# 117 - 6C21 Body integrity dysphoria

# 6C21 Body integrity dysphoria

435
Disorders of bodily distress or bodily experience
Boundary with hypochondriasis (health anxiety disorder)
Unlike individuals with hypochondriasis, who are preoccupied with the possibility of having one 
or more serious, progressive or life-threatening illnesses, individuals with bodily distress disorder 
are typically preoccupied by the symptoms themselves and the impact of the symptoms on 
their lives. Individuals with hypochondriasis may also seek medical attention, but their primary 
purpose is to obtain reassurance that they do not have the feared serious medical condition. 
Individuals with bodily distress disorder typically seek medical attention in order to get relief 
from their symptoms, not to disconfirm the belief that they have a serious medical illness.
Boundary with factitious disorder imposed on self
Individuals with factitious disorder imposed on self may also present bodily symptoms. If the 
presented symptoms have been feigned, falsified or intentionally induced or aggravated, factitious 
disorder imposed on self rather than bodily distress disorder is the appropriate diagnosis.
Body integrity dysphoria
Essential (required) features
• An intense and persistent desire to become physically disabled in a significant way (e.g. a 
major limb amputation, paraplegia, blindness) accompanied by persistent discomfort or 
intense negative feelings about one’s current body configuration or functioning, is required 
for diagnosis.
• The desire to be disabled results in harmful consequences, manifested in either or both of 
the following:
• attempts to actually become disabled through self-injury, which have resulted in the 
person putting their health or life in significant jeopardy;
• preoccupation with the desire to be disabled, resulting in significant impairment in 
personal, family, social, educational, occupational or other important areas of functioning 
(e.g. avoidance of close relationships, interference with work productivity).
• Onset of the persistent desire to be disabled occurs by early adolescence.
• The disturbance is not better accounted for by another mental disorder (e.g. schizophrenia 
or another primary psychotic disorder – in which, for example, a delusional conviction 
that the limb belongs to another person may be present – or factitious disorder) or by 
malingering.
• The symptoms or behaviours are not better accounted for by gender incongruence, by a 
disease of the nervous system or by another medical condition.
6C21
Disorders of bodily distress or bodily experience | Body integrity dysphoria

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders
Additional clinical features
• It is common for individuals to describe their discomfort in terms of feeling like they 
should have been born with the desired disability (e.g. missing a leg).
• Most individuals with this condition exhibit associated “pretending” or simulation 
behaviour (e.g. binding one’s leg to simulate being a person with a limb amputation, or 
using a wheelchair or crutches), which is often the first manifestation of the condition. 
These behaviours are usually done in secret. The need for secrecy may result in avoidance 
or termination of intimate relationships that would interfere with opportunities 
for simulation.
• Some individuals who attempt to make themselves disabled through self-injury try to 
cover up the self-inflicted nature of the attempt by making it look like an accident.
• Many individuals with body integrity dysphoria have a sexual component to their desire 
– either being sexually attracted to individuals with certain disabilities or being intensely 
sexually aroused at the thought of being disabled.
• Shame about the desire to be disabled is common in individuals with body integrity 
dysphoria, and most individuals keep this desire a closely guarded secret because of a fear 
of being rejected or thought to be “crazy” by others. It is common for the family, friends, 
co-workers and even their partners or spouses of individuals with body integrity dysphoria 
to be unaware of their desire. Some may seek treatment for associated depressive or other 
symptoms and yet not share their desire to be disabled with their health-care provider.
• It is assumed that most individuals with body integrity dysphoria never come to clinical 
attention. When they do, it is generally as adults – often when they seek the assistance 
of a health-care professional to relieve their distress, to help them actualize their desired 
disability, or because they have injured themselves in an attempt to become disabled.
Boundary with normality (threshold)
• Some individuals, especially children and adolescents, may have time-limited periods in 
which they pretend to have a disability such as blindness out of curiosity about what it is 
like to live as a disabled person. Such individuals do not experience a persistent desire to 
become disabled or the harmful consequences associated with body integrity dysphoria.
Course features
• The typical course is for the intensity of the desire to become disabled and consequent 
functional impairment to wax and wane. There may be periods of time where the intensity 
of the desire and the accompanying dysphoria is so great that the individual can think of 
Disorders of bodily distress or bodily experience | Body integrity dysphoria

437
Disorders of bodily distress or bodily experience
nothing else, and may make plans or take action to become disabled. At other times, the 
desire to become disabled and the associated intense negative feelings abate, although at 
no time does it completely cease to be present.
Developmental presentations
• The onset of body integrity dysphoria is most commonly in early to mid-childhood, 
although some cases have their onset in adolescence. The first manifestation is typically 
the child pretending to have the desired disability, often in secret.
Culture-related features
• Although apparently quite rare, cases have been reported in many different countries 
and cultures.
Sex- and/or gender-related features
• Among those who come to clinical attention, prevalence appears to be higher among males.
Boundaries with other disorders and conditions (differential diagnosis)
Boundary with schizophrenia, other primary psychotic disorders, and other mental 
disorders with psychotic symptoms
Somatic delusions may involve the conviction that a part of the person’s body does not belong 
to them. In such cases, a diagnosis of schizophrenia or another primary psychotic disorder, or a 
mood disorder with psychotic symptoms should be considered. Individuals with body integrity 
dysphoria do not harbour false beliefs about external reality related to their desire to be disabled, 
and thus are not considered to be delusional. Instead, they experience an internal feeling that they 
would be “right” only if they were disabled.
Boundary with obsessive-compulsive disorder
Obsessive-compulsive disorder is characterized by repetitive and persistent thoughts, images or 
urges that are experienced as intrusive and unwanted (ego-dystonic). In contrast, the repetitive 
Disorders of bodily distress or bodily experience | Body integrity dysphoria

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders
thoughts, images and impulses related to the desire to become disabled in body integrity 
dysphoria (e.g. fantasies of being disabled) are ego-syntonic, and are not experienced as intrusive, 
unwanted or distressing. Distress in body integrity dysphoria is typically related to not being able 
to actualize the disability, or to fear of the negative judgements of others.
Boundary with body dysmorphic disorder
Individuals with body dysmorphic disorder have persistent preoccupations about a part of their 
body that they believe is defective, or a perception that their appearance overall is ugly. In contrast, 
individuals with body integrity dysphoria are persistently preoccupied with a sense that the way 
their body is configured (e.g. for those who desire an amputation) or functions (e.g. for those who 
want to be paraplegic or blind) is wrong, unnatural and not as it should be.
Boundary with paraphilic disorder involving solitary behaviour or consenting 
individual
Some individuals have a paraphilic focus of intense sexual arousal involving the fantasy of 
having a serious disability, which may be associated with transient periods of wanting to acquire 
the disability that is the source of arousal. If the desire to acquire a disability occurs solely in 
connection with sexual arousal, body integrity dysphoria should not be diagnosed. A diagnosis 
of paraphilic disorder involved solitary behaviour or consenting individuals may be appropriate 
in such cases, if the individual is markedly distressed about this arousal pattern or if they have 
injured themselves as a part of enacting sexual fantasies related to it.
Boundary with factitious disorder and malingering
Individuals with body integrity disorder often simulate their desired disability as a way of 
reducing their negative feelings (e.g. a person who desires to be paraplegic may spend part or all 
of their time using a wheelchair). Moreover, they typically shun medical attention. In contrast, 
individuals with factitious disorder feign medical or psychological signs or symptoms in order to 
seek attention – especially from health-care providers – and to assume the sick role. Malingering 
is characterized by feigning of medical or psychological signs or symptoms for obvious external 
incentives (e.g. disability payments).
Boundary with diseases of the nervous system
Some diseases of the nervous system may cause symptoms that involve profound changes in the 
person’s attitude towards and experience of their own bodies (e.g. somatoparaphrenia, in which 
a paralysed body part is experienced as alien or as belonging to someone else.) If the persistent 
discomfort about the individual’s body configuration is better accounted for by a disease of the 
nervous system, then body integrity dysphoria should not be diagnosed.
Disorders of bodily distress or bodily experience | Body integrity dysphoria