Inventory for the Assessment of the Severity of Body Integrity Dysphoria (BID Assessment)


  • Erich Kasten Medical School Hamburg
  • Maria Garbos Medical School Hamburg (MSH)


Objective: Body Integrity Dysphoria (BID, also known as Body Integrity Identity Disorder, Xenophilia, Amputee Identity Disorder, Apotemnophilia) describes a very rare condition in which non-disabled people feel a desire or need for a physical disability (e.g. amputation, paralysis, blindness). BID is included in the new version of ICD-11 (6C21 Body integrity dysphoria), but thus far we are without a standard test of whether a subject suffers from BID and to which degree of intensity. Accordingly, the aim of this study was the development of an inventory for the assessment BIP and its severity. Methods: We created a questionnaire comprising 80 items that cover the desire for amputation alongside every other possible incongruity between an individual’s mental image of themselves and their actual physical condition and appearance. The questionnaire assesses six dimensions of the respondent’s experience: 1. Influence of BID on day-to-day life, work and dreams (12 items); 2. Perceived need for a disabled body (13 items); 3. Influence of BID on relationships and sexuality (7 items); 4. Influence of BID on emotions (10 items); 5. Development of BID in childhood and adolescence (4 items); 6. Coming-out, interaction with others, official certification (6 items). Results: We collected data from 213 BID sufferers (a comprehensive sample size, considering the rarity of the disorder). The findings show a significant difference (p<0.05) in subjectively perceived psychological distress between those expressing a desire for amputation, a desire for palsy and other desires. We further identified significant coherencies between the severity of the disorder and the age of its initial manifestation, the number of therapeutic options used by the sufferers and the presence of an erotic component. The findings enabled us to develop a classification of severity for BID which will prove to be of value to the diagnosis of the disorder and to the associated therapeutic options.