Skip to main content

Sadomasochism in Sickness and in Health: Competing Claims from Science, Social Science, and Culture

Abstract

This article reviews and compares competing depictions of sadomasochism (SM) sexuality, examining portrayals that range from sick to healthy, from normal to abnormal, and from dangerous to healing. The body of this article proceeds in four parts. The first section considers the treatment of SM in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). The second section addresses debates about the costs, benefits, and scientific validity of the inclusion and definition of SM in the DSM-5. It further highlights how quantitative and qualitative empirical studies of SM practitioners indicate that they fall within normal ranges in psychological and social functioning. The third section examines research on one negative consequence of the inclusion of SM in the DSM: It may interfere with the therapeutic relationship with clients who practice SM or have SM desires by reinforcing broader societal stigma and encouraging diagnostic misuse. The fourth section reviews an emerging body of research that reverses the “SM as pathology” discourse by showing the therapeutic and healing potential of bondage-discipline-dominance-submission-sadism-masochism (BDSM) practice and ethos. Based on this review, the conclusion argues that there is no valid reason to continue identifying SM as a potential mental disorder, and furthermore, there are detrimental effects of its association with pathology in the DSM-5.

This is a preview of subscription content, access via your institution.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C.: American Psychiatric Association; 2013.

    Book  Google Scholar 

  2. American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Text Revision. Washington, D.C.: American Psychiatric Association; 2000.

    Google Scholar 

  3. American Psychiatric Association, Task Force on DSM-IV. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. Washington: American Psychiatric Association; 2000.

    Google Scholar 

  4. Wright S. Discrimination of SM-identified individuals. J Homosex. 2006;50(2–3):217–31.

    PubMed  Article  Google Scholar 

  5. Klein M, Moser C. SM (sadomasochistic) interests as an issue in a child custody proceeding. J Homosex. 2006;50(2–3):233–42.

    PubMed  Article  Google Scholar 

  6. Wright S. Depathologizing consensual sexual sadism, sexual masochism, transvestic fetishism, and fetishism. Arch Sex Behav. 2010;39(6):1229–30.

    PubMed  Article  Google Scholar 

  7. Khan U. Vicarious kinks: S/M in the socio-legal imaginary. Toronto: University of Toronto Press; 2014.

    Google Scholar 

  8. Kleinplatz P, Moser C. Is S/M pathological. Lesbian Gay Psychol Rev. 2005;6(3):255–60.

    Google Scholar 

  9. Moser C, Kleinplatz PJ. Does heterosexuality belong in the DSM. Lesbian Gay Psychol Rev. 2005;6(3):261–7.

    Google Scholar 

  10. Moser C, Kleinplatz PJ. DSM-IV-TR and the paraphilias: an argument for removal. J Psychol Hum Sex. 2006;17(3–4):91–109.

    Article  Google Scholar 

  11. Krueger RB. The DSM diagnostic criteria for sexual sadism. Arch Sex Behav. 2010;39(2):325–45.

    PubMed  Article  Google Scholar 

  12. First MB, Halon RL. Use of DSM paraphilia diagnoses in sexually violent predator commitment cases. J Am Acad Psychiatry Law. 2008;36(4):443–54.

    PubMed  Google Scholar 

  13. Frances A. The forensic risks of DSM-V and how to avoid them. J Am Acad Psychiatry Law. 2010;38:11–4.

    PubMed  Google Scholar 

  14. First MB. DSM-5 proposals for paraphilias: suggestions for reducing false positives related to use of behavioral manifestations. Arch Sex Behav. 2010;39(6):1239–44.

    PubMed  Article  Google Scholar 

  15. Wakefield JC. DSM-5 proposed diagnostic criteria for sexual paraphilias: tensions between diagnostic validity and forensic utility. Int J Law Psychiatry. 2011;34(3):195–209.

    PubMed  Article  Google Scholar 

  16. Fedoroff JP. Forensic and diagnostic concerns arising from the proposed DSM-5 criteria for sexual paraphilic disorder. J Am Acad Psychiatry Law. 2011;39(2):238–41.

    PubMed  Google Scholar 

  17. Frances AJ, Widiger T. Psychiatric diagnosis: lessons from the DSM-IV past and cautions for the DSM-5 future. Annu Rev Clin Psychol. 2012;8:109–30. This article is of importance because it draws on the authors’ experiences with the DSM-IV to provide insight on how to improve future editions of the DSM.

    PubMed  Article  Google Scholar 

  18. First MB. DSM-5 and paraphilic disorders. J Am Acad Psychiatry Law. 2014;42(2):191–201. This article is of importance because it considers how some of the text of the DSM-5’s paraphilic disorders can be misinterpreted to produce false positive diagnoses in forensic settings.

    PubMed  Google Scholar 

  19. Wright S. Kinky parents and child custody: the effect of the DSM-5 differentiation between the paraphilias and paraphilic disorders. Arch Sex Behav 2014:1–2. This short article is of importance because it provides early evidence that the explicit differentiation between a paraphilic interest and a paraphilic disorder in the DSM-5 has had a positive effect for parents who are associated with BDSM in child custody cases.

  20. The National Coalition for Sexual Freedom. (February 16, 2010). Kinky is not a diagnosis. Retrieved December 11, 2014, from https://ncsfreedom.org/key-programs/DSM-5-revision-project/kinky-is-not-a-diagnosis.html.

  21. Krueger RB. The DSM diagnostic criteria for sexual masochism. Arch Sex Behav. 2010;39(2):346–56.

    PubMed  Article  Google Scholar 

  22. Litman RE, Swearingen C. Bondage and suicide. Arch Gen Psychiatry. 1972;27(1):80–5.

    CAS  PubMed  Article  Google Scholar 

  23. Hinderliter AC. Defining paraphilia: excluding exclusion. Open Access J Forensic Psychol. 2010;2:241–72.

    Google Scholar 

  24. Shindel AW, Moser CA. Why are the paraphilias mental disorders? J Sex Med. 2011;8(3):927–9.

    PubMed  Article  Google Scholar 

  25. American Psychiatric Association. Paraphilic Disorders Fact Sheet. 2013; Available at: http://www.dsm5.org/Documents/Paraphilic%20Disorders%20Fact%20Sheet.pdf. Accessed December, 11, 2014.

  26. The DSM-5 Paraphilias Subworkgroup. U 05 Sexual sadism disorder, “Rationale” tab [no longer available on-line]. Previously available at: http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=188#. Accessed December, 2012.

  27. Blanchard, R. DSM-V options: paraphilias and paraphilic disorders, pedohebephilic disorder, and transvestic disorder. 28th annual meeting of the association for the treatment of sexual abusers, October 1, 2009: http://individual.utoronto.ca/ray_blanchard/index_files/ATSA_DSM.html; 2009. Accessed December, 11, 2014.

  28. Blanchard R. The DSM diagnostic criteria for pedophilia. Arch Sex Behav. 2010;39(2):304–16.

    PubMed  Article  Google Scholar 

  29. Krueger RB, Kaplan MS. Paraphilic diagnoses in DSM-5. Isr J Psychiatry Relat Sci 2012; 49(4).

  30. Joyal CC, Cossette A, Lapierre V. What exactly is an unusual sexual fantasy? J Sex Med 2014

  31. Ogas O, Gaddam S. A billion wicked thoughts: what the Internet tells us about sexual relationships. Penguin; 2011.

  32. James EL. Fifty shades of grey: Random House; 2012.

  33. Donahue, D. (2012, August 30). Publishing world is turned on by fifty shades of grey. Retrieved December 13, 2014, from http://usatoday30.usatoday.com/life/books/news/story/2012-08-29/erotica-trend-fifty-shades-of-grey/57416594/1.

  34. Sax, D. (2012, May 24) The ‘fifty shades of grey’ stimulus. Retrieved December 13, 2014, from http://www.businessweek.com/articles/2012-05-24/the-fifty-shades-of-grey-stimulus.

  35. Moser C. Yet another paraphilia definition fails. Arch Sex Behav. 2011;40(3):483–5. This article is of importance because it carefully parses Blanchard’s proposed DSM-5’s definition of a paraphilia, which, with slight rewording, was essentially reproduced in the DSM-5. Moser shows that the definition fails to provide a coherent distinction between paraphilia and normophilia.

    PubMed  Article  Google Scholar 

  36. Daley A, Mulé NJ. LGBTQs and the DSM-5: a critical queer response. J Homosex. 2014;61(9):1288–312.

    PubMed  Article  Google Scholar 

  37. Moser C. Problems with ascertainment. Arch Sex Behav. 2010;39(6):1225–7.

    PubMed  Article  Google Scholar 

  38. Weinberg TS. Sadomasochism and the social sciences: a review of the sociological and social psychological literature. J Homosex. 2006;50(2–3):17–40.

    PubMed  Article  Google Scholar 

  39. Richters J, De Visser RO, Rissel CE, Grulich AE, Smith A. Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (BDSM): data from a national survey. J Sex Med. 2008;5(7):1660–8.

    PubMed  Article  Google Scholar 

  40. Powls J, Davies J. A descriptive review of research relating to sadomasochism: considerations for clinical practice. Deviant Behav. 2012;33(3):223–34.

    Article  Google Scholar 

  41. Jozifkova E. Consensual sadomasochistic sex (BDSM): the roots, the risks, and the distinctions between BDSM and violence. Curr Psychiatry Rep. 2013;15(9):1–8.

    Article  Google Scholar 

  42. Blaustein M. May 30, 2013 | 6:44 pm Whips, chains and full of life: BDSM practitioners ‘healthier and less neurotic’ than ‘vanilla’ peers. (2013, May 30). Retrieved December 10, 2014, from http://nypost.com/2013/05/30/whips-chains-and-full-of-life-bdsm-practitioners-healthier-and-less-neurotic-than-vanilla-peers/.

  43. Pappas, S. (2013, May 29). Bondage benefits: BDSM practitioners healthier than ‘vanilla’ people. Retrieved December 10, 2014, from http://www.livescience.com/34832-bdsm-healthy-psychology.html.

  44. Gray, E. (2013, June 5). BDSM correlated with better mental health, says study. Retrieved December 10, 2014, from http://www.huffingtonpost.com/2013/06/05/bdsm-better-mental-health-study_n_3390676.html.

  45. Wismeijer AA, Assen MA. Psychological characteristics of BDSM practitioners. J Sex Med. 2013;10(8):1943–52. This article is of importance because its comparison of BDSM practitioners and a control group found that the psychological profile of BDSM practitioners was healthy and balanced. Major newspapers picked up the study because it also revealed that BDSM practitioners have some psychological strengths and advantages over non-BDSM practitioners.

    PubMed  Article  Google Scholar 

  46. Newmahr S. Rethinking kink: sadomasochism as serious leisure. Qual Sociol. 2010;33(3):313–31.

    Article  Google Scholar 

  47. Faccio E, Casini C, Cipolletta S. Forbidden games: the construction of sexuality and sexual pleasure by BDSM ‘players’. Culture, health & sexuality 2014(ahead-of-print):1–13.

  48. Hébert A, Weaver A. An examination of personality characteristics associated with BDSM orientations. Can J Hum Sex. 2014;23(2):106–15. This study is important because it compared personality characteristics between dominants and submissives, groups that are normally lumped together in studies of BDSM practitioners.

    Article  Google Scholar 

  49. Kleinplatz P, Moser C. Toward clinical guidelines for working with BDSM clients. Contemp Sex. 2004;38(6):1.

    Google Scholar 

  50. American Psychological Association. Guidelines for psychotherapy with lesbian, gay, and bisexual clients. Am Psychol. 2000;55:1440–51.

    Article  Google Scholar 

  51. Barker M, Iantaf A, Gupta C. Kinky clients, kinky counselling? Feeling queer or queer feelings?: radical approaches to counselling sex, sexualities and genders. London: Routledge; 2014. p. 106–24.

    Google Scholar 

  52. Barker M. Turning the world upside down: developing a tool for training about SM. In: Langdridge D, Barker M, editors. Safe, sane and consensual: contemporary perspectives on sadomasochism. Basingstoke: Palgrave Macmillan; 2007. p. 261–70.

    Google Scholar 

  53. Nichols M. Psychotherapeutic issues with “kinky” clients: clinical problems, yours and theirs. J Homosex. 2006;50(2–3):281–300.

    PubMed  Article  Google Scholar 

  54. Nichols M. Couples and kinky sexuality: the need for a new therapeutic approach. Critical Topics in Family Therapy: Springer; 2014. p. 139–149. This paper is important because it outlines clinical issues that a therapist might confront when working with BDSM clients.

  55. Lawrence AA, Love-Crowell J. Psychotherapists’ experience with clients who engage in consensual sadomasochism: a qualitative study. J Sex Marital Ther. 2007;34(1):67–85.

    Article  Google Scholar 

  56. Kelsey K, Stiles BL, Spiller L, Diekhoff GM. Assessment of therapists’ attitudes towards BDSM. Psychol Sex. 2013;4(3):255–67.

    Article  Google Scholar 

  57. Pillai-Friedman S, Pollitt J, Castaldo A. Becoming kink-aware—a necessity for sexuality professionals. Sex Relationsh Ther 2014(ahead-of-print):1–15.

  58. The Kink Aware Professionals Directory: https://ncsfreedom.org/key-programs/kink-aware-professionals/kap-program-page.html. Accessed December 28, 2014.

  59. Kolmes K, Stock W, Moser C. Investigating bias in psychotherapy with BDSM clients. J Homosex. 2006;50(2–3):301–24.

    PubMed  Article  Google Scholar 

  60. Pope KS, Vasquez MJT. Ethics in psychotherapy and counseling: a practical guide. 3rd ed. San Francisco: Jossey-Bass; 2007.

    Google Scholar 

  61. Hoff G, Sprott RA. Therapy experiences of clients with BDSM sexualities: listening to a stigmatized sexuality. Electron J Hum Sex. 2009;12(9):30.

    Google Scholar 

  62. Kleinplatz PJ. Learning from extraordinary lovers: lessons from the edge. J Homosex. 2006;50(2–3):325–48.

    PubMed  Article  Google Scholar 

  63. Barker M, Gupta C, Iantaffi A. The power of play: the potentials and pitfalls in healing narratives of BDSM. In: Langbridge D, Barker M, editors. Safe, sane and consensual: contemporary perspectives on sadomasochism. London: Palgrave; 2007. p. 197–216.

    Google Scholar 

  64. Henkin WA, Langdridge D, Barker M. Some beneficial aspects of exploring personas and role play in the BDSM context. In: Langbridge D, Barker M, editors. Safe, sane and consensual: contemporary perspectives on sadomasochism. London: Palgrave; 2007. p. 229–40.

    Google Scholar 

  65. Easton D, Hardy JW. Radical ecstasy: SM journeys to transcendence. Greenery: Press; 2004.

    Google Scholar 

  66. Easton D. Shadowplay: S/M journeys to our selves. In: Langbridge D, Barker M, editors. Safe, sane and consensual: contemporary perspectives on sadomasochism. London: Palgrave; 2007. p. 217–28.

    Google Scholar 

  67. Turley EL, King N, Butt T. ‘It started when I barked once when I was licking his boots!’: a descriptive phenomenological study of the everyday experience of BDSM. Psychol Sex. 2011;2(2):123–36.

    Article  Google Scholar 

  68. Lindemann D. BDSM as therapy? Sexualities. 2011;14(2):151–72.

    Article  Google Scholar 

  69. Hammers C. Corporeality, sadomasochism and sexual trauma. Body Soc. 2014;20(2):68–90. This paper is important because it provides preliminary evidence of the potential healing power of BDSM ‘rape play’ for survivors of sexual assault.

    Article  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Ummni Khan declares she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ummni Khan.

Additional information

This article is part of the Topical Collection on Current Controversies

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Khan, U. Sadomasochism in Sickness and in Health: Competing Claims from Science, Social Science, and Culture. Curr Sex Health Rep 7, 49–58 (2015). https://doi.org/10.1007/s11930-014-0039-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-014-0039-1

Keywords

  • Sadomasochism
  • SM
  • Bondage-discipline-dominance-submission-sadism-masochism
  • BDSM
  • Kink
  • DSM-5
  • Paraphilias
  • Paraphilic disorders
  • Forensics and sexuality
  • Law and sexuality
  • Societal stigma
  • Diagnostic misuse
  • Healing