Hello Matthew, thanks for your question. 

Yes, there are some who got a tattoo before or after the amputation – for example, a pair of scissors with the demarcation line.

Regardless, there is no real coping strategy for BiD. I speak from 35 years of experience in which I have tried to find a generally accepted way to cope with a (still) non-amputated body.

Nothing helps, except going through with it – provided one has the necessary money. I have spent 35 years intensely searching for a solution to understand where BiD comes from and how to get rid of it. I have found nothing that truly helps. Certain strategies may provide temporary distraction, but only for days – not for weeks or months.

This is also one of the reasons why many people bury themselves in their work to distract themselves. One cannot run away from BiD, overcome it through therapy, or simply push it aside as mainstream thinking suggests – neither with psychotherapy, medication, alcohol, nor a thousand other means. BiD comes back – and worse than before.

Trying to overcome BiD with conventional methods is a battle against oneself, tied to common psychological clichés. In the worst case, this can lead to complete self-abandonment and even suicide. It is a dangerous path, depending on which psychologists or psychiatrists one encounters – whether they provide comfort or rather tear one down.

Anyone trying to fight BiD – depending on their level of suffering – without considering amputation will not find a satisfactory solution. For me personally, the price was simply too high when I tried to eliminate BiD without surgery – only for the sake of others. That was a big mistake on my part.

In my opinion and experience, amputation is unfortunately necessary in certain cases. Everything else makes no long-term sense, depending on the intensity of suffering. The longer a condition lasts, no matter which, the harder it is to endure.

Alternative? Coma, until a pill is developed that aligns with mainstream thinking. Suffering from BiD without having the legal option of surgery is no pleasure. It is nothing but unnecessary torment – sometimes more, sometimes less, but unfortunately forever. In the long run, the advantages of amputation outweigh the personal disadvantages.

In short: I have found no coping strategy – otherwise, I would have discovered one long ago. Guaranteed. I just want to leave this behind me, despite the known drawbacks, then everything will be fine. Without surgery, BiD is worse than non-sufferers can even imagine.

A crucial point: I believe it is important to intensify research on BiD so that younger generations do not have to suffer as much as the previous one. My own strength to endure is running out.I'm sorry, but at this point, I can no longer do without sarcasm – and at least it revives my fighting spirit a little.Of course, it would be desirable to turn back my biological age after an amputation (abroad) as compensation for the lost time due to all the psychological nonsense.

I will never go through this perceived psychological hell again. I have put it behind me, and it was cruel. It was inhumane and destructive.

If my experience regarding attempted coping strategies sounds too harsh, then feel free to delete it. But it is simply real.

@lefty 

Thanks for your response. 

Perhaps I should have been clearer in my original post. I didn't expect that a tattoo would eliminate BID. However, I wonder how successful or unsuccessful this strategy has been for them in making it more manageable. Given that some have seemingly done so, it seems some with BID are somewhat hopeful that this may help to some degree. 

In my blog post on the limitations and potential harms of VR/AR techniques, I suggest that VR/AR would likely increase dysphoria in the long term, and a commenter who participated in the study did mention this was the case for them. Perhaps tattoos would have the same effect as they may draw further attention to the limb. Conversely, body art on the offending limb may help limit the BID strain (not eliminate it) by allowing the individual to regain some agency over it. If so, perhaps this strategy is a useful interim solution whilst BID surgery is currently not possible.

You say the price was too high when attempting to eliminate BID via conventional methods. What sort of price do you mean, financial price or mental strain? 

Thanks!

Introduction

I have suffered physically (due to diagnosed chronic illnesses), mentally (due to a lack of humanity), and ultimately financially as well. The doctors took nothing seriously—horrible and unjust.

Nobody believed me when I said I had been defrauded of a large sum of money. Instead, my story was dismissed as a "conspiracy theory" when I tried to confront the then-responsible F-doctor about his statement regarding the two expert opinions more than ten years ago. All my legal proceedings regarding the fraud case are now underway. There are no words to describe what all these psychiatrists and psychologists have collectively done to me—listing all the details would go beyond the scope. It is a much deeper story that would fill hundreds of pages.

That is why I now only work with scientists. They seek knowledge and, in general, do not pass direct judgment but rather look for solutions.

Early Misdiagnoses and Lack of Recognition

As far as I know, a tattoo would not be a practical solution. Personally, I have no tattoos and no interest in getting one. Invisible ink does not exist to make things disappear, and yet it would still be one leg too many—it remains.

The greatest challenge I faced in my past psychotherapies was that BID was hardly recognized at the time. Doctors told me—long before scientific advancements were made in this area—that two expert opinions would be enough to approve an amputation: "That will be done. No problem." When I could not fulfill my request, the usual psychotherapy followed, aiming to "eliminate" BID. This drove me thousands of times to the brink of complete despair.

This process stretched over many years. The additional suffering was caused not only by BID itself but also by incorrect psychological interventions, which only made everything worse instead of better.

Lack of Acceptance and Wrong Treatments

Instead of receiving support, I was fought against—it felt like systematic destruction. One of the biggest problems was that BID could not even be diagnosed under the ICD at the time. It somehow felt like a war against arbitrary diagnoses. To this day, I am still waiting in vain for an apology from these doctors. There is simply no coping strategy—except undergoing surgery.

Dealing with BID is already extremely difficult on its own, but misguided psychological treatments make everything even more complicated and harder. It is unbearable. Fighting against BID is, therefore, definitely the wrong approach.

My Conclusion and the Need for Better Solutions

Diagnosing BID is much easier today thanks to the introduction of ICD-11 and the growing research landscape. There is more literature on the subject, and doctors can educate themselves better. However, the financial and mental burden of obtaining many correct BIID-BID diagnoses was far too high. This should be made easier.

I hope that, in the future, the process for BID patients will be similar to that of Gender Dysphoria—with clear diagnostic criteria and supportive measures. The psychological methods used against BID have severely damaged my self-confidence and still leave deep scars today. In fact, every form of psychotherapy has harmed me more than it has helped.

It would be desirable for BID patients to receive assistive devices such as wheelchairs, KAFOs, etc., after a medical examination. This should include supportive, appropriate psychological counseling involving the family and subsequently, if still desired, enable surgery. Such an approach would be an important step in the right direction.

For easier understanding. 

By now, I have almost processed everything that these therapists put me through. It all started gradually around 1991/1992. After my wife’s accident—which nearly ended the way my fate was supposed to but fortunately turned out relatively well for her—I struggled to accept that it wasn’t me. Bad luck.

I began psychotherapy to find the root cause of my feelings. My question was: Why is this so difficult for me? Back then, I barely had the words to describe my emotions, and the term BIID was unfamiliar to me. But around 2002, I saw a documentary on the topic. That changed everything because I realized I wasn’t the only person in the world going through this. From my "outing" in 2005/2006, the situation escalated. A psychiatrist told me—while my wife was present—that an amputation wouldn’t be a problem. Two evaluations, and I would be free of this burden. Obtaining those evaluations was far from easy.

In 2016, I confronted him again about his statement and presented my evidence. Up to that point, it had felt like a ride through hell just to get those reports. But instead of engaging in a rational discussion, he ignored my proof once again. He seemed offended and later threw me out. It’s absurd how recklessly doctors throw around psychological diagnoses without ever being held accountable. A great job for them—but not true medical care when they refuse to communicate and insist their opinion is the only one that matters.

Thanks to existing literature, diagnosing BIID is much easier today than it was in the past. I received over 30 different diagnoses (I eventually stopped counting) and felt deliberately misled—frustrating. It was not a pleasant experience. Quite the opposite. Devastating.

I could have continued investing in therapies back then, but after many detours, I achieved my minimum goal. The total cost from 1991 to 2016 amounted to around 250,000 euros. (Money is always an understandable reference for comparison.) Despite all the difficulties with the medical community beforehand, BIID was gradually recognized by higher authorities from 2013 onward, and since then, I have at least received necessary assistive devices—which give me some breathing room and endurance. However, I am still far from achieving my actual goal: a legal "correction," despite many high-level discussions.

From my experience, therapies that bring no benefit are logically completely useless. One does not need to be a psychologist to recognize that. When it comes to BID, only one type of therapy works, depending on the level of distress. The milder approach would be granting assistive devices.

Some conditions do not always require a wheelchair—for example, multiple sclerosis. That is how I roughly experience BID.

Small steps toward improvement mean getting closer to the goal while making life better, not worse—assistive devices as an intermediate solution. Achieving a legal correction, however, requires much more effort.

To my knowledge, there is no coping strategy for BID. One must accept it as it is and search for solutions that constructively help BID and enable personal progress—something that does not happen overnight. Ultimately, that is the only option. The opposition imposed by others is counterproductive, and from experience, I can only strongly warn against declaring BID a mere fabrication. My experience has shown that the only viable strategy for making life with BID at least somewhat more bearable is minimal adaptation. It is unfortunate how much time and energy were lost until things reached this point. Convincing those close to me that this was right for me was also not easy.

One final step remains, sadly. I have tried everything within my limited power. Unfortunately, I have not been able to achieve more legally.  I can't really contribute much more at the moment either.

@lefty's experience is the common one for people who suffer from BID; therapy does not work, nor do drugs help.  We need people who can properly diagnose BID.  It is not hard to diagnose, but one must fully understand how to do so.  If one is properly diagnosed with BID, they should be allowed to get proper affirming surgery.  Getting therapy to prove anything should not be needed.  That is the only thing that would help alleviate the pain BID causes a person.