Xenomelia: a social neuroscience view of altered bodily self-consciousness

Abstract

Xenomelia, the "foreign limb syndrome," is characterized by the non-acceptance of one or more of one's own extremities and the resulting desire for elective limb amputation or paralysis. Formerly labeled "body integrity identity disorder" (BIID), the condition was originally considered a psychological or psychiatric disorder, but a brain-centered Zeitgeist and a rapidly growing interest in the neural underpinnings of bodily self-consciousness has shifted the focus toward dysfunctional central nervous system circuits. The present article outlays both mind-based and brain-based views highlighting their shortcomings. We propose that full insight into what should be conceived a "xenomelia spectrum disorder" will require interpretation of individual symptomatology in a social context. A proper social neuroscience of xenomelia respects the functional neuroanatomy of corporeal awareness, but also acknowledges the brain's plasticity in response to an individual's history, which is lived against a cultural background. This integrated view of xenomelia will promote the subfield of consciousness research concerned with the unity of body and self.

Keywords: amputation; body integrity identity disorder; body modification; disability; medical ethics; neurology; psychiatry; sociology.

Figure 1

A view of xenomelia research that integrates three approaches. While the crosstalk between neurological (“brain-based”) and psychological (“mind-based”) approaches is commonplace, anthropological, and social studies of bodily appearance and its modifications have been neglected in neuroscience accounts. A social neuroscience view of xenomelia respects the interactions between an individual’s perception of the own body in relation to others’ bodies and as influenced by normative standards. It will also explore the neural correlates of these interactions and investigate, for instance, the constraints of empathy by social norms, or the impact of a person’s preconceptions of a “handicapped body” on brain function and structure.