Infantilism: Clinical Diagnosis and Practical Explication
by William A. Henkin, Ph.D.
Copyright c 1997, 2008 by William A. Henkin
[This essay was first published in CliniScope as Clinical Monograph #4, for the American Academy of Clinical Sexologists, 1997]
Infantilism is the eroticization of being treated as if one were a baby or a toddler. The preference for such treatment may take place in feeling, fantasy, and/or behavior, and may or may not involve support objects such as diapers and baby powder, rubber pants, nippled feeding bottles, playpens, rattles, and dolls.
Although it is mentioned in passing in the DSM-IV as one subset of sexual masochism (“a desire to be treated as a helpless infant and clothed in diapers,” American Psychiatric Association 1994, p. 529), infantilism is not a necessary or even a usual component of sexual masochism, nor is masochism (“the act [real, not simulated] of being humiliated, beaten, bound, or otherwise made to suffer,” American Psychiatric Association 1994, p. 529) a necessary or usual component of infantilism; neither are diapers a necessary component of infantilism, although they frequently are used in infantilist practices and some adults fetishize them who are not infantilists; and neither, incidentally, is infantilism a necessary or usual component of transvestic fetishism, although the two sometimes appear in conjunction with one another. Infantilism is a sexual fetish in itself, but, perhaps because it is infrequently seen by clinicians and is presumably relatively rare, it does not have its own DSM designation. For diagnostic purposes infantilism is appropriately coded 302.9, Paraphilia Not Otherwise Specified.
As a fetish, infantilism has both a clinically significant face and a clinically benign one. The two faces are distinguished in the same way they are distinguished with regard to other fetishes: the benign face is the “nonpathological use of sexual fantasies, behaviors, or objects as a stimulus for sexual excitement”; fetishes, including infantilism, become formally “paraphilic only when they lead to clinically significant distress or impairment” (American Psychiatric Association 1994, p 525).
For people who enjoy its benign face, infantilism is one form of erotic age play, in which consenting adults eroticize stylized behaviors or fantasies specifically on the basis of age to obtain pleasure and sometimes – as with any form of role play – to learn about themselves. Fantasies and erotic play in this genre of sexual theatre might include, for instance, a baby, a toddler, or a pre-teen paired with a parent or a parent surrogate, a grandparent or other elder, an authority figure such as a police officer, a schoolteacher, a nurse, or a nun, or another child of a similar or different age. Unless one of the age play roles is specifically that of an infant, however, the activity is not infantilism.
Many erotic infantilists do use diapers. Among them, those who were chronological infants when cloth diapers were the norm usually seem to prefer cloth diapers in their play, while those who were chronological infants after disposable diapers became popular generally prefer disposables (Henkin and Holiday, 1997 ). In addition to age fantasies, participants in infantilism or other forms of age play sometimes eroticize real or negotiated power differences or gender distinctions. This may be one reason the DSM-IV includes infantilism in its discussion of sexual masochism, and is probably associated with the extensive, largely self-published fantasy literature in the field concerning cross-gender infantilism forced on adult males by compelling women (e.g., Anonymous, no date). Infantilist groups often include among their ranks not just adults who enjoy being treated as if they are very young, but also adults who enjoy treating other adults as if they were infants, and who generally portray “mommies” or “daddies.” Although most infantilists, like most people, have a predominantly heterosexual orientation, homosexually oriented infantilists are well represented in social and support groups; in any case, males are so conspicuously more likely than females to practice infantilism (some estimates exceed 99% [e.g., Speaker, 1986]) that homosexual infantilist behavior literally cannot be uncommon where partnered activity occurs.
The clinically significant face of infantilism is what the psychoanalyst Wilhelm Stekel called psychosexual infantilism, which he regarded as a retreat from reality: a regressive psychic move toward a fantasy life whose goal is to become “the eternal infant” (Stekel 1952, p 85), helpless and irresponsible. As he describes their case histories, the psychosexual infantilists Stekel saw lived significantly disordered lives. Though chronological adults, most were severely, narcissistically dependent on what today we would call their co-dependent parents; they felt deeply inferior to other people; they felt depressed and out of control emotionally and were demonstrably out of control behaviorally; and they rarely derived erotic pleasure from their infantile activities, which more often concerned staying unemployed, isolated, and unencumbered in the parental home than with having a consenting adult sex partner feed them from a bottle, change their diapers, and lotion their genitals with arousal and/or orgasm as a likely goal or consequence.
While some of the behaviors and emotional needs that interested or informed Stekel’s clients are similar in nature to those encountered in the benign infantilism of erotic age regression – for attention, touch, and a surcease from care, for example – they are usually quite different in degree; and whereas the psychological profiles of erotic and psychosexual infantilists can and sometimes do overlap, suggesting that the benign and clinically significant faces of the fetish exist on a single continuum, their modes of expression can be greatly dissimilar if for no other reason than that the former generally exhibit a higher level of intra- and interpersonal functioning than the latter. Some of the psychosexual infantilists Stekel wrote about were anatomically under-developed, but that condition, which for Money (1961) defines morphological infantilism originating in hormonal imbalances, is neither a necessary nor a sufficient condition to define or express the sexual fetish under discussion here.
Like most people who discover they have sexual desires that lie outside the accepting arms of mainstream society, fetishistic infantilists often report that their early erotic experiences took place in isolation and in the belief that no one else in the world shared their interest. If they were lonely or isolated as children their sexual secret generally reinforced their solitariness, since they could hardly tell it to any of the adults they knew and quickly learned they could not tell other children either. As adults some infantilists discover the networks that connect people with similar concerns and expand their erotic and social lives to include a small circle of like‑minded friends through the mails, in newsletters, in internet chat rooms, or, less often, in groups that meet periodically.
Infantilism is not the same as sexual activity with minors, or thoughts and fantasies about sexual activity with minors, all of which are forms of pedophilia, although some pedophiles may be interested in sexual relations with children of the same, very young ages psychosexual infantilists sometimes express emotionally, and that many erotic infantilists like to imaginatively re‑experience for themselves. Deliberately cultivating an interest in infantilism has sometimes been used as an intervention in the psychotherapeutic treatment of active pedophiles, as a diversion to direct their attentions away from chronological children and toward other adults who may like to be treated as if they are children.
Like other fetishists, infantilists may “selectively view, read, purchase, or collect photographs, films, and textual depictions” of their sexual interests, and, like many other fetishists, they may “assert that the behavior causes them no distress and that their only problem is a social dysfunction as a result of the reaction of others to their behavior. Others report extreme guilt, shame, and depression” at feeling compelled to engage in sexual activities they do not like or feel to be immoral, or that compromise other aspects of their lives (American Psychiatric Association 1994, p 524).
Few sex therapists or psychotherapists see infantilists in their practices, partly because their numbers appear to be small and partly because the behaviors are considerably stigmatized. On the one hand, psychosexual infantilists of the sort Stekel saw are infrequently able to support themselves in a way that would allow them to seek individual psychotherapy even if they wanted to, and we no longer live in an era when grown children continue to live as dependents in extended families in their parents’ homes as they once more frequently did. On the other hand, some people who enjoy erotic infantilism may feel too embarrassed or ashamed to acknowledge their interest even in such a venue as a therapist’s office, while others may avoid psychotherapy or sex therapy because they prefer to see their erotic pleasure as a lifestyle rather than as a disorder to be “cured” (Speaker, 1986).
When an infantilist does show up in therapy, either to explore his fetish or to deal with other concerns, the therapist will usually have to exercise considerable patience to develop the level of trust and alliance she might anticipate sooner with most other clients. In psychoanalytic theory, infantilism is seen as a consequence of developmental arrest; according to learning theory, it is a result of rewards or punishments centered on specific behaviors such as bed-wetting early in life. Infantilists themselves have associated their fetish with a variety of instigators including childhood abuse and neglect, sibling rivalry, enuresis, and the pleasures of “stress-reduction and a reliable turn-on” (Speaker, 1986, p. 28). But from any psychological or sexological vantage, an interest in very young childhood so profound as to become associated with and even essential to a person’s erotic life bespeaks a need to tread cautiously around matters of early psychological or psychosexual wounding. Therefore, as with any other life disturbance, secondary diagnoses (e.g., sexual dysfunctions, depression, anxiety, character disturbances, work, intimacy, and relationship problems) may be apposite sequelae, whether the fetish itself is benign or clinically significant to begin with.
Because infantilism is so deeply concerned with feelings and behaviors that are taboo in our society (e.g., acting “childish,” being “helpless,” playing with children’s toys, explicitly enjoying urinary functions), an infantilist’s acknowledgment of his pleasures may arouse fear, anger, disgust, or other forms of displeasure in adults who do not share those interests. With infantilism, therefore, all therapists must be keenly alert to the possibility of counter-transference that points to their own unresolved issues with infantile or erotic behaviors.
Two Clinical Profiles
A. was a neatly-dressed 43-year-old heterosexual Caucasian male who earned a very modest living as a part-time computer operator: a job he found tolerable because he could do it at odd hours and it required little inter-personal contact. He did not like his work, did not want to work, and in fact worked no more than necessary to support himself minimally. He was referred through a sex information resource line, and presented complaining of difficulty finding sexual partners. He sat somewhat stiffly in his chair, kept a book on his lap throughout each of our interviews, and spoke in a deliberate, guarded manner with flattened affect.
A. described growing up as an only child with a father who was kindly but distant, and a mother who was short‑tempered, controlling, had infantile tantrums, and punished him severely by various modes including slapping his face and beating him with wire coat hangers even though, he said, he had done nothing wrong, was not a bad person, and did not deserve to be punished. His parents fought frequently, and his father withdrew from those fights into a private world. A. attended Catholic school, whose stability he liked, but his classmates picked on him and his teachers seemed to deprecate his efforts to be good.
A. identified the onset of his interest in infantilism at 11 or 12 years of age, and believed it derived from television commercials of mothers loving babies. He acknowledged pleasurable fantasies of being a baby. When he found infantilist publications and learned he was not alone in his interest he began to purchase incontinence products from mail-order companies he found identified in those publications. On several occasions he purged his closets and drawers of infantilist paraphernalia, but on each occasion began re-collecting material within a few months of the purge. He had visited professional mommies on several occasions, and though most times he felt humiliated or just felt like his adult self in diapers, which he did not regard as satisfying, he had had one good nurturing experience that way and, since all the other infantilists he had met were male and he regarded himself as heterosexual, he expected to explore this professional outlet for his fetish further.
A. had deeply unsatisfied needs for attention, comfort, nurturance, touch, and acceptance. He was introverted, narcissistic, and generally depressed. He had a great deal of rage toward both his parents as well as toward his peers, which he largely turned inward. He was frightened of intimacy and experienced immobilizing sorrow under what he felt somewhat desperately as the need to function as an adult. He masturbated once or twice a day, usually by rubbing his genitals through his diapers. He felt guilty about his sexuality, and did not know how to feel good about himself. He did not fantasize about sexual activities with adults of any sex.
In sex therapy mode I expected to teach A. to develop more options for fantasy and self‑pleasuring while he continued to work with the surrogate mommy with whom he had felt satisfied. In psychotherapy I expected to help him learn to re-parent himself and to gain insight into his process, and to consider expanding his social circle. But he remained guarded through three sessions, speaking almost monotonically and answering my questions very briefly. At the end of the third session, when I asked about future appointments, he made a fourth appointment for which he did not show up.
B., a 36-year-old unemployed gay Caucasian male, was referred for consultation by a professional dominant who specialized in infantilism as a mommy. As she had listened to his early childhood history of physical abuse by his father and sexual molestation by his mother, which included forced cross-dressing; to his adolescent history as a gay street hustler; and to his adult pedophilic fantasies in which he both molested young girls and was a young girl being molested, the mommy descried a persistent pattern of psychological dissociation similar to what used to be called multiple personality (American Psychiatric Association 1980) or multiple personality disorder (American Psychiatric Association 1987) and is now known as dissociative identity disorder (American Psychiatric Association 1994). When she explained what she perceived to B., and received confirmation through consultation, B. became extremely interested in his own care and worked closely with both the mommy and the consultant.
At the outset B. was intensely suicidal and self-mutilating: he had a history of overdosing with medications episodically when one alter wanted to go away, and of cutting his legs and arms with greater frequency when another alter wanted to relieve pain, feel vital, or express self-loathing. The infantilist turned out to be truly regressed: an infant alter who was afraid of adult male authority figures and made B. very reluctant to seek treatment either in private, which he could not afford anyway, or through public facilities. Since the mommy had established a strong alliance with B. she continued to work with him in her capacity as a mommy, but now more with an eye to helping him reparent his young alters than with providing an infantilist erotic experience, seeking psychotherapeutic consultation for herself and for him on a regular basis. After three years’ work B. was fully co-conscious, and an adult alter had taken executive control of his personality nearly all the time; after five years both B.’s suicidality and his other forms of self-inflicted violence had ceased altogether, and his youngest alters came out infrequently and with some pleasure instead of distress; after seven years he began to do volunteer work for a local disability center. He retained both infantilist and pedophile fantasies, but felt largely able to restrain the latter, and used the former as a form of pleasurable sexual expression.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, D.C., American Psychiatric Association.
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised, Washington, D.C., American Psychiatric Association.
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Washington, D.C., American Psychiatric Association.
Anonymous. Case Histories and Experiences of Adult Babies (no date). Seattle: Empathy Press.
Anonymous. Return to Baby Land (no date). Milpitas, CA: Amber Enterprises.
Henkin, W.A. and Holiday, S. (1997 ). It’s Never Too Late to Have a Happy Childhood: Infantilism and Erotic Age Regression. San Francisco: Daedalus.
Money, J. "Components of Eroticism in Man: I. The Hormones in Relation to Sexual Morphology," Journal of Nervous and Mental Disease. Vol. 132, 1961, pp. 239 ‑ 248.
Speaker, T.J. (1986). Psychosexual Infantilism in Adults. Sausalito, CA: DPF.
Steckel, W. (1952). Patterns of Psychosexual Infantilism. New York: Liveright.
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