June 21, 2024

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Quebec man has two fingers amputated to cure body integrity dysphoria

6 min read

It’s not the first time amputation has been used as a treatment for the rare condition

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Ever since he was a child he’d had “incessant,” intrusive thoughts about his left hand’s fourth and fifth fingers, the sensation that they weren’t his, that they didn’t belong to his body. At night, he’d wake from nightmares that his fingers were burning or rotting.

The young Quebec man was so desperate to get rid of his fingers he contemplated building a small, makeshift guillotine. “He couldn’t imagine himself living for the years to come with those fingers,” according to a recently published case report.

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Instead, a surgeon at his local hospital agreed to an elective amputation in what is being called the first described case of “digits amputation” for body integrity dysphoria, or BID, a rare and complex condition characterized by an intense desire to amputate a perfectly healthy body part, such as an arm or a leg.

The Quebec case involved an ambidextrous 20-year-old whose attempts at “non-invasive” relief, including cognitive behavioural therapy, Prozac-like antidepressants and exposure therapy, only increased his distress.

“He hides his fingers, keeps them flexed, leading to impaired dexterity, localized pain, irritability and anger,” Dr. Nadia Nadeau, of the department of psychiatry at Université Laval wrote in the journal Clinical Case Reports. He grew more determined to find a way to get rid of fingers he considered “intrusive, foreign, unwanted.”

“He had contemplated asking a friend to watch over him and be prepared to call emergency services in case his attempt led to a need for resuscitation,” Nadeau wrote.

After undergoing elective amputation, the nightmares and emotional distress immediately stopped, Nadeau said. The post-op pain resolved within a week, there was no “phantom pain” at one month follow-up and, without the two missing fingers, “he was able to pursue the life he envisioned as a complete human being without those two fingers bothering him.”

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“He won arm-wrestling games, was able to drive his four wheels, kept working with his hands without any problem,” Nadeau wrote. He was less angry, had “constructive life plans,” got along better at work and with family and has had no regrets, she said.

The amputation enabled him to live in alignment with his perceived identity

It’s not the first time amputation has been used as a treatment for BID. In the late 1990s, a surgeon in Scotland amputated one leg above the knee each in two men who’d felt a “desperate” need to be amputees, and who had been turned away by other doctors.

Despite the scandal that erupted, “At the end of the day I have no doubt that what I was doing was the correct thing for those patients,” the surgeon, Dr. Robert Smith, told a press conference.

The fact that there were only two fingers involved in the Quebec case, as opposed to a complete limb, made the decision to proceed easier for the medical team, Nadeau said.

For the patient, amputation “proved to be a highly satisfying curative treatment,” she reported.

“He is now living a life free from distressing preoccupations about his fingers, with all his symptoms related to BID resolved,” Nadeau wrote. “The amputation enabled him to live in alignment with his perceived identity.”

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Parallels have sometimes been drawn between BID and gender dysphoria. Nadeau’s patient, after doing some research, “related his condition to gender dysphoria,” she said. People with BID often feel their physical body doesn’t align with the image of the body they have in their minds.

While cutting off healthy, functioning body parts for psychological distress raises ethical concerns, BID sufferers sometimes resort to self-mutilation or “black-market” amputations, risking their lives, Nadeau said.

In 2008, an Australian man stuck his right leg, a limb he’d “hated” since childhood, in a bucket of dry ice for six hours, damaging the leg so badly doctors had no option but to amputate it below the knee. As Wired reported, the man, Robert Vickers, described experiencing “absolute ecstasy” when he woke up in hospital, missing his leg.

“The most naïve, succinct popular explanation is that someone wishing to have an amputation or paralysis must be ‘crazy’ or ‘insane.’ Both are wrong,” German neuropsychologist Erich Kasten wrote in a review of 20 years of research into BID.

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BID is likely rooted in an organic dysfunction in the brain, Kasten said, possibly “faulty connections” formed before birth and, as a result, “the corresponding body part is not correctly represented in the mental body image.”

“BID-affected people can move their leg or arm, but it is not really a part of what they perceive as their own body,” Kasten wrote.

The young Quebec man, whose brain imaging was normal, was embarrassed about telling his family what he was experiencing.

“Recognizing and addressing the unique needs of (BID) patients can lead to a future where they can live with more dignity, respect and optimal well-being,” Nadeau wrote.

National Post

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