BDSM and NSSI: A Proposal for a Survey Study

The following is a mock grant proposal for Self-Destructive Behaviors, written as my final project. I’ve never written a grant proposal before, and as much as I attempted to go off of my professor’s guidelines I really have no idea of the quality (I’ve yet to receive feedback). The point wasn’t so much to be accurate with the structure and choice of measures, but to practice structuring a feasible idea for study. In that regard I believe I came up with something interesting.

I’ve never been interested in the research side of the industry; I have so much more fun being a clinician, but I had a great time this semester studying BDSM. A bit of background, as I’ve posted a couple of my papers I’ve written on the topic, I have personal experience as a BDSM practitioner – I identify as a sub, though I’ve been known to switch. I chose to compare it with NSSI because, as a clinician, I’ve witnessed a stigma associated with patients who practice NSSI that is comparable to the stigma described in BDSM literature. Also, it’s undeniable both are related to an active choice to experience pain, but there’s dissonance between the psychological health of the respective practitioners. I don’t get into it here, but I believe it’s due to solitary versus shared activities. That would be another study entirely though.

I may do my Master’s thesis on BDSM, which I have to start researching in February.

Shibari

Specific Aims

Bondage-discipline, dominance-submission, sadism-masochism (BDSM) and non-suicidal self-injury (NSSI) are practices often engaged in secret, and known motivations behind them are murky at best. It has been suggested that those who practice BDSM and NSSI are doing so for emotional regulation. Stigma associated with each of these practices, particularly in the clinical environment, affects how much we know about why people start and keep intentionally hurting themselves. It has also prevented those who require it from seeking help or fully reporting symptoms. As a result, not much research has been devoted to assessing the personality traits of practitioners. Additionally, no surveys of the incidence of psychiatric diagnoses within BDSM populations have been performed.

It cannot be denied that the common thread in these practices is the persistent desire and choice to repeatedly engage in purposeful and direct harm to the self. Data has shown that NSSI is usually associated with certain personality disorders and other psychiatric diagnoses, whereas BDSM practitioners are more psychologically healthy than controls. It is important to discern what else these two populations have in common because of the disparity in psychological health. It seems a difference is not the hurting itself but who is doing the hurting. This study seeks to compare psychological characteristics of BDSM practitioners with those who engage in NSSI in the following areas:

°         Neuroticism

°         Extraversion

°         Openness to new experiences

°         Conscientiousness

°         Agreeableness

°         Rejection sensitivity

°         Attachment style

°         Subjective well-being

°         Cognitive reactivity

°         Distress tolerance

°         Impulsivity.

This study hypothesizes that BDSM and NSSI practitioners will overlap on traits usually associated with psychopathy: high cognitive reactivity and high impulsivity. However, BDSM practitioners will have higher association with more positive or adaptive psychological characteristics than those who engage in NSSI, thereby giving BDSM practitioners a higher capacity for distress tolerance and less incidence of psychiatric diagnoses (see Figure 2, p. 4 for summarization of hypothesized results).

Background and Significance

BDSM 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. 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. A professional dominatrix is a person that enacts a BDSM “scene” with a client in exchange for money; though “scenes” are erotic in nature, sexual contact of any kind is usually absent. Traditionally in the public and professional BDSM sectors sexual contact is not allowed or highly frowned upon.

Non-suicidal self-injury involves deliberate destruction of body tissue in the absence of intent to die. Common mechanisms include cutting, burning, hitting, and head banging. Like BDSM, it has also been misunderstood and stigmatized by clinicians and the general public, and is usually practiced in secret. It is often associated with Borderline Personality Disorder, but is also associated with anxiety, depression, suicidality, and other psychiatric disorders. Though, it isn’t always symptomatic of a larger disorder. Recent studies have begun to conceptualize NSSI as serving functions such as affect regulation and communication (Nock, 2009). While on the short term it can lead to distraction from negative emotion, long term effects are harmful. One’s feelings of guilt or shame can increase or intensify; one can become socially isolated; and the body can become permanently scarred (Wilkinson and Goodyer, 2011).

BDSM practitioners, in seeking therapy for issues not associated with BDSM have reported their clinicians more often have serious misconceptions regarding the practice, and therefore jump to conclusions with the client. Reported problems include considering BDSM to be unhealthy, requiring the client to give up the activity as a contingency for continuing to receive treatment, or confusing BDSM with abuse. For these reasons 33.7% report seeking out a “kink-aware” professional and sharing their BDSM interests early in order to gauge how comfortable they will be with that clinician (Kolmes, Stock, and Moser, 2006). NSSI is similarly misunderstood in that the action is sometimes assumed to be a suicidal gesture. This leads to incorrect treatment recommendations, and at times unnecessary placement under suicide watch.

Further study of the psychological characteristics of these populations could lead to more effective treatment options, and educate professionals about how to better interpret symptoms. Much of the literature on BDSM is qualitative or anecdotal; quantitative data would be a valuable addition to the field and oppose the stigma associated with the practice in a more concrete fashion.

 

Preliminary Studies

Much of the recent literature on BDSM 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. 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. Results are summarized in Figure 1; Figure 2 shows a summarization of hypothesized psychological characteristics of BDSM and NSSI practitioners.

 

  Neuroticism Extraversion Openness

To 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).

 

  Neuroticism Extraversion Openness to New Experiences Agreeableness Rejection Sensitivity Attachment Style Subjective Well-Being Cognitive Reactivity Distress Tolerance Impulsivity
BDSM Less More More Same Less Lower need for approval, secure Higher Same Higher capacity Same
NSSI More Less Less Same More Higher need for approval, insecure Lower Same Lower capacity Same

Figure 2: Hypothesized comparison of psychological characteristics

 

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.

Addressing possible motivations for engaging in a BDSM relationship, Lindemann (2011) interviewed a series of professional dominatrices reporting they 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

Likewise, Wilkinson and Goodyer identify four reasons why a person may choose to engage in NSSI:

  1. To relieve an intense, distressing affect such as sadness, guilt, or shame
  2. “Deserved” self-punishment
  3. Attention-seeking
  4. Social association with others that engage in self-harm

Similarities between the two populations seem to revolve around seeking relief of distressing emotions or experiences, atoning for a perceived wrong-doing, and desire to associate with other practitioners.

 

Research Design

Participants and Procedure: This study will assess adults, age 18 and older. BDSM practitioners will be those who have been involved in a BDSM relationship at least once in the lifetime. A BDSM relationship will be defined as a period of time in which a person repeatedly performs BDSM activities with another person (ex. significant other, professional dominatrix) or in a particular setting (ex. private club). Those who engage in NSSI are participants reporting having deliberately caused physical harm to their body at least once in the lifetime without intent to die. Participants will be solicited from both clinical and nonclinical populations, and those with a preexisting psychiatric disorder will not be excluded. Participants will be offered access to treatment if they report distress, or scores on a given measure indicate a clinical necessity. Those who report active suicidal ideation will be excluded and referred for treatment.

 

Measures: Measures will be used to discover any overlap in personality characteristics of BDSM and NSSI practitioners. Surveys will be computer based and accessible online. The following is a listing of proposed measures and possible questionnaires for each measure:

°         Five Factor Model

>        Neuroticism Extraversion Openness Personality Inventory  (NEO PI-R)

°         Attachment style

>        Attributional Style Questionnaire (ASQ) – measures how a person perceives themselves in relationships, determining attachment style to be either secure, avoidant or anxious

°         Rejection Sensitivity

>        Rejection Sensitivity Questionnaire (RSQ) – measures anxious expectations of rejection by significant others

°         Subjective well-being

>        World Health Organization Five Well-Being Index (WHO-5) – measures how a person has been feeling in the last two weeks

°         Cognitive reactivity

>        Leiden Index of Depression Sensitivity, revised (LEIDS-r) – measures the extent to which dysfunctional cognitions are triggered when a person is feeling sad

°         Distress tolerance

>        Distress Tolerance Test (DTT) – measures the level of frustration a person can handle in a given task (Nock and Mendes, 2008)

°         Impulsivity

>        UPPS Impulsive Behavior Scale – measures impulsivity across the dimensions of the Five Factor Model

°         Frequency of practice

>        How many times per week, month, or year a person engages in BDSM or NSSI

°         Duration of practice

>        How long a person has been engaging in the activity; at what age a person started

°         Co-occurring psychiatric disorders

>        Listing any current or past psychiatric diagnoses

°         Type of activity

>        Selection from common activities associated with each practice

  • BDSM: bondage/restraint, discipline, humiliation, infliction of physical pain, sensory deprivation/overload
  • NSSI: cutting, burning, head banging, intentionally breaking bones, ingestion of chemicals

 

Data Analysis: Data from the BDSM population will be compared with the NSSI population, and overlapping psychological constructs will be noted (see Figure 2, p. 4 for a summary of hypothesized results). Analyses will be conducted after input into an SSPS system. This study hopes to glean data from a relatively large population size, so a data collection period of at least 2 years is recommended.

 

Conclusion

This study hypothesizes that BDSM and NSSI practitioners will overlap in psychological characteristics that are risk factors for psychopathy, namely high cognitive reactivity and high impulsivity. In the presence of stressful life events the degree to which a person is capable of tolerating distress determines how and when a person reacts. Other personality traits will either strengthen or reduce distress tolerance. In both of these populations choosing to experience pain is a common factor, but initial studies show that long term effects differ. Positive psychological characteristics are associated with BDSM practitioners and negatives ones are associated with those who engage in NSSI. Discovering the cause of this disparity could lead to new treatment directions for both populations. Additionally the issue of experiencing pain as a means of recovery, or pain as a positive experience might be viewed more objectively and without stigma.

 

References

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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.

Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: prevalence,

sociodemographics, topography and functions. Psychological medicine, 41(9), 1981-6.

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

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

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.

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Nock, M. K. (2009). Why do people hurt themselves? New insights into the nature and functions

of self-injury. Current directions in psychological science,18(2), 78-83.

Nock, M. K., & Mendes, W. B. (2008). Physiological arousal, distress tolerance, and social

problem-solving deficits among adolescent self-injurers. Journal of Consulting and Clinical Psychology, 76(1), 28.

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.

Wilkinson, P., & Goodyer, I. (2011). Non-suicidal self-injury. European child & adolescent

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

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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-

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