'Most people want to change something about themselves, and the image I have of myself has always been one without legs,' Susan Smith wrote earlier this year in the Guardian (link unavailable). Smith (a pseudonym) relates her lifelong struggle as one of the untold number of those with Body Identity Integrity Disorder (BIID). Classified as a psychological condition, those who suffer from BIID long to amputate healthy appendages in the pursuit of an ideal body image.

To physicians and researchers, the origins of BIID still baffle, though patients' histories are strikingly similar. In an article for Psychology Today, William Lee Adams points out that many BIID sufferers 'encounter amputees as children and, as early as age 4, experience discomfort with their bodies.' According to leading BIID researcher, Michael First of Columbia University, humans gradually develop a psychological acceptance of their arms and legs, but seeing an amputee can disrupt this process.

According to the BIID Association, an advocacy group made up of medical, psychological, and psychiatric professionals, the disorder has other root causes, too. On its website, the group lists a few theories, including one that posits that children who feel 'unloved' and develop BIID might believe that 'becoming an amputee may attract sympathy and love.' Another hypothesis is that BIID might be caused by a 'neuro-pathological condition.'

Many of those with BIID take matters into their own hands if therapy and drugs do little to quell their desires. Like others, Smith carefully planned ways to damage her left leg in order to qualify for amputation. The process had Smith purchasing nearly 100 pounds of dry ice at a time to cover her leg and induce frostbite. Only after an unintended infection nearly killed her, Smith's leg was deemed unfit enough for amputation.