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At the cutting edge: A brief look at voluntary self-amputation

It was only very recently that I finally watched the film 127 Hours, the 2010 film directed by Danny Boyle based on the true story Aron Ralston, the canyoneer who cut off his own right forearm to free himself after it was trapped by a large boulder while rock climbing in Blue John Canyon (Utah, US). Apart from the early scenes in the film that were somewhat fictionalized, Ralston said the rest of the film was “so factually accurate it is as close to a documentary as you can get and still be a drama”. The act of self-amputation is known as autotomy (from the Greek ‘auto’ – meaning ‘self’ and ‘tomy’ meaning ‘severing’) but the term is used more widely in the animal kingdom and usually refers to animals that self-sever as a self-defence mechanism (often to escape a predator). Arguably Ralston’s case was also a self-defence mechanism as a way of escaping his own death.

In previous blogs I have looked at cases of people who have cut off their own limbs because they were sexually aroused by the thought of being an amputee (i.e., apotemnophilia) and those who have cut off their own limbs because they believe the limb doesn’t belong to their own body (i.e., Body Integrity Identity Disorder, also known as ‘amputee identity disorder’ and xenomelia). However, today’s blog looks at some cases of those who have self-amputated to survive. Such cases are incredibly rare and almost always occur when the person becomes trapped in deserted environments with no means of contacting anyone and little chance of rescues (as was the case of Ralston). Here are a few other infamous cases:

  • With his pocket knife, Al Hill, a 66-year old man from California, had to cut off his own left leg just below the knee after it got stuck beneath a fallen tree he was cutting (2007). He was all alone in a forest for 11 hours and decided that the only way he was going to survive was to cut off his own leg with his pocket knives. However, despite cutting himself free, Hill was unable to move as he was in constant agony. Thankfully, Eric Bockey one of Hill’s neighbours heard his screams and Hill, was eventually rescued by the fire brigade.
  • A South Carolina farmer Sampson Parker cut off his own arm after it got stuck in a corn harvester. Parker spotted a piece of cornstalk stuck in a farm but on trying to get it out, his hand got stuck in the machine. After an hour of being stuck and calling for help no-one came, and Parker’s arm became completely numb. He then used his John Deere pocket knife to start cutting his fingers off. However, a fire broke out and the only way he could save his life was to cut off his right arm as fast as he could. Once he had cut off his arm he drove himself to a nearby rode and got help from the local fire brigade. In a television interview, Parker said: “My skin was melting. It was dripping off my arm like plastic, plastic melting. I realized I was in trouble. I just told myself, ‘I’m not going to die here. I just kept fighting, kept praying. And then when I did get loose, I jumped up running, I had blood squirting from my arm. It was pretty scary there for a while. I could feel the nerves as I was cutting my arm off. It really wasn’t the corn picker’s fault. It was my fault. It was just a mistake I made”.
  • While driving a front-end loader deep underground, Colin Jones (a 43-year old Australian miner) became trapped when the vehicle overturned when it hit a pothole while turning a corner. Fearing the vehicle would catch fire because diesel was leaking from the loader, Jones quickly cut off his own right arm below his elbow with his Stanley knife. However, Jones was a little premature because the emergency services arrived early enough to save the arm but by then he had already amputated his arm. Unfortunately, the severed arm was too badly crushed to be re-attached to his body.
  • One of the most bizarre amputations concerned a 30-year old Polish farmer (Krystof Azninski). In 1995, Azninski was playing some Polish drinking games drinking with friends when someone in his social group said they should play some “men’s games”. As one report noted: “Initially they hit each other over the head with frozen turnips, but then one man upped the ante by seizing a chainsaw and cutting off the end of his foot. Not to be outdone, Azninski grabbed the saw and, shouting ‘Watch this then’, he swung at his own head and chopped it off”. The report also claimed that by amputating his own head, Azninski could arguably lay claim to be the “most macho man in Europe”. Most of us reading this would probably say he was the most stupid.
  • An 18-year old male construction worker (Ramlan) from Padang trapped in the rubble of a building that collapsed during the September 2009 Indonesian earthquake escaped after sawing off his own leg. Ramlan tried to pull his leg free but was unable to. Using a nearby garden hoe he tried to hack off his own leg but the hoe’s blade was far too blunt to penetrate his leg bone. Using his mobile phone (that was still working following the building’s collapse) he phoned a friend (33-year old Eman) who came to the rescue of Ramlan. Eman found another garden implement – a trowel – and gave it to Ramlan who again tried to hack off the trapped leg. Finally, Eman found a saw and handed it to Ramlan. However, half way through sawing his leg off, Ramlan became too exhausted to continue and Eman finished sawing off Ramlan’s leg. Eman then carried Ramlan to Yos Sudarso hospital. The surgeons then performed a proper amputation a little higher up his leg.

The motivation in all of these cases was obviously survival but there are other rarer cases where self-amputation has been performed for criminal or political purposes. For instance, in the late 1950s/early 1960s, around 50 people from Vernon (Florida, USA; population 780) performed self-amputations in an attempt to claim ‘loss-of-limb’ accident insurance. In fact around two-thirds of all loss-of-limb insurance claims in the whole of the USA at the time came from Vernon. John J. Healy, insurance investigator was quoted as saying: “Vernon’s second-largest occupation was watching hound dogs mating in the town square, its largest was self-mutilation for monetary gain”. An online article on the six most horrifying ways to get rich reported:

“L.W. Burdeshaw, an insurance agent, told the St. Petersburg Times in 1982 that his list of policyholders included a man who sawed off his left hand at work, a man who shot off his foot while protecting chickens, a man who lost his hand while supposedly trying to shoot a hawk, a man who somehow lost two limbs in an accident involving a rifle and a tractor, and a man who bought a policy and then, less than 12 hours later, shot off his foot while aiming at a squirrel. Insurance agents, probably disillusioned by the whole Belle Gunness affair, were a little suspicious. Cutting your hand at work may be possible. Sawing off your entire hand at work really takes some amount of sustained effort…No one in the town was ever convicted of fraud, and it’s not easy to find out just how much they got away with. What we know is that one farmer took out policies with 38 different companies before, in some no doubt comical accident, he lost his left foot. Luckily, the particular day of the “accident” he happened to be driving his wife’s automatic, since if he’d been driving his own stick shift he would have needed the left foot to use the clutch. He also happened to have a tourniquet in his pocket (in case of snake bites, he insisted). He could be telling the truth, right? Well, it turned out he’d taken out so much insurance that he was paying premiums that cost more than his total income. He collected more than $1 million from all the companies. The insurance companies fought it but conceded, ‘it was hard to make a jury believe a man would shoot off his own foot’”.

Another infamous case concerned Daniel Rudolph, the oldest brother of the Eric Rudolph, the 1996 Olympics bomber who on March 7, 1998, videotaped himself cutting off one of his own hands with an electric saw at his home in Ladson (a suburb in Charleston, USA) to “send a message to the FBI and the media”. An FBI statement said they had “followed standard procedures in conducting the search for Eric Robert Rudolph, a fugitive charged with a fatal abortion clinic bombing in Birmingham, Alabama, including interviewing his brother Daniel Rudolph. Daniel Rudolph’s decision to maim himself is regrettable and totally unexpected, given the nature of the contacts between the FBI and himself”.

Finally, in Figueira da Foz (Portugal), Orico Silva cut off one of his fingers in court in an “act of despair” after the presiding judge refused his offer to settle a €170,000 debt and ordered that part of his farm had to be sold. While in court, Silva took some bank papers from his briefcase and noticed a butcher’s knife that he’d recently bought at a market. On impulse he cut off his index finger and cut it into three (using a court table as an impromptu chopping board).

Unless self-amputations are sexually motivated or as a result of Body Integrity Identity Disorder, it would appear that self-amputation is rarely discussed and/or researched in the academic literature. The cases highlighted here show that there are many other reasons for self-amputation that are not the result of any kind of mental illness including the necessary (for survival reasons), the unnecessary (criminal or political reasons), or the downright bizarre (as an act of macho bravado).

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

Further reading

CNN Interactive (1998). Bombing suspect’s brother cuts hand off with saw. March 9. Located at:

Elst, M. (2010). 10 unbelievable amputation stories., February 22. Located at:

Fox News (2007). Farmer cuts off right arm with pocket knife to save life. November 26. Located at:

Gabbatt, A. (2009). Indonesian man survives quake by sawing off own leg. The Guardian, October 9. Located at:

Harkins, D. (2008). The 6 most horrifying ways anyone ever got rich. September 22. Located at:

Kennedy, J.M. (2003). CMU grad describes cutting off his arm to save his life. Pittsburgh Post-Gazette, May 9. Located at:

Reuters (2009). Man cuts off finger in court over debt. January 16. Located at:

Smith, A., Cornford, P. & Maguire, P. (2003). Arm trapped a fearing fire, tough miner knew what to do.Sydney Morning Herald. June 30. Located at:

Wikipedia (2013). Amputation. Located at:

Stumped? A beginner’s guide to xenomelia and body integrity and identity disorder

In a previous blog, I overviewed apotemnophilia, a sexual paraphilia in which individuals derive sexual pleasure and arousal from wanting to be an amputee. There are many case studies in the psychological literature where the individuals want to be an amputee but has no sexual motivation whatsoever. All of these published cases (irrespective of sexual or non-sexual motivation) are examples of what is often referred to as Body Integrity Identity Disorder [BIID]. Some psychologists – such as Dr. Robert Smith in a 2004 issue of the journal Psychiatry – also refer to BIID as ‘amputee identity disorder’.

A recent paper by Dr. Leoni Hiltie and her colleagues in the journal Brain, also reported a similar related condition that they call ‘xenomelia’ that is defined as “the oppressive feeling that one or more limbs of one’s body do not belong to one’s self”. (Having said that, it was actually Dr. Paul McGeoch and his colleagues who coined the term ‘xenomelia’ in a 2011 issue of Journal of Neurology, Neurosurgery and Psychiatry, where they reported four cases of individuals who wanted healthy limbs amputated – see below for more details of their study). However, just to confuse things further, another recent paper by Dr. Peter Brugger and his colleagues in the journal Frontiers in Psychology reports that xenomelia is the ‘foreign limb syndrome’ and is the new name of BIID characterized by the non-acceptance of one or more of one’s own extremities and the resulting desire for elective limb amputation or paralysis”. In yet another paper in a 2012 issue of American Behavioral Scientist, Dr. Jenny Davis refers to such individuals as being born ‘incorrectly-able bodied’ and thus defines the condition as ‘transableism’.

(I ought to add that I emailed Dr. Brugger to try and clarify the different defintions. He very helpfully replied that the “[Frontiers in Psychology paper] has a broader focus that the Brain paper. I more and more think that the social-psychological component of BIID [being equal to] xenomelia is larger than we assume. The many names (Jenny Davis used ‘transableism’) tell us that we are still in kind of pre-scientific state of research into the disorder. I prefer ‘xenomelia’ because it is neutral as to any interpretation”).

There are no estimates in the academic literature of the incidence or prevalence of BIID and related disorders. The website claims it has 1,500 visitors per day while another (unnamed) Yahoo! web group mentioned in a 2011 Newsweek article claims to have 1,700 members. Most academic papers on BIID report that those who suffer the disorder have a fixated desire to amputate one or more healthy limbs and often ask medical surgeons to amputate the limb(s) as a way to restore their psychological stability because they feel an “incomplete” person with four healthy limbs. Obviously this is very controversial but there is little evidence that medication and/or psychotherapy can successfully treat such individuals. The thinking of BIID sufferers is that an amputation would totally relieve their suffering. According the Wikipedia entry in BIID:

“The sufferer has intense feelings of envy toward amputees. They often pretend, both in private and in public, that they are an amputee. The sufferer recognizes the above symptoms as being strange and unnatural. They feel alone in having these thoughts, and don’t believe anyone could ever understand their urges. They may try to injure themselves to require the amputation of that limb. They generally are ashamed of their thoughts and try to hide them from others, including therapists and health care professionals. The majority of BIID sufferers are white middle-aged males, although this discrepancy may not be nearly as large as previously thought. The most common request is an above-the-knee amputation of the left leg”.

As I pointed out in my previous blog on apotemnophilia, many individuals who want to have a healthy limb amputated often pretend to be amputees and utilize prosthetics and assistive devices (e.g., crutches, wheelchairs, etc.) so that they can temporarily feel as if they are actually disabled and an amputee. Some psychologists, such as Dr. Robert Bruno (writing in a 1997 issue of the Journal of Sexuality and Disability, argue that those wanting to amputate a healthy limb are suffering from a Factitious Disability Disorder (FDD) and is akin to Munchausen’s Syndrome.

FDDs are conditions in which disability – real or pretended – provide an opportunity for the sufferer to be loved and attended to where no such opportunity has otherwise existed. 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). Bruno argues that those with BIID 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.

However, other authors (such as Jenny Davis) point out that many such individuals simply believe they were born with an incorrectly-able body and that the desire for amputation has little to do with wanting to be a patient but want to have a healthy limb amputated just to feel normal and complete. Other similar conditions also exist such as those individuals who desire to become paralyzed, blind, deaf, etc. In a 2011 article in Newsweek by Jesse Ellison, it was reported that for some BIID sufferers, the compulsion is so strong that they successfully amputate their own limbs. The article reported the case of one man who had made many attempts to sever his left hand but finally managed to cut it off using a power saw (and told his family he had done it accidentally). Another man froze his own leg so that it had to be medically amputated.

One theory on the origin of BIID is that it is a neurological failing of the brain’s inner body mapping function (located in the right parietal lobe). The four individuals in the paper by Dr. McGeoch and colleagues underwent a magneto-encephalography (MEG) scan during tactile stimulation of sites above and below the desired amputation line. The authors reported that their findings revealed:

“Significantly reduced activation only in the [right parietal lobe] of the subjects’ affected legs when compared with both subjects’ unaffected legs and that of controls…[We] propose that inadequate activation of the [right parietal lobe] leads to the unnatural situation in which the sufferers can feel the limb in question being touched without it actually incorporating into their body image, with a resulting desire for amputation”.

Such findings suggest that the condition is more biologically than psychologically based and suggests why such people appear to be resistant to psychological treatments and interventions. This also leads to some interesting ethical questions about whether someone who is physically healthy should have a medical intervention (i.e., an amputation) to become psychologically healthy. An interesting paper by Dr. Tim Bayne and Dr. Neil Levy in a 2005 issue of the Journal of Applied Philosophy reported that:

“In 1997, a Scottish surgeon by the name of Robert Smith was approached by a man with an unusual request: he wanted his apparently healthy lower left leg amputated. Although details about the case are sketchy, the would-be amputee appears to have desired the amputation on the grounds that his left foot wasn’t part of him – it felt alien. After consultation with psychiatrists, Smith performed the amputation. Two and a half years later, the patient reported that his life had been transformed for the better by the operation. A second patient was also reported as having been satisfied with his amputation. Smith was scheduled to perform further amputations of healthy limbs when the story broke in the media. Predictably, there was a public outcry, and Smith’s hospital instructed him to cease performing such operations”.

Bayne and Levy argued that in the case of some people with BIID, the ‘healthy limb’ is not as healthy as it might appear mainly because the sufferer perceives the limb not to be their own. In essence, they argue that the disorder is one of depersonalization and that such disorders are “invisible to the outside world”. They conclude (and I have to admit that I am persuaded by their arguments) that just because we can’t see the problem doesn’t mean we should dismiss the suffering that the condition might cause. They acknowledge that question of whether amputation is an appropriate response to this suffering is a difficult, but believe that in some cases it might be justifiable to amputate a physically healthy limb.

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

Further reading

Bayne, T. & Levy, N. (2005). Amputees by choice: Body Integrity Identity Disorder and the ethics of amputation. Journal of Applied Philosophy, 22, 75-86.

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

Davis, J. (2012). Prosuming identity: The production and consumption of transableism on American Behavioral Scientist, 56, 596-617.

Ellison, J. (2011). Cutting desire. Newsweek, October 28. Located at:

Hilti, L.M., Hanggi, J., Vitacco, D.A., Kraemer, B., Palla, A., Luechinger, R., Jancke, L., & Brugger, P. (2012). The desire for healthy limb amputation: Structural brain correlates and clinical features of xenomelia. Brain, 136, 318-329.

Large, M.M. (2007). Body identity disorder. Psychological Medicine, 37, 1513-1514.

Smith, R.C. (2004). Amputee identity disorder and related paraphilias. Psychiatry, 3, 27-30.

Wikipedia (2013). Body integrity identity disorder. Located at:

McGeoch, P.D., Brang, D., Song, T., Lee, R.R., Huang, M. & Ramachandran, V.S. (2011). Xenomelia: A new right parietal lobe syndrome. Journal of Neurology, Neurosurgery and Psychiatry, 82, 1314-1319.