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According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), sexual masochism disorder concerns individuals who freely admit to having the following topical paraphilic interests. These individuals are open about the sexual arousal they receive from the act of being beaten, humiliated, bound, or made to suffer in any other given manner, as manifested by fantasies and behaviors. They must report psychosocial difficulties that occur due to these sexual preferences in order to be diagnosed with sexual masochism disorder. However, if they do not declare associated distress—which may be represented by anxiety, shame, or guilt related to these paraphilic interests—they may be described as having masochistic sexual interest, but again, should not be diagnosed with this disorder. In addition, the excessive use of pornography involving the aforementioned paraphilic interests is also at times associated with sexual masochism disorder.

Diagnosing Sexual Masochism Disorder DSM-5 302.83 (F65.51)

The DSM-5 sets forth a couple diagnostic criterion, which must be met in order for a diagnosis of sexual masochism disorder to be made. Evaluate the following:

  • Over a period of 6 months or longer, the individual experiences intense sexual arousal when made to suffer (e.g., being humiliated, beaten, bound), as manifested by fantasies and behaviors.
  • The individual’s fantasies and behaviors cause cause significant distress or impairment in important areas of life, such as at work or in his or her relationships.

If the individual meets the criteria for sexual masochism, it should also be evaluated and specified if the disorder is…

  • with asphyxiophilia, which is when the individual restricts his or her breathing in order to achieve sexual arousal.
  • in a controlled environment, meaning the individual is living in a setting that specifically restricts opportunities to engage in masochistic sexual behaviors.
  • in full remission, whereas the individual has not experiences distress or impairment in important areas of life (e.g., socially or occupationally) for at least 5 years while in an uncontrolled environment.

Development of Sexual Masochism Disorder DSM-5 302.83 (F65.51)

Based on different individuals’ reports, the mean age at onset for masochism is about 19 years. However, earlier ages have also been reported for the onset of these particular paraphilic interests. Factors such as subjective distress (loneliness or guilt for example), psychiatric morbidity, hypersexuality, sexual impulsivity, and psychosocial impairment may vary over time and with age.

The prevalence of sexual masochism disorder is unknown at the time. However, in Australia, it is estimated that 2.2% of males and 1.3% of females have engaged in sexual behavior concerning the topical paraphilic interests, involving bondage, discipline, as well as dominancy and submission in the past year.

Differential Diagnosis

There are a few conditions that may be differential diagnoses for sexual masochism disorder. Therefore, it is important to carefully evaluate the diagnostic criteria and evidence of sexual masochism disorder, while also keeping the following possibilities in mind:

  • Transvestic fetishism
  • Sexual sadism disorder
  • Hypersexuality
  • Alcohol and substance use disorders

Is There Treatment for Sexual Masochism Disorder?

Like most other mental disorders, there are a few effective treatment options for sexual masochism disorder. These include:

  • Psychotherapy: The purpose and goal of this therapy is to uncover and work through underlying causes of unwanted and distressful behaviors. More specifically, cognitive therapy (a form of psychotherapy) works to restructure cognitive distortions; this involves correcting the individual’s beliefs that may lead him to completing the harmful acts. It may also help the individual learn skills to better handle their sexual urges.
  • Medication: Certain medications may be used to decrease the amount of testosterone circulating throughout the body in order to reduce occurrence of erections. Similarly, antidepressants may be prescribed to reduce the individual’s sex drive.

Fifty Shades of Grey: Displaying and Inciting Sexual Masochism?

Fifty Shades of Grey is a popular erotic romance novel, written by E.L. James, and film adaptation of the same name. It is the first installment in its trilogy, which follows the development of a strange but loving relationship between a recent college graduate, Anastasia Steele, and a young, rich businessman named Christian Grey. The story gained much attention and traction for its explicit sex scenes—of which featured bondage and other erotic practices—as well as its plotline surrounding sexual dominance and submission. It sure sounds like masochistic sexual interests are involved, huh? Absolutely. But does that mean the characters are suffering from sexual masochism? Possibly. Christian clearly is very fond of Anastasia and begins to develop deep feelings for her; however, his requirement of her sexual submission scares her and drives a wedge between the two. Eventually, she gives in to his pleas and her curiosity and finds that she enjoys engaging in the submission (first criterion). But it’s something she must keep secret from her loved ones and it absolutely affects her life outside of their relationship, which fulfills the final criterion.

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