Interesting study I found on Body Integrity Disorder
(www.ncbi.nlm.nih.gov)
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Should be noted these people are the 'real deal'. There is no social pressure/benefit to cut limbs off.
They are also batshit insane with what looks to be extremely odd sexual fetishes.
I would want a longer look at what is going on than a few interview sessions. This type of study is how we got to where we are today with other well known problems.