What is xenomelia?
The word xenomelia comes from the Greek words: “xeno ”, which means: “foreigner”, and “μελoσ” (melos), which refers to a “limb”; The word suggests the strangeness towards a limb of its own. It is also known as a body integrity identity disorder (BIID), it is a condition in which individuals have a vehement desire to amputate any of their healthy limbs, perceiving it as an "intruder" or oblivious to them; Some patients with BIID feel so much discomfort that they try to do it themselves when they are denied help, since they want to be disabled in some way, putting their lives and health in danger. There is a whole subculture around this condition.
Why is BIID classified as an identity disorder?
Because amputation desires are linked to an altered development of the "self" or of one's identity. By mutilating or becoming disabled electively they seek to build what they feel is: "their true self" or seek to rebuild their identity
It should be mentioned that, body image is an accessible representation conscious of the general shape and structure of the body itself. It derives from several sources, including visual and proprioceptive and forms the basis of one's beliefs about oneself (Bayne and Levy 2005). Also, the peripheral or central errors can disturb body image (Sacks 1984; Lutrija 1993).
What is acrotomophilia?
A paraphilia that consists in having sexual preference by someone who has some part of his body amputated.
Who is most affected by the identity disorder of body integrity?
Although there are no clear epidemiological data about BIID, Peter Brugger, from the University of Zurich, Germany, in his research concluded that in the vast majority of cases those affected with xenomelia or BIID, are mens; and the limb not accepted in 80% of the subjects studied, corresponded to a legmostly the left.
How do they feel after they "suppress" the part of their body they didn't want?
The reaction of a person without BIID, before the news that we had to amputate a limb, could naturally be very anxious, even reaching panic levels and feeling a deep sadness, because the simple idea that we had to cut off an arm , a leg or a hand, can demotivate us too much and even reach terrify…
In most cases of patients with xenomelia who amputate a limb, they feel that the emotional discomfort they have carried for so many years, depression, anxiety and isolation in which they were: fade away, by complying with His vehement desire for amputation. These subjects do not manifest guilt or regret a posteriori to his longed for cut, but they tend to feel happier, more satisfied or as some patients have said: "I finally feel complete."
At what age do people who have xenomelia or BIID begin to feel this?
Usually, they start from early childhood, many of them start between 4 and 5 years old, they can often play that they don't have a leg, that they lack an arm, that they are deaf or blind. While some children dream and play with being heroes, kings or warriors, others ... Long for and aspire to be disabled in some way. Also influences social learning, which starts at home: meeting the needs of children in early stages, including affective, is essential for their development.
When is amputation ethically permissible for doctors?
Elective amputations are ethically admissible if and only if they are strictly necessary to cure a serious condition, but not when they are carried out only for aesthetic, erotic or financial interests.
… So what about elective cosmetic surgery?
In the clinical practice of plastic surgery and Aesthetic Medicine, it can be seen that some patients seek “perfection” by modifying their bodies; The surgeon should often try to make them understand and specify realistic expectations. Many times despite being explained about their possible complications, certain patients take little importance to this, as they often feel that there will not be and that they will "look better" than they were before the surgery.
Within the legal medical aspects of cosmetic surgery, the doctor must provide due care to the patient and follow Very strict standards of care, which should not compromise health.
Do people who have many cosmetic surgeries have BIID?
The results of a study conducted by Michael First, and collaborators (2005), in subjects with identity disorder of body integrity, showed that the wishes of these patients began in childhood and none of the respondents suffered dysmorphic disorder, because they recognized that they did not want to get rid of the member because they perceived a defect in their appearance.
People with BIID, unlike those who suffer from body dysmorphic disorder and who perform many surgeries, as well as a series of procedures for aesthetic purposes, often never seem satisfied, often seeking to modify the “defects” they perceive in their body, some even want the doctor to continue doing surgeries even if they compromise their health. Both conditions require psychological help.
What are some treatments that have shown good results for people with xenomelia or BIID?
It is recommended to follow a psychotherapeutic, psychiatric, psychopharmacological and neurological treatment, although the person with xenomelia or BIID can have relief from certain symptoms and problems such as mood disorders and anxiety, which often present, does not take away the desire to amputate or get hurt to such a degree that they are disabled. It is necessary that the family and people who cohabit with the patient have knowledge of the characteristics of this condition and continue to be informed, since the neurosciences struggle to find answers and especially solutions to the problems that afflict these individuals.
Hernández-Pérez, Enrique et al. (2012). Selected subjects in cosmetic surgery. Mexico: Preprensa Digital, S.A.
Hänggi et al (2017). Structural and functional hyperconnectivity within the sensorimotor system in xenomelia. Brain and Behavior, 7 (3): e00657.
McGeoch PD et al (2009) Apotemnophilia: The Neurological Basis of Psychological Disorder. Nature Precedings: 1-5.
Hilti LM et al (2013) The desire for healthy limb amputation: structural brain correlates and clinical features of xenomelia. Brain, 136 (1): 318-329.