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Voluntary incontinence *after* involuntary incontinence?


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Hi folks,

I'm writing this thread to see whether my perspective on a couple of things is normal or extremely unusual.

The context is that I went into diapers 24/7 in the second half of 2012 (not all at once but gradually — 24/7 by about November). I started from a position of continence but didn't care to stay there, and my continence did basically disintegrate (at the time, I saw it as me untraining, but I now feel that's an oversimplistic view). Evaluating that and my actions around it, I wanted to reach out and solicit a few opinions from other people who are or have been IC.

First, I always got the impression that the "respectable, mainstream" AB/DL position was, effectively, that people who want to be IC don't know what they've got 'til it's gone, and that anybody who had actually been severely IC and stuck in diapers wouldn't want to go back to it. I had been severely IC and stuck in diapers for a significant fraction of my life prior to voluntarily returning to them, and while I definitely had negative experiences that were identifiably linked to having been IC and diapered, I guess I didn't ... develop that strong traumatic aversion that I was supposed to? On the contrary, I felt like if I hadn't gone through all of that, I might have been more averse to returning to it later. Having gone through it just made it seem like something I could actually choose to do.

Second, at the time I voluntarily chose to go back into diapers, my continence wasn't 100%. Earlier in my life, it had been 100%, but I then had a prolonged episode of severe IC and after that it was never quite the same (though I don't know if the severe IC "caused" the issues after it). After that episode, I had some variety of stress UI and FI, plus what seemed like new and transient food sensitivities that would cause a few accidents then f*** off, plus (not constant, but regular and consistent) minor soiling. I have no real idea why any of this happened because they only did enough differential diagnostics to determine it probably wasn't anything progressive and life-limiting, and after that they just chucked it all under my paediatric IC diagnosis. Whatever it was, it was functionally: full continence BUT don't run OR go for long walks OR offer to help anybody move house OR eat strange foods OR eat normal foods that are traitors now OR wear anything except black jeans and extremely easily replaceable black underwear OR let anybody smell you in case you had an accident and haven't realised yet. It was just short of being severe enough for doctors to do anything about, but quite sufficiently severe to make others treat me like I was deliberately lazy, picky, and didn't wipe my ass.

I definitely wanted to go back into diapers full-time as an AB/DL, and I think I ultimately did make the decision to start the path that led to 24/7 because I am an AB/DL. At the same time, I feel like certain actions I took which were stereotypically AB/DL (like allowing my continence to fall apart) were actually motivated heavily, perhaps primarily, by having been incontinent and having not been able to do well at being continent. Before going into diapers full-time, I was definitely consciously aware that if I had a choice between two scenarios:

  1. managing adequate continence, in underwear, with an unquantified but significant management failure rate, but tolerating it for the sake of staying in underwear
  2. managing minimal or no continence, in diapers, with near-100% management success

I would pick the latter with no hesitation.

Of course, the thing is that pretty much all of my reasonable issues with being mostly continent in underwear could have been solved by being mostly continent in diapers. Actually letting my continence disintegrate was not something I had to do. So why did I do it? Significantly because I was AB/DL, probably, but I feel like being IC was also a huge part of that. I feel like as a kid I was supposed to resent my body for betraying me by being incontinent, or resent my diapers for protecting me but being embarrassing. What actually happened was I came away resenting my continence for being a lot more work and still leaving me stressed and embarrassed, but being something I had to do regardless because it was "normal." Once I got into diapers, it was just useless information and useless work; I already knew I could function equally well if I didn't have it. So I let it go.

tl;dr — I guess what I'm asking is: can anyone relate to this? Is there anyone else who's been severely IC, "recovered," and then voluntarily chose to return to being IC because the alternative actually sucked just as bad if not worse?

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15 hours ago, Eido said:

(if this sounds familiar from a couple recent asks on your blog, there may be a reason for that ?).

Hey! Nice to talk to you again.

15 hours ago, Eido said:

I don't quite fit into the paradigm you describe, as I was never naturally IC

That's okay. I do think "artificial" IC counts for the purposes of this thread.

15 hours ago, Eido said:

or even medically diagnosed,

As someone with a lot of neurodivergences and mood conditions, I can tell you that I think self-diagnosis is valid (Iverson et al., 2008). There are limits, but this seems pretty unambiguous.

15 hours ago, Eido said:

I think you're correct that a good portion of it is because being an AB/DL tints the subject with validation of diaper desires and perhaps not a small bit of lust.

I do believe it's reasonable to suggest there is a conflict of interest there. The problem is that the conflict of interest is bilateral. As an AB/DL, it's important not to allow the heart to rule the head, so to speak, on continence-related issues. But when IC may have, or has, developed, it's also vitally important not to overcompensate for the fact that one is an AB/DL and therefore undermanage one's IC out of a feeling that one doesn't deserve it.

Also, I think it's definitely fair to point out the libidinal component of AB/DL stuff, up to and including voluntary loss of continence. The problem is that being libidinal doesn't make it go away. If someone wants to be IC and diapered at all times except directly after post-nut drop ("Sex and depression," 2009), they ... still want it 23 hours a day. What are they meant to do, jack off every six hours?

There's another user on this forum who is transfemme and who has explicitly compared wanting 24/7, and wanting to untrain, to gender dysphoria. While I'm also transfemme and I shy away from making that specific comparison, I don't think it's a dumb one. Both experiences are like having a fly buzzing around your ear every day for your entire life.

It really doesn't help that there's some evidence (Maczkowiack & Schweitzer, 2019) that that "moment of clarity" is a sequela of earlier trauma — the same kind, in fact, that Fuss, Jais & BitterGrey et al. showed was prevalent in AB/DLs (Fuss et al., 2019). Is it the case that the reason we think we don't deserve it and can't handle it, and are open to being validated in that, is the same reason we want it in the first place? The implications of that are messy.

15 hours ago, Eido said:

Which is brutal, especially when full continence is still fresh in the memory.

I understand this. I genuinely think if at one point I hadn't had pretty much flawless 100% control, having 80-90% control might not have seemed like such a slog.

15 hours ago, Eido said:

image/reputation at work

I also understand this, and when I made serious attempts to leave diapers, I came to the conclusion that I would really rather be known as the person who wears diapers than the person who needs diapers and doesn't wear them.

15 hours ago, Eido said:

When you're staring down the barrel of an indeterminate amount of time filled with frequent stress, annoyance, and humiliation, are you gonna go with that or with the thing that not only relieves you of that burden and makes life significantly smoother, but pushes your buttons too?

This was definitely something I explored because I had a few romantic non-sexual experiences in the years before I went into diapers, and I lost my virginity just after I went into diapers, at a point where I could still spend some time out of them. I contemplated leaving diapers, which at that point I likely could have done (my control had slipped a bit, but that was super early on) — and might have done had that relationship not exploded like a grenade for completely unrelated reasons. But as much as I was, at the time, maybe willing to leave diapers, I was also super, super aware that any relationship that required me to do that would be one that I would have extreme difficulty enjoying.

15 hours ago, Eido said:

For my part, I'm still on the fence.

I'm gonna keep my commentary selective because my approach also has drawbacks, I really don't want to be a partisan for my side, and I really do think that you should pursue the way that you genuinely feel is correct and sustainable.

15 hours ago, Eido said:

to be fair, I haven't put as much effort as I could into retraining,

This has been a constant problem for me — not on retraining, which I always phoned in and ultimately gave up, but I knew I was doing that while I was doing it. I have had real difficulty knowing what I like and what I intend, I think probably partly as a byproduct of autistic alexithymia (Preece et al., 2017), but also as a direct symptom of complex PTSD (Cook et al., 2005) and possible gender-incongruence-related depersonalisation/derealisation disorder (Colizzi et al., 2015). I have constantly been in the position of, "Should I be trying harder, or am I actually finding it impossible to try harder because this is pointless?"

15 hours ago, Eido said:

Would it really be so bad to just...let it happen?

From what you're saying, it seems like if you were to completely regain your continence, you would feel empowered and feel like your degree of agency is enhanced, which I absolutely think is a laudable thing to seek out. I think I said something like this in my reply to one of your tumblr asks, but at times like this — and especially when life has kicked you around a bit — it can often seem as if you must say, "Well, fuck me I guess, I have neither the power nor the standing to resist the dictates of circumstance; I didn't deserve the prize anyway and I deserve what I get." I think that's an illusion. If continence would make you feel better, you are entitled to keep fighting for it no matter how many roadblocks you encounter or how many times you stumble along the way. Having said that, I also think that the idea that being severely incontinent will ruin your life is a non sequitur in the strict sense; it could do so, but it is not guaranteed to.

I think you're in a situation where both alternatives are compelling, which sucks because, despite the hype, 99.9% of all the decisions a person will ever make have a preponderance of evidence in one direction or the other, so hard decisions are genuinely hard and nobody actually has the strength of character to make them. I don't want to be all "Make your choice, adventurous Stranger," (Lewis, 1955) but in making decisions where I know both options are loaded with regret, I ask myself: will I be able to resolve that regret and move past it given time, so that it only hurts sometimes, or will it take on haunting me, as a kind of sport? I definitely tend to prefer the first kind.

References

Colizzi, M., Costa, R., & Todarello, O. (2015, January 23). Dissociative symptoms in individuals with gender dysphoria: Is the elevated prevalence real?Psychiatry Research, 226(1), 173-180. doi:10.1016/j.psychres.2014.12.045. 

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., ... & van der Kolk, B. (2005, May 1). Complex trauma in children and adolescentsPsychiatric Annals, 35(5). doi:10.3928/00485713-20050501-05.

Fuss, J., Jais, L., Grey, B.T., Guczka, S.R., Briken, P., & Biedermann, S.V. (2019, June 22). Self-reported childhood maltreatment and erotic target identity inversions among men with paraphilic infantilismJournal of Sex & Marital Therapy, 45(8), 781-795. doi:10.1080/0092623X.2019.1623355.

Iverson, S.A., Howard, K.B., & Penney, B.K. (2008, December). Impact of internet use on health-related behaviours and the patient-physician relationship: A survey-based study and reviewJournal of the American Osteopathic Association, 108(12), 699-711. 

Lewis, C.S. (1955). The magician's nephew. The Bodley Head.

Maczkowiack, J., & Schweitzer, R.D. (2019, February 7). Postcoital dysphoria: Prevalence and correlates among malesJournal of Sex & Marital Therapy, 45(2), 128-140. doi:10.1080/0092623X.2018.1488326.

Preece, D., Becerra, R., Allan, A., Robinson, K., & Dandy, J. (2017, December 1). Establishing the theoretical components of alexithymia via factor analysis: Introduction and validation of the attention-appraisal model of alexithymiaPersonality and Individual Differences, 119, 341-352. doi:10.1016/j.paid.2017.08.003.

Sex and depression: In the brain, if not the mind (2009, January 20). New York Times.

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14 hours ago, Eido said:

I was worried for most of the day after that post that I'd overstepped, so it means a lot to know you find my situation valid as well ❤️

No worries! I figure if it stops being voluntary, it becomes involuntary :)

14 hours ago, Eido said:

If you don't mind me prying a bit, could you expand a little on what it was like for you as an ABDL when you were going through this transition?

Sure! The point at which I actually thought, "I have to manage my IC, regardless of what, as an AB/DL, I am allowed to do," was when my FI started developing. I had subclinical stress FI before diapers, but the presentation of FI that I developed in diapers was much more dramatic and severe. The reason that I had to have that come-to-Jesus moment was because effectively handling my FI while also retaining core competencies that were important to me, like the ability to move through the world freely, meant revising the way I lived the rest of my life much more radically than I had done either to go 24/7 or upon realising I had developed UI.

It kind of developed outward from diapering. I went 24/7 with the impression essentially that I was going to swan through the world in Abena M3s and boot cut jeans. I had been voluntarily messing for months before I identified loss of control, but specifically because it was voluntary and I hadn't been doing it 100% of the time, I hadn't bothered to seriously adapt my life to it. When it can happen just anywhere, on the other hand, Abena M3s + jeans just make you feel like you have a landmine attached to your ass. There was really simple ordinary stuff that suddenly became necessary to do in a tentative and doubtful way, like sitting down in my car. It became ridiculous.

For me, freedom of movement and action in that context required much heavier protection. I functionally needed more absorbency because... to be blunt, poop contains water; I needed to use diapering with much more body coverage so I wasn't risking a "containment breach" every time I moved too energetically; I needed to use multiple layers of diapering so that I had a margin of safety if worst came to worst, and I wasn't going to move to a disposable/disposable arrangement because I couldn't afford to throw out half the diapers I bought, unused, so I had to switch to using cloth diapers as either part or all of my diapering.

Basically it meant I had to switch from a "moderate, responsible" amount of diapering (which was based on a consumer choice I had made as a mostly continent AB/DL with entirely different needs) to a really just outrageously super-heavy amount of diapering. That took a lot of reconciling because if there's one AB/DL tendency I absolutely hate, it's maladaptive exhibitionism — "Look how massive and obvious my diaper is! Look at all these people who have to see it!" ADISC and DailyDiapers both seem to take a fairly hard line on that kind of shit, but it is everywhere fucking else. So at that point I ran into a psychological wall of "No! Properly managing your continence would turn you into one of those assholes!"

But in the end it was accept the bulk, or keep tiptoeing everywhere and have a heart attack at 20 from stress, or stop tiptoeing everywhere and become a biohazard. So I accepted the bulk. Which itself led to complications because I obviously needed clothes that would comfortably fit over it without emphasising it, and my baseline proportions are already weird in the same ways that diapers tend to accentuate, so like, any pants that comfortably fit over my diaper came down over my foot, and I hate altering clothing and it hates me.

So then I went into 18 months of weird awkward sartorial holding action to avoid confronting the fact that an off-the-shelf wardrobe which is properly mechanically adapted to that level of diapering, and to the mechanisms underlying the functional necessity thereof, tends to inevitably make you look like you're trying to look like you're 2, and that also felt like exhibitionism. How many non-AB/DL adults do you know who wear bib-and-brace overalls on the reg.? — The weird thing is, overalls weren't even a solution I adopted from other AB/DLs or from babywear. I got that idea through the ISC Primer ("Chapter 11: What to wear," 2005) which is very good, but unashamedly AB/DL-neutral-to-unfriendly ("Chapter 2: Diapers get a bum rap," 2005). The fact that I then became more aware of their status as traditionally babyish clothes is what contextualised them to me as unacceptable.

Anyway I had to come to terms with the fact that, as an IC AB/DL, it was functionally necessary for me to do things that, as a continent AB/DL, I would have felt it ethically necessary not to do. I don't think one should ever be lax in monitoring oneself, but it was eventually a choice between going mad and leaning slightly in.

14 hours ago, Eido said:

You mentioned that you ultimately decided to let go as a result of being one, but was there a particular event or thought process that prompted that decision?

It wasn't a conscious "I am doing this because I am an AB/DL" decision, just a decision that I am fairly sure I wouldn't have made if I wasn't an AB/DL. Basically, I had an incident at university at the end in mid-2012 where, as a result of the institution being disorganised, I had to not take a toilet break and ended up almost wetting myself, about five years after the last time I had done that involuntarily. I resolved to start wearing diapers specifically to deal with circumstances like that, and then I was like, "Well, actually, there are plenty of other circumstances in which this would also be useful," such that I was 24/7 by the end of the next semester.

Choosing to let my control fall apart also wasn't initially a conscious decision; I just think that if I had been deciding entirely as an IC person, I might not have decided to use my diapers completely instead of the toilet, which was really the foundation of everything else.

14 hours ago, Eido said:

There are just too many similarities to discount.

Yep. I think the theory that untraining-focused AB/DL is a presentation of body integrity dysphoria (Brugger & Lenggenhager, 2014) has merit. I will admit to being a sellout bitch because I think I still have too many hangouts to be an advocate for AB/DLs with BID, despite quite probably being one; if I got shirtfronted and asked to confirm my stance in front of a hostile audience, it would be difficult not to go all John 18:15-27 about it. Hopefully I improve with time.

14 hours ago, Eido said:

My refractory periods only began to be overwhelmingly negative and shameful after those events and after I began to see genuine progress towards losing continence

I can relate to the kind of events you're describing — I'm not gonna divert this thread to talk about my own experiences, but I'm really sorry that  what happened to you, happened to you. You deserved to be treated better.

I was definitely getting small nudges to quit diapers during refractory periods, which I write down to PCD. Ultimately, however, PCD is itself an altered mental state; it prevents impulsive libidinal behaviour, but it's useless as a means of evaluating the long-term appropriateness of that behaviour.

During the period between realising I was trans and starting HRT, I had periods where under particular stress I would mentally "flip" and accept my immediate family's paper-thin and obviously bullshit argument that I shouldn't transition. That's typical of complex PTSD (Pelcovitz et al., 2006) — "acceptance of a perpetrator's belief system."

Shame is "a perpetrator's belief system" on a large scale; it's the result of internalising the prevailing societal morality (Gilbert, 2003). I think PCD induces diaper-related shame because orgasmic release of oxytocin puts you in a receptive headspace (Carmichael et al., 1987; Hurlemann et al., 2010; Lane et al., 2012) and that "voice of society" suddenly becomes impossible to ignore. One of the reasons I particularly believe that last part is because oxytocin promotes both (1) trust and (2) dishonesty favouring your in-group (Shalvi & De Dreu, 2014); with oxytocin flooding your system, it could be that you'd be more likely to repressively lie to yourself, and more likely to believe it.

Society is wrong about a bunch of shit, even right down in its marrow, on things the truth of which has been decisively proven. PCD just makes you more likely to believe society is right, regardless of whether it actually is.

14 hours ago, Eido said:

Does letting go and accepting IC life make them go away, or at least soften them (you might be able to answer this one, in particular)? It seems to be a battle between ego and super-ego, where the ego's desires aren't likely to ever let up, so is the only option to alleviate PCD to dive into those desires, societal pressures be damned?

CW: partisanship!

"Does letting go and accepting IC life make them go away, or at least soften them [...]?" I can't tell you what it does as a rule; I don't know what it does as a rule. Here's what it did for me.

With regard to positive feelings about diapers, they stopped being a weakness. Before I achieved complete and unconditional acceptance, even well into diapers and continence loss, I was still stuck in the binge-purge cycle (BitterGrey, 2015), but because I couldn't be out of diapers it was externalised onto diaper-related content. Extreme stress would trigger days-long binges where I just ignored everything else. As well, even though diapers were one of the few things that broke through my total lack of happiness, they did so in a very intense way which could feel anxious, extreme, frenzied. After accepting whatever happened, giving myself permission, that evened out. The binges stopped, diminishing to what I guess is probably an ordinary level of ebb and flow; the happiness stopped making me tremble and stopped being laced with terror.

With regard to negative feelings about diapers, they stopped being incomprehensible and inaccessible, and became legible and solvable. Before full-time diapers, when I had PCD after diaper-related content, and I wanted to know why I felt so bad, my brain told me, "Because you're a fucked-up, malodorous little pervert, and you'll never know why, and I don't want to find out what other worms are wiggling under that rock." After full-time diapers and continence loss, I didn't have PCD as often, but when I did, my brain told me, "Because you're a self-mutilating freak, and this is you imploding from your own decadence."

After full-time diapers, continence loss, and acceptance, I might feel transiently bad, and my brain would be like, sort of lamely, "Ewww, you're in a messy diaper" (full acceptance came after pretty well-advanced loss of #2 control, so my brain just skipped bullying me for the wet diapers altogether). And I'd be like... "Why is that bad?" And my brain would be like, "... Uh. Because you need to change it before you go to bed." And I'd be like, "Thanks for the tip." And that would be that.

"is the only option to alleviate PCD to dive into those desires, societal pressures be damned?" That's a good question. The summary of my answer is: Probably, but if this is the good one, who gives a shit?

I want to expand on that answer. I'm not aware that there are any ways to get free of the desire to wear 24/7 and untrain other than to do those things. I'm not aware that there are any such ways in the pipe. I'm not aware that any are possible in principle.

Part of my decision to go ahead with all this, both originally (before accepting myself) and at the point of acceptance, was essentially I didn't feel I was obliged to wait for medical science to sign off on me being happy. I had a need to untrain, and there was no effective anti-need-to-untrain drug or therapy, so there was one solution for it, because I wasn't going to sit there with my thumb through the back of my boxers and this bug in my head.

But also, if there were, I don't know that I would take it. A funny story is that one of the best-known things about trans HRT is that one of the key components, estradiol, kills your libido — it was temporary for me and my understanding is it usually is (Defreyne et al., 2020). Given there absolutely is libidinal involvement in my relationship to diapers, I lost a big part of my active enjoyment of them. I didn't start hating them, they just stopped feeling so cool and interesting and started being mostly just... there, irrelevant to me. I was worried sick, because I started HRT well after my IC was formalised as absolutely permanently definitely forever, so I thought, "If I suddenly don't have a relationship with diapers any more, I'm done for." I was worried it was the beginning of a long fatal downhill.

But my libido came back, and was better-integrated with the rest of my brain because it was no longer so physically disgusting to experience. What I noticed while it was gone was... a hole. Like an unexpectedly missing tooth. I tried to do worldly things with that time but just... nothing came. That space was unnerving; it wasn't supposed to be there. I don't think I'd welcome another absence like that.

People are entitled to have expectations of me with regard to my diapers. People are entitled to modify their behaviour toward me as a result, or request that I modify mine. But I have always fundamentally disagreed with the idea that I should have voluntarily committed to leaving that hole in my heart just because others found my means unsettling or others were worried about my future. I researched my alternatives, I liked my means, and it is my future.

14 hours ago, Eido said:

It's difficult to say that I genuinely want continence. The perks that come with it, sure, but the ability itself...

Yeah. There were definitely times when I found myself missing aspects of continence, but it wasn't a stab-in-the-heart, lifelong pain; I generally found I could "get out by going through," making some change to my life that I hadn't previously thought of or hadn't previously seen the need to make, so that I could capture the positive facets of what was now absent within the context of not being continent.

Diaper changes can suck. But they always suck less than being stuck in briefs and staring longingly through the open door of a vacant toilet with a change table in it.

14 hours ago, Eido said:

You've given me a lot to chew on here and I appreciate it more than I can express. Cheers!

No worries! I hope it comes out to be the best possible thing.

References

BitterGrey (2015, July 23). The ABDL binge and purge cycle. Understanding Infantilism.

BitterGrey (2019, July 20). Why want diapers?. Understanding Infantilism.

Brugger, P., & Lenggenhager, B. (2014, December). The bodily self and its disorders: Neurological, psychological and social aspects. Current Opinion in Neurology, 27(6), 644-652. doi:10.1097/WCO.0000000000000151.

Carmichael, M.S., Humbert, R., Dixen, J., Palmisano, G., Greenleaf, W., & Davidson, J.M. (1987, January). Plasma oxytocin increases in the human sexual response. Journal of Clinical Endocrinology & Metabolism, 64(1), 27-31. doi:10.1210/jcem-64-1-27.

Chapter 2: Diapers get a bum rap (2005). In Incontinence Support Center (Eds.), The new diaper primer. Your Incontinence Support Center: A caring community.

Chapter 11: What to wear (2005). In Incontinence Support Center (Eds.), The new diaper primer. Your Incontinence Support Center: A caring community.

Defreyne, J., Elaut, E., Kreukels, B., Fisher, A.D., Castellini, G., ... & T'Sjoen, G. (2020, January 31). Sexual desire changes in transgender individuals upon initiation of hormone treatment: Results from the Longitudinal European Network for the Investigation of Gender IncongruenceJournal of Sexual Medicine, 17(4), 812-825. doi:10.1016/j.jsxm.2019.12.020.

Gilbert, P. (2003, Winter). Evolution, social roles, and the differences in shame and guiltSocial Research: An International Quarterly, 70(4), 1205-1230.

Hurleman, R., Patin, A., Onur, O.A., Cohen, M.X., Baumgartner, T., ... & Kendrick, K.M. (2010, April 7). Oxytocin enhances amygdala-dependent, socially reinforced learning and emotional empathy in humansJournal of Neuroscience, 30(14), 4999-5007. doi:10.1523/JNEUROSCI.5538-09.2010.

Lane, A., Luminet, O., Rimé, B., Gross, J.J., de Timary, P., & Mikolajczak, M. (2012, May 3). Oxytocin increases willingness to socially share one's emotionsInternational Journal of Psychology, 48(4), 676-681. doi:10.1080/00207594.2012.677540.

Pelcovitz, D., van der Kolk, B., Roth, S., Mandel, F., Kaplan, S., & Resick, P. (2006, February 19). Development of a criteria set and a structured interview for disorders of extreme stress (SIDES)Journal of Traumatic Stress, 10(1), 3-16. doi:10.1002/jts.2490100103.

Shalvi, S., & De Dreu, C.K.W. (2014, April 15). Oxytocin promotes group-serving dishonestyProceedings of the National Academy of Sciences of the United States of America, 111(15), 5503-5507. doi:10.1073/pnas.1400724111.

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