![[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 are collectively called adult babies and diaper lovers (or ABDLs). As a first step towards diagnosis, let's divide the AB/DLs into four groups. There are two overlapping groups with 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. Next, there are those who might also enjoy diapers or babyhood, but don't have a deep and specific desire for them. Finally, there are those with multiple symptoms, including those desires. This first step might be the only practical one, except for those with multiple symptoms.
ABDLs with only the one symptom might have 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 in 1987(APA 1987)[1](APA 2000 p 529)[2]. Both are categorized as paraphilias.
Both infantilism and diaper fetishism are single-symptom diagnoses, like "headache" and "joint pain" were once. Since desiring diapers or babyhood isn't that serious medically, there has been little research. ABDLs seldom need or seek medical help(Stekel 1952)[3](Pate 2003)[4]. 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)[4].)
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)[5]. An environmental influence is also present. Additionally, masochism (which arguably includes infantilism) is unique to the Western culture(Baumeister 1989)[7]. 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)[8]. 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)[9]. This, like most theories from within sexology, lacks testability. However, some theories outside of sexology might be worth noting. For example, Freud's defense mechanisms might give plausible explanations even thought they aren't testable (eg "Three Things to do with a Wet Knee Brace"). Attachment theory might also shed some light on the paraphilias, especially infantilism.
Conditioning experiments showed that arbitrary stimuli could be made erotic in the general population(Rachman 1968)[10] (Hoffmann 2004)[11]. 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)[12] These interests actually aren't a symptom. Medically speaking, there is no accounting for taste. Granted, it is a rare interest: Few who don't need diapers try them.
In the past, stigmas against diapers and "queer" interests kept those without a driving desire from experimenting. In contrast, those with infantilism or a diaper fetish generally would be compelled to practice them. Unlike those with kinks, ABDLs with diaper fetishism or infantilism might have struggled against the desire for years or decades. 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.
For clarity, this group would include ABDLs who don't fit in the other groups. Those in the other groups may develop kinks as well.
While these desires might be troubling and these interests might seem odd, they 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 (eg (Mitchell 1954)[13](Pandita-Gunawardena 1990)[14](Croakin 2004)[15](Miller 1986)[16]) 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)[17](Cardasis 1997)[18](Mack 2000)[19]. Among adults, "transitional objects" are indications of Borderline Personality Disorder (BPD)(APA 2000 pp 706-710)[20]. 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)[21].
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)[21]. 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)[21]. 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 these 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 surveyee 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)[22]. (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)[23]. The best option might be to moderate damaging practices such as binge and purge cycles, and carefully evaluating the acceptability these desires in light of their situation and beliefs.
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