In 1997, Dr. Richard Bruno of Englewood Hospital in New Jersey proposed the name factitious disability disorder, which he grouped into three types: people who are sexually aroused by amputees ("devotees"), those who use wheelchairs and crutches to make it seem as if they are amputees ("pretenders") and those who want to get amputations themselves ("wannabes"). In Dr. Bruno's taxonomy, those who manage to obtain amputations continue to be known as wannabes.

In 2000, Dr. Gregg Furth, a New York child psychologist and one of Dr. Money's co-authors on his 1977 paper, published a book about the disorder, calling it amputee identity disorder. In addition to his professional interest in the subject, Dr. Furth had a personal one: from early childhood, he had wanted to have his right leg amputated above the knee.

Dr. Furth wrote the book with Dr. Robert Smith, whom he met while searching for a surgeon who would perform the elective amputation. When Dr. Furth found him in Scotland, Dr. Smith had already done two such operations, and he agreed, after consulting with two psychiatrists, to operate on Dr. Furth. But in 2000 Dr. Smith's hospital, the Falkirk Royal Infirmary in Glasgow, prohibited any further procedures of this type. Dr. Furth never received his amputation.

The newest name, body integrity identity disorder, was first used by Dr. First of Columbia in the journal Psychological Medicine in 2004. In that paper, he described the results of a telephone survey of 52 people with the disorder: 9 of them had amputations and the rest yearned for it. He chose the name to distinguish the disorder from paraphilia, psychosis or body dysmorphic disorder (the false belief that a part of your body is ugly or abnormal).

To Dr. First, the closest analogy was to gender identity disorder.

"When the first sex reassignment was done in the 1950's, it generated the same kind of horror" that voluntary amputation does now, Dr. First said. "Surgeons asked themselves, 'How can I do this thing to someone that's normal?' The dilemma of the surgeon being asked to amputate a healthy limb is similar."

Still, the analogy is imperfect. "It's one thing to say someone wants to go from male to female; they're both normal states," Dr. First said. "To want to go from a four-limbed person to an amputee feels more problematic. That idea doesn't compute to regular people."

Dr. David Spiegel of Stanford said he believed that body integrity identity disorder sounded closer to either body dysmorphic disorder or anorexia nervosa, though he added that he had not seen any patients with the integrity disorder. The connection to anorexia, he said, is that people with B.I.I.D. "have a clearly mistaken belief about their bodies."