Body Integrity Identity Disorder: From A Psychological to A Neurological Syndrome

Body Integrity Identity Disorder (BIID) is a condition in which individuals experience an intense desire for amputation of an healthy limb. Recently, McGeoch and colleagues provided the first direct evidence that this syndrome may be neurological rather than psychological in its origin. However, before including BIID in body ownership disorders, several concerns should be clarified, exploring other components of body representation and not only somatosensory perception.     

Body ownership: When feeling and knowing diverge

Individuals with the peculiar disturbance of ‘overcompleteness’ experience an intense desire to amputate one of their healthy limbs, describing a sense of disownership for it (Body Integrity Identity Disorder – BIID). This condition is similar to somatoparaphrenia, the acquired delusion that one’s own limb belongs to someone else. In ten individuals with BIID, we measured skin conductance response to noxious stimuli, delivered to the accepted and non-accepted limb, touching the body part or simulating the contact (stimuli approach the body without contacting it), hypothesizing that these individuals have responses like somatoparaphrenic patients, who previously showed reduced pain anticipation, when the threat was directed to the disowned limb. We found reduced anticipatory response to stimuli approaching, but not contacting, the unwanted limb. Conversely, stimuli contacting the non-accepted body-part, induced stronger SCR than those contacting the healthy parts, suggesting that feeling of ownership is critically related to a proper processing of incoming threats.     

Amputees by choice: body integrity identity disorder and the ethics of amputation

ABSTRACT Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests.     

对话心智与身体：具身认知的内感受研究转向

具身认知观念试图强调心智是根植于身体的,身体经验会对认知过程产生重要影响。但对于心智与身体的对话是如何进行的？身体通过何种渠道如何影响心智？等问题困扰着具身认知的支持者。传统的具身认知研究遭遇可重复性危机,身体状态改变影响高级认知的结论受到质疑。近年来,越来越多的证据表明内感受与身体表征、具身情绪以及社会认知等存在着密切的联系,因而内感受很有可能在身体加工和高级认知过程中起着重要的调节作用。     

身体表征的分离:二分解释模型及其证据

身体表征是一种内部结构,它具有追踪身体状态并对其进行编码的功能。这种结构可以对身体进行错误的表征,并可以从身体中分离出来。来自海豹肢症与躯体失认症等方面的病例,证实部分身体畸形与脑损伤患者的身体表征存在分离;来自橡胶手错觉与全身错觉的实验证据,验证了健康个体身体表征分离的事实。基于上述证据,以身体图式和身体意象为二分维度的模型解释了身体表征的分离。未来的研究可以从神经心理学实验和虚拟现实技术着手,对身体表征的分离进行深入探究。     

Evidence for a Disturbance of the Body Schema in Neglect

Subjects with left neglect often fail to use and, in some instances, recognize the left side of the body. We performed a series of investigations to determine if this deficit is, at least in part, attributable to an impairment in the “body schema,” an internal three-dimensional, dynamic representation of the spatial and biomechanical properties of one's body. First, subjects were shown a series of pictures of a single hand and asked to determine if the stimulus was a right or left hand. Subjects with neglect but not other subjects with brain lesions identified pictures of left (contralesional) hands significantly less reliably than pictures of right hands. On the basis of evidence demonstrating that the identification of pictured hands involves the matching of the stimuli to an on-line mental representation of one's body, these data suggest that neglect may be associated with a disruption of, or failure to attend to, the body schema. Data from subsequent investigations contrasting patients with left neglect and Gerstmann's syndrome argue for a distinction between a body schema and a “body image,” or conceptual representation of the body which articulates with language.     

Mother—infant interaction structures and presymbolic self‐ and object representations

Using research on the purely social face‐to‐face exchange, we examine patterns of mother—infant interaction and their relevance for the presymbolic origins of self and object representations, focusing on the representation of inter‐relatedness between self and object. Based on a dyadic systems view in which the system is defined by both self‐ and interactive‐regulation processes, we argue that characteristic patterns of self and interactive regulation form early interaction structures, which provide an important basis for emerging self and object representations. What will be represented, presymbolically, is the dynamic interactive process itself, the interplay, as each partner influences the other from moment to moment. This is a dynamic, process view of “interactive”; or “dyadic”; representations. The argument that early interaction structures organize experience is based on a transformational model in which there are continuous transformations and restructurings, where development is in a constant state of active reorganization. To define the capacities on which a presymbolic representational capacity is based, we review the last decade's research on infant perception and memory, which has radically changed our concepts of representation. The interaction structures we describe illustrate the salience of arousal, affect, space, and time in the early organization of experience: (1) state transforming, the expectation that an arousal state can be transformed through the contribution of the partner; (2) facial mirroring, the expectation of matching and being matched in the direction of affective change; (3) disruption and repair, the expectation of degree of ease and rapidity of interactive repair following facial‐visual mismatches; (4) “chase and dodge,”; the expectation of the misregulation and derailment of spatial‐orientation patterns, without repair; and (5) interpersonal timing, the expectation of degree of vocal rhythm matching.     

Body satisfaction, sexual self-schemas and subjective well-being in women

The objectification of women's bodies in western culture creates special emphasis on women's representations of embodied aspects of themselves. I argue that women's satisfaction with their bodies is likely to have particularly strong implications for other embodied aspects of self: in this case, representations of their sexual selves. This paper examines the relationships between women's body satisfaction, their sexual self-schemas, and components of subjective well-being in a sample of 91 Australian women aged between 18 and 68. Body satisfaction and dimensions of women's actual sexual self-schemas predicted satisfaction with life, positive and negative affect. The relationships between body satisfaction and both positive affect and satisfaction with life were partially mediated by the positive dimensions of sexual self-schemas. This finding suggests that at least some of the negative consequences associated with body dissatisfaction are due to the negative implications of body dissatisfaction for women's beliefs about their sexual selves.     

A model of the synchronic self

The phenomenology of the self includes the sense of control over one's body and mind, of being bounded in body and mind, of having perspective from within one's body and mind and of being extended in time. I argue that this phenomenology is to be accounted for by a set of five dissociable cognitive capacities that compose the self. The focus of this paper is on the four capacities that compose the synchronic self: the agentive(B) self, which underlies the sense of control over one's body; the boundary(B) self, which underlies the sense of being bounded within one's body; the agentive(M) self which underlies the sense of control over one's thoughts; and the boundary(M) self which underlies the sense of being bounded within one's mind. I model the agentive(B) and agentive(M) selves as parts of the motor control system and the boundary(B) self as the capacity to form and integrated map of the body. I point to the delusion of thought broadcast as a possible source of evidence for future research on the boundary(M) self.     

The ‘I’ and the ‘Me’ in self-referential awareness: a neurocognitive hypothesis

The nature of the ‘self’ and self-referential awareness has been one of the most debated issues in philosophy, psychology and cognitive neuroscience. Understanding the neurocognitive bases of self-related representation and processing is also crucial to research on the neural correlates of consciousness. The distinction between an ‘I’, corresponding to a subjective sense of the self as a thinker and causal agent, and a ‘Me’, as the objective sense of the self with the unique and identifiable features constituting one’s self-image or self-concept, suggested by William James, has been re-elaborated by authors from different theoretical perspectives. In this article, empirical studies and theories about the ‘I’ and the ‘Me’ in cognition and self-related awareness are reviewed, including the relationships between self and perception, self and memory, the development of the self, self-referential stimulus processing, as well as related neuroimaging studies. Subsequently, the relations between self and different aspects of consciousness are considered. On the basis of the reviewed literature and with reference to Block’s distinction between phenomenal and access consciousness, a neurocognitive hypothesis is formulated about ‘I’-related and ‘Me’-related self-referential awareness. This hypothesis is extended to metacognitive awareness and a form of non-transitive consciousness, characteristic of meditation experiences and studies, with particular reference to the notion of mindfulness and other Buddhist constructs.     

Physical "Phantasies" and Family Functions: Overcoming the Mind/Body Dualism in Somatization

In this article, we examine some of the ways in which family therapists have conceptualized the experience of illness of unexplained physical origin. We argue that opinions about the etiology of somatic symptoms should not be the primary focus of therapeutic work with people who share the prototypical characteristics of what has been defined as "somatization disorder." We suggest that current research in neurobiology can expand the linguistic resources of clinicians and help them avoid perpetuating unhelpful dichotomies between the mind and the body.     

The ‘Platforms’ for Comparing Incommensurable Taxonomies: A Cognitive-Historical Analysis

This paper examines taxonomy comparison from a cognitive perspective. Arguments are developed by drawing on the results of cognitive psychology, which reveal the cognitive mechanisms behind the practice of taxonomy comparison. The taxonomic change in 19th-century ornithology is also used to uncover the historical practice that ornithologists employed in the revision of the classification of birds. On the basis of cognitive and historical analyses, I argue that incommensurable taxonomies can be compared rationally. Using a frame model to represent taxonomy, I show how rational comparisons were achieved in the historical case through compatible contrast sets and attribute lists. Through analyzing the cognitive processes of classification and concept representation, I further explain how rival taxonomies in the historical case could be rationally compared on ‘platforms’ rooted in such cognitive mechanisms as relational assumptions and preferences for body parts in conceptual processing. This revised version was published online in August 2006 with corrections to the Cover Date.     

Inscribing the body, exscribing space

The present paper briefly reviews recent advances in spatial cognition. A central tenet in spatial cognition is that spatial information is simultaneously encoded in multiple formats. It also appears that at the level of neural processing there is no clear distinction between the representation of space and the control of action. I will argue that these findings offer novel insight into the nature of dance and choreography and that the concepts used by cognitive neuroscientists to frame their findings can be fruitfully applied in a choreographic setting. Finally, I will speculate that both dancing oneself and watching dance may enhance one’s experience of space.     

Two‐year‐olds’ understanding of self‐symbols

This study investigated 48 2.5‐year‐olds’ ability to map from their own body to a two‐dimensional self‐representation and also examined relations between parents’ talk about body representations and their children's understanding of self‐symbols. Children participated in two dual‐representation tasks in which they were asked to match body parts between a symbol and its referent. In one task, they used a self‐symbol and in the other they used a symbol for a doll. Participants were also read a book about body parts by a parent. As a group, children found the self‐symbol task more difficult than the doll‐task; however, those whose parents explicitly pointed out the relation between their children's bodies and the symbols in the book performed better on the self‐symbol task. The findings demonstrate that 2‐year‐old children have difficulty comprehending a self‐symbol, even when it is two‐dimensional and approximately the same size as them, and suggest that parents’ talk about self‐symbols may facilitate their understanding.     

Bodily self and schizophrenia: The loss of implicit self-body knowledge

Schizophrenia spectrum has been associated with a disruption of the basic sense of self, which pertains, among others, the representation of one's own body. We investigated the impact of either implicit or explicit access to the representation of one's own body-effectors on bodily self-awareness, in first-episode schizophrenia (FES) patients and healthy controls (HCs). We contrasted their performance in an implicit self-recognition task (visual matching) and in an explicit self/other discrimination task. Both tasks employed participant's own and others' body-effectors. Concerning the implicit task, HCs were more accurate with their own than with others' body-effectors, whereas patients did not show such self-advantage. Regarding the explicit task, both groups did not exhibit a self-advantage, and patients showed a higher percentage of self-misattribution errors. Neither self/other nor implicit/explicit effects were found in both groups when processing inanimate-objects. We propose that FES patients suffer of a disturbed implicit sense of bodily self.     

父母在自我概念中的神经表征

在自我概念的构成中,他人尤其是亲密他人起着至关重要的作用。个体对父母相关信息的表征影响着个体自我概念的形成。对父母面孔的加工,涉及信息在个体知觉领域的表征;对父母人格特质的加工,涉及信息在个体心智领域的表征。个体对父母信息的神经表征存在性别和文化背景的差异。未来研究应整合表征父母信息的主要脑区及其作用,在研究思路上应考察家庭结构和依恋类型等因素。     

The pre-reflective experience of “I” as a continuously existing being: The role of temporal functional binding

The present moment is of infinitesimally brief duration. In the brain, however, there are perceptual processes that bind together events occurring at different times, on a time scale of milliseconds, into a coherent and integrated temporal representation. These processes include temporal integration, as in perception of biological motion, synchronisation, and change detection. These processes are also responsible for temporal integration and coherence in inner mental life, such as in mental imagery. I argue that this gives rise to the pre-reflective experience of the self as a continuously existing being. Temporal integration is also a feature of the experience of action–outcome relations, and I argue that this produces a pre-reflective experience of the self, not just as continuously existing, but also as the doer of both physical and mental actions. This is the foundation on which the idea of the self as continuously existing on longer time scales – the narrative self – is built.     

Morality Work among the Transabled

In the present article, I address the process of moral stigma resistance using an accounts studies framework. Specifically, I delineate and illustrate the concept of morality work. I demonstrate morality work empirically through a qualitative analysis of 17 years (1994–2011) of blog posts, archived content, and links to and from Transabled.org. Transabled.org is a website, blog, support group, and interaction forum for people with body integrity identity disorder (BIID)—a highly stigmatizing condition of incorrectly abled embodiment. Detractors accuse people with BIID of deep moral failings, including sexual perversion, dishonesty, greed, and attention seeking. In turn, persons with BIID neutralize claims of immorality through medicalization and biologization, and locate themselves on a moral high ground with a discourse of authenticity. In deconstructing transabled bloggers’ moral battle, I examine the process underlying deviant accounts.     

Amodal completion and relationalism

Amodal completion is usually characterized as the representation of those parts of the perceived object that we get no sensory stimulation from. In the case of the visual sense modality, for example, amodal completion is the representation of occluded parts of objects we see. I argue that relationalism about perception, the view that perceptual experience is constituted by the relation to the perceived object, cannot give a coherent account of amodal completion. The relationalist has two options: construe the perceptual relation as the relation to the entire perceived object or as the relation to the unoccluded parts of the perceived object. I argue that neither of these options are viable.