Doctors amputated the healthy fourth and fifth fingers of the left hand of a 20-year-old Quebec man because he believed that they were not part of his body.

Writing in the journal Clinical Case Reports, psychiatrist Nadia Nadeau explained that the man suffered from body integrity identity disorder (or body integrity dysphoria) and the only option was amputation. “Following amputation, the patient experienced immediate relief, with nightmares ceasing, emotional distress subsiding, and improved functionality,” she wrote. 

“Working in a sawmill, he considered building a small guillotine to cut his fingers. He was aware self-harm wasn’t a safe solution and could have repercussions on his relationships, reputation, and health. He couldn’t imagine himself living for the years to come with those fingers.”

Amputation of healthy limbs is sometimes called apotemnophilia. It is very rare, but in one notorious case in the late 1990s when a Scottish surgeon cut off the legs of two men who were desperate to become amputees. 

BIID obviously raises grave ethical questions. How does mutilation square with the principle of non-maleficence? But Nadeau points out that the patient might have amputated his fingers by himself, which could be very dangerous. In her opinion, it was more important for him “to live in alignment with his perceived identity”.