Sexual Masochism Disorder | Psychology Today

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Reviewed by Psychology Today Staff

Sexual masochism disorder is a paraphilic disorder, which involves recurrent, intense, sexually arousing fantasies, urges, or behaviors that are distressing or disabling and have the potential to cause harm to oneself or others.

Sexual masochism refers to engaging in, or frequently fantasizing about, being beaten, bound, humiliated, or otherwise made to suffer, resulting in sexual satisfaction. If people with this sexual preference report psychological or social problems as a result, they may be diagnosed with sexual masochism disorder. The types of distress that people with this disorder may experience include severe anxiety, guilt, shame, and obsessive thoughts about engaging in sexual masochism.

In contrast, if a person with sexually masochistic desires declares no distress, anxiety, ob­sessions, guilt, or shame, about these paraphilic impulses, and are not hampered by them in the course of daily life, they could be determined to have masochistic sexual interest but should not be diagnosed with sexual masochism disorder.

One specific type of sexual masochism is called asphyxiophilia, in which a person receives sexual satisfaction by having their breathing restricted. While some people engage in this practice with partners, others prefer to restrict their breathing while they are alone, and accidental death may happen as a result.

Sexually masochistic behavior is usually evident by early adulthood, and sometimes begins with masochistic or sadistic play during childhood

Contents

• Symptoms
• Causes
• Treatment

Symptoms

According to the DSM-5, to be diagnosed with sexual masochism disorder a person must experience recurrent and intense sexual arousal from being beaten, humiliated, bound, or aroused from some other form of suffering. These types of urges, fantasies, or behaviors must be present for at least six months and cause clinically significant troubles or difficulty in social, occupational, or other important areas in life.

The extensive use of pornography involving the act of being humiliated, beaten, bound, or otherwise made to suffer is sometimes an associated feature of the disorder

Why do people practice sexual masochism? Created with Sketch.

In a recent study, the most frequent reason for engaging in masochism and sadism was to give or exchange power with another person. Others responded that the practice allowed them to enter into an alternative state of consciousness, one that could lead to a somewhat meditative and relaxed state.

What is the prevalence of sexual masochism in the population? Created with Sketch.

According to a meta-analysis of research, BDSM-related (Bondage and Discipline, Dominance and Submission, Sadochism, and Masochism) fantasies were found to be common in both males and females, with 40 to 70 percent of the population engaging in fantasies about the acts, while about 20 percent reported engaging in BDSM. Individual studies have found similar, if smaller ranges, with several studies estimating 5 to 14 percent of Americans have engaged in BDSM. Few studies have focused on only masochistic behaviors. One study that did indicated only 1 to 2 percent of study participants in Australia engaged in sexual masochism.

Is sexual masochism a largely Western phenomenon? Created with Sketch.

There’s evidence to suggest sexual masochism may be unevenly distributed around the world and is most common in the affluent West, though there is less study of it outside of Western countries. BDSM (Bondage and Discipline, Dominance and Submission, Sadochism, and Masochism) practitioners appear to be most often white, well educated, and young.

How is sexual masochism disorder diagnosed? Created with Sketch.

A psychiatric diagnosis of sexual masochism is quite distinct from the act of enjoying sexual masochism. There are active communities of those who find sexual pleasure from bondage, domination, and masochism. For these people, life is not upended by such sexual preferences. To have a diagnosable sexual masochism disorder, the patient must experience ​​anxiety, ob­sessions, guilt, or shame about the acts for a prolonged period, typically six months or longer.

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Causes

There is no universally accepted theory explaining the root of sexual masochism, however, several ideas have been advanced. One theory suggests that paraphilias originate when inappropriate sexual fantasies are forbidden, and become stronger as they are suppressed. Another theory suggests that sadomasochistic behavior is a form of escape from one’s thoughts and allows the practitioner to enter into something resembling a meditative state. Through acting out fantasies, individuals allow themselves to feel new and different. Another theory suggests that childhood trauma, such as sexual abuse, can later manifest in a paraphilic disorder.

What causes someone to be a masochist? Created with Sketch.

In one recent study, ​​the significant majority of participants reported they had an intrinsic interest in masochism/submission starting at a young age. A smaller number of people connected the impulses to childhood sexual abuse and to parental discipline.

Is there a difference between men and women in sexual masochism? Created with Sketch.

According to recent research, women reported fantasizing about being dominated significantly more than men (65 percent in women compared to 54 percent in men), while men reported fantasizing about dominating someone significantly more than women (60 percent in men compared to 47 percent in women). Women desired to engage in masochism significantly more than men (28 percent in women compared to 19 percent in men).

Does engaging in sexual masochism mean a person is more likely to be a psychopath? Created with Sketch.

In the past, it has been believed that someone with a desire for sexual masochism must have psychiatric problems, including psychopathy. Recent research indicates that this is not true. Several recent studies suggest good psychological health among BDSM practitioners.

Treatment

Treatment for sexual masochistic disorder typically involves psychotherapy and medication that can reduce sex drive. The goal of psychotherapy may be to uncover and work through the underlying cause of the behavior that is causing distress. Cognitive therapies include restructuring cognitive distortions and empathy training. Restructuring cognitive distortions involves correcting any beliefs a patient has that may lead them to act on harmful thoughts. Cognitive-behavioral therapy can also help an individual learn skills to manage their sexual urges in healthier ways. Other common strategies include aversion therapy and imagery/desensitization techniques, in which individuals imagine themselves in a situation where they are participating in sexual masochism, and then experience a negative event to reduce future desire to participate in that activity again.

Advancing age is believed to reduce the symptoms and desires of sexual masochism, as it does with other paraphilic disorders, and with sexual urges generally.

Various medications can be used to decrease the level of circulating testosterone in the body with the aim of reducing the frequency of erections in males. Antidepressant medications may also be used to reduce sex drive.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Current Diagnosis & Treatment in Psychiatry

Treating Mental Disorders: A Guide to What Works

Labrecque, F., Potz, A., Larouche, M., & Joyal, C. C. (2020). What Is So Appealing About Being Spanked, Flogged, Dominated, or Restrained? Answers from Practitioners of Sexual Masochism/Submission. The Journal of Sex Research, 58(4), 409–423. https://doi.org/10.1080/00224499.2020.1767025

Wismeijer, A. A., & van Assen, M. A. (2013). Psychological Characteristics of BDSM Practitioners. The Journal of Sexual Medicine, 10(8), 1943–1952. https://doi.org/10.1111/jsm.12192

Brown, A., Barker, E. D., & Rahman, Q. (2019). A Systematic Scoping Review of the Prevalence, Etiological, Psychological, and Interpersonal Factors Associated with BDSM. The Journal of Sex Research, 57(6), 781–811. https://doi.org/10.1080/00224499.2019.1665619

An Introduction to BDSM for Psychotherapists | Society for the Advancement of Psychotherapy. (2021). Society for the Advancement of Psychotherapy. https://societyforpsychotherapy.org/an-introduction-to-bdsm-for-psychot…

Last updated: 09/15/2021 Clinical Terms Abuse/Neglect

• Child Abuse
• Child Neglect
• Elder or Dependent Adult Abuse
• Elder or Dependent Adult Neglect
• Pedophilia
• Reactive Attachment Disorder
• Sexual Sadism Disorder

Addictions/Substance Abuse

• Alcohol Use Disorder
• Amphetamines
• Caffeine
• Cannabis/Marijuana
• Co-Occurring Disorders
• Cocaine Use Disorder
• Gambling Disorder (Compulsive Gambling, Pathological Gambling)
• Hallucinogen Persisting Perception Disorder (HPPD)
• Hallucinogens
• Inhalant-Related Disorders
• Nicotine
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• Sedative, Hypnotic, and Anxiolytic-Related Disorders
• Sedatives
• Stimulant-Related Disorders
• Substance-Related Disorders
• Substance/Medication-Induced Psychotic Disorder
• Tobacco-Related Disorders

Aging

• Aging
• Delirium
• Elder or Dependent Adult Abuse
• Elder or Dependent Adult Neglect
• Empty Nest Syndrome
• Erectile Disorder
• Midlife
• Neurocognitive Disorders (Mild and Major)

Anxiety/Phobia

• Acute Stress Disorder
• Adjustment Disorder
• Agoraphobia
• Body Dysmorphic Disorder
• Generalized Anxiety Disorder
• Hypersomnolence
• Illness Anxiety Disorder
• Insomnia
• Nightmares
• Obsessive-Compulsive Disorder
• Panic Attack
• Panic Disorder
• Post-Traumatic Stress Disorder
• Separation Anxiety
• Social Anxiety Disorder (Social Phobia)
• Specific Phobia
• Tinnitus
• Vertigo

Attention Deficit/Hyperactivity

• Attention-Deficit/Hyperactivity Disorder, Adult
• Attention-Deficit/Hyperactivity Disorder, Children
• Attention-Deficit/Hyperactivity Disorder, Teen
• Developmental Coordination Disorder
• Dysgraphia
• Dyspraxia

Bipolar Disorders

• Bipolar Disorder
• Cyclothymic Disorder

Child/Adolescent

• Asperger's Syndrome
• Attention-Deficit/Hyperactivity Disorder, Children
• Autism Spectrum Disorder
• Child Abuse
• Child Neglect
• Childhood-Onset Fluency Disorder
• Communication Disorders
• Conduct Disorder
• Disinhibited Social Engagement Disorder
• Disruptive Mood Dysregulation Disorder (Children and Adolescents)
• Dyscalculia
• Dysgraphia
• Dyslexia
• Dyspraxia
• Encopresis
• Enuresis
• Intellectual Disability (Intellectual Developmental Disorder)
• Language Disorder
• Learning Disability
• Nonverbal Learning Disorder
• Pedophilia
• Provisional Tic Disorder
• Reactive Attachment Disorder
• Selective Mutism
• Separation Anxiety
• Speech Sound Disorder
• Tourette's Disorder

Communication Disorders

• Childhood-Onset Fluency Disorder
• Communication Disorders
• Language Disorder
• Speech Sound Disorder

Depression/Mood

• Adjustment Disorder
• Bereavement
• Co-Occurring Disorders
• Depressive Disorders
• Persistent Depressive Disorder (Dysthymia)
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• Visual Snow

Dissociation

• Depersonalization / Derealization Disorder
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• Dissociative Fugue (Psychogenic Fugue)
• Dissociative Identity Disorder (Multiple Personality Disorder)

Eating Disorders

• Anorexia Nervosa
• ARFID (Avoidant Restrictive Food Intake Disorder)
• Binge-Eating Disorder (Compulsive Overeating)
• Bulimia Nervosa
• Eating Disorders
• Obesity
• Pica
• Rumination Disorder

Impulse Control Disorders

• Intermittent Explosive Disorder
• Kleptomania
• Oppositional Defiant Disorder
• Pyromania

Movement Disorders

• Developmental Coordination Disorder
• Parkinson's Disease
• Persistent (Chronic) Motor or Vocal Tic Disorder
• Provisional Tic Disorder
• Stereotypic Movement Disorder
• Tourette's Disorder

Neurocognitive Disorders

• Alzheimer's Disease
• Dyscalculia
• Dysgraphia
• Dyslexia
• Dyspraxia
• Frontotemporal Dementia
• Intellectual Disability (Intellectual Developmental Disorder)
• Lewy Body Dementia
• Neurocognitive Disorders (Mild and Major)

Obsessive-Compulsive Spectrum Disorders

• Dermatillomania (Skin Picking)
• Hoarding Disorder
• Obsessive-Compulsive Disorder
• Onychophagia (Nail Biting)
• Trichotillomania (Hair Pulling)

Personality

• Antisocial Personality Disorder
• Avoidant Personality Disorder
• Borderline Personality Disorder
• Dependent Personality Disorder
• Histrionic Personality Disorder
• Malingering
• Narcissistic Personality Disorder
• Obsessive-Compulsive Personality Disorder
• Paranoid Personality Disorder

Psychosis/Schizophrenia Spectrum Disorders

• Brief Psychotic Disorder
• Catatonia
• Delusional Disorder
• Hallucinogen Persisting Perception Disorder (HPPD)
• Paranoid Personality Disorder
• Psychotic Disorder Due to Another Medical Condition
• Schizoaffective Disorder
• Schizoid Personality Disorder
• Schizophrenia
• Schizophreniform Disorder
• Schizotypal Personality Disorder
• Substance/Medication-Induced Psychotic Disorder

Sexuality

• Erectile Disorder
• Exhibitionism
• Fetishistic Disorder
• Frotteuristic Disorder
• Gender Dysphoria
• Genito-Pelvic Pain or Penetration Disorder (Sexual Pain Disorder)
• Hypersexuality (Sex Addiction)
• Orgasmic Disorder
• Paraphilias
• Pedophilia
• Sexual Desire Disorder
• Sexual Masochism Disorder
• Sexual Sadism Disorder
• Transvestic Disorder
• Voyeuristic Disorder

Sleep Disorders

• Circadian Rhythm Sleep-Wake Disorders
• Hypersomnolence
• Insomnia
• Narcolepsy
• Nightmares
• Non-Rapid Eye Movement Sleep Arousal Disorders
• Rapid Eye Movement Sleep Behavior Disorder
• Restless Legs Syndrome
• Sleep Apnea
• Sleep-Related Hypoventilation
• Sleepwalking

Somatization

• Conversion Disorder
• Factitious Disorder (Munchausen Syndrome)
• Illness Anxiety Disorder
• Somatic Symptom Disorder

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