Body Integrity Dysphoria (BID): Survey of Experts and Development of a Diagnostic Guideline

People who suffer from body integrity dysphoria (BID) feel a strong need to be disabled. The most common desire is for amputation or paralysis. Objectives: This study aims to gather the opinion of experts on which types of disabilities are included in BID, which therapies are useful and whether those affected should be supported in obtaining a disability. Methods: A questionnaire with 62 items and a flow chart were developed and sent to experts who have published work with regard to BID. Participants: 22 experts from 11 countries, mostly with an academic title and with an average age of 48.5 years, responded. Results: As expected, amputations and paralysis were clearly attributed to BID, other disabilities (toothlessness, incontinence, diabetes) received rather uncertain or negative scores. On average, those affected were not classified as mentally or psychiatrically ill. Neurological misconnection was considered the most likely cause. Experts did not think it was helpful to inform the health system or even the police about the desire to be disabled. Almost all experts supported the surgical solution of amputation by doctors. All participants believed that BID patients are aware of the limitations imposed by the desired disability. Finally, a flow chart is presented for diagnosis and therapy. Conclusions: The experts assume that the surgical solution is currently acceptable if it has been proven that the BID-affected person does not suffer from another mental disorder, there is a high level of suffering due to BID, other therapies have not been of any use and it is clear that the quality of life will actually increase as a result of achieving the disability.