![[Deutsch]](figures/deutsch.gif){kind=small}
By B. Terrance Grey
The reasons why people desire to wear diapers and/or be treated as a baby are as diverse as the people themselves. Those with these desires often self-identify as adult babies and diaper lovers (or ABDLs). As a first step towards diagnosis, let's divide the ABDL individuals into three groups. The first group includes those who might also enjoy diapers or babyhood, but don't have a deep and specific desire for them. The second group have only one symptom, a desire to wear diapers and/or be a baby. This desire is specific and persistent, and might be troubling. This group might be broadly diagnosed with paraphilic infantilism, a diaper fetish, or both. The third group includes those with multiple symptoms, including those desires.
Conditioning experiments have showed that arbitrary stimuli could be made somewhat erotic in the general population(Rachman 1968)[22] (Hoffmann 2004)[15]. These experiments exposed college students to pictures of neutral objects, such as shoes or coins, intermixed with erotic pictures. While these succeeded in causing an association (a "kink") they didn't demonstrate a compulsion (a paraphilia). 3% of ABDLs report developing their interests after being exposed to adult diapers, ABDL stories, etc.(Grey 2009a)[10].
Alternatively, Tiidenberg and Paasonen (2019)[24] write about ageplay as a BDSM practice, as opposed to an indication of paraphilic infantilism or a diaper fetish. Their sample was of women who identified as little girls in roleplay, joined by men who assumed the role of daddy. Arguably, they may have experimented with ageplay as part of adult sexual exploration and enjoyed it. The cultural boundaries against women being girlish are not as strong as those against men being babyish and/or wearing diapers. Some ABDL surveys report an older average age of onset for women (Hawkinson & Zamboni 2014)[14], specifically those that don't consider the right diaper critical(Grey 2008)[8]. Many ageplayers might not identify as ABDLs, and so not participate in ABDL surveys.
These interests actually aren't a symptom. Medically speaking, there is no accounting for taste. Granted, it is a rare interest. In the past, stigmas against diapers and "queer" interests kept those without a driving desire from experimenting. Few who neither need nor desire diapers try them. Diagnostically, this first group is the simplest. They might be able to point to a time in their adulthood where they experimented and found that they enjoyed it.
ABDL individuals with only the one symptom might be diagnosed with infantilism, diaper fetishism, or both. Diaper fetishism is, of course, a fetish where the erotic focus is on diapers. Infantilism is basically the desire to dress as and be treated as a baby. It was briefly yet formally defined by the American Psychiatric Association from 1987(APA 1987)[4](APA 2000 p 529)[5] to 2013. Both are typically categorized as paraphilias. (Alternative terms exist, but none are without historical baggage.)
In contrast to kinks and ageplay, those with infantilism or diaper fetishism generally would be compelled to practice them. They might have struggled against the desire for years. They would also tend to have become interested early in life, and may have done so in isolation, thinking that they were the only ones.
Both infantilism and diaper fetishism are single-symptom diagnoses. Since desiring diapers or babyhood isn't that serious medically, there has been little research. ABDLs seldom need or seek medical help(Pate 2003)[20]. In the future, they might be divided into proper syndromes, where clusters of symptoms are used to differentiate between specific conditions. (The phrase "adult baby syndrome" was coined for a TV show script(Pate 2003)[20].)
There are some trends among ABDLs that might give some clues about their causes. That ABDLs tend to be male suggests a strong biologic influence(Grey 2008)[8](Hawkinson & Zamboni 2014)[14]. An environmental influence is also present. Additionally, masochism (which arguably includes infantilism) is unique to the Western culture(Baumeister 1989)[1]. On average, an ABDL's preferred diaper is the one that was environmentally common during his early childhood, not necessarily the type he used as an infant(Grey 2009b)[9]. It is unknown whether this is the age range when the paraphilia forms, when the expression of an already-present paraphilia develops, or a mix of both.
There is, of course, no shortage of theories. One of the oldest might be Freud's proposal that fetishism was the result of castration anxiety(Freud 1905)[7]. These are discussed in more detail in What are Infantilism and Diaper Fetishes?.
Having infantilism or a diaper fetish does not preclude developing additional interests(Grey 2012)[12] and ABDL individuals report changes in the importance of aspects within ABDL fantasies and practices(Grey 2015)[13]. Because of this, it is uncertain if ABDL desires might be due to a single condition and later divergence of interests, multiple ABDL-specific conditions and later divergence, etc. For example, it might be difficult to differentiate between an individual with infantilism, an individual with a diaper fetish who acquired an interest in babyhood as part of ageplay, and an individual who enjoys ageplayer and includes diapers and babyhood.
While these desires might be troubling or odd, they generally aren't medically dangerous. Few ABDLs seek medical help. As a result, many cases in medical literature are actually unrelated conditions that coincidentally involved diapers or infancy somehow (e.g. (Mitchell 1954)[19](Pandita-Gunawardena 1990)[21](Croakin 2004)[3](Miller 1986)[18]) In addition to diapers, there are other sources of confusion. For example, an adult baby's stuffed animal might be confused with a "transitional object."(Stern 1993)[23](Cardasis 1997)[2](Mack 2000)[17]. Among adults, "transitional objects" are indications of Borderline Personality Disorder (BPD)(APA 2000 pp 706-710)[6]. The sex ratio (the ratio of men to women) of ABDLs diagnosed with BPD is close to what would be expected by coincidence, which suggests that the disproportionate frequency of BPD among ABDLs is an due to over-diagnosis(Grey 2010a)[11].
However, there are other conditions that are disproportionately frequent among ABDLs. One example is Asperger's Syndrome, a disorder on the Autism Spectrum. 4% of ABDLs reported having been diagnosed with it(Grey 2010a)[11]. They might come across as nerdy: Verbally articulate with specific interests, yet physically awkward with a difficulty reading emotions. Another would be Obsessive Compulsive Disorder, reported by 7% of ABDLs(Grey 2010a)[11]. Only early-onset OCD matches the sex ratio and onset age ranges typical of ABDLs. They would have an irrational drive to act to avoid negative outcomes. Each of these conditions can be differentiated based on their other symptoms.
In contrast to the others, this group might have a more serious condition, but also might be able to expect a better-researched diagnosis and more developed treatment options.
Academic curiosity and the desire to understand one's self are great reasons to explore the roots of one's desires. However, the causes might have more practical bearing on interpretations of the past and expectations for the future.
The ABDL's parents might be concerned that they did something to cause their child's desires for diapers or babyhood. In almost all cases, there is no reason to believe that the parents caused or could have prevented the development of infantilism and diaper fetishism. (Almost all cases, that is. One exceptional survey participant reported that his father had rammed a coat hanger wire down his urethra, causing emotional trauma and incontinence.)
The ABDL, or his parents, girlfriend, etc., might be seeking a "cure." The prognosis, of course, hinges on which group the ABDL is in. A kink might be easily given up or traded in for another kink. In contrast, infantilism and diaper fetishism are persistent. They are generally lifelong, although the urges might fade in later life(APA 200 p 568)[6]. (The author has corresponded with one man who claims to have "outgrown" his infantilism at 53.) There is no known cure. One unfortunate patient endured chemical treatment to "cure" another paraphilia only to end up developing a desire for diapers and babyhood(Lehne 2000)[16]. The best option might be to moderate damaging practices such as binge and purge cycles, and carefully evaluating the acceptability of these desires in light of their situation and beliefs.
Revised 16 June 2024: Updated to include ageplay, alone and in combination with infantilism and diaper fetishes.
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