RESIDENT: The Missing Piece: A Case Report of Body Integrity Dysphoria with 5-Month Post-Amputation Follow-Up
Presenting Author(s): Dr. Emma Hamid
Co-Author(s): Dr. Shamis Nabeel MD FRCPC
Date and time: 21 Mar 2026 from 14:35 to 14:50
Location: Saddleback & Glacier
Learning Objectives
1. Recognize the clinical features and diagnostic challenges of BID;
2. Explore ethical considerations in BID, including autonomy and non-maleficence; and
3. Understand harm reduction and interdisciplinary approaches in rare psychiatric conditions.
Abstract
Body Integrity Dysphoria (BID) is a rare and challenging psychiatric condition in which individuals experience an intense and persistent desire to amputate a healthy limb to resolve a mismatch between their physical body and internal identity (1,2). We present the case of a non-binary adult admitted to an inpatient psychiatry unit after submerging their right leg in dry ice in an attempt to force surgical amputation. This act reflected years of escalating dysphoria and psychological suffering, including social withdrawal and suicidality. Comprehensive psychiatric assessment ruled out psychosis, obsessive-compulsive spectrum disorders, and body dysmorphic disorder. The patient demonstrated longstanding BID beginning in early childhood, with consistent identity, intact insight, and decision-making capacity.
Following a multidisciplinary process involving psychiatry, hospital ethics, and surgical teams, the patient underwent an elective above-knee amputation. At five months post-operatively, they reported complete psychological relief, resolution of dysphoria, and no regret. Mood was stable (PHQ-9 and GAD-7 scores of 0), and quality of life and disability scores showed significant improvement. Phantom limb sensations were mild and well-managed with gabapentin. Functional recovery was strong, with return to work, increased independence, and marked social re-engagement.
This case illustrates the profound suffering associated with untreated BID and the potential benefits of a capacity-based, harm reduction approach. It underscores the diagnostic, ethical, and therapeutic complexity of BID and the value of collaborative, patient-centered care.
Literature References
1. Blom, R. M., Hennekam, R. C., & Denys, D. (2012). Body integrity identity disorder. PLOS ONE, 7(4), e34702. https://doi.org/10.1371/journal.pone.0034702
2. First, M. B., & Fisher, C. E. (2012). Body integrity identity disorder: The persistent desire to acquire a physical disability. Psychopathology, 45(1), 3-14. https://doi.org/10.1159/000330503