Desire for
amputation of a healthy limb has usually been regarded as a
paraphilia (
apotemnophilia), but some researchers propose that it may be a disorder of identity, similar to
Gender Identity Disorder (GID) or transsexualism. Similarities between the desire for limb
amputation and nonhomosexual male-to-female (MtF) transsexualism include profound dissatisfaction with embodiment, related
paraphilias from which the conditions plausibly derive (
apotemnophilia and autogynephilia), sexual arousal from simulation of the sought-after status (pretending to be an amputee and
transvestism), attraction to persons with the same body type one wants to acquire, and an elevated prevalence of other paraphilic interests. K. Freund and R. Blanchard (1993) proposed that nonhomosexual MtF transsexualism represents an erotic target location error, in which men whose preferred erotic targets are women also eroticize their own feminized bodies. Desire for limb
amputation may also reflect an erotic target location error, occurring in combination with an unusual erotic target preference for amputees. This model predicts that persons who desire limb
amputation would almost always be attracted to amputees and would display an increased prevalence of gender identity problems, both of which have been observed. Persons who desire limb
amputation and nonhomosexual MtF transsexuals often assert that their motives for wanting to change their bodies reflect issues of identity rather than sexuality, but because erotic/romantic orientations contribute significantly to identity, such distinctions may not be meaningful. Experience with nonhomosexual MtF transsexualism suggests possible directions for research and treatment for persons who desire limb
amputation.