Sexual masochism disorder

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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. [1] 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.

Contents

Current terminology

Sexual masochism disorder is the term employed by the current version of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association. [1] 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 applies only if the individual experiences clinically significant distress 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. [2] 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 the pain or humiliation. The ICD-10 specifies that mild forms of sadomasochism "are commonly used to enhance otherwise normal sexual activity" (p. 172) and that the diagnosis applies only if the behavior is preferred or required for sexual gratification. The condition is classified as one of the disorders of sexual preference, which include 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. [3] It is not a diagnosable condition in the DSM and ICD systems.

Previous terminology

Sexual masochism was the term employed in the DSM-III, [4] DSM-IV, [5] DSM-IV-TR. [6] Each manual noted that the condition referred to real rather than simulated or fantasized pain or humiliation.

Masochism was the term employed by the DSM-II. [7] 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 was not used in the DSM-II, and diagnoses did not have specific criteria until DSM-III.

Although sexual sadism was mentioned in DSM-I as one of the sexual deviations [8] (p. 39), sexual masochism was not.

Features

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. [1] Extensive use of pornography depicting humiliation is sometimes associated with sexual masochism disorder. [1]

Behaviors associated with sexual masochism disorder can be acted out alone (e.g., binding, sticking with pins, electric shock, and 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, and being verbally abused)., [6] and include being forced to cross-dress and being treated like an infant. [6]

In extreme cases, accidental deaths can occur, such as from engaging in self-application of electric shock. [9] One of the most extreme cases of masochism was that of Bernd Brandes, who answered a person advertisement from Armin Meiwes, who was seeking someone who wanted to be slaughtered and eaten. [10]

Comorbidity

There is limited empirical research on diagnoses that are common with sexual masochism disorder. Other paraphilic disorders are found to be comorbid with sexual masochism disorder in treatment settings. A small study of 120 women found an association between sexual masochism disorder and borderline personality disorder (BPD). Those with BPD were ten times more likely to have sexual masochism disorder compared to patients with other personality disorders. Those with BPD and sexual masochism disorder also reported more childhood sexual abuse. [11]

Controversy over Sexual Masochism Disorder

There is controversy over whether sexual masochism disorder should remain in the DSM. Those for the diagnosis argue the DSM differentiates between what is considered normal and pathology, and that retention of the diagnosis can be useful for research purposes, particularly in forensic populations. There also may be serious consequences (e.g., accidental death) if sexual masochism disorder is accompanied with asphyxiophilia, which involves practices to deprive oxygen to the brain.

However, many authors suggest that sexual masochism disorder is based on public opinion rather than scientific research, and that the diagnosis contributes to continued misconceptions and stigmatization. [12]

The DSM-V-TR characterizes sexual interests as being normophilic (normal) or paraphilic (anomalous). Paraphilia includes "any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners”. [13] All other interests are considered paraphilic. However, paraphilic interests are not unusual. In a study of 1,040 adults, 45.6% reported a desire to experience at least one paraphilic behavior, 23.8% reported a desire for masochism, and 19.2% reported engaging in masochism at least once in their life. [14]

Further reading

See also

Related Research Articles

<span class="mw-page-title-main">BDSM</span> Erotic practices involving domination and sadomasochism

BDSM is a variety of often erotic practices or roleplaying involving bondage, discipline, dominance and submission, sadomasochism, and other related interpersonal dynamics. Given the wide range of practices, some of which may be engaged in by people who do not consider themselves to be practising BDSM, inclusion in the BDSM community or subculture often is said to depend on self-identification and shared experience.

<span class="mw-page-title-main">Paraphilia</span> Atypical sexual attraction

A paraphilia is an experience of recurring or intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals. It has also been defined as a sexual interest in anything other than a consenting human partner. Paraphilias are contrasted with normophilic ("normal") sexual interests, though the definition of what makes a sexual interest normal or atypical remains controversial.

<span class="mw-page-title-main">Algolagnia</span> Core tendency of sadomasochism

Algolagnia is a sexual tendency which is defined by deriving sexual pleasure and stimulation from physical pain, often involving an erogenous zone. Studies conducted indicate differences in how the brains of those with algolagnia interpret nerve input.

<span class="mw-page-title-main">Sexual fetishism</span> Sexual arousal a person receives from an object or situation

Sexual fetishism or erotic fetishism is a sexual fixation on a nonliving object or nongenital body part. The object of interest is called the fetish; the person who has a fetish for that object is a fetishist. A sexual fetish may be regarded as a non-pathological aid to sexual excitement, or as a mental disorder if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life. Sexual arousal from a particular body part can be further classified as partialism.

<span class="mw-page-title-main">Transvestic fetishism</span> Psychiatric diagnosis

Transvestic fetishism is a psychiatric diagnosis applied to men who are thought to have an excessive sexual or erotic interest in cross-dressing; this interest is often expressed in autoerotic behavior. It differs from cross-dressing for entertainment or other purposes that do not involve sexual arousal. Under the name transvestic disorder, it is categorized as a paraphilia in the DSM-5.

<span class="mw-page-title-main">Sadomasochism</span> Giving or receiving of pleasure from acts involving the receipt or infliction of pain or humiliation

Sadism and masochism, known collectively as sadomasochism, are the derivation of pleasure from acts of respectively inflicting or receiving pain or humiliation. Practitioners of sadomasochism may seek sexual pleasure from their acts. While the terms sadist and masochist refer respectively to one who enjoys giving and receiving pain, some practitioners of sadomasochism may switch between activity and passivity.

<span class="mw-page-title-main">National Coalition for Sexual Freedom</span> Organization

The National Coalition for Sexual Freedom (NCSF) is an American sex-positive advocacy and educational organization founded in 1997. NCSF has over one hundred coalition partners, and over sixty supporting members. NCSF advocates on behalf of adults involved in alternative lifestyles with respect to sexuality and relationship composition, specifically for tolerance and non-discrimination of those so identified, as well as education for adults involved in such lifestyles. The organization's main office is in Baltimore, Maryland.

The term chronophilia was used by psychologist John Money to describe varying forms of romantic preference and/or sexual fixation limited to individuals of particular age ranges. Some such fixations, specifically those towards prepubescents and those towards the elderly, constitute types of paraphilia. The term has not been widely adopted by sexologists, who instead use terms that refer to the specific age range in question. An arguable historical precursor was Richard von Krafft-Ebing's concept of "age fetishism". Importantly, chronophilia are technically not determined by age itself, but by human sexual maturity stages, such as body type, secondary sexual characteristics and other visible features, particularly as measured by the stages of the Tanner scale.

Psychosexual disorder is a sexual problem that is psychological, rather than physiological in origin. "Psychosexual disorder" was a term used in Freudian psychology. The term of psychosexual disorder used by the TAF for homosexuality as a reason to ban the LGBT people from military service.

Biastophilia and its Latin-derived synonym raptophilia, also paraphilic rape, is a paraphilia in which sexual arousal is dependent on, or is responsive to, the act of assaulting an unconsenting person, especially a stranger. Some dictionaries consider the terms synonymous, while others distinguish raptophilia as the paraphilia in which sexual arousal is responsive to actually raping the victim.

<span class="mw-page-title-main">Sadistic personality disorder</span> Former personality disorder involving sadism

Sadistic personality disorder was a proposed personality disorder defined by a pervasive pattern of sadistic and cruel behavior. People with this disorder were thought to have desired to control others. It was believed they accomplish this through the use of physical or emotional violence. This diagnosis appeared in an appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). The later versions of the DSM do not include it. It was removed as psychiatrists believed it would be used to legally excuse sadistic behavior.

Paraphilic infantilism, also known as autonepiophilia and adult baby, is a sexual fetish or non-sexual kink that may involve role-playing a regression to an infant-like state. Paraphilic infantilism is a form of ageplay. People who practice paraphilic infantilism are often colloquially referred to as "adult babies", or "ABs".

<span class="mw-page-title-main">DSM-5</span> 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published. In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. However, not all providers rely on the DSM-5 for planning treatment as the ICD's mental disorder diagnoses are used around the world and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.

Martin Paul Kafka is an American psychiatrist best known for his work on sex offenders, paraphilias and what he calls "paraphilia-related disorders" such as sex addiction and hypersexuality.

Diaper fetishism, nappy fetishism, or diaperism is a type of garment fetish in which a person derives pleasure from wearing or using a diaper. Though separate and distinct, diaper fetishism can also be used as a component of various other kinks, such as ageplay or paraphilic infantilism, which together form a spectrum of practices colloquially referred to as "adult baby/diaper lover" or "AB/DL".

Compulsive sexual behaviour disorder (CSBD), is an impulse control disorder. CSBD manifests as a pattern of behavior involving intense preoccupation with sexual fantasies and behaviours that cause significant levels of psychological distress, are inappropriately used to cope with stress, cannot be voluntarily curtailed, and risk or cause harm to oneself or others. This disorder can also cause impairment in social, occupational, personal, or other important functions.

Other specified paraphilic disorder is the term used by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to refer to any of the many other paraphilic disorders that are not explicitly named in the manual. Along with unspecified paraphilic disorder, it replaced the DSM-IV-TR category paraphilia not otherwise specified (PNOS). In the revised DSM-5-TR published in 2022 no changes have been made regarding Other specified paraphilic disorder.

<span class="mw-page-title-main">Sexual sadism disorder</span> Paraphilia in which a subject derives gratification from inflicting pain

Sexual sadism disorder is the condition of experiencing sexual arousal in response to the involuntary extreme pain, suffering or humiliation of others. Several other terms have been used to describe the condition, and the condition may overlap with other conditions that involve inflicting pain. It is distinct from situations in which consenting individuals use mild or simulated pain or humiliation for sexual excitement. The words sadism and sadist are derived from the French writer and libertine Marquis de Sade, who wrote several novels depicting sexualized torture and violence.

Homosexuality was classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) beginning with the first edition, published in 1952 by the American Psychiatric Association (APA). This classification was challenged by gay rights activists in the years following the 1969 Stonewall riots, and in December 1973, the APA board of trustees voted to declassify homosexuality as a mental disorder. In 1974, the DSM was updated and homosexuality was replaced with a new diagnostic code for individuals distressed by their homosexuality. Distress over one's sexual orientation remained in the manual, under different names, until the DSM-5 in 2013.

References

  1. 1 2 3 4 American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. ↑ World Health Organization. (2007). International statistical classification of diseases and related health problems (10th rev., version for 2007). Retrieved from http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gf60.htm
  3. ↑ Aggrawal, A. (2009). Forensic and medico-legal aspects of sexual crimes and unusual sexual practices. New York: Taylor & Francis. p. 145.
  4. ↑ American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington, DC: Author.
  5. ↑ American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.
  6. 1 2 3 American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: Author.
  7. ↑ American Psychiatric Association. (1968). Diagnostic and Statistical Manual of Mental Disorders (2nd ed.). Washington, DC: Author.
  8. ↑ American Psychiatric Association. (1952). Diagnostic and Statistical Manual: Mental Disorders. Washington, DC: Author.
  9. ↑ Cairnes, F. J., & Rainer, S. P. (1981). Death from electrocution during auto-erotic procedures. New Zealand Medical Journal, 94, 259-260.
  10. ↑ Cantor, J. M., & Sutton, K. S. (2014). Paraphilia, gender dysphoria, and hypersexuality. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (3rd ed.) (pp. 589–614). New York: Oxford University Press.
  11. ↑ Frías Á, González L, Palma C, Farriols N (2017). "Is there a relationship between borderline personality disorder and sexual masochism in women?". Archives of Sexual Behavior. 46 (3): 747–754. doi:10.1007/s10508-016-0834-z. PMID   27600835. S2CID   254255482.
  12. ↑ 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. doi:10.1016/j.esxm.2019.02.002. PMC   6525106 . PMID   30956128.
  13. ↑ American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). p. 779. doi:10.1176/appi.books.9780890425787. ISBN   978-0-89042-575-6. OCLC   1313609485. S2CID   249488050.
  14. ↑ Joyal CC, Carpentier J (2017). "The prevalence of paraphilic interests and behaviors in the general population: A provincial survey". The Journal of Sex Research. 54 (2): 161–171. doi:10.1080/00224499.2016.1139034. PMID   26941021. S2CID   1671875.
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