Sexual masochism disorder
Sexual masochism disorder (SMD) is the condition of experiencing recurring and intense sexual arousal in response to enduring moderate or extreme pain, suffering, or humiliation. The Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association indicates that a person may have a masochistic sexual interest but that the diagnosis of sexual masochism disorder would only apply to individuals who also report psychosocial difficulties because of it.
Related terms and conditions
Sexual masochism disorder is the term employed by the current version of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association. It refers to the "recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors" (p. 694). It is classified as one of the paraphilias, called an algolagnic disorder (p. 685), which is one of the "anomalous activity preferences" (p. 685). The formal diagnosis of sexual masochism disorder would apply only if the individual experiences clinically significant distress to the individual or impairment in social, occupational, or other important areas of functioning.
Sadomasochism appears in the current version of the International Classification of Diseases (ICD-10) of the World Health Organization. It refers to the "preference for sexual activity that involves bondage or the infliction of pain or humiliation" (p. 172), and divides sadomasochism into "masochism" and "sadism" according to whether the individual prefers to be the recipient or provider of it. The ICD-10 specifies that mild forms of sadomasochism "are commonly used to enhance otherwise normal sexual activity" (p. 172), and that the diagnosis would apply only if the behavior is preferred or required for sexual gratification. The condition is classified as one of the disorders of sexual preference, which includes the paraphilias (p. 170).
BDSM is a colloquial term relating to individuals who willingly engage in consenting forms of pain or humiliation, typically for sexual purposes. It is not currently a diagnosable condition in either the DSM or ICD system.
Masochism was the term employed by the DSM-II. In that manual, the condition was classified as a sexual deviation, which was used to describe "individuals whose sexual interests are directed primarily toward…coitus performed under bizarre circumstances" (p. 44). The term paraphilia did not exist in the DSM-II, and diagnoses did not have specific criteria until DSM-III.
The prevalence of sexual masochism disorder in the population is unknown, but the DSM-5 suggests that 2.2% of males and 1.3% of females may be involved in BDSM, whether they have sexual masochism disorder or not. Extensive use of pornography depicting humiliation is sometimes associated with sexual masochism disorder.
Behaviors associated with sexual masochism disorder can be acted out alone (e.g., binding, self-sticking pins, self-administration of electric shock, or self-mutilation) or with a partner (e.g., physical restraint, blindfolding, paddling, spanking, whipping, beating, electric shock, cutting, pinning and piercing, and humiliation such as by being urinated or defecated upon, being forced to crawl and bark like a dog, or being subjected to verbal abuse). Behaviors sometimes include being forced to cross-dress or being treated like an infant.
In extreme cases, accidental deaths can occur, such as from engaging in self-application of electric shock. One of the most extreme cases of masochism was Bernd Brandes, who answered a person ad from Armin Meiwes, who was seeking someone who wanted to be slaughtered and eaten.
Following a phenomenological study of individual involved in sexual masochistic sessions, Sexual Masochism was described as an addiction-like tendency, with several features resembling that of drug addiction: craving, intoxication, tolerance and withdrawal. It was also demonstrated how the first masochistic experience is placed on a pedestal, with subsequent use aiming at retrieving this lost sensation, much as described in the descriptive literature on addiction. The addictive pattern presented in this study suggests an association with behavioral spin as found in problem gamblers. A behavioral spin is described as a process one goes through that is characterized by a behavior growing in frequency and magnitude, as indicated by the Criminal Spin theory. As it develops, it gains its own momentum which the individual finds almost impossible to terminate even when faced with known unwanted outcomes. For the participants in sexual masochistic sessions, the behavioral spin is manifested as a continuously reinforced process leading the masochist to engage in masochistic activity, perpetuating itself, and binding the addict to his/her behavior.
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