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Psych Congress  

The Intense Desire for Healthy Limb Amputation: A Dis-Proprioceptive Neuropsychiatric Disorder

Mihir Upadhyaya, MD; Henry Nasrallah, MD

This poster was presented at the 30th annual  Psych Congress, held Sept. 16-19, 2017, in New Orleans, Louisiana.

The first mention of a condition in which apparently nonpsychotic individuals have a strong, unrelenting desire to amputate ≥1 of their healthy limbs was published nearly 4 decades ago. Over time, this condition has been called Apotemnophilia, Body Integrity Identity Disorder, and now the latest name, Xenomelia. Once dismissed as a paraphilia, the condition in recent years has been re-investigated with neurologic testing and imaging, yielding evidence suggesting it may be attributable to a neuroanatomical anomaly. Published literature on this condition features studies with a limited number of participants. However, the results of this testing is quite stunning, and indicate that affected individuals predominantly desire amputation of the left lower limb, and correspondingly, usually have changes in cortical thickness in the right parietal lobe. Further investigation of this condition is warranted, particularly, more research into the precise nature of the anomalous neuroanatomy, biopsychosocial background of those with the condition, and longitudinal perspective of the childhood onset and evolution of symptoms. Large sample studies involving a collaborative effort across multiple sites are required. The goal of further research would be to better understand the condition, and then devise methods of treatment that would ideally divert an individual with the condition from desiring the amputation of a healthy limb.

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