In terms of treatment the reviewers found that selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) were sometimes effective in relieving the stress and depression associated with BIID, but they did not diminish BIID itself. The desire for amputation was unchanged. Further, in patients who did have the limb amputated, 70% had resolution of the desire for amputation, while 30% had a recurrence of the desire.
It is not yet clear what all this means, but there are some suggestions. Probably BIID is not one discrete disorder, but is the final result of several possible underlying causes that result in the brain-body mismatch.
The onset at young age and exposure to amputees is interesting, as these facts are compatible with the theory that body mapping occurs during young development and is partly due to experience. Perhaps, therefore, some people with BIID developed their internal body image based upon exposure to an amputee, and the missing limb therefore became the model of a whole body. It’s also possible that exposure to the amputee was simply a trigger but the predisposition has to be present already.
Regardless of how it develops, it will likely prove difficult to “cure” BIID. We do not yet have the technology to alter the brain’s wiring in a way that would be necessary to change the internal body image. The brain does have plasticity (the ability to change its wiring), but this plasticity is limited. Some basic functions can only develop at a young age, and once the window of development closes the wiring cannot be changed.
Perhaps brain plasticity may be able to reduce or correct BIID, but I could not find any research even attempting such an intervention.
Current treatments focus on reducing the negative consequences of BIID rather than BIID itself, namely the distress and depression. This seems like a reasonable approach, and should at least be tried prior to amputating a healthy limb, an intervention with only a 70% success rate.
The ethics of amputating a healthy limb to treat BIID are unclear. It is not unreasonable, however, based upon the principle of autonomy, and it does appear to improve the quality of life in most BIID patients who have an amputation. But this should be considered a last resort, only after serious attempts at non-invasive treatment have been made.
It is time, however, for BIID to come out of the shadows. It should not be stigmatized. It is simply a neurological disorder. Even though we do not yet have anything close to a cure, it can be addressed medically.
