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Sexual Infantilism in Adults: Causes and Treatment Part 3

Section 3 of Thomas John Speaker's Masters thesis "Sexual Infantilism in Adults: Causes and Treatment"

Causal influences in sexual infantilism:

It is difficult, if not impossible, to develop definitive, empirically-proven primary causal connections. In the past, behavior research has tended to focus in on a narrow aspect of the individual or the environment to the exclusion of the other variables which constitute reality, or to bend the reality through inference until it fits neatly into a particular model. Neither methodology provides a satisfactory explanation of the behavior.

The trend toward incorporating more factors influencing a particular behavior has led to the development of more global theories, systems models, such as the "ecological model". Systems models eliminate from study the fewest influences on behavior, presenting a scientific model which more closely parallels reality. An underlying assumption is that behavior occurs in an 'environment' of influences including physical setting, internal physiology, predispositions, time, and social roles -- a sociopsychological 'ecology' (Germain, 1979).

The ecological model follows the systems approach in eliminating the fewest variables influencing the behavior (Ibid.).

The ecological model does not correct the difficulty of defining primary causes with certainty, but does allow a better understanding of predisposing, precipitating, and reinforcing behavioral influences (Coleman, Butcher and Carson, 1980, p. 128).

Infantilist behavior can be viewed using an ecological model as relating to a number of causal factors: biology, stress (psychoanalytic view), faulty learning (behavioral view), blocked or distorted personal growth (humanistic or existential view), unsatisfactory interpersonal relationships and/or pathological social conditions (Ibid.).

Biological influences:

Coleman, Butcher and Carson (1980), in describing physio logical influence on behavior, have said:

... a wide range of biological conditions, such as faulty genes, diseases, endocrine imbalances, malnutrition, injuries and other conditions that interfere with normal development and functioning are potential causes of abnormal behavior (p. l28).

Several of these conditions have appeared in the literature on fetishes: genetic damage, endocrine imbalances, lesions of the temporal lobe, and enuresis.

Chromosomal abnormality was suggested by Kramp and Nielsen (1968) as a cause of "psychoinfantilism", a marked immaturity in several adult relatives of a boy with Down's syndrome (p. 19). If this immaturity or slowed development encouraged the subject to remain at an infantile level of psychosexual development, a causal relationship between adult infantilism and chromosomal abnormality could be demonstrated.

Nielsen and Thomsen (1972) replicated this research by comparing a group of twenty adult hospitalized females diagnosed as "psychoinfantile" and a matched group of twenty controls. They found "no connection" (p. 552). Among the case studies, only one person, C, reported any diagnosed chromosomal abnormalities. He has an XXY genotype and suffers from a chronic low testosterone condition, and none of the subjects exhibited the permanent, total form of regressive behavior exhibited in psychoinfantilism.

The case studies do not tend to support the hypothesis of genetic damage, yet the one diagnosis of chromosomal abnormality, the XXX genotype in C, points to a second possibility -- the influence of hormones on behavior. In C, the low hormone levels may have been more of a predisposing factor than his chromosomes. Money (1961) has suggested a link between hormone-influenced morphologic maturity and psychosexual development:

Morphologic maturity ... plays (an) indirect role in adult eroticism. ... as a prerequisite of normal maturation in the teens. Social maturity is significantly dependent on social interaction with persons of one`s own age, especially during the teens and early adult years. The person who looks sexually infantile is not fully acceptable to his group, since he looks much younger ...It is difficult for a boy who reaches the middle or late teens looking juvenile to behave in a socially mature and grown-up way, for other people, even close friends and family who know his age, habitually and unwittingly react to him in the basis of his physical appearance (p. 239).

Low testosterone levels could have slowed C's development of secondary sexual characteristics, and left him with an immature look. His appearance could have had a major impact on the reaction of his parents to the enuresis, influencing their tolerance to his needing diapers at age l2.

Hormonal levels were not evident in the histories of the other subjects but were found in a portion of other infantilism cases (Dinello, 1967). It would appear that hormonal influences can have an effect on the development of infantilism; further study is needed to determine the strength of predisposition. Hormone levels must be eliminated, however, a primary cause, "The direction or content of erotic inclination in the human species is not controlled by the sex hormones" (Money, 1961, p. 239).

Temporal lobe dysfunctions have been proposed as another possible physiological component of fetish etiology, in infantilism (Bethell, 1974) and other fetishes. Fetishists in some cases exhibited symptoms of epilepsy (Kolarsky, Freund, Machek and Polak, 1967); in others, they did not (Epstein, 1975). Epstein reported observable symptoms of temporal lobe damage in the non-sexual behavior of fetishists:

It should be noted that, at least in fetishism, the disturbance is not limited to sexual activity but is more widespread, involving varied behavioral areas (p. 253).

In the cases of infantilism in the literature and those presented here, only one case reported the appearance of behavior signs of brain damage (Bethell, 1974). Although it would take EEG readings of the l2 subjects to conclusively prove the absence of brain damage, the ability to conduct affairs at an adult level and the absence of epilepsy would seem to remove these subjects from the causal influence of temporal lobe lesions.

One physiological factor which did have predispositional influence on infantilism in these subjects was enuresis, "the habitual, involuntary discharge of urine after age 3" (Coleman, Butcher and Carson, 1980, p. 510). Statistics show:

Among 7-year-olds, an estimated 21.9% of the boys and 15.5% of the girls are enuretic, compared with only 3% of the boys and 1.7% of the girls at age 14 (Rutter, Yule and Graham, 1973), and only 1% or less in young adulthood (Murphy, et al., 1971) (Ibid.).

Among the cases presented here, five subjects (C,H,G,J and K) reported enuresis at least occasionally up to age 15, and each of them is enuretic now. A common remedy for enuresis was diapers, increasing the likelihood that diapers would be present at the onset of puberty when the behavior could be reinforced by sexual pleasure. Although enuresis can be caused by physiological conditions, most researchers attribute cause to psychological factors. In these cases, the eventual voluntary control of enuresis in all but one case (K) discounts the theory of organic dysfunction.

Psychoanalytic theory:

According to Freud, fetish behavior arises when normal sexual aim is somehow blocked and the emotional energy generated in sexuality is attached to an object instead of a person (Freud, 1962). Later theorists stated that a variety of conditions could create this 'block', such as castration anxiety (Bak, 1974), ego splitting and projective identification (Betty, 1972), and separation anxiety (Riophe and Galenson, 1975). There is disagreement about when the fixation which creates fetishes occurs, in childhood (Greenacre. 1968; Riophe and Galenson, 1973; Peto, 1975) or later (Fenichel, 1945; Bak, 1974; Storr, 1957). In addition, there is disagreement as to whether fetishes by definition are pathological (Stoller in Beach, 1976; Boss, 1940; Greenacre, 1968) or not (Freud, 1962; Storr, 1957).

It is impossible to evaluate the subjects' fetish in psychoanalytic terms: there simply is not enough information. But the case studies do lend some support to certain psychoanalytic concepts of fetishism. The choice of fetish object (i.e., diapers) does encourage the hypothesis of a latency period in fetish development (Bak, 1974). (The attraction to diapers would occur in infancy, be sublimated in childhood, and reappear during the stress of adolescence). Also the use of regression as a mechanism of ego-defense (e.g., E's explanation that diapers help in the abandonment of adulthood cares -- a return to care-free, cared for feelings of infancy") is congruent with psycho-analytic theory (Coleman, Butcher and Carson. 1980, p. 119). It is in the area of anxiety reduction and defense mechanisms that psychoanalytic theory has the greatest value.

Behavioral Theory:

Behavioral theory holds that fetishes are a conditioned sexual reaction. Sexual arousal is paired with particular objects, the behavior is reinforced by sexual pleasure and the behavior becomes assimilated (learned) (Bandura, 1969). This hypothesis has been tested and replicated in the laboratory (Rachman, 1966; Rachman and Hodgson, 1968), and is the basis for much of the therapy used to extinguish fetishes (Faustman, 1976; Marshall, 1974; Bebbington, 1977: Barlow, 1974).

The pairing of diapers and/or rubber pants with sexual arousal during early masturbatory experiences occurred in ten of the twelve cases presented. (D's first masturbatory experiences involved rubber sheets lubricated with urine, and E, although wearing diapers at age 16, did not begin to masturbate until after 18 years of age). The correlation between the presence of infant clothing during early masturbatory experience and the later arousal by these objects demonstrates a primary causal link between early sexual conditioning and adult sexual preferences.

It seems clear that although the link between fetish objects and sexual arousal may be made early but such learning in no way guarantees the continuance of fetish behavior. Maintenance is dependent upon many factors including repetition and reinforcement of the pairing of the fetish object and sexual pleasure (Bandura, 1969; Marquis, 1970). This occurred in all of the subjects.

Existential and Humanistic Theory:

According to humanistic and existential perspectives, blocked or distorted personal growth is a primary cause of psychopathology. Presumably, human nature tends toward cooperation and constructive behavior; if we show ... maladaptive behavior, it is because of distortion of our natural tendencies by an unfavorable environment (Coleman, Butcher and Carson, 1980, pp. l27-128).

As in psychoanalytic theory, it is difficult to assign cause using the information presented in the case studies. It is impossible to account for selective memory and other distortive effects in recalled histories. Yet, humanistic and existential concepts do have some support in these case histories.

Several of the case histories mention situations in which parents discouraged maturation either actively (G, who was diapered as "punishment": H, who was diapered for wetting his pants) or passively (e.g., J and K). J mentions this situation explicitly;

In a vast majority of children who are bedwetters, there is a situation where the child is treated like a baby. Many times the parents. usually the mother, likes to keep the child as a baby in order that he will build a dependence on her ... the use of diapers and plastic pants, beds with side rails, etc. ....encourages bedwetting. Diapers are put on for wetting, so why not? ... (T)he continuous treatment of the child as a baby ... will reinforce baby ways.

This attempt to retard or halt maturation (and accompanying independence) is especially obvious in the case of G, who was diapered for wetting the bed after age 6:

Gradually, she (Mother) started diapering me (for punishment) for other things such as ... playing in the water and getting my clothes or shoes wet, failing to eat all of my dinner at meal times, not minding her, etc. ...When I was 8-or 9-years-old, my parents wanted me to take piano lessons. Well, I love music but generally hated to practice the piano. Prior to Christmas (that year), a rumor was started around home that if my piano lessons did not get better, Santa might leave a pair of pink baby pants in my stocking. I laughed it off and ignored my lessons -- and in my stocking? Pink baby pants! From then on, if a practice went poorly, I was put into diapers and my pink baby pants and made to continue practice (C).

The social environment presented in the family could not only serve to block growth and maturation but also to encourage regression as in the case of sibling rivalry where regression to infantile stages in order to gain parental love and attention is positively reinforced. Rather than learning a new behavior, the child is encouraged to go backward.

There are also two cases presented here where friends aided to etiology of the fetish by reinforcing the social acceptability of regression, B and C. In C, reinforcement came after the fetish had been reinforced sexually, when he attended a summer camp at which he met other boys, some of whom were older, who were also in diapers; this reinforced C by assuring him that he was not alone in wearing diapers at this age. While this reinforcement would tend to decrease pressures for change, it probably aided C in self-esteem through reassurance that he "wasn't the only one in the world", a statement counselors commonly hear from persons practicing sexual variations. B also was reinforced socially by the neighbor boy who wore diapers and taught B to masturbate. This environment assured B that his interest in rubber pants was shared by at least one other person, and also allowed for the presence of diapers and rubber pants through B's early masturbatory experiences.

Factors in Maintenance of Sexual Infantilism:

That the diaper fetish persists in the face of some strongly negative pressures (e.g., E: "People may be willing to accept gayness, but someone who wants to wet or mess his pants??? Hardly.") is convincing evidence that the reinforcements for the behavior are also strong. These reinforcements can be divided into two categories although there is considerable overlap: sexual pleasure and emotional satisfaction.

The sexual pleasure experienced by the subject is obvious. Most reported the "turn-on" aspect of wearing diapers or practicing infantilism rituals with a partner was seen as the premier benefit. (Every subject answered "Yes" to the survey question, "Do you find wearing diapers sexually exciting?").

For some, the arousing quality lies in the fetish object (e.g., D: "I like the feel, smell, clamminess (and) bulkiness ... of diapers and waterproofs"). For others, the arousal was generated by less tangible qualities such as humiliation, embarrassment and taboo violation:

There seems to be a "put-down" or "humiliation" aspect. There is a keen sense of excitement wearing diapers (wet at times) in a crowd and no one knowing. There is an excitement in the risk of being caught wearing them. In addition, there is a feeling of embarrassment at "having" to wear diapers (J).

Within the last few months, I've found myself wetting my diaper before I realize that I am wetting. This excites me as does the fact that I'm wearing baby apparel instead of adult apparel (K).

There also is arousal in the belief that diapers are a "sure- fire" method of sexual release: "...I don't score with a trick as often as I'd like to. Fortunately ... I can "get-off" on diaper wearing" (G).

For many of the subjects, diapers enhance a-regression, if temporarily, to the feelings of childhood:

I feel a tremendous release in diapers, like I am loved and cared-for (F).

...it (infantilism) serves as a great emotional catharsis during times of stress... (E).

Rubber, diapers, baby food, clothes, etc., ALL LEAD TO FULFILLMENT .... It allows me to feel the feelings I was denied as a child (D).

For these people, infantilism is just as much a coping mechanism as it is a fetish. They are not fixated at a certain level, but rather behave as 'time-travelers', alternating between functioning at an adult level (managing careers, families, relationships, etc.) and functioning at an infantile level (wearing diapers, wetting, drinking from a baby bottle, etc.). Sexual infantilism behavior is compartmentalized, being a behavior that is engaged in only in certain times and situations when it seems "appropriate". There is a conscious decision as to whether to have an infantile experience or not, whether the motivation is for sexual pleasure or as a coping behavior. They use regression as a defense mechanism in times of stress to gather strength for coping or as a method of using illusion to maintain momentum in the face of a difficult reality (cf., Goleman, 1979).

Whatever the motivation, the subjects find the effects of infantilism to be positive and rewarding and this reinforcement maintains the behavior.


It can be seen that the case histories of sexual infantilists presented here support certain fetish models and act as 'deviant' cases for others. The ecological model, being the most flexible, is able to accommodate each of the behavioral influences and probably presents a picture of behavior which is closest to the data.

Although the subjects shared many similarities in experience, each developed the infantilism fetish through a unique set of circumstances, something which happens in all sexual development. Only one model of fetish development was strongly supported enough to justify the hypothesis of the existence of a primary causal relationship (the behavioral), yet even the behavioral theory required other ecological influences to maintain the behavior into adulthood. This suggests that no model which excludes ecological components will be adequate to explain a behavior as complex as sexual infantilism. Models of behavior which analyze the greatest variety of influences will tend to be more adequate in understanding causal relationships in behavior.

Treatment Recommendations:

The ethical implications of recommending treatments for fetishes will be discussed in the next section. In the past, therapists have generally recommended that all fetishes be treated, especially in the case of highly variant behaviors like sexual infantilism. Advances in assessment and treatment of fetishes have motivated a general rethinking of the need for therapist intervention which is particularly apropos in this study.

It is safe to say that those subjects who wish treatment should have it. None of the subjects expressed a desire to eliminate the fetish, but a few were concerned about behavioral self-control (e.g., E: "...occasionally, I feel consumed by the fetish and the many hours and dollars spent sustaining it. ...Also, there is the fear that it will prove to be a professional disaster"). These people would benefit from a therapy which enhanced feelings of self-management (Wilson and Davison, 1975). In addition, assessment and therapy should be individually tailored to the needs of the client.

For the others, it would seem to be best left as a matter of self-selection. Infantilism is a pleasurable and perhaps adaptive behavior for them. It would be difficult to remove (Sansweet, 1975), if it is not severely maladaptive or socially disruptive behavior, and there is little or no desire for extinction in the subjects. As long as the behavior is managed through discretion and does not involve criminal behavior, uninvited therapist intervention could easily be argued to be an unethical violation of individual rights.

Therapists must recognize that they can act as agents of social control, stigmatizing and managing the behavior of the client for an authority structure. Doing so encourages the client to submit to the whims of authority, thus increasing or at least maintaining the power of the elite and encouraging client dependency. Conversely, by supporting individual rights, therapists can encourage a reflective process in the client and enable the client to question the status quo (Halleck, 1971). This latter process seems much more humanistic, enabling the client to overcome social and psychological obstacles and actualize potentials. This direction involves a healing, a process of growth, whereas support of the social controllers may result in the therapist convincing the client to 'scar' and submit to 'cure'.

Examined: 9 April 1980| HTML conversion: 4 June 2010

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