Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

Amputate healthy limb? (Apotemnophilia)

Discussion in 'General Issues and Discussion Forum' started by admin, Jun 24, 2005.

  1. admin

    admin Administrator Staff Member


    Members do not see these Ads. Sign Up.
    Docs go out on a limb
    Sarah Wotherspoon and Janelle Miles
    23 Jun 05
    From Herald Sun
     
  2. Cameron

    Cameron Well-Known Member

    Very interesting dilemma and I have a paper on the Bioethics of Toe Cutting pending publication in the UK. Apotemnophilia (desire to have an amputation) is not that rare albeit sensational when the person wants a leg or arm removed. A very much neglected aspect of podiatry is the managment of people living with psychological (and often psychosexual) challenges. The rise and popularity of cosmetic surgery has brought the bioethical issues in caring for these patients to the fore which I am sure will interest all practitioners.

    What say you?
    Cameron Kippen

    Hey, what do I know?
     
  3. If you consider body modification as an extension of cosmetic surgery then an interesting ethical and medico-legal dilemma presents itself. In the scenario where a patient presents with a request for foot modification like the young lady with the intermetatarsal studs - what should the clinician do. Whilst the first maxim of healthcare should be 'do no harm', it is worthwhile considering what the outcome might be if the patient self-administered insead. Perhaps in cases such as this a more appropriate maxim would be, 'minimise any harm'. In practice, sexual health have been upholding this principle for years when distributing conoms to under-age teens. Shouldn't podiatry do the same? Certainly there is evidence the NHS recognises and addresses these issues with the radical approach to BDS but I wonder how podiatrists would deal with such a dilemma? And the indemnity costs.

    Mark
     
  4. Felicity Prentice

    Felicity Prentice Active Member

    While I have no problem with the notion of surgery to alleviate psychosocial problems (losing a leg probably has effects of equal magnitute on the individual as some of the psychotropic medications, which essentially amputate personalities....) But I would not be doing surgery of that nature in my role as a Podiatrist, I would leave it to a team approach between therapist and well insured surgeon. Very well insured.....

    There was a recent case where a young woman sued the medical team that performed her transgender surgery (she was originally a young man). She argued that she had not be sufficiently screened and counselled, and that she regretted the decision and wanted to go back.... Hmmm, it could be tricky glueing the limb back on (or anything else that had been cut off...)

    cheers,

    Felicity
     
  5. Trish

    Trish Welcome New Poster

    Amputate healthy limb

    Have these Melbourne researchers lost touch with reality? An amputation is a risky and very expensive operation, plus all the aftercare and help these people would need to continue with their lives. Who will pay for all of that?
    I suppose the amputee would be considered 'disabled' and no longer be expected to work, maybe entitled to benefits as a disabled person. I wonder if that has anything to do with their 'psychological condition'?
    Or am I being cynical?!
     
  6. stewart

    stewart Welcome New Poster

    No i do not agree that these researchers have lost touch with reality. Do remember that the article appears to be written by a philosopher and ethicist.

    In the 1st post from Admin it highlights that the condition is extremely rare (around 1000 people worldwide) and people with the condition are known to attempt self-amputation; chainsaws and shot-guns are referenced. If we are to focus purely on the financial aspect then i am sure that there is a balance somewhere between long-term pharmacological therapy, psychiatric intervention and managment of botched self-amputation versus amputation.

    I am also sure that much ethical debate could be provoked if we were to concern ourselves with the psychological and physical torment that the condition must impose on sufferers.
     
  7. Craig Payne

    Craig Payne Moderator

    I recall an episode of Law & Order on this .... the plot was based on a "back street" surgeon performing these operation to amputate limbs for those with this condition...but one of them died :(
     
  8. Cameron

    Cameron Well-Known Member

    Netizens

    Trish wrote

    >Have these Melbourne researchers lost touch with reality? An amputation is a risky and very expensive operation, plus all the aftercare and help these people would need to continue with their lives. Who will pay for all of that?

    The apotemnophiles pay for there hospital expenses and prosthesis by themselves. hat is ofen a stimpualtion and one which overtakes criticism of fairness for all.

    I suppose the amputee would be considered 'disabled' and no longer be expected to work, maybe entitled to benefits as a disabled person.

    That is not what the person wants and they have live for two years as an amputee and exhaust all forms of other treatment before surgery is even contemplated. These are people living with a preoccupation to have three limbs instead of four. It is not for sympathy nor to become dependent, is it because their ideal body is minus one limb.

    I wonder if that has anything to do with their 'psychological condition’.
    Or am I being cynical?!

    The psychological condition is real and there are no other therapies available. The preoccupation is oppressive and leads apotemnophiles in desperation to cut their limbs off to the danger of their lives.


    Stewart wrote

    >If we are to focus purely on the financial aspect then I am sure that there is a balance somewhere between long-term pharmacological therapy, psychiatric intervention and management of botched self-amputation versus amputation.

    In the treatment of apotemnophilia no pharmaceutical or psychiatric intervention has shown to improve the condition. These folks have a life long obsession relieved only by amputation.

    >I am also sure that much ethical debate could be provoked if we were to concern ourselves with the psychological and physical torment that the condition must impose on sufferers.

    That is certainly part of the debate.

    The key to the bioethical issue is the patient’s right to make the request for “amputation on demand.”, and the physician’s autonomy to grant it or otherwise.

    The same debate is related to cosmetic toe surgery, where despite the obvious inclusion of patients with body dimorphic disorders, there is a pattern of “normals” demanding body sculpting which presents the same bioethical dilemmas to podiatrists.


    Craig Wrote
    >I recall an episode of Law & Order on this .... the plot was based on a "back street" surgeon performing these operation to amputate limbs for those with this condition...but one of them died

    It has happen.

    Cameron
    Hey. what do I know?
     
  9. One Foot In The Grave

    One Foot In The Grave Active Member

    Is there much difference to someone with Anorexia whose desperation leads them to starve themselves to the danger of lives?? I'm sure many anorexics would attest the the preoccupation with being thin is oppressive and rules their lives...

    However they're "treated"...not allowed to indulge the self-image that their skeletal frames are "fat".

    How does this differ?
    Why should one be accommodated and the other be treated?
     
  10. Felicity Prentice

    Felicity Prentice Active Member

    The therapies used in the intervention of eating disorders are much the same as body dysmorphic disorders. The goals are to address underlying psychodynamic issues while instituting behavioural and cognitive changes. In addition, there are a range of medications (mainly the SSRI's) which may have benefit.

    However, the use of phrases such as 'indulge the self-image' might not be entirely helpful. The person with an eating/body image disorder has a genuine psychiatric illness, and the notion of 'indulgence' sounds a bit like telling some-one with depression to 'pull up their socks'. The sad fact is that with some body image disorders, it is not possible to achieve the state where the individual can reconcile their internal image with the external reality. The mortality rate for anorexia/bulimia is disturbingly high.

    If a person has a psychiatric condition whereby their existence is untenable unless a limb is removed, then ultimately amputation might save their life. Psychiatric treatment is not 100% effective (our suicide rates attest to that), so surgical intervention might be the only option.

    cheers,

    Felicity
     
    Last edited: Jul 12, 2005
  11. One Foot In The Grave

    One Foot In The Grave Active Member

    Fully aware of that...just couldn't think of the right word (still can't!) to use instead of "indulge". I'll consult my trusty thesaurus next time!! :eek:
     
  12. Cameron

    Cameron Well-Known Member

    Felicity is perfectly correct

    >If a person has a psychiatric condition whereby their existence is untenable unless a limb is removed, then ultimately amputation might save their life. Psychiatric treatment is not 100% effective (our suicide rates attest to that), so surgical intervention might be the only option.

    In apotemnophilia psychiatric treatment ( pharmaceutical and otherwise) has been shown to be completely ineffective. Before surgical treatment is undertaken however the person must first exhaust all other forms of care.

    Cameron
     
  13. Cameron

    Cameron Well-Known Member

    Apotemnophilia: call for better understanding

    netizens

    The condition apotemnophilia describes people with a fixation to have a limb amputation (usually healthy). This of course has caused much concern to many in the medial fraternity but a University of Sydney academic has recently brought the subject up again with a call for better understanding

    http://au.news.yahoo.com/a/-/latest/5129206/amputating-healthy-limbs-ok/

    toeslayer
    More on foot sculting and apotemnophilia at:
    http://toeslayer-retifismandfetishism.blogspot.com/2008/10/foot-sculpture-and-apotemnophilia.html
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Re: Amputate healthy limb?

    The Bizarre Request for Amputation
    Rachel Barnes
    International Journal of Lower Extremity Wounds December 2011 vol. 10 no. 4 186-189
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Re: Amputate healthy limb?

    Apotemnophilia or Body Integrity Identity Disorder: A Case Report Review
    Bou Khalil R., Sami Richa
    International Journal of Lower Extremity Wounds October 21, 2012
     
  16. Admin2

    Admin2 Administrator Staff Member

    Apotemnophilia

    Apotemnophilia is a neurological disorder characterized by the intense and long-standing desire for amputation of a specific limb, or a need to become paralyzed, blind or deaf.[1] Another more recent term for it is body integrity identity disorder (BIID) in which otherwise sane and rational individuals express a strong and specific desire for the amputation of a healthy limb or limbs. Apotemnophilia has features in common with somatoparaphrenia.[2] Some apotemnophiles seek surgeons to perform an amputation or purposefully injure a limb in order to force emergency medical amputation.[3][4]

    A separate definition of apotemnophilia is erotic interest in being or looking like an amputee.[5][6] This separate definition should not be confused with acrotomophilia, which is the erotic interest in people who are amputees.[7] Apotemnophilia was first described in a 1977 article by psychologists Gregg Furth and John Money: "Apotemnophilia: two cases of self-demand amputation as paraphilia." More recently (2008), V.S. Ramachandran, David Brang and Paul D. McGeoch have proposed that it is a neurological disorder caused by an incomplete body image map in the right parietal lobe.[8]

    The study carried out David Brang, Paul McGeoch and V.S. Ramachandran in 2008 was only able to work with two subjects.[2] In 2011 Paul McGeoch et al. published the results of an experiment in which they were able to obtain MEG images of the parietal lobes for four research subjects, three 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."[9] This reported abnormality in the function of the right parietal lobe was subsequently supported by an 2013 anatomical study by Peter Brugger's group, which found a reduced cortical thickness of this part of the brain in people who desired an amputation when compared to controls.[10]

    Michael First, a psychiatrist at Columbia University, has pointed out that the theory advanced by Ramachandran and his colleagues fails to account for the fact that people who desire amputation of a limb sometimes change their preference as to which limb they would like to have amputated, however this is also clearly from First's work a very rare phenomenon.[11]

    In 2011 a group of researchers at the University of Southern California (Brain and Creativity Institute) proposed an alternative hypothesis. These researchers proposed that "individuals with BIID may have a discrepancy between the commands from the motor cortex 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 phantom limbs after amputation.[12]

    1. ^ "Apotemnophilia" (PDF). 
    2. ^ a b Brang, D McGeoch, P & Ramachandran VS (2008). "Apotemnophilia: A Neurological Disorder" (PDF). NeuroReport. 19 (13): 1305–1306. doi:10.1097/WNR.0b013e32830abc4d. PMID 18695512. 
    3. ^ Bensler, J. M.; Paauw, D. S. (2003). "Apotemnophilia masquerading as medical morbidity". Southern Medical Journal. 96 (7): 674–676. doi:10.1097/01.SMJ.0000078367.94479.B9. PMID 12940318. 
    4. ^ Berger, B. D.; Lehrmann, J. A.; Larson, G.; Alverno, L.; Tsao, C. I. (2005). "Nonpsychotic, nonparaphilic self-amputation and the internet". Comprehensive Psychiatry. 46 (5): 380–383. doi:10.1016/j.comppsych.2004.12.003. PMID 16122539. 
    5. ^ Money, J.; Jobaris, R.; Furth, G. (1977). "Apotemnophilia: Two cases of self demand amputation as a sexual preference". The Journal of Sex Research. 13 (2): 115–124. doi:10.1080/00224497709550967. 
    6. ^ Everaerd, W. (1983). "A case of apotemnophilia: A handicap as sexual preference". American Journal of Psychotherapy. 37 (2): 285–293. PMID 6869634. 
    7. ^ Dixon, D. (1983). "An erotic attraction to amputees". Sexuality and Disability. 6: 3–19. doi:10.1007/BF01119844. 
    8. ^ Brang,David, McGeoch, Paul, Vilayanur, Ramachandran, Apotemnophilia:a neurological disorder, NeuroReport, Vol 19, No 13, 27 August 2008
    9. ^ McGeorch, Paul, Brang, David, Song, Tao, Lee, Roland, Huang, Mingxiong, Xenomelia: anew right parietal lobe syndrome, J Neurol Neurosurg Psychiatry, 22 May 2011
    10. ^ Hilti, L. M.; Hänggi, J; Vitacco, D. A.; Kraemer, B; Palla, A; Luechinger, R; Jäncke, L; Brugger, P (2013). "The desire for healthy limb amputation: Structural brain correlates and clinical features of xenomelia". Brain. 136 (Pt 1): 318–29. doi:10.1093/brain/aws316. PMID 23263196. 
    11. ^ Callaway Ewen, NewScientist, Life, March 24, 2009
    12. ^ 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),[1]
     
  17. Cameron

    Cameron Well-Known Member

    netizens

    I submitted an article on apotmenophilia and BMD to the UK podiatry journal and it took nearly three year to have it published. I was very pleased to see the editorial committee eventually had the courage to do so.

    toeslayer.
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Apotemnophilia or Body Integrity Identity Disorder
    A Case Report Review

    Rami Bou Khalil, Sami Richa
    International Journal of Lower Extremity Wounds December 2012 vol. 11 no. 4 313-319
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    The desire for healthy limb amputation: structural brain correlates and clinical features of xenomelia
    Leonie Maria Hilti, Jürgen Hänggi, Deborah Ann Vitacco, Bernd Kraemer, Antonella Palla, Roger Luechinger, Lutz Jäncke, Peter Brugger
    Brain (2012) doi: 10.1093/brain/aws316 First published online
     
  20. NewsBot

    NewsBot The Admin that posts the news.

  21. NewsBot

    NewsBot The Admin that posts the news.

    Neural Basis of Limb Ownership in Individuals with Body Integrity Identity Disorder
    Milenna T. van Dijk, Guido A. van Wingen, Anouk van Lammeren, Rianne M. Blom, Bart P. de Kwaasteniet, H. Steven Scholte, Damiaan Denys
    PLoS ONE 8(8): e72212. doi:10.1371/journal.pone.0072212

     
  22. Craig Payne

    Craig Payne Moderator

    Finally found more on this episode: http://allisonleotta.com/2012/05/svu-episode-13-22-strange-beauty/

    Also Apotemnophlilia is more of a sexual disorder; wanting to have a limb removed for psychological/psychiatric reasons is really 'Body Integrity Identity Disorder'

    Body integrity identity disorder

    "Self-amputation" redirects here. See also Autotomy.

    Body integrity identity disorder (BIID, also referred to as amputee identity disorder)[1] is a psychological disorder in which an otherwise healthy individual feels that they are meant to be disabled.[2][3][4][5] "Transability", an almost identical disorder, is medically recognized by the American Psychiatric Association's DSM-5, but BIID is not. BIID is related to xenomelia, "the dysphoric feeling that one or more limbs of one's body do not belong to one's self".[6]

    BIID is typically accompanied by the desire to amputate one or more healthy limbs. It also includes the desire for other forms of disability, as in the case of a woman who intentionally blinded herself,[2] or individuals who have themselves surgically or chemically sterilized. BIID can be associated with apotemnophilia, sexual arousal based on the image of one's self as an amputee. The cause of BIID is unknown. One hypothesis states that it results from a neurological failing of the brain's inner body mapping function (located in the right parietal lobe) to incorporate the affected limb in its understanding of the body's physical form.[citation needed]

    1. ^ Smith, R. C. (2004). "Amputee identity disorder and related paraphilias". Psychiatry. 3 (8): 27–30. doi:10.1383/psyt.3.8.27.43394. 
    2. ^ a b "Woman desperate to be blind had drain cleaner poured in eyes, now happier than ever". Tribune Media Wire. 1 October 2015. Retrieved 2 October 2015. 
    3. ^ Davis J. L. (2012). "Narrative construction of a ruptured self: Stories of transability on Transabled.org". Sociological Perspectives. 55 (2): 319–340. doi:10.1525/sop.2012.55.2.319. 
    4. ^ Boesvel, S. (2015, June 3). "Becoming disabled by choice, not chance: ‘Transabled’ people feel like impostors in their fully working bodies." The National Post.
    5. ^ Shad (11 June 2015). "Desiring disability: What does it mean to be transabled?". CBC Radio. Retrieved 11 June 2015. 
    6. ^ Hilti, L. M.; Hanggi, J.; Vitacco, D. A.; Kraemer, B.; Palla, A.; Luechinger, R.; Jancke, L.; Brugger, P. (2012). "The desire for healthy limb amputation: Structural brain correlates and clinical features of xenomelia". Brain. 136: 318–329. doi:10.1093/brain/aws316. 
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    The Patient Requesting Amputation
    Thomas M. Dunn, Ryan M. Moroze
    Open Journal of Medical Psychology, 2013, 2, 193-196
     
  24. Greg Fyfe

    Greg Fyfe Active Member

    http://www.abc.net.au/catalyst/stories/2576978.htm

    This episode of catalyst gives a good insight into some of the issues. If I recall correctly it also contains an experiment that demonstrates how the brain can be "tricked" about body image, quite simply.

    Cheers
    Greg
     
  25. NewsBot

    NewsBot The Admin that posts the news.

    Is the desire for amputation related to disturbed emotion processing? A multiple case study analysis in BIID
    Gabriella Bottinia, Peter Brugger & Anna Sedda
    Neurocase: The Neural Basis of Cognition
     
  26. NewsBot

    NewsBot The Admin that posts the news.

    Apotemnophilia, body integrity identity disorder or xenomelia? Psychiatric and neurologic etiologies face each other
    Sedda A, Bottini G
    Neuropsychiatric Disease and Treatment 2014, 10:1255-1265
     
Loading...

Share This Page