The missing piece: a case report of body integrity dysphoria with 5-month follow-up

Body integrity dysphoria (BID) is a rare condition characterized by persistent incongruence between an individual’s body identity and an intact limb, with limited evidence to guide management. A nonbinary adult in their mid-30 s, assigned male at birth, presented after deliberately applying dry ice to the right lower limb to induce tissue necrosis and necessitate amputation. They described childhood-onset limb dysphoria, extensive preparation for life without the limb, and no improvement with prior trials of sertraline, aripiprazole, and risperidone. Psychiatric assessment demonstrated intact reality testing, minimal depressive and anxiety symptoms, exclusion of psychotic, obsessive–compulsive, and body dysmorphic disorders, and preserved decision-making capacity. After multidisciplinary review and ethics consultation, a right lower limb amputation was performed for a limb that had become non-salvageable due to self-inflicted injury. The patient reported immediate relief of distress and, at 5-month follow-up, maintained resolution of dysphoria, restored body congruence, and good functional adaptation without psychotropic medication. This case illustrates the diagnostic and ethical complexities of BID and describes short-term, case-based evidence of symptomatic relief following limb removal in a context, where amputation was also medically indicated. It underscores the need for cautious, individualized, multidisciplinary assessment and for further research before any firm conclusions can be drawn about the safety, effectiveness, or generalizability of surgical approaches for BID.