In limbo: dealing with extreme body dysmorphia

Should doctors comply with requests to amputate healthy limbs?

Body dysmorphic disorder (BDD) is a particularly extreme form of unhappiness with body form. It can result in an overwhelming feeling that a healthy limb or digit is an alien extension that doesn’t belong to the body, accompanied by a desperate desire to have the alien limb amputated.

A woman featured on a BBC ‘Horizon’ documentary commented: “Everything about my life is ordinary except this one aspect, and it’s very hard to fit that into the rest of my life. My legs are extraneous. They shouldn’t be there, they don’t feel, it doesn’t feel right that they extend beyond where I feel my body should end.”

The condition poses a dilemma to doctors – should they go along with a patient’s wishes and amputate, or refuse on the grounds that the limb is healthy?

The condition came to the attention of the media in the late 1990s, when Robert Smith, a consultant surgeon in Scotland, amputated the healthy legs of two patients, at their request. He justified the procedures, saying there was a risk that the patients would otherwise seek backstreet amputations or intentionally injure themselves. He subsequently wrote a book on the subject with one of the patients.

Where surgery does not resolve dissatisfaction, amputation might be regarded as an unacceptable approach to solve the problems of BDD (though surgery appeared to resolve the problems of Dr Smith’s patients). On the other hand, the condition could be likened to transsexualism, where gender reassignment surgery is deemed acceptable if desired.


Further reading

About this resource

This resource was first published in ‘How We Look’ in June 2008 and reviewed and updated in November 2014.

Psychology, Neuroscience, Health, infection and disease, Medicine
How We Look
Education levels:
16–19, Continuing professional development