The Desirability of Difference: Georges Canguilhem and Body Integrity Identity Disorder

One-year follow-up of amputation as a curative treatment for body integrity dysphoria: A case report

Key Clinical Message

Elective amputation as a treatment for Body Integrity Identity Disorder (BIID) or Body Integrity Dysphoria (BID) where noninvasive treatments prove ineffective and the patient's distress is substantial, may permit long-term remission of symptoms at follow-up.

Abstract

We present the one-year follow-up post-surgery of an ambidextrous male who sought elective amputation of his left hand's fourth and fifth fingers after an unsuccessful trial of psychotherapy and pharmacotherapy for Body Integrity Dysphoria. He had no psychiatric comorbidities. At one-year follow-up, his dysphoria was still in remission. He exhibited full adaptation in his social and occupational life, demonstrating increased ease in hand use compared to pre-amputation. He reported sleeping well, happiness, good health and continued acceptance by friends and family. This one-year post-surgery follow-up, at 22 years old, underscores the efficacy of amputation as a curative treatment, high patient satisfaction, and the quality of life gained through the procedure.

Being in Relation, Being through Change

Ethics exists among beings that can relate to one another and who can create change in one another. Although this may appear as a simple truism, the implications of relation and change in bioethics are manifold. For instance, one can relate not only to others, but also can enter into self-relation by relating to oneself. Self-relation problematizes autonomy insofar as one does not have immediate access to all of oneself and so therefore also does not immediately fully determine oneself in the way that an uncomplicated understanding of autonomy might imply. This article proceeds as a preliminary exposition of the concepts of relation and change as they apply to bioethics, particularly as they inform autonomy, action theory, and the porous subject.