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Debunking “Sexual Masochism Disorder”

For those who are unfamiliar with the DSM (currently the DSM-5) or The Diagnostic and Statistical Manual of Mental Disorders, is the result of nearly 14 years of effort by hundreds of international experts in all aspects of mental health. It is an impressive resource for mental health professionals to gauge criteria for diagnosing a client who may suffer from mental illness or personality disorders.

While it is a very helpful and supportive resource on many topics related to mental health, masochism has proven to be one that lacks a truly compassionate perspective in their current understanding. Whether due to a lack of thorough, experiential-based insight or perhaps the absence of spiritual consideration and allowance of true divine autonomy, the conceptualization of why masochists are the way we are seems a bit beyond their reach.

There doesn't seem to be much unpacking of the subject beyond surface level sexual associations, rather than diving into what truly motivates us, why we want what we want, or how we can integrate that desired identity into a healthy, happy, functioning life. Why haven't they dedicated much effort to continually evolving the research and broader understanding of masochism, as they have with depression, anxiety, or other disorders such as bipolar or narcissism?

Sadomasochism is understandably, routinely misunderstood. I don’t fully understand it and I’ve lived with an awareness of my own nature since I was very young. There are those in widespread society who even view BDSM-inclined folks as anti-feminist or disempowering women, failing to see that embracing something so misunderstood but rings true for you - is the most empowering, feminist choice one could make. Not to mention that many men crave to be submissive or masochistic too. It's not so black and white as people see it, but people fear what they don't understand, so having patience with those triggered by our choices can support our own sanity.

Though where the medical community is concerned, this is not to condemn at all the tools or therapeutic methods that may help people. Whether in giving context to masochistic fantasies, or working to relieve the negative effects of masochism. If so, that’s wonderful. But upon my own deeper reading of the current “Sexual Masochism Disorder” as classified in the DSM-5, I found some of their criteria and ideology startling, as it rang deeply untrue for me.

Again, this speaks only to MY experience after years of deep reflection, inner healing and personal growth work, some of you may have vastly different experiences. Sadomasochism in any respect is intimately personal and individual... but for those out there who, like me, don't resonate with this particular perspective on masochism, I wanted to share my breakdown of their description. It's rather lengthy, fair warning.

The first issue to address with how masochism is currently perceived by the mental health community who agreed on this diagnosis and criteria, is that it only acknowledges sexual masochism. Not masochism in its other forms: emotional, physical, even spiritual masochism (due to religious trauma or dogmatic spiritual manipulation). Even Masochistic Personality Disorder is not currently a part of the DSM, the previous proposals for MPD to be considered focused on masochism as a pathological psychological affliction.

Theodore Millon, creator of Millon Theory discussed Masochistic Personality Disorder as "an evolution of protection against distress by reformulation pain experiences as a desired state, sometimes to the extent that suffering becomes noble." There isn't much in his work on masochistic personality disorder specifically, but he does have some great insights and revelations that struck much more closely to home for me as constructive, supportive reflections.

But as far as what the DSM-5 currently dictates on sexual masochism disorder, the following excerpts are pulled from Heather Sheaffer, MA, LCSW and her summary on Theravive. You can read the full article and review the other listed Paraphilia Disorders here. My commentary on the sections of her review are written in bold purple font, beneath the paragraphs in quotations.


“The DSM-5 explains that sexual masochism disorder is diagnosed in individuals who experience sexual arousal in response to extreme pain, humiliation, bondage, or torture. The masochist will have unrelenting fantasies with urges to be beaten, bound or humiliated during sex (American Psychiatric Association, 2013). Although behaviors associated with sexual masochism disorder are very prevalent, diagnostic criteria requires that the patient experience distress, such as shame, guilt or anxiety related to sexual fantasy, urges or sexual experiences. Milder forms of masochism between consenting adults, referred to as "BDSM", are not classified as disorders by the DSM-5.  Diagnosis occurs when certain criteria are met.”

Phew... That statement basically leaves us with the idea that as long as masochism occurs in mild forms, between adults (so no partner, not healthy?) and that one doesn’t experience “shame, guilt or anxiety”, then great news, your masochism is not a disorder and you’re good to go.

It’s ironic to me that the answer seems so simple, lying right in front of our eyes... Shouldn’t we address the “shame, guilt and anxiety” one experiences, likely due to 1,000 different circumstances that could leave someone feeling ashamed, uncomfortable or confused about their masochistic or sadistic nature (much like homosexuality used to be regarded)? Shouldn’t we offer tools of self-acceptance, self-awareness, boundaries and nurture self-love, rather than just placing a disorder label onto them and adding MORE “shame, guilt or anxiety” to a patient’s already likely heavy shoulders?

Okay, onto the next section...

Diagnostic Criteria for Sexual Masochism Disorder

  • Recurrent intense fantasies, urges, or behaviors involving real acts of receiving extreme physical pain, torture, or humiliation for sexual arousal.

Since when were fantasies a bad thing? If they torture us in a way we do not actually want, then the work lies in gently releasing those fantasies through acceptance and various therapeutic modalities. However, if we instead gave them a proper outlet: a consensual BDSM relationship, creative writing, art, role play or acting... then there is nothing harmful about mere thoughts, fantasies or desires, kept safe in your head or in healthy creative expression.

  • Present for at least 6 months

Yes, I’d agree you likely have some deeply rooted masochistic tendencies or a masochistic identity if it’s over 6 months.

  • Results in significant impairment or distress in daily life (relationships, occupational or social functioning)

Yes absolutely - masochism becomes an issue when it damages or impairs our ability to function or maintain relationships, a job, health, etc. But does the label “disorder” really help us to improve any of that? More likely, many of us masochists will fall deeper into the victimhood trap, fueling our fire believing we have a reason to be weak, broken or viewed as bad. A label can help... but it also can amplify our feelings of helplessness or overwhelm.

  • Specify if it is occurring with Asphyxiophilia (sexual arousal by asphyxiation)

Safe and moderate practice of asphyxiation (choking) is ABSOLUTELY crucial. Only play around with someone you can truly, deeply trust, even love and respect. Also one who knows what they're doing. If that is all in place, there is nothing wrong with it in and of itself, and certainly nothing wrong with simply desiring asphyxiation, being intrigued, curious or turned on by it.

  • Masochistic behaviors can be self inflicted, but must be differentiated between injury not for the purposes of sexual arousal. The masochist inflicts pain on themselves for reasons of arousal.  Cases of severe injury or death do happen, and are especially worrisome when an individual with a paraphilic disorder also has psychopathy.

The masochist inflicts pain on themselves for reasons of arousal.”

I’ve seen this said in a few of different sources and each time I disagree with it. While I believe that is a big draw for many of us, and it may be a large contributing factor to certain aspects of masochism, it's not as clear cut as that. To negate that a masochist would inflict pain upon themselves, physical or emotional, for any other reason than sexual pleasure, seems a bit short sighted. Like they gave up too easily and moved on.

It’s an over-simplification of something that science and the mental health community has yet to understand, and as such, they still associate it with the leading sources on masochism. Those date back to the late 19th and 20th centuries, with experts such as Sigmund Freud, in which sadomasochism was only ever referenced in a sexual light.

It’s not that the current medical understanding of masochism isn’t true, it’s just that it is not the whole picture. I don’t know if any of us are close to digging too far beneath the surface on this subject, but I know that this doesn’t feel like the true salve on our bleeding hearts that a masochist looking for help would require.

I would encourage those in the mental health field to probe deeper, ask more questions beyond what's been provided so far on this subject. Dig beneath the surface of current medical understanding. There is more to find there if you keep searching, I promise. Beneath all of these listed “disorders”, we are all still human beings. We all have a heart and a soul that needs care and love. And if we happen to truly, wholeheartedly love things you don't personally understand, don't box us in quite so quickly to being mentally ill, disordered, wired wrong, etc...

We do all want the same things - health, happiness, thriving relationships, meaningful work, comfort and safety, we just need you to try to learn our language. Help give us tools for healing that ALIGN with our identity and desires, not that cause friction like guilt, shame or anxiety for "being this way" in the first place. That might help in making an unmotivated masochist excited and eager for something beyond just pain.

Alright, rant over, let's get back to it...

Symptoms of Sexual Masochism Disorder

“Sexual Masochism Disorder is characterized by a pattern of sexual arousal for being made to suffer through physical violence or humiliation. According to changes in the DSM-5, common manifestations include being beaten, bound, or verbally abused. In some cases, asphyxiation is used to achieve sexual desire and patients often enjoy pornography or erotic literature involving masochism. To be diagnosed, the symptoms must cause impairment or distress. If the patient is not experiencing anxiety, guilt, shame or other negative feelings related to masochistic sexual desires, it is considered a sexual interest, not a disorder. In all diagnosed cases, the patient must admit to having these fantasies and urges (American Psychiatric Association, 2013).”

They clarify the distinction between a sexual interest and disorder, which is good, but again they rest their case upon whether a patient feels anxiety, guilt or shame around these desires. How many of us don’t?

When was the last time society at large, made a reference to masochism that wasn’t shrouded in judgement, confusion, or humor - whether poking fun at it or trying to normalize it through subtle irony. We aren’t taught to feel GOOD about our masochistic nature, so why would they expect a die hard masochist to not experience some guilt, shame or fear around something so confusing? Again, addressing those negative feelings seems like a far more productive option, at least to begin with.

“All patients who present with sexual masochism disorder have an erotic interest in a significant power discrepancy between partners. The common term for these relationships is BDSM. Although most patients with sexual masochism disorder prefer to play a submissive role in sexual encounters, many assume both roles at different times with different partners (Shindel and Moser, 2011). In general, the BDSM community is strongly marginalized, and experiences stigma. Many who engage in BDSM within consensual relationships and do not experience guilt, shame or other negative emotions view the behavior as a subculture or alternative lifestyle choice, not a sexual deviance (Stiles and Clark, 2011).”

Yes I agree in my experience, a big part of the draw is the power discrepancy... I do identify as submissive, I do view it as an alternative lifestyle choice now (took a long time to get there), and the BDSM community is very marginalized and experiences stigma - but non-sexually inclined, or at least not strictly sexual masochists, experience that stigma to perhaps an even greater degree. Since some people don't even realize it's a thing to be an emotional, physical or spiritual masochist.

“BDSM subculture is so prominent that professionals, called a dominatrix, are hired to physically and verbally abuse paying male clients with sexual masochistic fantasies and desires. These women rarely, if ever, engage in sexual intercourse with clients, but instead use control and humiliation to foster sexual fantasy. When using these services, men with sexual masochistic fantasies and desires tend to experience a therapeutic response. One study reported that clients experience a psychological revitalization through shame, develop control over past trauma, and find alternatives to sexual repression (Lindemann, 2011).”

And at last, an illuminating and supportive path is finally eluded to... “that clients experience psychological revitalization through shame, develop control over past trauma, and find alternatives to sexual repression”... Could we actually allow ourselves to embrace our darkness for healing? Even if it pushes the boundaries of what society deems is normal or healthy? Using our masochistic nature to ENHANCE our relationship to ourselves and others, not to impair or damage it. Using pain for therapeutic release, to relieve anxiety, to ground into our body, release stored trauma in the body, and to embrace our sexuality or identity. What if the gift is in the curse?

“Distress related to masochistic behavior, such as anxiety, guilt or shame is a diagnostic criterion for sexual masochistic disorder. Although is is estimated that 16% of men consult a therapist to discuss sexual masochistic behavior or fantasy, only about 6% wishes to stop. Most patients who see sex therapists for sexual masochistic disorder usually name a different presenting problem. Besides distress, there is no clinical measure to differentiate pathological masochistic fantasy from non-pathological masochistic fantasy (Shindel and Moser, 2011). Because of stigma, many members of the BDSM community handle their sexual masochistic fantasies with concealment and secrecy. This often means that those who are troubled by any aspect of their behavior are less likely to seek help (Stiles and Clark, 2011).”

The shame is what needs addressing. That needs our attention and care, and that can be “cured” far easier than masochism itself can be, as for many of us, it does not feel true to view masochism as a disordered aspect of ourselves. It feels like our truth, our identity, the creative and fullest expression of who we are on earth as humans in this lifetime. Many of us aren’t looking for a cure or way to fix our masochistic nature’s because that’s not the issue that needs fixing. The shame, guilt, anxiety and fear around the stigma, lack of tools or support as a sadomasochist, is the core issue we face.

According to this summary, for practically the entire criteria to be hinged upon a patient experiencing very normal human emotions of guilt, shame, or anxiety, around a subject that is not accepted in society and that no one educates you on how to embrace, accept or safely integrate your life... you’d have to be an enlightened master to not experience some shame or anxiety under those circumstances. Don’tcha think?

If you’ve hung in there this long, we’re almost done!

“ The most common risk associated with sexual masochism disorder is injury related to beating or binding. Autoerotic asphyxia is a specific type of sexual masochism that involves oxygen deprivation by means of neck compression during sexual activity. The most common manifestations of autoerotic asphyxia are hanging, ligature or plastic bags. Autoerotic asphyxia can be done with a partner or during masturbation. In some cases, patients use alcohol, drugs or chemical substances in conjunction with limiting oxygen to enhance sexual pleasure. Autoerotic asphyxia is the leading cause of death directly related to sexual masochistic disorder. Due to the self-inflicted nature or such deaths, it is something difficult to determine whether death was accidental or the result of suicide (Solarino, et al. 2011).”

Wouldn’t more education and better resources for support and safety be an easier and perhaps more effective tactic than again, trying to “cure or fix” the masochistic nature itself. Given that you are trying to fix, not only someone’s identity and sense of self, but perhaps their most heartfelt desires, the perceived incurable patient who doesn’t wish to “keep themselves out of harms way”, instead could be viewed as a highly unmotivated human who has no inner pull or heartfelt desire to give up on that which he loves and associates his or her sense of self with.

The last section discussed treatments for sexual masochism disorder. They range from medication which cannot cure the disorder but is aimed to help reduce libido and anxiety, therefor reducing the desire for masturbation or sexual fantasies. Then keeping a journal of ones fantasies to discuss with a therapist and explore the patients needs within and outside of their sexuality.

My only feeling on treatment is that it is 100% personal preference and what works for you. If you feel any of those would be supportive or helpful, then that is absolutely where you should start and might indeed be the very right path for you. Again, no shame need accompany any of this - though that is easier said than done. But if you would rather focus treatment upon those negative feelings of guilt, shame or anxiety - if you desire to integrate your sadomasochistic nature and continue to explore your fantasies with curiosity, safety and love - then don’t forget the path of self-awareness, self-love, safety, tenderness and self-acceptance is available to you as well.

Alrighty my friends, pardon any typos - it's 1 am and I've been at this piece for hours. As always, I would love to hear your thoughts below or on social media if you feel called to share.