Sufferers of BIID often complain that they do not feel "whole" while in possession of the limbs in question. An amputee wannabe has a very fixed idea of which limb is unwanted, and what level of amputation will make them a "whole" person. The most commonly expressed desire is to have a leg removed above the knee, but sometimes the person is looking to rid themselves of an arm, a leg below the knee, or sometimes multiple limbs.
The disorder usually includes feelings of intense jealousy at the sight of an amputee. An individual stricken with BIID will commonly "rehearse" the amputated state in private and in public by pretending that the limb is not present, sometimes binding the arm or leg so it cannot be easily moved. Some even design and fabricate prostheses to allow themselves to appear to have the amputation they desire.
Since there are very few surgeons willing to separate a person from his or her healthy limbs, some sufferers of Body Integrity Identity Disorder go so far as to destroy the limbs in question so that amputation becomes the only option. There are reports of individuals freezing the unwanted arm or leg with dry ice, or creating a wound and deliberately infecting it. Some have used even more extreme measures, such as shooting one's own leg with a shotgun, cutting off a limb with a chain saw or homemade guillotine, or allowing the limb to be run over by a train.
An ordinary person who must have a limb amputated due to injury or infection is typically emotionally devastated by the loss; but astonishingly, individuals with BIID who successfully banish the unwelcome limbs describe feelings of "completeness and enablement" after amputation, and rarely express regret even after many months. Some theorize that BIID is an extreme demonstration of Munchausen syndrome, a condition where the sufferer feigns or creates symptoms of illnesses in himself or herself in order to gain attention, sympathy, and comfort. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Munchausen's. BIID seems to have a similar pathology, where the subject seeks the special attention given to the disabled.
A number of people with this disorder also exhibit acrotomophilia, which is a strong sexual attraction to amputees. Considering this, along with the strong jealousy towards amputees and the complaints of not feeling "whole," it seems that sufferers of BIID don't want to lose a limb so much as they want to gain an amputation.
Most amputee wannabes describe feelings of shame and unworthiness, and a keen awareness that their ambition to abandon perfectly healthy limbs is bizarre. People with this condition gain little help from psychiatric or psychological therapy, and any treatment merely helps to control the desire rather than to abolish it. It is not a well understood disorder, and there is no known effective treatment aside from giving them the subject the amputation they desire.
A surgeon in Scotland named Robert Smith has amputated the legs of two otherwise healthy people who were suffering from BIID, but after some negative publicity the procedure was effectively banned by the National Health Service in the UK. But if nearly all sufferers of Body Integrity Identity Disorder are left feeling much happier and more "complete" after the removal of a limb, and there is no other effective treatment, is it necessarily a bad thing to allow them what they desire?