Understanding Infantilism (.org)

Other Conditions Prevalent Among AB/DLs

In 1954, William Mitchell wrote about one patient who, upon seeing a safety pin, would hum, stand still, and then walk backwards (1954). The article mentioned neither the desires for diapers nor babyhood, but would later be cited as the source of the association of epilepsy and infantilism (e.g. Arndt, 1991; Pandita-Gunawardena, 1990). A growing list of other conditions have been associated with the desire for diapers and/or babyhood, typically based on a similarly inadequate sample.

To AB/DLs, this obscurity imposes two direct risks. First, paraphilic infantilism and diaper fetishism are relatively harmless conditions. Because of this obscurity, they might get confused with more severe or dangerous conditions, such as epilepsy. This might cause undue anxiety and unnecessary medical treatment. Second, this obscurity might lead some with more severe or dangerous conditions to believe that they just have paraphilic infantilism or diaper fetishism. As a result, they might neither seek nor accept necessary medical treatment. This study was intended to resolve some of this obscurity.

Method

This study used data from the second of the AB/DL survey series, as previously detailed by the author (Grey, 2009). The 64-question online survey was composed and posted to the Internet at the author's website, understanding.infantilism.org. The questions briefly explored interests, practices, and backgrounds of AB/DLs. The survey was announced to a number of email and web-based AB/DL communities. Participation was voluntary and anonymous.

It explored the possibility that the desires of some AB/DLs might be rooted in conditions other than paraphilic infantilism and diaper fetishism. Participants were asked if they had been diagnosed with epilepsy, long-term fecal incontinence/ uncontrolled soiling, long-term urinary incontinence/ uncontrolled wetting, some other physical disability, Asperger's Syndrome, Attention-Deficit Hyperactivity Disorder (ADHD), autism, some other developmental disorder, bipolar disorder, Borderline Personality Disorder (BPD), Dissociative Identity Disorder/ multiple personalities (DID), Obsessive Compulsive Disorder (OCD), and some other psychiatric disorder, excluding depression and developmental disorders. Some of these conditions have been associated with infantilism in medical literature, such as OCD (Croarkin, Nam, & Waldrep, 2004). Others were frequently discussed in AB/DL forums, such as Asperger's Syndrome (e.g. ADISC, 2008; DialyDiapers, 2007). While the survey was underway, a report was published associating Asperger's Syndrome with the paraphilias, including one case of infantilism (Robinow, 2009).

The survey included one question on the relationship between these conditions and the participant's desires for diapers and/or babyhood. Since these conditions were rare, it was believed that the level of confounding between multiple conditions would be acceptable. There was also an essay question, permitting participants to mention other conditions, and to enter their comments on effects that their conditions might have had on their interests.

The survey section on coincidental conditions included questions on ten specific conditions and three general groups, not including paraphilic infantilism or diaper fetishism, listed above. Since published information on these conditions typically grouped patients as male or female, without statistics on transgendered patients, the following analyses will include data only non-transgendered AB/DLs.

A total of 997 responses were received for this survey, excluding responses from potential minors and probable duplicates. Of these, 687 self-identified as non-transgendered AB/DLs and completed all the relevant questions. The questions relevant to this paper are self-identification on the AB-to-DL range (S2Q3), sex (S2Q4), the above conditions (S2Q31 through S2Q43), and the relationship between the participant's AB/DL interests and other conditions (S2Q44).

Results

The number of conditions surveyed that AB/DLs reported having been diagnosed with is plotted in Figure 1. 63% of participants (432) did not report having any of the specific conditions or groups of conditions surveyed.

Figure 1, Number of Conditions Reported. The bars show the number of conditions that AB/DLs reported having been diagnosed with, excluding paraphilic infantilism and diaper fetishism, from a list of conditions that have been associated with paraphilic infantilism and diaper fetishism. It is based on S2Q31 through S2Q43.

Incontinence

Given that they both might involve diapers, a connection between incontinence and being an AB/DL was expected. Long-term urinary incontinence was reported by 9.0% of AB/DLs (62), and long-term fecal incontinence was reported by a 3.3% (23). Overall, 9.9% of AB/DLs (68) reported some form of long-term incontinence.

Figure 2, Incontinence Among AB/DLs. A bar chart showing the reported relationship between incontinence and the desires for diapers and/or babyhood, as reported by incontinent AB/DLs, based on S2Q32, S2Q33, and S2Q44. Vertical lines show the standard error.

Figure 2 plots the relationship between incontinence or another condition and desires for diapers and/or babyhood, as reported by incontinent AB/DLs. No relationship (Unrelated) was reported by 26% of incontinent AB/DLs (18) and a causal relationship (cause) was reported by 37% (25).

One man wrote about "Nocturnal enuresis (bedwetting) that continued into my adult years. Over the years I've had various medical evaluations/consultations, but with no resolution for my wetting issues (especially bedwetting). I've incorporated AB things (actually adult sizes of the same things I used during my early to late childhood, i.e., footed jammies/sleepers, onesies™, etc. The AB part of me is a good coping mechanism because so many of the issues are SO comparable to toddlers & preschoolers who are not yet completely potty trained. (I relate very well to the comparisons)." He identified as a "Real bedwetter who includes AB things for coping", but selected "Other" on AB-to-DL self-identification (S2Q3), and so is not included in the above statistics.

Another man wrote "I have always worn diapers 24/7 for wetting and messing. When going through puberty those diapers when wet and messy became a turn-on." A woman added "Diapered 24/7 (medical): Since I must wear diapers I have fun with it."

Some AB/DLs reported incontinence as an Effect, not a cause. One man remarked "My girlfriend and I spent about a year getting me unconditioned, and [wearing diapers] more or less 24/7...Then we split up, and I'm left incontinent. I'm getting better currently though." One woman wrote "I believe that wearing diapers for many years resulted in my wetting without having control." 12% of incontinent AB/DLs (8) reported that their incontinence was a result of their desires..

A further 6% (4) reported that their desires, incontinence, and possibly other conditions were both causes and effects of each other (Both). Finally, 7% (5) reported that their desires and conditions were both the result of some other common Factor. (The remaining 12% reported incontinence in S2Q32 and/or S2Q33, but reported not having been diagnosed with another condition in S2Q44.)

Other Specific Conditions

The prevalence of Epilepsy, Autism, and Dissociative Identity Disorder reported by AB/DLs was at or below two percent. This limits both the size and significance of the subsample. As a result, the following analysis focused on Asperger's Syndrome, ADHD, bipolar disorder, borderline personality disorder, and obsessive compulsive disorder.

Figure 3, Prevalence of Conditions Among AB/DLs. This bar chart contrasts the expected prevalence for the mostly male AB/DL population, and the prevalence observed in the survey results, based on S2Q35, S2Q36, S2Q39, S2Q40, and S2Q42. Vertical lines show the standard error.

Figure 3 shows the expected prevalences for these conditions, after adjusting for the survey's mostly male sample, and the prevalence observed in the survey data. The contrast is most dramatic for Asperger's Syndrome, with 0.7% expected and 3.6% observed, Χ²(1)=21.28, p<.001. The contrasts for borderline personality disorder (1.2% expected, 3.5% observed, Χ²[1]=8.10, p=.004) and obsessive compulsive disorder (3.0% expected, 6.5% observed, Χ²[1]=9.29, p=.002) were also statistically significant. The contrast for ADHD is not statistically significant if the 12% general prevalence is used for the calculation, with 14.6% expected and 16.0% observed, Χ²(1)=0.55, p=.5. Since the 12% value and the survey both referred to the diagnosis, not the condition itself, this is appropriate. The contrast for bipolar disorder was not significant, with 6.0% expected and 6.5% observed, Χ²(1)=0.16, p=.7.

Figure 4, Number of AB/DL Women in the Sample with other Conditions. This bar chart contrasts the number of AB/DL Women expected in the survey data, given the prevalence among AB/DLs, the mostly male AB/DL population, and the published sex ratios for the other condition, with the number observed in the survey results. The values are based on S2Q4, S2Q35, S2Q36, S2Q39, S2Q40, and S2Q42. Vertical lines show the standard error without taking the result quantum into account.

Figure 4 shows the number of AB/DL women reporting various conditions, and the number expected given the prevalence of those conditions among the AB/DLs. Because of the small numbers involved, a binomial test was used to evaluate significance. The following values represent one-sided confidences.

Three of 25 AB/DLs with Asperger's Syndrome were female, while given the sex ratios of Asperger's Syndrome and the AB/DL community, only 0.6 of the 25 would have been expected to be female (2.3% expected, 3 of 25 observed, p=.02). Similarly, 9 of 45 AB/DLs with and OCD were female, when only 2.4 were expected (5.3% expected, 9 of 45 observed, p<.001). The contrast in sex ratios for ADHD (5.3% expected, 9 of 110 observed, p=.1), bipolar disorder (9.9% expected, 5 of 45 observed, p=.5), and BPD (22.3% expected, 4 of 24 observed, p=.4) were not statistically significant.

Discussion

This analysis explored two groups of conditions, previously associated with desires for diapers and/or babyhood. The first was incontinence, which might involve diapers directly. The second involved other conditions that had been associated with AB/DLs in literature or online discussions. The majority of AB/DLs reporting not having any of these conditions. This suggests that no one condition of those surveyed drives the desires of most AB/DLs. Furthermore, it suggests that those conditions collectively are not involved with the desires of the majority of AB/DLs. However, for a minority of AB/DLs, their desires might be rooted in one or more other conditions, other than paraphilic infantilism or diaper fetishism.

Given the intuitive connection between incontinence and the desire for diapers and/or babyhood, it was fairly easy to explore. However, even in this case, the relationship was not simple. Some participants clearly considered their incontinence as the reason they became AB/DLs. In contrast, some AB/DLs reported developing incontinence as a result of being AB/DLs.

Of the specific conditions, epilepsy, autism, and dissociative identity disorder were reported by only around two percent of AB/DLs or less each. The prevalence of ADHD and bipolar disorder among AB/DLs differ significantly from expectations based on published values for the general population. It is possible that a general over-diagnosis of ADHD was large enough to obscure any relationship between ADHD and the desires for diapers and/or babyhood. It is also possible that bipolar disorder might also be overrepresented among the AB/DLs: The value for the general population includes subthreshold bipolar disorder, while some of the participants with subthreshold bipolar disorder might have reported not being bipolar. However, the present data does not support these possibilities.

The over-representation of Asperger's Syndrome, BPD, and OCD among AB/DLs is consistent with a relationship between these conditions and a desire for diapers and/or babyhood. However, there are other possible explanations. In addition to the risk of general over-diagnosis, the conditions that have been associated with paraphilic infantilism or diaper fetishism might be over-diagnosed among AB/DLs. One thoughtful participant conveyed "Although I've never been diagnosed with obsessive compulsive disorder, I've read recently that there are similarities to OCD and fetishes. So maybe I do have a form of OCD." He correctly did not report having been diagnosed with OCD. However, if AB/DLs disproportionately have themselves checked for OCD or any other disorder, they would be more likely to receive a diagnosis. Especially for rare disorders, it wouldn't take many extra cases to cause an artificial trend.

One aspect that might be partially insulated from over-diagnosis is the sex ratio. For example, Asperger's Syndrome and ADHD are predominantly male conditions. Since this trend is known, males would be more likely to be over-diagnosed with these conditions, so few women would be expected. Like the prevalence, the expected sex ratio will also be affected by the mostly male sample of the AB/DL survey. If there is no relationship between these predominantly male conditions and the predominantly male desires, very few women would be expected. Few women would coincidentally have both the condition and paraphilic infantilism or diaper fetishism. In contrast, if there were a strong causal relationship between the condition and the desire, the sex ratio would be similar to that of the condition itself. That is, the women would desire diapers and/or babyhood due to the other condition alone, as opposed coincidentally also having paraphilic infantilism or diaper fetishism, and so be more numerous.

Asperger's Syndrome

Asperger's Syndrome might be more prevalent than reported in the survey, since the diagnosis was not established during the developing years of many AB/DLs. Older AB/DLs with Asperger's Syndrome might have been evaluated for Autism, but not pass the threshold for diagnosis. Asperger's Syndrome and Autism share the symptoms of impaired social interaction as well as restricted repetitive behavior, interests, and activities. They differ in the development of language, which is delayed only in Autism (APA, 2000, p 84). Asperger's is a developmental disorder that can be diagnosed in early childhood, and is most prevalent in boys. During the course of this survey, one case of infantilism was documented as an example of the over-representation of paraphilias and transgenderism among those with Asperger's Syndrome (Robinow, 2009).

Of the AB/DLs surveyed that reported having Asperger's Syndrome, 48% (12) thought that one or more of their conditions had caused their desires for diapers and/or babyhood, or that the two were the result of a common cause.

Asperger's Syndrome might cause a social isolation, either due to a disinterest in others or an inability to relate to others emotionally. One woman wrote that she had "always had extensive general imaginative fantasy life, been introverted and not needing other people to feel validated." She continues that she was "able to explore [being a] DL with no fear of discovery and without any shame or concerns regarding 'perversions' or guilt etc."

Hypersensitivity or insensitivity are also sometimes considered as symptoms of Asperger's. One participant wrote "I've trouble [interpreting] the feelings of [needing] to go (because of Asperger's), so I have random accidents, if [I do not] follow a toilet routine. Also the diaper is a more concrete way of sexual stimulation than abstract humans and for [those with] Asperger's that is more pleasant." He did not report being incontinent.

Of course, not all AB/DLs with Asperger's thought it was the cause of their interests: One wrote "I do not think my mental condition(s) affected my being an AB/DL. As for diagnoses of ADHD and Asperger's, the latter came from a neuropsychologist who noted that the earlier verdict of ADHD was most likely a misdiagnosis. Probably the only effect it would have had on my early development as AB/DL was to turn my observations inward so I was more likely to notice a fetish in myself than proper social interaction with other people."

Borderline Personality Disorder

Borderline Personality Disorder (BPD) is characterized by pervasive instability in moods, impulse control, interpersonal relationships, self-image, and behavior. Beginning in early childhood, its symptoms might also include frantic efforts to avoid abandonment and chronic feelings of emptiness (APA, 2000, pp. 708-710; Lieb et. al., 2004). The instability of self-image might cause a borderline individual to be conflicted about gender or race (Wilkinson-Ryan & Westen, 2000). Conflicts of age, such as an adult believing that he or she was a baby or child, might cause a superficial similarity to paraphilic infantilism.

A more broadly documented commonality with AB/DLs is the tendency for borderline individuals to have stuffed animals. It has been argued that an infant's "transitional object," a particular blanket for example, plays a role in his or her transition from infancy toward independence and a stable sense of self (Winnicott, 1971). Borderline individuals, who do not complete this transition, might continue to form such bonds with objects. This argument has been stretched to the point where even voice mail might be considered a transitional object for a borderline individual (Finch, 2002). Neither needing to be associated with a transition nor needing to be an actual object, anything could potentially be a declared an adult transitional object.

The presence of stuffed animals has been used as an indicator of BPD, called the "positive teddybear sign" (Cardasis, Hochman, & Silk, 1997; Mack & Viederman, 2000; Schmaling, DiClementi, & Hammerly, 1994; Stern & Glick, 1993). While an affection for stuffed animals is sometimes an used as a quick indicator of BPD, the American Psychiatric Association did not include it as one of the nine diagnostic criteria (APA, 2000, pp. 708-710). The false "teddybear sign" might increase the probability of receiving a diagnosis of BPD. A higher probability of a BPD diagnosis among AB/DLs would be consistent with the disproportionate prevalence but proportionate sex ratio shown in the survey data.

Of the AB/DLs surveyed that reported having BPD, 38% (9) thought that one or more of their conditions had caused their desires for diapers and/or babyhood, or that the two were the result of a common cause.

Having BPD affects how AB/DLs experience their desires. One participant commented "I'm not sure how to explain it. It's like my body grew up but my mind did not. I can function as an adult when needed but [I'd] much rather be a baby." Another wrote "My borderline personality definitely has to do with me being an AB/DL. I am so afraid of abandonment and rejection, and all I want to do it be held and cared for. Borderlines always want a mommy or daddy figure to come back and take care of them and love them. That is what I want. I figure if I'm a baby, I get reparented. Wearing diapers helps a great deal in this as it's such an intimate thing to get my diaper changed by another person. For someone to change my messy and wet diapers, it means that they truly care for me and are willing to take care of me."

Obsessive Compulsive Disorder

Obsessive-Compulsive Disorder involves recurrent obsessions or compulsions (APA, 2000, pp. 456,460-462). The association between OCD and being an AB/DL might be due an article about one patient, a man with recurrent, intrusive thoughts and behaviors involving diapers, crawling on the floor, etc. (Croarkin, Nam, & Waldrep, 2004) The impulse towards paraphilic behaviors, such as those common to AB/DLs, could be considered a compulsion. However, paraphilias are differentiated from OCD in that the actions of the former might be pleasant, while the actions of the later are thought necessary to avoid feared consequences (APA, 2000, pp. 456,460-462).

OCD overall has a broad onset age range and a sex ratio (percent female) near 50%. However, childhood onset OCD is more common in boys (Noshirvani et. al., 1991). It typically occurs at different ages depending on sex: modally 6 to 15 years of age for males and 20 to 29 years for females (APA, 2000, pp. 456,460-462).

One participant wrote "In regards to the OCD I have a strong dislike of tidy environments to the extent that I will pull things off shelves and leave piles of games, sketches, doodles or remnants of other activities strewn about to feel more comfortable with the environment. It results in a childlike messiness and reliance on others to clean up after me which furthers the mental undertones that I associate with the roleplay and environmental comforting side of being an AB." In contrast, another participant wrote "Because I have OCD, I have the need to be extremely clean about everything I do, including the the changing and cleaning up of my (or my girlfriend's) diapers. Usually, changes occur on my bed, but no matter what type of contact has been made, the sheets must be changed before I can sleep in the bed again."

Of the AB/DLs surveyed that reported having OCD, 29% (13) thought that one or more of their conditions had caused their desires for diapers and/or babyhood, or that the two were the result of a common cause.

Asperger's Syndrome, ADHD, OCD, and Tourette's Syndrome were clustered by one author, due to the similarities among their characteristic stereotypies, impulses, compulsions, and ticks (Atwood, 2007). Tourette's Syndrome was not surveyed specifically, but two participants mentioned having it in responses to an essay question (S2Q46). Neglecting the predominantly female late-onset OCD, these four conditions are predominantly male conditions with early or teen onset, similar to paraphilic infantilism and diaper fetishism. These commonalities suggest a mechanical similarity in the six conditions, even though they express themselves differently.

Conclusions and Limitations

Many conditions, outside of paraphilic infantilism and diaper fetishism, have been associated with the desires for diapers and/or babyhood. Typically, these associations have been based on an anecdotal connection or a few cases. In this study, the possibility of a relationships between those desires and epilepsy, incontinence, Asperger's syndrome, ADHD, autism, bipolar disorder, borderline personality disorder, DID, and OCD were explored.

While this study had the benefit of a larger sample size, its results are not without limitations. Specifically, participants were not examined individually and diagnosed specifically as part of this research. Participant's self-report of previous diagnoses had to be taken as reported. The sample size could moderate random variations, but would be unable to compensate for systematic shifts in diagnoses. The clearest example is Asperger's Syndrome: The same AB/DL might have not been diagnosed with autism, diagnosed with Asperger's Syndrome, or diagnosed with an autism spectrum disorder, depending on the AB/DL's birth year. Additionally, the sample size was arguably not large enough: Even given the overrepresentation of Asperger's Syndrome among AB/DLs, the sex ratios of Asperger's and the AB/DLs were such that less than one woman AB/DL with Asperger's was expected.

The majority of AB/DLs surveyed reported not having been diagnosed with any of these conditions. This suggests that, for the majority, their desires are not due to any of these conditions. However, for a minority of AB/DLs, there might be a connection between their desires and one or more of these conditions.

The connection with incontinence is reasonably intuitive, but the relationship was not simple. Some participants reported that their incontinence caused their desire for diapers and/or babyhood, while others report incontinence being the result of their desire. Others reported a more complicated relationship, and still others reported believing there was no relationship whatsoever for them.

Epilepsy, autism, and DID were each reported by only two percent of AB/DLs or less each, and so were not explored further.

The prevalence of Asperger's Syndrome, BPD, and OCD significantly exceeded expectations based on the general population, after correcting for the survey's predominantly male sample. That is, these conditions, or at least these diagnoses, are overrepresented among the AB/DL community. Asperger's Syndrome and OCD also had a significantly higher percentage of women than would be expected in the survey's predominantly male sample by mere coincidence. the overrepresentation of BPD might be due to infantilists' stuffed animals being wrongly interpreted as borderline individuals' transitional objects, resulting in an over-diagnosis of BPD among AB/DLs. ADHD and bipolar disorder did not appear to be significantly overrepresented among AB/DLs.

The disproportionate prevalence and sex ratio results suggest that there is a relationship between Asperger's Syndrome or OCD and the desire for diapers and/or babyhood in a minority of AB/DLs. It is possible that these other conditions caused the desires or were the result of some common factor. However, there are other possible explanations for these trends.

These results suggest a relationship between a desire for diapers and/or babyhood and incontinence (reported by 9.9% of AB/DLs), Asperger's Syndrome (3.6%), and OCD (6.5%). The majority of AB/DLs reported having none of the conditions surveyed.

Email BitterGrey Last Update: 21 Jan 2017| First: 5 Nov 2010

Do you have Questions, tips, suggestions, or other feedback?

1. ADISC (2008) Autism and diapers...? Retrieved Nov 4th, 2010, from http://www.adisc.org/forum/diaper-talk/1426-autism-diapers.html
2. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC, American Psychiatric Association, 2000, pg. 84
3. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC, American Psychiatric Association, 2000, pp. 708-710
4. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC, American Psychiatric Association, 2000, pp. 456,460-462
5. Arndt, William B., Jr. (1991). Gender Disorders and the Paraphilias, International Universities Press, pg 394
6. Atwood, T. (2007) The Complete Guide to Asperger's Syndrome. Jessica Kingsly Publishers. pg 20,46
7. Brown, R. T., Freeman, W. S., Perin, J. M., Stein, M. T., Amler, R. W., Feldman, H. M., Pierce, K., Wolraich, M. L. (2001) Prevalence and Assessment of Attention-Deficit/Hyperactivity Disorder in Primary Care Settings Pediatrics Vol. 107 No. 3 March 2001, p. e43
8. Cardasis W, Hochman J A, Silk K R: (1997) Transitional objects and borderline personality disorder. Am J Psychiatry 1997; 154:250-255 [PDF]
9. Croarkin, P., Nam, T., Waldrep, D. (November 2004). Comment on Adult Baby Syndrome. Am J Psychiatry 161:2141
10. Dailydiapers (2007) Are You An Autistic Ab/dl? (2007) Retrieved Nov 4th, 2010, from http://www.dailydiapers.com/board/index.php?showtopic=7503
11. Finch, S., J., (2002) Voice Mail as a Transitional Object in the Treatment of Borderline Personality Disorder. Can J Psychiatry. 2002 Dec;47(10):974-5.
12. Fireman, B., Koran, L. M., Leventhal, J. L., Jacobson, A. (2001) The Prevalence of Clinically Recognized Obsessive-Compulsive Disorder in a Large Health Maintenance Organization Am J Psychiatry 158 (11): 1904
13. Grey, B. T. (2009)Diaper Preference among AB/DLs Retrieved from http://understanding.infantilism.org/surveys/abdl_diaper_preferences.php
14. Judd, L. L., Akiska, H. S. (2003) The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases Journal of Affective Disorders, Volume 73, Issues 1-2, January 2003, Pages 123-131
15. Kessler, R. C., Adler, L., Barkley, R., Biederman, J. Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E., Zaslavsky, A. M. The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication Am J Psychiatry 163:716-723, April 2006 doi: 10.1176/appi.ajp.163.4.716
16. Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., Bohus, M. (2004) "Borderline Personality Disorder" Lancet 2004; 364:453-61
17. Mack A, Viederman M: (2000) The Use of a Transitional Object in the Context of Medical Illness. Psychosomatics 41:433-435, October 2000 [PDF]
18. Merikangas, K. R., Akiskal, H. S., Angst, J., Greenberg, P. E., Hirschfeld, R. M. A., Petukhova, M., Kessler, R. C. Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication Arch Gen Psychiatry. 2007;64(5):543-552.
19. Mitchell, W. (1954) Epilepsy with Fetishism Relieved by Temporal Lobectomy. Lancet. Vol. II, pp. 626-630
20. Noshirvani HF, Kasvikis Y, Marks IM, Tsakiris F, Monteiro WO:(1991) Gender-divergent aetiological factors in obsessive-compulsive disorder. The British Journal of Psychiatry 158: 260-263
21. Pandita-Gunawardena, R. (1990). Paraphilic Infantilism, A Rare Case of Fetishistic Behaviour. British Journal of Psychiatry. 157, 767-770
22. Remschmidt, H., Kamp-Becker, I. (2007) Asperger?s Syndrome ? an Autism Spectrum Disorder. Dtsch Arztebl 2007; 104(13): A-873
23. Robinow, Oliver (2009) Paraphilia and transgenderism: a connection with Asperger's Disorder?, Sexual and Relationship Therapy, 24:2, 143 - 151.
24. Rowland, A. S., Umbach, D. M., Catoe, K. E., Long, S., Rabiner, D., Naftel, A. J., Panke, D., Faulk, R., Sandler, D. P. (2001) Studying the Epidemiology of Attention-Deficit Hyperactivity Disorder: Screening Method and Pilot Results Can J Psychiatry 2001:46:931?940
25. Schmaling K B, DiClementi J D, Hammerly J: (1994) The Positive Teddy Bear Sign: Transitional Objects in the Medical SettingJ Nerv Ment Dis. 1994 Dec;182(12):725.
26. Stern T, Glick R: (1993) Significance of stuffed animals at the bedside and what they can reveal about patients. Psychosomatics 1993; 34:519-521 [PDF]
27. Wilkinson-Ryan, T., Westen, D. (2000) Identity Disturbance in Borderline Personality Disorder: An Empirical Investigation. Am J Psychiatry 157:528-541, April 2000
28. Winnicott, D.W. (1971). Playing and Reality. London: Tavistock Publications.

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