In considering possible therapies and treatments for BIID, I have been trying to determine what functions effective BIID treatment must perform. I have come to the conclusion that there are three requirements for BIID treatment to be effective, and that these relate closely to the three ways in which identity is determined:
- One’s state of being
- The way one experiences oneself
- The way one is experienced by others
Thus effective BIID treatment must allow the sufferer to:
- Take on the physical state of having the required disability
- Experience oneself as having the required disability
- Be experienced by others as having the required disability
I’m going to look more in depth at these and then look at how potential treatments relate to these criteria.
Taking on the physical state of having the required disability
Ultimately, BIID is about having the identity of someone with a particular disability while physically lacking that disability (note that the sufferer may have other disabilities; these do not relate to BIID as BIID is focussed specifically on one particular disability), so to treat this part of the condition a treatment should allow the sufferer to, at least temporarily, take on the physical state of the required disability as closely as possible. It is important to note here that pretending has limited effectiveness in this area, as while the sufferer may be simulating the required physical state they are still aware that they do not actually have that state.
Experiencing oneself as having the required disability
One way that one determines one’s state of being is by noting how one experiences oneself. One cannot instinctively know what one’s state of being is, but can gather that information only through observation either by themselves or by other people. In the case of BIID, experiencing oneself as having the required disability will go a long way in helping the sufferer to feel at ease, even if they do not actually have that disability. This is where pretending comes in, because by simulating the required disability the sufferer then experiences themselves as being disabled, and “fools” their brain into believing that their physical state is in line with their identity.
Being experienced by others as having the required disability
The other way in which one determines one’s state of being is based on the observations of others. Ultimately the importance here is not so much to be perceived as disabled for the sake of it (i.e. BIID is not attention-seeking), but because being perceived as disabled and treated as disabled will aid the BIID sufferer in experiencing themselves as disabled. This is why BIID sufferers will often make a point of getting to know others as a disabled person, or communicating online as if they were disabled, because these things help them to experience themselves as physically disabled even though they are aware that they are not.
Effectiveness of various treatments
Having now explained the three criteria for BIID treatment to be effective, I will now look at a range of potential treatment options and how their effectiveness relates to these criteria.
The most common treatment option which every BIID sufferer is aware of is pretending, or simulating the required disability. I have touched on this in the discussion of the criteria themselves, but I will go into more depth here.
Pretending does not change the sufferer’s physical state, and this is its ultimate flaw. No matter how realistically the sufferer can simulate their required disability, it is still not real and they are still aware that it is not real. As long as they are aware that they are not really disabled, they will be aware that their physical state does not match their identity, and thus their BIID feelings will to some extent remain, meaning that the effectiveness of the treatment is limited.
Nevertheless pretending is still very effective, as it has the potential to meet both of the other criteria. A pretender who is successful in simulating their required disability will most certainly experience themselves as a disabled person, and by pretending in the company of others they will be perceived as a disabled person also (this latter point is, I believe, why many pretenders seek to spend time pretending in public, often beyond the extent to which they would otherwise spend time in public). Thus pretending is still effective, and during long periods of pretending it is possible for the sufferer to begin to neglect the fact that they are not physically disabled and to become “caught up” in their experience as a disabled person and in such situations pretending has the potential to give the sufferer virtually complete – although temporary – relief from their BIID, and this, combined with the relatively easy availability of this treatment, is why pretending is a popular treatment for BIID.
I’m including both self-inflicted injury and medical surgery with the goal of acquiring the required disability together in one section here, mainly because there is little to say about this mostly-hypothetical treatment. Logically, acquiring the required disability will alter one’s physical state to be in line with one’s identity (although there may still be minor discrepancies between the identity and the physical state in the case of self-injury where the sufferer has little control over the final outcome, although these are usually too small to cause significant distress). From this follows on both the sufferer now experiencing themselves as a disabled person and being experienced by others as a disabled person, confirming their physical state as being that of a disabled person.
There are many different types of “therapy”, but in this context I am using the term to refer to traditional-style mental therapy, such as CBT and related “talking therapies”. Analysing these in terms of the aforementioned criteria is challenging, mainly because they do not meet any of the criteria – and that may hint at the reason for their ineffectiveness. If there is any benefit to be gained from these, it works on a different mechanism than the mechanism described here, specifically I believe by attempting to alter the sufferer’s “incorrect” identity rather than to alter their experiences and their physical state to bring them in line with their identity.
The ultimate treatment
This section is completely hypothetical, sadly, but I would like to conclude by outlining what I believe would be the ultimate treatment for BIID. While I am a strong proponent of surgery/transitioning, I do acknowledge that there are numerous complications, mainly from a legal standpoint, with said treatment and the ultimate treatment would get around those complications without compromising on effectiveness. According to the proposed criteria, I believe that this treatment could exist in a hypothetical world, and maybe with enough advances in scientific and medical research it will one day be available.
My proposal, then, is for the sufferer to be able to move at will between the physical state of having their required disability and the physical state of not having their required disability. Thus the treatment can be used in much the same way as pretending, but without the limitation of pretending that the sufferer’s physical state is still that of someone without the required disability. With this treatment, the sufferer would in reality be able to temporarily acquire the required physical state, and while I doubt that many sufferers would choose to move back to a non-disabled state it does eliminate the complications that arise from the permanence of surgery/transitioning.
I’m not really sure why I’m writing this because it’s mostly hypothetical at this stage, but ultimately everything starts with a hypothetical suggestion or concept, and having a clear set of criteria would be a great help when attempting to develop new treatments for BIID. The issue still remains, however, of how to effectively apply these criteria to practical research, as I see the scope for treatment methods that successfully meet all of the criteria as somewhat limited.