There are other human conditions that are not a choice and they are deeply held beliefs about a persons internal identity.
The trans-abled people who truly feel they should be disabled and that part of their body is 'foreign' and should be cut off is one example (or they should be blind or deaf). They often act "as if" in wheelchairs, crutches, braces, earplugs etc... to cope with it. Or they might cause self harm so the offending part can be removed.
I wonder (if properly diagnosed) that we should give them disabled parking placards or let them participate in the special/Paralympics? That would match with their diagnosis and help them integrate, wouldn't it? Might be better than them trying to find someone to cut off a healthy leg. (Though anecdotally, surgery is often the thing that actually works...therapy does not)
Should we let them self-ID? What policy would work for them?