Antonietta Lasala, Francesco Paparo, Vincenzo Paolo Senese, and Raffaella Perrella*
Author information Article notes Copyright and License information Disclaimer
Go to

Abstract

Background: Knowledge of the Adult Baby-Diaper Lovers (ABDL) phenomena is quite recent and there are, of yet, few studies on this phenomenon. Aim: This study was conceived to investigate the functions of ABDL behaviours and the characteristics of ABDL in an online Italian community sample. We hypothesized that ABDL phenomena were associated with general psychological maladjustment and with an experience of parental rejection during childhood. It was also assumed that there would be differences in ABDL profiles based on the age of appearance of their first Adult Baby-Diaper Lover (ABDL) fantasies. Method: An internet-based study was conducted and it involved 38 adults aged between 18 and 74 years (M = 34.95; SD = 12.25). Participants were first given an ad hoc questionnaire, which was devised to obtain information about the anamnestic variables related to ABDL. Then, the participants filled out the Cognitive Behaviour Assessment 2.0 battery to obtain anamnestic information regarding their psychological, medical, and personal history and to evaluate primary psychological dimensions in clinical practice. Finally, they filled out the Adult Parental Acceptance–Rejection Questionnaire, to evaluate their recollections of parental perceived rejection, and the Personality Assessment Questionnaire, to evaluate the primary psychological aspects related to parental rejection. Results: The data indicated that adults with ABDL showed the presence of anxious traits and recollections of parental rejection during childhood. Moreover, associations were observed between current or previous ABDL phenomena enuresis and negative mood states. Conclusion: Specific kinds of parental modes, anxiety traits, and enuresis seem to be the source of ABDL interests. Moreover, ADBL behaviours seem to assume different functions and meanings.

Keywords: adult baby, diaper lovers, paraphilia, paraphilic infantilism, fetishism
Go to:

1. Introduction

Typical and atypical sexuality is difficult to examine due to the intimate and variable nature of the study. Furthermore, the notion of sexual deviation changes with regard to different historical ages and, in its definition, is influenced by socio-cultural variables [1]. DSM-5 defines paraphilia as: “any powerful and persistent sexual interest other than sexual interest in copulative or pre-copulative behaviour with phenotypically normal, consenting adult human partners” [2] (pp 794). In recent years, in the paraphilic field, a peculiar phenomenon has been described, called Adult Baby/Diaper Lovers (ABDL), which concerns persons who act a voluntary regression to a previous age and/or wear a diaper for psychological reasons [3].

The first documented cases of ABDL are dated to 1964, however, to date, there are still few studies that have described this phenomenon. Tuchman and Lachman [4] described a case of a 29-year-old male who regularly wore diapers and masturbated when he wore them. In 1967, Diniello [5] referred a case of man who had orgasms when he wore diapers, and he adopted other infant behaviours, such as eating baby food or drinking from a baby bottle. Benthell [6] reported a case of a man with brain damage for whom wearing little girl clothes and the diaper was necessary to have an erection and sexual gratification. Evciment and Gratz [7] described a 57-year-old male case who was hospitalized because he was a TV ffected by hallucinations and had declared to have a desire to be 3-years-old children and to be nurtured by his wife as if she were his mother. In this case, sexual fantasies were not present, and the treatment and resolution of hallucinations did not lead to the dissolution of ABDL fantasies.

Kise and Nguyen [8] reported a case where ABDL interests were included in a gender dysphoria framework. The man required psychological counselling because of gender dysphoria but he did not perceive ABDL interests as a distressing factor. Cernowsky and Bureau [9] reported a case of a woman affected by depressive symptoms and ABDL interests who was asking for help only for the former symptoms, not for the latter. Banbury, Lusher, Lewis, and Turner [10] described a case of two adults who practiced ABDL and had a drug addiction, showing that in both cases, either the addiction and the ABDL practices could be considered an auto-medication practices carried out to face sexual abuses during childhood. In both cases, only the drug addiction was perceived as distressing or as a dangerous problem. Caldwell [11] referred to a man who masturbated while wearing a diaper and asked his wife that a diaper became a component of their sexual life.

More recently, Zamboni et al. [12,13,14,15,16], to describe the more general characteristics of the ABDL population, conducted a study using a large sample of ABDL, by means of standardized measures. In particular, the authors investigated the ABDL features in a sample composed of 1934 members of the online ABDL community. The data showed that ABDL phenomena were diffuse mostly among males. Male members identified their own ABDL interests before females, and they focused on the sexual dimensions of ABDL practices. Both males and females perceived the component of being dominated as the primary pleasant aspect of the ABDL behaviour [12]. About half of the sample were in a romantic relationship. In some cases, the ABDL desires were satisfied with a romantic partner, but about 50% of partners disapproved of ABDL behaviours [13]. The majority of the sample did not experience distress for the ABDL behaviours, but when present, the distress was related to other factors, such as the partner’s knowledge of ABDL interests, the fear of being discovered or being misunderstood, or the feeling of shame for family members [14].

 

In summary, the analysis of the literature available so far shows that behaviouristic patterns of ABDL are variable. Indeed, for some persons ABDL behaviours have a sexual aim [4,5,6,11], whereas for other persons ABDL behaviours do not have a sexual motivation [7]. Hawkinson and Zamboni [12], in line with other authors [1,7,11], have hypothesized the existence of at least two different subgroups of ABDL. Indeed, in their study [12] they observed that the link between infant regression and diaper fetishism were not always present. For example, some persons that were more focused on the regressive dimension declared that they perceived sexual arousal for other childhood objects as well. This interest did not fit the necessary criteria for a fetishistic disorder. For this reason, the authors hypothesized that interests in infant regression could have different meanings and functions in these two subgroups.

 

In the first group, ABDL behaviours seem to have a sexual nature and this condition has been named as “Diaperism” or “Diaper Lovers” (DL) [3]. In this group, some individuals are dominated by a fetishist interest in the diaper [9,11,12,17]; other individuals are excited by stool and urine release in a diaper. In this latter cases, a qualitative analysis made by Zamboni [15] showed that ABDL simulated excrementary functions with food or water to feel excited due to the dirty diaper’s contact with their genitals; other individuals can focus on diaper tissue and the tactile feel for diaper touch on the genitals [15]; whereas other individuals use ABDL behaviours as a part of a bondage discipline sadism and masochism (BDSM) sexual practice. In this case, sexual arousal concerns the submission and humiliation that are inside the sado-masochistic relationships [3,9,15]. For example, Zamboni and Madero [18] made an analysis of asexual individuals in the online ABDL community, confirming the hypothesis that ABDL, like BDSM, could represent a way to decrease anxiety and to sexually satisfy a partner.

In the second group, ABDL behaviours seem to have a mainly regressive nature or function. This condition is known as “Paraphilic Infantilism”, “Autonephiofilia” [19], “Adult Baby Syndrome” (ABs) [20], or “Adult Baby” (AB). Members of this group feel a wish to be a baby, adopting typical infant behaviour, such as wearing diapers, drinking from a baby bottle, playing with baby toys. These behaviours are likely aimed to encourage identification with a baby and to simplify infant regression [12,16,18]. Considering that for AB individuals neither research of sexual arousal nor sexual pleasure is a priority, it is not possible to consider this practice as a paraphilic interest or behaviour [10].

 

In this case, AB behaviours can be in response to different functions for different people [12]. For example, for some individuals, AB behaviour could have an interpersonal nature and result from anxious attachment with the main caregiver. For example, the infantile regression can be inserted in a role-play, defined by Lewis [21] “Ageplay”, with the presence of a partner in a “mommy” or “daddy” role. Zamboni [13,16] showed a greater involvement of both a romantic partner and other partners in AB practice among persons more focused on enjoyment role-playing and with higher levels of anxious attachment. Zamboni [16] and Zamboni and Madero [18] hypothesized that for these persons, AB behaviour was a way to create social, romantic and/or affective links, decreasing simultaneously interpersonal anxiety. For other individuals, AB behaviours could be a way to relax, to avoid negative mood state or daily responsibility, even to become a lifestyle [8,10,11]. For other persons, instead, AB practices could reveal the attempt to re-live and change their own childhood [22] and to accomplish love and acceptance not felt during childhood [12]. Finally, individuals are defined as ABDL when no specific classification about the motivation of the practices has been done, or when they present both infant regression and sexual connotation [3,12].

 

Given the variability of ABDL manifestations, a specific cause for the ABDL behaviours cannot be identified. In the literature, different hypotheses have been proposed for the genesis of ABDL interests. According to some scholars [3,8,10], ABDL practices are related to traumatic developmental experiences. In this perspective, ABDL interests are considered as a way to elaborate psychological conflict consequent to traumatic experiences from childhood, such as sexual or physical abuse or experiences of victimization.

 

For other authors, ABDL practices and fantasies are associated with a negative or inadequate parental relationship [16,22]. Supporting this perspective would be the extensive literature that highlights how an inadequate relationship with caregivers can lead to the development of atypical or paraphilic sexual desire [23]. Data confirmed the association between ABDL practices and the quality of the early parental relationship, showing that ABDL behaviours were more frequent in adults with an anxious attachment or negative parental relationships [12,16]. Moreover, Zamboni [16] found a positive correlation between AB role-play and being raised only by a mother.

 

Other scholars associate the erotic fixation and infant regression observed in the ABDL practices to the presence of incontinence [9,11]. For example, Cernowsky and Bureau [9], according to a behaviouristic perspective, have hypothesized that incontinence episodes lived during childhood were associated with negative parental reactions, that these parental behaviours generated negative feelings for children, and that wearing diapers decreased the negative arousal, determining safety and protection feelings, thus reinforcing the association between ABDL behaviours and a positive state. A similar hypothesis was formulated by Zamboni [15], who observed that some ABDL participants reported that their practices were related to their incontinence.

 

Based on the statements of some ABDL individuals, other scholars have hypothesized that ABDL behaviours can be considered the expression of more general dysfunctional coping strategies [10,11,22] carried out to avoid negative mood states, such as sadness and frustration, to decrease anxiety or to escape from daily responsibilities. This interpretation is also confirmed by the data observed by Hawkinson and Zamboni [12] that showed that, in males, the levels of anxiety or a negative mood state were positively associated with the frequency of AB role-play not with DL interest. Finally, according to some scholars [7,9,11] ABDL manifestations could reflect a behavioural spectrum, from paraphilic interest to obsessive-compulsive behaviours. In this perspective, ABDL could be a sub-clinical form of obsessive-compulsive disorder.

 

Starting from the above-mentioned considerations, the present study is designed to highlight the existence and the diffusion of ABDL phenomena in Italy. In fact, given that ABDL phenomena are still an under investigated field and given the absence of previous research on ABDL in the Italian context, our aim was to provide descriptive information on both ABDL phenomena and persons who have this behaviour. In particular, we have assessed the presence of the main elements associated with ABDL in the literature in a specific Italian population: persons who use ABDL online communities to express and share their own ABDL interests.

 

Moreover, as only one study showed an association between a negative or inadequate parental relationship and the appearance of ABDL fantasies [9], a second object of this study was to investigate if the adults with ABDL showed more negative recollections of parental acceptance–rejection compared with the general Italian population. The innovative aspect of our study consists of investigating, in a systematic way, the association between the degree of parental acceptance/rejection, both maternal and paternal, and ABDL practices. In particular, we hypothesized that ABDL interests are positively associated with the degree of experienced rejection from both parental figures. In this perspective, ABDL phenomena could be considered one of the possible consequences of perceived parental rejection during childhood [24,25,26].

 

Moreover, linked to this latter hypothesis, given that the literature (see Interpersonal Acceptance Rejection Theory, IPAR Theory, [26]) has widely confirmed the link between childhood rejection experiences and psychological adjustment, a further objective of this study was to assess whether the presence of ABDL fantasies were associated with a more negative psychological adjustment in general, when compared with the overall Italian population. Furthermore, given that, in the literature, ABDL phenomena were present in psychopathological disorders, such as depression [9] and obsessive-compulsive disorder [11], we wanted to obtain an evaluation of the main clinical problems most frequently encountered in clinical practice.

 

In particular, on the one hand we wanted to exclude underlying psychopathological conditions causing ABDL phenomena, such as the presence of obsessions that lead to compulsive behaviours, such as wearing a diaper. On the other hand, we wanted to have a clarified framework, both on the associations between ABDL phenomena and on other psychological issues, such as depressive mood states, specific phobias, or stress and its effect on physical states. Finally, given that an extreme variability of ABDL phenomena have been observed, we have hypothesized that there could be differences in ABDL profiles based on the age of appearance of the first ABDL-related fantasies. Indeed, given that it has been observed that some adults reported the appearance of fantasies already before or during adolescence, while others only after adolescence, a further and final exploratory objective of the present study was to compare these two groups on the psychological dimensions considered.

 

In carrying out this study, we have taken into account that it is rare that adults with ABDL seek psychological or any other help [8,9,14,16]. Therefore, it is impossible to define the incidence of this phenomenon in the Italian population or refer to specific facilities or centres. For this reason, participants have been recruited by means of the main Italian ABDL online communities’ websites and thanks to the help of the Chair of the Italian AB Nursery Association. Indeed, adult-baby nurseries are the only place where an adult with ABDL can carry out childish activities and satisfy their own desire to be a baby.

 

2. Materials and Methods
2.1. Sample

Recruitment and testing conformed with the local Ethics Committee requirements and the Declaration of Helsinki. Participants joined the study on a voluntary basis. Before taking part in the research, participants were asked to read and approve an informed consent document. Participants were informed about privacy, the use of data, the lack of payment for participation, and the possibility of interrupting their participation in the study at any time, without any personal or legal repercussion. Complete anonymity was guaranteed to all participants. To be eligible for the study, participants had to be more than 18 years of age and to participate in at least one of the Italian ABDL online communities. The final sample was composed of 38 participants, 36 males and two females. The age of the participants ranged from 18 to 72 years (M = 34.95; SD = 12.25) and they were from different regions of Italy. The majority of the sample came from northern Italy. About 50% of the sample had a level of education of Secondary School, 77% of the sample did not have a current relationship, and 64.8% of the sample had a job. The main demographic characteristics are reported in Table 1.

Table 1
Demographic characteristics and descriptive statistics. Adult Baby-Diaper Lovers (ABDL).

Variables %
Residence 
Northern Italy 65.8
Central Italy 18.4
Southern Italy 7.9
Other 7.9
Level of Education 
Junior High School 13.9
Secondary School 50
University (3 years) 13.9
Master Degree 19.4
Post-Graduate degree 2.8
Civil State 
Unmarried 77.8
With relationship 5.6
Married 11.1
Divorced 5.6
Work 
Student 21.6
Employee 43.2
Self-Employed 21.6
Unemployed 10.8
Retired 2.7
Appearance of first ABDL fantasies 
Childhood 55.3
Adolescence or adult age 44.7
Triggers of ABDL fantasies 
Physiological 15.8
Psychological 31.6
ABDL behaviour influenced by triggers 
Yes 44.7
No 55.3
Triggers to ABDL behaviour 
Negative mood state 23.7
Traumatic events 7.9
Incontinence 5.3
Other 5.3
Open in a separate window

 

Note. Triggers of ABDL fantasies: events associated with the genesis of ABDL fantasies. Physiological: enuresis or issue of sphincter control; Psychological: i.e., the loss of a parent in childhood, a lack of attention by parents, physical or psychological abuse, humiliating experiences. ABDL behaviour influenced by triggers: behaviours of ABDL are influenced by particular circumstances, mood states, events, or physical conditions. Negative mood states: frustration, sadness, stress, solitude, and the need of protection. Other: sexual arousal; satisfaction of a need.

 

2.2. Procedures
The research procedure was implemented in a digital format and it was implemented using an online module. The module was organized into two sections, preceded by informed consent. The first section was created to collect the basic demographic information and anamnestic phenomena related to ABDL. The second section was designed to collect information about the psychological, medical, and personal history of the participants and to get a global evaluation of the participant’s psychological well-being. In particular, in the second section participants were administered all the scales included in the Cognitive Behavioural Assessment 2.0 battery [27], the Adult Parental Acceptance–Rejection Questionnaire [28], and the Personality Questionnaire Assessment [29]. To contact the wider range of participants from the online community, the Chair of the Italian AB Nursery Association was asked to share the link to take part in the study on the main websites and online social communities dedicated to the Italian ABDL adults or linked to the official website of the AB Nursery: www.abdl.forumcommunity.net; the Italian section of the international website www.abkingdom.com; and the Italian community of Facebook “Adult Baby d’Italia e del mondo”. A brief description of the general aims of the study was given with the link. Participants could participate in the study by following the link. The administration of the protocol started after they accepted the informed consent. Starting from October 18th, 2018, a link to the online module was presented. The entire procedure required about 90 minutes for completion.

 

2.3. Measures
2.3.1. Ad Hoc Questionnaire

An ad hoc questionnaire was developed to collect the basic demographic information (e.g., date of birth, gender, employment, civil status, educational qualification, and family structure). This questionnaire was also finalized to obtain information about the age of appearance of ABDL fantasies and possible concomitant events (“In the year of appearance of ABDL interests and/or fantasies, can you remember some special events that could have had an impact on that appearance”) and about the influence imprinted by special circumstances, mood states, and/or physical conditions on the desire to act ABDL (“According to you, are your ABDL behaviours linked to special events; circumstances; mood states, and/or physical conditions?”).