Monday, November 06, 2017

Body dysmorphic disorder and urban primitives

Apotemnophilia is a rare psychotic disorder in which the person has a compulsion to have an amputation of one limb or part there off. It was first described in 1977 and relates not to a sadistic nor masochistic intention, but instead to the idea of self-fulfilment brought about by being an amputee. The compulsion is similar to the angst suffered by transgender people who may be relieved only when transgender relocation is complete by surgical intervention.

Apotemnophilia should be distinguished from "acrotomophilia" which is a sexual attraction to amputees. Acrotomophilia is a paraphilia of the stigmatic/eligibilic type in which sexuerotic arousal and facilitation or attainment of orgasm is dependent only upon being with an amputee (humps in stumps), or an attraction to the idea of being an amputee (a wannabe). Apotemnophilia is not a sexual disorder but a major fixation on carrying out a self-contrived amputation, or obtaining one in a hospital. The cause of both conditions remains a mystery and although treatment involving counselling and pharmaceutical management is prescribed, it frequently fails to relieve severe anxiety associated with apotemnophilia. The condition often goes undiagnosed and more importantly untreated. Frustration and desperation drives many to self amputation with tragic consequences. Orthopaedic surgeons have on rare occasions amputated healthy limbs at the request of their patients. This procedure is not without controversy and will only be considered when all other forms of treatment have been exhausted. As with gender relocation surgery protocols are strict and patients screened very carefully. Opposition to this type of cosmetic surgery is fierce and centres where these procedures are undertaken are few and far between in the world. Experts believe a recent increase of apotemnophilia may be due to the internet and networks of would-be self-amputators sharing their experience.

Body dysmorphic disorder is more common than apotemnophilia and this describes a condition where people are convinced they have a defect in their appearance. Believing they have a misshapen, smelly, or otherwise defective body part they will submit themself to all manner of cosmetic surgical procedures including going to the orthopaedic surgeon or surgical podiatrist to have a toe amputated (or part thereof). Others may suffer Munchhausen syndrome, a condition where people deliberately fain illness or induce symptoms, to seek care as a means of attention seeking. This can be so severe they will undergo needless operations including amputation. The important difference between apotemnophiliacs and people with Munchhausen syndrome is apotemnophiliacs are usually satisfied with one operation.

Body awareness is a major preoccupation with people of the 21st century as the rise in cosmetic surgery will attest. Not only does the technology exist, there are waiting lists of people wanting to have expensive elective procedures done, including shortening the length of toes or surgically filleting them. Modern primitives (Urban primitives) is a term used to describe people in Western Society with tattoos, body piercing, scarification and the like and many have turned their attention to foot embellishments, such as foot rings, tattoos and decorative implants, branding and cutting. The motivation for engaging in these varied practices may be personal growth, rite of passage, or spiritual or sexual curiosity. Foot binding is also used by some to reduce the size of feet and ‘sculpting’ (self amputation of a toe - or parts thereof) is on the increase.

In fifteenth century Spain, the male peacock fashion was to wear a broad fitting shoe that measured 12 inches across the ball of the foot. Called the Bears Paw each shoe had individual compartment for all ten toes. Previously the style had been to wear long pointed shoes (poulaines) but that came to an abrupt end. Costume in these days rarely changed so quickly unless there were good medical reasons (i.e. borne out by plagues etc.). The prince regent in Spain was born with polydactilism (six toes) and as it was more risky to amputate the sixth toe they decided to change the shoe fashion instead from long and thin to short and broad. The moon boot style footwear or Bears Paw caught on across the European Courts almost instantly because there was a syphilis epidemic which left many rich and powerful men with painful feet.

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