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This variation sees an attacking wrestler first lock an opponent in the pumphandle hold before then using the hold to raise the opponent up over the shoulder of the attacking wrestler. From here the attacking wrestler brings the opponent down into the belly-to-belly position before then sitting down for a reverse piledriver with the opponent's head impacting the mat between the legs of the attacking wrestler.
Delirious performs a double pumphandle reverse piledriver, named the Chemical Imbalance II, in which he stands behind a bent over opponent and threads both of the opponent's arms between their legs. He then grabs both of the opponent's wrists with both hands and lifts up, forcing the opponent to flip forward. The opponent then lands on their head in the piledriver while Delirious falls to a sitout position.