The Patient Requesting Amputation


Although infrequent, there are patients who present themselves to surgeons and ask that a limb be amputated. Generally, such patients fall into one of three categories. The first is those suffering from “Body Integrity Identity Disorder” (BIID), a condition in which individuals feel that one of their limbs is foreign to the rest of their body, and must be removed. The second category is Apotemnophilia, a fetishized desire to become an amputee to enhance sexual gratification. Such drive for sexual gratification may lead to requests for amputation. Finally, the third category is delusional beliefs secondary to severe mental illness that may compel an individual to seek amputation, or even attempt self-amputation. We present a fourth type of patient: the Global War on Terrorism veteran with a severely injured arm demanding amputation to fit in with others who use prosthetic devices. In this instance, the cause of injury was a motor vehicle collision. We speculate that our case is not the only one and that a fourth category of patient demanding amputation is emerging. Further study is needed.

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T. Dunn and R. Moroze, "The Patient Requesting Amputation," Open Journal of Medical Psychology, Vol. 2 No. 4, 2013, pp. 193-196. doi: 10.4236/ojmp.2013.24029.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] T. E. Quill and H. Brody, “Physician Recommendations and Patient Autonomy: Finding a Balance between Physician Power and Patient Choice,” Annals of Internal Medicine, Vol. 125, No. 9, 1996, pp. 763-769.
[2] L. Seyfried, K. A. Ryan and S. Y. Kim, “Assessment of Decision-Making Capacity: Views and Experiences of Consultation Psychiatrists,” Psychosomatics, Vol. 52, No. 2, 2012, pp. 115-123.
[3] M. B. First, “Desire for Amputation of A Limb: Paraphilia, Psychosis, or A New Type of Identity Disorder,” Psychological Medicine, Vol. 35, No. 6, 2004, pp. 919-928.
[4] G. M. Furth, R. Smith and E. Kübler-Ross, “Amputee Identity Disorder: Information, Questions, Answers, and Recommendations about Self-Demand Amputation,” 1st Book, 2002.
[5] B. D. Berger, J. A. Lehrmann, G. Larson, L. Alverno and C. I. Tsao, “Nonpsychotic, Nonparaphilic Self-Amputation and the Internet,” Comprehensive Psychiatry, Vol. 46, No. 5, 2005, pp. 380-383.
[6] K. Fisher and R. Smith, “More Work Is Needed to Explain Why Patients Ask for Amputation of Healthy Limbs,” BMJ, Vol. 320, No. 7242, 2000, p. 1147.
[7] R. M. Blom, R. C. Hennekam and D. Denys, “Body Integrity Identity Disorder,” PloS One, Vol. 7, No. 4, 2012, Article ID: e34702.
[8] J. A. Parsons, W. A. Brown and A. D. Sirota, “Inappropriate Amputation Requests,” Psychosomatics, Vol. 22, No. 9, 1981, pp. 822-823.
[9] C. Ryan, “Out on a Limb: The Ethical Management of Body Integrity Identity Disorder,” Neuroethics, Vol. 2, No. 1, 2009, pp. 21-33.
[10] A. L. Bryant, “Consent, Autonomy, and the Benefits of Healthy Limb Amputation: Examining the Legality of Surgically Managing Body Integrity Identity Disorder in New Zealand,” Journal of Bioethical Inquiry, Vol. 8, No. 3, 2011, pp. 281-288.
[11] S. Müller, “Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified?” The American Journal of Bioethics, Vol. 9, No. 1, 2009, pp. 36-43.
[12] T. Bayne and N. Levy, “Amputees by Choice: Body Integrity Identity Disorder and the Ethics of Amputation,” Journal of Applied Philosophy, Vol. 22, No. 1, 2005, pp. 75-86.
[13] S. Ramsay, “Controversy over UK Surgeon Who Amputated Healthy Limbs,” The Lancet, Vol. 355, No. 9202, 2000, p. 476.
[14] D. Brang, P. D. McGeoch and V. S. Ramachandran, “Apotemnophilia: A Neurological Disorder,” Neuroreport, Vol. 19, No. 13, 2008, pp. 1305-1306.
[15] M. J. Giummarra, J. L. Bradshaw, M. E. R. Nicholls, L. M. Hilti and P. Brugger, “Body Integrity Identity Disorder: Deranged Body Processing, Right Fronto-Parietal Dysfunction, and Phenomenological Experience of Body Incongruity,” Neuropsychology Review, Vol. 21, No. 4, 2011, pp. 320-333.
[16] O. Blanke, F. D. Morgenthaler, P. Brugger and L. S. Overney, “Preliminary Evidence for a Fronto-Parietal Dysfunction in Able-Bodied Participants with a Desire for Limb Amputation,” Journal of Neuropsychology, Vol. 3, No. 2, 2009, pp. 181-200.
[17] A. Sedda, “Body Integrity Identity Disorder: From a Psychological to a Neurological Syndrome,” Neuropsychology Review, Vol. 21, No. 4, 2011, pp. 334-336.
[18] J. Money, R. Jobaris and G. Furth, “Apotemnophilia: Two Cases of Self-Demand Amputation as a Paraphilia,” The Journal of Sex Research, Vol. 13, No. 2, 1977, pp. 115-125.
[19] J. M. Bensler and D. S. Paauw, “Apotemnophilia Masquerading as Medical Morbidity,” Southern Medical Journal, Vol. 96, No. 7, 2003, pp. 674-676.
[20] W. Everaerd, “A Case of Apotemnophilia: A Handicap as Sexual Preference,” American Journal of Psychotherapy, Vol. 37, No. 2, 1983, pp. 285-293.
[21] M. Large, N. Babidge, D. Andrews, P. Storey and O. Nielssen, “Major Self-Mutilation in the First Episode of Psychosis,” Schizophrenia Bulletin, Vol. 35, No. 5, 2009, pp. 1012-1021.
[22] K. W. N. Blacker, “Four Cases of Autocastration,” Archives of General Psychiatry, Vol. 8, No. 2, 1963, pp. 169-169.
[23] W. C. Myers and M. Nguyen, “Autocastration as a Presenting Sign of Incipient Schizophrenia,” Psychiatric Services, Vol. 52, No. 5, 2001, pp. 685-686.
[24] A. Kushner, “Two Cases of Auto-Castration Due to Religious Delusions,” British Journal of Medical Psychology, Vol. 40, No. 3, 2011, pp. 293-298.
[25] C. D. Mellon, C. Barlow, J. Cook and L. D. Clark, “Auto-castration and Autopenectomy in a Patient with Trans-sexualism and Schizophrenia,” The Journal of Sex Research, Vol. 26, No. 1, 1989, pp. 125-130.
[26] C. B. M. D. Franke and J. A. M. D. Rush, “Autocastration and Autoamputation of the Penis in a Patient with Delusions of Sexual Guilt,” Jefferson Journal of Psychiatry, Vol. 21, No. 1, 2007, p. 2.
[27] D. Hall, B. Lawson and L. Wilson, “Command Hallucinations and Self-Amputation of the Penis and Hand during a First Psychotic Break,” The Journal of Clinical Psychiatry, Vol. 42, No. 8, 1981, pp. 322-324.
[28] I. Schweitzer, “Genital Self-Amputation and the Klingsor Syndrome,” Australasian Psychiatry, Vol. 24, No. 4, 1990, pp. 566-569.
[29] M. Tomita, Y. Uchijima, K. Okada and N. Yamaguchi, “A Report of Self-Amputation of the Penis with Subsequent Complication of Myiasis,” Hinyokika Kiyo, Vol. 30, No. 9, 1984, pp. 1293-1296.
[30] B. Volkmer and S. Maier, “Case Reports-Successful Penile Replantation Following Autoamputation: Twice!” International Journal of Impotence Research, Vol. 14, No. 3, 2002, pp. 197-198.
[31] S. Gyan, S. Sushma, S. Maneesh, S. Rajesh and M. Misra, “Successful Microsurgical Penile Replantation Following Self Amputation in a Schizophrenic Patient,” Journal of the Urological Society of India, Vol. 26, No. 3, 2010, pp. 434-437.
[32] E. Sorene, C. Heras-Palou and F. Burke, “Self-Amputation of a Healthy Hand: A Case of Body Integrity Identity Disorder,” Journal of Hand Surgery (British and European Volume), Vol. 31, No. 6, 2006, pp. 593-595.
[33] S. C. Schlozman, “Upper-Extremity Self-Amputation and Replantation: 2 Case Reports and a Review of the Literature,” The Journal of Clinical Psychiatry, Vol. 59, No. 12, 1998, pp. 681-686.
[34] G. W. DeMuth, J. J. Strain and A. Lombardo-Maher, “Self-Amputation and Restitution,” General Hospital Psychiatry, Vol. 5, No. 1, 1983, pp. 25-29.
[35] R. Tavcar, M. Dernovsek and V. Zvan, “Self-Amputation of Left Hand: A Case Report,” The Journal of Clinical Psychiatry, Vol. 60, No. 11, 1999, pp. 793-794.
[36] T. Kobayashi, T. Osawa and S. Kato, “Upper-Extremity Self-Amputation in a Case with Schizophrenia,” European Psychiatry: The Journal of the Association of European Psychiatrists, Vol. 17, No. 3, 2002, pp. 172-173.
[37] P. Betz and W. Eisenmenger, “Unusual Suicides with Electric Saws,” Forensic Science International, Vol. 75, No. 2, 1995, pp. 173-179.
[38] P. M. Coons, H. Ascher-Svanum and K. Bellis, “Self-Amputation of the Female Breast,” Psychosomatics: Journal of Consultation Liaison Psychiatry, Vol. 27, No. 9, 1986, pp. 667-668.
[39] P. M. Coons, “Self-Amputation of the Breasts by a Male with Schizotypal Personality Disorder,” Hospital and Community Psychiatry, Vol. 43, No. 2, 1992, pp. 175-176.
[40] C. J. Alroe and V. Gunda, “Self-Amputation of the Ear: Three Men Amputate Four Ears within Five Months,” Australasian Psychiatry, Vol. 29, No. 3, 1995, pp. 508-512.
[41] R. Weinstock and R. Copelan, “Self-Amputation of the Ear: A Case Study,” Canadian Journal of Psychiatry Revue Canadienne de Psychiatrie, Vol. 33, No. 3, 1988, p. 242.
[42] K. Koh and B. K. L. Yeo, “Self-Enucleation in a Young Schizophrenic Patient—A Case Report,” Singapore Medical Journal, Vol. 43, No. 3, 2002, pp. 159-160.
[43] M. Large, D. Andrews, N. Babidge, F. Hume and O. Nielssen, “Self-Inflicted Eye Injuries in First-Episode and Previously Treated Psychosis,” Australian and New Zealand Journal of Psychiatry, Vol. 42, No. 3, 2008, pp. 183-191.
[44] A. V. Kumar and C. E. Geist, “A Case Report of Bilateral Autoenucleation and Its Prevention,” Orbit, Vol. 26, No. 4, 2007, pp. 309-313.

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