A Scottish surgeon who has amputated the limbs of healthy patients at their request is trying to get their psychological disorder formally recognised so that the amputations can be covered by the National Health Service. Dr Robert Smith had performed two of these operations before his hospital, the Falkirk Royal Infirmary in Glasgow, forbade him to do any more.

The desire to have healthy limbs amputated is a rare but well- documented disorder which goes under several names: apotemnophilia (love of amputation), factitious disability disorder, amputee identity disorder, or body integrity identity disorder (BIID). The notion of mutilating or removing healthy tissue is already accepted by the medical profession. Sex reassignment is the most extreme example, but cosmetic surgeons make a living out of nose jobs and breast reductions. The same reasoning is used to justify sterilisation and vasectomies. But people suffering from BIID have failed to convince doctors that they should be given what they want.

The condition is slowing filtering into soap operas and popular culture. One of the winners of the New York International Fringe Festival last year was Armless, a play about a middle-aged suburbanite with the disorder. However, BIID is not just a weird joke. In 1998 the urge to become an amputee led a 79-year-old New Yorker to have a deregistered California surgeon cut off his leg in Tijuana, over the Mexican border. The man later died of gangrene and the doctor was jailed.