Self-Inflicted Hand Amputation without Replantation in a Patient with Body Integrity Identity Disorder: A Case Report

Area of Science:

• Psychiatry
• Trauma Surgery
• Medical Ethics

Background:

• Body Integrity Identity Disorder (BIID) is a rare condition characterized by a persistent desire to amputate or paralyze a healthy limb.
• Patients with BIID often experience significant distress and functional impairment due to their condition.

Observation:

• A case is presented of a patient who self-amputated his hand using a log splitter due to a long-standing belief that the limb did not belong to him.
• Upon admission, the patient refused replantation, was found to be nonpsychotic, and was diagnosed with BIID.
• The patient was declared competent to make his own medical decisions, and a revision amputation was performed.

Findings:

• BIID presents a diagnostic challenge for physicians managing traumatic injuries.
• Ethical considerations support elective amputation as a definitive treatment for BIID.
• Conservative treatments, including pharmacotherapy, are generally ineffective for BIID.

Implications:

• Awareness of BIID is crucial for healthcare providers to ensure appropriate patient care and management.
• Elective amputation, when deemed medically and ethically appropriate, may offer harm reduction for individuals with BIID.
• Further research into the neurobiological underpinnings and effective treatment modalities for BIID is warranted.