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Try out PMC Labs and tell us what you think. Learn More. We hypothesized that ABDL phenomena were associated with general psychological maladjustment and with an experience of parental rejection during childhood. 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.
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. : 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 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. 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 ].
The first documented cases of ABDL are dated to , however, to date, there are still few studies that have described this phenomenon. Tuchman and Lachman [ 4 ] described a case of a year-old male who regularly wore diapers and masturbated when he wore them. In , 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 year-old male case who was hospitalized because he was affected 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. The data showed that ABDL phenomena were diffuse mostly among males. 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 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 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 case, sexual arousal concerns the submission and humiliation that are inside the sado-masochistic relationships [ 3 , 9 , 15 ]. In the second group, ABDL behaviours seem to have a mainly regressive nature or function. 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.
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. 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 ]. 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 deed 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 research on ABDL in the Italian context, our aim was to provide descriptive information on both ABDL phenomena and persons who have this behaviour. 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.
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 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.
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. Recruitment and testing conformed with the local Ethics Committee requirements and the Declaration of Helsinki. Participants ed 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 majority of the sample came from northern Italy. The main demographic characteristics are reported in Table 1. Demographic characteristics and descriptive statistics. Physiological: enuresis or issue of sphincter control; Psychological: i.
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. 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. In particular, in the second section participants were administered all the scales included in the Cognitive Behavioural Assessment 2. 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.
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, , a link to the online module was presented. The entire procedure required about 90 minutes for completion.
An ad hoc questionnaire was developed to collect the basic demographic information e. To obtain a broad-spectrum measurement of psychological well-being, all participants were administered the Cognitive Behavioural Assessment 2. The State-Trait Anxiety Inventory—X1 Form and X2 Form [ 30 ] are composed of 20 items that indicate the presence of anxiety, tension, and discomfort, or the lack of these moods. The X1 Form evaluates the presence of anxiety state; it is an environmental anxious state.
The X2 Form evaluates the presence of anxiety traits, which are personality dimensions that cause an increase in anxiety states in both anxious and not anxious circumstances. The battery also includes a short version of STAI-X1 10 items [ 27 ], which allows for an evaluation of the increase or the decrease of anxiety state while the subject is completing the protocol and it allows us to obtain an accuracy index of the battery. The Autobiographical folder—psychological anamnesis [ 27 ] is composed of 56 items, with multiple choice and open-ended answers, to collect anamnestic information.
This the part of test is meant to obtain information about the personal history, education, attitudes, and main relationship of the participant. Moreover, this section of C. The questionnaire is composed of 48 items subdivided into four scales: extroversion-introversion E , emotional instability N , social maladjustment P and control scale L. Subjects must assess whether the content of the items describes itself, through dichotomous answers yes—no.Adult diaper wearer
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An Exploratory Study of Adult Baby-Diaper Lovers’ Characteristics in an Italian Online Sample