Self-amputation craving defies diagnosis, researchers say

<body leftmargin="0" bgcolor="#000060" text="#FFFFFF" link="#FFFF00" vlink="#FF9900"> <table border="0" cellpadding="0" cellspacing="0" width="95%" height="1"> <tr> <center> <td valign="top" width="33%" height="33"> <b> <p class="MsoNormal"><font face="Arial" size="5">Self-amputation craving more complex than once thought, researchers say</font></p> </b> <p class="MsoNormal"><font face="Arial" size="1">Sept. 11, 2005<br> Special to World Science</font> </p> <p class="MsoNormal"> <b><font size="2" face="Arial">When an affable, middle-aged man entered the Veterans Affairs Medical Center in Milwaukee, Wisc., and told doctors he wanted an amputation—he always had—they spent months trying to cure him through therapy.<br> <br> Then, he packed both his legs in dry ice for seven hours, causing severe frostbite and forcing surgeons to chop off both legs above the knee. That done, he told doctors, he was finally happy.<br> <br> For a while.<br> <br> Lately, the man, called “Patient A” by physicians to protect his privacy, has been talking about doing the same thing to his left arm, doctors report.<br> <br> Researchers are studying why some people persistently want to have limbs amputated, and finding that the motivations are surprisingly varied. As a result, doctors are struggling with the question of how to diagnose, let alone treat, the condition. <br> <br> Whereas scientists once considered it solely as an aberration of a sexual or psychotic nature, researchers are learning that some “wannabes” have different motivations. Five psychiatrists from the medical center, who saw Patient A, wrote of these findings in the September-October issue of the research journal <i> Comprehensive Psychiatry</i>.<br> <br> The Internet is feeding and encouraging would-be self-amputators by bringing them together wannabe amputees, the researchers added.<br> <br> The “wannabe amputees” commonly say amputation is to them a form of self-fulfillment. They claim it would, paradoxically, make them feel “whole.” </font></b> </p> <p class="MsoNormal"> <b><font size="2" face="Arial"> Some also admit less exalted motivations, including, in Patient A’s case, a wish for attention—including attention in the form of taxpayer-funded social services. </font></b> </p> <p class="MsoNormal"> <b><font size="2" face="Arial"> Patient A indeed applied for and received Social Security disability benefits after his operation.<br> <br> He wanted amputation, he said, partly because it’s “something about me that is noticed, accords me certain accommodations and cannot be denied,” according to the <i> Comprehensive Psychiatry </i>paper.<br> <br> The authors described him as intelligent, articulate and tranquil, but with a troubled childhood, a failed marriage and on-and-off transsexual tendencies. </font></b> </p> <p class="MsoNormal"> <b><font size="2" face="Arial">He never expressed a regret over his amputation, the researchers said, but he did agree to undergo more therapy afterward. There, he “revealed that he had been interacting on the Internet in a news group designed for self amputees. Through these online communications, [he] deepened his motivation, developed the means, and finalized his determination to act on his desire.”<br> <br> It’s unknown how prevalent the condition is, and doctors still don’t know its causes, wrote the researchers, Bertrand D. Berger and colleagues. <br> <br> One way to gain insight into the condition, they added, might be to explore what it has in common with other, better understood psychiatric conditions. One might possibly then classify it as a variant of one of these conditions. But this strategy has proven difficult, they wrote. <br> <br> One diagnosis that might have applied in Patient A’s case is borderline personality disorder, the researchers wrote. This is a condition characterized by impulsive actions, mood instability, chaotic relationships, and frequently, self-mutilation.<br> <br> A problem with this diagnosis is that self-mutilation in borderline patients typically has different motivations, Berger and colleagues wrote. Whereas they often “cut or burn themselves when dissociating, attempting suicide, or reaffirming the sense of being evil… our patient reported the amputation as a means of being whole.”<br> <br> Another possible diagnosis would be body dysmorphic disorder, a condition whose patients are convinced they have a defect in appearance, Berger and colleagues wrote. Patients believe they have a misshapen, smelly, or otherwise defective body part. <br> <br> But again, the situation with Patient A and many other wannabe amputees is different. Their “preoccupation is not necessarily focused on a problem with the limb, but rather on not being ‘whole’ with the limb,” Berger and colleagues wrote.<br> <br> Whatever the cause of the condition, Internet discussion groups for people with the condition have blossomed. So have groups for people with a related condition, known as acrotomophilia—a sexual attraction toward amputees.<br> <br> The desire to be amputated itself is known as apotemnophilia, a coin termed by the researchers who first described the condition in the modern era in 1977, according to Berger and colleagues.<br> <br> As one index of how popular the subject is on the Internet, one discussion group for both amputee wannabes and those attracted to them has garnered more than 3,400 members since its founding just two months ago.<br> <br> “Without the Internet, our patient may never have met someone with similar ideas,” Berger and colleagues wrote. “The Internet helped provide a blueprint for self-amputation. Without the Internet, our patient may never have conceived, let alone used a method to bring about, self-amputation. We anticipate that increasing Internet access will lead to more cases of self-amputation.”</font></b> </p> <b> <p><font face="Arial" size="2">* * *</font></p> </b> <p><b><font face="Arial" size="2" color="#FFFFFF">Send us a <a href="mailto:editor@world-science.net">comment</a> on this story, or <a href="mailto:?Body=http://www.world-science.net/othernews/050911_amputfrm.htm">send it to a friend</a></font></b> </p> <p> </center> </td> </tr> </table> </body>