BDSM: Perception versus Reality – Distinguishing Between Healthy Practitioners and Paraphilia

The following is my final term paper for Abnormal Psychology; we would write about whatever we wanted, so I chose BDSM. I did a presentation on the topic earlier in the semester for Self-Destructive Behaviors and had so much fun with the research I did more for this paper. In fact, I may do my graduate thesis on BDSM as it relates to nonsuicidal self-injury.

50 shades of hay

Introduction

BDSM is a practice that has been historically misunderstood, stigmatized, and even feared. It is often assumed by the general public and clinicians alike that practitioners of bondage-discipline, dominance-submission, sadism-masochism must engage in such behaviors as a result of a mental illness, past trauma, or an inclination toward criminal activity. Others assume it must be a precursor to or replacement for sexual activity, or it’s just “kinky sex.” Finally, it’s assumed that BDSM is all about the experience or inflicting of pain. For these reasons practitioners have been stigmatized and discriminated against, even when seeking therapy for matters not concerning BDSM, or are presumed to have a paraphilia or other psychiatric diagnosis.

Research has shown that practitioners of BDSM do not fit with these assumptions at all; in fact they are more psychologically healthy than controls in almost all domains examined, and it has been shown the practice is more about sensory pleasure than sex. Many practitioners have referred to the practice as a lifestyle, or a leisure activity. Additionally, what keeps people going back? This paper will examine the current perceptions clinicians in the field have of BDSM practitioners and discuss what researchers have found about their actual psychological state, and use this to clearly distinguish a practitioner from a person with a paraphilia. Then motivations for the practice of BDSM will be discussed, as well as the role of pain.

BDSM and Roles

BDSM is short for bondage-discipline, dominance-submission, sadism-masochism, and can include many different types of activities, such as bondage, discipline training, role-playing, spanking, whipping, controlled sensory deprivation or overload, objectification, fetish activation, humiliation, and other diverse types of pain administration. Because the practice is so varied, a precise definition is difficult; it is agreed that BDSM involves elements of role-play, mutual consent to participate, and mutual definition of activities. It has been suggested that erotic power exchange may be a good descriptor, since the practice may or may not involve sexual activity (Williams and Storm, 2012). Three roles have been identified: dom, sub, and switch. The dom, or the dominant role, is the person exerting control, whereas the sub, or the subordinate role, gives up control; a switch is a person that shifts between roles. BDSM can be performed in private, as in the privacy of the home; in public at clubs that cater to people who have this particular interest; or in the professional sector, as in the role of a professional dominatrix, for example. Wherever and however it is performed, there is a prevailing theme: more often than not sex is not present. In fact, at least in the public and professional domains, it is seen as taboo to combine the practice with sex.

Diagnostic Criteria for Paraphilias

In the DSM, BDSM manifests in Sexual Sadism, Sexual Masochism, and Autoerotic Asphyxiation (AEA). DSM-IV-TR diagnostic criteria for Sexual Sadism are:

  1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.
  2. The person has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

Krueger proposes the DSM 5 remove the real, not simulated aspect of the definition of Sexual Sadism (Krueger 2009 a). DSM-IV-TR diagnostic criteria for Sexual Masochism are:

  1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) or being humiliated, beaten, bound, or otherwise made to suffer.
  2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Proposed changes to this include again removing real, not simulated, as well as adding a specifier of Asphyxiophilia (sexually aroused by asphyxiation) (Kreuger 2010 b). Autoerotic Asphyxiation is listed in the DSM under Paraphilias Not Otherwise Specified; diagnostic criteria are:

  1. Recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving 1) non-human objects, 2) the suffering or humiliation of oneself or one’s partner, or 3) children or other nonconsenting persons that occur over a period of at least 6 months.
  2. Behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

It is characterized by intensified sexual arousal by oxygen deprivation, and can be self-administered or done with a partner. It is because of AEA that a fourth focus of criterion A has been proposed: an atypical focus involving human subjects (self or others) (Kafka 2009). It’s estimated that between 250-1,200 deaths annually occur from AEA in the US, and incidence of male to female participation is 50:1 (Cowell 2009).

 hank

 

Demographics and Psychological Characteristics

Much of the recent literature bases their demographic and psychological information on a study by Richerts et al., which took place in Australia in 2001-2002 with 19,307 participants aged 16-59, each of whom were interviewed by phone. The purpose was to determine whether people who engage in BDSM were more likely to have experienced sexual coercion, sexual difficulties, and/or psychological issues. It was found that the three aspects to their hypothesis were completely unsupported. In terms of demographics, the following was found: in the past year, 2.2% of men and 1.3% of women had engaged in a BDSM relationship; overall, 1.8% of men and 1.2% of women had engaged in a BDSM relationship at some point in their lives. BDSM is significantly more likely in bisexual and gay-identified men, and in bisexual and lesbian-identified women. Additionally, women who engage in BDSM are more likely to be aged 16-19 or over 50, and have a regular partner they do not live with. For men and women, practitioners of BDSM had a greater number of sexual partners over the lifetime.

Building on the Richters et al., Wismeijier and van Assen sought to delve deeper into the psychological characteristics of BDSM practitioners. In 2013, 902 BDSM and 434 control participants filled out online questionnaires measuring rejection sensitivity, attachment style, level of subjective well-being, and the Five Factor Model, which covers neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. The roles in BDSM were also discussed, which hadn’t been covered in the literature up to this point (see Figure 2).

Results showed that BDSM practitioners displayed more favorable psychological characteristics than controls, and doms were more likely to exhibit the most favorable when compared to subs, switches, and controls. Results are summarized in Figure 1. Rates missing from the literature include incidence of specific psychiatric disorders. Most studies investigated terms such as psychological distress, psychological health, and/or psychological well-being; there doesn’t yet seem to be one that has investigated, for example, the incidence of depression or personality disorders in practitioners of BDSM. Though these results would imply that there would be a lower incidence of psychological disorders in this population, the data would provide useful insight to more specific aspects of the effect BDSM has on the psychological health of practitioners. Also missing is whether or not these personality characteristics are present before a person begins practicing BDSM, or if psychological health improves as a person continues to practice. Psychological hardiness would be interesting to measure as well.

Neuroticism Extraversion OpennessTo New Experiences Conscientiousness Agreeableness Rejection sensitivity Attachment Style Subjective Well-Being
P Less More More More Less Less Lower need for approval; less anxiously attached Higher
NP More Less Less Less More More Higher need for approval; more anxious attachment Less

Figure 1: Comparison of psychological characteristics in BDSM practitioners (P) and controls (NP) (data from Wismeijier and van Assen 2013).

Submissive Dominant Switch
Male 33.4% 48.3% 18.3%
Female 75.6% 8% 16.4%

Figure 2: Rates of roles in BDSM (data from Wismeijier and van Assen 2013)

Effect of Negative Clinical Perception on Treatment

Based on the above findings, it seems the stigma that BDSM practitioners carry is rather opposite to the reality. This, taken with the diagnostic criteria of Paraphilias can lead to a better understanding of when the practice of BDSM dips into the realm of a clinical disorder. There is a need for this, as much of the literature indicates the stigma associated with the practice of BDSM has interfered with practitioners receiving psychological treatment, even when their symptoms and distress have nothing to do with their BDSM practice.

Lindemann (2011) reports psychologists previously described a BDSM practitioner as “wandering through the kingdom of hell… a criminal… cannibalism, necrophilism, and vampirism.” Kolmes, Stock, and Moser (2006) identified the following themes of biased care in psychotherapy:

  1. Considering BDSM to be unhealthy
  2. Requiring the client to give up BDSM activity in order to continue treatment
  3. Confusing BDSM with abuse
  4. Client having to educate the therapist about BDSM
  5. Assuming that BDSM interests are indicative of past family/spousal abuse
  6. Therapist misinterpreting their expertise by stating that they are BDSM-positive when they are not actually knowledgeable about BDSM practices.

This study stated that 74.9% of people were not seeking treatment for BDSM interests, whereas 12% and 11% said treatment was either related or tangentially related, respectively. Of those seeking treatment, 65.1% shared their BDSM interests with their therapist, and 28.6% had not. What was most telling, though, was that the people who chose to share their BDSM interests report doing so, and doing so early in treatment, to gauge whether or not they would be comfortable with a particular therapist. Additionally, 33.7% report purposefully seeking out “kink-aware” professionals. The following testimonials, taken from interviews also included in this study, highlight the importance of not allowing one’s prejudices to affect clinical practice, or a patient’s treatment:

“BDSM only came into play when I had to educate her that it was not abuse, that it was not harmful to me, that I was not self-sabotaging with it, nor acting out past family/spousal abuse. It actually took quite a few sessions to get the therapist over their hang ups and misconceptions about BDSM. Time that could have been better spent on the actual issues I was there for.”

 

“I think that there are definitely aspects of BDSM that can be harmful when someone isn’t mindful of their own limits, needs, and such… finding a therapist who would be open to helping me along the path in the healthiest way possible would be invaluable!”

Many liken their participation in BDSM to that of a leisure activity , such as mountain climbing, or hiking (Newmahr 2010). Conceptualizing BDSM in this manner, especially in consideration with the data on the psychological health of practitioners, it seems silly for a clinician to ask a client to justify, or even stop their practice in order to receive treatment. According to Williams and Storm (2012), regular practice promotes trust, communication, spirituality, and intimacy within relationships; can provide new understandings of self and past experiences; and can lead to new insights about unnoticed phenomena.

Pain

By its very nature, though, it is understandable why someone not already involved in the practice might feel fearful. BDSM conjures up images of black leather, whips, and chains. Across the board BDSM involves some element of pain, either physical, psychological, or both. Neurologically, the experience of pain releases endorphins, which are neurotransmitters that modulate the experience of pain. Schneider (2009) argues that this causes an altered state of mind, allowing a person to have a new perception of how to control a situation. He further argues that pain is not an objective experience, but a social construct whose definition of experience relies on context. If a person is able to be in control of their pain it can produce feelings of pride, accomplishment, catharsis, and positive identity.

This seems to support anecdotal findings from Lindemann (2011) in which a series of professional dominatrices (pro dommes) were interviewed in New York and San Francisco. Originally beginning as general field research, Lindemann found that the majority of pro domes viewed themselves as “therapists” and described the value of their work in four categories:

  1. Healthful alternatives to sexual repression, due to societal stigma
  2. A means by which people can atone for their past
  3. Mechanisms for gaining control over prior traumas
  4. A way to experience psychological revitalization through shame

The pro dommes did receive compensation from clients for their services, and though their work can be conceptualized as “erotic labor,” in almost all cases no sexual contact was involved. The majority of women also participated in a BDSM lifestyle outside of the professional capacity, 33% had college degrees, and 39% had graduate degrees.

This study helps to conceptualize a person’s motives for participating in BDSM. Pro dommes describe some of the benefits of their work to extend a participant’s self-awareness. In the case of gaining control over prior trauma, for example, it was said that by re-enacting the scenario on the clients own terms he was able break through his bonds and take the first step toward working past the trauma. For a humiliation scene, “a client has his desires paradoxically affirmed and normalized through the process of shaming… to be heard for who you are is very therapeutic… so it’s a whole thing about trust and letting out this part of yourself that needs to come out” (161). Lindemann also proposes the “Spiderman’s uncle” phenomenon, which states ‘with great power comes great responsibility,’ and highlights the motivations of a client who holds a great deal of power in his professional life but will hire a pro domme in order to give up that power to experience relief.

There are a great deal of motivations, it appears, to utilize the practice of BDSM. Even if a person doesn’t classify themselves as a BDSM practitioner, they can still derive enjoyment from the experience of pain. In a study regarding the experience of sexual pleasure and pain, questions were asked about the experience of being bitten, inflicting pain, and receiving pain; see figure 3 for a summary of rates. Conceptualizing BDSM as therapy as opposed to a leisure activity does require caution, as it could imply that there’s something wrong that needs fixing.

Being bitten Inflicting pain Receiving pain
Male 26% 4.8% 2.5%
Female 26% 2.1% 4.8%

Figure 3: Experience of sexual pleasure to pain (data from Kreuger 2010 a)

BDSM versus Paraphilia

Research has shown that practitioners of BDSM are psychologically healthy, at times more so than controls, and that motivation for the practice is not to act out potentially criminal aggressions, it is to discover more about the self. In distinguishing a practitioner of BDSM from a person with a paraphilia, on must consider two factors: motivation and consent. Practitioners of BDSM almost never consider sex as the primary motivation for their actions; it may not be present at all. Furthermore, consent is always attained for every activity. In fact, the reason the actions are therapeutic is because of consent; consent equals control. Paraphilias on the other hand are sexually motivated and are not consensual. This results in illegal activity and trauma to another person, whereas the result of a BDSM relationship can have very positive results.

Further Directions

As mentioned before, missing from the literature is a discussion of particular psychiatric diagnoses of practitioners of BDSM, and if favorable personality characteristics existed before BDSM practice or they develop with practice. Also missing is a discussion of how people get into the practice in the first place as opposed to any other leisure activity, such as rock climbing.  Additionally, because of the pain component one wonders if there’s a connection between nonsuicidal self-injury (NSSI) and BDSM. Is there any overlap in people who practice one or the other? Would the practice of NSSI ever lead to the practice of BDSM? Additionally, the etiology of BDSM is missing. Further studies are needed to address these questions.

Conclusion

BDSM, a practice long stigmatized and feared, is one that can be considered a leisure activity whose participants are more psychologically healthy and have a higher subjective well-being than controls. Though on the surface it seems to share similarities to those diagnosed with paraphilias or other psychiatric disorders, the two are vastly different in motivation, outcome, and psychological health of practitioners. BDSM may even be considered as a form of therapy to aid people in pushing past prior trauma, fears, and relief from every day stressors. This paper sought to elucidate the psychological state, motives, and activities of BDSM practitioners, as well as dispel any preconceived notions regarding the practice itself or those who enjoy it. Clinicians who may treat a practitioner in the future should seek to educate themselves on safe and healthy practices, rather than allowing stigma to effect treatment. With further research, there may even be a chance to use it in treatment positively in the future.

References

Barker, M., Iantaffi, A., & Gupta, C. (2007). Kinky clients, kinky counselling? The challenges

and potentials of BDSM.

Baumeister, R.F. & Scher, S.J. (1998). Self-defeating behavior patterns among normal

individuals: Review and analysis of common self-destructive tendencies. Psychological Bulletin, 104, 3-22.

Cowell, D. D. (2009). Autoerotic Asphyxiation: Secret Pleasure—Lethal

Outcome?. Pediatrics, 124(5), 1319-1324.

Kafka, M. P. (2010). The DSM diagnostic criteria for paraphilia not otherwise

specified. Archives of sexual behavior, 39(2), 373-376.

Kolmes, K., Stock, W., & Moser, C. (2006). Investigating bias in psychotherapy with BDSM

clients. Journal of Homosexuality, 50(2-3), 301-324.

Krueger, R. B. (2010). The DSM diagnostic criteria for sexual sadism. Archives of Sexual

Behavior, 39(2), 325-345.

Krueger, R. B. (2010). The DSM diagnostic criteria for sexual masochism.Archives of sexual

behavior, 39(2), 346-356.

Lindemann, D. (2011). BDSM as therapy?. Sexualities, 14(2), 151-172.

Newmahr, S. (2010). Rethinking kink: sadomasochism as serious leisure.Qualitative

Sociology, 33(3), 313-331.

Paraphilic Disorders Fact Sheet (2013). American Psychiatric Association.

Richters, J., De Visser, R. O., Rissel, C. E., Grulich, A. E., & Smith, A. (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.

Schneider, A. (2009). The Rhythm of the Whip. Social Psychology Quarterly,72(4), 285-289.

Williams, D. J., & Storm, L. E. (2012). Unconventional Leisure and Career: Insights into the

Work of Professional Dominatrices. Electronic Journal of Human Sexuality, 15.

Wismeijer, Andreas A.J. & van Assen, Marcel A.L.M (2013). Psychological Characteristics of

BDSM Practitioners. Journal of Sexual Medicine, 1943-1952.

Wright, S. (2006). Discrimination of SM-identified individuals. Journal of Homosexuality, 50(2-

3), 217-231.

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