It also matters greatly who's around. Around here, I can say Diaper McNappy Fluffbum the 3rd, and laugh, even when I feel all Lil Miss Sensitive, because no one here is interested in using that word as ammunition against me. Same goes for family reun----, oh, I mean, um, conventions, like CAPcon, TeddyCon, or similar.
In my everyday life, though, that word carries with it, "You're level of function is slipping! You'll never do (Pick a thing)! Do you want to turn into your sister!? People see you both differently because of your CP, so, you have to watch yourself! (So tired of that particular part. Like I'm too stupid to know that? I've been hearing it sense I was 12!) Threaten, threaten McThreateny threaten! Roar!"