А я как раз кое-что нашел
Цитата:
A case of a 17-year-old boy, reported by Dinello (3), was
more characteristic of the kind of presentation that Mr. A
manifested. This patient had worn diapers under his
clothing, used baby bottles, and eaten baby food since age
15. He had also received medical treatment for an imbalance
of growth hormone. Eventually, however, he gave up
wearing diapers and began dressing in women’s clothing.
He, too, masturbated while wearing the diaper.
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The diagnostic understanding in the case of Mr. A is a
complicated matter. A survey of DSM-IV revealed no disorder
that truly fit Mr. A’s clinical picture. We could rule out
a psychotic disorder since the patient clearly stated that he
knew that he was not a baby but only wished to be one. He
also had adequate reality testing and sufficient ego
strength to pull himself together when he went to work.
From a psychodynamic perspective, he clearly manifested
a form of splitting characterized by an unintegrated coexistence
of two self-representations—an adult who works
in law enforcement and a regressed baby. However, he did
not meet criteria for borderline personality disorder. Nor
did he have dissociative identity disorder because he was
clearly aware of both self-representations, he did not have
periods of amnesia, and he did not use a different name to
describe the “baby” part of himself. Although he might
have fit into the category of dependent personality disorder
at first glance, it would have been a mistake to apply
this label to him since, in his work, he was apparently capable
of making decisions, assuming responsibility, and
performing duties on his own. Even in his private life as a
“baby,” he lived a fairly isolated existence rather than depending
on others to take care of him.
The diaper fetish obviously led us to consider paraphilia
as Mr. A’s central diagnosis. As Dr. Pate suggests, the wearing
of diapers was obligatory for sexual arousal, and classically,
we think of paraphilias as involving an obligatory
and exclusive scenario for sexual arousal (4). However, as
more data have accumulated about the various paraphilias,
we have become increasingly aware that exclusivity regarding
the means of sexual arousal is not necessarily a
hallmark of paraphilia. In one study of 561 men seeking
evaluation and treatment for paraphilia (5), fewer than
30% of the subjects confined their deviant behavior to
only one perversion.
In the classical view of fetishism, castration anxiety is
central (6, 7). The concerns about physical harm were regarded
as resulting from chronic traumatic interactions in
the first few months of life. To experience bodily integrity,
the child needs to be soothed by its mother or by transitional
objects. In the absence of the availability of a
mother or such objects, the child may require a fetish,
something “reassuringly hard, unyielding, unchanging in
shape, and reliably durable” (7, p. 102). As psychoanalysis
shifted from a sexually based drive theory to a paradigm of
internal object relations and self-psychology, the understanding
of fetishism also changed. Kohut (8), for example,
viewed fetishism as a way of maintaining control over
a nonhuman version of a mothering figure. He described a
patient who made a fetish of underpants to deal with feelings
of helplessness about the traumatic unavailability of
his mother. Mitchell (9) stressed that an intense sexual
need for a fetishistic object may actually reflect severe
anxiety about the loss of one’s sense of self. One may obtain
a sense of coherence or a firmer sense of identity from
having the fetish available.
Although the patient provided a limited history, we got
some sense of his unconscious agenda by studying what
he created with the evaluating psychiatrist. We learned
that he was adopted, and we could speculate that he had a
long-standing and ongoing conviction that he missed out
on the ideal infancy because he was rejected by his biological
mother. We could also observe active mastery over
passively experienced trauma. In his relationship with Dr.
Pate, he insisted on being the one who made the appointments
so that he was in charge and ultimately abandoned
her, rather than giving her the opportunity to abandon
him—a preemptive strike, in effect. Another significant
part of the history is that his wish to be a baby began at approximately
age 12, when puberty must have been approaching.
We can speculate that one of the determinants
of the adult baby syndrome in this case may have been a
wish to avoid the threat of genital sexuality by regressing to
an infantile dependent state.