Attraction to disability
Attraction to disability is a sexualised interest of people in the appearance, sensation and experience of disability. It may extend from normal human sexuality into a type of sexual fetishism. Sexologically, the pathological end of the attraction tends to be classified as a paraphilia. (Note, however, that the very concept paraphilia continues to elude satisfactory definition and remains a subject of ongoing debate in both professional and lay communities) Other researchers have approached it as a form of identity disorder. 
- 1 History
- 2 As fetish subculture
- 3 Population
- 4 Explanations
- 5 Response
- 6 Treatment
- 7 In film
- 8 See also
- 9 References
- 10 External links
Allusions to this type of attraction are found in, among others, the works of Herodotus, classical Vietnamese legend, works by Bruegel the Elder, de Brantôme, de Montaigne, Pushkin, Brecht, Susan Sontag, J.G. Ballard, Diane Arbus, Bulgakov, Dalí, Hemingway, Mayakovsky, von Stroheim, Helmut Newton, and Buñuel and roles by James Dean. The attraction may be present in the Chinese foot binding tradition.
This type of human sexual attraction has become more widely known over the past century through Interwar decadence, the Sexual Revolution, and the advent of the World-Wide Web. A number of artists have portrayed it: Drama producer Andriy Zholdak produces plays with disabled people; sculptor Marc Quinn makes statues of them; photographers Gerhard Aba, Petrina Hicks, Eric Kroll, Ronald Parisi, Romain Slocombe, and Yury Solomko portray them; directors produce films like Um crime delicado; and Chinese balletomanes produce dance performances with them. The attraction also features regularly in Japanese anime and manga.
The rare pathological attraction to disability has been studied by psychologists since the late 19th century, with a relative resurgence of interest since the mid-1970s. Until the 1990s, it tended to be described mostly as acrotomophilia, at the expense of other disabilities, or of the wish by some to pretend or acquire disability. Bruno (1997) systematised the attraction as factitious disability disorder. A decade on, others argue that erotic target location error is at play, classifying the attraction as an identity disorder. In the standard psychiatric reference Diagnostic and Statistical Manual of Mental Disorders, text revision (DSM-IV-tr), the fetish falls under the general category of "Sexual and Gender Identity Disorders" and the more specific category of paraphilia, or sexual fetishes; this classification is preserved in DSM-5.
As fetish subculture
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In the paraphilia, the attracted (who refer to themselves as "devotees" within the fetish subculture) are specifically aroused by disabled people, simply because of their disability. The disability may be minor like missing fingers, profound like blindness and (stereotypically) amputation, or quadriplegia. Some devotees desire people with cognitive disabilities[original research?].
Desires to pretend to be disabled and acquire a disability are extensions of the pathological disorder. About half of all devotees occasionally pretend (43 percent of Nattress , sample of 50). Avowed "wannabes" seem to number not more than five percent of the devotee-wannabe population, though Nattress (1996) found 22 percent of his sample of 50 had wanted to become disabled. Accordingly, Bruno (1997) puts those afflicted with versions of the paraphilia under the broad heading of Devotees, Pretenders, and Wannabes (DPWs), as used here.
Well over half of DPWs have felt this pathological attraction since childhood, as typical in paraphilias. The Amelotatist (see References) found that 75 percent of its sample of 195 were aware of the attraction by age fifteen. Those attracted often cherish early memories of a sexuoerotic tragedy (a "first sighting") involving an object of their future attention, often an older member of the opposite sex, as stereotypical in paraphilic etiology. About a quarter report discovering the paraphilia in puberty and a few in maturity.
In intensity, this pathological type of attraction ranges between optional and preferred in most DPWs. As its intensity grows, pretender and wannabe elements may emerge and increase. Thus, detailed inquiries as to what sensations there are or are not in the parts of the body affected by disability are regularly posed in DPW forums frequented by disabled people, suggesting an exhaustively detailed DPW curiosity as to the experience of a disability. Avowed wannabes seem to feel their aspect of the attraction significantly more keenly than ordinary devotees, and for many it has exclusive intensity.
The aforesaid has given grounds for the attraction to disability to be represented as the continuum Bruno (1997) termed factitious disability disorder. At its less-intense devotee end, there is sexualised fascination with the existential aspects of disability and its appearance. In its middle pretending area is strong desire to reproduce the sensations of disability. At its intense wannabe end is an imperative to acquire a disability which may prompt self-harm.
According to DPW fetishists, their attraction does not appear to pose dangers to DPWs' partners or third parties. However, it can be noted that the DSM-IV includes this paraphilia within the diagnostic criteria of psychiatric pathology. Fetishists raise objections to the characterization of their preference as an aberrant pathology. However, objections have also been raised by members of the disabled community on the grounds that such fetishes objectify and dehumanize them. Some people with disabilities willingly participate in the fetish subculture, for example, contributing model photos (e.g., Debbie van der Putten).
From the point of view of DPWs, they believe that their erotic ideals are conventionally attractive people who happen to be disabled. They are at ease with their disability and, rather than resenting it, do little to conceal it. Their attractiveness grows in direct proportion with the extent to which they parade their differences in contravention of social norms.
DPWs have individual preferences: Those desiring people with one disability may feel little or no attraction toward people with other disabilities. Alongside defining the preferred disability, preferences may define whether it is acquired or congenital, traumatic or caused by illness, elapsed periods since it was acquired, whether it involves physical scarring, and even trivia such as whether it affects the left or right side. How the disability is displayed is a preference area, with some DPWs having preferred clothing, props, behaviour, and even environments. The enormous variety of devotee preferences is shown by the large number of narrowly specialised devotee fora: groups dedicated to amputees with bandaged stumps, people in leg-braces, disabled brides, hook prosthesis users, leg amputees who use pylon prostheses, non-users of prostheses, people with one short leg, people with limbs in plaster casts, and so on. Individual preferences may be firm or flexible and may evolve with time but seem rarely to "switch" from one type of disability to another. Individual DPWs' exact personal preferences are rarely, if ever, replicated in others.
A key feature of the attraction, preferences seem to serve two purposes. First, they fix the appearance and circumstances of the sexuoerotic "tragedy", in their view, perpetuating and reinforcing its influence. Second, they act as an excuse which keeps inhibited devotees from pursuing relationships (see Behaviour), since narrow preferences are unlikely to be satisfied.
There are many indications that male and female DPWs may have differing overall preferences. Thus, the preference for women with one leg who walk with crutches appears most common among males, while preferences for men with one arm or are paralysed appear more common among females. DPW preferences are overlaid over common attractiveness criteria. Male DPWs routinely rank disabled women by looks, while female DPWs routinely rank disabled men by charisma, with "looks" and "charisma" having mainstream meanings.
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A distinction has to be drawn between people who feel some sex-tinged fascination with disability on the one hand and aware members of the DPW subculture on the other (also see Behaviour below).
In 1976, Ampix, a company selling DPW pornography, had a clientele of about 300. A decade later, Fascination, a DPW community quarterly publication, had a circulation of under 1000. As the world-wide web began rolling out a decade hence, DPWs in dedicated fora numbered under 10,000. By 2006, the world devotee community comprised up to 100,000 members of several hundred internet fora. Duplication/multiplication of memberships, dead memberships, and the probable "grey zone" of under-motivated, merely curious, or accidental forum members would indicate that there were anywhere between 30,000 and 50,000 DPWs worldwide in 2006.[need quotation to verify]
By sex, it is consistently reported[need quotation to verify] that over 90 percent of DPWs are male. Women attracted to disability may view their feelings as romantic rather than sex-centred, be disheartened by male domination of the DPW scene, or just generally find porn and/or public discussion of sexual issues less gratifying then men.
By sexual orientation, the share of homosexual and bisexual DPWs appears identical to that in the general population, implying a dominant heterosexual interest. There are indications, however, that some heterosexual DPWs may be attracted to members of their own sex with their preferred disability. This ambivalence may be more common among female DPWs. There are also indications that where the "first sighting" involved a person of the same sex, the future DPW may grow up homosexual.
By age, the acknowledgement of the attraction may occur from pre-puberty onwards, with today's DPWs discovering the subculture in their teens.
By educational and career attainment, The Amelotatist reported a high proportion of highly educated and successful people among its sample of 195. This was confirmed by Nattress (1996), all of whose 50 subjects had completed higher education and pursued careers. This may indicate greater than average DPW susceptibility to parental and peer pressures.
By geography, in 2006 DPW fora membership indicated one or fewer DPWs per million inhabitants in some countries, with a mean of 5 to 8 a million and peaks of 30 to 50 a million. North America and Western Europe had most DPWs, followed by the former USSR, eastern China, Japan, Australia, Southern Africa, and the rest of the world. Southern Asia and Africa appear to have none or extremely few DPWs. Differing levels of internet access are clearly at play, though the spread also reflects national, cultural, class, lifestyle, and period factors and parent-child and peer relationship paradigms.
DPWs appear to fall into two groups: Most think they are unique, while some assume the attraction is universal and are disappointed to find it confined to very few others.[need quotation to verify]
Inhibitors to DPW behaviour
Many DPWs feel intense guilt and shame at deriving pleasure from others' misfortunes and fear parental, family, peer, and public reprimand. They sense the stigmatic-eligibilic paradox and fear ridicule for desiring people in a way that they feel some may brand in a negative way. They also fear censure from the very people they desire.
Some wannabes report mistrusting their feelings and being unwilling to surrender to them. This guilt and fear from all sides, added to the customary guardedness of sexual minorities, form powerful inhibitors to DPWs' publicising their feelings and pursuing preferred partners. Claims to have overcome guilt and fear appear to bestow DPW community kudos.
Under different formulations, the question of whether — given an opportunity — a devotee or pretender would embark on a relationship with a disabled person, is posed occasionally in devotee Web fora. Answers indicate that inhibitions are so powerful in some devotees and pretenders that they exercise strict self-denial. They also indicate that many devotees and pretenders feel ill-equipped for relationships with disabled people, not only as regards the attendant family, social, career, and other dimensions but also as regards the prosaic realities of living with disabled partners. Those declaring willingness to pursue relationships often decry the lack of set etiquette for encounters between themselves and disabled people who may also be dealing with significant inhibitions.
Instead of relationships, some DPWs seek unencumbered and non-committing transactions with understanding or needy disabled people. This is evidenced by at least three devotee fora (2007) for disseminating and sharing information on disabled prostitutes and a dozen "disabled courtesan" websites (2006). Rather than being merely sexual, however, it seems that such transactions involve the disabled partners displaying a wide range of intrinsically "disabled' behaviours" including dressing in specific clothing, play-acting specific routines, and optionally making public appearances with their escorts.
There are claims[need quotation to verify] that female DPWs may be less inhibited and more direct about their attraction and that they tend to form relationships with preferred partners more easily.
Central DPW dilemmas
The defining dilemmas DPWs face, in their own view, is that their ideally desired relationship is highly unlikely to materialise, and if it does, that it is unlikely to be successful.
- The statistical/probability dilemma is that the very small number of potential partners is further reduced once the usual criteria which apply in relationships are applied. Thus, a DPW seeking an ideal relationship must first find potential partners who have the preferred disability. Further, they must be available for a relationship. Still further, such potential partners must also be personally appealing to the DPW and vice versa. To these criteria are added practical/logistic considerations which reduce the availability of potential partners practically to nil.
- The emotional dilemma is the inability of sexual satiety to satisfy broader emotional needs. The issue at play is the disparity of motivations: In a relationship, devotees seek to satisfy an unusual sexual drive, while their potential partners seek satisfaction for the usual range of human relationship needs.
DPWs sense these dilemmas and react to them in three basic ways that often form a sequence. Denial involves the stubborn belief that a partner is waiting and needs to be discovered or the obstinate insistence on prolonging unsuccessful relationships with persons with the preferred body type. Resignation involves abandoning, or not embarking upon, the search for a partner. Accommodation involves three basic behaviors which ameliorate the perceived truth that the "ideal" relationship is unattainable: fantasizing with or without able-bodied partners, seeking purely sexual encounters, and (rarely) celibacy.
The Amelotatist found that 55 percent of a sample of 195 DPWs had dated disabled people, 40 percent had been sexually intimate with disabled partners, and 5 percent had current disabled spouses. Nattress (1993) found that 41 percent of a sample of 50 DPWs had, or were in, relationships with disabled partners.
Relationships between DPWs and disabled people tend to be reported as being ordinary, the attraction being sated by the fact of the partner's disability. It appears that the attraction to disability is undisclosed in a proportion of DPW-disabled relationships. DPWs may press disabled partners to put their disabilities to the fore in intimate situations and exhibit them in social ones. Sexually, some DPWs have been reported to engage in active tactile observation as much as in intercourse.
That DPWs find it hard to satisfy both sexual and emotional needs is borne out in findings by both Nattress (1996) and Dixon (1983). They report that, despite reasonable success in obtaining sexual contact with disabled people, just 21 percent of DPWs had had long-term relationships with disabled partners.
About half of DPWs fail to establish relationships with disabled people. "Second-best" options for them are relationships with pretenders and wannabes. Practically all DPWs have experience of relationships with able-bodied partners. Such relationships are also reported to be ordinary despite the (mostly undisclosed) attraction to disability on the part of one partner.
Although it is not common knowledge within mainstream communities, the internet has revolutionized the process by which DPWs can meet each other while pursuing meaningful relationships. Some of these individuals, however, have expressed a level of concern when it comes to their first face to face encounters. While most of these encounters are completely safe, there are important guidelines to provide a sense of security to either party who may feel vulnerable.
Many DPWs redirect their desires into creative pursuits. A number of them occupy positions offering professional contact with the disabled. Others are members of disabled people's social and/or political fora. Collecting disability-linked objects is a pastime for some DPWs.
Over the past decade, a number of DPWs have launched websites with images of their ideal partners, descriptions of fictional encounters with them, and DPW pornography (often produced in cooperation with disabled people). Online, DPWs exchange images of disabled people, descriptions of sightings and meetings of/with them, potted biographies of disabled people, techniques for attracting their attention, and opinions on acceptable DPW behaviour. There are attempts to condemn the objectification of disabled people. Wannabe fora are dominated by inquiries as to which doctors may be willing to inflict elective disability.
The DPW community has a growing English-based jargon which emerged in the 1930s. The label "devotee", adopted in the early 1980s due to the rhyme with "amputee" has entered research usage. "Wannabe" is another internal label, with a variety of other terms coined (thus, "sighting" for an encounter with a disabled person), borrowed, or modified from the disabled world (thus, "sticks" instead of "crutches") or other sexual minorities (thus "devdar", a modification of "gaydar", denoting the supposed devotee ability to foretell "sightings" of people they desire, or "transabled", another term for wannabe and an alliterative modification of "transsexual").
As stated above, many DPWs derive pleasure by pretending to have a disability. Others may persuade some non-disabled partners to pretend. There was overwhelming evidence that males in the devotee chatrooms which sprang up during the 1990s pretended to be disabled women en masse. This confirms a widespread proneness to pretending first mooted in The Amelotatist, as well as the continuum between devotees, pretenders, and wannabes. Being a premeditated confidence trick, pretending tends to be viewed as unedifying by the high DPW community.
Of concern to members of the disabled community and law enforcement are pathological and predatory behaviours that may be exhibited by some persons with this particular fetish, including the following examples.
Some DPWs collect personal data on disabled people, follow and photograph them candidly, call them and write to them, contrive to encounter them, and seek them out at healthcare establishments and disability gatherings. This "potted palm syndrome" (practitioners are said to peep from behind parlour plants) is condemned within the DPW community. Where it spills over into stalking, such behaviour may give grounds for prosecution. Over 85% of Nattress's sample of 50 DPWs stated that they would follow an unknown disabled person matching their preference. Over 57% stated that they would attempt to start a conversation with a randomly encountered disabled person who matched their preference.
The wholesale circulating of images of disabled people is a behaviour under attack from some sections of the DPW community. Most images are obtained candidly, distribution (if commercial) does not benefit those depicted, and risks compromising them since the context is sexual. Alongside this, commercial images of disabled models are invariably "copywronged" by DPWs posting them on the internet for free use by others, thus depriving models of expected income. "Electronic surgery" ("ES", retouching photographs of able-bodied people to make them look disabled) is also popular in some DPW circles. The resulting images are widely circulated on the DPW web, jeopardizing the reputations of the original subjects. Images of people known to be dead continue in circulation.
People attracted to disability appear to have been obsessed with images for as long as the attraction has been known. Stories are told within the community of collectors who had succeeded in garnering tens of thousands of images in the pre-Internet era. The DPW fascination with images lends considerable credulity to claims that the attraction to disability is voyeuristic and hence forms part of the sadomasochistic continuum.
DPWs practicing intrusive, stalking, and fetishist behaviour, and who peddle images, often plead a paucity of potential partners, of opportunities to approach such partners in a normal fashion, and the lack of established etiquette for such encounters.
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The established view of the attraction is that it is part of the paraphilic, or sexual fetish, spectrum. Research since 2000 focusing on amputee wannabes has produced evidence that at least in some cases the condition is an aspect of identity disorder. Research is hampered by the aforementioned secretiveness of DPWs. It is likely to remain so in view of the widespread DPW conviction[need quotation to verify] that sexological, journalistic, or other inquiries into them can only bring disbenefits.
There follows a listing of proffered explanations. A number of them are repeated (under different formulations) by all relevant sides.
- Suppressed homosexuality. This first explanation (by Krafft-Ebing in his 1886 Psychopathia Sexualis) assumed that amputation stumps resembled phalli and were thus seen as a safe alternative by latent homosexuals. This was in line with the contemporaneous linking of much sexual oddity with homosexuality and with the author's intent of linking the "antipathic instinct" (homosexuality) with all "perversions";
- Sadism deriving satisfaction from disabled people's perceived lower status;
- Masochism deriving satisfaction by self-denigration through association with stigmatised partners; wannabes are masochists wishing to acquire permanent physical stigma;
- Voyeurism gratified by the unusual behaviour and appearance of disabled people. Willing disabled partners are exhibitionists capitalizing on their unusual physique. Wannabes are also would-be exhibitionists seeking satisfaction in the reaction of other people;
Psychology views sadism and masochism as interchangeable, with voyeurism and exhibitionism as their respective aspects. Devotees’ observation-based behavior and preference for display-minded partners seem to support explanations 2 to 4. Devotee pornography tends to display the appearance of disability across a range of activities rather than focus on sexual situations.
Subsidiary observations include:
- Teratophilia because of the desire for deformed people;
- Classical fetishism, since the focus of desire is shifted from a person to parts of a body and/or objects. Physical stigma without the rest of the person, as well as disability aids do feature to a significant extent in DPW pornography;
- Suppressed coprophilia, since amputation stumps may be interpreted as resembling stools.[need quotation to verify] This early hypothesis is in line with the linking of sexual behaviour to toilet training.
Contemporary sexology does not consider the attraction problematic unless exercising it infringes the rights of one of the parties and/or those of third parties. Explanations include:
- Imprinting or the influence of influential events on behaviour. Encountering visibly disabled people in childhood awakes strong emotions which may give rise to quasi-logical reasoning and a desire for people with the type of trauma encountered. Care received during hospital stays may awaken a wish to become disabled (as a way of ensuring continuous care), later projected onto others. Freud is credited with discovering conditioning ("imprinting" in sexology) in the context of fetishism;
- Implied parental approval: if, on encountering someone disabled, a future DPW’s parents express admiration, the child may conclude that disability inspires regard, later ranking it among sexual preferences. This is among explanations mentioned by Dr John Money in Lovemaps;
- Flight from pressure: strict parenting and/or onerous peer environments may cause the future devotee to seek respite in sickness and disability. With time, the wish to become disabled is "projected" onto others. The analogy with Munchausen Syndrome (simulating or inducing illness as a route to compassion and benefits) here is reasonably clear in wannabes. In them, projection has failed, leaving them to see themselves as more attractive if disabled. The fact that most DPWs feel the attraction since childhood also backs the above explanations. There are also suggestions that there are more DPWs in America, Europe, and the Far East due to specific parent/peer-driven achievement models there. This is another explanation mentioned in Lovemaps;
- Inferiority complex causing projection: DPWs may have been made to feel inferior in childhood and may project their ambitions onto disabled people, who perforce have to overcome many barriers;
- 'Darwinism': DPWs see disabled people as proven in natural selection, having cheated death and overcome adversity;
- The unknown: children experience fascination with and fear of the unknown when encountering a disabled person. As adolescents, they may experience similar emotions when first approaching the opposite sex. This fascination with alienness may become associated with arousal over time through classical conditioning. Eventually, arousal will be triggered by the emotion;
- "The missing phallus": When exposed to the nude female body, some men are fascinated by the fact that "the penis is missing", and there is an alternative and sexual organ (in fact, one reminiscent of a wound) in its place. This feeling of surprise may become a part of sexual attraction. The sight of a missing limb may evoke a similar feeling. Similar to 6 above, this explanation was proposed by Dr Anne Hooper in 1978;
- Attention seeking and envy: Since disabled people tend to draw more than average attention, children observing them may conclude that one has to be disabled to enjoy attention. In puberty, disability would be included in their attractiveness criteria.
- Erotic target location error: The desire of some male transvestites and transsexuals to assume the appearance of their sexual ideal was transposed by analogy to amputee wannabes by First (2005), who backs his claim with research by himself and others since 2000. Since the condition of some wannabes appears not to be primarily sexual (except by association), the explanation defines the attraction to disability as an identity disorder. It is put forward within the narrow context of amputee wannabes, and the author does not address the DPW continuum discussed above. Interestingly, the wannabe community has always defined itself in terms very similar to those First and Lawrence (2006) use, with the indigenous label "transabled" gaining ground by 2005 at the expense of "wannabe."
The DPW community constantly debates the origins of the attraction ("the Why?"). The Amelotatist, reporting a poll of 195 devotees was a community contribution and the first synthesis of explanations. A 2005 straw poll in two DPW fora revealed that in childhood many respondents (often first or only children) felt alienated from peers, forming solitary interests in inter alia, transportation, or collecting. This may indicate that empathy with the disabled, subject to exclusion in most cultures, is among the motivations for the attraction. It may also indicate that admiration is at play in the attraction, inasmuch as the disabled perforce overcome inhibitions similar to those many DPWs face, as hinted above.
Current explanations and claims include:[need quotation to verify]
- The attraction is a mere addition to the physical attractiveness criteria which everyone has for potential partners;
- Everyone wishes to have a distinguished partner, and disabled people stand out as unique amid a physically standard population;
- Disabled people perform a number of actions in original ways which capture onlookers, rather like ballerinas capture audiences;
- The attraction is a sexualized extension of protective compassion for misfortune, fascination with uniqueness, and hero-worship;
- Each DPW may have become one for a variety of personal motivations rarely replicated in others;
- The attraction is not primarily sexual since it involves an overall curiosity about the broad existential aspects of disability rather than its narrow sexual aspects. There is indeed overwhelming evidence that, rather than being sex-centred, the attraction is "sex-diffused". Dedicated pornography caters to people erotically intoxicated with the appearance, spectacle, and perception of the entire disabled experience, rather than merely with nudity or sex;
- The attraction is an expression and extension of infantile non-conformity, being a counterpoint to the mainstream attitude to disability and sex. The attraction (or approving awareness of it) features in non-conformist avant-garde artists' work. Another argument in favour of this explanation is that DPWs, who may be more than averagely successful (see The Amelotatist in Population above) and hence analytical, are able to sense the flaws in the conventional attitude to disability at a formative age and react against them by cultivating an opposing attraction;
- Empathy: Some DPWs (wannabes in particular) clearly experience body image issues, which disabled people also encounter;
- Religious, occult, and esoteric explanations are that the attraction is programmed into some people by a higher power in order to provide a pool of potential partners for the disabled; that it is sent by a higher force to test or build DPWs' characters through exposing them to practically insurmountable deficit; that it is evidence of past lives in which the wannabe occupied a disabled body and the devotee had a disabled partner; that it focuses on the supposedly intriguing juncture where the physical body is severed, but the astral body continues (disabled people are claimed to have healthy auras).
Assertions that the attraction is a paraphilia are borne out by numerous aspects of it, including the early sexuoerotic "tragedy" perceived or imagined by the fetishist and the DPW proneness to other paraphilias. The attraction's complexity and breadth, however, do appear to reach across into states that are not classifiable as paraphilic, as well as spill over into the area of identity disorders (at least for some wannabes).
Voyeurism/exhibitionism/sadomasochism and fetishism are certainly present in DPWs but far from the forefront and not to the exclusion of a very broad range of other, and predominant, motivations. The latter are a diffuse blend of sexualised compassion, protectiveness, and maudlin empathy with the poignancy of stigma and disability. There is anecdotal evidence that some DPWs exhibit mild introversion and alienation. If true, this would tend to make them more likely to empathise with the experience of disabled exclusion and stigma or to admire the perceived heroism of disabled people in overcoming exclusion and stigma, hence prompting them to seek disabled partners.
The DPW claim that the desire is an augmentation of widely shared attractiveness criteria is amply borne out by widespread public erotization of commonplace physical distinctions ranging from dimples and gappy teeth, through moles and freckles, to spectacles, dental braces, and limbs in casts. The fact that "freak shows" featuring disabled performers were popular fairground attractions until after the Second World War hints that a significant number of ordinary people harbour curiosity about unorthodox appearance and modi operandi, at least some of which can be assumed to be tinged with sex. The undying popularity of elective physical modification, such as body part piercing, tattooing, and sundry cosmetic interventions (surgical or not), exhibits at least some drives in common with wannabeism. The attraction to disability appears to be the extreme tip of a "pyramid" of commonplace, less common, and minority attractions to unorthodox physique and the desire to have such physique oneself. For the most part, these attractions are not paraphilic.
Another DPW claim — that the attraction visits different people for different reasons — also appears reasonable in view of the sheer number and diversity of proffered explanations (most with their "lobbies"), coupled with the extremely small number of DPWs and the DPW community's palpable heterogeneity.
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DPWs assert that the attraction appears deviant only from the untenable position that disabled people are intrinsically unattractive or asexual. Since devotees' desired relationships are voluntary and equal in principle, and since the disability has already been sustained, they point out that issues of deriving pleasure from others' misfortune have no place in debates on the attraction. While disclaiming paraphilic explanations, they stress that their preferred relationships are "because of", rather than "despite", disability, thus unwittingly restating the stigmatic-eligibilic paradox.
The DPW community rejects scientific inquiry into the attraction because it may throw an unhealthy shadow over it and because it feels science can bring no real insight. It is minded to move toward coalescing as a lifestyle grouping like the gay community; today, scientific inquiry into the latter is viewed as unnecessary and discriminatory. Similarly to the gay community, which rejected the term "homosexuality" in favour of "gayness", devotees reject terms like "amelotasis" in favour of internal ones like "devotee/ism". Words like "fetish" or "paraphilia" appear to raise loud devotee hackles, probably due to very widespread ignorance and/or alarm of/at their meanings and implications. DPWs energetically dispute sadomasochistic explanations, claiming that to them the disabled are not less able and inferior but hyper-able and superior ("godlike"; this dovetails with the element of admiration mentioned above). Teratophilic and coprophilic explanations are vigorously rejected as fanciful and offensive.
Disabled people have been welcomed into the DPW community since its emergence. The community feels that public acceptance of the rights and equality of disabled people would benefit its members, not least by removing blocks and inhibitors to their self-expression. In social attitudes, some DPWs appear to sense a paradoxical parallel between their position and that of disabled people. They also feel that borderline behaviour by some of their number would be curtailed or obviated by social acceptance of the attraction. Hence, their community expresses unreserved support for the disability movement.
The disability movement is many times larger than the DPW community, and the latter rarely comes to its attention. The movement perforce backs the DPW stance that the disabled ought not to be branded unattractive and asexual but by the same token resists suggestions that they ought to welcome the attentions of a sexual minority. If it has any real stance on DPWs, the movement is generally negative, seeing them as unacceptably needy and fetishistic. Despite early hopes that DPWs were welcome allies in the battle against lookism, the movement has found that they do not offer any escape from the tyranny of visual norms; they merely pile bizarre standards atop mainstream ones. In addition, the "hero adulation" and protectiveness elements of the attraction are ideologically most unwelcome to the movement. More insiduously, DPWs are seen as entryist. Thus, "visibility" is a disability movement issue on which DPWs are attempting to influence views. Cosmesis is widely available to the disabled. Some welcome this as hiding physical differences and aiding integration; others claim it perpetuates a visual norm implying that disability is ugly. DPWs promote the latter side.
People with disabilities
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Despite the explosion of the DPW web, many disabled people remain unaware of the attraction. Those newly introduced to it often report initial alarm and deep shock. Subsequent reactions (often after further research) appear to involve deep introspection and an eventual revision of attitudes. While some aspects of the attraction remain unacceptable and disquieting to disabled people, others appear welcome and liberating. If DPW forum membership is a sign of approval, by mid-2006 there was one disabled member for ten or more DPWs - a proportion somewhat lower than a decade earlier. Nevertheless, in 30 years, up to 500 disabled people have offered images of themselves for sale to devotees, several dozen of them even becoming "devotee courtesans". Often, their "impresarios" are themselves disabled women. This may be interpreted as approval but also as economic exploitation of a marginalized minority group.
The fetishization of disability may reflect a desire to objectify the person with the disability. The focus of the fetishists' attention is not the individual with the disability but rather one component of their physical or mental health, one that invariably represents a weakness or exploitable position. The attractiveness of the disability may leave the person with the disability feeling dehumanized, in a way similar to people targeted on the basis of race or ethnic origin, a concept known as a "racial fetish". These fetishes have in common the fact that a minority group is subjected to stereotyping, "in that the logic of stereotyping in the public domain draws upon the same mechanisms that underlie the fetish in the private domain". The "otherness" and vulnerability projected onto the person with the disability can be, and frequently is, offensive to that person. Many people with disabilities resent being defined by their disability.
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The attraction to disability has not occasioned public concern, even in the more extreme forms that have come to light since the 1990s. It has also failed to occasion genuine concern among disabled people. Most DPWs appear not to find the attraction burdensome and to resist treatment as threatening the entire fabric of their sexuality, as well as stigmatising them. The sole reported exceptions involve wannabes presenting to medical professionals to request treatment. Researchers are non-judgmental; the two exceptions are Riddle, who believes the attraction opens new opportunities to disabled people, and Bruno, who feels the attraction holds scant promise for DPWs and disabled people.
As far as informal remedies go, it may be claimed that the "disabled courtesans" mentioned above offer a form of "treatment" by offering an "escape valve" to those DPWs who have the means and need to enact the purely physical imperatives of their desires. It may also be claimed that the DPW/disabled people gatherings mentioned above offer a loose form of "group treatment" to DPWs who have the means and feel the need to attend.
Reported medical treatments center on psychotherapy for distressed individuals presenting for treatment. Thus, Riddle  suggests that the aim in a psychotherapeutic encounter should be to make devotees "learn to love themselves", while Bruno elaborates by advocating the pre-planned thought-stopping substitution of appropriate behaviors and introspection methods.
In the case of wannabes suffering distress through erotic target location error, Lawrence (2006) moots the possibility of testosterone-lowering medication in parallel with that of elective limb removal through surgical intervention.
- Pumpkin (2002), a sorority girl is drawn to a disabled man.
- Abasiophilia — the fascination for disabled people who use leg-braces or other orthopaedic appliances
- Agalmatophilia — the desire for mannequins or for statue-like immobility, feigned or caused by illness or paralysis
- Acrotomophilia — the desire for partners with missing limbs
- Apotemnophilia — the desire to acquire a disability ("wannabeism," "transability")
- Body dysmorphic disorder — the pathological dislike of one's own physique for subjective reasons
- Body modification — the deliberate altering of physique for non-medical reasons
- Disability pretenders — one who behaves as if disabled and/or alters their appearance so as to suggest they are disabled
- Eyeglass fetishism — the desire for partners who wear spectacles
- Handicap fetishism — another term for the broad range of attractions to disability
- Legbrace fetishism — the desire for partners who use leg braces; an aspect of abasiophilia
- Medical fetishism — a sexualised interest in observing medical practice and receiving medical treatment
- Munchhausen's syndrome — a psychological disorder whose sufferers feign illness and/or cause themselves self-harm
- Pornography addiction — the excessive or exclusive reliance on pornography to attain sexual arousal (also known as “pictophilia”)
- Robot fetishism — the desire for people dressed to appear like robots and acting as robots
- Teratophilia — the desire for deformed or monstrous people
- Transformation fetish — the desire for people who undergo physical transformation (mostly an aspect of pornography fetishism) or body modification
- Voyeurism — the excessive or exclusive reliance on observing other people to attain sexual arousal
- Money, J.; Simcoe, K. W. (1984). "Acrotomophilia, sex and disability: New concepts and case report". Sexuality and Disability 7: 43. doi:10.1007/BF01101829.
- Money, J. (1991). "Paraphilia in Females". Journal of Psychology & Human Sexuality 3 (2): 165–172. doi:10.1300/J056v03n02_11.
- Moser, C. (2011). "Yet Another Paraphilia Definition Fails". Archives of Sexual Behavior 40 (3): 483–485. doi:10.1007/s10508-010-9717-x. PMID 21210203. 
- Balon, R. (2013). "Controversies in the Diagnosis and Treatment of Paraphilias". Journal of Sex & Marital Therapy 39: 7–0. doi:10.1080/0092623X.2012.709219.
- Blom, R. M.; Hennekam, R. C.; Denys, D. (2012). "Body Integrity Identity Disorder". In Harrison, Ben J. PLoS ONE 7 (4): e34702. doi:10.1371/journal.pone.0034702. PMC 3326051. PMID 22514657.
- Lawrence, A. A. (2006). "Clinical and Theoretical Parallels Between Desire for Limb Amputation and Gender Identity Disorder". Archives of Sexual Behavior 35 (3): 263–278. doi:10.1007/s10508-006-9026-6. PMID 16799838. 
- Bruno, Richard L. (1997), "Devotees, Pretenders, & Wannabes: Two Cases of Factitious Disability Disorder", The Journal of Sexuality & Disability 15 (4): 243–260
- Lawrence, A. A. (2009). "Erotic Target Location Errors: An Underappreciated Paraphilic Dimension". Journal of Sex Research 46 (2–3): 194–215. doi:10.1080/00224490902747727. PMID 19308843.
- McRuer, Robert, and Anna Mollow (2012). Sex and Disability. Duke University Press. pp. 360–1. ISBN 9780822351542.
- Blanchard, Ray (2009-06-25). "Paraphilias and the DSM-V: General Diagnostic Issues and Options Exemplified with Pedohebephilic Disorder. Paper presented at 19th WAS World Congress for Sexual Health, June 25, 2009, Göteborg, Sweden". Retrieved 2013-07-05.
- Disabled Dating
- Dixon, D. (1983). "An erotic attraction to amputees". Sexuality and Disability 6: 3–6. doi:10.1007/BF01119844.
- Safe Amputee Dating
- Brang, D.; McGeoch, P. D.; Ramachandran, V. S. (2008). "Apotemnophilia: A neurological disorder". NeuroReport 19 (13): 1305–1306. doi:10.1097/WNR.0b013e32830abc4d. PMID 18695512. 
- Hilti, L. M.; Hanggi, J.; Vitacco, D. A.; Kraemer, B.; Palla, A.; Luechinger, R.; Jancke, L.; Brugger, P. (2012). "The desire for healthy limb amputation: Structural brain correlates and clinical features of xenomelia". Brain. doi:10.1093/brain/aws316. 
- Blanke, O.; Morgenthaler, F. D.; Brugger, P.; Overney, L. S. (2009). "Preliminary evidence for a fronto-parietal dysfunction in able-bodied participants with a desire for limb amputation". Journal of Neuropsychology 3 (2): 181. doi:10.1348/174866408X318653. 
- First, M. B. (2005). "Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder". Psychological Medicine 35 (6): 919–928. doi:10.1017/S0033291704003320. PMID 15997612. 
- Riddle, G. C. (1988). Amputees and Devotees: made for each other?. Irvington Publishers.
- Riddle, G. C., The Origins of Devotees' Attraction. Invited Presentation to the Fascination Conference, Chicago, June 1988
- The Amelotatist: A Statistical Profile, Ampix [exeunt], Lawndale, California, 1979
- Elman, R. Amy, "Disability Pornography: The Fetishization of Women's Vulnerabilities," Violence Against Women, 3.3 (June 1997), pp. 257–270
- Everaerd, W., "A Case of Apotemnophilia: A Handicap as Sexual Preference," The American Journal of Psychotherapy, 37, pp. 285–293, 1983
- Fleischl, M. F., "A Man's Fantasy of a Crippled Girl," The American Journal of Psychotherapy, 14, pp. 471–748, 1960
- Hooper, A., "The Amputee Fetish," Forum [exeunt], June 1978, Penthouse Publications Ltd, London
- Lamacz, M., J. Money, Vandalized Lovemaps: Paraphilic Outcome of seven Cases in Pediatric Sexology, Prometheus, Buffalo, N.Y., 1989
- London, L. S., Dynamic Psychiatry: Transvestism-Desire for Crippled Women, Vol. 2, New York, Corinthian, 1952
- Money, J., Jobaris, R., Furth, G., "Apotemnophilia: Two Cases of Self-demand Amputation as a Paraphilia," The Journal of Sexuality Research, 13, pp. 115–125, 1977
- Money, J., Lovemaps: Clinical Concepts of Sexual/Erotic Health and Pathology, Paraphilia, and Gender Transposition in Childhood, Adolescence, and Maturity, Irvington, New York, N.Y., 1986
- Money, J., The Adam Principle, Prometheus, Buffalo, N.Y., 1993
- Michel Eyquem de Montaigne, "Of the Lame or Crippel," Chapter xi, Booke iii, Essays, (translated from the original French)
- Nattress, L., Jr., "The Female Amputee as an Object of Interest and Sexual Attraction," in Pfeiffer, David, Stephen C. Hey, Gary Kiger — Eds., The Disability Perspective: Variations on a Theme, Salem, Oregon, USA, The Society for Disability Studies and Willamette University, 1993
- Nattress, L., Jr., Amelotasis: A Descriptive Study (second edition), unpublished doctoral dissertation, 1996
- "Steiner, Dr Karl," readers' queries, Men Only, Paul Raymond Publications, London, February 1978 et seq.
- Storrs, B., "Devotees of Disability," New Mobility 6, pp. 50–53, 1997
- Storrs, B., "Amputees, Inc.: Amputees pitching Products and Themselves to Devotees of Disability," New Mobility 7, pp. 26–31, 1997
- Taylor, B, "Amputee Fetishism: An Exclusive Journal Interview with Dr. John Money of Johns Hopkins," The Maryland State Medical Journal, pp. 35–38, March, 1976
- various, Forum (readers' letters), "One-Legged Appeal" and "Monopede Mania," Penthouse, Penthouse Publications, London, June 1974 et seq.
- Wakefield, P. L., Frank, A., Meyers, R. W., "The Hobbyist: A Euphemism for Self-Mutilation and Fetishism," Bull Menninger Clinic, 41, pp. 539–552, 1977
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