With the theory of autogynephilia in disarray, Blanchard and Lawrence propose a theory that transsexualism is an "amputation fetish", by "lumping" GID, BIID and apotemnophilia.


Investigative report by Lynn Conway

June 20, 2004

[Updated 8-10-06; 1-17-07]



Blanchard's autogynephilia theory of transsexualism has been left in disarray by the Bailey book fiasco and subsequent scientific deconstruction by Madeline Wyndzen. It will likely never recover its early cult following amongst sexologists.


Undeterred in their life-quest for scientific fame by discovering the cause of transsexualism, Ray Blanchard and his close colleague Anne Lawrence have since turned their speculations towards developing a new theory.  By "lumping" together and making connections between GID, BIID and apotemnophilia, and by making parallels between proposed treatment protocols, Blanchard and Lawrence have implicitly surfaced a theory that transsexualism is actually a "male sexually-paraphilic amputation fetish".


Following are links to conference schedules and media reports (included in this page below) that document the development of the Blanchard-Lawrence GID = BIID theory-project:, leading up to the presentation of their theory by Lawrence at the 2004 IASR Annual Meeting:


Item 1. Third Annual International BIID Meeting, “STEPPING INTO THE FUTURE”,  JUNE 6, 2003.


Item 2. "Off With My Arm!" by Shana Liebman, Beth Broome and Mike Albo, New York Observer, June 30, 2003.

Item 3. Scientific Program, Thirtieth Annual Meeting, International Academy of Sex Research (IASR), June 16-19, 2004.


Item 4. "Theoretical and Clinical Parallels Between Body Integrity Identity Disorder and Gender Identity Disorder", A. A. Lawrence, Thirtieth Annual Meeting, International Academy of Sex Research (IASR), June 16-19, 2004. (see abstract below)



Update of August 10, 2006:


In 2006, Lawrence published a paper on this "research" in the IASR journal (recall that Blanchard's close colleague and supporter Zucker is President of IASR and that Bailey runs IASR's SEXNET). In this paper, Lawrence rehashes Blanchard's two-type theory of transsexualism as if it were a scientific fact, and then attempts to correlate type-2 trans women with amputation wannabees.


You will notice that Lawrence changed the title for the journal article from that used at the 2004 IASR meeting. Here Lawrence spells out "Desire for Limb Amputation" instead of referring to it as "Body Integrity Disorder", thus making even clearer her assertion that transsexualism is an "amputation fetish". The resulting paper is one of the most deeply defamatory and emotionally disturbing treatments of gender transitioners that we have ever seen.


The following item links to a PDF file of the Lawrence paper, and the abstract is found below. Transwomen and those who love them should approach this paper with caution; they may experience considerable angst upon reading Lawrence's hideous caricatures of their identities as women.


Item 5: "Clinical and Theoretical Parallels Between Desire for Limb Amputation and Gender Identity Disorder", by Anne Lawrence, Archives of Sexual Behavior, Vol. 35. No.3, June 2006, pp. 263-278. (PDF file).



Update of January 17, 2007:


On January 9, 2007, the infamous NARTH organization began promoting Lawrence's pathologization of trans women as having an "amputation fetish", in the following prominent review in the NARTH website:


Item 6: "Clinical And Theoretical Parallels Between Desire For Limb Amputation And Gender Identity Disorder", Reviewed by Christopher H. Rosik, Ph.D., NARTH.com, January 9, 2007.


This NARTH review is likely to promote rapid spread of the Lawrence-Blanchard theory amongst reversionists and the religious right, providing them with what they'll eagerly perceive as strong "scientific" ammunition to use against gender transitioners.



But why is this happening?


What inner demons drive Lawrence (and Blanchard) to continue doing such things to the trans community?


Andrea James may have the answer:


Andrea notes that "Lawrence has significant bias based on personal erotic interest. The incident involving examining an unconscious Ethiopian patient for signs of genital amputation led to Lawrence’s resignation as a medical doctor, so it seems pretty obvious to most people that Lawrence’s “theory” is in fact an attempt to make unusual sexual interests like Lawrence’s an indicator that Lawrence is a “real transsexual,” as Lawrence has defensively claimed to be."


"Like Bailey, Lawrence’s “science” is really an exercise in identity politics, an attempt to expand a traditional definition in order to match their self-identities. Thus Bailey continually represents himself as a “single heterosexual male” instead of a divorced closet case, and Lawrence is a “real transsexual” instead of a surgical fetishist with a kink for ritualized genital modification."


Need we say more?





[Note: in the following items, bold red characters are locators of especially relevant text]:


At the Third Annual International BIID Meeting, JUNE 6, 2003, Blanchard and Lawrence "lump" GID and BIID (a code word for apotemnophilia):





Body Integrity Identity Disorder

2003 Meeting

Announcing the Third Annual International BIID Meeting


FRIDAY, JUNE 6, 2003, 9AM--5PM




¨      Welcome and introduction of speakers, participants and guests by Michael First, MD

¨      1st Speaker:  Dr. Michael First:  “Desire for Amputation of a Limb:  Paraphilia, Psychosis or a New Type of Identity Disorder”

o       Dr. First summarized the results of a structured telephone interview study involving 52 subjects who self-identified as having had a desire to have an amputation.  The results indicated the existence of a distinct clinical condition, characterized by a “lifelong” desire for an amputation, typically, of one or more “major limb(s)” (e.g. a[n] arm[s] or leg[s]). 

o       This condition was found to correlate with serious negative consequences, i.e. amputation attempts marked impairment and distress. 

o       Similarities between this condition and Gender Identity Disorder were explored.

o       Dr. First suggested that this condition be conceptualized as an unusual dysfunction in the development of one’s fundamental sense of who one physically is, and called “Body Integrity Identity Disorder.”           

o       Dr. First noted that a paper based on this study was recently submitted to the American Journal of Psychiatry and that it will probably take months before it is known whether it will be accepted for publication.

¨      2nd Speaker:  Dr. Robert Smith: Amputee Identity Disorder: Is Surgery Appropriate?  (co authored by Dr. Keren Fisher, Dr. Russell Reid and Dr. Richard Fox)

o       Dr. Smith first defined Amputee Identity Disorder (AID/BIID), identified many reasons why people self-injure and compared and contrasted AID/BIID with various conditions-- including paraphilias, Munchausen’s Syndrome and Body Dysmorphic Disorder.  Etiology and symptoms of the disorder were discussed.

o       The second portion of the talk moved into a discussion of the case presentations.  8 patients initially presented to the team for initial evaluation and screening to be considered for amputation and only 3 made it to consultation with the surgeon. Standard assessments and evaluation criteria were discussed.

o       Outcomes for all the patients who received surgery were discussed.  All patients who underwent the procedure reported marked positive changes in their lives and improvement of function.

o       Dr. Smith discussed the reasons why elective amputations can no longer be done in Falkirk, Scotland. 

o       Dr. Smith discussed recommendations and observations made as a result of his experience performing elective amputations (particularly the importance of patient selection).

¨      3rd Speaker was Ray Blanchard, PhD: “Theoretical and Clinical Parallels Between BIID and GID”

o       Dr. Blanchard discussed the parallels between BIID and GID, the history of social acceptance of Sexual Reassignment Surgery (SRS) and assessing the therapeutic impact of sex reassignment surgery and elective amputation.

o       Dr. Blanchard asked the question: Which aspects of GID phenomena are relevant to BIID?.  He also discussed the taxonomy of male-to-female transsexualism.

o       Dr. Blanchard covered the aspects of social acceptance of SRS, including positive clinical evidence, backing of prestigious institutes and experts, favorable social climate, sympathetic media and high-profile attractive pioneers.

o       Dr. Blanchard discussed his belief that outcome studies on the therapeutic impact of SRS would never have been sufficient to bring about social acceptance of surgical intervention, but they were certainly necessary.  His hypothesis was that the same fact may hold true for the surgical treatment of BIID.

¨      Lunch followed Dr. Blanchard’s talk

¨      4th Speaker was Anne Lawrence, MD, PhD: “BIID and GID: Paraphilia,
Identity, and Access to Care”

o       Dr. Lawrence defined the term “paraphilia” using the DSM-IV criteria, and discussed the interaction of paraphilia and identity in Gender Identity Disorder.  Dr. Lawrence posed the question “Is the desire for amputation a paraphilia?”  She also covered objections to the idea that the paraphilia model applies to BIID.

o       Dr. Lawrence discussed a paradigm referred to as the “Erotic Target Location Error” model (developed by Drs. Freund and Blanchard).

o       The final portion of Dr. Lawrence’s talk focused on the public health model of “Harm Reduction” as it could apply to BIID – both in the areas of motivating surgical professionals to be of assistance to this population, and helping members of the community who attempt self-amputation to take steps to preserve life and minimize damage.  Legal concerns were also discussed in this portion of the talk.

¨      Movie Trailer Presentation: Jeremy Wang-Iverson  of Vesto Productions

o       Pretender’s Dance -- 3 minute movie (fiction) trailer about a dancer who discovers that her boyfriend has BIID and pretends and uses that to inspire her dancing.  The trailer has been developed for this 20-minute short film, and a feature may be developed at a later time.  Discussion followed about the ability of the public to comprehend the subject matter based on the trailer.

¨      Group Discussion re: Future Plans

o       Goals of Pilot Program

§         Develop screening criteria to rule in those most likely to benefit from surgery

§         Develop instruments to measure intensity of BIID in order to evaluate clinical change post-surgery

§         Collect pre-op and post-op data and at certain follow-up points in order to document whether improvement, if any, is sustained

§         Determine that condition fits basic criteria for BIID:

            ·        Age at onset in childhood or adolescence

·        Reason for amputation is to restore true identity

·        Absence of other psychiatric conditions that could explain desire for amputation, especially psychosis

§         Require that reversible measures be tried first: e.g.-high dose sustained trial of SSRI (e.g. Prozac, Zoloft, etc.), and psychotherapy

§         Insure that some sort of assistance is available to the full-spectrum of people with BIID, including those not seeking surgery at this time

§         Possible inclusion of a “real life test,” possibly including use of applicable adaptive equipment for an extended period of time

o       Issues to be Considered

§         Are there any absolute exclusionary criteria for surgical consideration?

§         What are the legal issues involved in setting up a pilot program?

§         How do we identify and train therapists who are interested in working with clients with BIID, and what will be the protocol they follow?

§         How do we deal with the desire/need for multiple “major limb” amputations?

§         What are the socio-economic issues involved in elective amputations?

§         How can information about BIID be most effectively disseminated to the international medical community (particularly the surgical and psychiatric communities)?

§         Can future meetings be held abroad to increase access to those from other countries?  Would an institution similar to Columbia Medical Center be available to host such a meeting?

§         What will be the procedure for long-term follow-up of participants in the BIID program?  (Follow-up with people who have already achieved major-limb amputation(s) at the desired site(s) to determine surgical efficacy may be a related goal.)

§         How can the website be changed and/or improved to assist people in accessing information, and increase access to studies, therapist training, etc.






2. Lawrence's and Smith's thinking on GID and BIID is then

reported in The New York Observer following the BIID meeting:



The attendees at the BIID meeting, especially Blanchard's and Lawrence's colleague Robert Smith, were clearly intrigued with a news story that was then making the rounds.  In early May, shortly before the BIID meeting, outdoorsman Aron Ralston had made national news headlines when he saved his own life by sacrificing a forearm:


"Aron Ralston Sacrifices His Right Arm to Save His Life", By Jessica Strelitz, Carnegie Mellon Magazine



"In a story told around the globe, Ralston (E'97) had fought fate and come out on top. An experienced climber and outdoorsman, Ralston went hiking alone down Utah's Bluejohn Canyon on April 26. As he climbed over a boulder, it shifted, pinning his right arm against a canyon wall. Five days later, after having tried fruitlessly to budge the 800-pound rock, he broke the bones in his forearm and amputated his arm below the elbow with a dull pocketknife. The operation took about an hour. Once free, he rappelled down a 60-foot cliff and walked five miles before finding help."


In a gross breach of medical ethics, Dr. Smith could not restrain himself from making an implicit remote-diagnosis of apotemnophilia in the Ralston case, just as Blanchard, Bailey and Lawrence have made ever so many remote diagnoses of autogynephilia in cases of transitioned women.  Here is how Dr. Smith's reactions to the Ralston story are reported in the Observer article (at  http://www.newyorkobserver.com/pages/story.asp?ID=7572 ):


When young hiker Aron Ralston made headlines after he escaped from a rock slide by cutting off his own arm with a penknife, most saw an inspirational story of the indomitable will to live.  Dr. Robert Smith couldn't agree more.  Dr. Smith is an expert in a rare disease called Body Identity Integrity Disorder (BIID), in which sufferers feel an obsessive need to lose a limb in order to feel "themselves." (He used to perform amputations for BIID patients-until the British Medical Council made him stop.)


Lawrence then jumped in and reminded people to lump GID and BIID, and also offered self-help tips for do-it-yourself self-amputees:


"BIID is often compared to Gender Identity Disorder. "[They] are two sides of the same coin," said Dr. Anne Lawrence."  "Dr. Lawrence offered some helpful tips for "reduced-harm" D.I.Y. methods. Ketamine (a.k.a. Special K), for example, is a "good anesthesia for amateurs." She also recommends a pneumatic tourniquet, although "it's hard to say it was a chainsaw accident when there is a tourniquet in the house." "



By the way, as you will see below, the Observer article also reports that:


Dr. First and two Canadian doctors are determined to enter BIID into the next edition of the Diagnostic and Statistical Manual of Mental Disorders.


We wonder who the "two canadian doctors" are who are determined to get BIID into the next DSM.?  Blanchard must be one, but who is the other one?  Zucker maybe?  Anyways, this is a familiar story, eh? 



Implications for people who have had to undergo amputations because of injuries or illness:


When sexologists make "remote diagnoses" of "sexual paraphilia" in amputees, they spread suspicions that many unexplained amputations are actually the result of BIID.  Even though these sexologists have never even met the individuals they are "diagnosing" in this way, many amongst the public take media reports of their "scientific" speculations quite seriously.


Thus these sexologists now threaten to cause many individual amputees to become the subjects of gossip and suspicion as being sexual paraphilics (i.e., of having caused their own amputations for sexual reasons), in much the same way these sexologists brought many transwomen under suspicion as being sexual paraphilics (under Blanchard's theory of "autogynephilia").


When trans women protested against the validity of and poor science behind the "autogynephilia theory", they were "remotely diagnosed" and publicly labeled as autogynephiles in a witch-hunt conducted by Bailey, Blanchard and Lawrence. Thus most amputees are likely be frightened to death to protest this new sexualized-pathologization of amputees, lest they themselves be subjected to witch-hunts in which they are openly "diagnosed" as being sexual paraphilics by these same sexologists.

Based on past experiences with the scientific defamation of trans women by these researchers, we believe that medical research IRB committees and research integrity overseers should be on a close lookout for any psychological research proposals that involve amputees as human subjects, in order to protect the human rights of amputees, and to insure that their identities and case histories are kept completely confidential.


We also strongly recommend that protocols be developed for sanctioning academic researchers who make remote-diagnoses of sexual paraphilia in individuals simply on the basis of those persons being amputees, and without having even met them. Furthermore, since many amputees are outed by their physical handicaps, the entire class should be considered endangered with respect to potential stereotyping as male sexual paraphilics under the theories now being promoted by academic psychologists and sexologists.








June 30, 2003



Off With My Arm!

by Shana Liebman, Beth Broome and Mike Albo


When young hiker Aron Ralston made headlines after he escaped from a rock slide by cutting off his own arm with a penknife, most saw an inspirational story of the indomitable will to live.

Dr. Robert Smith couldn't agree more.

Dr. Smith is an expert in a rare disease called Body Identity Integrity Disorder (BIID), in which sufferers feel an obsessive need to lose a limb in order to feel "themselves." (He used to perform amputations for BIID patients-until the British Medical Council made him stop.)

Dr. Smith had just arrived from Scotland for the third annual BIID conference, which was held at Columbia Presbyterian Hospital June 6. On the evening before the conference, BIID sufferers and doctors from around the world gathered for cocktails at the Riverside Drive home of Dr. Gregg Furth. Dr. Furth, a New York psychiatrist, is a longtime crusader for increased BIID research. He has also been trying for many years to persuade doctors to cut off his right leg.

"It's off the radar of most medical professionals," explained Dr. Michael First, the conference organizer and a psychiatrist at Columbia University. "That's because most sufferers are ashamed to tell anyone. But the desire is so intense, it prevents them from having intimate relationships or fully functioning."

Dr. First and two Canadian doctors are determined to enter BIID into the next edition of the Diagnostic and Statistical Manual of Mental Disorders.

"Most people assume this is psychotic, which is the technical term for crazy," Dr. First said. But in his recent survey of 52 BIID sufferers, "no one was psychotic or delusional. They knew their desire was abnormal."

Also, most were well-educated, middle-aged white males who were first stricken when they saw an amputee during childhood. Chris, a soft-spoken retiree from a tiny West Coast town, has been consumed since childhood by the desire to remove his right leg above the knee. In the disease's nomenclature, he's an S.A.K.-single (limb) above the knee. Although he thinks about it all the time, he only recently told his wife, 32 years after they were married.

She is trying to be supportive.

"I love him, so I will deal with it .... I mean, if I argue for women's rights to choose-but I want him to lose a little weight before the surgery."

Last year, as a "trial run," Chris had "an accident" during which his friend chopped off the top of his finger. "I am really happy with it," he said, smiling shyly. But he is still waiting and hoping, he said, to find a doctor to amputate his right leg.

According to Dr. First's study, no form of therapy, including anti-psychotic drugs, decreased the intensity of the desire in the study's subjects. In addition, 99 percent of those who were amputated were ecstatic with the results and had no desire to lose another limb.

BIID is often compared to Gender Identity Disorder.

"[They] are two sides of the same coin," said Dr. Anne Lawrence. "They're both about feeling like you're in the wrong body and wanting to change that body." Dr. Lawrence, a transsexual herself, was invited to the conference for her expertise on the topic. Unlike sex changes, however, amputating a healthy limb disables the patient-so it's considered unethical, although not illegal.

It was the finding in Scotland that the practice was unethical that put a stop to Dr. Smith's amputations.

"I'd still do it if I could," he said.

Many BIID sufferers who can't find a willing surgeon are desperate enough to go to Thailand or Russia. And many do it themselves. In 2001, George Boyer shot off part of his leg. After his landlady rescued him from bleeding to death, he convinced doctors to professionally finish the job. His only regret was not doing it sooner.

Dr. Lawrence offered some helpful tips for "reduced-harm" D.I.Y. methods. Ketamine (a.k.a. Special K), for example, is a "good anesthesia for amateurs." She also recommends a pneumatic tourniquet, although "it's hard to say it was a chainsaw accident when there is a tourniquet in the house."

Another suggestion: have a friend monitor the procedure-preferably someone who wants it to succeed. A good choice for this role might be a devotee, someone who is sexually attracted to amputees. Like Paul, who came from Belgium for the conference and feels strongly that "we need more public images of hot amputees."

"What about Eddie McGee from Big Brother?" was the first comment in five hours from the dapper 70-year-old in the back of the classroom-who yearns to feel the absence of his right leg, but has decided against it since he plays organ in church.

"But is he really a sex symbol?" Paul asked.

Matthew, a scruffy playwright in a Bauhaus T-shirt, has always been attracted to paraplegics. He dumped his last "model-type" girlfriend for Stephanie, a sweet, slightly overweight BIID sufferer. His friends thought he was crazy. "It's harder than being gay," he said. But the two bonded over their shared desires, and his now fiancée just moved across the country to live with him.

"Why not jump in with both feet?" she said.

-Shana Liebman 






3. Blanchard and Lawrence bring forward their new GID-BIID theory project

at the 2004 IASR Meeting:


In 2004, Ray Blanchard became the new President of the International Academy of Sex Research, an organization of sexologists who study "deviant sexualities".  In his opening Presidential Symposium at the IASR Meeting in June, 2004 (see below), Blanchard brought forward his and Anne Lawrence's new project:  The "lumping" of GID with BIID (i.e., with apotemnophilia):


SYMPOSIUM II: Apotemnophilia and Body Integrity Identity Disorder
Chair: Ray Blanchard
· Anne Lawrence “Theoretical and Clinical Parallels Between BIID and Gender Identity Disorder”
· Michael First “Desire for Amputation of a Limb: Paraphilia, Psychosis, or a New Type of Identity Disorder”
· Richard Green—Discussant







International Academy of Sex Research





Thirtieth Annual Meeting

Helsinki, Finland

June 16-19, 2004

(Wednesday afternoon through Saturday evening)


Hosts:                   Osmo Kontula and Elina Haavio-Mannila

                            The Population Research Institute

                            Family Federation of Finland

                            Iso-Roobertinkatu 20-22A

                            P.O.Box 849, FIN-00101 Helsinki, FINLAND

                            T.: +358-9-22805123

                            F.: +358-9-6121211

                            E: Osmo.Kontula@vaestoliitto.fi



The Annual Conference of the International Academy of Sex Research (IASR) in Helsinki is organized by The Population Research Institute, Family Federation of Finland in cooperation with The Finnish Association for Sexology and the Finnish Foundation for Sex Education and Therapy (SEXPO).


Location:              Hanasaari – The Swedish-Finnish Cultural Centre

                            FIN-02100 Espoo, FINLAND                                                   

                            T: +358-9-435020

                            F: +358-9-467291

                            E: hanasaari@hanaholmen.fi




Ray Blanchard, Chair (CANADA)                        Roy Levin (ENGLAND)

Lori Brotto (USA)                                             Richard Lippa (USA)

Brian Gladue (USA)                                          Ilsa Lottes (USA)

Elina Haavio-Mannila (FINLAND)                        Marta Meana (USA)

Gilbert Herdt (USA)                                          Lena Nilsson Schönnesson  (SWEDEN)

Melissa Hines (ENGLAND)                                 Lucia O’Sullivan (USA)

Janet Hyde (USA)                                             Jim Pfaus (CANADA)

Osmo Kontula (FINLAND)                                  Theo Sandfort (USA)

Jacques van Lankveld (NETHERLANDS)               



Lucia F. O’Sullivan, Ph.D.

HIV Center for Clinical and Behavioral Studies

Columbia University

1051 Riverside Drive, Unit 15

New York, New York  10032-1007    USA 

T:  212-928-6111; F:  212-928-6161; Email:  LFO2@columbia.edu









10:00 a.m. - 1:00 p.m.      IASR Officers Meeting

1:00 p.m. – 4:00 p.m.                  Conference Registration

3:00 p.m. – 4:00 p.m.                  Coffee Break

4:30 p.m. – 4:45 p.m.                  WELCOME

                                      Hosts, Elina Haavio-Mannila and Osmo Kontula

                                      IASR President, Ray Blanchard


4:45 p.m. - 6:30 p.m.                  SYMPOSIUM I:  Sex Research in Finland

                                      Chair:  Osmo Kontula

·         Elise Kosunen “Adolescent Sexual Behaviour Research in Finland

·         Elina Haavio-Mannila “Comparative Sex Research in the Baltic Area”

·         Jukka K. Lehtonen “Lesbian, Gay and Queer Research in Finland

·         Osmo Kontula “Renaissance of Romanticism in the Era of Increasing Individualism”


6:30 p.m. – 7:30 p.m.                  INVITED LECTURE I:  Anna Rotkirch

                                      “Sex in the Post-Socialist City:  Why Do Sexual Liberalism and

 Gender Equality Not Go Hand in Hand?”


7:30 p.m. – 7:50 p.m.                  In Memoriam

                                      Chair:  Richard Green

8:15 p.m.                         Leave for Opening Reception


8:30 p.m.-10:30 p.m.                  Opening Reception and Buffet Dinner

                                      Hosted by Espoo City at Karhusaari Art Centre







8:00 a.m. – 10:00 a.m.      Registration


9:00 a.m. – 10:45 a.m.      SYMPOSIUM II:  Apotemnophilia and Body Integrity Identity Disorder

Chair:  Ray Blanchard

·         Anne Lawrence “Theoretical and Clinical Parallels Between BIID and Gender Identity Disorder” (webpage note: see abstract, below)

·         Michael First “Desire for Amputation of a Limb:  Paraphilia, Psychosis, or a New Type of Identity Disorder”

·         Richard Green—Discussant


10:45 a.m. – 11:00 a.m.     Coffee Break


11:00 a.m. – 12:00 p.m.     INVITED LECTURE II:  Peter Hegarty

“Sex, Secrecy, Silence & Self-Report”


12:00 p.m. – 1:15 p.m.      Lunch

                                      Working Lunch of Archives Editorial Board


1:30 p.m. - 3:15 p.m.                  SYMPOSIUM III:  Endocrinology of Female Sexual Arousal & Desire

                                      Chair:  Jim Pfaus

·         Jim Pfaus “Endocrinology of Female Sexual Arousal & Desire:  An Introduction”

·         Irwin Goldstein “Central and Peripheral Role of Androgens in Female Sexual Arousal and Desire”

·         Kim Wallen “Androgens, Estrogens and Female Sexual Motivation”

·         Peter Eriksson “Alcohol, Testosterone and Sexual Behavior in Women”


3:15 p.m. – 3:45 p.m.                  Coffee Break


3:45 p.m. – 4:45 p.m.                  INVITED LECTURE III:  Katherine Frank

                                      “Men Who Visit Strip Clubs”


4:45 p.m. – 6:00 p.m.                  SYMPOSIUM IV:  International Policy on Public Health

                                      Chair:  Gil Herdt

·         Gilbert Herdt “North America—Sexual Health, Education, and Rights in the U.S.”

·         Nike Asiet “Africa--Sexual Health Policy in the African Initiative”

·         S. Carrara and M.L. Heilborn “Latin America—Sexual Health and Rights in Brazil”

·         Michael Tan “Asia—Sexual Health Policy in Asia”

·         Diane Di Mauro “Sexual Health Policy in the U.S.”


6:00 p.m. – 7:30 p.m.                  Dinner on your own

7:30 p.m. – 10:30 p.m.      POSTER SESSION (with cash bar)

                                      Chair:  Lisa Diamond



FRIDAY, JUNE 18, 2004


9:00 a.m. – 10:45 a.m.      SYMPOSIUM V:  Sexual Sadism and  Masochism—Sexually

                                      Motivated Homicide and Self Harm

                                      Chair:  Wolfgang Berner

·         Wolfgang Berner “Concepts of Sadism and Masochism:  An Introduction”

·         Steve Hucker “Survivors of Hypoxyphilic Practices”

·         Reinhard Eher “Violent Sexual Offenses in Relation to Paraphilias and Personality Disorders”

·         Peter Berger “Follow-up of Rapists and Sexual Murderers”

·         Andreas Hill “The Relevance of Sadism for Recidivism in Sexual Murderers”


0:45 a.m. – 11:00 a.m.     Coffee Break


11:00 a. m. – 12:30 p.m.    SYMPOSIUM VI:  Premature Ejaculation

                                      Chair:  David Rowland

·         Kevin E. McKenna “Central Neural Control of Ejaculation”

·         Marcel D. Waldinger “A New Animal Model for Research of Early Ejaculation”

·         David L. Rowland “Mind-Body Relationships in Early Ejaculation”

·         Stanley Althof “Assessment of Early Ejaculation:  Review of New and Existing Measures”


12:30 p.m. – 2:00 p.m.      Lunch

                                      Working Meeting I of Program Committee for 2005

3.30 p.m. – 5.30 p.m.                  Helsinki City Reception at the City Hall


6:00 p.m. – 10:00 p.m.      BALTIC SEA SOCIAL EXCURSION

Helsinki sightseeing, Suomenlinna tour, and dinner on board






9:00 a.m. – 10:45 a.m.      SYMPOSIUM VII:  Redefining Adolescent Sexual-Minority Development

                                      Chairs:  Ritch Savin-Williams and Lisa Diamond

·         Paula Rust “Young Adults Creating Sexual Identity in a World of Shifting Sexual Meanings”

·         Stephen Russell “The Intersections of Same-Sex Romantic Attractions and Relationships among U.S. Adolescents”

·         Ritch Savin-Williams “The Relationship Between Sexual Behavior, Sexual Identity, and Sexual Orientation”

·         Lisa Diamond “The Kids are Alright:  New Pathways for Intimacy and Identity among Sexual-Minority Youth”


10:45 a.m. – 11:00 a.m.     Coffee Break

11:00 a.m. – 12:00 a.m.     INVITED LECTURE IV:  Arthur Arnold

                                      Title TBA


12:00 p.m. – 2:00 p.m.      Lunch

                                      Working Meeting II of Program Committee for 2005


2:00 p.m. – 3:45 p.m.                  SYMPOSIUM VIII:  Sex Research & The Internet

                                      Chair:  Lena Nilsson-Schönnesson

·         Michael Ross, Simon Rosser, Jeffrey Stanton & Joe Konstan “Attitudes Toward Cybersex of Latino men Who Have Internet Sex with Men and Their Relationships with Sexual Practices in Cybersex and in Real Life”

·         Anne Bowen “Women and Internet Dating:  Where is the Risk?”

·         Alex Carballo-Dieguez, Michele Shelin, G. Dowsett, R. Remien, P. Lin, C. Dolezal, I. Balan, & A. Ventuneac “Ethnography of ‘Bareback’ Internet Services”

·         Jacques Van Lankveld “Internet Therapy for Males with Sexual Dysfunctions:  A Pilot Study”

·         Mark Williams “Methodological Issues Related to Using the Internet as a Means of Collecting Sexological Data”


3:45 p.m. – 4:00 p.m.                  Coffee Break


4:00 p.m. – 5:00 p.m.                  PRESIDENTIAL ADDRESS:  Ray Blanchard

5:00 p.m. – 7:00 p.m.                  BUSINESS MEETING (Members Only)


8:00 p.m. – 12:00 a.m.      ACADEMY BANQUET -- Hanasaari Restaurant




Item 4. "Theoretical and Clinical Parallels Between Body Integrity Identity Disorder and Gender Identity Disorder", A. A. Lawrence, Thirtieth Annual Meeting, International Academy of Sex Research (IASR), June 16-19, 2004.

International Academy of Sex Research
Thirtieth Annual Meeting
June 16-19, 2004



Lawrence, A.A., 1812 E. Madison St., # 102, Seattle, Washington 98122 
USA (email: alawrence@mindspring.com)

The desire for amputation of a limb, which First (2003) has called Body Integrity Identity Disorder (BIID), has sometimes been regarded as a paraphilia (apotemnophilia). BIID appears similar in some ways to gender dysphoria or transsexualism, which is termed Gender Identity Disorder (GID) in the DSM-IV. Persons with BIID and GID both experience a profound sense of wrong embodiment and seek surgical assistance to modify their bodies. Both BIID and GID were originally considered to be paraphilias and in both conditions there is a high prevalence of other paraphilic interests and a strong male predominance. Nevertheless, persons with BIID and GID typically state that paraphilics explanations incompletely describe their experiences. Most persons with BIID acknowledge sexual attraction to amputees (acrotomophilia), and many persons with GID are also sexually attracted to the category of persons they aspire to live as and resemble. Persons who wish to assume the appearance and role of an amputee temporarily are called pretenders; their condition may bear the same relationship to BIID that transvestism or transvestic fetishism bears to GID.

Males who experience GID commonly report a history of sexual arousal to the thought or image of themselves as female, an erotic interest Blanchard (1989) called autogynephilia. The majority of persons who currently undergo male-to-female sex reassignment surgery (SRS) in the US give such a history (Lawrence, 2003). Apotemnophilia may bear the same relationship to BIID that autogynephilia bears to GID. Freund and Blanchard (1993) suggested that autogynephilia reflects an erotic target location error: Males who are attracted to women are also attracted to the idea of temporarily or permanently changing their bodies to resemble the target of their erotic interest. Erotic target location errors have also been described in gay men and in pedophiles. Apotemnophilia may represent the intersection of an unusual erotic target preference (acrotomophilia) and an erotic target location error.

Gender dysphoric males who deny autogynephilic arousal sometimes display physiologic arousal to stimuli with autogynephilic content, and such denial is correlated with the tendency to portray oneself in a socially desirable manner. I hypothesize that males with BIID who deny apotemnophilia might similarly display physiologic arousal to stimuli with apotemnophilic content, and might also display socially desirable responding. Medications that moderate paraphilic sexual interests, such as SSRIs and antiandrogens, might be beneficial in some cases of BIID. Finally, experience in males with GID suggests that surgery (i.e., SRS) can often be an effective treatment for persons who express a paraphilic wish to modify their bodies.




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