Monday, 6 June 2011

BIID and the Body Map

From Neurophilosophy:
In BIID, or apotemnophilia, individuals express a strong desire to have a healthy limb amputated at a very specific location. People with this condition usually describe the affected limb as being "intrusive" or "over-present", and report that they have had the desire to remove since early childhood, but do not understand why. This desire can be so strong that sufferers sometimes resort to damaging the affecting limb irreparably, thus forcing doctors to amputate it. The vast majority of BIID sufferers have no other psychological disturbances, and almost always say that they feel much happier when the limb is eventually amputated.

A growing body of literature suggests that body awareness disorders such as BIID occur as a result of abnormal activity in the right parietal lobe, which is known to be essential for constructing a mental representation of the body. Specifically, this body image is constructed in the superior parietal lobule (SPL), which performs a function referred to as multisensory integration, whereby different types of sensory information entering the brain are brought together. Thus, information from the visual parts of the brain and the primary somatosensory cortex, which processes tactile sensations and proprioceptive information relating to the position of the body within space, is sent to the superior parietal lobule. There, it is combined with information from the motor cortex, which controls movement, and all is processed further to generate an internal model of the body. If these processes are perturbed, the body image is compromised.
In BIID, the situation is apparently reversed: the body image is missing a representation of the affected limb. But the body image distortion seen in BIID is almost certainly congenital. Children born with missing arms or legs sometimes experience phantom limb syndrome, suggesting that there is a representation of the limb in the brain, even though it has never existed. The body image is, therefore, probably "hard wired" during development. The experience of BIID sufferers is consistent with this, as they typically report that they have had the desire to have a limb amputated since early on in their lives. It seems the brains of apotemnophiles fail to generate a representation of the affected limb, because of some aberrant developmental mechanism. The limb has never been a component of the body image, so the afflicted person grows up believing that it feels "wrong", but cannot explain why.
I hypothesise that the difference between non-op and pre- or post-op transsexuals is caused by different degrees of masculinisation or feminisation of the superior parietal lobule.

The trouble is - I have no idea how to test this hypothesis. It fits with everything that we know, but that doesn't mean it's true.

All I can say is that when I was 4 years old, long before I had any concept of the differences between girls and boys, that what was "down there" felt... supernumary. Incorrect. Shouldn't be there. Furthermore, after genital reconstruction in 2006, things felt right. Not completely, there still seems something that should be there, in my abdomen, that isn't. But far, far closer to "natural" than before. Even things like urination are effortless, my instincts take over, whereas before I had to concentrate on what I was doing. I had to think, it was neither instinctive nor natural to have somewhat masculine anatomy, even if it didn't resemble the usual kind thereof.

That matches rather closely the description of BIID: but is normal for a woman, just as having a body image that involves external genitalia (and does not involve womb or cervix) is normal for a man.

I hope that one day, we'll be able to point to the areas of the brain that define gender identity more exactly, rather than "in the lymbic nucleus". That we will be able to do the same for sexual orientation, which is probably a very complex phenomenon, certainly involving sense of smell amongst other things, and be more exact than saying "it's in the hypothalamus and elsewhere". That we can do the same for male-vs-female toy preference, which has a strong correlation with sexual orientation amongst "effeminate" gay men and "butch" lesbian women; and finally, the body map in the superior parietal lobule. The latter appears to be more plastic than the others, but "more" here means "not very much".

Research on the latter might find palliative treatments for men who have been castrated, and women who have had vulvectomies, both of whom suffer the same kind of severe distress found in transsexuals. Distress that goes well beyond the problems caused by sexual incompetence. Reconstruction in conjunction with such treatment is the ideal course, but that may not be possible. The brain might need de-programming afterwards to remove the effects of the palliative treatment once reconstruction has been performed, or the patient gets BIID again.

More work needed. And as always, remembering that we're not dealing with machines here, but people, with feelings, emotions, human rights. I know that some researchers, at least, forget that. Maybe it's necessary not to get too involved in order to help people, but in some cases I think it's just pure lack of empathy towards those who are too different from themselves.


Anonymous said...

It seems like most transwomen regard Anne Lawrence as crazy and/or evil for promoting the concept that there's a similarity between apotemnophilia and transsexualism, but she's almost certainly partially correct.

On the other hand, as Zoe notes here, I think it's very important for scientists, trans-geeks, and desperate-for-validation transfolk to keep in mind that "scientifically provable etiologies" of transsexualism relating to brain research aren't going to instantly result in victory for tolerance so we can just "be normally different"... for some compelling reflections on this topic, I'd like to refer Zoe's readers here to Quinnae Moongazer's post on Raiders of the Lost Etiology.

Anonymous said...

Surely, though, if you're going to be using that to relieve the distress in cisgendered? people who have been castrated or had vulvectomies, it's a short step to using it to treat transgendered individuals who's body image to not map onto their real bodies? Such treatment would be cheaper, more effective, and I daresay in the long run possibly better for the patient.

- The One Who Understands

Zoe Brain said...

The trouble with that is that we have two problems - something missing and something extra. We may be able to re-program to reduce distress from something missing, but the something extra... unlikely.

So trans men will continue to be most distressed about their chests, while accepting lack of 100% effective phalloplasty, and trans women will continue to accept lack of womb while being distressed about external genitalia.

Anonymous said...

Hmmm. If, however, we manage to reprogram the mental body map to accept the physical body as it is, then that raises some very, very significant legal issues, especially if it's far cheaper than paying for someone to have a sex reassignment. Insurance companies and national health services would be far more willing to pay for the latter, and one can imagine parents having their children treated - it doesn't remove the gender identity problem, but it does remove the body dysmorphia, significantly reducing? distress. Indeed, one might argue there would be a moral imperative to prefer this over a "crude" method of sex reassignment... the only problem is, fitting in with the rest of society. It would be nice, yes, if those who are "transgendered" didn't have to look like the gender they consider themselves to be to be accepted, but... I do wonder if society actually forces a lot of people to have a sex change who would otherwise be comfortable.

It would be an ethical and legal minefield, to be sure. Personally, I'd recommend it's use, coupled with a more tolerant and accepting society, plus mild hormonal therapy ...

Anonymous said...

Oh, I forgot to sign...

- The One Who Understands

Anonymous said...

For discussion:
A difference between BIID and TS is that the "target" body in BIID is a disabled body. The target body for TS patients is a fully functional body with the other set of 'bits' (it's a pity medical science can't currently deliver this).

I posit this difference is enough to justify preferring psychological treatment measures for the BIID patient but preferring physical treatment measures for the TS patient.

Slightly Annoyed from Berwyck upon Tweed

Nicole Jade said...

BIID is only part of the issue here. Often it works in reverse where an amputee will still feel like their severed limb is present, in which case the target body is NOT a disabled body. The vast majority of TS people will tell you that how they feel in their mind and heart about what their gender is FAR more important than what their body is telling them. Now, it is correct that getting the mind to accept how the body is MIGHT be more socially acceptable but I know of no cases, or precious few cases, where a TS person has been able to fully accept their body but hundreds of cases where they have been able to satisfactorily fashion their body to how their brain sees it. Even if you know of an exception or two on each side there is still practically an unbridgeable gap between the two scenarios.

Hylie Random said...

Hmm...since my transness is less about "Get this off of me!" and more about "Yes there is a third gender and I'm one of it, regardless of my bits, thankya,"My thought is...the problem seems more with other people than me.
Sure, I'd like to have a blended set of male/female bits, but it would be more important to me to be seen as what I feel myself to be and to get what ought to be a right of self-definition.

We ought to be able to define our gender, not have it be defined for us. Hope that wasn't too off-topic.

Nicole Jade said...

You might be in the minority of "trans" people who are trying to be a third gender.

Anonymous said...

"A difference between BIID and TS is that the "target" body in BIID is a disabled body. The target body for TS patients is a fully functional body with the other set of 'bits' (it's a pity medical science can't currently deliver this)."

Err, no. The target body in BIID is a healthy, fully functional body - just as it is in the case of transsexuality. If fixing the affected part of the brain would solve the issue, then it would be the moral choice, rather than mutilating a perfectly functional body. Now, as I've been saying, that only deals with the physical issues - but I would contend that it is a preferable course of action to take as opposed to mutilating (and don't try to deny it, it is mutilation, even if it's done with consent). The whole gender social side wibbly wobbly ball can be dealt with seperately.

The way I see it, you can't argue for such a hypothetical treatment to be used for BIID but not for transsexuality. It's inconsistent.

-The One Who Understands

Nicole Jade said...

I guess you could call all surgery "mutilation."

Anonymous said...

"If [strikeout] fixing [/strikeout] mutilating the affected part of the brain would solve the issue..."

How blithely is surgery on the seat of the self, the most fragile, poorly-understood, and complex organ of the human body to be undertaken...

Reading this, I got the idea that all the people who refer to transsexual surgeries (including MtF surgeries) as "mutilation" are transfixed by an obsession with reproduction... which is, as far as I can see, the only result of transsexual surgeries where they might, in an objective sense, be considered "mutilation".

Anonymous said...

Look, most surgery is mutilation, even if done for a good reason. Amputating an arm is mutilation; that's not to say it's wrong if, say, the arm is badly infected and must be removed to save the body.

"How blithely is surgery on the seat of the self, the most fragile, poorly-understood, and complex organ of the human body to be undertaken... "
Blithely? Surgery? No, I merely suggested it would be preferable to surgery on the body to, aha, repair the affected part of the brain. The point I've been trying to make - which you would have known if you'd read my comments properly - is that you can't be inconsistent and decide transsexuality should be solved surgically, but BIID neurologically - both, it the limited context used, are disorders where the mental image does not map onto the body. The gender issue is a separate discussion; as I've said, the argument against it one may use is that today's society requires transgendered individuals to have surgery to be accepted.

-The One Who Comprehends

Nicole Jade said...

Some people who undergo transsexual surgery may have been born infertile. Sometimes it just goes with the territory.

Anonymous said...

>Err, no. The target body in BIID is a healthy, fully functional body - just as it is in the case of transsexuality.

Huh? Someone with BIID feels the need to amputate a healthy limb, thus creating a disability / losing function (leg => can't run, arm => can't pick up objects).

Anonymous said...

Their body isn't diabled, though... they want to render it disable, but that's not the same.

Anonymous said...

@Anon 1:55:00am

Yeah so isn't that the point?

Someone with BIID has a healthy body that they want to render disabled (target body is disabled)

Someone with TS has a healthy body that they want to swap for another healthy body of the other sex (target body is NOT disabled)

So psychiatric treatment of a BIID patient aims to prevent a disability - which is a good thing. There's no disability to prevent in TS patients, so psychiatric treatment does not have that value / justification.

Other Anon

Bad hair days said...

> The trouble is - I have no idea how to test this hypothesis

Thats quite easy. I came to recognize this very late and I verified it (by asking for experience and watching videos, not by performing violant acts).

If a preoperative transsexual women gets a kick to her testicles she will feel the pain where her ovaries would be. And she holds her hands there in pain. Yet a man holds his hand where the impact was.

Unknown said...


As a hypnotherapist i am doing a dissertation and the neuroscientist VS Ramachandran has postulated that transgender may be in part related to apotemnophilia so if you google that that might help you