BIID (Body Integrity Identity Disorder)

What is body integrity identity disorder (BIID)?

Body integrity identity disorder (BIID), or body integrity dysphoria, is a mental health condition where you feel that a limb or healthy body part shouldn’t be part of your body. You’re aware that this body part is healthy; you can still feel, use and move this body part, but you don’t believe it should be yours. You want to live life without the use of that limb.

As a result, you might ask a healthcare provider for an amputation or attempt a self-amputation of your healthy limb. This can be extremely dangerous and potentially life-threatening. The outcome of BIID is physical disability.

Your desire for amputation or physical disability may make you feel complete — as if your physical self finally matches your true identity. Unfortunately, there’s no way to know whether an amputation will help you achieve this goal. Non-amputation treatment options are available to help you manage this condition.

What body parts does BIID affect?

Body integrity identity disorder can affect any part of your body. Most often, you may feel like one of the following isn’t part of your body:

• Leg.
• Arm.
• Finger.
• Toe.
• Eye(s).
• Ear(s).
• Teeth.

One study found that the left leg was the most commonly affected limb. Some participants in the study said that their right leg was useful; they needed to use the right leg to drive a vehicle, for example. This motivated study participants to want to keep their right leg.

How common is BIID?

BIID is rare. Many people don’t seek treatment or hide their symptoms from others, so the exact rate of occurrence is unknown.

What are the symptoms of BIID?

The characteristics of body integrity identity disorder or body integrity dysphoria include:

• A strong desire to be physically disabled or experience life without a body part.
• Discomfort or intense feelings that a healthy body part isn’t suitable for your body or doesn’t belong.
• A preoccupation with personal desires that take you away from activities you enjoy like socializing or interpersonal relationships.
• Behaving like you have a disability even though you don’t have one.
• Self-harm behaviors or self-mutilation of the part of your body you don’t believe should be there.

Symptoms range from mild (you have strong feelings about your body) to severe (you attempt self-harm) and vary for each person who experiences this condition.

What does it feel like to have BIID?

If you have BIID, you may experience:

• A sense of “over-completion” or that something’s not right with your current body configuration.
• Exhaustion from trying to hide your true feelings from others.
• Obsessive thoughts about your body.
• Extreme stress or anxiety that you’re not presenting your physical self to the world in the way you see yourself.
• Depression that you’re unable to live as your true self without a physical modification.

These feelings usually begin in childhood and early adolescence, often between ages 5 and 10.

What causes BIID?

Healthcare providers aren’t sure of the exact cause of body integrity identity disorder. Research suggests it could be the result of structural abnormalities in the part of your brain that regulates body perception. More than one part of your brain is involved with body perception, including your:

• Somatosensory cortex and parietal lobe.
• Insula (between the temporal and frontal lobes).

What are the complications of BIID?

Body integrity identity disorder may drive you to harm yourself to reach your goals, even if you don’t consider your behaviors to be “self-harm.” This could lead to complications like:

• Uncontrolled bleeding.
• Infection.
• Nerve damage.
• Severe pain.
• Phantom limb pain after amputation or self-amputation.

It’s extremely dangerous to attempt self-mutilation. The risks may seem secondary to your desire to live without a body part. Self-amputation is potentially life-threatening. If you’re thinking about harming yourself, contact a healthcare provider or your local emergency services number.

You can also reach out to the Suicide and Crisis Lifeline by calling or texting 988 (U.S.). While self-amputation isn’t an attempt on your life, counselors are available to talk to you if you’re in a rough spot or thinking about living without a healthy part of your body.

How is BIID diagnosed?

A healthcare provider, usually a psychiatrist, will diagnose body integrity identity disorder. They’ll talk with you about how you feel about your body and perform a physical exam to verify the health of the limb or body part you’d prefer not to have.

Many people don’t receive a diagnosis. Or they receive a diagnosis after performing self-harm behaviors in an emergency room or asking a surgeon for help amputating a healthy limb.

If you experience constant, obsessive and harmful thoughts about changing your body, contact a healthcare provider. They’re available to help you manage these thoughts and find a treatment plan that’s right for you.

Is BIID listed in the DSM-5?

Body integrity identity disorder isn’t listed in the current Diagnostic and Statistical Manual of Mental Illnesses, or DSM-5-TR. This is the newest edition of the American Psychiatric Association’s reference book on mental health conditions. BIID is mentioned within the DSM-5-TR relating to body dysmorphic disorder.

Healthcare providers list body integrity identity disorder as “body integrity dysphoria” in the International Classification of Diseases (ICD-11). The ICD is a tool for healthcare providers to diagnose and classify conditions in clinical settings.

How is BIID treated?

Treatment is challenging for body integrity identity disorder. There isn’t a single treatment available for BIID alone. Healthcare providers will offer several forms of treatment to avoid amputation of a healthy limb and prevent you from performing harmful behaviors. Treatment may include:

• Cognitive behavioral therapy.
• Medications to treat depression and anxiety.
• Wearing a prosthetic, using a wheelchair or crutches.
• Using virtual reality to simulate living without a part of your body.

Often, medications and therapy can reduce some symptoms of BIID. Treatment won’t get rid of your desire to live without a limb or body part. But it can reduce the amount of stress you feel so you can manage it long term.

Your provider might suggest participating in clinical trials or research studies to learn more about the condition and test new treatment options.

Does amputation cure BIID?

This is a difficult question to answer. It may seem like an amputation will fulfill your desires and cure BIID. You may not regret your decision to remove a healthy limb, but it will make your life more difficult and stressful than how you feel today. There’s no guarantee that removing a healthy part of your body will allow you to feel a sense of completion. This is why performing an amputation for BIID is controversial in healthcare.

Ethically, surgeons and providers won’t perform an amputation on a healthy limb without a clear medical need. This goes against the “do no harm” principle of healthcare. The consequences and risks associated with an amputation could be lifelong, dangerous and deadly.

Removal of a limb or body part may not fully address the underlying psychological challenges you face. It may seem like the only solution to you now, but there’s no way to know that removing your limb will provide the outcome you expect.

Amputations are permanent. You can’t undo this type of procedure if you don’t like the result.

What can I expect if I have BIID?

BIID is a challenging condition to manage on a daily basis. It can take you away from your loved ones and activities you enjoy. Amputation is a permanent and often dangerous outcome of BIID. Never try to self-amputate.

Reach out to a healthcare provider if you experience constant intrusive thoughts that lead you to consider self-harm. Available treatment options don’t eliminate your desires entirely, but they can make it easier to live with and reduce how often obsessive thoughts intrude on your daily life.

When should I see a healthcare provider?

Talk to a healthcare provider if you experience frequent, distracting thoughts about removing a healthy part of your body. Contact emergency services right away if you’re in immediate danger.

What questions should I ask my healthcare provider?

• What type of treatment do you recommend?
• Are there side effects of treatment?
• Will an amputation help me feel better?
• What do I do if therapy and other treatments don’t work?

Is BIID a mental disorder?

Body integrity dysphoria, or body integrity identity disorder, is a mental health condition. Research shows that the causes of this condition may relate to how your brain formed during childhood development. This is why symptoms are common during childhood. Abnormal development of certain areas of your brain can influence how you perceive your body.