Desire to be disabled: Body Integrity Identity Disorder

Desire to be disabled direct Integrity indistinguishability rowdyismBody Integrity Identity unhealthiness (BIID) is a r ar phenomenon in which individuals desire to be discern disabled with the amputation of fully functioning sleeves. BIID is described as the disparity amongst the individuals perception of their body and the actual form of their physical body (Bayne Levy, 2005). Other mental disorders and classifications have been cerebrate to BIID, including Gender Identity infirmity, Body Dysmorphic Disorder, and Hypochondriasis. The neurologic origins of BIID are unkn possess at this time, and word of this context with elective amputation is highly controversial. As a clinical audiologist, it is essential to recognize symptoms of BIID in patients, as well as be aware of the possible intervention of BIID through vestibular testing. Arguments for and against elective amputation will besides be discussed, as well as differential diagnoses of BIID.Audiology and BII DAs a clinical audiologist, sexual climax into contact with a patient who has Body Integrity Identity Disorder (BIID) is rare. However, the possibility does exist and it is most-valuable to translate the characteristics if one should encounter a BIID patient. The awareness of BIID in the audiology field can come into play concerning treatment of BIID, with one possible option incorporating aspects of vestibular testing.Body Integrity Identity DisorderJohn first took leftover prescription painkillers and numbed his left foot in ice water to land impending pain. He then buried his foot in dry ice for six hours to construct severe frostbite and force surgeons to operate (Adams, 2007).The previous insert from William Lee Adams article, Amputee Wannabes, describes a 33-year-old mans wish for amputation of his foot. thither was nonhing physically or medically wrong with this branch John only stated that he did non feel comfortable with his own body and felt as though his foot was non a part of him. After create severe frostbite to spread through off his foot, Johns leg was amputated preceding(prenominal) the knee. Post- surgery, he went on to describe that the operation resolved his anxiety and allowed him to be at ease in his own body (Adams, 2007).What causes someone to desire amputation of a reasoning(a) limb? This desire was first inform by French surgeon Jean-Joseph Sue in 1785 (Lawrence, 2006). However, this delusion only began to receive public guardianship in the early 2000s due to the increase in documented cases. Soon thereafter, a psychiatrical condition titled Body Integrity Identity Disorder (BIID), previously cognise as Amputee Identity Disorder (AID), became the more favorable diagnosis for these individuals. Currently, it is estimated that only a few thousand muckle worldwide are afflicted with BIID (Henig, 2005). BIID is described as a disparity betwixt the individuals perception of their body and the actual form of their physical body (Bayne Levy, 2005). A common complaint of these individuals is that the limb is alien and feels as though it is not part of them. Remarkably, those with BIID are often free of psychological issues, outside of their desire for amputation. Many are of regulation intelligence, have families, and hold jobs much(prenominal) as lawyers, professors, and doctors (Henig, 2005). So what triggers these seemingly design individuals to desire amputation?The neurological origins of this disorder are unknown, yet those with BIID share similar back curtilage. Most are exposed to an amputee at a five-year-old age, usually before they are 4 years old, and the fascination stems from this encounter. They begin to experience discomfort with their own bodies, and the delusion is full-blown by the time they reach puberty. As the sinking BIID researcher at capital of South Carolina University, Michael First believes that these individuals encounter an amputee while they are still in the developm ental stage in which customary individuals come to accept the existence of their own arms and legs. He believes the sight of an amputee prevents such acceptance (Adams, 2007).Although the neurological cause of BIID is unidentified, many associations have been made between BIID and other psychoses in order to narrow blast the diagnosis. Whether this disorder occurs because of a single experience during childhood, or stems from a combination of other psychological conditions, it is important to discuss other closely related diagnoses of BIID.Differential Diagnoses of BIIDSome professionals, such as Michael First, have suggested that BIID whitethorn involve a similar psychological desire as is seen in Gender Identity Disorder (GID), better known as transsexualism (Lawrence, 2006). GID is a condition in which wrong embodiment is the main concern. more than commonly, a male patient feels as though they are a female trapped in a males body. In both BIID and GID, dissatisfaction with o nes own body occurs because their body part in question disagrees with their comprehend sense of self (Mller, 2009). This displeasure, as well as the desire for amputation, is the commonality of BIID and GID. resemblingities to a fault exist between BIID and a condition known as Body Dysmorphic Disorder (BDD). The desired outcome of those with BDD is also amputation, moreover these individuals mistakenly believe that a part of their body is disease-ridden or remarkably ugly. BDD ties in closely to anorexia nervosa, organism that they are both delusions based on misguided perceptions of ones own body (Bayne Levy, 2005). On the contrary, the only grounds for amputation for those with BIID revolved around the fact that the body part felt foreign, despite the individuals knowledge that the limb was abruptly healthy.Desiring a DisabilityIndividuals who are suffering with BIID have also been associated with individuals who desire to contract disabled, or rattling believe they are di sabled or sick when they are not. One such disorder is known as Hypochondriasis, with the term hypochondriac being used more often for these individuals. Hypochondriasis is a psychiatric disorder where an individual constantly fears that they have or, at some point, will have a earnest disease, even when there is no medical proof or diagnosis (Hypochondriasis, 2002). These individuals misinterpret their physical feelings as symptoms of a serious disease, similarly to those with BIID who misinterpret their healthy body part as not being part of them. Symptoms that hypochondriacs face are also similar to those with BIID, including severe anxiety and depression. Hypochondriacs are not fabricating their symptoms, and become extremely concerned with minor problems such as excessive sweating, dizziness, and occasional tinnitus (Hypochondriasis, 2002). Hypochondriasis can also be as socially debilitating as BIID, in that it also causes individuals to not function at work or in their daily lives.Another phenomenon associated with the desire to be disabled is known as non-organic hearing button (NOHL). NOHL is described as responses to a hearing test indicating a deficit greater than can be explained by organic pathology (Austen Lynch, 2004). Some motives for NOHL behavior hold monetary and personal gain, such as being involved in a car accident and fabricating a hearing loss as a conjunctive injury. However, not all individuals who are labeled as NOHL are malinger some truly believe they have a hearing loss, or do not serve to the audiological testing even though their hearing sensitivity is normal. There are also those known as deaf wannabes, who, much like amputee wannabes, desire to belong to a community that is based on the balk or disorder. Deaf wannabes whitethorn have grown up in the deaf community, and although they have normal hearing sensitivity, wish to be deaf themselves.Overall, these conditions listed above may or may not be exclusive. An individ ual may not suffer from desired amputation based solely on the condition of BIID, BDD, or GID alone. Rather, they may suffer from a variety of combinations of these disorders, including Hypochondriasis and NOHL. With NOHL as a possible association, audiologists may be included in the group of professionals who interact and help with the treatment of these patients. That being said, the associations of these disorders and the knowledge that they are closely linked may lead to the best possible diagnosis of individuals who suffer from a desired disability.Arguments in Favor of Healthy Limb AmputationMany individuals who suffer with BIID believe that amputation is the only option. Upon learning of BIID, most people would consider it a psychotic disorder that by no means should be solved through elective amputation. However, the argument for permission of amputation by surgeons has been strongly considered. Individuals with BIID often feel desperate, and if this frustration continues it may lead to dangerous behaviors. These behaviors may include self-inflicted wounds, causing infection of these wounds, and burning a limb to injure it beyond repair in order to provoke amputation. Furthermore, these individuals may go as far as carrying out amputation on their own if a surgeon will not do it. Between 1997 and 1999, elective amputations were allowed in the United Kingdom in order to avoid these hazardous behaviors of individuals with BIID. However, such trading operations were quickly criminalize after they caught the attention of the public (Sorene et al., 2006). In order to minimize the harm that these individuals may inflict on themselves, amputation of healthy limbs by competent surgeons may be a viable option.Another argument for the amputation of healthy limbs would be that an individual has the right to alter ones body in the pursuit of acceptance and happiness (Jotkowitz Zivotofsky, 2009). Similar to those who undergo cosmetic surgery, as well as those wh o have had surgery due to Gender Identity Disorder, individuals with BIID are unsatisfied with their physical appearance and desire a change. Although both cosmetic surgery and GID surgery also encounter many arguments against altering ones appearance or gender, they are nationally recognized as an accepted medical practice. If these types of surgery are allowed to improve ones body image, then elective amputations may not be far-removed from these common practices.A lowest argument for the amputation of healthy limbs is the possible therapeutic effects that may occur post-surgery. Bayne and Levy (2005) describe this argument in four stages (1) the individual suffers because of their condition (2) amputation is expected to yield relief from this suffering (3) less-serious approaches and treatments will not bring about this relief and (4) the severity of amputation is minimal compared to purpose relief of this disorder. Some individuals who are afflicted with BIID have stated that their condition has interfered with their social lives (Bayne Levy, 2005), including their jobs and leisure activities. These individuals do have valid emotions and are truly suffering from an internal crisis, so regardless of the diagnosis of BIID, psychological intervention is necessary. Also, seeing as some BIID individuals go to extreme measures in order to reach button from their unwanted limbs, the therapeutic effects may be reason enough to allow healthy limb amputations.Arguments against Healthy Limb AmputationWithout question, the allowance of healthy limb amputations by surgeons would inevitably be met by immune forces. Society is likely to lead these arguments with feelings of repugnance and disgust. In the case of individuals who have lost limbs from accidents or disease, the imagination of amputating a fully functioning limb is appalling. Paddy Rossbach, the president of Amputation Coalition of America, stated that Its very troublesome for people who have been thro ugh what they consider to be a devastating life experience to understand why anybody would want to mutilate himself in this way, (Henig, 2005). Others who suffered unwanted amputation often say that the existence of BIID diminishes what they have been way out through emotionally. Desired amputation will meet public disdain, and those who have experienced unwanted amputation will undoubtedly be at the forefront.An additional argument against healthy limb amputations is the life-threatening consequences of such operations. According to Mller (2009), the principle of nonmaleficence states that physicians should not fulfill amputations without medical necessity. Such amputations often have severe consequences besides causing the individual to be disabled, including infection, phantom pains, thrombosis, paralysis, and necrosis (Mller, 2009). Furthermore, such operations may not be sure-fire at bringing about the desired relief. In some cases, desire for a new amputation of a previous ly accepted limb may follow the first operation (Hilti Brugger, 2010). Amputation causes irreversible hurt that may not heal properly, and if the operation is not justified based on life-saving measures, permission of such operations may never be accepted.Possible Treatment Vestibular Caloric Testing?A final argument against healthy limb amputations is the possibility of vestibular caloric stimulation as a treatment option for BIID. Although the neurological cause of BIID is unknown, one speculation is the involvement of the right parietal lobe. Evidence of somatoparaphrenia, or the belief that part of ones own body is not their own, has been documented in cases of right parietal lobe virgule patients (Mller, 2009). Neuroscientists Vilayanur Ramachandran and Paul McGeoch suggested that the right parietal lobe may also be involved in BIID patients, with supportive depict that most who desire amputation show a left-side preference, as well as an emotional rejection of their unwant ed limb (Mller, 2009). The speculation that vestibular caloric stimulation (specifically left-ear cold water irrigation) may be a treatment option for BIID is based on its known temporary treatment of somatoparaphrenia. Benefits of caloric stimulation over amputation include less-expensive treatment, lack of side effects, and immediate results showing if the treatment is working or not (Ryan, 2009). Overall, a trial of vestibular caloric stimulation should be the first step in treatment of BIID, and a clinical audiologist would perform this type of testing. For this reason, knowledge of BIID and the expertise to deal with these types of patients is important for audiologists to understand. Although caloric testing has not been be to relieve BIID patients of their suffering, and the effects on bodily awareness may disappear as soon as the caloric stimulation has stopped, it is a less drastic approach that has been speculated to be successful.In ConclusionThe express mail knowledge of BIID as a valid psychological condition, as well as causes and treatments, is a obstacle to finding some sort of relief for these individuals. Whether or not elective amputation is the solution for patients with BIID, the drastic decisiveness to remove ones limb forever should not be made until more is known regarding BIID. Regardless of the flat coat and probable causes of this disorder, individuals are still suffering daily from the notion that a body part is not their own. Intervention is necessary for BIID patients, whether it be vestibular testing by an audiologist, or other therapeutic remedies. Physicians should perform a thorough diagnostic evaluation when encountering a patient with BIID. Prior to causing irreversible damage to that individuals body, other treatment options and therapy should be researched.