Some of the most bizarre paraphilias that occasionally make their way into reputable psychology journals are those that involve sexual gratification from amputation of some description. Since the late 1800s, the medical literature has described men and women who are sexually attracted to amputees, those who limp, or use crutches, braces and wheelchairs, as well as individuals who pretend to be or who actually want to become disabled. These have included references in the books of Wilhelm Stekel (Sexual Aberrations,
1930), Richard von Krafft-Ebing (Psychopathia Sexualis,
1932), Magnus Hirschfield (Sexual Anomalies and Perversions,
1944), as well as published case studies such as M.F. Fleischl's study of "A man's fantasy of a crippled girl"
(American Journal of Psychotherapy,
1960) and Louis London's study of "Transvestism-Desire for crippled women"
(Dynamic Psychiatry, 1952).
A more recent development in the world of amputee paraphilias has been the advent of the internet. This has brought global attention to people with disabilities and their admirers. Most of these sites are chat rooms and home pages for male devotees of female amputees. However, there are lots of other sites including female devotees of male amputees, particular sexual orientations (heterosexual, homosexual) and particular attractions (e.g. crutches, plaster casts, crutch, and neck braces).
In 1977, the renowned US sexologist John Money of the John Hopkins University coined the term ‘apotemnophilia’ in the Journal of Sex Research. Apotemnophilia (Greek for "amputation love") refers to being sexually excited by the fantasy or reality of being an amputee. This behavior is often accompanied by obsessive scheming to convince a surgeon to perform a medically unnecessary amputation. This might seem to most people to be a type of masochism but reported case studies suggest that there is no erotization of pain itself – only of the healed amputated stump. To give you an inside look at the world of the apotomnophile, here is a real life case account from Professor Money's files.
"A man phoned up asking if he could have his leg amputated. He was told that this would not be possible but he continued to phone and write to the unit for the next four years. It was later discovered that he had made many attempts to self-inflict serious injury to his left leg. His obsession had been present since he was 13 years old in the form of self-amputee fantasies. On one notable occasion he hammered a stainless steel rod into his left leg and then tried to infect the open wound by smearing it on facial acne mixed with anal and nasal mucous. When his leg showed serious signs of infection he reported it to the hospital. Unfortunately his attempt failed as antibiotic treatment cleared the infection up. Looking into the childhood background, the most prominent early recollection was his left leg being severely burned by an overturned pot of boiling oatmeal at the age of two years old. This left him unable to walk for a year. However, there was little else in his family history to suggest the origins of such bizarre behavior."
Given the unconventional desires of the apotemnophile, it is perhaps unsurprising that self-mutilation occurs. To some extent, the condition resembles Munchausen's Syndrome in that MS patients are obsessed with self-inducing symptoms repetitively for the sake of being a patient whereas the apotemnophile is obsessed with the symptom themselves for the sake of being an amputee.
Acrotomophilia is a slightly different paraphilia to apotemnophilia and refers to being sexually aroused by a partner who is an amputee. They are excited by the stump or the stumps of the amputee partner and is dependent upon them for sexual arousal and attainment of orgasm. An example of this is given in the case study below (again from the files of Professor Money).
"This case involves a 47-year old man with an amputee fascination. His interest started at school when as an obese child he would try to do anything to avoid PE classes. It was at this stage he first started thinking that if he was an amputee he wouldn't have to take part in these sessions. As he reached adolescence, he started to pretend to be an amputee by tying one of his legs up and making a peg to walk around on. It was during one of these "pretend" sessions that he experienced his first orgasm. As he reached late adolescence, he switched from fantasizing about being an amputee himself to wanting an amputee partner. He even made his own scrapbook turning Hollywood filmstars like Marilyn Monroe into amputees. He eventually got married and four years into his marriage he told his wife about his fantasies. She didn't take the news well and it was never mentioned again for a further six years. However, later in the marriage, his wife would occasionally pretend to be an amputee while making love. Through an acquaintance, he developed friendships with a number of amputees and had sexual relationships with some of them. Interestingly, he claimed that his paraphilia was unlike other paraphilias because it was not always sexual and the fantasy was 24 hours a day."
One of the interesting insights offered by the acrotomophile above was that he was part of an amputee network and was in regular correspondence with 55 other amputee devotees. Some of these were married to amputees while others had never even met one. Those who had ended up with amputee partners sometimes changed their focus and became ‘wannabe’ amputees. With regards to the amputee fixation itself, around a quarter of the network were sharply focused on the stump itself and are very exact about what it should feel and look like (some being attracted to the scars – the more the better). Around a quarter of the network were really turned on by the asymmetry that amputation brings. For these people, bilateral amputees (for example, people with both legs amputated) were a turn-off.
In 1983, the first survey of male acrotomophiles was published in the journal Sexuality and Disability. The 195 acrotomophiles in the study were all customers of AMPIX (a company providing stories about and pictures of amputees) and were described as white, college educated, professional males. The results revealed that 75% had been aware of their interest in amputees by the age of fifteen. It was also reported that 55% of respondents had dated amputees, 40% had had sex with an amputee, and only 5% had married an amputee. 53% of the respondents had pretended to be an amputee (11% having done so publicly) and 71% had fantasized about being an amputee.
Dr. Robert Bruno, Director of the Post-Polio Institute (New Jersey) described two cases in an effort to understand the psychology of "devotees, pretenders and wannabes" (DPWs). So what exactly are DPWs? Put very simply:
• Devotees are non-disabled people who are sexually attracted to people with disabilities, typically those with mobility impairments and especially amputees.
• Pretenders are non-disabled people who act as if they have a disability by using assistive devices (for example braces, wheelchairs, and crutches). This may be done in private or in public so that they can 'feel' disabled or are perceived by others as having a disability.
• Wannabes actually want to become disabled, sometimes going to extraordinary lengths to have a limb amputated.
Dr. Bruno has also reported some of his case studies in the scientific literature. A variety of explanations have been offered for DPW's attractions, desires and behaviors. The most appealing explanation involves the pairing in childhood of a disability-related stimulus with sexual arousal. For example, one plaster-cast devotee reported by Dr. Bruno had his first sexual experience with a girl who was wearing a leg cast. However, only 19% of respondents to the AMPIX survey related their interest in amputees to any kind of direct contact with a disabled person, and the overwhelming majority of devotees have reported their interest in disabled persons began long before puberty. Others have suggested that DPW's desires develop from a combination of a strict anti-sexual attitude in the child's household, deprivation of maternal love and parental rejection in early childhood that creates a fear for survival and a self-generated fantasy for security. Some case reports appear to suggest that deprivation of parental love, coupled with seeing parents' positive emotional response to a disabled child, set the stage for attraction to the disabled. However, there may be other psychological factors at work as we shall see in the final case outlined below from the case notes of Dr. Bruno.
"A 45-year old white female with a history of childhood polio continually complained of arm and leg weakness, daily fatigue, disturbed sleep, imbalance and falling. Through her twenties and thirties she had many operations (on her hips and legs) and often became depressed. She had twice attempted suicide. In her early forties, she was given knee and ankle braces to treat her "instability." Because of discomfort, she rarely wore these and began using crutches. The patient's husband stated that she was again able to walk at home and in the hospital when she was in a psychotic state but not at any other time. He recalled that his wife had always wanted to have a "little disability" that would not limit her, like wearing braces on both legs, but only up to her calves. She thought that her mother and people in general would have treated her more kindly if she had been a disabled child."
Her childhood desire to have a 'little disability' was something she thought would have allowed her to be "treated more kindly," and her subsequent development of a Factitious Disorder, suggest that those with factitious physical disabilities can be combined with DPWs to create a diagnostic grouping that Dr. Bruno calls Factitious Disability Disorders. These are conditions in which disability - real or pretended - provide an opportunity to be loved and attended to where no such opportunity has otherwise existed. As noted earlier, Professor Money observed that apotemnophilia may share something in common with Munchausen's Syndrome. However, Professor Money distinguishes between the Munchausen's patient, who is obsessed with self-inducing symptoms repetitively for the sake of being a patient, and the apotemnophile who is supposedly satisfied with a single amputation.
The commonality between both conditions is they engage in the behavior "for the sake of being a patient" (to receive the care and attention that would otherwise not be obtainable). Apotemnophiles need only one - albeit very extreme - medical intervention that leaves them with a lasting and obvious stigma of disability that they believe will permanently satisfy their need for love and attention. If the common psychological foundation of these conditions is that disability will satisfy unmet needs for love and attention, then there are only two factors that differentiate between DPWs and those with a factitious physical disability – the awareness of a desire to appear or actually become disabled and physically appearing to be disabled.