What Drives People to Want to Be Amputees?

Aside from this obsession, First said his BIID patients can appear to be mentally healthy.

"The most striking thing about these people, is that if you were to meet one, you wouldn't have a clue that there was anything unusual about them," he said.

The fascination with being handicapped nearly always begins in childhood, said First. Karl said the first inkling that he wanted to be an amputee came when he was just 5 or 6 years old.

He often took refuge from his own family life in the home of a neighbor who was disabled by polio. Then he saw a young amputee.

"It was kind of like the proverbial light bulb going over the cartoon character's head," Karl said.

His first reaction, he said, was envy. But still, Karl said he considers himself normal.

Dan (who asked that his last name not be used) is a biomedical engineer who lives and works in a small town near the French Alps, and he has carried the same obsession as Karl's throughout his life.

Dan, who is intensely physical and loves hiking and skiing, said he had thought of amputating his own leg using dry ice and a power saw. To reduce his anxiety, he sometimes pretends to be an amputee.

Even when he is exercising, Dan said, "I find myself imagining, OK, how hard would it be, wearing a prosthesis?"

Dan said that if he does decide to amputate his leg, he would consider it a "rational" act. "Having my leg off would cause a handicap and suffering," he said. "But BIID also causes handicap and suffering, and it's just a matter of which is worse."

Most doctors consider the act of removing a perfectly healthy leg or arm to be unethical. Unfortunately, that doesn't stop the obsession. In fact, Dan's obsession got so bad last year that he searched and located a surgeon in the Philippines who would perform an amputation for a price -- one leg for $10,000.

In the end, Dan said the steep price and questions about the surgeon's competence kept him from following through.

Desperation and a Hint of Regret

Lilly, however, was determined to finish the job. She mutilated her left leg last year by freezing it with dry ice, hoping doctors would be forced to amputate it.