http://kfor.com/2015/10/01/woman-sa...r-fulfilling-lifelong-wish-of-becoming-blind/
I read a couple threads on SDN about this, including the one from June here in Psychiatry. I was disappointed that the discussion was primarily between self-described "patients" and "non-students", and there was very little serious input by any psych residents or attending psychiatrists.
Obviously anyone can chime in but I'm especially hoping to get some opinion from the latter in this thread. From my reading, these just seem like delusions and should be treated like delusions. If a man walks into a psychiatrists office and says "I think the government is after me", the psychiatrist probably won't say "well lets get you hidden then." Likewise, I would guess if someone walks into a psychiatrist office and says "I don't think i should have a tongue", the psychiatrist probably won't say "let me find my scissors."
Is this a subset flavor of schizophrenia? Is it even mental illness? More people on the extreme end of the spectrum of wanting to be special snowflakes?
One must have a wide-differential when seeing patients with such symptoms. Such symptoms may occur in the context of psychosis but then you would see a clear disturbed reasoning behind the belief. For example, if someone reveals that they want their leg amputated, and it becomes clear this is because there is a special rod that aliens have implanted, then it is clear the patient is delusional and may have a psychotic disorder such as "schizophrenia". One the other hand, one may wish to have a limb amputated because they have a sexual fetish and have masturbatory fantasies about being an amputee and being worshipped by others who are sexually aroused by amputees. There may be a hypochondriacal preoccupation with disease. The patient may have an obsessive-compulsive spectrum disorder (wrongly called illness anxiety disorder and classified as a "somatic symptom and related disorders" in DSM-5) and believe they have an osteosarcoma that has been missed and wish to have their leg amputated for this reason. Or they may have a morbid anxiety such as found in OCD, such as thoughts their leg will somehow be contaminated, or become gangrenous and find thoughts of amputating diminish the anxiety produced by such obsessions. The patient may have a factitious disorder and feign symptoms in order to have their limb amputated for no obvious external reward, possibly for the sick role. This may be complicated as many patients with factitious disorder
do have additional external motivation (such as disability payments) but these are not primary. There may be no psychopathology and simply a response to frustration - perhaps the patient has an itch that won't go away and is driving them crazy, and they think amputation will help but do not wish to reveal they simply have an itch. The patient may be a drug addict seeking amputation because they think it will help to obtain narcotics. Patients with antisocial personality disorder may sometimes go to extreme lengths to obtain their goals. Finally, an hysterical conversion should always be considered with bizarre neuropsychiatric symptoms.
As you can see, in psychiatry it is important to have an open mind to the problems the patient has and not make the error that too many psychiatrists have that a belief or wish they cannot understand is delusional. On the contrary, many such patients labeled as "delusional" are nothing of the sort and a careful history may reveal some other psychopathology, or no psychiatric disorder at all.
with my neuropsychiatrist hat on I will say I believe there is a Body integrity identity disorder, but I don't believe it is a psychiatric illness, but a behavioral neurology syndrome akin to asomatagnosia. The agnosias are fascinating symptoms and there are many kinds of agnosia that the typical psychiatrist or neurologist may be unaware of. In the differential must be alien limb syndrome, which can occur in cortico-basal degeneration and creutzfeld-jakob disease amongst other neurodegenerative diseases. It may also be a disorder of monitoring of the self.
I do not believe the woman in the article the op links has BIID and it is not true that these people are seeking to be disabled. On the contrary they feel disabled by a limb that does not seem to be their own. This woman clearly does not have a behavioral neurological syndrome. She started wearing dark glasses and and using a cane by the age of 18. I would want to know more about her social and developmental history. Patients who use such props typically in my experience have severe alexithymia and are completely unable to verbalize their intenral distress. They often have disorganized or preoccupied or anxious attachment styles, and come from backgrounds with severe invalidation, neglect, trauma. Patients who gravitate to having particular conditions often see how others with a particular condition are treated. For example, a neglected child may see the sympathy and care provided to a blind relative and fantasise about being blind. If this is carrying right through adulthood it would suggest an early developmental arrest. A fixation on blindness is also ripe for dynamic interpretation. The most fantastical part of the story is the woman did not make herself blind but apparently found some nutty psychologist to make her blind. Why this is something that she needed someone else to do her is also very revealing and suggests she does not have a behavioral neurological syndrome but more likely to be a seriously disturbed individual.
