AB/DL as a Psychological Syndrome: Impact and Future
I've been reading and scouring databases and medical journals as of late to find material relating to specifically Adult Babies. Some of the case studies currently published have been relativity recent (in the last decade). A lot of the cases presented tend to be somewhat extreme, but I often wonder about this particular comment on a recent case study:
Clinicians involved in the treatment of Mr. A often questioned whether his symptoms represented OCD, a paraphilia, or some new diagnostic entity.
Comment on Adult Baby Syndrome/Drs. Pate and Gabbard
Croarkin, Paul; Nam, Theodore; Waldrep, DouglasView Profile; Pate, Jennifer ; Gabbard, Glen. The American Journal of Psychiatry161.11 (Nov 2004): 2141-2142.
Mr. A was a published AB/DL case study (found in full at the end) and many of the researchers often remarked about this being "New territory." An interesting excerpt from that report:
Adult Baby Syndrome is a recently described symptom cluster, which has not yet become part of any official psychiatric classification system. There have been only a few case reports in the literature, which presented either as a paraphilia or an obsessive-compulsive disorder (OCD) (Croarkin, Nam, & Waldrep, 2004; Dinello, 1967; Malitz, 1966; Pate & Gabbard, 2003; Tuchman & Lachman, 1964). These patients shared the common symptoms of wearing diapers, drinking milk out of a bottle, eating baby food, and wanting to become a baby.
"A recently described symptom cluster..."
There's often a lot of talk about this being an identity. So I often wonder what that implication would be if more case studies came out and held some compelling evidence to suggest this being a new diagnostic entity beyond a paraphilia or some other type of disorder. Many AB/DLs I've seen in the community have sought counseling for other matters and they sometimes bring up their AB/DLism. Would that change therapy at all? Would it change perception?
I don't believe this following example (and this is simply to be provocative to entice discussion), : Anorexia is a well researched eating disorder. There are some online communities that glorify and make an identity out of it (Pro-Ana). Would classification of ABism as a disorder put us in that same category as Pro-Ana in this way in the public moreso?
This is a very open ended question on how the community at large views such case studies and what impacts some of the research may have on perception of AB/DL if it builds off current papers. Some general questions to get it rolling: What do you think overall? What research or case studies do you find essential in answering this question? What do you think the future holds in later studies for AB/DLs?
Comment on the case studies too, at the bottom.
Pate, Jennifer E (11/01/2003). Adult baby syndrome. The American journal of psychiatry. , 160 (11), p. 1932 - 6
Pate and Gabbard present the case of a man who appeared as a baby for psychiatric evaluation and treatment, whose request for treatment is apparently complicated by a variety of other motives. This clinical presentation is an extreme version of a common form of resistance to psychotherapy--namely, instead of using the process for understanding and change, the patient secretly hopes to establish a perfect parent-child relationship to make up for what he or she felt was missed in childhood.
Although our standard diagnostic nomenclature in psychiatry covers many conditions, patients still appear in psychiatrists' offices who do not fit a well-defined psychiatric disorder. Unusual behaviors may escape psychiatric classification if they do not create subjective distress, do not distress others, and do not involve functional impairments or legal problems. Entire subcultures related to these behaviors may exist outside of the awareness of psychiatrists and other mental health professionals. When no descriptive diagnosis is apparent, clinicians may still use psychodynamic knowledge and skills to assess a patient's conscious and unconscious agendas and understand a patient's complex reasons for seeing a psychiatrist.
With this case conference, we present the case of a man who appeared as a "baby" for psychiatric evaluation and treatment. It soon became apparent that the patient's request for treatment was complicated by a variety of other motives.
Mr. A, a 35-year-old single Caucasian man, contacted our clinic by telephone to schedule an evaluation because "I am supposed to be a 35-year-old, but I want to be a baby. I won't ever get married or have kids if I am stuck as a baby." During our initial telephone contact, Mr. A spoke in a soft, childlike voice. He had some difficulty providing basic demographic data and would answer questions by saying, "I don't know." After a brief initial interview, Mr. A requested an intake appointment with a female therapist.
Mr. A arrived on time for his appointment. he was dressed as a child and continued to speak in a childlike voice. During the first interview, Mr. A stated that he had wanted to be a baby since the age of 12 and he began wearing diapers at age 17. He was now seeking treatment because his desire to be a baby interfered with interpersonal relationships. He was unable to identify any precipitating events or stressors preceding his desire to be a baby or his subsequent return to wearing diapers. He began wearing diapers when he moved out of his parents' home and was able to purchase and wear diapers secretively, without his parents' knowledge. He continued to be secretive about his baby activities, but he would wear his baby clothes outside his home to several specific places, including toy stores, the barber shop, the masseuse, and the psychiatry clinic. Mr. A repeatedly stated that he wanted "to be taken care of by a mommy who can hold me and rock me and give me a bottle." He frequently reiterated his wish to go to a place "where they would make me be a baby." Mr. A acknowledged that his desire to be a baby interfered with his social activities because he preferred to stay at home and engage in activities associated with being a baby, including wearing diapers and baby clothes (which he purchased from a web site for adult babies). He slept in a crib in his closet and explained, "A crib is a real baby bed, and that makes me a real baby." He drank out of a bottle and often ate baby food. He liked to play with blocks, cars, and Playdoh.
Mr. A reported during the first interview that wearing diapers was "a kind of a sexual thing," but he was initially unable to describe what he meant by this statement. During a later session, when he was asked about the sexual nature of wearing diapers, he reported that he masturbated while wearing his diapers. He reported that wearing diapers was sexually stimulating and that he would often think about "how I am a baby" and masturbate in his diapers several times per day. He masturbated only while wearing diapers. He also urinated and defecated in his diapers and used approximately five diapers per day. On several occasions, Mr. A asked for "a prescription for diapers." When asked about the need for a prescription, he stated that "it would make me be a baby" and that with a prescription, the diapers would be less expensive.
Obtaining additional history from Mr. A was extremely difficult because he was frequently reluctant to provide detail and would often answer questions by replying, "I don't know." He seemed impatient with the gathering of historical data, as though it interfered with his own agenda.
Past Psychiatric History
Mr. A reported that he had sought psychiatric evaluation on one earlier occasion but did not return for follow-up because "The lady was mean." He had never been involved in psychiatric treatment and has never received a prescription for psychotropic medications. He has never been hospitalized for psychiatric reasons. Mr. A also has no history of suicide attempts.
Past Medical History
Mr. A had had a tonsillectomy at the age of 5. He had no chronic medical illnesses. He had no history of significant childhood injuries or illnesses. He currently took no medications.
Mr. A lived alone in an apartment. He was employed in law enforcement in an outlying community. He said that he enjoyed his work and that while he was at work, he did not feel like a baby. According to Mr. A's report, his desire to engage in infantile activities did not interfere with his work. His colleagues did not know about his baby-related activities. He reported significant social isolation due to his desire to be a baby. Although he had dated women in the past, his last date was several years ago.
Mr. A was the older of two children who were adopted at birth. His sister was married and did not have children. Although his sister had met her biological parents, Mr. A said that he had never wanted to meet his biological parents because his adoptive parents felt like his "real parents." Mr. A described his adoptive parents as being "very nice and always there. They are religious but not overly religious. Just normal." He has always felt closer to his adoptive father than to his adoptive mother and enjoyed going fishing with him. Mr. A described his adoptive mother as "boring because she reads a lot." He described his life growing up as "fun." He reported no history of sexual, physical, or verbal abuse. He attended regular classes and made average grades, despite not enjoying school. He was a college graduate. He had worked in law enforcement for the past 10 years. He described his sexual orientation as heterosexual. He was not currently involved in a romantic relationship. He dated his first girlfriend at the age of 17 and had had about five girlfriends. He had never been involved in a sexual relationship and stated that he planned to "wait until I get married." He was in a relationship with his last girlfriend "for a couple of months a couple of years ago."
Mr. A reported no symptoms of depression, anxiety, or psychosis. He reported no problems with substance use. He said that he consumed alcohol infrequently and had no current or past history of illicit drug use. He had never been arrested and reported no involvement in illegal activities.
Mental Status Examination
Mr. A was a Caucasian man who appeared to be approximately his stated age but was dressed as a child in Winnie the Pooh overall shorts with a Winnie the Pooh shirt underneath. He was well groomed and had a strong odor of baby powder. He had a pacifier in the pocket of his overalls. He carried a diaper bag with a bottle in the side pocket and a bib, baby blanket, and adult-sized diapers inside. He spoke in a quiet, childlike voice. He often answered questions by saying, "I don't know" or "Okay." He was cooperative but extremely passive during the interview. He appeared embarrassed and anxious. He sat on his hands throughout most of the interview and often rocked back and forth. Eye contact was generally appropriate. Mr. A removed a bottle from his diaper bag, lay down on the couch with his feet propped up on the arm of the couch, and stared at me for several minutes while he drank from his bottle. His mood appeared to be euthymic. His affect was anxious, in a constricted range, and blunted in intensity. His thought processes were logical and goal directed. He volunteered little additional information and provided brief answers to the questions I asked. With regard to thought content, he reported no auditory or visual hallucinations or suicidal and homicidal ideation. He often perseverated on his desire to be a baby and at times appeared almost delusional in his belief that he actually was a baby. However, when pressed, he could acknowledge that he was not "really a baby"-he just wanted to be one.
Over the five sessions that we met for this extended evaluation, Mr. A stated that he felt that we worked well together. When asked what was "mean" about the clinician who conducted his earlier psychiatric evaluation, he replied, "I think she is just always mean." I asked him about things I might say or do that could potentially feel mean, and he responded by saying that he did not feel I was mean and could not imagine situations in which I would be perceived as being mean.
Although he reported feeling comfortable discussing his problems openly during our sessions, he seemed intent on controlling our agenda. During his telephone calls to schedule appointments, he always asked, "What is going to happen when I come there?" I felt he did not trust me as much as he stated he did. In addition, his desire to "go to a place where they would make me be a baby" often served as an obstacle to developing a therapeutic alliance and diverted our attention to why I could not fulfill this desire.
I had complicated countertransference feelings toward this patient. Initially, I was eagerly anticipating the opportunity to work with such an unusual patient. I often imagined working with him for several years to come and feeling the pride of seeing him "grow up." Along with the positive feelings associated with working with Mr. A, I also felt trepidation. One of my primary goals was to avoid "being mean," like his earlier therapist. I often felt restricted by this constraint and censored what I said. I wanted Mr. A to keep returning for our sessions, and I was afraid of saying something that would alienate him. I felt I had to tiptoe through a veritable minefield or I might lose my extraordinary patient. I was disappointed by the absence of any literature about working with this type of patient. As a neophyte psychiatrist, I still prefer the guidance provided by books and supervision. As Dr. Gabbard, my consultant with this unique patient, often said, "To quote Indiana Jones, we are making this up as we go along."
There were also frequent feelings of frustration in working with Mr. A. I felt annoyed that he was unable to schedule sessions ahead of time; instead, he contacted me after hours in the middle of a week to schedule an appointment for that week. He attributed his inability to schedule appointments at the end of each session to uncertainty about his work schedule. Everything had to be on his terms, leading me to feel controlled. I was also growing impatient with his repeated questions regarding "What is going to happen when I come there?" I had explained this many times. I felt frustration because of his soft, childlike voice. I often could not hear or understand what he was saying. During our sessions, I often felt uncomfortable since he would lie on the couch and drink from his bottle while staring at me provocatively. I questioned the appropriateness of allowing the patient to lie on the couch and drink from a bottle. After discussing the issue with my consultant, Dr. Gabbard, I recognized that forbidding such behavior would fit right into Mr. A's effort to make me into a maternal figure, telling him what to do and what not to do. Additionally, I did not want to assume a punitive maternal role. Although he was not able to articulate his thoughts or feelings at this time, his constant staring and unwillingness to discuss his feelings disturbed me. There was something vaguely uncomfortable about it-a cross between being regarded as a sexual object and as a longed-for mother.
Mr. A was a 35-year-old Caucasian man with no known past psychiatric or medical history who came in for evaluation because "I am stuck as a baby." Because he was adopted at birth, little was known about his genetic predisposition to psychiatric disorders. On one level, Mr. A appeared to have a paraphilia involving diapers. His wearing of diapers was obligatory for sexual arousal, and his desire to wear diapers had an obsessional quality. However, the psychodynamic issues were more complicated. Mr. A had dependent personality characteristics, including an excessive need or desire to be cared for, difficulty expressing opinions and disagreement, and a desire for others to assume responsibility for his life (i.e., to "make me be a baby"). However, there were also aggressive undertones manifested by his refusal to schedule appointments in advance and his displeasure with the interview room because "it's not a baby room." His baby-related activities consumed a significant portion of his free time, but he had some ambivalence about his identity as a baby because he sought psychiatric evaluation and reported that he eventually wanted to marry and have children. He recognized that both were incompatible with his "being a baby."
Despite encouragement to bring his work schedule to the session, he continued to avoid scheduling appointments in advance. During our last session, we continued to discuss his desire for me to place him somewhere in which he would "have to stay a baby." For example, he asked that I admit him to a nursery at a nearby children's hospital or see him in the child psychiatry clinic. Because I felt that this ongoing desire interfered with the therapy, I spent time explaining that it was not possible for me to admit him to places such as these because he was not actually a baby. At the end of this session, we again discussed scheduling issues. He was unable or unwilling to commit to an appointment time and asked if he could call me next week and come in to see me then. I responded affirmatively, and we concluded the session. I have not met with him again. After presenting this case at a weekly case conference at Baylor Psychiatry Clinic, I was told by several moonlighting residents that Mr. A often calls the local psychiatric hospitals in the middle of the night to engage in lengthy conversations with the nurses about his wish to be a baby.
Several months later, I contacted Mr. A to see how he was doing and to explore his interest in returning for treatment. He reiterated his desire to be seen in a nursery. At the end of our conversation, Mr. A admitted that he liked being a baby and was not sure that he wanted to change his behavior. I wished him well and encouraged him to contact me in the future if he wished to pursue treatment.
In a recent episode of the hit television series ER, a fully grown man dressed in a diaper was pushed down the hallway of the emergency room on a gurney. A psychiatric resident walked beside the gurney, wielding a copy of the Comprehensive Textbook of Psychiatry. He explained to the perplexed attending physician that the patient has "adult baby syndrome." In reality, even though this syndrome, also called "infantilism," has made it onto network television, it is not yet included in psychiatric textbooks. Perhaps the reason that it has not found much of a home in our psychiatric literature is that most people who fit this profile do not consider themselves patients. However, there are 68 pages of web sites on Google.com that contain the phrase "adult baby," and many similar entries are reportedly omitted. In perusing one of the most popular web sites for adult babies, I learned that more than 15,000 people have logged on to this particular web site in the last 23 years. Adult babies can use the web site to arrange meetings at parties, play together, and choose from a large selection of plastic pants, diapers, adult baby outfits, and adult baby-sitting services. This web site, and others like it, also displays a good deal of sexually provocative material, including sexual appliances, photographs of dominatrices, and promises of punishment for being "bad."
In a search of the psychiatric literature (MEDLINE, 1966 to the present, and PsycINFO, 1987 to July 2002), we were able to locate only three references that were even remotely related to this syndrome, all from the 1960s. Malitz (1) reported a case of a 20-year-old college student who was arrested by police for breaking into a house. He reported that the reason he broke into the house was because of a compulsion to wear diapers and defecate in them. Orgasm regularly accompanied defecation, even if he did not masturbate. He knew that the house in which he was caught would have diapers in it since there was a baby in the house. The patient also liked to wear rubber pants over the diaper. The patient did not, however, think of himself as a baby.
Tuchman and Lachman (2) reported on another patient with legal problems, in this case, for molesting his 4- and 6-year-old daughters. He would wear rubber pants over his diaper and enjoyed urinating and masturbating in it. This patient made no statement suggesting that he wanted to be a baby.
These two cases were both characterized as antisocial behavior, with a predominant emphasis on the fetishistic or sexual aspects of wearing diapers and rubber pants. Unlike Mr. A, neither patient had all of the characteristics of adult baby syndrome.
A case of a 17-year-old boy, reported by Dinello (3), was more characteristic of the kind of presentation that Mr. A manifested. This patient had worn diapers under his clothing, used baby bottles, and eaten baby food since age 15. He had also received medical treatment for an imbalance of growth hormone. Eventually, however, he gave up wearing diapers and began dressing in women's clothing. He, too, masturbated while wearing the diaper.
The diagnostic understanding in the case of Mr. A is a complicated matter. A survey of DSM-IV revealed no disorder that truly fit Mr. A's clinical picture. We could rule out a psychotic disorder since the patient clearly stated that he knew that he was not a baby but only wished to be one. He also had adequate reality testing and sufficient ego strength to pull himself together when he went to work. From a psychodynamic perspective, he clearly manifested a form of splitting characterized by an unintegrated coexistence of two self-representations-an adult who works in law enforcement and a regressed baby. However, he did not meet criteria for borderline personality disorder. Nor did he have dissociative identity disorder because he was clearly aware of both self-representations, he did not have periods of amnesia, and he did not use a different name to describe the "baby" part of himself. Although he might have fit into the category of dependent personality disorder at first glance, it would have been a mistake to apply this label to him since, in his work, he was apparently capable of making decisions, assuming responsibility, and performing duties on his own. Even in his private life as a "baby," he lived a fairly isolated existence rather than depending on others to take care of him.
The diaper fetish obviously led us to consider paraphilia as Mr. A's central diagnosis. As Dr. Pate suggests, the wearing of diapers was obligatory for sexual arousal, and classically, we think of paraphilias as involving an obligatory and exclusive scenario for sexual arousal (4). However, as more data have accumulated about the various paraphilias, we have become increasingly aware that exclusivity regarding the means of sexual arousal is not necessarily a hallmark of paraphilia. In one study of 561 men seeking evaluation and treatment for paraphilia (5), fewer than 30% of the subjects confined their deviant behavior to only one perversion.
In the classical view of fetishism, castration anxiety is central (6, 7). The concerns about physical harm were regarded as resulting from chronic traumatic interactions in the first few months of life. To experience bodily integrity, the child needs to be soothed by its mother or by transitional objects. In the absence of the availability of a mother or such objects, the child may require a fetish, something "reassuringly hard, unyielding, unchanging in shape, and reliably durable" (7, p. 102). As psychoanalysis shifted from a sexually based drive theory to a paradigm of internal object relations and self-psychology, the understanding of fetishism also changed. Kohut (8), for example, viewed fetishism as a way of maintaining control over a nonhuman version of a mothering figure. He described a patient who made a fetish of underpants to deal with feelings of helplessness about the traumatic unavailability of his mother. Mitchell (9) stressed that an intense sexual need for a fetishistic object may actually reflect severe anxiety about the loss of one's sense of self. One may obtain a sense of coherence or a firmer sense of identity from having the fetish available.
As the conceptual models of psychoanalysis have moved more and more into the arena of object relations, we recognize that the relational aspects of perverse scenarios are crucial to comprehensively understand patients with paraphilias (8-12). If we consider the case of Mr. A in depth, we would be shortsighted to view his wearing of diapers as simply a fetish involving his need for sexual gratification. There is little doubt that he had major difficulties in the area of relationships. For example, he had trouble establishing an intimate relationship, and his social isolation was striking.
One of the best ways of evaluating a patient's problems in the area of object relatedness is in a detailed examination of the transference-countertransference developments in an evaluation process. In other words, the patient's internal object relationships forged in childhood are repeatedly externalized in interpersonal interactions in the present. Mr. A, for example, illustrated his need to control others by the way in which he approached the scheduling of sessions with Dr. Pate. Moreover, by studying the way he used the sessions and related to Dr. Pate, we can identify his wishes and desires within interpersonal relationships. When he arrived at the sessions, he did not use the time with his psychiatrist to identify problems and try to find ways to solve them. Instead, he simply enacted a desired scenario by lying on the couch, drinking from his bottle, and staring provocatively at Dr. Pate as though he wished to establish an eroticized mother-infant relationship with her. By allowing this behavior to unfold in the interviews, Dr. Pate gained a wealth of valuable diagnostic information.
The clinician's reactions to the patient indicated something of the characteristic problems the patient encounters in relationships. Dr. Pate described this mode of relatedness as having elements of treating her as an object of sexual desire while also evoking a feeling that she was supposed to be a maternal caretaker. This type of relatedness has a coercive quality that left little room for Dr. Pate's subjectivity or autonomy. She must be completely under his control, an object that gratifies his fantasy life.
The case of Mr. A illustrates two core psychodynamic principles: 1) patients who come for psychiatric treatment may be ambivalent about getting help and attempting to change, and 2) the conscious agenda that is spoken by the patient may be at odds with the actual behavior of the patient in the interview. Mr. A attempted to establish a relationship with Dr. Pate that fulfilled his wish to be a baby taken care of by a mother, even though he professed that he wanted to stop being "stuck" in his wish to be a baby. Ogden (13) stressed that the transference-countertransference scenario itself may be perverse. In the psychoanalytic setting, he suggested that the patient establishes a perverse mode of relatedness as a way of evading an experience of psychological deadness. The drama that is enacted is designed to present a false impression that the patient is actually alive in his power to excite, rather than deadened and empty. Mr. A used Dr. Pate as though she herself were a fetish that would make him feel alive and whole, and that may have been more important than actually undertaking a treatment process to change his behavior. The fact that he was quite withholding when giving his history may reflect the fact that he was not truly interested in collaborating with Dr. Pate in figuring out how his past was repeating itself in the present.
Although the patient provided a limited history, we got some sense of his unconscious agenda by studying what he created with the evaluating psychiatrist. We learned that he was adopted, and we could speculate that he had a long-standing and ongoing conviction that he missed out on the ideal infancy because he was rejected by his biological mother. We could also observe active mastery over passively experienced trauma. In his relationship with Dr. Pate, he insisted on being the one who made the appointments so that he was in charge and ultimately abandoned her, rather than giving her the opportunity to abandon him-a preemptive strike, in effect. Another significant part of the history is that his wish to be a baby began at approximately age 12, when puberty must have been approaching. We can speculate that one of the determinants of the adult baby syndrome in this case may have been a wish to avoid the threat of genital sexuality by regressing to an infantile dependent state. Moreover, by his bizarre and provocative presentation, Mr. A assured himself that he would become a special patient to Dr. Pate and, in fact, to the entire psychiatric clinic, where many people would gawk at him as he walked in and out of the clinic.
Adult baby syndrome is still a new entity for psychiatrists, and there are undoubtedly variations within the syndrome. Mr. A's statement that he wanted someone to "make him be a baby" evokes images of the sadomasochistic scenarios enacted by a dominatrix and her clients. Indeed, a significant number of middle-aged men seek out dominatrices to spank them, punish them, and tell them that they have been "a bad boy." The wish to be treated as a baby is probably a spectrum condition that has many manifestations involving men, women, heterosexuals, bisexuals, and homosexuals.
As with all paraphilic disorders, the treatment is challenging because there is rarely sufficient motivation for patients to change. In this regard, Mr. A's situation resembles what is commonly found in transvestism. In other words, male transvestites enjoy dressing as women, and they rarely have any interest in changing their behavior. The adult baby syndrome "flies below the radar" of psychiatric diagnoses because individuals wishing to dress as babies rarely see themselves as patients who need psychiatric treatment. The web sites for this disorder suggest that there is probably some overlap with transvestism, since there are numerous photographs of men dressed as female babies.
Mr. A ultimately decided to stop coming to the clinic to see Dr. Pate when he realized that she would insist on a treatment plan and a set of goals, rather than simply colluding with the enactment of a perverse scenario of pretending to be a mother and a baby with him. As with many patients, his request for "treatment" may have been suffused with other agendas. To Mr. A, a relationship with a therapist held out the promise of a blissful setting in which no demands would be placed on him for adult behavior. This clinical presentation is an extreme version of a common form of resistance to psychotherapy-namely, instead of using the process for understanding and change, the patient secretly hopes to establish a perfect parentchild relationship to make up for what he or she felt was missed in childhood.
"In reality, even though this syndrome, also called infantilism, has made it onto network television, it is not yet included in psychiatric textbooks."
1. Malitz S: Another report on the wearing of diapers and rubber pants by an adult male. Am J Psychiatry 1966; 122:1435-1437
2. Tuchman WW, Lachman JH: An unusual perversion: the wearing of diapers and rubber pants in a 29-year-old male. Am J Psychiatry 1964; 120:1198-1199
3. Dinello FA: Stages of treatment in the case of a diaper-wearing seventeen-year-old male. Am J Psychiatry 1967; 124:94-96
4. Freud S: Three essays on the theory of sexuality (1905), in Complete Psychological Works, standard ed, vol 7. London, Hogarth Press, 1953, pp 125-243
5. Abel GG, Becker JV, Cunningham-Rathner J, Mittelman M, Rouleau JL: Multiple paraphilic diagnoses among sex offenders. Bull Am Acad Psychiatry Law 1988; 16:153-168
6. Greenacre P: The transitional object and the fetish: with special reference to the role of illusion. Int J Psychoanal 1970; 51: 447-456
7. Greenacre P: Fetishism, in Sexual Deviation, Second ed. Edited by Rosen I. Oxford, UK, Oxford University Press, 1979, pp 79-108
8. Kohut H: The Restoration of the Self. New York, International Universities Press, 1977
9. Mitchell SA: Relational Concepts in Psychoanalysis: An Integration. Cambridge, Mass, Harvard University Press, 1988
10. McDougall J: Plea for a Measure of Abnormality. New York, International Universities Press, 1980
11. McDougall J: Identification, neo-needs, and neo-sexualities. Int J Psychoanal 1986; 67:19-31
12. Gabbard GO: Psychodynamic Psychiatry in Clinical Practice, 3rd ed. Washington, DC, American Psychiatric Publishing, 2000
13. Ogden T: The perverse subject of analysis. J Am Psychoanal Assoc 1966; 44: 1121-1146
Jennifer E. Pate, M.D.
Glen O. Gabbard, M.D.
Received Oct. 31, 2002; revision received May 3, 2003; accepted May 15, 2003. From the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Address reprint requests to Dr. Pate, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. One Baylor Plaza, Houston, TX
Archives of Sexual Behavior
October 2011, Volume 40, Issue 5, pp 857-859
Adult Baby Syndrome and Gender Identity Disorder
Kristina Kise, Mathew Nguyen
Adult Baby Syndrome (ABS) has been reported now by several authors. Pate and Gabbard (2003) associated it with paraphilia and Croarkin, Nam, and Waldrep (2004) connected it to Obsessive–Compulsive Disorder (OCD). Evcimen and Gratz (2006) described a case that was associated with neither paraphilia nor OCD. We present a case of ABS in a patient in which there did not seem to be a connection to either paraphilia or OCD, but, interestingly, the case was further complicated by gender identity issues.
Mr. B is a 38-year-old biological male who prefers to be identified as a female; therefore, Mr. B will further be referred to as Ms. B. She currently lives in a nursing home. She was first placed in a nursing home per her request after she was hospitalized with chest pain 2 years prior. She was referred for psychiatric treatment by her nursing home physician for evaluation of “delusions.” Ms. B stated that she was born with both female and male reproductive organs, specifically, uterus, ovaries, and a penis, and claimed she was raised as a female. Her primary complaint during the evaluation was that the nursing home staff often addressed her as a male rather than a female. When this occurred, she became very upset and essentially had a temper tantrum, grabbing her chest, gasping for air, crying hysterically, yelling and cursing, and demanding to see a supervisor: “It takes an army of nurses to calm me down.” Ms. B also did not like male staff in her room because of a reported history of sexual abuse by an uncle at the age of 3. She also claimed physical abuse by a staff member in her previous nursing home who had allegedly hit, slapped, and punched her in the stomach.
Ms. B’s other complaint was that she liked to be treated as a baby. The Certified Nurse Aide who accompanied her said she often regressed to an infant, particularly at night time. She used bottles, pacifiers, and baby-talk. She would rather have a crib than a bed. Ms. B had been engaging in these behaviors the last 2 years, but stated she had wanted to be a baby for the last 7 years. She said that the pacifier gave her security. She wore a brief due to incontinence but insisted on calling it a diaper so she could be identified more as a baby. Ms. B stated she would like to be a baby because it relieved her of all her adult responsibilities. She felt she would not have to worry about anything as babies are innocent. She did not “want to grow up.” Often when asked a question, she prefaced her answer with “Well, as a baby” and then proceeded to answer the question. The patient stated, “For the record, I don’t consider myself an adult. I would like to be treated as a baby, be re-taught, and be re-trained.” She was very clear, however, that she knew she was not a baby.
Ms. B denied a history of depression. She reported as a teenager being placed on fluoxetine for 2 weeks but had not been on antidepressants since. However, her medical record indicated that she was currently on escitalopram 10 mg daily. The patient denied taking any psychiatric medications and was very upset that this was on her medical record. She denied current depressive symptoms and suicidal ideation. Ms. B also did not endorse any current subjective anxiety symptoms. She reported a history of sexual molestation and physical abuse; however, her symptomatology did not meet the level of Posttraumatic Stress Disorder. Other than this unusual desire to become a baby, the patient did not endorse nor did she display other psychotic symptoms, such as auditory or visual hallucinations, paranoia, ideas of reference, thought broadcasting, thought insertion or disorganized behavior or speech. The patient reported being placed in a psychiatric hospital 8 months prior because the nursing home did not want her anymore. She endorsed seeing an outpatient psychiatrist in 1994 for evaluation for gender reassignment surgery and was reportedly approved for surgery, but had yet to have the surgery for unclear reason. The patient reported having Guillain–Barre syndrome at the age of 13 that required a tracheotomy and left her paraplegic.
The patient reportedly graduated high school and then obtained a master’s degree in architecture. She had been unemployed for 11 years. She stated that she quit working because of arthritis in her hands and was currently on disability for this. Both parents were deceased. Ms. B had never been married. She reported dating a male in high school, but her sexual orientation was not specified. Prior to living in a nursing home, she was living in a group home. She had only been in her current nursing home for the last 3 months. Prior to that, she was living out of state in another nursing home.
On mini-mental status testing, Ms. B scored a 25 out of 27. She could not spell “world.” Her sentence was, “I am a baby. Girls.” She appeared somewhat older than her stated age. She was alert and oriented. She sat in a wheelchair with her legs covered by a blanket. She was wearing feminine clothing and had chin-length hair, male facial features, and male body build with a deep voice and a notable tracheotomy scar. She had some abnormal movement of mouth and tongue consistent with tardive dyskinesia. She reported her mood as good, but her affect was somewhat bizarre. Her speech was of normal rate, rhythm, and volume. Her thought process was circumstantial. She was preoccupied with wanting to be a baby.
At the end of the initial visit, a diagnosis was not clear. She did not appear depressed or psychotic. There were noted inconsistencies at that time and collateral information was needed. We referred Ms. B for neuropsychological testing to aid in the diagnosis, specifically looking for cognitive functioning, effort, and psychosis.
After the initial appointment, records available from our psychiatric facility and the main hospital were reviewed. Many inconsistencies in the patient’s history and other pertinent data were discovered. Firstly, she was seen by Endocrinology in 2004 for gender reassignment. It is clearly stated that she is a biological male and changed her name to a female name in 2000. A recent ultrasound ordered by the nursing home physician clearly demonstrated only male anatomy. Furthermore, there were two psychiatric admissions in 2004 and 2006. She was admitted in 2004 for depression and, at that time, reported a past diagnosis of bipolar, 30 previous hospitalizations, and 28 previous suicide attempts. Her past psychiatric medications included Zyprexa, Lexapro, Paxil, and Prozac. She was discharged to a group home at her request. Her psychiatric admission in 2006 was again for depression. This time she reported a history of substance dependence for which she went to rehab at the age of 24. She also endorsed sexual abuse by an uncle during this admission, but stated it was from the ages of 9–10 (rather than 3–4). The patient reported having only completed the 10th grade with special education on this admission. There was no mention on this or the previous admission of having a degree in architecture. She was living with a brother at this time and discharged home. It was noted during this admission that she was very demanding, manipulative, and attention-seeking. The patient was admitted for chest pain in 2008 and, at her request, was only then admitted to a nursing home in 2008.
Ms. B was seen in our clinic for follow-up 4 weeks later. She had not yet had any neuropsychological testing. On this visit, she was focused on wanting to be taken off psychiatric medications and being allowed to assume the identity of a baby in the nursing home. She further clarified that she wanted to be a baby to escape reality when things go wrong or she has situations she doesn’t know how to get out of. She was absolutely fixated on becoming an adult baby. She then reported a history of physical and sexual abuse by her parents, which she did not report at her last visit. Now, one may think she didn’t feel comfortable discussing this in her first visit, yet she was comfortable discussing abuse by an uncle and a nursing home staff member in the previous visit. There were numerous inconsistencies. When presented with records demonstrating previous hospitalizations at our psychiatric hospital, a history of 28 suicide attempts, and the ultrasound results, she denied ever being admitted to the psychiatric hospital and was very angry, demanding to have copies of those records. She stated the ultrasound was wrong and that she did have female organs. Her story changed again and she stated she had been an adult baby since the teenage years. She also reported being raised as a baby until age 7. She denied ever having lived on her own, when, in fact, two discharge summaries clearly indicated that she did. She began requesting state hospital placement, implying that there she would be taken care of properly. During this appointment, it was also noted that there were no signs of lower extremity atrophy which would be consistent with paralysis. She also had poor eye contact throughout. At the end of the visit, she requested a 2 week appointment. It appeared she was interested in convincing the interviewer it was acceptable to assume the identity of a baby in the nursing home. Again, we emphasized that we would like for her to obtain neuropsychological testing. She did not follow up despite attempts to call her nursing home.
Ms. B presents a diagnostic dilemma in a number of ways. Confounding the clinical picture may be issues of depression and anxiety. Her previous records of multiple psychiatric admissions and various psychoactive medications do hint to a past diagnosis of a mood disorder. Regarding her intense and persistent desire to be identified as a baby, the differential diagnoses may include Delusional Disorder, Dependent Personality Disorder, or even another personality disorder. The patient does not present with a fixed, false belief. She knows that she is not a baby, but would like to be treated as such. One could see how a past physician might have viewed her as psychotic and placed her on olanzapine given the intensity and bizarre nature of her desire to become a baby. Unfortunately, we did not have the records to review the context under which olanzapine was prescribed. Her changing stories and denial of past events, such as being in the psychiatric hospital multiple times, could suggest different personalities with different pasts. A further history would be needed to evaluate for dissociative symptoms. One would also need to consider pathological lying (pseudologia fantastica). This diagnosis would be favored over delusions, as the patient’s story changed within a matter of minutes and weeks, whereas a delusion should be fixed. If we believed that the patient was lying, then malingering should also be considered. Malingering would be unlikely as it would be unclear what the patient’s gain would be. Her wanting this level of nurturance could speak to a personality disorder (such as Dependent Personality Disorder); however, the focus on being treated as if she were a baby and acting as such (wearing a diaper, using a pacifier) is what is unusual, even in the context of depression and personality disorders. Perhaps desiring the identity of a baby is an entity all in itself, just like Major Depressive Disorder or Schizophrenia. Pate and Gabbard (2003) suggested the name “Adult Baby Syndrome.” It is also referred to as infantilism in the literature. This does not represent a new phenomenon, with some cases in the literature dating as far back as the 1960s. In some instances, ABS seems to represent a paraphilia. An online search reveals a number of websites regarding this, with those persons preferring to call themselves Diaper Lovers. It is often referred to as a diaper fetish in the scientific literature. Like paraphilia, it appears that most patients with ABS do not wish to change their behavior and therefore rarely seek psychiatric treatment. It does not appear, however, to be strictly a paraphilia for Ms. B. She specifically denied sexual pleasure, although we must admit she was an unreliable historian. Additionally, her primary intent seems to be one of gaining attention and additional care, freeing her from adult responsibilities.
Most cases of ABS present with identification of a desire to be a baby at a young age. Croarkin et al. (2004) reported a case of a 32-year-old male admitted for depression who had recurrent, intrusive, ego-dystonic thoughts and behaviors involving wearing diapers and becoming a baby. He also denied any sexual gratification related to these behaviors. They suggested it may be related to OCD. However, in the case of Ms. B, her thoughts and behaviors were ego-syntonic, which would go against a diagnosis of OCD.
Evcimen and Gratz (2006) described a 25-year-old male who wished to be a 10-year-old girl. Pettit and Barr (1980) described a case of 24-year-old man who began dressing in female clothes at the age of 10 and began to dress as a baby at the age of 15. Lehne and Money (2003) described a man with a changing fetish who ultimately considered himself an “adult baby” at the age of 45. His previous fetishes involved transvestic fetishism and pedophilia. Some noted similarities in these cases include a common past history of sexual abuse. Several share transgender issues and, notably, when dressing as a baby, they can dress in the opposite sex. However, few assumed a transgender identity when not assuming a baby’s identity, which Ms. B did. Ms. B insisted on being addressed as a female, cross-dressed since childhood, took female hormones, and had requested gender reassignment surgery, suggesting a diagnosis of Gender Identity Disorder (GID). The gender issues seem to pre-date the ABS symptoms. A psychodynamic explanation would be beyond the scope of this article; however, we may speculate the following: As few people in her life acknowledged her wish to assume a female identity, she may have suffered significant internal stress, which may have hampered her ability to psychologically develop appropriately. An inability to move through psychological developmental milestones may have led to this regression to ABS. Further investigation into the connection and potential co-morbidity between ABS and GID may lead to interesting findings. Clearly further information gathering and clarification would be needed to further understand Mr. B’s presentation and pinpoint a diagnosis and/or etiology of this unusual behavior. Unfortunately, she did not show for her next two appointments and, to this date, has never followed up.
Commentary on “Adult Baby Syndrome” by Evcimen and Gratz (2006)
Evcimen and Gratz (2006) described a symptom cluster that they labeled “Adult Baby Syndrome.” In the writer’s opinion, the case they described is more likely to have been sexually motivated or sexual in origin, despite the history of concurrent, rather atypical psychotic phenomena. The writer’s clinical team has seen a number of such cases, including one described below, that could be categorized as “autohebepedophilic dysphoria.”
A 25-year-old single male presented to our clinic with a stated desire to be a little girl of 10 year of age. He presented with his hair in pigtails, wearing an approximation of a little girl’s garb, including a dress and shoes. He spoke in a little girl’s voice and reported shaving his body hair and engaging in little girl’s pastimes. He furthermore indicated that his age was 10, although he was fully cognizant of his actual age of 25 years.
He reported that, since puberty or grade school, his strongest sexual arousal was associated with the fantasy of himself having the physical characteristics and social role of a little girl. He had a lesser degree of sexual arousal and interest associated with thoughts or fantasies of external (i.e., real) prepubescent or early pubescent girls. Although he stated that he wished to achieve the social role and physical status of an early pubescent female, he declined treatment with long-acting sex-drive-reducing medications (gonadotrophin-releasing agonist). His intelligence was estimated in the low normal to borderline range. There was no evidence of actual cognitive defect, psychosis, or affective disturbance.
Blanchard (1989) has described the concept of autogynephilia, which is a male’s sexual preference for himself having the body and sexual characteristics of the opposite sex, with gender dysphoria arising as a consequence of such sexual preference. Transvestism most often accompanies autogynephilia; however, there are cases of autogynephilia in which transvestism is absent. Transvestism itself, of course, can occur without autogynephilia.
Lawrence (2006) has described phenomena associated with apotemnophilia that parallel the phenomena associated with autogynephilia and related gender dysphoria. In such cases, the fetishistic arousal and preference for the social role of an amputee with subsequent amputation as a dysphoric consequence may be seen.
Some of our cases of diaperism or pedophilic transvestism have presented as primarily fetishistic. More commonly, however, this “transvestitic” activity has presented with concurrent autoerotic phenomena that might be described as “autoinfantophilia” or “autopedophilia.” These cases have been associated with a greater or lesser degree of dysphoria involving a wish to achieve the social and physical characteristics of a child or infant. The individuals with a more apparent or severe associated dysphoria have presented with attempts to alter their physical characteristics in order to approximate the related erotic preference. Despite the somewhat extreme nature of the phenomenon, there has been no evidence of psychotic illness in any of our cases.
Interestingly, the reported secondary interactive partner preference of these cases has been variously heterosexual, homosexual and pedophilic. This is in contrast to autogynephilia, in which the interactive partner preference is always gynephilic. Like autogynephiles, some of these cases have reported a degree of associated masochism.
It may well be then that there is, in autoerotic disorders in general, a hierarchy of related phenomena paralleling transvestic fetishism and autogynephilia. Such a hierarchy could be conceptualized and articulated as fetishism, autoerotic paraphilia, and finally autoerotic paraphilia with varying degrees of dysphoria, which–in the most severe cases–involves attempts to alter physical and social characteristics to conform to the individual’s autoerotic sexual preference.
I'm familiar with the case of Mr. A, having found that several years ago. I found it interesting, though I wondered if it was genuine. I suppose it is. Logically, little is known about us because most of us don't seek psychological help, at least not specifically for that which is being called, Adult Baby Syndrome.
As you probably know, in 1970, my college senior year, my mom sent me to a psychiatrist for exactly this, and for being gay. As you also know, being gay in 1970 could place one into a residential mental facility against one's will. It was at such a large facility outside of Princeton where I was sent, though I was not a resident. To be honest, I felt that I was mentally ill. Wanting to wear and use diapers as well as being attracted to young males went against all the accepted norms of late 60's society. Being an adult baby still does, even in the year 2013.
Having lived for 66 years, I have some historical perspective, but psychological perspective is as vague now as it was then. Not only are we not understood, we don't really understand ourselves. The desires exist; they simply are.
As I explained in another recent thread, my mom had called and set up the appointment, so my shrink may have researched infantilism before I arrived for my appointment. His opinion was that I'd outgrow it, something which wasn't very much help. He was far more concerned about my attraction to males, because that could land one in jail, or worse. Sometimes people such as myself got beaten, or murdered. I had my share of fights growing up, as well as being hit upon by other boys for sex. It was not easy growing up.
As was said in the other thread, we're not known because we, for the most part, don't seek professional help. Most of us function in society, and keep our regressive side well hidden. I agree with you, Geno, that it does seem that many of us site having other psychological problems. Depression may be the most prevalent, and we see a great number who profess to be on the Autistic scale. We see a much greater percentage than on general sites, of those who identify with the opposite gender, as you have sited in one of your cases.
The question is valid, is Adult Baby Syndrome also part of some greater psychological dysforia? I can cite my own case, having trouble socializing as a very young child, being bullied and because of my personality, lashing out and fighting back. By junior high I was cutting and setting things on fire, including myself. By high school I had tried to commit suicide. I probably put my parents through hell, yet they managed to support me and love me.
To your original question, yes, I believe it is a syndrome, a dysfunction of some sort. I would have been quick to affirm that when I was a teenager, a young adult, and a young father. I didn't understand the urges I couldn't say no to, nor could I accept them. This site has enabled me to finally make peace with it all. Perhaps there's both acceptance and sanity in numbers.
Good topic Geno, and I suspect many members will have something to contribute to this post, including myself.
This is a very good topic!
All of this is very interesting and I've never heard of Mr. A until now.
Do I think it should be defined in the latest DSM? I don't know, a disorder has a negative stigma.
I do think however, that AB/DL's (and other categories) are portrayed poorly and there is little understanding around it.
In the end - I just don't know. More research should be conducted.
The problem is always the ability to discus the urges in an anonymous setting. I would be absolutely mortified if my extended family found out about this.
Somewhere in an alternate universe where everyone can talk about their quirks and kinks freely and openly there is probably a shot or a pill I would sell my soul for either.
Very interesting topic, I too had read the first one but not the others, until now.
I think this is a very difficult question to find one single answer. It is easy to say it is a syndrome as the case studies had found, however you can take the evidence of all three cases and apply it to just about any situation where there is someone with a mental illness and an odd sexual fetish. Would you class someone who like being spanked by mistresses, who also happened to be very depressed, as having Mistress Spanking Syndrome?
With all the cases the AB part of the patients personality and sexual use of diapers are wrapping a very serious mental disorder in its own right. The case about the LG seems to allude to some child abuse issues. Also it seems to allude to medical and depression issues mixed in with poor guy in the nursing home.
I personally think it is wrong to label a fetish with a medical syndrome as this can only do more harm. As Dogboy stated, 99% of folk who engage their desires also live perfectly normal lives and wait to be back at home to indulge. This is the same for the man who wants a beating from his mistress, he would not suddenly decide at work to have this done in the tea room! Also, what about people who live these kinds of lives all the time, I know a couple who run there own fetish business, the woman is dominated all day every day. She is the most happy and well rounded person you could hope to meet. Does she have mental illness or a disorder?
I think these kinds of studies, while trying to find some reasoning, are hard for the doctor to deal with. What I mean by this is that they are trying to associate desires to a generic term or phrase, when everyone embraces their kinks, fetishes and relaxing tools in different ways. If I was to go to doctor about my desires I would probably be locked away. I don't just like ABDL things but some very extreme BDSM play. If the doctor did not also have these feelings and enjoy them, they would think I was dangerous to women, yet of course, I only do these things with women who also want to engage in it.
It would take an eternity to come up with a correct diagnosis to fit all people who enjoy a strange kink. The cases above are very interesting but I just feel the are extreme and have to many other aspects to be considered before applying a blanket diagnosis. I would not say I 'suffer' from my odd behaviours and feel the opposite, they give me life and power to enjoy and succeed in life. I feel the case studies have no objectivity and no comparison with others who enjoy this without underlying mental illness. But still a good read and it does highlight the dangers of how people can get detached from society due to past experiences or severe mental illness.
Everyone here should read these types of things and re-evaluate themselves to make sure they have no dangers of slipping into this.
From my own experiences, and the experiences of others in the community, I've noticed that not all ABDLs fit the classic fetish definition. For some of us, wearing diapers is something we do for sexual pleasure, and so it fits with the idea of a fetish very easily (in general, this describes people who are DLs). However, some of us see our little side as a shift in identity. We don't do it for sexual reasons, but as a means of escape or a way to identify with parts of our personality (typically, this describes ABs).
So I think that in some cases, this can certainly be analyzed as a fetish - when people do this as a way of expressing sexual desire, I think it fits the classic fetish mould quite well. Evcimen and Gratz's case, for example, sounds like a fetish to me. The patient was sexually attracted to the idea of becoming a little girl. So in this case it does sound like a fetish (granted, a disturbing one, with the patient's history of interest in actual children). But what about those of us who do this for non-sexual reasons?
The idea of LGs kept popping into my mind as I read that last study. LGs are people, usually men, who like to dress up as little girls. But in my case, and the descriptions of other LGs on here, this isn't a sexual thing. In my case it's more wrapped up in the idea of escaping stereotypical adult male responsibilities, and being able to express myself in ways that would be more appropriate for a young child. I simply enjoy taking on a girl's role, and all the things that go with that, whether it's the status, the clothing, the toys, or the emotional expression. Sexuality doesn't enter into the picture at all when I regress, so I don't think it can be described as a fetish.
So Geno, I think you're right that in a lot of cases, we may be looking at something entirely new here. Non-sexual ABs and related folks such as LGs probably fall under a new subheading. What we do can't really be described as a fetish. So I think another heading is more appropriate.
I think that future research should focus on links with other conditions, or on the possibility of this being a whole new psychological subheading. Some good candidates might be:
Autism spectrum - A lot of ABs seem to report being somewhere on the autism spectrum (for example, Asperger's syndrome). Also, I've seen some assertions that people on the spectrum have a high rate of sexual fetishism. I think this may be tied to both sensory issues (liking certain sensations, such as the feel of a wet diaper, that most people wouldn't) and ways of interpreting the world (most people think of infancy as safe and comfortable, but for someone on the spectrum, they may interpret this as meaning that it's better to be a baby sometimes). A link between the autism spectrum and ABDL would be a fascinating study.
Obsessive-Compulsive Disorder - In obsessive-compulsive disorder, people have rituals or techniques they use to cope with stresses. For some, ABDL is a way they cope with stresses. There could be a relation here. I'm not saying that ABDL is a symptom of OCD, but that the two may have similar patterns, and that the development of OCD may have patterns that help illuminate the development of ABDL.
Gender dysphoria - For non-sexual ABDLs, they seem to describe their little side almost in terms of an identity. When I regress, it's like returning to the role of a young girl temporarily. The possible relationship to gender dysphoria is that ABDLs see themselves in a role different from the "normal" one prescribed by society. Again, not saying that ABDL is directly tied to gender dysphoria, but that it may have similar patterns. Perhaps a different sort of "role dysphoria", in which someone wants to be a baby some or all of the time? I think this would need some research to establish as valid, but it's a neat possible direction. Also, different degrees of ABDL exist (occasional regression vs. wanting to be a baby all the time, like Mr. A in the first study). Different degrees of gender dysphoria also exist, from occasional cross-dressing to going through sexual reassignment surgery and physically becoming the other sex (in line with their true gender). So I wonder if ABDL may be a different sort of dysphoria.
I think the main future direction for research is the need to look at all sorts of ABDLs, not just the extreme ones as profiled in this study. The problem is, most ABDLs won't want to identify as such for fear of retribution. We're also rare enough that finding a valid sample would spread over a huge area. You'd have to probably use the internet to get a large sample of less extreme ABDLs, and you'd have to have very clear confidentiality standards in place. I think it's a very challenging field but would be a fascinating one to see develop.
Thanks for posting these - I used to try and research ABDL in college, but since graduating I've lost my database access. I'd love to be able to keep up with the research on this!
I think this can cause us distress if we are not accepted and it affects us trying to get a relationship and affects our marriage because the other person does not accept it. But should it be a disorder? Being gay used to be and it also caused them distress and still does if they are not accepted by their family. Being transgender is seen as a disorder because of the distress it causes due to not being accepted or understood. But if they live their gender the way they feel, they're fine. Same as we're fine if we are allowed to wear our diapers and live our AB life. I think if it goes too far like that one 35 year old man, then it's a real condition.
I like your take on this Adventurer, I have some points I would like to add.
Care needs to be taken with your argument about ABDL being a different sort of dysphoria. I see your point that the emotional 'need' to regress or switch gender could be a negative mental issue, but there are so many reasons why one would do this. I have spoke to a few who engage in regression because they were introduced to it by someone else and feel it is 'fun' but they cannot relate it to past aspects of their lives. They maybe had a partner who was ABDL and found the 'play' surrounding this to be enjoyed. They would then put it from their mind until the next time this came up.
I do not want to go back to the sexual side, as I respect that not everyone has this side, but if you have spent anytime with people into all kinds of kinks then it becomes clear very quickly that some people just like trying new things. Some of these things stick. An ex-girlfriend of mine now enjoys wearing diapers from time to time, because I introduced her, so in theory she may be considered a DL. However when we have spoke about it, she has no thoughts going back, and has no psychological issues accepting this. For her it something fun and different to do at times. There is no deep and meaningful memory or need, she simply takes it for what it is. What about the people who wear diapers for comfort and do not regress or even wet them? Would it be fair to say they are suffering from something in their mind, or are they just expressing themselves in an odd way?
It is hard to pinpoint terminology to use for such a vast field, you said yourself there is the non-sexual and sexual sides. I can relate some past experiences back to why I do what I do, so I guess it could be a form of dysphoria for me. But I am content and do not have emotional stresses about it. I think we are too niche a group to ever get a correct 'diagnosis' if one was ever needed.
Any research in this field will always be hit and miss and divide opinions but it is very interesting to explore. One way could be a questionnaire for people to complete and see why they do things, where the emotions come from, do they suffer depression or anxiety. The problem is if the horny brigade fill them in you will get a lot of 'I want mummy to change me' kind of answers, this will only scupper any attempts to collect real data on the issue. You would also need to assume everyone understands themselves enough to answer truthfully and with authority.
*sigh* Ironically I stumbled across some medical journals about AB/DL syndrome myself some days ago.
I don't know why, but it's been the first thing that popped up for me, exactly the weirdest thing I could imagine probably. Although I've been looking for certain psychological reports anyway, just different one's actually.
The name itself for trying to describe this is already absurd... syndrome? Associated with something individual, AB/DL is simply an adjective on one aspect. Makes no sense whatsoever, since those mentioned are certainly characteristics that belong to known disorders. The next thing that pops up in time will surely be an anime syndrome or something similar. However, there is a post anime depression syndrome, but that's only slang for being kind of cast down after finishing a series. ;-)
Anyway, what I mean is simply that it's grotesque. Since it's more and more common and has a bit of publicity... it's something special all of a sudden. It's just all to familiar with what has been with BDSM over the last decades, or a fetish in general, where diapers usually got sorted into as well. And handled this way, so usually by helping to accept this part and bring it to an acceptable level. At least if you do not need to get rid of it at all as in those examples, but that's another... story.
So how long has any kind of SM been associated with quite drastic disorders? The practice still carries with it a certain amount of social stigma. It's difficult for people to understand, and for some it can seem downright scary. For individuals who prefer a more vanilla sexual life with no kink, it can seem odd that there are people who want to be whipped, restrained or otherwise disciplined. Equally as disturbing can be imagining oneself being the person who enjoys doing these things to others. For many people the practices associated with sadomasochism can bring up strong reactions, one of them commonly being, "That's dangerous!"
Even more, most have long had a tendency to view the practice as pathological and even perverted. Common assumptions about people who participate are that they psychologically maladjusted. To a big degree too much people still think that way, you will probably find them around every corner... although mostly we're better off not knowing them anyway, to be honest. ;-)
Still it took ages for studies like "S&M practitioners are healthier and less neurotic than those with a tamer sex life" to appear finally, or anyway to have this idea to begin with. Although perhaps originally they thought about trying to brand mark it in an unpleasant way and it just backfired.
It's quite nice to have a study, but what does common sense tell us already? Doing what you like obviously cannot hurt, you only need to know which line you cannot cross. Knowing what it ethically and socially acceptable and what not. Or simply the old golden rule: Regarding love everything is acceptable, as long as everyone who is involved also enjoys it.
As for asexual reasons what should it matter anyway. A lot of people pick their noses day in and day out, in private. So who cares, or who should? No one, no harm done and their noses - not ours. Our nappies, not theirs. What we like doesn't need to be what they like, but therefore it's nothing special, as long as it has no consequences or rather if it doesn't interfere with anything or anyone around us.
However, if that line is getting blurry, or if someone lost their relation to reality anyway... what to say, if you're nuts... you're nuts. That's harsh, but fact: Those people obviously need help and if they're able to recognize that themselves, all the better.
As mentioned, if there's no possibility of stopping any harmful pattern of behaviour, in which way they may ever be, it's OCD. And if individuals lose their perception of what and who they are or lost it already, well what`s that... Dissociative identity disorder.
Ultimately this is no syndrome that needs it's own case of description or case study. There's nothing to gain.
Just sayin', a hard-edged point of view in a manner of speaking.
I think this can cause us distress if we are not accepted and it affects us trying to get a relationship and affects our marriage because the other person does not accept it. But should it be a disorder? Being gay used to be and it also caused them distress and still does if they are not accepted by their family. Being transgender is seen as a disorder because of the distress it causes due to not being accepted or understood. But if they live their gender the way they feel, they're fine. Same as we're fine if we are allowed to wear our diapers and live our AB life. I think if it goes too far like that one 35 year old man, then it's a real condition.
I think there are several issues comparing a sexual orientation and what seems to be often a coping mechanism or lifestyle based on a paraphilia. So I don't think the "well gay used to be considered a disorder..." is particularly convincing on the future of it in studies.
If we reduce "Adult Baby-ness" as a coping mechanism, one that potentially carries with it a number of negative consequences for individuals, I think most studies would classify it easily as more or less an addiction.
If we reduce it to a paraphilic lifestyle, it's already on the books: " DSM 5 classifies paraphilic disorder as 'a paraphilia that causes distress or impairment to the individual or harm to others.'
So while the majority of AB/DLs are well adjusted, the question comes up what "distress or impairment" is in these cases. Is it because society is judgmental that causes use distress? Or is it because living as an infant to whatever length is inherently detrimental financially and socially overall?