BIID: Body Integrity Identity Disorder

As recently presented in the book The Man Who Wasn't There" by Anil Ananthaswamy, is not real.

First, let me explain by "not real". We got to go down a philosophical pathway first and note a distinction between two types of pathology. There are pathology's (or diseases) that are genetic and show irreversibility. And then there are diseases that exist because of some underlying condition that the person isn't aware of (i.e blood pressure, diet, stress) that can be changed.

Anil Anathaswamy and others who claim that BIID is a "neurological disorder" and thus requires a medical treatment (removal of the body part the person wants to remove) are advocating what seems to me to be an insanely extreme position - and ironically enough (from an Indian writer) Anathaswamy doesn't seem to recognize the influence MIND - that is, experiences human beings have in their everyday interactions with other human beings - can have on the body; and, I might add, ones sense of relation towards a body part is no different from the other ways the mind can go wrong.

Take these disorders: anorexia, spasmodic dysphonia.

The first one is a disorder of how someone experiences their own body. The cause, of course, is the overwhelming influence (as experienced by the anorexic) of the significance society ascribes to body image. Causally speaking, some aspect in the anorexic's early relational environment (as between mother and her, father and her, individual siblings and her, and the emergent properties at higher levels) makes her vulnerable to succumbing to the influence society places on body image. I want to make clear that I am speaking probabilistically: when certain combinations come together (say a gene and a certain environment) the likelihood of a certain phenotype (or consequence in behavior) is made either high or low.

Anytime anorexia appears, it can be said to have these certain relational qualities "scaffolding" the appearance of the condition. The end phenomenological (or as psychologically experienced) state is the sensation that ones body looks fat. I don't know what that's like and neither do you: it requires the presence of certain preconditions to 'make apparent' the "reality" that one is overweight, even though one may in fact be desperately underweight.

The second condition is one I myself once dealt with. I suffered a severe relational trauma at 13 which occurred again at 15 and 16. The result was post-traumatic stress disorder which, since it was caused by bullying, is given the substitute title of "developmental trauma", also known by other theorists as "complex trauma".

The issue of psychological or emotional trauma is ultimately about the way energy flows through the nervous system. Our nervous system is built to process a certain rate of information. When were relaxed and yet focused - a necessary mental state for effective socializing - information passes through between humans with very high fidelity. On the other hand, when we feel threatened, our brain switches from whats called the "social engagement system" to the "fight, flight" system. This fight-flight system is also the sympathetic nervous system. In other fields, this system is called the hypothalamic-pituitary-adrenal axis.

Whenever were shocked into defensive reaction, our brain released chemicals from the hypothalamus (CRH) which caused the pituitary gland to release adrenocorticotropin into the blood stream which causes the adrenal glands (which lie atop the kidneys) to release adrenaline and cortisol. Cortisol breaks down glucose to power cell activity for the needed energy to mount an affective defense reaction. That's basically what's happening when were "stressed" by the world.

When being bullied, I realized that I couldn't speak. What I heard whenever I attempted to speak was some sort of anxiety; an unseen effort, compulsively and desperately enacted; excessively alert to the cues of others, I found myself operating as if 'from without', taking on the mean views of others - what I experienced in the bullying - and "self-organizing", as all smart organisms do, was to anticipate the environment I was about to interact with.

Spasmodic Dyphonia is the belief that this raspy, stressful effort to speak is caused by an unrecognized neurological disorder, instead of being a consequence of relational trauma over development. This too is explicable on the basis of trauma during communication; ergo, the organ implicated is the voice - the communicative apparatus. Because communication, or rather, the PROTEST against the bullies was never fully enacted - or even effectively enacted (that is, experiencing stress during the effort) the voice still 'contained' it; no doubt under a fMRI scanner the relevant brain areas will light up.

Should we infer from a brain scan that the brain is causing it? Or should we instead trace the dots and see that certain experiences created this response: it was the over-activation of the stress response system and the deleterious effects it has on brain cells that created this "post-traumatic" condition.

Finally, back to body integrity identity disorder, with reference, again, to the impact of emotional trauma on how the brain self-organizes in response (with a bias to threat defense). Imagine being 3 years old and witnessing a car accident. All around you people are screaming; a women cries for help. Scared, you turn to your mother but she isn't around you. Now, of course, most children will be sent bonkers by this situation. They will cry and cry and search. Now lets say you fall down and bang your knee, really, really hard. You begin crying and wailing for help, but no one comes in what seems like infinity.

In the brain at those same exact moments, the stress caused by the situation at hand sent the HPA Axis tres loco. It is leading to powerful feedback loops between certain brain areas like the amygdala and the nucleus accumbens. The brain is on "high alert", feeling threatened and enacting a defense behavior that could elicit help from other adults. In particular, we want to highlight the 'social' parts of the brain as well as the parts that deal with meaning and narrative. "Mommy" is missing, and the loss is terrible: felt so deeply because psychological individuation has yet to happen.

The hitting the knee at the same time brought into the chorus of activity the area of the sensory cortex that deals with the knee. The knee - in pain - is being 'incorporated' into a sequence of neurological events that's presently processing an existential loss of self; the mother - the source of identity at this age - is missing, and so in a sense, so is the child. Hitting the knee brings the 'knee' into the experience of absence.

Is it that hard to see this as an etiology for the adult sensation that a particular limb doesn't feel like ones 'own'?

Add to that the human proclivity to think, obsess, particularly when we live in a rather cut-throat, high activity world that makes strong demands for strength and power (business, celebrity culture, politics, sports). People with the sensation of not feeling like a particular limb is theirs, when stressed, would likely think about their limb at those moments in a decidedly paranoid way. Over time, the need for the limb to 'go' emerges, again, gradually - as a consequence of brooding and "feedback loops" in the brain.

I've seen stories about this before and read a few issues about this having to do with both people who wanted their legs amputated because they felt alien to them or they hurt ( but these people could use their legs fine )

Also people who have had limb removed, having pain in the limb still and they would use mirror therapy to help with pain.

More and more I've thought about it, more it dictates our thoughts really are our reality, what we think is what we feel, it's a prison in many cases to have this issue.

Good work on posting

We can also see something similar in gender dysmorphia and homosexuality. Any 'end state' is essentially accounted for by certain conditions in a previous state. The process is whats called 'law-based' i.e depending on cause and effect contingent relationships.

ADHD, so often claimed to be caused by "genes", again, is the result of early life relational conditions. Due to inconsistent caregiving, i.e mixing messages, being available some times, but moody, irritable, dismissive or abusive at other times, necessarily produces a personality that inclines towards "other awareness", or attentiveness to the cue eliciting a negative feeling. The mind becomes 'constructed' to attend to cues, and thus to formulate behavior in terms of what the other party's behavior dictates.

Over time, what develops is a mind that is high reactive (in order to be aware of possible threatening cues) prone to anxiety, obsessions, hyper-activity - such as jumping or performing some action to release energy - and of course, a wavering attention. These things all have one thing in common: quick, impulsive activity. Emotions and cognitions move with such tenacity that the mind is always being "caught sideways" by new ideas and new associations.

It's what's called a "phentotype" in biology. We now know that relational events in a certain time scale tend to organize in certain predictable ways.

We can also see something similar in gender dysmorphia and homosexuality. Any 'end state' is essentially accounted for by certain conditions in a previous state. The process is whats called 'law-based' i.e depending on cause and effect contingent relationships.

ADHD, so often claimed to be caused by "genes", again, is the result of early life relational conditions. Due to inconsistent caregiving, i.e mixing messages, being available some times, but moody, irritable, dismissive or abusive at other times, necessarily produces a personality that inclines towards "other awareness", or attentiveness to the cue eliciting a negative feeling. The mind becomes 'constructed' to attend to cues, and thus to formulate behavior in terms of what the other party's behavior dictates.

Over time, what develops is a mind that is high reactive (in order to be aware of possible threatening cues) prone to anxiety, obsessions, hyper-activity - such as jumping or performing some action to release energy - and of course, a wavering attention. These things all have one thing in common: quick, impulsive activity. Emotions and cognitions move with such tenacity that the mind is always being "caught sideways" by new ideas and new associations.

It's what's called a "phentotype" in biology. We now know that relational events in a certain time scale tend to organize in certain predictable ways.