The Frontal Cortex

Body Image Disorders

A fascinating, if macabre, interview with a man who intentionally cut off his hand:

BME: We’ve touched on it, but I guess now the big question — “why”?

I’m one of those body-integrity-disorder (BIID) dudes. As long as I can remember, having two hands was a defect in my body — something that was not meant to be. For me philosophically, it’s totally different from body mods, which I also have. I don’t think I had any choice. My right hand just didn’t belong to my body. As a little kid, I soon learned that I was the odd one out, and that amputation was a bad thing. My parents reprimanded me for staring at amputations, but it was totally mesmerizing for me. Somehow I made it through high school, with hormones and peer pressure doing their best to mask my feelings. In college, I met a wonderful woman, and our love kept my thoughts of amputation at bay at first, but the need grew and grew. I don’t know how I ever made it through to getting my Master’s. My mind was more and more consumed, so that sometimes I would even blurt out an embarrassing word, like “stump” or “hook”. I don’t think she really grasped what was going down, but my lover couldn’t take my distraction, and we parted company very sadly.

That’s via kottke. I wonder if body integrity disorder has anything in common with eating disorders, like anorexia. Both seem to be profound rejections of the body as it is. Both illnesses cause people to become fixated on altering their own form, even though such alterations are extremely dangerous. Most neurobiological explanations for eating disorders focus on dopamine and activity in the prefrontal cortex – in this sense, an eating disorder is just perfectionism run amok – but I wonder (and this is utterly baseless speculation) if it really makes sense to talk about eating disorders without talking about the distortions of body image. I found this rather interesting brief report while searching for relevant papers:

Anorexia Nervosa (AN) has been associated with a functional deficit of the right hemisphere, a plausible cause for the severe disturbances of body image that are among the most important predictors for clinical severity of AN. However, current therapeutic approaches are relatively ineffective as regards this parameter. We therefore searched for a stimulation treatment that would increase right hemispheric activity and improve body image. We proposed intensive somatosensory stimulation of the whole body to serve this purpose. A conventional custom-made neoprene diving suit was worn by a female anorectic patient over underclothes for one hour three times per day.

At the beginning, the patient was 19 years old (46.50 kg, 179 cm; BMI 14.5). Since the age of 14, she has been suffering from AN (ICD-10 restrictive type). Before our treatment, she underwent two in-patient and three ambulatory psychotherapies. ody weight increased significantly from 47.22 kg (SD 1.01) without treatment to 48.06 kg (SD 0.76) during the period wearing the diving suit. We assume that significantly gained body weight and smaller angle deviations at t2 are consequences of an improved body image representation due to an activation of the right hemisphere by the increased somatosensory stimulation while wearing the diving suit.

In other words, the man who cut off his hand might have tried electrically stimulating the hand that didn’t feel like it belonged. Perhaps his somatosensory cortex just needed a bit more activation.


  1. #1 Rachael
    February 21, 2008

    Okay, I’ve got issue with the body suit article. From 47.22 +/- 1.01 to 48.06 +/- 0.76 = T value of 4.52? No way. Besides which, where do the error bars come from, since this is one person? The only way to get from a T value of 4.52 to a P value of less than 0.001 would be for more than 8 samples. They might be taking “n” as the number of measurements, but that’s an inappropriate way to calculate the statistic (since I could weigh myself every 3 minutes and then have statistical power to prove anything I want!). We’re talking about weight gain of 1 pound – weight fluctuates that much every day just from water intake.

    My issues with stats aside, you are making an interesting comparison between the two cases. Certainly some anorexics are categorized as having Body Dysmorphic Disorder (BDD). However, as evidence by a spectrum of severity in the disorder, I do think that many anorexics originate from the more typical perfectionism root. I think there’s a difference between a body image that can be overcome through therapy or treatment with antidepressants and a fundamental distortion of self image that impairs a person’s ability to function in daily life (BDD).

    Back to your idea, maybe that’s why exercise is so satisfying. After exercising, I always have the thought in my head that it just feels so great to feel my body move around. Exercise makes me feel good because it forces me to become aware of my body’s shape in space, its abilities and its limits

  2. #2 jope
    February 21, 2008

    Cool, I had searched without success for that paper, after running across a reference to Grunwald and his suit. Thanks for finding that! Curious footnote: The subject supposedly absconded with her suit, thus preventing further research. (yeah, sounds shaky to me) See bottom of this book review for the mention.

  3. #3 Laura Collins
    February 21, 2008

    I think you may want to look at the body image distortion issue as a common co-morbidity, but not always a part of the disorder. In some cultures what we would otherwise call anorexia is not accompanied by body image issues or even a fear of fat. The way the patient describes “why” they don’t eat may be culturally bound.

    Another example is that often young anorexics don’t start out with body dissatisfaction, but end up thinking that is at the root of it because of suggestion by society or clinicians.

    Last, there’s this: there is evidence that most people suffering from malnutrition get increasingly distorted body images. The Minnesota Starvation experiment, for example. And every person on a diet!

  4. #4 leandra
    February 24, 2008

    Random thought: couldn’t body integrity disorder be compared more accurately to the desire to change one’s sex, as opposed to something like anorexia which has lots of cultural influences tied to it? Obviously, so does gender and sex but a lot of transgender people feel the same kind of intense desire to change their bodies, that the genitals they have don’t belong there. They feel quite strongly about this, just as this man who cut off his hand feels his hand didn’t belong to his body. (And in both cases, this is something the person has known about themselves from an early age).

    This is probably the main reason I don’t really have a problem with people who want to cut off their limbs for such a reason-if it is seriously affecting their quality of life not to do so(just like not transitioning sex can seriously affect a person’s life), why not? It’s not like they can’t survive without their limb. Unlike anorexia, which is a harmful disease, cutting off a limb, once it’s done, is not really harmful if they desire it so strongly. I would imagine (based on pure speculation, admittedly) that the degree to which people suffer from anorexia is largely culturally influenced, but that a small amount of cases represent people with a form of body integrity disorder that would be present regardless of society.

  5. #5 quidnunc
    February 25, 2008

    “I think there’s a difference between a body image that can be overcome through therapy or treatment with antidepressants and a fundamental distortion of self image that impairs a person’s ability to function in daily life (BDD)”

    BDD is treatable. It’s an interesting question whether BIID responds to CBT or similar treatments. Patients with severe BDD do literally see themselves as deformed or nonhuman looking and that perception does change with therapy. There is an intuition that Body Integrity Disorder might not be as amenable due to an unusual functional/physical profile. I couldn’t find any papers on this topic, unfortunately.

  6. #6 Carrie
    April 5, 2009

    I think this type of research is fascinating. As someone in recovery from anorexia, I can attest to the truth of Collins’ comments: the starvation that is the hallmark symptom of anorexia does increase body distortions. And weight restoration helps to restore a normal sense of body perceptions.

    However, a return to a normal weight doesn’t always eliminate these distortions altogether, a fact of which I am also painfully aware. Previous research has shown that a subset of patients with anorexia continue to experience ongoing body distortions in spite of recoveries in other areas. I think perhaps these types of therapies, of helping restore normal sense of how to experience your own body, can perhaps be an important adjunct to therapy once normal weight and eating habits have been restored.

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