This leads to larger questions about the nature of identity. One point of contention among clinicians is whether apotemnophilia is, as John Money thought, really a paraphilia. The devotees I think are paraphilic, but not the apotemnophiles. Like these people, who are uncomfortable with their identities and want to change sex, apotemnophiles are uncomfortable with their identities and want to be amputees. But just what counts as apotemnophilia is part of the problem in explaining it.
Some wannabes are also devotees.
Others who identify themselves as wannabes are drawn to extreme body modification. There seems to be some overlap between people who want finger and toe amputations and those who seek piercing, scarring, branding, genital mutilation, and such. Some wannabes, Robert Smith suggests, want amputation as a way to gain sympathy from others. I didn't understand why, but I knew I didn't want my leg. Her view of herself has always been as a double amputee, with stumps of five or six inches.