title: Limb amputation and other disability desires as a medical condition.
abstract: Some people have a profound dissatisfaction with what is considered an able-bodied state by most others. These individuals desire to be disabled, by conventional standards. In this Review, we integrate research findings about the desire for a major limb amputation or paralysis (xenomelia). Neuropsychological and neuroimaging explorations of xenomelia show functional and structural abnormalities in predominantly right hemisphere cortical circuits of higher-order bodily representation, including affective and sexual aspects of corporeal awareness. These neural underpinnings of xenomelia do not necessarily imply a neurological cause, and a full understanding of the condition requires consideration of the interface between neural and social contributions to the bodily self and the concept of disability. Irrespective of cause, disability desires are accompanied by a disabling bodily dysphoria, in many respects similar to gender dysphoria, and we suggest that they should be considered a mental disorder.
authors.affiliation: Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland. Electronic address: peter.brugger@usz.ch.
authors.forename: Peter
authors.initials: P
authors.lastname: Brugger
authors.affiliation: University Research Priority Program Ethics, University of Zurich, Zurich, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Christen
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Lena
authors.initials: L
authors.lastname: Jellestad
authors.affiliation: Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hänggi
mesh_terms: D000671:Amputation, Surgical / Q000523:psychology*; D057215:Body Dysmorphic Disorders / Q000175:diagnosis* / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology*; D006801:Humans