title: Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy.
abstract: BACKGROUND
  The syndrome of apotemnophilia, body integrity or amputee identity disorder, is defined as the desire for amputation of a healthy limb, and may be accompanied by behaviour of pretending to be an amputee and sometimes, but not necessarily, by sexual arousal.
  
  
  METHODS
  A case history is presented of a 35-year-old man who was referred because of his desire for amputation of his left leg, without sexual connotations. The course of a combined cognitive behavioural psychotherapy with SSRI treatment is described.
  
  
  RESULTS
  Symptoms showed considerable similarity with obsessive-compulsive disorder, and some similarity with body dysmorphic disorder according to DSM-IV, but the core symptom seemed to be strongly connected with a sense of identity. Treatment with a selective serotonin re-uptake inhibitor decreased levels of distress only. The effects of cognitive restructuring of the psychotherapy were limited, whereas the behavioural elements substantially reduced the behaviour of pretending to be an amputee.
  
  
  CONCLUSIONS
  The rare syndrome of apotemnophilia raises unresolved questions of classification. Psychotic disorders should be ruled out carefully. The model designed in the current cognitive behavioural approach may serve as a starting point for further development of intervention protocols for this rare disorder.
authors.affiliation: Institute of Extramural Medicine (EMGO), Amsterdam, The Netherlands. a.braam@vumc.nl
authors.forename: Arjan W
authors.initials: AW
authors.lastname: Braam
authors.forename: Sako
authors.initials: S
authors.lastname: Visser
authors.forename: Daniëlle C
authors.initials: DC
authors.lastname: Cath
authors.forename: W J G
authors.initials: WJ
authors.lastname: Hoogendijk
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000523:psychology*; D001828:Body Image; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003861:Depersonalization / Q000175:diagnosis / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology*; D005162:Factitious Disorders / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology*; D017374:Paroxetine / Q000627:therapeutic use; D011599:Psychopathology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology*; D013577:Syndrome
chemical_list: D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors