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Sexual Masochism Disorder

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Sexual masochism disorder is a paraphilic disorder, which involves recurrent, intense, sexually arousing fantasies, urges, or behaviors that are distressing or disabling and have the potential to cause harm to oneself or others.

Sexual masochism refers to engaging in, or frequently fantasizing about, being beaten, bound, humiliated, or otherwise made to suffer, resulting in sexual satisfaction. If people with this sexual preference report psychological or social problems as a result, they may be diagnosed with sexual masochism disorder. The types of distress that people with this disorder may experience include severe anxiety, guilt, shame, and obsessive thoughts about engaging in sexual masochism.

In contrast, if a person with sexually masochistic desires declares no distress, anxiety, ob­sessions, guilt, or shame, about these paraphilic impulses, and are not hampered by them in the course of daily life, they could be determined to have masochistic sexual interest but should not be diagnosed with sexual masochism disorder.

One specific type of sexual masochism is called asphyxiophilia, in which a person receives sexual satisfaction by having their breathing restricted. While some people engage in this practice with partners, others prefer to restrict their breathing while they are alone, and accidental death may happen as a result.

Sexually masochistic behavior is usually evident by early adulthood, and sometimes begins with masochistic or sadistic play during childhood


According to the DSM-5, to be diagnosed with sexual masochism disorder a person must experience recurrent and intense sexual arousal from being beaten, humiliated, bound, or aroused from some other form of suffering. These types of urges, fantasies, or behaviors must be present for at least six months and cause clinically significant troubles or difficulty in social, occupational, or other important areas in life.

The extensive use of pornography involving the act of being humiliated, beaten, bound, or otherwise made to suffer is sometimes an associated feature of the disorder

Why do people practice sexual masochism?

In a recent study, the most frequent reason for engaging in masochism and sadism was to give or exchange power with another person. Others responded that the practice allowed them to enter into an alternative state of consciousness, one that could lead to a somewhat meditative and relaxed state.

What is the prevalence of sexual masochism in the population?

According to a meta-analysis of research, BDSM-related (Bondage and Discipline, Dominance and Submission, Sadochism, and Masochism) fantasies were found to be common in both males and females, with 40 to 70 percent of the population engaging in fantasies about the acts, while about 20 percent reported engaging in BDSM. Individual studies have found similar, if smaller ranges, with several studies estimating 5 to 14 percent of Americans have engaged in BDSM. Few studies have focused on only masochistic behaviors. One study that did indicated only 1 to 2 percent of study participants in Australia engaged in sexual masochism.

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There is no universally accepted theory explaining the root of sexual masochism, however, several ideas have been advanced. One theory suggests that paraphilias originate when inappropriate sexual fantasies are forbidden, and become stronger as they are suppressed. Another theory suggests that sadomasochistic behavior is a form of escape from one’s thoughts and allows the practitioner to enter into something resembling a meditative state. Through acting out fantasies, individuals allow themselves to feel new and different. Another theory suggests that childhood trauma, such as sexual abuse, can later manifest in a paraphilic disorder.

What causes someone to be a masochist?

In one recent study, ​​the significant majority of participants reported they had an intrinsic interest in masochism/submission starting at a young age. A smaller number of people connected the impulses to childhood sexual abuse and to parental discipline.

Is there a difference between men and women in sexual masochism?

According to recent research, women reported fantasizing about being dominated significantly more than men (65 percent in women compared to 54 percent in men), while men reported fantasizing about dominating someone significantly more than women (60 percent in men compared to 47 percent in women). Women desired to engage in masochism significantly more than men (28 percent in women compared to 19 percent in men).


Treatment for sexual masochistic disorder typically involves psychotherapy and medication that can reduce sex drive. The goal of psychotherapy may be to uncover and work through the underlying cause of the behavior that is causing distress. Cognitive therapies include restructuring cognitive distortions and empathy training. Restructuring cognitive distortions involves correcting any beliefs a patient has that may lead them to act on harmful thoughts. Cognitive-behavioral therapy can also help an individual learn skills to manage their sexual urges in healthier ways. Other common strategies include aversion therapy and imagery/desensitization techniques, in which individuals imagine themselves in a situation where they are participating in sexual masochism, and then experience a negative event to reduce future desire to participate in that activity again.

Advancing age is believed to reduce the symptoms and desires of sexual masochism, as it does with other paraphilic disorders, and with sexual urges generally.

Various medications can be used to decrease the level of circulating testosterone in the body with the aim of reducing the frequency of erections in males. Antidepressant medications may also be used to reduce sex drive.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
Current Diagnosis & Treatment in Psychiatry
Treating Mental Disorders: A Guide to What Works
Labrecque, F., Potz, A., Larouche, M., & Joyal, C. C. (2020). What Is So Appealing About Being Spanked, Flogged, Dominated, or Restrained? Answers from Practitioners of Sexual Masochism/Submission. The Journal of Sex Research, 58(4), 409–423.
Wismeijer, A. A., & van Assen, M. A. (2013). Psychological Characteristics of BDSM Practitioners. The Journal of Sexual Medicine, 10(8), 1943–1952.
Brown, A., Barker, E. D., & Rahman, Q. (2019). A Systematic Scoping Review of the Prevalence, Etiological, Psychological, and Interpersonal Factors Associated with BDSM. The Journal of Sex Research, 57(6), 781–811.
An Introduction to BDSM for Psychotherapists | Society for the Advancement of Psychotherapy. (2021). Society for the Advancement of Psychotherapy.…
Last updated: 09/15/2021