Vol 9, No 2 - Neuropsychiatric Manifestations of Neurodegenerative Disease
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Poster Hostile interactions between body and self The anarchic hand While the “alien hand sign” designates the feeling of non- belonging of one’s own hand, the sign of the “anarchic hand” involves the loss of control over complex goal- directed motor behavior that runs counter to a patient’s intentions.1 Antagonistic actions range from the mildly annoying (unzipping a just-zipped jacket; taking back coins just handed over to another person) to the highly embar- rassing (public masturbation), to overt acts of self-aggres- sion.The latter come again in degrees: an anarchic hand may simply induce pain (eg, by beating the head or pinch- ing  the  nipples)  or  actively  try  to  kill  the  patient  (by drowning,2 but most frequently by choking).The anarchic hand sign occurs after anterior lesions of the corpus callo- sum and the supplementary motor area. In contrast, the alien hand sign is reported in corticobasal degeneration and related progressive degenerative diseases, but also after focal, vascular, or space-occupying lesions to the pos- terior part of the corpus callosum encompassing adjacent parietal  cortex. Both  alien  and  anarchic  limbs  (lower extremities can be affected too) are thus interhemispheric disconnection syndromes, in which either ownership of (posterior disconnection) or agency over (anterior dis- connection) a limb is no longer acknowledged. Both left and right hemispheric lesions may lead to contralateral alien and anarchic hands, but in right-handed patients seri- ous self-destructive behavior appears to be more common if the left hand, ie, the right hemisphere, is affected.3 Mental autotomy One of the most bizarre disorders of the relation between body and self is a condition labeled “body integrity iden- tity disorder” (BIID).4 Psychiatrically otherwise healthy individuals express the explicit wish to have a fully func- tional limb amputated. Hostility against the unwanted limb takes various forms, from pressure cuffing to freezing, and to mechanical injury severe enough to enforce profes- sionally performed amputation. Sometimes, the borders between elective amputation attempts and less drastic forms of self-injury are blurred.5 The cerebral mechanisms Copyright © 2007 LLS SAS. All rights reserved Our body houses the various selves we are. It continuously informs us about the position of its limbs, both relative to themselves and relative to the trunk and head. It allows us to feel touch, to reach out and touch others, and to differentiate between passively received and self-delivered touch. It provides us with information about temperature, pressure, and gravity, and it mediates basic sensations, feelings, and emotions, from pain, fatigue, and hunger to relaxation, lust, and ticklish joy. Enabling us to look up to the stars, it even shows us how small we are, how limited in reach, and how alone most of the time. Only our body is constantly present; it is the only object that abidingly stays with us throughout our lives. It is perhaps this continuity that binds together the different components of our self—sensory-receptive, motor-agentive, emotional— and makes us feel that we are one self in one body. All this said, we note that there are various neurological conditions in which the unity between body and self is thoroughly shaken. We may no longer acknowledge ownership of parts of the body, or we may deny agency over bodily actions. We may feel alienated or spatially separated from our body, or project the experience of touch into objects in extracorporeal space. Although not obligatorily eliciting a morbid reaction, such disintegrations between body and self occasion- ally induce overt hostility. The present note provides a glimpse into some major types of auto- aggression after body-self fragmentation.