From Apotemnophilia to Body Integrity and identity disorder: A case report and literature

Introduction. - The term of apotemnophily was used for the first time by Money in 1977 to name patients who desire an amputation of a healthy limb. Case. - We present a case report of a thirty-two years old military woman, who was hospitalized in a neurology service because of a chronic pain syndrome. The disorders began with a knee trauma complicated by chronic pain causing multiple complaints. At first sight, we are challenged by her desire to amputate her lower limb. Discussion. - A literature review highlights controversial positions regarding the nosographic place of apotemnophily: initially classified within paraphilias, the desire to amputation of a healthy limb was later identified by some authors as a body integrity and identity disorders and then studied as a neurological disorder. The clinic of our patient open minded our diagnostic reasoning to other clinical entities such as a depressive disorder with melancholic and psychotic characteristics, an illness anxiety disorder, a body dysmorphic disorder. Conclusion. - Beyond the controversies, the main risk for these patients is to meet a doctor who decides to treat them with a mutilatory surgical gesture. The therapeutic challenge is to create the conditions of reception of this complaint and to hear the identity claim that it carries. The multidisciplinary approach associating psychiatrist, clinical psychologist and sometimes surgeons when it's appropriate, must prevent medical nomadism and must try to relieve the patient from the suffering of identity. (C) 2019 Published by Elsevier Masson SAS.