In January 2000, U.K. newspapers reported a series of articles on the Scottish surgeon Robert Smith. Smith had recently amputated the healthy legs of two of his patients. But this wasn’t a case of unfortunate accidents. Smith had amputated the legs at the request of the patients. After the operations both men made public interviews declaring how much happier they were after having their healthy legs removed. And these are not isolated cases, as Carl Elliot writes
Healthy people seeking amputations are nowhere near as rare as one might think. In May of 1998 a seventy-nine-year-old man from New York travelled to Mexico and paid $10,000 for a black-market leg amputation; he died of gangrene in a motel. In October of 1999 a mentally competent man in Milwaukee severed his arm with a homemade guillotine, and then threatened to sever it again if surgeons reattached it. That same month a legal investigator for the California state bar, after being refused a hospital amputation, tied off her legs with tourniquets and began to pack them in ice, hoping that gangrene would set in, necessitating an amputation. She passed out and ultimately gave up. Now she says she will probably have to lie under a train, or shoot her legs off with a shotgun. 
These people describe themselves in terms such as: “I felt, this is who I was.” and “It is a desire to see myself, be myself, as I ‘know’ or ‘feel’ myself to be.” The condition which each of these individuals was suffering from was that of body dysmorphia, or apotemnophilia.
Another condition in which people feel their body does not reflect their true self is transgenderism. In transgenderism an individual believes their physical body is of the wrong gender for who they really are. Such individuals are also willing to undertake major surgery to change their gender. Although both conditions are characterised by a mismatch between the physical body and the body the individual professes is appropriate for them, Legion Theory provides quite different explanations for these two conditions.
The realm primus is an internal representation of the physical world. An important aspect of the realm primus is the boundary between the body and the physical world. As an individual develops, the processes of the realm primus differentiate from those of the corporate self, and the differentiation between the external world and the child gradually develops. But if this boundary is too small, then parts of the person’s body will appear to be alien to them and to be part of the external world (apotemnophilia). This would result in, a desire to remove that part of the body, which to them, is part of the world, rather than part of themselves.
The explanation of transgenerism, is quite different. Many have said that “we have both male and female in all of us”. And we know from DID, that selves who are alters have their own self image in terms of their age, physical appearance, and their gender. In over 50% of cases individuals with DID have alters who are of the opposite gender to the physical body. Transgenderism results from a situation in which one, or more, of the selves has a gender image opposed to that of the physical body.
- Elliot, 2000, p. 73
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Elliott, C. (2000). A New Way to be Mad. (amputations sought by healthy people). The Atlantic Monthly, 286(6), 73-84.