Editor’s Note:
This interview was curated by Leandro Loriga, Ph.D., as part of the 🟡 Expert Interview Series on BodyIntegrityDysphoria.com. Minor edits were made for clarity and grammar, without altering the substance of the responses.
I would like to thank Laura Lalee for generously sharing her time and expertise. Her insights offer a compelling and compassionate perspective on the evolving landscape of BID research and clinical care, and mark an important contribution to this ongoing series.
Could you briefly introduce yourself and your current research focus?
My name is Laura Lalee, and I am a 25-year-old doctoral student currently pursuing my PhD at IPU Berlin. I hold a Master’s degree in Clinical Psychology and Psychotherapy from Humboldt University of Berlin and obtained my license to practice as a psychotherapist in 2024.
In addition to my doctoral studies, I lecture first-semester students on “Introduction to Scientific Research” at MHB in Brandenburg.
For the past five years, I have been deeply engaged with the topic of BID, which forms the core focus of my PhD research. My current project investigates potential treatment approaches for BID, building on my previous work that I have presented at the BID-Conference in Hamburg and have published on.
Beyond this, I have also explored ethical questions related to medical practice, including the legalization of elective amputations, drawing comparisons to gender-affirming procedures for transgender individuals.
What inspired you to explore Body Integrity Dysphoria, and more specifically, the treatment experiences of those affected?
I came across BID more or less by chance while researching an entirely different condition. As I delved deeper, I noticed that BID was about to be included in ICD-11, the international classification system for diseases, as a mental disorder. At the same time, gender incongruence was being removed from the chapter on mental disorders and placed in a different section.
This raised profound questions for me: Where do we, as a society, draw the line when it comes to interventions on an intact body? Why are some desires for bodily modification seen as legitimate, while others are considered pathological or even ethically unacceptable?
As I continued my research, it became increasingly clear how little is currently known about BID, especially in terms of treatment options. Frankly, that is a major problem, as many affected individuals suffer greatly. Some even risk dangerous self-harm or undergo illegal procedures abroad in an attempt to align their bodies with their internal experience.
The few studies that do exist show that when the body is modified to match the identity, such as through amputation, the psychological distress can significantly decrease or even disappear entirely. Thereby, two major challenges emerge: Firstly, elective amputations are currently not legally permitted in Germany. Secondly, the current data is insufficient to provide a sound justification for legalization, particularly as long as alternative treatments remain under-researched.
Before making such a serious decision as legalizing elective amputations, we need to thoroughly examine and study all possible alternative treatments. Through my research, I aspire to help fill this gap. For me, the primary goal is that the suffering of those affected must no longer be ignored. We urgently need to help them quickly and effectively which requires far more research into treatment methods.
How does this research fit into your doctoral work or broader academic goals?
Alongside my PhD, I aim to work as a practicing psychotherapist. I also hope to be able to support BID-affected individuals in my clinical practice.
I still hope that there may be at least one therapeutic approach that can help alleviate the suffering of those affected, not necessarily by making the desire for amputation disappear, but by reducing their distress.
Similar to the support available for transgender individuals, psychotherapy could help those with BID to manage their coming-out process or better cope with the pressure and consequences of the discrepancy between body and identity, especially given that elective amputations are currently not legal in Germany.
Why did you choose to conduct your study at the International Psychoanalytic University Berlin?
I consciously chose the IPU Berlin because I had already written my Bachelor’s thesis on BID at this institution. I proposed the topic at the time and received strong support from my supervisor. Given how sensitive and rare this topic is, I deeply appreciate that I had the opportunity to engage with it there.
For my doctoral work, it was important to me to continue collaborating with my former supervisor. He is not only my doctoral advisor but also brings extensive experience in the area of gender incongruence, a topic that shares interesting parallels with BID.
Furthermore, IPU has a strong psychodynamic and psychoanalytic focus. I believe this is a very fitting context for studying BID, especially since we don’t yet fully understand where the disorder originates. The psychodynamic perspective offers valuable frameworks for researching and understanding BID.
Your study focuses on people’s experiences with various treatment approaches for BID. Could you walk us through the structure of your study?
My study follows a qualitative approach and primarily relies on semi-structured interviews. These interviews can take place either in Berlin or online.
At the beginning, general questions about the experience of living with BID will be asked. This is followed by detailed questions regarding previous treatment experiences before the interview concludes with individual opinions and recommendations from the participants.
Prior to being invited to the interview, participants will receive three online questionnaires. One of them assesses the severity of BID, another captures possible comorbidities, and the third evaluates the individual’s personality organization from a psychodynamic perspective. This allows me to gain a more comprehensive picture of the participants’ personality profiles.
How did you develop your methodology — particularly the decision to combine semi-structured interviews with psychometric assessments?
Since there are currently only very few studies on treatment experiences in BID, and the cause of the disorder remains unclear, we are not yet able to develop targeted, specific treatment approaches. Nevertheless, it is important to provide support to those affected.
This is why it is crucial to closely analyze existing treatment attempts: What has helped to reduce the distress? Which methods or aspects were helpful, and which were not? What were the reasons for a premature termination? Only in this way can we begin to develop initial, BID-specific treatment guidelines.
It would have been possible to rely solely on questionnaires to assess what has been tried and how effective it was. However, it was especially important to me to hear the personal experiences and opinions of those affected in detail. Semi-structured interviews provide an appropriate framework for this, as they allow enough space for individual narratives.
The additional questionnaires primarily serve to better understand the participants’ personality profiles and to identify potential exclusion criteria, in order to ensure data quality.
What have been some of the practical or ethical challenges in recruiting and interviewing participants on such a sensitive topic?
The study is currently still in the data collection phase. Surprisingly, participant recruitment is going very well. A significantly higher number of people have expressed interest than I initially anticipated, which, of course, makes me very glad.
Many individuals affected by BID are highly engaged and eager to actively support research in this area. So far, over 40 people have reached out, although we are unable to include all of them.
One major advantage is that many participants who have already taken part are actively recommending the study to others affected. Additionally, recruitment has been facilitated by the support of BID experts, which I deeply appreciate.
I am very grateful to both the participants and the professionals for their support.
What types of treatment approaches are you most interested in capturing, and why?
As a psychologist, I am particularly interested in whether and how psychotherapy has helped those affected. My intention is not to suggest that psychotherapy should completely eliminate the desire for a disability, but rather that it may help reduce psychological distress to some extent.
At this stage, it is especially important to offer supportive care to those affected so they know that they are not alone. This can help prevent them from resorting to more severe measures, such as dangerous acts of self-mutilation.
I am especially eager to learn more about experiences with psychodynamic approaches, as most participants so far have received behavioral therapy.
Of course, I also place particular emphasis on individuals who have already achieved their desired disability, in order to examine whether these measures actually lead to sustainable improvements in well-being and whether they are later regretted.
Are there any underexplored interventions or therapeutic models you’re particularly curious about?
As I have already mentioned, I currently see a small gap in the area of psychodynamic approaches to BID. Very few of my participants so far have tried depth psychology-based or analytic psychotherapy.
In addition, I could imagine that hypnotherapy might be a promising complementary method worth exploring further in the context of BID.
Without revealing confidential data, have any common themes or unexpected patterns emerged so far from your interviews?
My study is still in the midst of data collection, so the findings are preliminary at this stage. However, what I have observed so far is that participants with a stable social network and the courage to come out to close individuals tend to show lower levels of distress. That could be a promising potential therapeutic goal.
What has surprised you most in your conversations with participants?
What surprised me at the beginning of my conversations with participants was how differently the level of distress caused by BID can manifest. While some individuals struggle intensely with the inner experience of living in the “wrong” body and suffer from significant psychological stress, there are others who, despite this profound conflict, have found a remarkably stable way of coping with it.
This wide range highlights that focusing solely on the desire for physical change is not sufficient. Equally important are individual coping strategies, the social environment, life circumstances, and available psychosocial resources.
Based on what you've seen so far, how would you summarise the current landscape of BID treatment — what works, what doesn’t, and what might be missing?
Based on the current state of research, it can be said that there is still no universally effective therapy for BID. Psychotherapeutic approaches, particularly those focusing on acceptance, strengthening self-worth, and coping strategies, could help some individuals better manage their experiences. However, these interventions have not yet led to a lasting reduction in the underlying desire for amputation or physical change.
It also becomes clear that many conventional therapeutic methods reach their limits when dealing with BID, especially when they primarily pathologize the phenomenon or aim to “eliminate” the desire through therapy. This can lead to frustration on both sides, for the individuals affected and for the therapists.
What is often lacking is a holistic, differentiated, and de–pathologizing approach that considers both the level of identity and the psychosocial context.
Although my study is still ongoing, it partially aims to capture the perspectives and wishes of those affected in order to determine what future treatment approaches should encompass.
From your perspective, what are the most pressing misunderstandings surrounding BID in clinical settings today?
The biggest problem I currently see is the lack of awareness about the existence of BID in clinical settings. Many professionals, whether psychologists, physicians, or therapists, are initially unfamiliar with the term. The inclusion of BID in the ICD-11 was an important first step, but as long as the ICD-10 remains in use alongside it, there is a clear need for education and further training.
Some affected individuals reported that they had already attempted to seek psychotherapeutic support, in some cases, however, they were turned away because the professionals were simply unfamiliar with the condition. There is an urgent need to communicate BID in a more differentiated and clear manner, particularly in terms of differential diagnostic distinctions, in order to counteract stigmatization. Many individuals still fear not being taken seriously or being labeled as “crazy.”
In your opinion, how should clinicians and therapists begin to approach BID more ethically and effectively?
From my perspective, the first and most important step is an open, non-judgmental approach. BID is a highly complex phenomenon that cannot be easily categorized within existing diagnostic or therapeutic frameworks. Therapists and physicians should therefore take the time to truly understand the individual experiences of those affected, without rushing to pathologize or moralize.
Ethically, this also means respecting the autonomy and self-understanding of the individuals concerned, even if their desire for bodily modification may be difficult to comprehend at first glance. The goal is not to immediately endorse or reject this desire, but to take it seriously within a safe space and reflect on it together.
Do you think BID treatment frameworks could benefit from comparison to those used in other identity-related conditions, such as gender dysphoria?
I believe that comparing BID with other identity-related topics, such as gender dysphoria, can provide valuable insights for how to approach BID, especially from an ethical and structural perspective. Both phenomena share certain characteristics: a deep, persistent feeling that one’s body does not match the inner self, significant psychological distress, and often a desire for bodily modifications to achieve a more coherent sense of self.
At the same time, it is important not to equate the two too hastily: the social context, the level of public visibility, and the historical development of the discourses differ significantly. BID remains under-researched in many areas and therefore requires its own specialized concepts, ideally taking existing models into account without merely transferring them. It should especially be noted that there is already a large body of research on gender dysphoria, which cannot yet be said for BID.
The comparison is certainly legitimate, as long as it is approached in a nuanced and context-sensitive manner.
Has working with BID participants changed the way you think about mental health, embodiment, or identity?
Through my conversations with those affected during my study, one central aspect became very clear to me: only they themselves can truly convey what it is like to live with BID, and their perspective is indispensable for understanding the disorder.
One example that particularly opened my eyes was the discussion about the term “pretending”. Some affected individuals reject this term because it implies that they are faking another illness or disability such as paraplegia. In fact, their goal is not to imitate someone else but to better cope with their own disorder – BID.
Some clearly state that they do not actually want paraplegia but rather want to feel identity-congruent with their BID, which they achieve most closely in a state resembling paraplegia. This distinction is crucial. It shows that BID is not a random desire to become disabled, but a deep need for bodily congruence that manifests differently in each individual.
How has this project shaped your approach as a researcher and future clinician (if applicable)?
It has only reinforced what I have always believed: it is essential not to view those affected merely as “cases,” but as experts of their own lived reality. Especially with BID, a disorder that often seems rare and difficult to access, direct engagement with the subjective experiences of those affected is indispensable.
What would you say to other early-career researchers who are interested in exploring complex or controversial topics like BID?
I would definitely encourage them to also tackle complex or controversially discussed topics like BID, especially because there is still so much unexplored and unresolved in these areas. Those who engage with such topics can not only make a scientific impact but often also contribute concretely to improving the lives of those affected.
Once your study is complete, what impact would you ideally like it to have — on research, clinical practice, or public understanding?
One of my foremost aims is to raise awareness of Body Integrity Dysphoria (BID) among clinicians, researchers, and the wider public, ensuring the condition is taken seriously and openly discussed.
- In research, I hope my work will will help lay the groundwork for the development of a specific, well-founded treatment concept.
- In clinical practice, I hope it will help foster sensitivity and greater confidence in dealing with BID so that those affected no longer face misunderstanding or rejection.
- Regarding societal perception, I wish for BID to be recognized not as a mere “curiosity” or fringe phenomenon, but as a genuine psychological condition that people live with and that deserves serious consideration.
Is there anything else you’d like to share — about your journey so far, your research values, or what drives your interest in BID?
What interests me about BID is not just the topic itself, but what it reveals about our understanding of mental health. It clearly shows how quickly research tends to take seriously only what is easily measurable or socially acceptable. BID is often overlooked precisely because it doesn’t fit neatly into existing categories – and that is exactly why it warrants closer attention.
What is particularly interesting is the fact that this raises real questions of research ethics: Am I willing to take seriously what I do not immediately understand?
And BID is not an abstract fringe phenomenon. It is highly current and relevant. In Germany, elective amputations are not legal, which leads many affected individuals to seek treatment abroad or to harm themselves in order to “create” their desired physical state. This shows how urgently we need approaches that are medically and ethically responsible and that do not increase psychological distress but take it seriously.
