Thursday, April 1, 2010

Apotemnophilia and body dysmorphic disorder

There appears to be an increase in the number of people wanting to have healthy limbs amputated suffice the subject has become an interest to medical and social research. The findings are complex with the motivation to have an amputation surprisingly varied. Apotemnophilia describes a psychotic disorder where the person has a compulsion to have a limb or part there off, amputated. This is a quite separate condition from acrotomophilia which describes a sexual attraction toward amputees.

Acrotomophilia is a paraphilia of the stigmatic/eligibilic type in which sexuerotic arousal and facilitation or attainment of orgasm is dependent only upon being with an amputee (humps in stumps), or an attraction to the idea of being an amputee (a wannabe). Apotemnophilia is not a sexual disorder but a major fixation on carrying out a self-contrived amputation, or obtaining one in a hospital. The cause of both conditions remains a mystery and although treatment involving counseling and pharmaceutical management is prescribed it frequently fails to relieve severe anxiety associated with apotemnophilia.

Apotemnophilia was first described in 1977 and relates not to a sadistic nor masochistic intention but instead to the idea of self fulfillment brought about by being an amputee. The compulsion is similar to the angst suffered by transgender people who may be relieved only when transgender relocation is complete by surgical intervention. The cause of ampotemnophilia remains a mystery and no treatment involving counseling and or pharmacy will reduce the anxiety. Because the condition is not well recognized many apotemnophiliacs go undiagnosed and more importantly untreated. Frustration and desperation drives many to self amputation with tragic consequences.

There are cases now cited where orthopedic surgeons have amputated healthy limbs at the request of their patients. Although small in number and obviously controversial the procedures are only conducted once all other forms of treatment have been tried. Like gender relocation surgery the protocols are strict and patients screened very carefully. Opposition to this type of cosmetic surgery is fierce and centres where these procedures are undertaken are few and far between. Many experts believe the increase of apotemnophilia is due to the internet and networks of would-be self-amputators sharing their experiences and a growing number of medics willing to perform amputations for them.

A significant number of people go to their podiatrist unaware they suffer from body dysmorphic disorder, a condition where people are convinced they have a defect in the appearance of their feet. Convinced they have a misshapen, smelly, or otherwise defective body part they will submit to all manner of cosmetic programs. People living with Munchhausen syndrome, a condition where people deliberately get sick or induce symptoms of illness because they like attention will also seek care as a means of receiving attention. The important difference is Munchhausen patients do this repeatedly, whereas most apotemnophiliacs seem satisfied with a one off operation.

Body awareness is a major preoccupation with people of the 21st century as the rise in cosmetic surgery will attest. Not only do we have the technology we also have cues of people waiting to have expensive elective procedures done and this might include shortening the length of toes or surgically filleting them. Modern primitives (Urban primitives) is a term used to describe people in Western Society with tattoos, body piercing, scarification and the like and many have turned their attention to foot embellishments, such as foot rings, tattoos and decorative implants, branding and cutting. The motivation for engaging in these varied practices may be personal growth, rite of passage, or spiritual or sexual curiosity. Foot binding is also used by some to reduce the size of feet and ‘sculpting’ (self amputation of a toe - or parts thereof) is on the increase.

In fifteenth century Spain, the male peacock fashion was to wear a broad fitting shoe that measured 12 inches across the ball of the foot. Called the Bears Paw each shoe had individual compartment for all ten toes. Previously the style had been to wear long pointed shoes (poulaines) but that came to an abrupt end. Costume in these days rarely changed so quickly unless there were good medical reasons (i.e. borne out by plagues etc.). The prince regent in Spain was born with polydactilism (six toes) and as it was more risky to amputate the sixth toe they decided to change the shoe fashion instead from long and thin to short and broad. The moon shoe footwear style caught on across the European Courts almost instantly. The reason being there was a syphilis epidemic which left many rich and powerful men with painful feet.

More information
Body Identity Catalyst (ABC Australia).

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