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Ask the Mental Health Expert Archives 2001-2004

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Adult in Diapers

Q. We are faced with the issue of a 19-year-old male wearing a diaper and about 2 months ago, he chose to live with a 33-year-old man, although the 19-year-old maintains he is not homosexual. The 19-year-old believes that wearing a diaper is normal and that is what he wants to do. What category does this fall under? Are there some resources available? What might be the underlying reason for wanting to live in diapers?

A. If the urge or need to wear diapers is part of an overall problem in achieving fulfilling, age-appropriate sexual relations, it may represent one of the so-called paraphilias. This rather controversial group of disorders--and not everybody views them as such--includes conditions such as exhibitionism, cross-dressing (transvestism), and fetishism. This last category involves the use of non-living objects--such as women's undergarments, leather harnesses, etc.--as the preferred or exclusive means of achieving sexual arousal.

In the absence of the fetish object, the individual is often unable to become sexually aroused. Usually, this type of paraphilia becomes established in adolescence, and tends to be chronic. It is easy to understand why some of the paraphilia diagnoses (in DSM-IV) are controversial--some people would consider these categories as mere value judgments regarding what is proper sexual behavior. But the DSM-IV is careful to include, among the criteria for paraphilias, "...clinically significant distress or impairment in social, occupational, or other important areas of functioning."

Absent those features, it cannot be said that the person suffers from a real disease or disorder, even though many people might object to the behavior. With respect to wearing diapers in the case you describe, it is not clear that the person truly suffers from anything at all--though, of course, I can't rule that out. I would certainly be speculating if I gave you the underlying reasons why this individual does what he does. It may depend on when this behavior actually began.

Some people would differentiate a diaper fetish--which usually begins at puberty--from something called infantilism, which begins much earlier. There is very little professional information on this subject, but some interesting speculation by Kathi Stringer may be found on the website, http://www.toddlertime.com/dx/regression/infantilism.htm She argues that the onset of infantilism is in early childhood, and is associated with a deep-seated need to regress and identify with the infant personality. She associates this, in some cases, with a history of abuse or trauma, which the child seeks to counteract with fantasies of being cared-for (e.g., diapered) in the way infants are coddled. Stringer does cite a few references in the psychoanalytic literature--but I think these theories are sorely in need of well-designed empirical studies.

I think the more important questions to ask about the 19-year-old you describe are these: is he basically happy and able to function in the larger world? Can he deal with people outside his home in a reasonable and mature way? Can he earn a living? If the answer to all three questions is 'yes', I'm inclined to be less worried about him. If the answer to one or more of these questions is 'no', it might be useful to encourage this young man to get some professional counseling.

June 2003

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