11371_Transgender Individuals among an Online Adult Baby Diaper Lover Community Sample – An Exploratory Study

Minnesota State University, Mankato
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Theses, Dissertations, and Other Capstone Projects
2018
Transgender Individuals among an Online Adult
Baby Diaper Lover Community Sample: An
Exploratory Study
Elizabeth Gibson
Minnesota State University, Mankato
Follow this and additional works at: https://cornerstone.lib.mnsu.edu/etds
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Recommended Citation
Gibson, Elizabeth, “Transgender Individuals among an Online Adult Baby Diaper Lover Community Sample: An Exploratory Study”
(2018). All Theses, Dissertations, and Other Capstone Projects. 800.
https://cornerstone.lib.mnsu.edu/etds/800
Running Head: TRANSGENDER INDIVIDUALS AMONG AN ABDL ONLINE
COMMUNITY

1

Transgender Individuals among an Online Adult Baby Diaper Lover Community Sample: An
Exploratory Study

By
Elizabeth Gibson

A Thesis Submitted in Partial Fulfillment of the
Requirements for Degree of
Masters of Arts
In
Clinical Psychology

Minnesota State University, Mankato
Mankato, Minnesota
May 2018

TRANSGENDER INDIVIDUALS AMONG AN ABDL ONLINE COMMUNITY
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April 9, 2018

Transgender Individuals among an Online Adult Baby Diaper Lover Community Sample: An
Exploratory Study

Elizabeth Gibson

This thesis has been examined and approved by the following members of the student’s
committee.

____________________________________
Dr. Eric Sprankle, Adviser

____________________________________
Dr. Brian Zamboni, Committee Member

____________________________________
Dr. Jeffrey Brown, Committee Member
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Table of Contents
Abstract …………………………………………………………………………………………………………………….
4
Introduction ………………………………………………………………………………………………………………..
5
Literature Review………………………………………………………………………………………………………..5-14
Fetish/Paraphilia History
…………………………………………………………………………………………..
7
Transgender History
…………………………………………………………………………………………………
8
Purpose ………………………………………………………………………………………………………………..
13
Methods
……………………………………………………………………………………………………………….
15-21
Participants …………………………………………………………………………………………………………..
15
Measures
………………………………………………………………………………………………………………
16
Procedure
…………………………………………………………………………………………………………….
20
Results
…………………………………………………………………………………………………………………
21-25
Discussion ………………………………………………………………………………………………………………..
25
References ………………………………………………………………………………………………………………..
30
Appendix A ………………………………………………………………………………………………………………
34
Appendix B……………………………………………………………………………………………………………….
38
Appendix C……………………………………………………………………………………………………………….
44

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Abstract
There is a lack of literature on the transgender community and individuals with atypical sexual
interest which can lead to multiple aspects of stigma based on an individual’s gender identity and
sexual preferences. The current study used archival data that was collected by researchers at the
University of Minnesota in the Program of Human sexuality in 2011. Data was collected using
an online survey which sought to survey online communities of individuals who identify as
Adult Baby Diaper Lovers (ABDL). In this study, 83 transgender and gender variant individuals
were analyzed with five main research questions. We were interested in how the sample was
identifying their gender, their frequency and duration of ABDL practices, how their ABDL
behaviors functioned within romantic relationships, if negative mood states were associated with
ABDL behavior, and the participant’s opinions of their ABDL behaviors. Results did not
indicate significance on the specific research questions. However, most importantly, this study
aimed to increase the literature on under-researched populations to decrease the stigma
surrounding expressions of gender identity and atypical sexual preferences. Further implications
of this study are discussed.

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Introduction
The adult baby diaper lover (ABDL) community consists of individuals who refer to
themselves as adult babies (i.e., those who enjoy role-playing as infants or toddlers), and/or
diaper lovers (i.e., those who wear diapers voluntarily, but might not participate in other infant-
like behaviors) (Hawkinson & Zamboni, 2014). There have been a handful of case studies
examining these ABDL behaviors and practices beginning in the 1960s. Malitz (1966) and
Dinello (1967) were among the first to report on this phenomenon. These early studies concluded
that diaper-wearing among the individuals studied was a maladaptive behavior. Malitz (1966)
claimed that the 29-year-old male individual they studied wore diapers to regain the attention and
love from his mother. Dinello (1967) concluded that the 17-year-old male individual’s diaper
wearing was related to their parental relationship. These are the first cases of reported ABDL
behaviors that were studied and both cases were related back to the individual’s maternal
relationship.
Paraphilic infantilism was introduced by Pandita-Gunawardena (1990) when they
examined a case of an 80-year-old man with such interests. They concluded that the individual’s
behavior was a fixation on being a baby rather than a regression back to infancy. Next, Adult
Baby Syndrome was introduced by Sanders (1997) when they studied a 15-year-old boy with
paraphilic involvement with diapers. For this individual, Sanders focused his treatment on
changing the boy’s thoughts regarding sex and approaching the behavior in a nonjudgmental
manner to not assume that something was inherently pathological with the individual.
Researchers have related adult baby behaviors to other psychological disorders like
depression, obsessive-compulsive disorder, and inconclusive diagnoses (Croarkin, Nam, &
Waldrep, 2004; Evcimen & Gratz, 2006; Kise & Nguyen, 2011). Evcimen and Gratz (2006)
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studied a case of a 57-year-old male who presented with lifelong and persistent symptoms
associated with Adult Baby Syndrome including wanting to be, and act like, a baby. Evcimen
and Gratz found this individual wished to be a baby who wore diapers, but the individual denied
incorporating the diapers into any sexual behaviors.
While Evcimen and Gratz (2006) labeled the individual in their case study with Adult
Baby Syndrome, no definite diagnosis or label was provided to the 32-year-old individual case
examined by Croarkin, Nam, and Waldrep (2004). In this case, the person wanted to be treated
and act like a baby, but, similar to the aforementioned case (Evcimen and Gratz, 2006), he did
not find the diapers to be sexually stimulating.
Most recently, Kise and Nguyen (2011) examined a 38-year-old individual presenting
with Adult Baby Syndrome behavior, and they suggested a diagnosis of Gender Identity
Disorder. This diagnosis was concluded because the male-assigned-at-birth individual desired to
be addressed as female and that her infant-like behavior could be related to not expressing her
preferred gender since a young age.
These case studies are interesting because they show the different aspects of ABDL that
reflect each subtype: Some associating the practice with sexual stimulation, and others preferring
the role play aspects. Individuals practicing ABDL behaviors, both for sexual and nonsexual
pleasure, align with results found by Hawkinson and Zamboni (2014). Their results found two
subgroups to the ABDL community: Adult Baby, who role play as babies and use items relating
to infancy, and Diaper Lovers, who wear diapers voluntarily and are mainly interested in sexual
activity, but may not participate in other baby-like behaviors. Thus, the current literature has
begun to highlight the ABDL community, but not regarding how these practices and behaviors
are expressed in a transgender and gender variant sample.
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Fetish/Paraphilia History
The effects of pathologizing sexual paraphilias like ABDL and other paraphilias can
cause stigma within an individual and society (Giami, 2015). Up until 1975, the classification
produced stigma with the use of the term Deviation, meaning that atypical sexual interests are
somehow inherently pathological for deviating from the norm. With the DSM-III in 1980, the
term paraphilia was introduced under the new category of “Psychosexual disorders” (Giami,
2015).
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is utilized by
psychological, psychiatric, and medical professionals. The DSM has been modified throughout
the past decades to reflect the current diagnostic classifications related to gender identity. The
current diagnostic criteria state that “Paraphilias become pathological when they become a
substitute to coital sexual activity and, to some extent, exclusive and obsessive practices”
(American Psychiatric Association [APA], 2013; Giami, 2015). A paraphilia is an atypical
sexual arousal pattern that doesn’t cause distress or impairment so it would not be a disorder
(APA, 2013). Interestingly, fetishism is the only disorder in which psychological distress is
included as part of the criteria; this is only when the occurrence of the fetishistic habits starts to
negatively impact a person’s social life (APA, 2013; Giami, 2015). Money (1984) classified
“unusual sexual interests” similar to fetishes as atypical sexual interests are labeled as “unusual”
since, “they are not exclusively focused on heterosexual coitus and do not fit the heteronormative
norm; moreover, they do not fit with the standard of a loving or romantic reciprocal relationship”
(Giami, 2015, p. 1132; Money, 1984).
Under the Paraphilic Disorders in DSM-5, it includes Fetishistic Disorder, for which an
individual experiences distress and impairment due to their fetishistic interests. This diagnosis
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has had modest changes throughout the DSM’s history, but the main feature has maintained that
it includes “an interest in non-erogenous body parts in addition to an interest in nonliving
objects” (Krueger & Kaplan, 2012; APA, 2013). Fetishistic objects can include diapers and
related baby items, and these items are found sexually stimulating to some individuals because of
their texture or their smell (Money, 1984). Money also concluded that a diaper fetish
(autonepiophilia) has an early origin in life. While this diagnosis has not had as much
disapproval as the Gender Identity Disorders, some have debated over its removal because it can
stigmatize those individuals who practice such behaviors (Krueger & Kaplan, 2012).
Transgender History
Transgender and gender variant individuals have been documented throughout history
and across many cultures. Gender identity ranges across cultures including the two spirit
individuals in Native American tribes (Roscoe, 1991; Williams, 1986), acault in Myanmar
(Coleman, Colgan, & Gooren, 1992), maa khii in Thailand (Taywadietep, Coleman, &
Domronggittigule, 1997), travesti in Brazil (Kulick, 1998), and hijras in India (Bockting, 2014;
Nanda, 1999).
Transgender is used as an umbrella term to refer to individuals whose gender identity is
in contrast with their sex assigned to them at birth (typically based solely on the appearance of
the external genitalia (APA, 2015). Transgender individuals include transgender women and men
who feminize or masculinize their bodies through their attire and through possible hormone
therapy or surgery. Gender variant is another term used to embody individuals that express
themselves as neither strictly male or strictly female (APA, 2015). For this thesis, we will
conceptualize gender on a continuum rather than a male-female binary. With these terms in
mind, it is important to remember that each individual’s experience is unique to themselves and
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one term does not fit all.
With the transgender experience, this may or may not include a desire for social and/or
medical transition, which may include changing one’s name, receiving hormones, undergoing
gender-confirming surgeries, and changing legal documents, among others. Recently, some
transgender individuals have disputed that they are not experiencing their gender identity as
variations but actually on the complete opposite end of the gender spectrum (Bockting, 2014).
This distinction presents a difference in transgender and gender variant or non-binary gender
identities as gender variant individuals can present as different genders depending on how they
feel from day to day.
In the nineteenth century, theories regarding transgender individuals began developing in
the psychological and medical communities. Up until the mid-twentieth century, transgender
individuals were still considered as “psychopathological” (Drescher, 2014). With the revision of
DSM-III in 1980, Psychosexual Disorders became a category consisting of Transsexualism and
Gender Identity Disorder of Childhood (GIDC). This category was the first occurrence of Gender
Identity Disorder (GID) appearing as the disorder classification. This disorder was the first
descriptive, symptom-based diagnosis for transsexualism that also included a diagnosis for
children (Beek et al., 2015). The most significant change from DSM-IV to DSM-5 was moving
gender dysphoria into a separate category from sexual dysfunctions and paraphilias to sexual and
gender identity disorders (Beek et al., 2015). GID would be moved around to different sections
with changed diagnostic names in the following decades until under the current DSM, DSM-V,
they would be placed under Gender Dysphoria with a diagnosis for children/adolescents and
adults (Drescher, 2014).
There are still several controversies surrounding the diagnosis of Gender Dysphoria in
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DSM-5. These controversies reflect the issue of diagnosing gender expression and labeling it as a
mental disorder. Within the LGBT community, some people feel that this diagnosis should be
removed altogether as they see that it is wrong to diagnosis variations of gender identity and
expression as mental illness (Drescher, 2010). However, all medical treatments must have a
corresponding diagnostic code which is necessary for health insurance coverage, so other
individuals are apprehensive about removing gender dysphoria because of the need for insurance
coverage in treatment (Drescher, 2014). When 201 organizations world-wide, who work for the
well-being of transgender individuals, were surveyed by the DSM-5 GD sub-workgroup, over
half (55.8%) supported the removal of the diagnosis from the DSM. Nevertheless, the main
argument for keeping the diagnosis in the DSM was due to healthcare reimbursement (Drescher,
2014). Those fighting for the removal of the diagnosis argue that, in doing so, it would reduce
the stigma of mental disorders and increase acceptance in our society.
Another component in the debate for GD’s removal is that across cultures individuals
with psychiatric disorders are stigmatized (Drescher, 2014). Past researchers have argued that
transgender individuals face double stigmatization through being transgender and also having a
mental illness diagnosis. This stigma can create even more difficult circumstances for this
population, and some have argued that these conditions validate justifications in favor of moving
the GD category out from the mental disorders section (Drescher, 2014).
The sample for the current study consists of transgender and gender variant individuals
who also happen to be interested in ABDL sexual behaviors and practices. This sample could
face double stigma due to their sexual interests and gender identity, which could be a barrier to
seeking treatment or receiving quality treatment and care from practitioners. With the potential
of stigmatization because of their gender identity and an atypical sexual interest, our participants
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could face a compounding stigma. This double stigma from their gender identity and ABDL
could be an example of multiple forms of stigma our sample could encounter in their daily lives
and when disclosing to others. Link and Phelan (2001) describe the concept of stigma as existing
when elements of labeling, stereotyping, separation, status loss, and discrimination occur
together in a power situation that allows it. It is important for psychiatric and medical
professionals to examine their stigmatized views to assist and treat this underserved population
best. As Quinn and Chaudoir (2009) found, stigma affects gender identity, relationships, and
health outcomes. Thus, stigmatization of transgender and gender variant individuals with ABDL
interests and practices could be affected even more significantly due to their gender identity and
sexual preferences.
Transgender Stigma

The stigma associated with a mental health diagnosis related to gender identity is evident
in the history of the DSM (Drescher, 2014). The removal of homosexuality as a diagnosis from
the DSM in 1973 assisted in the beginning to remove stigma from the homosexual community.
With this elimination, many psychologists and psychiatrists left the stigmatizing and
pathologizing of homosexuality and sexual orientations in the past. With the backing of the
scientifically supported authority of the American Psychological Association (APA), a new
societal perspective began in which homosexuality was not seen as an illness. Not until the late
1990s did the transgender movement reach a more progressive perspective moving towards
acceptance of this gender identity (Drescher, 2014).
While the revisions in the DSM relating to the removal of homosexuality as a disorder
has shifted the heterosexual norm for sexual preferences to be more inclusive of the well-being
of individuals in non-procreative sexual behaviors, the stigma faced by transgender individuals is
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still alive today. In a national study of US transgender individuals conducted in 2013 found 70%
of transgender individuals reported verbal abuse and harassment due to being transgender, and
38% reported discrimination at their place of employment (Bockting et al., 2013).
Bockting et al. (2014) examined transgender men and women and found that their sample
had inordinately high levels of depression, anxiety, somatization, and overall psychological
distress. They concluded that these mental health results were not just a display of gender
dysphoria but actual distress related to enacted and felt stigma. Enacted stigma is described as
having actual experiences of discrimination, and felt stigma is described as stigma that is
conscious, anticipated, or perceived rejection, and both stigmas were positively related to
psychological distress (Bockting et al., 2014).
Transgender and gender identity stigma has been discussed but our sample could also
face stigma related to their alternative sexual interests and behaviors. Within the U.S., an
estimated 2% to 10% of the population participate in non-traditional sexual practices which are
commonly called kink, but can also encompass sexual role play or sexual paraphilia (Waldura et
al., 2016). An individual who practices ABDL could fall within this category of sexual paraphilia
and therefore, experience stigma from society because of their non-traditional sexual
preferences. When accessing healthcare, this stigma can affect an individual when they
experience stigmatizing interactions, stereotyping, or discrimination with mental and medical
professionals (Waldura et al., 2016). Many mental health and medical professionals may not
have the competency to work with individuals involved in alternative sexual lifestyles. The
National Coalition for Sexual Freedom (NCSF) does list mental health professionals who
distinguish themselves as “kink aware” (NCSF, 2012). However, the NCSF does not have a way
of screening these professionals to confirm their competency (NCSF, 2012). This can make it
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difficult for those who do not feel comfortable disclosing their sexual preferences in a mental
health or medical setting because of the potential for stigmatization to occur.
Purpose
For the current study, we are using archival data which was originally collected by
researchers at the University of Minnesota in the Program in Human Sexuality. An online survey
was used to recruit participants from communities of ABDL. We will provide descriptive
information and exploratory analyses on the 83 transgender, gender variant, intersex, and
transsexual participants not included in the original study’s analyses. We will use these data to
expand upon the previous research regarding this specific paraphilia and how it affects the
transgender and gender variant samples that were surveyed. We are expanding on an archival
dataset by examining the transgender and gender variant sample of responders with similar
inquiries as the original study conducted by Hawkinson and Zamboni in 2014 in hopes to expand
on gender differences concerning negative mood states, possible perceived problems, and
opinions of ABDL behaviors and practices. This research will assist in reducing stigma regarding
the transgender and gender variant communities and paraphilic preferences by increasing
competency in mental health practitioners working with these individuals. It will also increase
research on paraphilia in relationships specifically within the transgender and gender variant
communities which are under-researched. We are investigating the transgender and gender
variant responders because their non-binary gender identities could yield information about what
function this paraphilic behavior serves in this specific sample. Overall, this study will raise
awareness regarding paraphilia specifically in those transgender and gender variant individuals
with ABDL interests and behaviors.

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Thesis questions

This thesis aims to answer questions relating to a sample of transgender and gender
variant adults who find sexual enjoyment through role-playing and behaving like a baby. Since
past literature has minimally researched this topic, our goal is to explore different areas of
relationships, feelings, and opinions regarding ABDL behaviors and practices amongst a
transgender and gender variant sample. Therefore, the following research questions are
proposed:
• The first research question is qualitative, how is this sample identifying? We want to
know how participants are describing their gender identity.
• The second question focuses on the frequency and duration participants have been
involved in ABDL practices and behaviors. We will examine the age participants became
interested in ABDL and when they began practicing these behaviors. Then, examining
the frequency of their diaper use in days, weeks, and days in a month. Next, exploring
how frequently others are involved in their ABDL practices and how frequently they
practice these behaviors alone.
• The third research question looks at participants ABDL behavior and practices within
their romantic relationships. We will examine gender and number of years participants
were in a current or most recent relationship and the number of years the participants
existing or the last partner knew about ABDL behavior. We will also examine gender and
frequency of their current or most recent romantic partner being involved in ABDL
behaviors and the frequency of someone other than the current romantic partner being
involved in ABDL behaviors.
• The fourth research question investigates whether negative mood states are associated
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with ABDL behavior. We will use specific ABDL behaviors and the Profile of Mood
States (POMS) scores to analyze this question.
• The fifth research question is what the participants’ opinions are on ABDL behaviors and
perceived problems. We will analyze questions related to how their ABDL behaviors
may have begun. The last research question, how are the participants’ ABDL practices
and behaviors related to aspects of their romantic relationships.
Methods
Participants

Approximately 2,849 participants completed the survey. Of these, 104 individuals
submitted their surveys indicating that they identified as transgender or gender variant.
Participants were included if they chose transgender or gender variant from the gender identity
question and if they indicated in the comment section feelings of gender dysphoria, being
transgender, or gender variant. The initial 104 participants included 16 participants that had
chosen male or female but indicated through qualitative data that their gender identity directs
more towards transgender or had comments regarding gender dysphoria. Of those 16 male and
female responders, 6 were included in analyses and recoded as transgender due to their
qualitative responses. These 6 participants included 2 female participants that indicated intersex
in their qualitative data and were recoded as transgender. Participants were eliminated if they did
not explicitly report transgender or gender variant gender identities and if they spoke more
towards age play or sexual orientation regarding age play. Of the resulting 94 participants, 2
were eliminated because they were younger than 18 years old and 9 were eliminated because
they completed 25% or less of the survey. Of these, 83 participants completed enough of the
survey to be included in the final analyses.
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The resulting participants ranged in age from 18 years to 71 years (M = 32.81, SD =
13.34). In Appendix A, Table 1 shows the demographics collected for this sample by gender
identity. The majority of participants were transgender (61.4%). Both transgender and gender
variant participants were more sexually attracted to both males and females, at 52.9% and 71.9%
respectively. Regarding family of origin household structure, the majority of participants
(73.5%) grew up in a two-parent household (male-female) with one brother or sister. Formal
education level varied amongst participants, but the majority of participants (92.7%) had
received at least a high school diploma with the exception of one transgender participant who
completed less than the 9th grade in school. Income levels ranged from less than $25,000 per year
to over $100,000 per year, but the largest group of participants reported making less than
$25,000 (49.4%). Transgender participants with a job averaged about 6 years at their current job
and gender variant participants with a job averaged about 8 years at their current job.
Measures

The survey started with demographic inquiries. Participants provided their age, gender
identity, sexual orientation, household structure (i.e., number and gender of parents growing up),
and number of siblings. Participants then indicated their education level, current job, length of
time at their current job, and their income.
Frequency of ABDL Behaviors

The frequency of ABDL behavior questions were created by the original researchers
(Hawkinson & Zamboni, 2014). Participants provided the age they developed interests in ABDL,
and the age they began practicing. They specified if they were currently practicing ABDL and
the length of time they had been practicing. Participants indicated how much time (total hours)
they were wearing diapers on a typical day, then indicating in weeks (total days), and months
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(total days). The measure also asked the frequency of solo ABDL sexual activities, solo non-
ABDL sexual activities, partnered ABDL sexual activities, and partnered non-ABDL sexual
activities. All items for this measure are listed in Appendix B.
Relationship Questions
Participants indicated how many committed romantic relationships they have had in their
lifetime and if they were presently in a romantic relationship (including duration). If participants
indicated that their partner was aware of their ABDL behaviors they were asked how long their
partner had been aware. Next, using a Likert scale ranging from 1 (Never) to 5 (Always),
participants responded to the frequency that their partner was included in ABDL practices and
the frequency of someone else (not their romantic partner) being included in their ABDL
practices. All items for this measure are listed in Appendix B.
Specific ABDL Behaviors and Sexual Stimulation
Participants indicated when they practiced ABDL, and how frequently they involved nine
specific ABDL behaviors: wetting, messing, using diapers, using other baby items, having a
mommy without sex, having a mommy with sex, having a daddy without sex, having a daddy
with sex, and playing with baby toys on a Likert scale from 1 (Never) to 7 (All the time). Then,
participants were asked which sexual activities they liked the most: no sexual activity, partaking
in sexual activities by themselves, or partaking in sexual activities with someone else. Next, on a
Liker-type response scale, participants answered how sexually stimulating they believed the
following to be: an adult man, an adult woman, diapers, baby clothing, baby toys, other baby
items, and non-ABDL sex toys. Finally, on a Likert-type response scale, they reported the
importance of five ABDL behavior aspects: the diaper itself, the ease of a diaper, being
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dominated or under the control of another person, being a baby, and being sexually excited about
ABDL. All items for this measure are listed in Appendix B.
Parental Relationship
The Brief Maternal and Paternal Relationship scales were developed for this study, in
which participants indicated whom they were raised by (a mother/female caregiver or a
father/male caregiver). Within each scale, six dimensions were examined. On a scale ranging
from 1 to 6, participants chose the number that best corresponded with their feelings about how
their mother/father/caregiver acted towards them. These six dimensions were: Detached from me
to Involved with me, Hostile towards me to Not hostile toward me, Rejecting me to Accepting me,
Controlling me to Non-controlling, Unfair with me to Fair toward me, Not caring toward me to
Caring toward me. A more positive relationship with a parent was exhibited with higher mean
scores.
Attachment Scale
The Experiences in Close Relationships Scale (ECR)- Short Form was used to assess
adult attachment (Wei at al., 2007). This 12-item questionnaire evaluates adult attachment based
on two dimensions: attachment anxiety and attachment avoidance. On a 7-point Likert scale,
from 1 (Strongly disagree) to 7 (Strongly agree), participants answered with their degree of
agreement on each statement. Examples of statements provided were: “I want to get close to my
partner, but I keep pulling back” (attachment avoidance) and “I get frustrated if romantic partners
are not available when I need them” (attachment anxiety). To get final scores for both attachment
styles, the subscales were averaged. A higher mean score is related to higher degrees of
attachment anxiety and avoidance. Previous research suggests the ECR has strong psychometric
characteristics (Wei et al., 2007).
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Mood States
The Profile of Mood States (POMS) shortened version, is a 37-item questionnaire used to
measure six factors: Tension-Anxiety, Depression-Dejection, Anger-Hostility, Fatigue-Inertia,
Vigor-Activity, and Confusion-Bewilderment (Shacham, 1983). On a 5-point Likert scale
ranging from 1 (Not at all) to 5 (Extremely), participants indicated on each item within the past
week how they had been feeling. Subscales were added together to create a total score (except
for Vigor-Activity, which was subtracted). Higher mood disturbance was exhibited by higher
total scores. For the current study, the internal consistency of the overall POMS scale was .94.
All items for this measure are listed in Appendix B.
Opinions and Perceived Problems

To examine participant’s views on ABDL, a Likert scale from 1 (Strongly disagree) to 7
(Strongly agree) was used and they indicated their level of agreement with three statements: “I
enjoy being treated like a baby,” “I enjoy sexual activity as a part of my ABDL practices,” and “I
am comfortable with my ABDL practices.” Then they indicated their level of agreement, using
the same Likert response scale, with statements that a person is born with ABDL sexual interests,
a person learns ABDL sexual interests, ABDL interests are associated with something in their
childhood, and ABDL interests are associated with toilet training.
To examine perceived problems, participants indicated the amount of times they have
tried to stop their ABDL behaviors in their life; if their ABDL interests and behaviors have
inhibited a romantic relationship; if anyone had recommended that they get help to stop, control,
or manage their ABDL habits; if ABDL hindered their job, social life, or other fundamental
aspects of daily functioning; and if they had sought therapy for ABDL interests. Then
participants indicated if there was ever more than six months that ABDL behaviors had produced
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significant distress and problems in their life (e.g., professionally, socially, legally, relationally).
Next, they indicated if they thought they would be able to stop their ABDL interests or behaviors
if they wanted to do so. Lastly, participants used a Likert scale from 1 (Negatively) to 7
(Positively), to answer how they viewed the ABDL features in their life. All items for this
measure are listed in Appendix B.
Procedure
In 2011, the University of Minnesota Medical School collected survey responses via
online ABDL specific community websites (i.e., diaperspace.com, bedwettingabdl.com,
adisc.org). In the original study that was published by Hawkinson and Zamboni (2014), the
transgender and gender variant responders were excluded from the analyses which only reported
on the findings of cisgender responders. The survey began with an informed consent document
stating their involvement in the study would be anonymous, that they would not receive
compensation, and that they were able to stop the survey at any time. Participants provided
consent by accessing a link to the survey, reviewing a consent form, indicating that they
understood the consent form (yes or no option), and affirming that they were 18 years or older.
Participants were made aware that there was minimal risk to participating in the survey, that
responses would be kept confidential and anonymous, and that participation was completely
voluntary and that they were free to withdraw at any time.
The survey started with a demographics section leading into questions regarding the
participant’s ABDL interests, desires, behaviors and fantasies and then questions concerning the
effects of these practices on the participant’s life and romantic relationships. Next, participants
answered questions regarding their parental relationships. The survey concluded with two
additional questionnaires, an adult attachment questionnaire and a short version of the Profile of
TRANSGENDER INDIVIDUALS AMONG AN ABDL ONLINE COMMUNITY
21
Mood States.
Results
Frequency and Duration of ABDL
A one-way MANOVA analyzed transgender and gender variant participants as the
independent variable and three dependent variables: the age participants became interested in
ABDL fantasies or behaviors, the age participants started to practice ABDL behaviors, and the
number of years the participants had been practicing ABDL behaviors. Pearson correlations
indicated that the age participants became interested in ABDL was correlated with when they
began to practice ABDL (r = .71, p < .000) and negatively correlated with how long they have been practicing ABDL behaviors (r = -.23, p < .05). The age participants began practicing ABDL was negatively correlated with how long they had been practicing these behaviors (r = -.39, p < .000). The MANOVA was not significant, Wilks’ l= 0.968, F(3, 79) = 0.86, p = 0.46, h 2 = 0.03. Power to detect the effect was 0.23. See Appendix A, Table 2 that includes means and standard deviations of the variables examined. A second one-way MANOVA examined transgender and gender variant participants as the independent variables and three dependent variables: frequency of wearing diapers in a typical day (i.e., hours), week (i.e., days), and month (i.e., days). Pearson correlations specified that typical day diaper wear was correlated with typical week diaper wear (r = .75, p < .000) and typical month diaper wear (r = .69, p < .000). Typical week diaper wear was correlated with typical month diaper wear (r = .90, p < .000). The MANOVA was not significant, Wilks’ l= 0.933, F(3, 79) = 1.80, p = 0.15, h 2 = 0.07. Power to detect the effect was 0.45. See Appendix A, Table 2 that includes means and standard deviations of the variables examined. TRANSGENDER INDIVIDUALS AMONG AN ABDL ONLINE COMMUNITY 22 A third one-way MANOVA analyzed transgender and gender variant participants as the independent variable and the following two dependent variables, frequency of practicing ABDL sexual behaviors alone and then with another person in a typical month. The dependent variables were correlated (r = 0.59, p < .000). The MANOVA was not significant, Wilks’ l= 0.948, F(2, 77) = 1.45, p = 0.24, h 2 = 0.05. Power to detect the effect was 0.30. See Appendix A, Table 2 that includes means and standard deviations of the variables examined. A fourth one-way MANOVA was considered using gender (transgender and gender variant) as the independent variable and the following two dependent variables: frequency of practicing sexual behaviors alone, and frequency of sexual behaviors with another person, without ABDL in a typical month. The dependent variables were not correlated (r = .16, p = .21). Thus, further analyses were not conducted. Relationship Variables About half of transgender and gender variant participants reported being in a current romantic relationship, 45.1% (n = 23) and 53.1% (n = 17) respectively. A one-way ANOVA examined gender as the independent variable and the number of lifetime committed romantic relationships as the dependent variable. Results from this analysis were not significant, F (1, 81) = 0.92, p = 0.34. See Appendix A, Table 3 that includes means and standard deviations of the variables examined. Transgender (n = 19, 37.3%) and gender variant (n = 17, 53.1%) participants in current romantic relationships reported high rates of their current romantic partner knowing about their ABDL practices. A one-way MANOVA analyzed transgender and gender variant participants as the independent variable and the following two dependent variables: the number of years they have been in their current or most recent relationships and how long their current or most recent TRANSGENDER INDIVIDUALS AMONG AN ABDL ONLINE COMMUNITY 23 partner knew about their ABDL behaviors. The dependent variables were correlated (r = 0.86, p < .000). The MANOVA was not significant, Wilks’ l= 0.89, F(1, 37) = 2.22, p = 0.12, h 2 = 0.11. Power to detect the effect was 0.42. See Appendix A, Table 3 that includes means and standard deviations of the variables examined. Another MANOVA examined transgender and gender variant participants as the independent variable and the following two dependent variables: how frequently their current romantic partner was involved in their ABDL behaviors and the frequency of some other than their partner being involved. The dependent variables were correlated (r = 0.35, p < .01). The MANOVA was not significant, Wilks’ l= 0.98, F(1, 54) = 0.62, p = 0.54, h 2 = 0.02. Power to detect the effect was 0.15. See Appendix A, Table 3 that includes means and standard deviations of the variables examined. Mood States and ABDL Behavior To analyze how negative mood was related to ABDL behaviors, correlations were examined between total POMS scores and specific ABDL behaviors. The first set of ABDL specific behavior questions asked how often participants engage in the following: wetting, messing, using diapers, using other baby items, having a mommy with or without sex, having a daddy with or without sex, and playing with baby toys. The second set of ABDL specific behavior questions investigated how sexually stimulating participants found the following: diapers, other baby items, baby clothing, baby toys, and non-ABDL sex toys. The last set of ABDL specific behavior questions asked how important certain aspects of ABDL are to the participant and included: the diaper itself, the convenience of a diaper, being dominated, being a baby, and sexual excitement. Results from this correlational analysis did not indicate statistical significance between the POMS total score and any of the ABDL specific behaviors. See TRANSGENDER INDIVIDUALS AMONG AN ABDL ONLINE COMMUNITY 24 Appendix A, Table 4 that includes correlations between mood states and specific ABDL behaviors. Opinions on ABDL Behavior and Perceived Problems A one-way MANOVA was conducted to examine transgender and gender variant participants as the independent variable and the participant’s level of agreement with the following two dependent variables: one learns ABDL sexual interests and ABDL interests are related to toilet training. The dependent variables were correlated (r = 0.33, p < .01). The MANOVA was not significant, Wilks’ l= 0.99, F(1, 74) = 0.06, p = 0.94, h 2 = 0.002. Power to detect the effect was 0.06. See Appendix A, Table 5 that includes means and standard deviations of the variables examined. The majority of transgender and gender variant participants reported “No” when reporting if there was ever a period of more than 6 months that their ABDL interests had caused significant problems and distress in their lives, 80.4% (n = 41) and 71.9 (n = 23) respectively. A second one-way MANOVA analyzed transgender and gender variant participants as the independent variable and the following five dependent variables: the number of times in their life they have tried to stop their ABDL behaviors, ABDL interfered with a romantic relationship, someone suggested they get help/stop/control/manage their ABDL behaviors, ABDL interfered with their job, social life, or other important areas of their life, and times they had seen a therapist for ABDL behaviors. The dependent variables were correlated. The MANOVA was not significant, Wilks’ l= 0.89, F(1, 72) = 1.67, p = 0.15, h 2 = 0.11. Power to detect the effect was 0.55. See Appendix A, Table 5 that includes means and standard deviations of the variables examined.