Little is known about mental images (cognitive representations with sensory qualities) in body integrity identity disorder (BIID). This study aimed to determine whether individuals with BIID experience mental images and, if so, whether they differ to those experienced by individuals with body dysmorphic disorder (BDD) and healthy controls. A semi-structured interview on mental images and their qualities was delivered to a sample of 22 individuals with BIID and 19 with BDD, and 22 healthy controls. Both the BIID (n = 15, 68.2%) and BDD (n = 14, 73.7%) groups reported significantly more mental images than healthy controls (n = 3, 13.6%), but no differences between the two clinical groups were found. While mental images in BDD were focused on 'flawed' body parts, images in BIID involved the desired handicap. Mental images in BIID were experienced as less distressing and more sexually arousing compared to BDD. No further differences were found between the groups (e.g., regarding sensory multimodality, dominance of a specific body part). Although the two groups reported a similar frequency of mental images, images appear to serve different functions across conditions. Clinically, it may be necessary to target the positive mental images in BIID to improve treatment outcome.