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Sexual masochism disorder 101: What is a masochist?

Sexual masochism disorder 101: What is a masochist?

Everyone has their sexual preferences or fetishes — for some, that involves extremely erotic practices like being tied up, handcuffed, or being otherwise made to suffer. That said, there’s a fine line between having a sexual fetish and struggling with sexual fantasies and behaviors that cripple your life. When it reaches this point, you might be dealing with sexual masochism disorder.

What Is Sexual Masochism Disorder?

Sexual masochism disorder is a paraphilic disorder characterized by someone being persistently and intensely sexually aroused from pain or humiliation, to the point of functional impairment. Sexual masochism disorder is not about getting turned on by BDSM (bondage-discipline, dominance-submission, and sadomasochism). It’s about having distress or difficulties in your life because of the extremity of those sexual feelings. 

Sexual Masochism Disorder Vs. Masochistic Behavior

There is nothing wrong with having sexual kinks or fetishes, even if they involve bondage or suffering. Healthy people from all walks of life engage in BDSM fantasies and activities. As long as everything is consensual and doesn’t involve debilitating injury to yourself or your partner, it’s probably okay. But the American Psychiatric Association makes a clear distinction between the relatively common interest in being harmed or humiliated during sex (sexual masochism), and sexual masochism disorder. The former is a nonpathological sexual preference; the latter causes significant personal distress. 

People with sexual masochism disorder don’t just experience sexual arousal from the act of being beaten, humiliated, bound, or made to suffer in another manner. They also experience great difficulties in their lives because of these intense sexual preferences. Their impairments might present as anxiety, shame, or guilt, for example. But if someone gets sexual gratification from their own pain and they don’t experience distress, they just have masochistic sexual interests. Masochistic behaviors only sometimes equate to a mental health disorder.

What Are the 8 Paraphilic Disorders?

What is a paraphilic disorder? The word paraphilia refers to abnormal sexual desires. But what are normal sexual desires? The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines nonparaphilic (aka “normophilic”) sex as “sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners.” Anything outside of that is paraphilic. The main paraphilic disorders are as follows:

*Also called an algolagnic disorder because it depends on pain and suffering.

Sexual Masochism Disorder Symptoms

As with any other illness, one must meet certain criteria to get diagnosed. According to the DSM-5, an individual must experience the following to be diagnosed with sexual masochism disorder:

  • Over a period of six months or longer (a loose guideline), the individual experiences intense sexual arousal when made to suffer, as manifested by fantasies, urges, and behaviors.
  • The fantasies and actions cause significant distress or impairment in important areas of life, like at work or in one’s relationships.

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

  • Involves asphyxiophilia, also known as autoerotic asphyxiation, which is when the individual restricts his or her breathing in order to achieve the desired arousal.
  • Is in a controlled environment, meaning the individual is living in a setting that specifically restricts opportunities to engage in masochistic sexual behaviors.
  • Is in full remission, whereas he or she has not experienced distress or impairment in important areas of life for at least five years while in an uncontrolled environment.

Is Sexual Masochism Common?

It’s hard to estimate exactly how common sexual masochism is, but BDSM seems to be more popular among men than women. What percentage of the population are masochists? One Australian study cited in the DSM-5 showed that 2.2% of males and 1.3% of females had participated in BDSM in the previous year.

What Do Masochists Do in Bed?

Masochists may enjoy a wide range of fantasies and activities in bed, including the following:

  • Physical restriction (use of handcuffs, bondage)
  • Pain play (spanking, use of clothespins or whips, electric shock)
  • Verbal abasement
  • Rape fantasies
  • Gagging
  • Role-play 
  • Experimentation with power dynamics
  • Autoerotic asphyxia

Sexual masochists might also enjoy pornography that depicts humiliation and suffering. 

Is Sexual Masochism Dangerous?

Sexual masochism disorder with asphyxiophilia can be dangerous. Autoerotic asphyxia practices can sometimes lead to accidental suffocation, causing brain injury or death. In the United States, autoerotic asphyxia may claim as many as 1,000 lives every year. 

What Causes Sexual Masochism Disorder?

How are masochists made? What turns a person into a masochist? There’s no clear cause for sexual masochism disorder, but experts have explored some contributing factors

  • Biologic factors (gender identity, sex hormone levels, pain and reward systems in the brain)
  • Psychological factors (personality traits, personality disorders, sensation-seeking levels and impulsivity)
  • Attachment styles (within couples)
  • Education levels
  • Addiction

According to the DSM-5, the mean age of onset for masochism is 19.3 years. Surveys show that almost 80% of people who participate in BDSM say that they started liking sadistic or masochistic activities from a young age. 

Sexual Masochism Disorder Treatment

If no harm is being done, sexual masochism does not require treatment. But in the case of functional impairment or emotional distress, people may choose from a couple treatment options. If you need help managing symptoms or overcoming sexual masochism disorder, the following approaches have proven effective:

1. Psychotherapy

One purpose of therapy can be to uncover and work through underlying causes of unwanted, distressful feelings and behaviors. If your intense and persistent sexual interests are hampering your personal goals, then therapy might help you come to terms with your desires. Cognitive behavioral therapy (CBT) can be especially effective in restructuring thoughts and beliefs that end up causing you pain. It may also help you accept yourself and your sexual fantasies, urges, or behaviors.

2. Medication

Certain medications may be used to decrease testosterone levels and, in turn, reduce the occurrence of erections. Additionally, antidepressant medications may be prescribed to reduce overall sex drive.

Sexual Masochism Disorder Example: “Fifty Shades of Grey”

“Fifty Shades of Grey” is a popular erotic romance novel written by E.L. James, which was later adapted for the big screen. It is the first installment of its trilogy, which follows the development of what some would call a strange, yet intimate relationship between a recent college grad Ana Steele and a young, rich businessman Christian Grey. 

The book gained significant attention and traction for its explicit sex scenes — which feature 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? But does that mean the characters are suffering from sexual masochism? 

Christian clearly is very fond of Ana and begins to develop deep feelings for her; however, his sexual preferences scare her and ultimately drive a wedge between the two. Eventually, she gives into his pleas and her curiosity and finds that she enjoys engaging in the submission. But it’s something she must keep from her loved ones, which proves to damage her relationships — fulfilling the two criteria for sexual masochism disorder.

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  • Writer
  • 3 sources
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Emily Simonian
Emily Simonian, M.A., LMFTHead of Clinical Learning

Emily Simonian is a Licensed Marriage and Family Therapist (LMFT) who has direct training and experience working with family and relationship issues, as well as working with individuals. She also specializes in treating stress/anxiety, depression, and substance abuse, as well as self-esteem issues and general self-improvement goals.

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Taylor BennettSenior Content Strategist

Taylor Bennett is the Head of Content at Thriveworks. She received her BA in multimedia journalism with minors in professional writing and leadership from Virginia Tech. She is a co-author of “Leaving Depression Behind: An Interactive, Choose Your Path Book.”

We only use authoritative, trusted, and current sources in our articles. Read our editorial policy to learn more about our efforts to deliver factual, trustworthy information.

  • Richters, J., de Visser, R. O., Rissel, C. E., Grulich, A. E., & Smith, A. M. (2008). Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (BDSM): data from a national survey. The journal of sexual medicine, 5(7), 1660–1668.

  • Coluccia, A., Gabbrielli, M., Gualtieri, G., Ferretti, F., Pozza, A., & Fagiolini, A. (2016). Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet Underrecognized Disease. Case reports in psychiatry, 2016, 5474862.

  • De Neef, N., Coppens, V., Huys, W., & Morrens, M. (2019). Bondage-Discipline, Dominance-Submission and Sadomasochism (BDSM) From an Integrative Biopsychosocial Perspective: A Systematic Review. Sexual medicine, 7(2), 129–144.

We update our content on a regular basis to ensure it reflects the most up-to-date, relevant, and valuable information. When we make a significant change, we summarize the updates and list the date on which they occurred. Read our editorial policy to learn more.

  • Originally published on January 13, 2022.

    Author: Taylor Bennett

  • Updated on August 10, 2022.

    Editor: Wistar Murray
    Reviewer: Emily Simonian, LMFT
    Changes: Added “What Is Sexual Masochism Disorder?,” “What Do Masochists Do in Bed?,” and “Is Sexual Masochism Dangerous?” Content added about additional paraphilic disorders and the prevalence of sexual masochism. Clinically reviewed to confirm accuracy and enhance value.


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