Body Integrity Identity Disorder and Hoarding Disorder Lecture Notes

These flashcards cover key concepts related to Body Integrity Identity Disorder and Hoarding Disorder based on the provided lecture notes.

What is Body Integrity Identity Disorder (BIID)?

A condition where individuals experience a strong desire to amputate a healthy limb.

What was the average age of subjects in the Columbia University 2005 study on BIID?

48.6 years.

What are the most common age of onset for BIID?

Childhood or adolescence.

2005 study at Columbia University

surveying 52 subjects reporting strong desire to amputate a healthy limb:

• Average age 48.6 years (23‐77)

• Men (n=47); Female (n=4)

• Age of onset childhood or adolescence

• Leg preference, above the knee most common

• Left > right

• 90% higher level of education

• 27% obtained amputation via shotgun, chainsaw, woodchipper, dry ice.

What percentage of subjects in the BIID study reported a primary reason for wanting amputation as restoring true identity?

63%.

Neurobiological Underpinnings

• Reduced cortical thickness in the areas of the parietal lobe and a reduced cortical surface areas of the somatosensory cortices and anterior insular cortex.

• Interoception

• Sensory processing

• Right-sided cortical abnormalities are associated with a strong desire for left-sided limbs for amputation.

  • This has been shown in different studies.

Possible Causes

The premotor cortex and cerebellum are regions associated with the experience of body ownership and the integration of multisensory information.

Researchers results suggest that BIID is associated with structural brain anomalies and might result from a dysfunction in the integration of multisensory information, leading to the feeling of disunity between the mental and physical body shape.

What is one structural brain abnormality found in BIID subjects?

Reduced cortical thickness in areas crucial for sensory processing.

Treatment for BIID

• psychotherapy

• medication

• amputation/surgery

What are DSM specifiers?

• With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space.

• With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.

• With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

• With absent insight/delusional beliefs: The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

What are the main characteristics of Hoarding Disorder?

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.

B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them.

C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).

D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi Syndrome).

F. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder)

What are some common items that individuals with Hoarding Disorder tend to save?

Types of items

• Newspapers, magazines, mail, papers, books

• Containers, craft items

• Clothing, shoes

• Furniture

• Household items, appliances, etc.

• Animals

Why?

• Emotional attachments

• Sentimental

• Instrumental/useful

• Intrinsic/beautiful

Stages

• Minimal clutter

• Mild clutter

• Moderate clutter

• Severe clutter

• Extreme clutter.

Contributing Factors

• Genetic contributions

• Family discord

• Interpersonal stressors

• Insecure attachment style

• Trauma

• Low self-worth

• Shame/guilt

• Emotion Regulation-Distress tolerance difficulties

What contributes to social and functioning problems in individuals with Hoarding Disorder?

• Social isolation

• strained relationships

• work problems

• legal/financial issues

• interference with major personals or career goals

• 6% have been fired because of hoarding

• credit card debt

• high expenses

• property damage

• eviction, divorce, bankruptcy

What is the Hoarding Rating Scale-Interview (HRS-I) used for?

To assess clutter, difficulty discarding, acquisition, distress, and impairment in daily functioning.

Which population demographic is most affected by Hoarding Disorder?

Single females.

What percentage of the population is estimated to have Hoarding Disorder?

4-6%.

What common comorbidity is found in individuals with Hoarding Disorder?

Major depressive disorder, affecting approximately 50% of individuals.