A Double Dose of "Different": Disorders and Diaper Loving

DylanLewis

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Thank you for the reply DylanLewis. And sorry to leave this hanging so long.

I see how, in your theoretical framework, ABDL-ism(?) wouldn't fit as a paraphilia. I'm curious whether this definition is unique to you or whether it is used by other psychologists? For instance, this article at psychology today doesn't include the notion of comfort: https://www.psychologytoday.com/us/conditions/paraphilias For them, it seems like the necessity or preoccupation with the object of desire is central, together with either a sense of distress or resulting in harm.



Oh, yes. That clearly makes sense. And I'm sure it is true in many cases. So, I see how your view is coherent and also has explanatory power.

But maybe that isn't the whole picture? Wouldn't it work to take food as a parallel, non-dissociative comfort? Lots of people over-eat because it's comforting. It doesn't make eating a symptom of a deeper underlying condition. There are people who over-eat as a symptom of pathology. But there are others who over-eat for comfort in only isolated cases. There's no real long-term pathology. And of course there are lots of other parallels: occasional alcohol use, nicotine, exercise, etc. Not dissociative, not pathological, but definitely comforting when under stress.

So, well, I guess what I'm saying is that I think sex is pretty comforting. (blush) Whether it's ABDL sex, homo- or hetero-sexual ... it doesn't matter. It's comforting.
Brandi

I understand your second query to be whether being ABDL can simply consist (only) of getting emotional comfort from a sexual attraction/use of diapers? – optionally flavoured (spiced?) with blushing to individual taste, of course. That is, depending on the individual, may being ABDL involve neither dissociation nor a (pathological) paraphilia? In other words is simple healthy sexual enjoyment in diapers sufficient to explain being ABDL?

As mentioned before, human experience is diverse and all things are possible. I’m also the least qualified person to be talking about sexuality. But, in my view, there are lots of indications that for the greater majority of ABDLs it’s a bit more complicated (whether that’s acknowledged or not).

Certainly being ABDL does not necessarily involve a paraphilia. It is typically associated only with the strongly conflicted early stages of our identity formation and fades/disappears with self acceptance.

Also certainly, being ABDL can involve healthy sexual enjoyment. Simple? I don’t think so. I suspect for many ABDL their sexual expression is significantly influenced by childhood attachment issues; erotic targets which are focused on the fantasized transformation of the self (to an infant or child), instead of or beside sex with an adult partner; and/or switches/intrusions/passive influence between different identity fragments or alters. There’s nothing pathological about any of that, but it’s not simple vanilla sex.

And healthy sexual enjoyment in diapers is not sufficient explanation for all or most of the characteristics of being ABDL. I suspect many self accepting ABDLs don’t engage in sexual activity each, or even most, time(s) they wear a diaper. But they still get emotional comfort from the other times. That isn’t explained by sex. And some ABDLs don’t mix sex with diapers at all but still derive emotional comfort.

There are also a range of other ABDL characteristics / symptoms which are not explained by a sexual attraction to diapers on its own. These include changes in affect (feeling/identity states), including but not limited to, the binge and purge cycle, or triggering of an irresistible need for a diaper); childhood attachment issues; and mood disorders such as anxiety or depression.

I hope this makes sense.
 

Brandi

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Incontinent
I hope this makes sense.
Well, yes, in the sense that you are saying that ABDL behavior/attraction isn't just one thing, its a spectrum of issues. Yes, that does make sense. And it does make sense too that dissociation plays a role in at least some (if not most) cases.

I guess I'm reserved on the idea that ABDL behavior or attraction must include dissociation. I guess I don't have any strong argument to the contrary, it's just that it seems like there isn't compelling evidence (that I'm aware of) to reach such a sweeping conclusion. But, I certainly can't prove that view wrong.

If I could add this, though: I've wondered about that very issue--whether its primarily an emotional/psychological issue rather than strictly physical one--that explains incontinence in some cases in adults. Obviously, that doesn't explain every case. A previously continent woman with pelvic organ prolapse or a man after a prostatectomy has a sufficient physical explanation. But what about the person who seems anatomically normal and yet struggles with some degree of urgency and incontinence even as a young adult? I think that's an especially sensible explanation if there's a history of abuse or shaming after wetting in the person's youth. That can be truly traumatizing, and it makes all kinds of sense to ask whether there are psychological vectors playing into adolescent and young adult incontinence. Were that the case for someone, then dissociation and especially the presence of dissociated alters/parts makes abundant sense.

I suffered abuse as a child (primarily physical and emotional) and I was shamed for my bladder problems. I developed good day-time control as an adolescent, with only occasional minor issues at night. But the problem never completely went away, and I always had to be careful about planning ahead. By the time I was thirty, I was well down the slope toward incontinence again. A lot of emotions from my childhood came back with the physical problems, and the anxiety seemed to make the physical problems so much worse. And if you had accidents as a child, there's absolutely no doubt that the sense of panic when you think you can't hold out to get to the loo is exactly a replay of childhood experience. So is there a sense of comfort in wearing protection? Oh my gosh, yes!
 

Brandi

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The definition of a paraphilia is "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one's partner, or children or other nonconsenting persons that occur over a period of six months." ABDL can include a paraphilia for diapers – particularly in the initial stages of the identity the savage internal conflict can drive compulsive behaviours which would fit the definition. That still doesn't make it the primary or defining feature of being ABDL.
...
The designation of ABDL as a paraphilia was arbitrary, without clinical rigor.
...
The valid means of ascertaining the primary clinical explanation for any set of symptoms is via a differential diagnosis. This matches the symptoms with the diagnostic criteria for relevant clinical conditions to ascertain which of the latter best explains most of the symptoms. To my knowledge there has never been a published competent differential diagnosis for ABDL. Money and subsequently, the DSM, defined infantilism as a paraphilia without ever having undertaken a differential diagnosis based on a comprehensive set of the relevant symptoms. This is a significant gap in clinical knowledge which has contributed to the lack of understanding of ABDL by mental health professionals. I am hoping to address this in my next book.
OK ... I'm officially outclassed in this discussion!
I see that your thinking about ABDL is much richer than I thought before.

I'll comment on the comfort issues in response your statements there.

Anyway, thanks, DylanLewis. The conversation has been stimulating! And I think that whether you've got it all worked-out now or not, you are bringing some important perspectives and insights to the table. Hopefully, someone in the research community will someday pickup on what you are saying.
 

DylanLewis

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Adult Baby
Well, yes, in the sense that you are saying that ABDL behavior/attraction isn't just one thing, its a spectrum of issues. Yes, that does make sense. And it does make sense too that dissociation plays a role in at least some (if not most) cases.

I guess I'm reserved on the idea that ABDL behavior or attraction must include dissociation. I guess I don't have any strong argument to the contrary, it's just that it seems like there isn't compelling evidence (that I'm aware of) to reach such a sweeping conclusion. But, I certainly can't prove that view wrong.

If I could add this, though: I've wondered about that very issue--whether its primarily an emotional/psychological issue rather than strictly physical one--that explains incontinence in some cases in adults. Obviously, that doesn't explain every case. A previously continent woman with pelvic organ prolapse or a man after a prostatectomy has a sufficient physical explanation. But what about the person who seems anatomically normal and yet struggles with some degree of urgency and incontinence even as a young adult? I think that's an especially sensible explanation if there's a history of abuse or shaming after wetting in the person's youth. That can be truly traumatizing, and it makes all kinds of sense to ask whether there are psychological vectors playing into adolescent and young adult incontinence. Were that the case for someone, then dissociation and especially the presence of dissociated alters/parts makes abundant sense.

I suffered abuse as a child (primarily physical and emotional) and I was shamed for my bladder problems. I developed good day-time control as an adolescent, with only occasional minor issues at night. But the problem never completely went away, and I always had to be careful about planning ahead. By the time I was thirty, I was well down the slope toward incontinence again. A lot of emotions from my childhood came back with the physical problems, and the anxiety seemed to make the physical problems so much worse. And if you had accidents as a child, there's absolutely no doubt that the sense of panic when you think you can't hold out to get to the loo is exactly a replay of childhood experience. So is there a sense of comfort in wearing protection? Oh my gosh, yes!
Brandi
Thanks for your thought provoking replies re the issue of whether being ABDL is explained as a form of dissociation.

I very sorry to hear that you were abused and shamed as a child and of its legacy in adulthood. That sucks. It really sucks. Re the relationship between emotional issues and continence - I have some understanding of this - I have chronic anxiety which is often manifested as an anxious bladder (ie. if I'm out, constant vigilance re the location of nearest toilet etc).

Re your reservations about the ubiquity of dissociation as an explanation for ABDLs. I understand your reservation. I am conscious of the risk of an overly reductionist view. Notwithstanding that, I believe that we are only just beginning to understand the pervasiveness and legacy of childhood dissociation, and that for many/most being ABDL is a form of dissociation.

Anxiety and depression are now well understood. So that we commonly ask ourselves, am I anxious? - knowing that not all anxiety consists of a screaming panic attack. Or we can ask ourselves, am I depressed? - knowing that depression has less pronounced and more pervasive forms than (literally) not being able to get out of bed. However as yet, collectively, we don't have the understanding and awareness of dissociation to see it in ourselves or others.

Firstly, its prevalence is underestimated. A recent meta-analysis of 98 other studies (link below) found that across multiple countries around 10% of the population would meet the criteria for a dissociative disorder. As mentioned before Dr Marlene Steinberg, a leading authority, cited a survey that indicated that 14% of the US population has symptoms of substantial dissociation. That puts its prevalence on a par with the better understood mood disorders like anxiety and depression. Considering that ABDLs probably amount to 1 in 1000, it isn't unlikely that we are a subset of a much larger population with substantial symptoms of dissociation.

Secondly, because our awareness, or what the psychs call our 'index of suspicion', is so badly calibrated we don't see the more subtle and pervasive forms of dissociation. We don't recognize anything less than fragmented ('United States of Tara') Dissociative Identity Disorder (DID) as dissociation. Dissociation is commonly a lot more subtle (even for DID). One of the most common forms of dissociation is depersonalization. That is commonly experienced as emotional numbing, the sense of being an observer in your own life, or not feeling that you fully inhabit your own body. Paradoxically, depersonalisation is a common partner with anxiety - the pairing can be seen in a cycle of experiencing distressing anxiety and then numbing to try and prevent the recurrence of those symptoms. In dissociation the eruption of distressing feelings is called an 'intrusion', while the lack of feeling and connection is called 'a withdrawal'. Both elements are commonly present.

Dissociation can be insidious and chronic. The theory of Structural Dissociation (introduced in the 2006 book 'The Haunted Self', cited below), indicates that dissociation commonly pairs one part of the personality which houses deep emotion (hurt, fear, anger) with another 'apparently normal' part which is usually presented to the world. The latter's purpose is to deny and minimise the distressing feelings of the 'emotional' part (and the past which gave rise to those feelings). The 'emotional part' is all intense/explosive feelings/needs while the 'apparently normal part' is depersonalised, numbed and in denial. We spend much of our time inhabiting the 'normal part' seeking to push away or down the feelings that we fear would cause us to either shut down or explode. The point is even when we are inhabiting the 'apparently normal part' we are still dissociated - because the 'withdrawals' are sapping our ability to feel our own emotions or connect with others.

So what about ABDLs and dissociation? The answer lies in the diapers! Really. Let me explain. Psychiatrist Colin Ross (whom you quite rightly cited approvingly) says -

“… a good conceptual framework for the spectrum of dissociation is the inner child spectrum. The inner child is therapeutic lingo for unresolved feelings from childhood. The only question is: are these just feelings, or are they contained in an inner structure that has some degree of separateness from the adult self?

The inner child spectrum goes: no inner child – a metaphorical inner child – a sense of an inner child – a definite knowledge that there is an inner child inside – the inner child is visualized internally – the person and hear and talks to the inner child (DID).” [Treatment of Dissociative Identity Disorder: Techniques and Strategies for Stabilisation]


ABDLs have a compelling, irresistible need for diapers. That's not metaphorical, and it is way more tangible than internal (creative) visualisation. Our inner child is not metaphorical in terms of Dr Ross's spectrum of dissociation. We don't hear or talk to our inner child so being ABDL is not like DID. But our inner child manifests in persistent, consistent, physically tangible ways (the need for diapers). As Dr Ross explains that means our 'inner child' is contained in an inner structure in our psyche that has some degree of separateness from our adult self. That's a form of identity alteration, one of the five components of dissociation. (The alternative is to posit that an ABDL's irresistible need for diapers has no relationship to their 'inner child'. That seems like denial to me.)

Interestingly, the theory of structural dissociation indicates that there are three levels of dissociation. DID is the third (highest) level. I believe many ABs, including myself, have the second (middle) level of dissociation. It is possible that some ABDLs, especially DLs, might have the first (lower) level of dissociation - where the inner child is less 'elaborated', a personality fragment, rather than a full alternative personality.

So if its dissociation there has to be trauma. We commonly think of trauma as (only) combat, childhood sexual abuse, rape, a car accident in which someone dies, etc. I suspect many ABDLs when they hear the phrase 'past trauma' think to themselves, 'well that's not me, none of that ever happened to me'. I believe that we need to recalibrate our understanding of the type and nature of trauma that can produce the more subtle chronic forms of dissociation. Broken emotional bonds between a young child and their mother/caregiver can make a child vulnerable to being traumatised by the 'ordinary catastrophes of childhood' (temporary separations from mother, hospitalisations, accidents, bullying etc). Again, these broken emotional bonds, called insecure attachments, are very common. Studies, replicated across advanced western countries, indicate that one third of children have an insecure attachment. A minority of ABDLs have suffered abuse and neglect in childhood. I suspect many others have these less obvious forms of trauma.

Re your comment about feeling officially outclassed? Definitely not. I'm sorry if it came across that way. I sometimes have a surfeit of enthusiasm at discovering something new, especially if it seems as though it might also be a first discovery. Like many ABDLs I lived most of my life with the conflict and shame about myself. It has given me a thirst to understand things as deeply as I can. It is also part of my own journey of coming to terms with myself.

References:

'The prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies. Journal of Trauma & Dissociation' Kate, Mary- Anne, Jamieson, Graham & Hopgood, Tanya

Can be accessed at - https://www.researchgate.net/profile/Mary_Anne_Kate

Colin Ross. Treatment of Dissociative Identity Disorder: Techniques and Strategies for Stabilisation (2018) (digital and hardcopy: Amazon)

Onno van der Hart, Ellert R.S. Nijenhius, Kathy Steele. 'The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization' (2006) (digital & hardcopy: Amazon)
 
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