Doctor amputates man's healthy fingers to relieve 'body integrity dysphoria' in Quebec

A Quebec man who felt that he should not have fourth and fifth fingers on his left hand successfully petitioned a doctor to remove them.

A surgeon went ahead and removed the man's healthy fingers in a case of "digits amputation," believed to be the first of its kind to relieve so-called body integrity dysphoria.

The ambidextrous 20-year-old man had apparently tried therapy and pharmaceutical drugs to relieve the feeling that he had two fingers that should not be there, but the National Post reports that this only "increased his distress."

In the journal Clinical Case Reports, Dr. Nadia Nadeau, of the Department of Psychiatry at Université Laval in Quebec City said of the patient: "He hides his fingers, keeps them flexed, leading to impaired dexterity, localized pain, irritability and anger." 

The National Institutes of Health defines body integrity identity disorder as "the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord."

Nadeau said that the man had been determined to find a way to remove these fingers. The case study said that he'd been contemplating removing his two fingers since childhood, even considering creating a guillotine specifically for the purpose.

"He had contemplated asking a friend to watch over him and be prepared to call emergency services in case his attempt led to a need for resuscitation," Nadeau said.

The man's nightmares and "emotional distress" allegedly ceased upon the removal of his two fingers, and after the surgical pain dissipated, he did not experience phantom pain. 

The case study read that without his healthy fingers, "he was able to pursue the life he envisioned as a complete human being without those two fingers bothering him."

"Recognizing and addressing the unique needs of (BID) patients can lead to a future where they can live with more dignity, respect and optimal well-being," Nadeau said.

While cases of this kind have come up before, most notably in Scotland in the 1990s when a man demanded his leg be removed to satisfy his feeling that he should not have two legs, Nadeau said that because the Quebec man just wanted his fingers removed, it was an easy decision.

"He is now living a life free from distressing preoccupations about his fingers, with all his symptoms related to BID resolved," Nadeau wrote. "The amputation enabled him to live in alignment with his perceived identity."

"Lobbies of persons suffering from BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment," the National Institutes of Health stated. "Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted."

While some researchers say that body identity dysmorphia is a brain condition, due perhaps to "faulty connections" in the pre-born brain where the "corresponding body party is not correctly represented in the mental body image," the Quebec man's "brain imaging was normal."