Apotemnophilia Masquerading as Medical Morbidity

J. Mike Bensler, MD, Douglas S. Paauw, MD, FACP

Disclosures

South Med J. 2003;96(7) 

In This Article

Abstract and Introduction

We report a case of apotemnophilia, or "love of amputation," in a man in his mid-20s. Apotemnophilia is defined as self-desired amputation driven by the patient's erotic fantasy of possessing an amputated limb and overachieving despite being handicapped. The desire of a patient with apotemnophilia for amputation is obsessive, and a history of repeated, unexplained injuries to the same segment of the body is common among these patients. Patients with apotemnophilia secretly harm themselves to necessitate amputation of an injured limb, which creates a diagnostic challenge for the health care provider because of the atypical presentation of self-inflicted medical morbidity caused by apotemnophilia.

Two case reports of apotemnophilia, or "amputation love," were first described by Money et al[1] in 1977. Everaerd[2] and Wise and Kalyanam[3] also have reported cases of this extremely rare paraphilia, but few case reports exist in the mainstream medical literature. Furth and Smith[4] recently wrote a book on the subject that outlines the various characteristics of apotemnophilia. The Internet has also contributed to the increasing amount of information available about apotemnophilia that is widely accessible to the general public.[5] This disorder of self-desired amputation is related to the erotic fantasy of undergoing amputation of a limb and subsequently overachieving despite a handicap. Apotemnophilia has been compared with Munchausen syndrome and masochism,[1] but the characteristic findings of this fascinating disease clearly distinguish apotemnophilia as a unique paraphilia. Few psychiatrists have evaluated and treated patients with apotemnophilia, and even fewer primary care providers have knowledge of the disorder. We report the case of a patient in his 20s with apotemnophilia who presented with several conditions mimicking common medical problems.

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