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The Clinical Mental Health Experience of Persons with Paraphilic Infantilism and Autonepiophilia. A phenomenological research study - Chapter 1

Sections: Index- 1- 2- 3- 4- 5- a- b- c- d- References

Chapter 1 of The Clinical Mental Health Experience of Persons with Paraphilic Infantilism and Autonepiophilia. A phenomenological research study, a doctoral dissertation bDr. Rhoda J. Lipscomb, PhD, LPC, DAACS, BCPC. It is also available in PDF.

In the field of psychology and psychotherapy, there are numerous articles and chapters in text books devoted to the treatment of various paraphilia and fetishes, especially those that infringe on the rights of others such as pedophilia, exhibitionism, voyeurism, and frotteurism. The Diagnostic and Statistical Manual for Mental Disorders (DSM-5, American Psychiatric Association, 2013) and the legal system declare these disorders considered to be criminal offenses and problematic for society at large (Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 566). The DSM-5 definition of these particular paraphilias states they continue to be included “because of their noxiousness or potential harm to others, are classed as criminal offenses” (American Psychiatric Association [APA], 2013, p. 685). Many of these treatment strategies focus on psychological and pharmacological treatments intended to change or control the individual who exhibits these problematic behaviors. Very little is written or discussed regarding fetishes that are consenting and non-exclusive in a sexual manner yet cause the individual shame, embarrassment, depression, anxiety and difficulty in interpersonal relationships, especially romantic relationships. The focus of this dissertation will be on a greater understanding of the issues involved so that treatment of individuals presenting with sexually non-exclusive, consenting paraphilic infantilism and autonepiophilia receive more empathetic and compassionate care.

While young children might show a passing interest in diapers, the urges of those with paraphilic infantilism and autonepiophilia are generally life-long. It is reported that as many as 52% of individuals with these fetishes may try desperately to change. Few, maybe 0.1%, if any, are successful (Grey, 2011, para. 2). Autonepiophilia, also known as diaper fetishes or diaper lovers, are the easiest to understand. This is a fetish, a sexual attraction to diapers or other infantile objects. The diapers themselves serve as a sexual focus. Their idealized partner would be an erotic lover and if the partner is willing, diapers and other fetish objects would be incorporated into their sexual relationship (Grey, 2011, p. 2).

Paraphilic infantilism, or Adult Baby, is not a fetish (Grey, 2011, p. 2). It focuses on the self-image of the person who has an alternate self-image of a baby. This is similar to a transvestite, except that instead of engaging a female alter-ego every now and then, the paraphilic infantilists engage in an infantile alter-ego (Grey, 2011, p. 2). This may include the use of adult sized diapers, baby clothing, toys, etc. If the person’s partner is willing to engage in role-play, she/he will play the role of the parent or caregiver while the adult baby would play the infant, toddler or young child. Sex during the role-play is often thought of as incestuous. The adult baby and partner often have a typical sexual relationship outside of the infantilism role-play (Grey, 2011).

According to clinical research it appears that those who engage in these behaviors fall along a spectrum from only Adult Baby (11%), to mostly Adult Baby but sometimes diaper lover (14%) to mostly diaper lover sometimes Adult Baby (29%) to only diaper lover (18%) with about 19% feeling equal levels of each ("The Basics," 2013, p. 5).

In order to better understand the significance of this topic, it may be best to share a story of an actual event. A less seasoned therapist was asked by a clinical supervisor to assist with a session of group supervision. One of the supervisee’s presented a case of a couple where the male half was struggling with a diaper fetish. As the supervisee presented the case, she made it clear to the group that she found this patient to be freakish and perverted and presented her case in a way to induce the most shock of the group. The therapist, who was assisting in the supervision, was appalled that a professional counselor, even in the privacy of a group supervision setting, would discuss a patient in such disparaging terms. Even more to her disappointment was the fact that the clinical supervisor did not address this lack of professionalism or obvious prejudice by the supervisee or how this bias could affect the level of treatment this couple would receive. The importance of this matter became even clearer a few months later when her first diaper fetish patient entered her office seeking therapy. Over the past few years, additional patients have found their way to her office door so the thoughts about the best practices for treatment of these individuals have been molded through professional experience. Since there is limited data written on the treatment of individuals with autonepiophilia or paraphilic infantilism, as the saying goes: “To quote Indiana Jones, we are making this up as we go along” (Pate & Gabbard, 2003, p. 3).

The Problem

Discussions with sexual therapists, who specialize in patients with alternative means of sexual expression, has brought up the question regarding why more fetish patients with issues of shame, self-esteem building, as well as management of depression and anxiety symptoms do not seek out psychotherapy. The psychotherapy and psychology field have a long and less than stellar history when it comes to the area of understanding and normalizing human sexual behavior (Bullough & Bullough, 1977). In some ways the field continues to remain stuck with judgmental attitudes toward human sexuality despite great advancements in ideology, for example, views regarding homosexuality. While psychology and psychotherapy have made advances, further study is necessary to address the attitudes of the field regarding diaper fetishism. Specifically, there may be an opportunity for a new respect for those patients who are brave enough to seek therapy for issues relating to fetishes after reading only the abstract of a professional journal article from 2005 called “A case of diaper fetishism.” In the abstract alone, the term “perverted” or “perversion” was used four times to describe the 22 year old patient presented in the article (Oguz & Uygur, 2005, p. 133). With this level of bias in a peer-reviewed journal article, one wonders how the profession of psychotherapy ever expects those from disenfranchised communities such as paraphilic infantilism and autonepiophilia, to trust that they will receive anything other than judgment and ridicule, rather than, empathetic and compassionate care.

Yet positive and compassionate stories of experience with psychotherapists also are found in the literature. As one individual writes, “as I become more aware of my internal needs and wants, I accept them more. Through therapy I am slowly getting to accept this aspect of myself, but it is difficult and a long road” ("Survey #2," 2009, p. 2). Most have a very similar theme when they talk to a therapist who tells them that as long as the person is not causing harm to themselves or others, is able to engage in typical sexual encounters with a partner and it doesn’t interfere with daily activities such as work, that it is OK and there is no reason to stop the behaviors ("Survey #2," 2009).

Much of the understanding regarding fetishism has been documented between 2006 and 2013 by B. Terrance Grey, a self-defined diaper fetishist, in a series of surveys with up to 2000 men and women who identify engaging in this phenomenon. While the psychological community has made little headway with formalized studies into this area of sexology, it appears those within this community have taken it upon themselves to create a wealth of sexological studies worthy of serious attention. Based on the lack of credible peer-reviewed studies in this unique area of paraphilia, a combination of both academic and infantilism/diaper fetish community resources will be used to create the most accurate portrait of the historic and modern day environment for patients and how the psychotherapeutic community might more effectively engage this population for treatment.

Purpose of this study

The purpose of this qualitative phenomenological research is to explore the participant’s world view and perspective. It will use a social constructivist model and a phenomenological inquiry to describe and understand the sexual lives of individuals who practice these particular fetishes (Creswell, 2014) by conducting open-ended and semi-structured interview questions, assessed by mining the data to explore the participants lived experiences and perspectives. The objective of this research will be to look back at common beliefs about the paraphilic population; to propose some new ideas for building a more effective therapeutic alliance, especially trust, in the psychological profession and treatment ideas that respect the unique flavor of this group of people.

The rationale of this study is to continue upon and add to the discussion of those voices in the field of psychology, psychotherapy and sexology who advocate for more balanced treatment approaches for those patients who would be diagnosed with paraphilias, especially those of a consenting, non-threatening manner. There may be reason to believe that “paraphilias, sexual orientation, and gender identity are not learned, or at least not learned the same way sexual dysfunctions are learned” (Moser, 1992, p. 65) so that we may need to begin to consider broadening our understanding of these definitions. The researcher hopes to discover whether the findings from this research provide significant evidence such that advocacy and resource development may be necessary to reach the underserved members of this community by the mental health community. It appears that many of these individuals suffer needlessly with treatable symptoms of shame, low self-esteem, depression and anxiety rather than risk how they fear they will be treated should they seek mental health treatment (Speaker, 1986).

Research Questions

As the research regarding this area of sexology was analyzed, a number of questions became apparent as needing to be considered.

  1. The research indicates that many individuals who engage in paraphilic infantilism cannot identify a trauma or event that caused their atypical sexual interests. Could these atypical sexual interests be a type of sexual orientation similar to heterosexual, homosexual or bisexual?
  2. Is it possible for individuals who desire paraphilic infantilism to engage in these behaviors in a psychologically healthy manner? Is it possible to treat the symptoms with which many in this community suffer (depression, anxiety, low self-esteem, shame and embarrassment) by encouraging the use of their atypical sexual behaviors in a consenting manner?
  3. According to the research, only a small percentage (12%) of individuals who engage in paraphilic infantilism will admit to a therapist about their atypical sexual behaviors and seek treatment. Of those, the majority (91%) report the experience as between very helpful to no effect and only 9% report the experience as hurtful or very hurtful. If this is true, what causes so many in the paraphilic infantilism community to be distrustful of the mental health community?
  4. Many individuals who engage in paraphilic infantilism suffer with untreated conditions that are easily managed with psychotherapy due to their distrust of the mental health community. What, if anything, could the mental health community change to improve the level of trust from the paraphilic infantilism community?


Limitations: A phenomenological study of only a few individual men has limitations when applied to the larger community of individuals with the same type of paraphilias. The fact that this study had only male participants and no female participants is another obvious limitation. While the majority of individuals with these particular paraphilias are predominately male, there is a larger than average number of female infantilists as the literature shows and the research will discuss later. There was the assumption that the answers given by the participants in the study were honest and forthright, however due to the high levels of shame and embarrassment regarding the atypical behaviors engaged in by members of this fetish community, complete honesty cannot be assured.

Delimitations: This phenomenological study was set up to use individuals from the State of Colorado, in the United States of America. It was limited to individuals between the ages of 25 to 45 years of age, individuals who were actively involved in either age play or diaper fetish, the participants could have had experience with the mental health community or may not have had any, their education level as to be minimally currently enrolled in an undergraduate college program or graduated, their fetish play will be of a consensual nature, and their sexual behavior will be non-exclusive in regards to their fetish.

Definition of Terms

There is a difference between the psychological terms and the terms heard within the communities of individuals who engage in these unique fetishes. For the broadest level of understanding, the variety of terms that may be encountered range from academic, peer-reviewed journal articles and text books to the Internet web sites that cater to the unique fetish communities as well as the vernacular of patients who present themselves in clinical practice.

Autonepiophilia: Coined by John Money PhD, first in his 1984 article in the American Journal of Psychotherapy and later in his 1986 book Lovemaps. In his journal article, he defines it simply as “diaperism” (Money, 1984, p. 167). In Lovemaps, he expands his definition as follows: “a paraphilia of the stigmatic/eligibilic type in which sexuoerotic arousal and facilitation or attainment of orgasm are responsive to, and dependent upon impersonating a baby in diapers and being treated as one by the partner” (Money, 1986, p. 259).

Infantilism: “Described as a post-pubescent person seeking the emotional experience of returning to childhood or infancy using regression and/or other props, such as diapers, to build an authentic experience. Infantilists do not want to involve children; they want to be a child” (Bent, 2012, p. 13)

Psychosexual Infantilism: A term coined by Wilhelm Stekel to describe a phenomenon he observed in patients who he believed were seeking a source of erotic stimulation as well as sympathy and love from their parents by regressing into a state of childhood. (Stekel, 1952, Chapter 1) Also described as “the erotic return to babyhood” (Speaker, 1986, p. 1)

Paraphilic Infantilism: “A paraphilia characterized by the desire to wear diapers and be treated as an infant or toddler” (http://www.odd-sex.com/adult-baby-play-paraphilic-infantilism.htm)

Sexually Exclusive: “in which only the Paraphilic imagery and behaviors are fantasized during the desire phase, and produce sexual arousal. Other fantasies and behaviors do not elicit erotic arousal. (Granzig, 2012, p. 7)

Sexually Non Exclusive: “in which the individual has both normaphilic and paraphilic sexual desires.” (Granzig, 2012, p. 7)

Normophilia: “a condition of being erotosexually in conformity with the standard as dictated by customary, religious, or legal authority.” (Money, 1986, p. 266)

Paraphilia: “a condition occurring in men and women of being compulsively responsive to and obligatively dependent upon an unusual and personally or socially unacceptable stimulus, perceived or in the imagery of fantasy, for optimal initiation and maintenance of erotosexual arousal and the facilitation or attainment of orgasm.”(Money, 1986, p. 267)

Fetish: “is a narrower field of paraphilia, in which the source of stimulation or arousal is an inanimate article such as high heeled shoes, or a choker, or material such as fur, leather, or rubber.” (Bent, 2012, p. 198) Some authors also include arousal to specific parts of the body such as feet or hair (Bent, 2012, p. 198) while other authors define arousal to specific parts of the living body as partialism (Granzig, 1997, p. 2)

Ego-dystonic: The distress some individuals experience when their sexuoerotic desires are in conflict with their personal sense of right and wrong. (Granzig, 2012, p. 7)

Ego-syntonic: The lack of distress some individuals experience when their Paraphilic desires appear to be acceptable or even highly prized. (Granzig, 2012, p. 7)

Age-play: “Age-play is simply adults who are role-playing being a different age. During age-play, some people will take on the role of children while others take on the role of adult or caregiver roles. Age-play is simply a variation of erotic role-play” (Bent, 2012, p. 197).

Adult baby, Adult infant, Adult Toddler, Adult Pre-schooler: “The generic term ‘Adult baby’ comprises Adult Infants, Adult toddlers and Adult Preschoolers for Littles that identify as ages newborn to five years. Note these ages are at best approximate” (Bent, 2012, p. 197).

Little Ones or Littles: A common term used within the Adult Baby community to describe someone who enjoys infantilism and/or diaper fetishes. The age range can vary from Adult infant to Adult teenager (Bent, 2012, p. 13).

Big: “The regular, adult persona of an adult baby: or one who cares for adult babies” (Barber, 2011, p. 148).

AB/DL: Adult baby/Diaper lover (http://understanding.infantalism.org/)

Diaper lover: “A diaper fetishist who does not necessarily have an interest in infantilism.” (Barber, 2011, p. 148) Often diaper lovers have a strong sexual component to the fetish, however not always.

Regression: “The act of mentally returning to a younger age.” (Barber, 2011, p. 149) “is where the adult reverts to the behaviors and emotions of a younger age – usually infant or toddler” (Bent, 2012, p. 198).

Role play: “A theatrical practice in which people assume a role different from their actual role, in this context during sexual encounters” (Barber, 2011, p. 149).

This is only a partial list of the most relevant terms that will be helpful for readers of this particular study. For further study see http://understanding.infantilism.org and look under Glossary A/Z (Grey et al., 2011).

Importance of this study

A little over 40 years ago the American Psychological Association removed homosexuality as a mental disorder from the Diagnostic and Statistical Manual of Mental Disorders and as of August 2014, there are now nineteen states and the District of Columbia that have legalized same-sex marriage with the majority of the remaining states in judicial review of their laws ("Same-sex marriage," 2014). For those who have been alive during this time in history, the enormity of these changes, how it has impacted the mental health treatment approaches for gay and lesbian patients and the importance for the millions of American citizens these changes affect is abundantly clear. According to the literature, attitudes about infantilism and diaper fetishes have begun to change among those born in the past 20 to 25 years causing a trend towards being more well-adjusted within supportive communities and free of the emotional scars that those born prior to this time have experienced. This trend is expected to continue or increase (Grey, 2011). Just as the attitudes about treatment approaches for gay, lesbian and bisexual individuals has changed dramatically in the past 40 years with the changing cultural attitudes, it is time for the mental health profession to catch up with AB/DL community attitudes.

Dissertation: 2014| HTML conversion: 14 September 2014

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This work is copyright Dr. Rhoda J. Lipscomb, PhD, LPC, DAACS, BCPC, posted by permission. Dr. Lipscomb can be reached at dr.rhoda@yahoo.com.