Sexual Masochism: Signs, Possible Disorders, And Reducing Stigma

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Psych CentralSubscribeSexual Masochism, Sexual Sadism, and Potential Disorders

Medically reviewed by Lori Lawrenz, PsyD — Written by Zuri White-Gibson — Updated on February 25, 2022

Masochism
Sadism
Sadomasochism
Misconceptions
Examples
Recap

Signs of sexual masochism and sadism are not necessarily symptoms of a mental health disorder. It’s time to reduce the stigma.

Hands bound with fuzzy blue soft handcuffs — Juan Moyano/Stocksy United

For some, open conversations about sex continue to be a touchy subject, especially if you engage in practices that are deemed “unconventional.”

Bondage, Discipline, Sadism, Masochism (BSDM) lies under the larger umbrella of kink, which is considered sexual activity that does not “follow the straight and narrow.”

If you’re someone less versed in the ins and outs of BDSM, hearing of a person being slapped or tied up during sex may sound scary, but in reality, many feel empowered through their engagement.

It’s important to learn the difference between healthy fun and a potential issue. While avoiding pain is paramount for some, others find it pleasurable.

What is masochism?

Sexual masochism is defined as taking erotic pleasure in receiving pain.

While this can include being tied up, beaten, or degraded verbally, it can also include more subtle acts, such as biting or rough sexual intercourse.

What is sadism?

Sadism is defined as taking erotic pleasure in inflicting pain on others.

Similarly, this can include using bondage on another individual, impact play, or degradation.

Marla Renee Stewart, MA, sexologist and lecturer in Women’s and Gender Studies at Clayton State University in Morrow, Georgia, says, “There’s two sides to everything — for every masochist, there is a sadist.”

What is sadomasochism?

Sadomasochism refers to the enjoyment of both giving and receiving pain in sexual settings.

Consent is a non-negotiable pillar when it comes to safety within kink and BDSM. All parties involved have to agree to boundaries around activities that will take place — otherwise, you are involved in an abusive situation.

Misconceptions about masochism and sadism

Because of the stigma that surrounds the kink community in tandem with the lack of accurate media portrayals (no, “Fifty Shades of Grey” does not count — boundaries should never be crossed) there are often misunderstandings about the intricacies of the community and how sexual interactions unfold.

For those outside of the community, it can be assumed that violence or aggression during sex is the only important facet, whereas key elements of safe “play” include:

informed consent
safe words
boundaries and limits
aftercare

Masochism and sadism as paraphilia

Several researchers have referred to desire around pain as “disordered,” defining it as a paraphilia. Paraphilia is a condition characterized by abnormal sexual desires typically involving extreme or dangerous activities.

While experts may separate masochistic or sadistic behavior from disordered behavior depending on severity, the inclusion of the term as a paraphilia leads to the idea that those desires are “deviant.”

Stewart discusses the stigma around engaging in BDSM, particularly masochism and sadism, because of these preconceived ideas about how it may feel and what it says about an individual.

Studies have suggested those who participate in BDSM-related activities are no more likely to have diagnosed mental health disorders, and may even have better psychological health than those who do not.

When it comes to biology, the pain and pleasure centers within our brains are very close together and research shows that they release similar chemicals when engaged, resulting in a pleasurable response to pain.

Clinical definitions

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) definition is clear that a recurrence of distressing thoughts and urges around masochism are necessary for it to be considered a disorder.

According to their entry on sexual masochism disorder, diagnostic criteria include:

The person experiences intense urges or behaviors involving receiving extreme physical pain or humiliation for erotic purposes.
These urges significantly and negatively impact day-to-day life.
Symptoms are present for at least 6 months.

If a medical professional diagnoses sexual masochism disorder, they may specify if additional conditions may be present. For example, the specifier “with asphyxiophilia” means a person has been diagnosed with sexual masochism disorder and experiences sexual arousal by asphyxiation (restricting breathing). However, a specifier is not a requirement for diagnosing sexual masochism disorder.

The DSM-5 diagnostic criteria for sexual sadism disorder similarly include:

The person experiences intense urges or behaviors involving inflicting or observing physical or psychological suffering of another person for erotic purposes.
The person has acted on these urges with a person without their consent or the urges significantly and negatively impact day-to-day life.
Symptoms are present for at least 6 months.

Both DSM-5 diagnoses require the person to experience significant distress, which is different from BDSM in which there is consent and no distress. Plus, sexual sadism disorder can involve a nonconsenting partner, which is unacceptable in BDSM.

Some experts suggest that while changes from the fourth to the fifth edition of the DSM have brought some improvements with regard to paraphilic disorders, there’s still a high risk of falsely diagnosing people with disorders such as sexual masochistic or sexual sadism disorder based on the updated criteria in DSM-5.

‘It’s abuse’

Stewart cites both misunderstandings and our current association with pain as reasons behind the stigma. “It’s around religion and slavery, and [they] can be attributed to why we believe that pain is a ‘bad’ thing and why we should not seek it out,” she says.

Historically, there are ample examples of people gaining pleasure from both giving and receiving pain, and if you and your partner(s) fully enjoy yourselves, there is no cause for concern.

“Pain is used to punish. So, if we think about anything in history, we’ve been taught over time that we use pain for punishment rather than to actually enjoy the pain,” Stewart explains.

However, when consent is incorporated into the process and boundaries are respected, then activities that occur are not abusive.

In fact, according to a 2015 study, some who engage in these kink activities have reported that it can be therapeutic, while others report that engaging in BDSM enables folks to reach an alternate state of consciousness or that it serves as an alternate form of leisure or meditative practice.

Hurt vs. harm

Stewart discusses the differences between hurt and harm, and how it’s commonplace to use the terms interchangeably even though they’re quite different.

“Harm is where we say, ‘harm is where the psychological trauma is,’ but not necessarily the hurt, the pain. We’ve just been taught that when things are painful, they are not good. So it just takes a lot of that unlearning,” she says.

One of the main differences between hurt and harm is the role of consent. Pain inflicted and received between two consenting adults can include hurt, but without everyone having consented, it becomes abuse — resulting in harm.

Examples of masochism and sadism

Potential engagements in masochism or sadism may include:

biting
scratching
rough sexual intercourse
bondage, including rope play or suspension
impact play, including slapping, whipping, or spanking

Because these are actions that typically cause pain and, in some cases, can lead to pleasure, incorporating them during sexual encounters falls under the category of BDSM.

Let’s recap

Masochism and sadism are important parts of BDSM interactions, and despite the continued stigma that folks within the kink community receive, when engaged among consenting adults, it can lead to positive experiences.

The DSM-5 has entries for both sexual masochistic disorder and sexual sadistic disorder, both of which require an extreme desire for pain — either to be given or to inflict — to the point that their regular lives are significantly and negatively impacted and they’re unable to function.

This differs greatly from kink practices, which can be playful, empowering, fun, and sexy — without negatively affecting day-to-day life.

If you engage in practice similar to those listed with partners who fully consent and you’re not feeling any distress around your engagements, then there is a good chance that your sexual interactions are just plain old kinky.

But if you have concerns about your urges and desires, you can always seek out a medical professional or sex therapist to discuss.

8 sourcescollapsed

Brown A, et al. (2019). A systematic scoping review of the prevalence, etiological, psychological, and interpersonal factors associated with BDSM.https://www.tandfonline.com/doi/full/10.1080/00224499.2019.1665619
First MB. (2014). DSM-5 and paraphilic disorders.http://jaapl.org/content/42/2/191
Graham B, et al. (2015). Member perspectives on the role of BDSM communities.https://www.tandfonline.com/doi/full/10.1080/00224499.2015.1067758
Joyal C, et al. (2017). The prevalence of paraphilic interests and behaviors in the general population: A provincial survey.https://www.tandfonline.com/doi/abs/10.1080/00224499.2016.1139034?journalCode=hjsr20
Labrecque F, et al. (2020). What is so appealing about being spanked, flogged, dominated, or restrained? Answers from practitioners of sexual masochism/submission.https://www.tandfonline.com/doi/full/10.1080/00224499.2020.1767025
Scott DJ, et al. (2006). Variations in the human pain stress experience mediated by ventral and dorsal basal ganglia dopamine activity.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6674764/
Stewart MR. (2021). Personal interview.
Wright S. (2008). Discrimination of SM-identified individuals.https://www.tandfonline.com/doi/abs/10.1300/J082v50n02_10

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Medically reviewed by Lori Lawrenz, PsyD — Written by Zuri White-Gibson — Updated on February 25, 2022

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Sexual Masochism: Signs, Possible Disorders, And Reducing Stigma

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What is masochism?

What is sadism?

What is sadomasochism?

Misconceptions about masochism and sadism

Masochism and sadism as paraphilia

Clinical definitions

‘It’s abuse’

Hurt vs. harm

Examples of masochism and sadism

Let’s recap

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