ICD-11 Diagnosis of Body Integrity Dysphoria: A Case Report.

Body integrity dysphoria (BID) is a rare disorder, in which individuals experience a persistent desire to become physically disabled, often through limb amputation. It is now included within the International Classification of Diseases 11th Revision (ICD-11), and this is one of the first case reports to describe the application of these new diagnostic criteria. This also raises the question of treatment pathways for individuals with the disorder, with recognition bringing legitimacy to patients' experience, and responsibility to professionals. We describe the experience of a 50-year-old man with a long standing desire for his leg to be amputated. He described frustration with the support available, and shame associated with accessing this. After discussions in an online forum he caused dry ice burns to his leg, which resulted in a below-knee amputation. The patient was satisfied with this outcome. All the essential features of ICD-11 diagnostic requirements for BID were met, as well as a number of additional clinical features. New diagnostic criteria appeared both accurate and acceptable to our patient. This formal recognition of the diagnosis presents a new challenge to services about how best to support individuals, and whether there needs to be development of clinical guidance to support clinicians.