What’s your crutch? The bizarre world of amputee fetishes

Some of the most bizarre paraphilias that occasionally make their way into reputable scientific journals are those that involve sexual gratification from amputation of some description. Since the late 1800s, the medical literature has described men and women who are sexually attracted to amputees, those who limp, or use crutches, braces and wheelchairs, as well as individuals who pretend to be or who actually want to become disabled. These have included references in the books of Wilhelm Stekel (Sexual Aberrations, 1930), Richard von Krafft-Ebing (Psychopathia Sexualis, 1932), Magnus Hirschfield (Sexual Anomalies and Perversions, 1944), as well as published case studies such as M.F. Fleischl’s study of “A man’s fantasy of a crippled girl” (American Journal of Psychotherapy, 1960) and Louis London’s study of “Transvestism-Desire for crippled women” (Dynamic Psychiatry, 1952).

The relationship between amputated limbs and sexual desire was little known about outside of particular academic circles, but was first brought to public attention in the letters pages of Penthouse in 1972 (see below). Although some thought these letters were a joke, it became clear that for a small minority of people, this was a rare but bona fide paraphilia.

Letter in Penthouse (May 1973): “I am 27, and have been an amputee since I lost my left leg at mid thigh when I was about eight. Probably because I have been an amputee for so long, I’ve never been shy about my lack of leg. For the last four years I have been married to a man who is fascinated by the stump of a female amputee. As a result I usually short skirts when I go out, allowing the end to show. When my husband is home, I wear short skirts so that my stump is fully exposed. I have never liked to use an artificial leg, and mostly I use a single crutch, and believe it ot not, a good ol’ peg leg…..probably many people think a peg leg is not very feminine, but it is practical for me. Sexually I feel I can compete with any two-legged girl. Because my husband is so turned on by the sight of my stump, I usually begin our lovemaking by undressing slowly at the foot of the bed. Once I have my clothes off, I lift my stump so that it points towards my husband and I begin to massage it. This excites my husband greatly, so he takes over and we go from there”

A more recent development in the world of amputee paraphilias has been the advent of the internet. This has brought global attention to people with disabilities and their admirers. Most of these sites are chat rooms and home pages for male devotees of female amputees. However, there are lots of other sites including female devotees of male amputees, particular sexual orientations (heterosexual, homosexual) and particular attractions (e.g. crutches, plaster casts, crutch, and neck braces). One specific bulletin board posting entitled “Bunion Love” requested “photos, videos, or correspondence of girls with deformed/crippled feet, or toe/toes amputated or who have severe bunions on their feet. The more severe, the better.”

Apotemnophilia: In 1977, the renowned US sexologist John Money of the John Hopkins University  coined the term “apotemnophilia” in the Journal of Sex Research. Apotemnophilia (Greek for “amputation love”) refers to being sexually excited by the fantasy or reality of being an amputee. This behaviour is often accompanied by obsessive scheming to convince a surgeon to perform a medically unnecessary amputation. This might seem to most people to be a type of masochism but reported case studies suggest that there is no erotization of pain itself – only of the healed amputated stump. To give you an inside look at the world of the apotomnophiliac, here are two real life case accounts from Professor Money’s files. Both involve people who had an erotic and obsessive desire to be an amputee.

Case Study 1: A man phoned up Professor Money’s sex research unit asking if he could have his leg amputated. He was told that this would not be possible but he continued to phone and write to the unit for the next four years. It was later discovered that he had made many attempts to self-inflict serious injury to his left leg. His obsession had been present since he was 13 years old in the form of self-amputee fantasies. On one notable occasion he hammered a stainless steel rod into his left leg and then tried to infect the open wound by smearing it on facial acne mixed with anal and nasal mucous. When his leg showed serious signs of infection he reported it to the hospital. Unfortunately his attempt failed as antibiotic treatment cleared the infection up. Looking into the childhood background, the most prominent early recollection was his left leg being severely burned by an overturned pot of boiling oatmeal at the age of two years old. This left him unable to walk for a year. However, there was little else in his family history to suggest the origins of such bizarre behaviour.

Case Study 2: A second man wrote to Professor Money for literature on the phenomenon of self-amputation. The patient reported that when he was engaged in homosexual or heterosexual intercourse he would fantasize about an amputee or being one himself. Pictures of both naked and dressed amputees were also used for masturbation purposes. Strangely, his fantasies were not always erotic and it was discovered that he could be aroused by visualizing an amputee engaging in an activity that required considerable effort on their part to overcome their physical handicap (e.g. an amputee water ski-ing). Although he considered many non-surgical ways to become an amputee, when it came down to it, he was too scared of inflicting pain to do it himself. Eventually he got a job working with handicapped people but was still attempting to find a surgeon who would amputate his leg. He continued to maintain that he would only be at peace with himself once he had been through the amputation. Looking into the patient’s background, it was discovered that he had been born with a clubbed right foot for which his father constantly criticized him. The condition was corrected during adolescence. His first amputation thoughts occurred at the age of eleven years old but these were not sexually explicit until the age of about fifteen when there was an amputee who worked with him. However, these childhood events are insufficient in explaining why it occurred.

Given the unconventional desires of the apotemnophiliac, it is perhaps unsurprising that self-mutilation occurs. To some extent, the condition resembles Munchausen’s Syndrome in that MS patients are obsessed with self-inducing symptoms repetitively for the sake of being a patient whereas the apotemnophiliac is obsessed with the symptom themselves for the sake of being an amputee.

Acrotomophilia: Acrotomophilia is a slightly different paraphilia to apotemnophilia and refers to being sexually aroused by a partner who is an amputee. They are excited by the stump or the stumps of the amputee partner and is dependent upon them for sexual arousal and attainment of orgasm. An example of this is given in the case study below (again from the files of Professor Money).

Case Study 3: This case involves a 47-year old man with an amputee fascination. His interest started at school when as an obese child he would try to do anything to avoid PE classes. It was at this stage he first started thinking that if he was an amputee he wouldn’t have to take part in these sessions. As he reached adolescence, he started to pretend to be an amputee by tying one of his legs up and making a peg to walk around on. It was during one of these “pretend” sessions that he experienced his first orgasm. As he reached late adolescence, he switched from fantasizing about being an amputee himself to wanting an amputee partner. He even made his own scrapbook turning Hollywood filmstars like Marilyn Monroe into amputees. He eventually got married and four years into his marriage he told his wife about his fantasies. She didn’t take the news well and it was never mentioned again for a further six years. However, later in the marriage, his wife would occasionally pretend to be an amputee while making love. Through an acquaintance, he developed friendships with a number of amputees and had sexual relationships with some of them. Interestingly, he claimed that his paraphilia was unlike other paraphilias because it was not always sexual and the fantasy was 24 hours a day. 

One of the interesting insights offered by the acrotomophiliac above was that he was part of an amputee network and was in regular correspondence with 55 other amputee devotees. Some of these were married to amputees while others had never even met one. Those who had ended up with amputee partners sometimes changed their focus and became “wannabe” amputees. With regards to the amputee fixation itself, around a quarter of the network were sharply focused on the stump itself and are very exact about what it should feel and look like (some being attracted to the scars – the more the better). Around a quarter of the network were really turned on by the asymmetry that amputation brings. For these people, bilateral amputees (for example, people with both legs amputated) were a turn-off.

In 1983, the first survey of male acrotomophiles was published in the journal Sexuality and Disability. The 195 acrotomophiles in the study were all customers of AMPIX (a company providing stories about and pictures of amputees) and were described as white, college educated, professional males. The results revealed that 75% had been aware of their interest in amputees by the age of fifteen. It was also reported that 55% of respondents had dated amputees, 40% had had sex with an amputee, and only 5% had married an amputee. 53% of the respondents had pretended to be an amputee (11% having done so publicly) and 71% had fantasized about being an amputee.

Another study completed in 1996 surveyed 50 acrotomophiles. The participants were again white college educated, professional males. Of these, 96% had been aware of their interest in amputees by their teens. In this sample, 41% had been married to or lived with an amputee, more than 43% had pretended to be amputees and 22% desired to become amputees. Using psychometric tests, the acrotomophiles were found on average to have high scores on self-esteem, but low scores on social interest, emotional stability and personal relations. Such tendencies have become a concern of people with disabilities since acrotomophiles demonstrate problematic behaviors. These include collecting names, addresses and phone numbers of disabled persons, obsessive and intrusive phone calls, letters and e-mail to persons with disabilities, attending and sometimes organizing disability-related events, lurking in public places to watch, take covert pictures of, talking to and touching disabled persons, and even engaging in predatory stalking.

Devotees, Pretenders and Wannabes: Dr. Robert Bruno, Director of the Post-Polio Institute (New Jersey) described two cases in an effort to understand the psychology of “devotees, pretenders and wannabes” (DPWs). So what exactly are DPWs? Put very simply:

• Devotees are non-disabled people who are sexually attracted to people with disabilities, typically those with mobility impairments and especially amputees.
• Pretenders are non-disabled people who act as if they have a disability by using assistive devices (for example braces, wheelchairs, and crutches). This may be done in private or in public so that they can ‘feel’ disabled or are perceived by others as having a disability.
• Wannabes actually want to become disabled, sometimes going to extraordinary lengths to have a limb amputated.

Dr. Bruno has also reported some of his case studies in the scientific literature:

Case Study 4: A 48-year old white female had been interested in men who had mobility impairments since she was a teenager. The first evidence of her interest was in high school when she dated a boy who had a severe limp. Although they kissed, she reports not being very sexually aroused by him and was interested, not in having intercourse, but in being with him and potentially seeing his affected leg. She then had a one-off date with an “obese and mildly retarded” wheelchair-bound man who she met through a personal ad. After their first passionate kiss she went to the bathroom and masturbated to orgasm by imagining herself having sex with the man. She did not want to have sex with him, as just the thought of him in his wheelchair was enough to give her an orgasm. She continued to search, obsessively at times, for disabled men. However, things changed when on a work trip she noticed a wheelchair behind the front desk of the hotel and first had the idea that she could pretend to be disabled. She started to do this regularly and after each trip out in a wheelchair she would return to her room and masturbate to orgasm while sitting in the wheelchair. The fantasies that aroused her were not even sexual. She would imagine her legs being paralyzed or picture herself being in a wheelchair. Alternatively she would imagine a paralyzed man walking on crutches, or his braces. This was enough to bring her to orgasm. Her ultimate fantasy was to meet a disabled man while she was pretending to be disabled and have sex. However, she denied strongly that she herself wanted to have a disability.

Looking into her childhood, she described herself as a lonely child whose parents ignored her. However, she recounted an incident when a local child, who had had polio and walked with crutches and leg braces, walked past their home on the way to school. Her parents appeared to show more concern for the boy than for her. She also remembered how her teacher would give more attention to the disabled children. After these experiences she would play in the family garage using croquet mallets as crutches and tieing sticks to her legs for braces. She also remembered finding her old baby carriage and pretending it was her wheelchair. Basically, she wanted to be a disabled child so she would be loved.

A variety of explanations have been offered for DPW’s attractions, desires and behaviours. The most appealing explanation involves the pairing in childhood of a disability-related stimulus with sexual arousal. For example, one plaster-cast devotee reported by Dr. Bruno had his first sexual experience with a girl who was wearing a leg cast. However, only 19% of respondents to the AMPIX survey related their interest in amputees to any kind of direct contact with a disabled person, and the overwhelming majority of devotees have reported their interest in disabled persons began long before puberty.

Attraction to disabled persons has also been related to homosexuality, sadism and bondage. However, recent surveys find no increased prevalence of homosexuality, sadism or interest in bondage among acrotomophiles. Several case studies have indicated that there may be a higher incidence of transvestites and transsexuals among DPW’s. However, the notion that an apotemnophile is a “disabled person trapped in a nondisabled body” is difficult to justify, as there is no ‘naturally-occurring’ state of disability that would correspond to the the two naturally-occurring genders. Others have suggested that DPW’s desires develop from a combination of a strict anti-sexual attitude in the child’s household, deprivation of maternal love and parental rejection in early childhood that creates a fear for survival and a self-generated fantasy for security.

Some case reports (like the one above) appear to suggest that deprivation of parental love, coupled with seeing parents’ positive emotional response to a disabled child, set the stage for attraction to the disabled. However, there may be other psychological factors at work as we shall see in the final case outlined below from the case notes of Dr. Bruno.

Case Study 5: A 45 year old white female with a history of childhood polio continually complained of arm and leg weakness, daily fatigue, disturbed sleep, imbalance and falling. Through her twenties and thirties she had many operations (on her hips and legs) and often became depressed. She had twice attempted suicide. In her early forties, she was given knee and ankle braces to treat her “instability.” Because of discomfort, she rarely wore these and began using crutches. The patient’s husband stated that she was again able to walk at home and in the hospital when she was in a psychotic state but not at any other time. He recalled that his wife had always wanted to have a “little disability” that would not limit her, like wearing braces on both legs, but only up to her calves. She thought that her mother and people in general would have treated her more kindly if she had been a disabled child. 

Her childhood desire to have a ‘little disability’ was something she thought would have allowed her to be “treated more kindly,” and her subsequent development of a Factitious Disorder, suggest that those with factitious physical disabilities can be combined with DPWs to create a diagnostic grouping that Dr. Bruno calls Factitious Disability Disorders. These are conditions in which disability – real or pretended – provide an opportunity to be loved and attended to where no such opportunity has otherwise existed. As noted earlier, Professor Money observed that apotemnophilia may share something in common with Munchausen’s Syndrome. However, Professor Money distinguishes between the Munchausen’s patient, who is obsessed with self-inducing symptoms repetitively for the sake of being a patient, and the apotemnophile who is supposedly satisfied with a single amputation.

The commonality between both conditions is they engage in the behaviour “for the sake of being a patient” (to receive the care and attention that would otherwise not be obtainable). Apotemnophiles need only one – albeit very extreme – medical intervention that leaves them with a lasting and obvious stigma of disability that they believe will permanently satisfy their need for love and attention. If the common psychological foundation of these conditions is that disability will satisfy unmet needs for love and attention, then there are only two factors that differentiate between DPWs and those with a factitious physical disability – the awareness of a desire to appear or actually become disabled and physically appearing to be disabled.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Berger, B.D., Lehrmann, J.A., Larson, G., Alverno, L. & Tsao, C.I. (2005). Nonpsychotic, nonparaphilic self-amputation and the internet. Comprehensive Psychiatry, 46, 380-383.

Brang, D., McGeoch, P. & Ramachandran V.S. (2008). Apotemnophilia: A neurological disorder. Cognitive Neuroscience and Neuropsychology 19, 1305-1306.

Bruno, R.L. (1997). Devotees, pretenders and wannabes: Two cases of factitious Disability Disorder. Journal of Sexuality and Disability, 15, 243-260.

First, M.B. (2005). Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 35, 919–928.

Dixon, D. (1983). An erotic attraction to amputees. Sexuality and Disability, 6, 3-19.

Everaerd, W.  (1983). A case of apotemnophilia: A handicap as sexual preference.  American Journal of Psychotherapy, 37, 285-293.

Griffiths, M.D. (2001). Stumped! Amputee fetishes. Bizarre, 44, 70-74.

Money, J. (1990). Paraphilia in females: Fixation on amputation and lameness. Journal of Psychological Human Sexuality, 3, 165-172.

Money, J., Jobaris, R. & Furth, G. (1977). Apotemnophilia: Two cases of self-demand amputation as a paraphilia.  Journal of Sex Research, 13, 115-125.

Money, J. & Simcoe, K.W. (1986). Acrotomophilia, sex and disability: New concepts and case report.  Sexuality and Disability, 7, 43-50.

Storrs, B. (1997). Devotees of disability, New Mobility, 6, 50-53.

Storrs, B. (1997). Amputees, Inc.: Amputees pitching products and themselves to devotees of disability. New Mobility, 7, 26-31.