The DSM-5 (the diagnostic bible of the therapeutic community) states that there are two conditions necessary for the diagnosis of a sexual masochism “disorder” to be present.
- The individual experiences sexual arousal in response to fantasies urges or behavior involving extreme pain, humiliation, bondage, or torture.
- The person experiences DISTRESS or DYSFUNCTION in significant areas of his life because of these sexual fantasies, urges, or behaviors.
Light “BDSM” or “S&M” is quite common among people who enjoy active, related sex lives. Forms of masochism between consulting adults are NOT classified as “disorders” by the DSM-5. A diagnosis of a problematic occurrence of persistent and unrelenting fantasies, urges, or behaviors involving pain, suffering or humiliation ONLY occurs when the following criteria are met:
- “Recurrent intense fantasies urges or behaviors involving real acts of receiving extreme physical pain, torture, or humiliation for sexual arousal.
- Present for at least six months.
- Results in significant impairment or DISTRESS in daily life (relationships, occupational, or social functioning).”
If the person is not experiencing anxiety, guilt, shame, or other negative feelings related to his/her masochistic sexual desire it is considered a sexual “interest” (KINK), NOT a disorder.
Sexual Masochism and the BDSM Subculture
People who present with sexual masochism have an erotic interest in power discrepancy. The term for these types of relationships is Bondage Discipline Sadism and Masochism (BDSM). Sexual masochists usually prefer to play the submissive (bottom) role, and very often play different roles with different partners. BDSM is still marginalized and shamed, although, in recent years, practitioners of BDSM have become more accepted as being in a subculture, or alternative lifestyle choice, and KINK people are NOT considered as sexual “deviants”.
Part of sex addiction treatment may involve the exploration of if, and how, the person’s “kink” could be integrated into an overall healthy lifestyle.
Within the BDSM subculture, professionals, called dominatrixes, are hired to physically and verbally abuse paying male clients with sexually masochistic fantasies and desires. A dominatrix will rarely have intercourse with her client but instead uses control and humiliation to enable the client to achieve sexual satisfaction. An experience with a dominatrix may result in the person achieving a therapeutic response – a psychological revitalization through pain and humiliation, mastery over past trauma, and may find alternatives to impotence or sexual repression.
Prevalence of Sexual Masochism
Fantasies related to sexual masochism are fairly common. Many, if not most, sexually active adults enjoy being bitten or scratched during consensual sexual activity. Only a small percentage of men with sexually masochistic fantasies or urges go to see a therapist. Of those, even a smaller percentage report a desire to stop. Besides distress or dysfunction, there is no way to differentiate pathological masochistic fantasies from non-pathological fantasies, urges, or behaviors. Because there is such shame and stigma about what people perceive to be their “deviant” fantasies, people who are distressed about these behaviors are unlikely to seek help.