Friday, October 24, 2008
Acrotomophilia:Wannabes, devotees and pretenders
Dysmorphophilia was a condition described in 1888 by von Krafft-Ebing and related to a sexual attraction to "bodily defects." He illustrated dysmorphophilia with two case histories i.e. a young man sexually excited by the sight of a women's disfigured feet and the other a young man who pretended to be lame using two brooms for support. In both cases the behaviour was well established with the latter, a preoccupation from early childhood. Today the second case might be better described as apotemnophilia or an erotic desire in being or looking like an amputee.
In 1977 John Money used the terms auto-apotemnophilia and allo-apotemnophilia to discriminate between the erotic interest of wanting to be (apotemnophilia) or appear as an amputee; with the sexual desire to have an amputees as a partner (acrotomophilia). Within fetish communities acrotomnophiliacs are called Devotees, Amputee Lovers or Admirers. The term ‘amelotatism’ is sometimes used as a synonim for acrotomnophilia in formal text. There have been surveys published of what type of amputation attracts most acrotomnophiliacs. The greatest attention is given to lower limb amputees with a single amputation that present with a stump. Consequently the amputee is referred to colloquially as a “hump in stump.’
According to Bruno, (1997) some acrotomophiles find foot deformities like clubfeet and bunions very attractive whereas others may be stimulated by finger and toe amputees. Solvang (2007) believes all devotees otherwise follow a normal conception of attractiveness. Bruno (1997) reported some acrotomophiles predatory stalk disabled persons, making obsessive and intrusive phone calls; as well as sending letters and emails to persons with disabilities, They will often attend and sometimes organise disability related events in order to watch or take pictures of disabled people. Acrotomophiles will deliberately engage amputees in conversation and take any opportunity to touch them. The attraction to amputees seems to arise early in life with many cases reported before the age of six or seven (Nattress, 1996, cited in Bruno, 1997). Dixon (1983) published results of a survey of 195 acrotomophiles (males) and three quarters had been aware of their interest in amputees by age 15. Just over half (53%) of the respondents had pretended to be an amputee (11% having done so publicly) and 71% had fantasised about being an amputee. This implies the majority of devotees are also pretenders and wannabes. These findings appear consistent with other studies.
Several psychological theories to explain the phenomenon have been proffered such as a child may identify body image with an influential encounter with someone who is an amputee. At critical stages of the child’s development an amputee may become a "love object." Depending on the age of the child this may establish an association between a disability related stimulus and sexual arousal. Most authorities accept the primal instinct to recognise a weakened prey may be interpreted as a less threatening partner who is more attainable or more easily dominated. Alternatively the child may adopt the mantle of the lame to seek attention. According to Bruno (1997) the "love object" theory however fails to fully explain the obsessiveness and compulsive attraction to disabled persons (devotee) nor does it demonstrate the powerful desire to appear or to become disabled (pretender).
Nurture theorists believe a child brought up in a household deprived of maternal love and/or parental rejection in early childhood may through fear develop survival coping mechanisms including self-generated fantasies. These may act as a trigger and when the parent is seen showing concern for a physically challenged child, the offspring rationalises they would be more lovable in this state. Taylor (1976) suggested the childhood fear of amputation could be replaced by an erotitisation of the stump i.e. transforming a terror into a joy. This however does not explain why many acrotomophiles demonstrate an interest in the pre puberty years. According to the author the injured child sees the removal of a limb as representing partial destruction of his own body which satisfies his need for self-destruction and at the same time makes him more attractive to others. Later with puberty, the emotional turmoil returns but on this occasion, the solution is applied to a person to whom the adolescent is sexually attracted. From out of the subconscious the thought evolves to be lovable the person must be an amputee. Whilst this theory provides a credible explanation many of the published case histories do not conform.
One other psychological theory which might help explain the obsession to be with disabled persons as well as the desire to pretend to be disabled is described as Factitious Disability Disorder (FDD). These is a condition in which disability (real or pretend), affecting oneself or others, is perceived as an opportunity to be loved and attended to where no such opportunity has otherwise existed. To this effect apotemophilia may share something in common with Munchausen's Syndrome. (Money, Jobaris, & Furth, 1977). Research has shown the desire to be disabled is present in the wannabe and pretender but not always in devotees. Here the feeling is shared with a patient with factitious disability. The appearance of disability is present in the wannabe who successfully becomes disabled, a person with a factitious disability and in the pretender while using assistive devices. A neuro-anatomical explanation may involve an anomaly in the cerebral cortex relating to the limbs. When prioprioception centres are effected in the right side of the inferior-pariental lobule of the brain this adversely effects proprioception. A condition similar to somatoparaphrenia may exist and males appear more likely to be affected since the size of the inferior-parietal lobule is smaller in males than females. Some experts believe this malfunction is more likely to affect men and may also explain why most requests for amputations are usually left-sided limbs. The likely hood is the condition is probably explained by a combination of factors (Riddle 1988) and not just one in particular. Attraction to disabled persons has also been related to homosexuality, sadism and bondage. (Wakefield, Frank, & Meyers, 1977). The stump appears to represent a penis, providing a less threatening sexual stimulus for male "latent homosexuals" and a counterphobic protection against the fear of castration. Therefore in apotemnophilia and acrotomophilia the desire for amputation may be a "counterphobic" antidote for males who fear castration. Reported surveys however have found no increased prevalence of homosexuality, sadism or interest in bondage among acrotomophiles. (Dixon, 1983; Nattress 1996 cited in Bruno, 1997). Body modification has been defended as a private ritual of self-ownership and freedom of choice.
Asexual preoccupation may be diagnosed as Body integrity identity disorder (BIID) or Amputee Identity Disorder, which is like ampotemnophilia but with no sexual component. Apotemnophilia is usually sexually motivated and therefore a true paraphilia. Apotemnophilics will sometimes go to extraordinary lengths to have a limb amputated (Storrs, 1997) and autoapotemnophilia whether amputation of one's own body parts or operating on a partner for the sake of sexual pleasure has been recorded. Also some apotemnophiles seek surgeons to perform an amputation or purposefully injure a limb in order to force emergency medical amputation. Elliot (2000) described a phenomenon where people had been refused voluntary amputations of healthy limbs and subsequently performed amputations on themselves. It is now recognised all apotemnophiliacs are masochistic and the pain associated with amputation and or rehabilitation is not the primary goal. Many authorities believe apotemnophilia should be classified as a neuro-psychological condition, with a biological aetiology instead of the traditional psychiatric disorder. Like body dysmorphic disorder or a preoccupation with what people see as a physical defect, the apotemnophile shares the same concerns with those living with a gender-identity disorder, i.e. uncomfortable with their body identity. They would regard their limbs as a type of surplus and want to become an amputee. There are chat rooms, meeting points, and electronic bulletin boards catering for both "wannabes" and "devotees." Currently there is more material dedicated to devotees than wannabes. "Pretenders", are non disabled people who act as if they have a disability by using assistive devices such as braces, crutches, and wheelchairs. This pretence may be done either in private or in public.
Bruno RL 1997 Devotees, pretenders and wannabes: Two cases of Factitious Disability Disorder. Journal of Sexuality and Disability, 1997; 15: 243-260.
Dixon D 1983 An erotic attraction to amputees. Sexuality and Disability 6: 3-19.
Money J 1977 Peking: The sexual revolution In Money J & Mustaph H (eds) Handbook of sexology Amsterdam: Excerpta Medica.
Money J, Jobaris R, Furth G 1977 Apotemnophilia: Two cases of self-demand amputation as a paraphilia. J Sex Res 13: 115-125.
Riddle GC 1988 Amputees and devotees: Made for each other? NY:Irvington Publishers.
Storrs B 1997 Amputees, Inc.: Amputees pitching products and themselves to devotees of disability. New Mobility 7: 26-31. Elliot (2000)
Taylor B 1976 Amputee fetishism: an exclusive journal interview with Dr. John Money of Johns Hopkins. Maryland State Med J March: 35-38.
von Krafft-Ebing E. 1932 Psychopathia Sexualis. NY: Physicians And Surgeons Books.
Wakefield PL, Frank A, Meyers RW 1977 The hobbyist: A euphemism for self-mutilation and fetishism. Bull Menninger Clinic 41:539-552.