This is the paper that I recently presented at the WPATH (World Professional Association for Transgender Health) Conference in Atlanta, Georgia.

Body Integrity Identity Disorder and Castration

K. H. W., Ph.D.

Apotemnophilia, Body Dysmorphic Disorder (BDD), Amputee Identity Disorder, Body Integrity Identity Disorder (BIID), Male-to-Eunuch gender dysphoria. These are similar, but not the same thing.

What is today largely known as Body Integrity Identity Disorder was first described by John Money in 1977, and named apotemnophilia. He defined it in terms of a sexualized fetish wherein a disability is either desired or admired. He suggested that the remaining stump of a limb is eroticized, or was used as a motivation for overachievement notwithstanding a disability. This is not to be confused with Acrotemnophilia, which describes a person who is sexually attracted to other people who are already missing limbs. Undoubtedly, there are some who are sexually motivated for amputation, but they are not as common as once believed, and are a minority of those with BIID

“The term BIID was coined specifically for those who desire to be an amputee in order to replace the term “apotemnophilia…a term which essentially meant being sexually turned on by the idea of being an amputee. The problem with this term, of course, is that it focused exclusively on the sexual arousal part of the condition and ignored what I consider to be the central element…one of desired identity.”

–––Michael First

Of course, there are some who are sexually motivated.

“Beginning about puberty my earlier castration urge became sexualized… I frequently tortured and banded and abused my balls…. (Many years later) I still get off on castration thoughts.”

–––R***

“Many who desire penectomy only are fetishistic, and frequently talk of sexual frustration as their motivating desire. But not so of those seeking nullification – they are more often M-to-E. BIID people tend to be much more castration oriented, at least those I’ve talked to.”

–––C***

Body Dysmorphic Disorder is often confused with BIID, but in fact they are quite different. Typically, BDD involves a distorted perception of one’s body, thinking some aspect or part of it is abnormal; often something that is only slightly wrong and not visible to others. A BDD seeks to change what is perceived as abnormal to make it normal. There is an obsessive revulsion toward the physical attribute in question, feeling that some element of one’s appearance is repugnant. It may be associated with delusional belief systems. An anorexic might be an over-simplified, but effective, example. In some cases BDD perception can be changed, but not often. In most cases, surgery does not cure BDD, unlike BIID, which it does cure. .

The term Amputee Identity Disorder, which does not include other disabilities, was first suggested by Furth and Smith in 2000, was a precursor of the term Body Integrity Identity Disorder, which was proposed by First in 2005. BIID has in large measure superseded both Amputee Identity Disorder and Apotemnophilia as the preferred term.

The essential concept of BIID is that the individual is obsessed with the removal or disablement of one or more physically healthy limbs, appendages, or senses. There is a perception that the body does not match their mental picture of themselves, frequently being unable to connect to their body as it is, as opposed to how it “should” be. It involves the wish to alter one’s bodily identity.

“I’ve thought about this a lot, in various ways, since I was a teen. Is it a fantasy? It’s not particularly arousing, so I wouldn’t call it a sexual fantasy, but I do find the thought of being castrated very appealing at a deeper level.”

-R***

Most people who experience BIID have all or a combination of some of the following symptoms:

1) The individual’s need for the impairment required is a settled matter.

2) There exists a sense that one’s body is not correctly configured, that one is incomplete, or not whole and that the presence of the subject limb, appendage, or sense, is itself an impairment or disability.

3) Some may be jealous of someone who has the desired impairment; some not only wish impairment, they are also devotees.

4) Feelings of shame about the feelings. These individuals feel completely alone and do not believe anyone else can suffer from such bizarre ideas. They may have been in psychological treatment without ever informing the therapist of their underlying desire, thus an apparent failure of the currently available treatments to resolve their problem.

5) Repeated episodes of depression and sometimes suicidal thoughts or attempts, undoubtedly some completed.

6) Rehearsal activity (pretending or “play”) during which they imitate the impaired state in private or in public. Here, the use of banding of the testicles or penis is common. Sometimes, there have been plans of self injury to achieve impairment – sometimes carried through.

While not in the DSM-IV-TR, it has been proposed as an addition for the DSM-5. The proposed criteria are

A.) An intense and persistent desire to become physically disabled in a significant way (e.g., major limb amputee, paraplegic, blind), with onset by early adolescence.

B.) Persistent discomfort, or intense feelings of inappropriateness concerning current non-disabled body configuration.

C.) The desire to become physically disabled results in harmful consequences, as manifested by either (or both) of the following:

(1) the preoccupation with the desire (including time spent pretending to be disabled) significantly interferes with productivity, with leisure activities, or with social functioning.

(2) attempts to actually become disabled have resulted in the person putting his or her health or life in significant jeopardy.

D.) The desire to become disabled is not primarily motivated by sexual arousal nor by any perceived advantages of becoming disabled.

E.) The disturbance is not a manifestation of a psychotic process, is not due to a primary neurological condition, and is not better accounted for by another mental disorder.

It will probably not be an official category in the DSM-5, but is likely to appear in the research appendix.

Nieder and Richter-Appelt have described Parallels between GID and BIID:

There is a profound dissatisfaction with embodiment and a desire to surgically alter the body.

Transsexual people regularly state that they feel trapped in the wrong body; BIID-individuals often believe they are living in the wrong body form.

Additionally, there is often simulation of the desired physical representation in terms of cross-dressing and pretending.

Furthermore, for people heading for a hormonal and surgical cross-sex treatment, and for those who are seeking an elective amputation, it is not a conscious choice. Rather they feel that they need to do it.

Besides this, transsexual people and BIID individuals claim that they feel, behave, and have personality characteristics like the desired individuals, For example, transsexual man often has a kind of a tomboy history with rough-and-tumble play; a person with the need to be paraplegic checks every route he has to follow if he could manage it with a wheel chair.

At some point of their individual development, all transsexual and BIID individuals feel a sense of guilt for who they are.

Both groups are very heterogeneous.

---(Nieder and Richter-Appelt 2009)

Initially, BIID was described as concerning only peripheral limbs, most commonly left above knee amputations. However, a search of the literature from 1957 to 2005 by Swindell and St. Lawrence found a variety of cases, which could broadly fall under the current definition of BIID. Of those non-psychotic cases reported during that period, 32% involved amputation of the penis, making it the most common amputation. In the same compendium, First makes reference to castration as an area that would appear to fit the BIID criterion, yet suggests it needs further study.

Our research suggests that voluntary castration, penectomy, or both should be considered as BIID in some cases, and in other cases a Male to Eunuch Gender Identity Disorder (MtE GID).

Some researchers believe that Body Integrity Identity Disorder can be seen as a mental illness (First, 2005; Furth, 2000). Others believe it may be a neurological condition wherein the brain’s mapping function in the right parietal lobe does not appropriately incorporate the affected limb in its map of the body form (McGeoch, 2008; Ramachandran, 2007). Some others yet believe it's a neuropsychological condition. Yet others believe that the origin involves an early witnessing of farm animal castration, for which there is some evidence (Brett, et al. 2007).

“I think what touched it all off was seeing a banded baby goat and then seeing them after their balls dropped off… I mainly had older friends (I was about 11), they were doing puberty; I thought it (puberty) was a bad idea. Being obsessed with nothing below the dick was the norm; no puberty was like an added bonus… You know, if a Dr offered to do it (castrate me), and I could afford it, I think I would do it in a minute.” –– –B***

Some report experiencing an early exposure to and/or awe/admiration of someone with the desired impairment. In any case, BIID seems to originate quite early, sometimes with awareness as early as 5 years of age, and most seem to report a definite onset by the time of puberty, at the latest.

“I have heard the theory that witnessing an animal castration at a young age essentially imprints the notion of castration. It never did that for me – I never witnessed an animal castration. I always knew something was wrong down there, early on, but it didn’t really come into my conscious awareness until puberty just what it was. I just knew my nuts needed to be gone…. I just knew that my testicles had to go. It was never a real turn-on for me, although there was some occasional masturbatory reinforcement. I am very happy that I was castrated and am a contented male.”

–––W***

Based on some rough estimates and extrapolations (Johnson, et al. 2007), it has been suggested that there are ten to twelve thousand voluntary eunuchs of various sorts in North America today. There are a great many more who are “wannabes” who desire a castration, penectomy, or nullification, who have yet to achieve their desire. Quite a few men also actively fantasize about castration with no desire to ever carry it out.

There are discussions about the concept of impairment, or disability, where many people suffering from Body Integrity Identity Disorder say they do not need an “impairment,” they do not want a disability. As opposed to impairment, the desired amputation is considered instead a “repairment,” or a correction of one’s body to match the image that one is “wired” for.

“BIID is… a person's manifest encounter with a disability, the treatment (the surgeries?) for which, if done wisely, corrects the disability. In the model of BIID that makes useful sense to me, surgeries in response to BIID do not result in disability, and surgeries are not sought with the actual intent of disability; rather, the surgeries correct the actual disability when such surgeries are appropriately done.”

–––J****

As opposed to Apotemnophilia, or BDD, a “transabled” (as some with BIID prefer to refer to themselves) person does not believe that they are abnormal, either psychologically or somatically. They fully realize that possession of all limbs and appendages and senses is in fact normal. There is instead a consideration that one or more of these do not belong where they are – that their body image does not include them.

Based on case reports and our data (Johnson, et al., 2007) the majority of people who experience BIID function well in society, are not psychotic or delusional, and are generally above average in intelligence and education level. Men seem to be more likely than women to experience BIID, and it would appear from existing case reports that most are Caucasian, although our research indicates a greater representation of different races and ethnicities. Some internet amputee sites suggest there may be a greater number of BIID amputees who are women as well.

Most surgeons will not treat people with BIID by performing amputations, although there are some who will do so quietly and discretely. Many with BIID will relentlessly search out doctors who are agreeable. Some seek “cutters,” illicit “surgeons” such as veterinarians, surgical nurses, or simply some back alley operator, or they attempt self-castration by surgery, testicular alcohol injections in order to damage them sufficiently to warrant removal. There are of course significant ethical and other considerations in performing an amputation, medically, socially, and legally.

The crux of the psychosocial perspective, as I see it, is that if the only effective cure for BIID is the removal of the offending appendage, then that which follows from it is also a part of the disorder. As a result, if effective daily function necessitates the use of HRT, that ought to be deemed appropriate, and thus is not an unethical or fraudulent use of resources. (Bayne, 2005)

*****

In closing,

“Is being diagnosed with a Body Integrity Identity Disorder a bad thing? A revolting disorder? I'm not sure. I'm not sure why I had to be castrated, but my desire to be castrated consumed me until it was accomplished. Why? What was it inside of me that pushed me to accomplish this? Some think I had a demon, some think I had a mental illness, perhaps Obsessive Compulsive, some think I was stressed out and sexually frustrated. I don't know why I needed to be castrated, I'm just glad that I was. It doesn't really bother me to be diagnosed with a BIID, simply because the compulsive desire to be castrated is outside of normal for most men... Only a small percentage of men in this world ever fully act on getting their balls cut off, I am one of them and that's alright with me.” –––H***

References:

Bayne, Tim and Levy, Neil. “Amputee by Choice: Body Integrity Identity Disorder and the Ethics of Amputation,” Journal of Applied Philosophy, 2005, 22(1) 75-86

Brett, Michelle A., et al. “Eunuchs in Contemporary Society: Expectations, Consequences, and Adjustments to Castration (Part II),” Journal of Sexual Medicine, 2007; 4; 946-955.

First, Michael. “Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder,” Psychological Medicine 2005, 35: 919-928 Cambridge University Press

First, Michael. “Origin and Evolution of the Concept of Body Integrity Identity Disorder,” in Stirn, A. Thiel, S., and Oddo, S. (Eds.) Body Integrity Identity Disorder: Psychological, Neurobiological, Ethical and Legal Aspects, 2009, Pabst Science Publishers, Lengerich, Germany.

Furth, G.M. and Smith R. Amputee Identity Disorder: Information, Questions, Answers, and Recommendations About Self-Demand Amputation, 2000, Authorhouse

http://biid-info.org/How_do_I_know_if_I_have_BIID%3F retrieved 04 April 2011

http://devolinks.com/ retrieved 24 July 2011

http://devolinks.com/Groups/AmpLinks retrieved 24 July 2011

Johnson, Thomas W., et al. “Eunuchs in Contemporary Society: Characterizing Men Who Are Voluntarily Castrated (Part I),” Journal of Sexual Medicine, 2007; 4; 930-945

McGeoch, P., Ramachandran, V.S., and Brang, D. “Apotemnophilia: A Neurological Disorder,” Neuroreport. 19(13):13005-1306, August 27, 2008

Money, John. The Journal of Sex Research. Vol. 13, No2, pp.115-125 May, 1977

Money, John. American Journal of Psychotherapy. 1984 Apr; 38(2):164-79

Nieder, T.O., and Richter-Appelt, H. (2009). “Parallels and Differences between GID and BIID and Implications for Research and Treatment of BIID,” In: Stirn, A., Thiel, S., and Oddo, S. (Eds.) Body Integrity Identity Disorder: Psychological, Neurobiological, Ethical and Legal Aspects, Lengerich, Germany: Pabst Science Publishers, pp. 133-138.

Ramachandran, V.S., McGeoch, P. “Can vestibular caloric stimulation be used to treat apotemnophilia? “ Medical Hypotheses, Volume 69, Issue 2, Pages 250-252, 2007

Roberts, et al. “A Passion for Castration: Characterizing Men Who are Fascinated with Castration, But Have Not Been Castrated,” Journal of Sexual Medicine, 2008, 5 (7) 1669-1680

Swindell, M. and St. Lawrence, J. “Body Integrity Identity Disorder: An Overview,” in Stirn, A. Thiel, S., and Oddo, S. (Eds.) Body Integrity Identity Disorder: Psychological, Neurobiological, Ethical and Legal Aspects, 2009, Pabst Science Publishers, Lengerich, Germany.

Thomson-Smith, Lydia D. Body Integrity Identity Disorder: The Need for Physical Impairment. Fastbook Publishing, 2010 (Editorial Comment: Several very indirect discussions or comments suggested by this book, although it is a waste of time and money and paper. There are 5-6 direct references in limited manner to BIID within its 85 pages. It reads like an over-extended term paper that is completely off topic of its title.)

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kristoff wrote: Fri Sep 30, 2011 10:11 am Apotemnophilia, Body Dysmorphic Disorder (BDD), Amputee Identity Disorder, Body Integrity Identity Disorder (BIID), Male-to-Eunuch gender dysphoria. These are similar, but not the same thing.

"

I was surprised that their is not more crossover.

Fantasizing of limb amputation has little difference from fantasizing about penis amputation, to me.

Sure they are different but, so is losing an arm as opposed to a leg, etc.

Thanks for sharing

Moi

While Kristoff’s presentation was essentially state-of-the-art when he made it in 2011, there has been a great deal of progress since. Prof. Michael First of Columbia University (and some of his colleagues) proposed that BIID be included in the DSM-5 that is due out next month. The word is that BIID won’t make it this time, but that it will be included in the appendix as a condition that requires further research.

Several neuroanatomists have produced solid research on the neurological component of BIID. They tend to prefer the term “XENOMELIA” for the condition. The term comes from the Greek and means “foreign limb.” Unlike

kristoff wrote: Fri Sep 30, 2011 10:11 am Body Integrity Identity Disorder, which

is four ENGLISH words that are foreign to the rest of the world, xenomelia is short and equally foreign to everyone.

Peter Brugger (University Hospital Zurich) and Paul McGeoch (University of California, San Diego) have done the primary research indicating that xenomelia is tied to the sensory cortex of the right parietal lobe of the brain. They hypothesize that the most common body parts to be effected will be the genitals, followed by the left lower limb. It’s a failure of the brain to properly map existing body parts, which are then perceived as foreign objects attached to the body. The only known cure (in the absence of any way to rewire the brain) is to remove the offending parts.

An important scientific congress on xenomelia was held in Zurich on March 14 and 15 of this year. Michael First, Paul McGeoch, Peter Brugger, Silvia Oddo (University Hospital Frankfurt), Gabriella Bottini (Niguarda Hospital in Milan), and several others were invited participants in the congress. I was invited, but Social Security only covers so much and my travel expenses wouldn’t have been tax deductible. I will post excerpts from the congress report once it becomes available.

Hopefully one day soon the medical community will accept our need to change our bodies to feel complete and provide us the care we need.Wouldn't be great if you could go to your doctor and tell him(or her) what you feel you need to change. The doctor would explain the options you have, you would have a short psychological evaluation( a few hours max) then you could receive the needed corrections. People wouldn't have to use cutter's or take things into their own hands and do diy surgery. Every day the emergency rooms and morgue receive people that have tried to find peace of mind and failed!

Nidaho Rachel (imported) wrote: Sat May 04, 2013 10:34 am Hopefully one day soon the medical community will accept our need to change our bodies to feel complete and provide us the care we need.Wouldn't be great if you could go to your doctor and tell him(or her) what you feel you need to change. The doctor would explain the options you have, you would have a short psychological evaluation( a few hours max) then you could receive the needed corrections. People wouldn't have to use cutter's or take things into their own hands and do diy surgery. Every day the emergency rooms and morgue receive people that have tried to find peace of mind and failed!

I´m hoping that too, I think that it lays in our genes.Taking a psychological evaluation + see what your genes are giving of options.When we look at the transcommunity it´s been taking 30 years to get some respect.Just the thought that bodyparts are temporarily would confuse people even more.

Scientific understanding of how the activity of genes is controlled (or regulated?) is a problem in biology that is becoming increasingly well understood. Genes "make" protiens, and that is all that genes do, so the most recent, widely accepted by geneticists, scientific models hold, as best I have been able to learn.

There is the genotype of an organism (a person being an organism) which can become known through the methods of gene sequencing. There is also the phenotype, which is how genes are expressed in an organism.

For anyone not very familiar with this, looking up "genetics" and "epigenetics" on Wikipedia may be helpful.

I joined the Eunuch Archive in the summer of 2011, close to two years ago, after finding aspects of prejudice among some members of the medical community after the testicular prostheses I had activated a foreign body reaction that was quite uncomfortable at times and that I thought might lead to impaired immune system functioning.

I happen to be a licensed Wisconsin Registered Professional Engineer who has both B.S. and Ph.D. degrees in bioengineering. Bioengineering is, to me, engineering applied to the phenomenon of life. Engineering is, to me, the solving of practical problems, efficiently, effectively, and economically, using scientific principles. In my work in bioengineering, the practical problem that got my most intensive and extensive attention was solving some of what are, to me, among the most difficult problems of theoretical biology.

Let me put that more simply? The practical problem toward which I put my main bioengineering effort is developing and testing a theory of everything that really is a theory of everything (not a theory of everything in physics of the sort that Einstein and Hawking have not, so I gather, been able to demonstrate - not everything is within the realm of physics, so a theory of everything that is a physics theory is, methinks, forever impossible), which I find is necessarily and inevitably a biological theory.

As a licensed professional engineer, my license requires that I work in accord with the Code of Ethics of the National Society of Professional Engineers. That Code has three basic canons as I understand it: in my work as a Professional Engineer, I am to 1. Hold paramount the public safety. 2. Work in, and only in, areas of my professional competence. 3. Do both (1.) and (2.) without deception.

So what?

To not be at risk of losing my license, I need to be competent in the areas of biology that are relevant to my work in bioengineering. Since my practical work is largely focused on developing practical applications of theoretical biology, and the necessary theoretical biology appears to me to not yet exist, as a result of which one of my practical problems is advancing the "cutting edge" of theoretical biology, my license as Professional Engineer requires that I be a competent theoretical biologist.

What is all of the above word hodgepodge about?

Knowing what "your genes are giving of options" is a terribly inadequate way of dealing with an epigenetic phenomenon. Finding it personally wise and necessary to part with one or more body parts is inescapably epigenetic.

My arriving at eunuch status was the result of my deciding to do as much as was practical to avoid dying of cancer in the manner of my dad and brother, having recognized in 1986 that my cancer risk was an epigenetic phenomenon. Twenty seven years after I had my main cancer-risk-reduction-intended surgeries, no more effective or efficient, or economical method for reducing my risk has been developed by the medical community.

I had massive difficulty finding physicians and surgeons who were capable of listening to my cancer risk concerns in prior to 1986.

People who encounter BIID have no less need for proper medical care and treatment than I did; yet social prejudices continue to block many people from receiving appropriate medical treatment for very real, albeit epigenetic, conditions.

Most of the physicians I have met are fairly clueless as to the biological mechanisms of epigenetics, most of them have the simple view, based on Mendelian genetics, wherein a gene "causes" a phenotypic trait; I find that simple view to be often tragic when used as the basis for medical care and treatment.

Absent a way to remain physically alive for all of the rest of eternity and beyond, all body parts are inescapably temporary. Or, did I miss something?

Thanks Janekane

This is one of many reasons that I use forums, you will get smarter cos other members have other educations/jobs/interests.

The reason that I wanted to use the gene was because it would make it easier to gain respect and/or surgery.It could be interesting to see how easy it would be to find similarities(gene/proteins) in & within these categories:

Eunuchs

MtF - straight

MtF - lesbian

FtM - Straight

FtM - Gay

Neutrois

When I look at some of MtF it seems that there body responds better/faster on HRT than others.This could mean that there gene/proteins were ”supporting” the right hormone.

Where does I fit in ?

Was annoyed by the fact that I never have had a girlfriend.At the age of 35 I stumble across AVEN.

My sex-life was haven´t been the same after that !!!!!!!!!!!!

My ability to get horny was dropping, sometimes I was able to masturbate 3 times a day.

Today I´m thinking about how my life would be without my junk.Have had an idear for some time now.My girlfriend and I aggrees to get fixed.First year: uterus+balls Second: Boobs+nipples Third year: vagina+penis

Interesting thread. Never thought much about it but as I read through it I couldn't help but wonder if it all could be compared to other things that make up our psyche. Why are some more athletic, more artistic, more intelligent, gay or straight or in between? The list could go on.

While Kristoff’

JesusA (imported) wrote: Sat Apr 27, 2013 6:57 pm s presentation was essentially state-of-the-art when he made it in 2011, there has been a great deal of progress since. Prof. Michael First of Columbia University (and some of his colleagues) proposed that BIID be included in the DSM-5 that is due out next month. The word is that BIID won’t make it this time, but that it will be included in the appendix as a condition that requires further research.

Several neuroanatomists have produced solid research on the neurological component of BIID. They tend to prefer the term “XENOMELIA” for the condition. The term comes from the Greek and means

“foreign limb.” Unlike

kristoff wrote: Fri Sep 30, 2011 10:11 am Body

JesusA (imported) wrote: Sat Apr 27, 2013 6:57 pm Integrity Identity Disorder, which

is four ENGLISH words that are foreign to the rest of the world, xenomelia is short and equally foreign to everyone.

Peter Brugger (University Hospital Zurich) and Paul McGeoch (University of California, San Diego) have done the primary research indicating that xenomelia is tied to the sensory cortex of the right parietal lobe of the brain. They hypothesize that the most common body parts to be effected will be the genitals, followed by the left lower limb. It’s a failure of the brain to properly map existing body parts, which are then perceived as foreign objects attached to the body. The only known cure (in the absence of any way to rewire the brain) is to remove the offending parts.

An important scientific congress on xenomelia was held in Zurich on March 14 and 15 of this year. Michael First, Paul McGeoch, Peter Brugger, Silvia Oddo (University Hospital Frankfurt), Gabriella Bottini (Niguarda Hospital in Milan), and several others were invited participants in the congress. I was invited, but Social Security only covers so much and my travel expenses wouldn’t have been tax deductible. I will post excerpts from t

he congress report once it becomes available.

Bump. Did you ever get that Congress report?

Amen to this! I am living proof that this is real and it DOES exist. My psychologist would agree and in fact, it was she that informed me of this condition and diagnosed me with having it. Now the next step is to get surgery to correct it, (or me).