Synonym: body integrity identity disorder, BIID, self demand amputation
Source: apo = separation, philia = desire
Clinical features:
(1) The person has a strong desire to have a perfectly healthy limb removed.
(2) The person may visit multiple surgeons asking that the limb be removed.
(3) If no surgeon is willing to amputate the limb, then the patient may mutilate the limb to the point that it has to be removed.
(4) The person appears otherwise to be perfectly rational.
(5) Failure of psychotherapy or medications to reduce the desire for amputation.
(6) In the classic patient, resolution if the limb is removed.
Theories of causation:
(1) sexually fantasy about being an amputee.
(2) distorted body perception, possibly related to an underlying neurologic disorder.
(3) psychic distress.
Differential diagnosis:
(1) other conditions associated with self-mutilation
(2) amputation fetish (sexually aroused by someone with an amputation, acrotomophilia)
(3) psychosis
