At the age of 4, Robert encountered a teenager whose left leg had been amputated. "I wanted to be him," Robert says, explaining why, at age 12, he strapped a tourniquet above his left knee in a failed effort to induce necrosis. Now a doctor in Manhattan, he still wishes he could be one-legged, "with a midthigh, above-the-knee amputation."
Robert suffers from Body Identity Integrity Disorder (BIID), a bizarre psychological condition in which people fixate on amputating healthy limbs to achieve their ideal body image. (Imagine having an unwanted third arm.) In addition to feeling trapped in the wrong body, sufferers often endure shame
and depression. Commonly known as "amputee wannabes," they hope
to sever limbs at specific points—most frequently the left leg above the knee.
The origins of the condition remain mysterious, though sufferers share similar histories. They encounter amputees as children and, as early as age 4, experience discomfort with their bodies. The condition always cements by puberty. One explanation is that humans pass through a developmental stage during which they come to accept the presence of their arms and legs, says Michael First, a leading BIID researcher at Columbia University. Encountering an amputee appears to thwart that acceptance.
Counseling and medication consistently fail to resolve BIID symptoms. Furthermore, surgeons will not perform amputations on people with BIID because bringing harm to patients violates the Hippocratic oath. Sufferers contend that refusal of surgery harms them by prolonging their agony—and they may be right. According to First, in the few cases of elective amputation, patients report a complete end to their discomfort.
Wannabes go to extreme lengths to achieve peace. Some have allowed themselves to be run over by trains or forced medical amputation by shooting themselves. Others partially alleviate the need through mimicry: They bind up a limb and use wheelchairs and crutches.
Robert, now 70, distracts himself with work and church activities, though he recognizes the strategy's limits: "I worry how I will deal with BIID when I can no longer be active in other things."
Case Study: John, 33, a software engineer in the Pacific Northwest
Preparation: John first took leftover prescription painkillers and numbed his left foot in ice water to reduce impending pain. He then buried his foot in dry ice for six hours to induce severe frostbite and force surgeons to operate.
Resolution: Doctors amputated John's leg below the knee. As he recovered from surgery, he remained under psychiatric observation. His team of doctors had never heard of BIID.
Aftermath: Though John now needs a prosthetic, he does not regret his decision. He says that amputation resolved much of his anxiety and helped him feel comfortable in his body. However, he still struggles with depression stemming from years of hiding his condition.
Learn more: biid.org