also potentially
increase the desire to now want to do that further.
And then it could lead into another negative.
Yeah, I see what you're saying.
I think that, and of course not to compare apples and oranges here, but if you don't
like your nose, you get a nose job.
With trans individuals, there's this body dysmorphia and nothing will make that go away
until they transition and feel that that's a successful transition.
So I'm wondering in this case, this is part of what they're saying is an identity thing,
then it's like, do you amputate your foot?
But I think that you would go into a doctor and a doctor would look at you funny.
Yeah, right, exactly.
I mean, it's, I don't know.
And again, that's why it's so important to have this education and to understand what
this disorder is so that people can now start to seek treatment so that those people can
be the ones that are studied and we can find things out like this.
Because we've seen, like I was just about to say next, not many people will come forward
to seek help with this disorder.
It's not really clear how prevalent it is.
Like they don't tell us that there's none of number because there could be many people
out there that are experiencing this and it's just considered rare because it doesn't get
talked about.
I mean, there's definitely things all over the world in different cultures, body modifications
and such.
And again, not to compare an amputee situation like that, but I mean, it's part of autonomy.
Right.
Yeah, it's very wild.
And honestly, it's one of those things too where I was like, I wanted to bring this and
it's been on my list for a while, but there's just not a lot of information about it.
So I'm relaying everything that I can about it and I know, but it's important that people
are aware of things like this so that maybe, hey, maybe someone listens to this and they
go, oh my gosh, that's actually exactly how I feel and I didn't even think about it.
I'm going to go talk to someone so that I can get that professional help.
For sure.
We definitely don't want to be like, oh, that's weird, bro.
It's just that it's fascinating.
It is.
And it's again, it's very rare.
But yeah, that's pretty much all I have.
I just wanted to add if you or somebody, you know, are having signs or symptoms of BID,
it is important to understand that you're not alone.
Your thoughts and feelings are real and matter and there is always someone out there that
is willing to listen.
There are ways to find relief that do not include self-mutilation or amputation.
And please speak to your healthcare provider or psychology professional.
If you're contemplating self-mutilation, always dial 911 or you can reach the national
suicide hotline at 988-247.
Absolutely.
No matter what, your safety is important.
This might be something that you're experiencing and you don't know how to handle it and you
might feel like you are the quote unquote crazy person.
But there's a way to go about these things.
There's a way to handle these things and what we don't want is for people to hurt themselves.
Absolutely not.
So yeah, definitely always talk to a professional in instances like this and remember that you're
not alone.
There's plenty of resources as well online that are available.
But yeah, that's my mental breakdown.
Very interesting, very interesting stuff.
Thank you.
I hope you guys enjoyed this one and I think that's all we have.
Yeah.
I'll see you on Thursday for another case.
And we all love you.
Bye.
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