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The Clinical Mental Health Experience of Persons with Paraphilic Infantilism and Autonepiophilia. A phenomenological research study - Chapter 4

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

Chapter 4 of The Clinical Mental Health Experience of Persons with Paraphilic Infantilism and Autonepiophilia. A phenomenological research study, a doctoral dissertation Dr. Rhoda J. Lipscomb, PhD, LPC, DAACS, BCPC. It is also available in PDF.

The research focused on understanding the worldview of four men from the AB/DL community in Colorado. Unlike previous studies conducted by Speaker (1986), Hawkinson and Zamboni (2014), or Grey (2006-2013) in which all of the participants were anonymous to the researcher, these individuals were known to the researcher and interviewed face to face with the set of questions identified in Appendix D, as well as given the questionnaire in Appendix C to answer privately. For research purposes, each of the participants was given a code to identify them and protect their confidentiality.

Due to the small sample size of this study, the findings presented cannot be generalized to the larger AB/DL community. Rather, the themes and patterns that emerged are an addition to existing studies as well as a means to promote ideas for future research in this unique area of sexuality studies.

The results of this study are mixed for the four research questions outlined in Chapter One, with research question #1 showing the strongest results. Following a reporting of the results of the research questions, larger patterns and themes that emerged from the research are discussed.

Research Questions

Research question #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?

According to the questionnaire results, all four participants reported a desire to wear diapers that appeared to have no preceding traumatic event, starting as early as age 6 (#003M), with two reporting approximately age 8 (#002V, #004B) and one with vague memories of a fascination with diapers at age 9, which became a desire to wear them by age 12 (#001R). Participant #003M summed it up in his face to face interview stating that as early as first or second grade “for whatever reason I had this thought that I wanted to wear a diaper… … why I do not really know.” This response was similar to most of the other participants in the study.

Conversely, participant #002V had the most unique experience. Starting at the age of 3 he reported having a condition called encopresis in which an individual holds their bowels and refuses to allow solid waste to be expelled from the body. This causes the bowels to become impacted, causing the liquid waste to go around the impaction and giving the person frequent accidents. While he stated that he was not sure what caused this condition, he said, “my diaper loving interest and an extension of that is toilet play definitely can be traced right to that.”

Use of diapers for sexual arousal during childhood (described as from the ages of 10 to 20 years) was reported on the questionnaire from a low of two times a year (#002V) to once every few months (#001R) to twice a month (#003M, #004B), and sexual fantasies involving diapers were reported more often, with one fantasizing monthly (#002V), one fantasying weekly (#001R), and two fantasying daily (#003M, #004B). For each participant, the results for frequency of sexual fantasies that did not include diapers were identical to the frequency of sexual fantasies involving diapers. In addition, the percentage of sexual fantasies that included diapers during the ages of 10 to 20 ranged from a low of less than 25% of the time (#002V) to approximately 50% of the time (#001R, #004B) to a high of 75% of the time (#003M). Participant #004B reported that his thoughts and fantasies involving being a baby started as early as fourth or fifth grade “when I first noticed I like to rub myself on carpet… There would be a little bit of stimulation there but never ending in ejaculation or anything like that.” By age nine or ten he “was very resourceful, as I was able to make my own diapers” and

“had desires for some of the neighbor ladies and older girls in the neighborhood. I wanted them to baby me, diaper me, and take care of me. I just had that fantasy, and I eventually began when I started masturbating that is what I would masturbate to.”

Participant #001R reported the thoughts began as early as fourth grade and “I really started to think about this on a more consistent basis in probably sixth or seventh grade.”

The participants were not asked specifically about the relationship with their mothers to explore whether there were any unresolved issues that may have also played a role in their desire for nurturing and being cared for in such a manner. The small amount of information provided by participants about their early maternal experiences does not give the impression that maternal care was lacking or that his had an influence on their later ABDL desires.

When asked if their other sexual interests were weaker than, equal to, or greater than their sexual interests in diapers, the results showed a strong preference for diapers. The responses were one weaker than (#002V), two equal to (#001R, #004B), and one greater than (#003M). The reason for engaging in diapers was unanimous, with 100% of participants responding that they “cannot help it.” Answers to the question “How often do you find diapers to be sexually arousing?” was split evenly, with half stating “most of the time” (#003M, #001R) and half stating “always” (#002V, #004B). Participant #001R stated that “over the years… it has become more sexual, and it has become more prevalent.” Participant #003M stated “going through puberty and becoming online sexually… it kind of morphed into this emotional, sexual, stress-relieving entity.”

These results, while small and not completely conclusive to the larger AB/DL community, indicate a strong likelihood that additional research is needed by the sexology community to investigate the possibility of broadening the definition of sexual orientation beyond our current understanding of the genders with whom people want to be sexual. While all of the participants reported positive sexual relationships with others at various points in their lives, and denied any specific childhood trauma that could be a contributing factor, and yet the desire for diapers and fantasies of being the baby remained.

Research question #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?

Study participants were asked if during their childhood years, between the ages of ten to twenty, they engaged in their fetish activities alone or with a consenting or non-consenting partner. 100% of participants answered that they engaged in these activities alone, with one (#004B) stating he once surprised a lover by wearing diapers on one occasion. He described this situation by saying, “it ended very quickly, and it ended very poorly.” He was unclear whether this happened during his teen years or during his early twenties. The value wearing diapers had to their emotional state during these years was also assessed, with 100% of participants stating that wearing diapers made them feel better and 50% (#003M, #004B) stating that it also functioned as a self-soothing mechanism. Participant #003M stated, “I have noticed… …wearing a diaper actually calms me down and helps me sleep.” Participant #003M was not clear whether wearing diapers to help him sleep was an activity he discovered in childhood or adulthood although he was clear he wore diapers in childhood. It appears the wearing of diapers along with fantasies of being taken care of served not only as an early sexual fantasy but also as a coping mechanism and a means of self-soothing when dealing with anxiety, depression, and stress, despite the price these individuals paid via the increased shame and embarrassment that came from doing something they knew their peers or families would not approve of them engaging in or understand.

All of the participants mentioned struggling with issues of shame, anxiety, depression, and fear of being discovered. As participant #004B stated, “I was depressed, and I was definitely anxious because you do not want anybody to find out, I mean you do not want anybody to know about this stuff, and it creates anxiety and stress.”

All of the participants reported using their fetishes not only as a private means of sexual arousal in fantasy and masturbation and most of them reported using their fetishes as a means of self-soothing relating to issues of stress, anxiety, depression and difficulty sleeping. There was only one report of a study participant surprising a non-consenting partner with diapers and this appeared to have happened on only one occasion. Aside from that one occasion, all participants involved sexual partners in their fetishes, if they did so at all, after first talking with their partners about their fetish interests.

Research question #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?

The four participants in this study all sought out therapy for a number of reasons. 100% of them sought therapy to help them understand their diaper fetish and difficulties in their relationships. It was not specifically stated by the participants whether their relationship difficulties were related to their fetishes or other non-related relationship issues. Of the various options listed on the questionnaire, 75% listed understanding age play and depression, 50% listed anxiety and looking for a “cure,” and only 25% listing anger management, self-esteem, and non-fetish sexual issues. 50% made their disclosure to their therapist in the first session, while 50% took several sessions, without stating how many sessions was defined by ‘several’, in order to build that level of trust. 100% stated that their therapists’ reaction to their issue was knowledgeable, compassionate, and understanding with no desire or intent to “cure” them of their fetish. Two of the participants entered therapy initially wanting a “cure” for their fetishes and chose to remain in therapy upon learning there was no cure and learning to accept them as they were was the best approach to treatment.

In the AB/DL community, beyond the on-line world of anonymous web sites there appears to be a lack of a true face to face community, as most of the participants in this study (75%) did not know or have friends within the larger AB/DL community. Therefore, most could not answer the question as to what caused others not to seek therapy. #003M was the only member with ties to others in the local AB/DL community, and in his opinion many he knew avoided therapy due to their fear of judgment by a therapist as well as their belief that a therapist would pathologize their fetish as the cause of the symptoms of depression, anxiety, or self-esteem issues. He stated,

“From the people I know in the community and myself, it does seem like depression, anxiety, anger, stress—all that stuff can really, kind of—it seems to be quite apparent within the community, and it seems like a large part of that is due to the fact that most people keep this very secret.”

It was the expectancy that this research would shed further light onto the question about what stops those who engage in paraphilic infantilism and autonepiophilia from seeking help from the mental health community. Unfortunately, the data collected from these research participants was inadequate to fully answer that question.

Research question #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?

The answers to questions that related to this research question were not as consistent among the participants as with previous questions, so a clear answer to this question continues to be elusive. The most consistent answer the participants agreed upon was that the therapeutic community needs to be able to express that it is possible for those with these fetishes to be accepted for whom they are and that therapists will also teach them the tools to accept themselves. Participants stated what was helpful for them, such as #003M’s statement that

“from all my experience actually getting to sit down with somebody and discuss this and being able to feel safe about it… …has helped tremendously with me being able to kind of integrate the whole AB/DL thing into me and not have the depression and stress and everything surrounding it as much.”

Participant #002V stated, “I think it is lack of acceptance [that keeps people from getting help]. Even myself, I think a lot of people are afraid that they are going to be judged by the therapist.”

This research question failed to create the data necessary to fully support an adequate answer. Further research would be necessary to better understand the changes necessary to bring more AB/DL people into therapy and help them to feel they will be treated with understanding and acceptance rather than the judgment they fear.

Patterns and Themes

The data from this research produced a number of patterns and themes about the individuals who engage in these unique fetishes. The comments from the face to face interviews identified in Appendix D as well as the self-administered questionnaire in Appendix C suggest that there is little in common amongst members of the AB/DL community. Many in this community live an isolated existence involving very few people whom they trust with their secret life. Most appear to make few connections with others in the AB/DL community, and, other than their intimate partner and therapist, they lack a strong support network for their AB/DL issues.

Participants were asked in their current adult life which typical AB/DL behaviors they engaged in and then quantify it as “never,” “rarely (less than once a year),” “sometimes (1-10 times per year),” “often (1-20 times per month),” or “daily.” 75% stated they wore diapers “often,” while one participant (#002V) indicated “sometimes.” Wetting diapers during the day was at 50% stating “sometimes” and 50% stating “often.” Wetting diapers at night was less frequent an activity, with 75% stating “sometimes” and one participant (#002V) stating “never.” Soiling a diaper was a less frequent activity, with 75% stating “sometimes” and one participant (#003M) listing it as “rarely/sometimes.” Rarely/sometimes was not an official category however this participant marked both categories so it was listed in the data this way. Masturbating in diapers was a more common activity yet still split between the participants, with 50% stating “sometimes” and 50% stating “often.” This information is shown in Figure 1 below.

Figure 1. Diaper behavior

Figure 1. Diaper behavior

Themes of BDSM (bondage and discipline, dominance and submission, sadism/masochism) appear to be a common practice linked to many of those who enjoy AB/DL play. 75% admitted to enjoying receiving bondage from “sometimes” to “rarely,” and 100% of them stated they enjoy being submissive to a partner, with 75% citing this as “often” and 25% as “sometimes,” although sex play with a partner while in diapers was low on the response scale (50% “never,” 25% “sometimes,” and 25% “rarely”). Part of the reason for the lower frequency of those behaviors could be based on whether the participants had consenting partners who wished to engage with them in these behaviors rather than their interest in the behaviors. Two of the participants stated they did not include their partners in sexual play that involved diapers because their partners preferred not to do it, and one answered that his partner will do it sometimes, yet begrudgingly. The majority of their AB/DL activities were performed alone, despite 75% of the participants reporting they were married and the single participant stating he had girlfriends/friends with benefits yet rarely had sex play with diapers. Two of the married participants admitted to AB/DL play with a professional Dominatrix and one with a phone sex operator. Across the board, 100% of the participants reported always playing the baby role when asked what role in diaper play they enjoy and prefer. This information is shown in Figure 2 below.

Figure 2. AB/DL sex play

Figure 2. AB/DL sex play


Patterns are items where at least 50% of the participants indicated an affirmative response to an answer. As studies by Speaker (1986), Hawkinson and Zamboni (2014) and Grey (2006-2013) have shown the interest in age regression, role-play, or diapers as a sexual fetish varies among the AB/DL community. The participants of this study were no different, with two participants (#003M, #001R) stating they enjoyed age-play regression, one participant (#004B) stating he enjoyed age-play role-play and sexualized diaper fetish, and one (#002V) preferring sexualized diaper fetish over age-play. Nursing from a breast was a behavior that only two participants stated they engaged in with any frequency (#003M stated “rarely” and #004B stated “sometimes”). Behavior such as use of pacifier was listed by two participants as “sometimes” (#003M, #004B) and two as “rarely” (#001R, #002V), and items such as use of bib, eating baby food, sleeping in a crib, using of high chair or playing with a teddy bear were only mentioned by one participant (#003M) as “rarely” or “sometimes.” Two of the participants reported no recollection of any child abuse (#003M, #001R) with one (#002V) reporting some emotional neglect and one (#004B) reporting some mild to moderate spankings.


Themes are areas where at least three or all four participants indicated a particular behavior, emotion, desire, or other issue. From the behavior standpoint there were a number of behavioral themes. Receiving bondage was a theme, with 75% of participants reporting it on occasion. All of the participants enjoyed masturbating and wetting in diapers during the daytime with various frequencies ranging from “sometimes” to “often,” while 75% enjoyed wetting them at night with a frequency of “sometimes.” 100% of the participants reported using AB/DL pornography to supplement their sexual lives, with one reporting it “rarely” (#002V), two “often” (#003M, #004B), and one daily (#001R). Most of the participants (75%) reported having sex exclusively with women, while one (#002V) reported having sex primarily with women.

Most of the emotional themes were expected of this group, with nearly all of them expressing emotions of shame, depression, anxiety, stress, and fear as well as often using their fetish behaviors to soothe themselves from these emotions. 75% of participants reported their early sexual experiences were positive ones, even though they did not include their fetish objects or behaviors in these early sexual experiences. Most of the participants felt a strong lack of acceptance by the non-fetish community, and some even felt some disapproval by the larger fetish community regarding age-play and diaper fetishes. Participant #003M, who had the most involvement in the local AB/DL and general kink community, stated, “AB/DLs are kind of categorized in this taboo category even within the kink community to a certain extent.”

The frequency of desire for wearing diapers as well as finding diapers sexually arousing varied among the participants. 75% often wore diapers, with 50% always finding diapers sexually arousing and 50% finding diapers sexually arousing most of the time. The age that the desire to begin wearing diapers started early for all of the participants, with one at age six, two at age eight, and one at age twelve. This showed that at least 75% of the participants experienced a desire for wearing diapers long before puberty began. The participants were unanimous in their desire to play the baby role, and 75% expressed a desire for a mother or mother figure or the desire to be nurtured and cared for by another.

The last strong theme that came out of the face to face interviews was a desire to express to the world that what they desired was not in any way related to pedophilia. Several of the participants feared being confused with such a label and went to great lengths to explain that they wanted to either regress or role-play the baby role, often in a sexualized way, yet had no desire to ever have any sexual contact with actual children.


The purpose of phenomenological research is to investigate the meaning of the lived experience of people to identify the core essence of human experience or phenomena as described by research participants (Bloomberg & Volpe, 2012). The four participants in this study, most of whom enthusiastically volunteered for the study, were known to the researcher either as patients in her psychotherapy practice or in her sphere of social influence. Because the participants were known to the researcher rather than anonymous participants as in most studies, this gave the researcher a unique insight into the lives of the four participants. All were given the option to end their participation within the study with no negative consequences to their therapy in order to avoid any ethical issues, and all continued their involvement without hesitation. They bravely chose to share some of their most intimate, embarrassing, and painful memories in the hopes of advancing the academic knowledge of the clinical mental health and sexology community. Much of their motivation was the hope that by participating in this study, there could be greater understanding, acceptance, and treatment for others who in the future become brave enough to trust the mental health community with their secret lives.

The members of the AB/DL community are as varied as the members of many disenfranchised alternative communities. The themes that were discovered by the research represent the values and beliefs of the participants regarding the meaning of their AB/DL desires in their lives. The most critical theme that emerged from the research was the desire for a mother or mother figure despite the evidence that none of those in this study reported a poor relationship with their mothers. Questions about the exact relationship with their mothers were never asked so whether participants had a positive or negative relationship with their mothers were not part of this study. None of the participants stated there was a lack of this relationship in their pasts, and the desire for that nurturing, caring dynamic remained as they grew older. Several of the participants stated in their questionnaires that they sought out professional sex workers to act out these roles when they were not getting enough of these desires met in their primary relationship and the use of fantasy or AB/DL pornography was not enough to satiate the need. The desire for these experiences began early in their lives: all reported they did not know what brought them on at the age they began, and none of them truly wanted to be relieved of their fetishes, even though two initially entered therapy wondering if there was a “cure.”

The participants discussed the challenges that these desires presented in their lives and the often elaborate ways they went about hiding their secret life to the majority of the world. While they discovered that using their fetish was a self-soothing way to manage emotions of depression, anxiety, stress, and problems sleeping, it also created strong emotions of shame, guilt, and fear that deeply affected their sense of self.

The act to seek therapy was a strong theme for all of the participants as a way to understand and address the AB/DL desires and behaviors and as a way to learn to manage their depression, anxiety, shame, anger, and stress as well as learn tools to help with self-acceptance. These men sought a way to understand their atypical sexual desires and put them in context with their greater role as productive members of society. All of these participants were college educated, employed, and involved with family, friends, and intimate partners. They sought help to understand that their desire for nurturing and being cared for as a baby. Often when they accepted the “little” side of them, as many called it, they discovered their adult side was better able to handle the stresses of adult life. While 100% sought out a female therapist with whom to share their secret life, this aspect was not part of the research, so its importance is unknown.

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.