BIID is basically just an analogue of AGP. And, exactly like in AGPs it is not a real, singular condition, but a product of interactions between social factors and (usually) more generally abnormal behavior.
In fact, it's actually startling how similar they are. To start with you commonly see the same pattern of other-directed sexual attraction which combines with or leads to self-directed attraction. So, in AGPs this would be jacking off to tranny porn then progressively coming to self-insert as the tranny while in BIID, it's arousal by amputees/amputation to arousal of being/becoming an amputee. This then graduates into an obsession that metastasizes into the subject's non-sexual fantasies and eventually they develop a powerful affective association with the mere concept of being a woman/amputee.
And just like in troons, this confounds researchers who recognize the obviously sexual element, but also observe that it evidently isn't
purely sexual. Also, just like in troons some researchers postulate elegant "not a mental illness" brain-related etiologies, but fail to turn up any real evidence beyond some vague non-specific associations here and there. In BIID this is even more true since you don't have the confounding from HSTS's or from HRT. There is a view that it has something to do with right parietal lobe (the sensory homunculus), but the evidence is weak and what does exist is probably just a case of fMRI studies not being very reliable. My bet is that even if statistical differences in right parietal lobe grey matter (causal relevance of which would still be less than certain) is reliably replicable it's probably just because BIID patients are generally unusual for other reasons.
To really drive home just how much these are essentially the same phenomenon: BIID probably has the
same comorbidity associations. Firstly, they have
lots of paraphilias (pedophilia, transvestism or other fetishism):
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As an aside note how many of them had exposure to amputees; being exposed to amputees is apparently a major risk factor, which again you would expect since where else would they get the idea from? This all seems very familiar:
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Additionally, a huge fraction of them also are troons or want to be troons, at least:
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It seems likely that they are more often psychotic. There is also a tentative association with personality disorders:
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No clear evidence of any association with obsessive-compulsive tendencies, but small literature and it can still be noted that in specific case studies patients are described as having an obsessive-compulsive relationship with amputation etc., which is basically what you see in troons as well except in connection to gender. I would bet that a thorough investigation would turn up some at least weak association.
Interestingly enough, I'm not aware of any association with autism in the literature. A PubMed search turns up no hits for any combination of BIID and autism or ASD. However, there is BIID sub-reddit (naturally) and they are apparently very autistic:
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Note also the "more likely to be gender diverse" thrown in there as well. I would also suspect that there is a association with autistic-ness more generally which would extend into the sub-clinical range.
Also there is - and I'm not shitting you on this - a kind of overlap with diaper fetishism where the individual wants to be rendered incontinent e.g. by having their spinal cord severed.
In conclusion, AGP-driven troonism is of the same family of psychological disorders as BIID; two different variants of identity-based
coomsumption.
I broadly agree, but I'd more strongly emphasis the influence of post-pubertal social failure. This isn't really related to over-protective parenting or anything, but rather to the underlying psychological abnormalities present in a lot of troons. Autism or at least spergy tendencies loom large here. For a lot of autists, the end of childhood proper is difficult; they struggle with forming or even understanding romantic and sexual relationships, they often get bullied for making faux pas and bullying in general increases massively at around the same time. At the same time, making friends often becomes harder and they may become
more conscious of their failure in this area. Further to this, the transition to secondary school denies them the ability to bond with younger kids which in my experience seems to be a very common coping mechanism for autists who struggle to make friends.
All of these factors, and particularly that last one can could drive a young autist to strongly idealize and want to return to their elementary school years when everything was better. Moreover, following from that last point you can very easily see how pedophilic tendencies could easily develop; feeling rejected or unable to associate with age-peers, they can easily look back at that say 4th grader who they played with when they were in 6th grade. And, like all romantic/sexual attractions that manifest at this stage, once they get into the brain, they don't tend to get out all that easily.
This story also explains why the phenomenon has both sexual and non-sexual components. I feel as though the diaper sort of stuff could be roughly analogous, just taken a few steps further. There may also be some abnormal sensory processing related stuff involved as well and there is something generally abnormal about autistic sexual development.
Hearsay, but claims are he ignores patients requests on their own surgery.
