The Desire for Amputation or Paralyzation: Evidence for Structural Brain Anomalies in Body Integrity Identity Disorder (BIID)

Abstract

Background: Body Integrity Identity Disorder (BIID) is a condition in which individuals perceive a mismatch between their internal body scheme and physical body shape, resulting in an absolute desire to be either amputated or paralyzed. The condition is hypothesized to be of congenital nature, but evidence for a neuro-anatomical basis is sparse.

Methods: We collected T1-weighted structural magnetic resonance imaging scans on a 3T scanner in eight individuals with BIID and 24 matched healthy controls, and analyzed the data using voxel-based morphometry.

Results: The results showed reduced grey matter volume in the left dorsal and ventral premotor cortices and larger grey matter volume in the cerebellum (lobule VIIa) in individuals with BIID compared to controls.

Conclusion: The premotor cortex and cerebellum are thought to be crucial for the experience of body-ownership and the integration of multisensory information. Our results suggest that BIID is associated with structural brain anomalies and might result from a dysfunction in the integration of multisensory information, leading to the feeling of disunity between the mental and physical body shape.

Fig 1. Significant smaller grey matter volume in the left ventral premotor cortex in BIID subjects (PMv: p = 0.006 (SVC), T = 4.27,maximum difference at MNI x = -36, y = 6, z = 22).

Fig 2. Significant smaller grey matter volume in the left dorsal premotor cortex in BIID subjects (PMd: p = 0.007 (SVC), T = 4.33, maximum difference at MNI x = -18; y = -6; z = 52).

Fig 3. Significant larger grey matter volume in the left cerebellum in BIID subjects (p = 0.038 FWE corrected), T = 5.47, maximum difference at MNI x = -2, y = -90, z = -34).