Symptoms of Sexual Masochism Disorder

Sexual masochism disorder is a psychiatric condition that centers on the need to receive physical or psychological pain from another person in order to experience sexual gratification. The United States’ most prominent mental health organization, called the American Psychiatric Association (APA), includes the condition within a larger group of sex-based disorders called paraphilic disorders. Not everyone who engages in sexual masochism has sexual masochism disorder. Before qualifying for a diagnosis, affected individuals must meet the guidelines for the disorder set forth in the APA’s reference text on mental illness, known as the Diagnostic and Statistical Manual of Mental Disorders.

Sexual Masochism Basics

Along with sexual sadism, transvestism, exhibitionism, voyeurism and several other sex-related behavioral patterns, sexual masochism is something mental health experts call a paraphilia. Although they encompass widely varying behaviors, all paraphilias are linked by the presence of sexual preferences that fall outside of the boundaries of society’s rules for “normal” sexual practices. Some paraphilic practices qualify as unusual or “abnormal” because they impact negatively on the lives of participants or on the lives of people exposed to those participants. However, a paraphilic practice may also qualify as abnormal even if it doesn’t produce a real-world negative impact, as long as mainstream society views that practice in a negative light.

Sexual masochism is viewed as a paraphilia because it couples the receipt of pain and/or humiliation with sexual arousal and release. Most people who engage in sexually masochistic practices choose activities that ritualize pain and humiliation inside relatively restrained boundaries, the Merck Manual for Health Care Professionals reports. However, some people engage in practices that may actually result in serious or severe pain or humiliation. Specific activities that can take place in either context include beating (flagellation or spanking), bondage, rape simulation, skin piercing and intentional use of electrical shock. While sexually masochistic activities often involve another person who applies pain and humiliation, they may also involve self-directed behaviors.

Sexual Masochism Disorder Basics

While some people involved in sexually masochistic behaviors experience a negative life impact related to those behaviors, others do not. Prior to May 2013, the language used in the Diagnostic and Statistical Manual (DSM) did not accurately reflect this fact. Instead, the DSM’s language essentially equated sexual masochism as a paraphilia with sexual masochism as a mental disorder. In fact, the DSM referred to all paraphilic disorders as paraphilias, thereby making an unmistakable link between paraphilic behavior of any kind and mental illness.

By the time the American Psychiatric Association started working on the new fifth edition of the DSM (known as DSM 5), the scientific and medical consensus in the mental health community was that doctors need to clearly distinguish paraphilic behaviors that harm mental health from paraphilic behaviors that don’t harm mental health. In line with this consensus, DSM 5 changes the category of illnesses once known as paraphilias into the category of illnesses now known as paraphilic disorders. It also appends the word “disorder” to the name of each paraphilic condition, in order to distinguish it as a mental illness from the paraphilia associated with it (sexual masochism becomes sexual masochism disorder, sexual sadism becomes sexual sadism disorder, and so on).

A person who engages in the paraphilia called sexual masochism must meet one of two initial criteria in order to receive a diagnosis for sexual masochism disorder, according to the standards established in DSM 5. The first of these criteria states that an affected individual must experience mental anguish from his or her actions, fantasies, or urges that comes from within and does not arise only in response to outside social pressure. The second of these criteria states that an affected individual must produce anguish in someone else, or somehow involve a minor or non-consenting adult in his or her sexually masochistic practices. In addition to fulfilling one of these two criteria, a person with sexual masochism disorder must either actively engage in masochistic sexual practices for at least half a year, or experience strong, recurring fantasies or urges related to sexual masochism for at least the same period of time.

Treatment Considerations

Doctors usually treat paraphilic disorders with psychotherapy, certain types of mind- or body-altering medication, or a combination of both psychotherapy and medication. However, the Merck Manual for Health Care Professionals notes, people affected by sexual masochism disorder have relatively low chances for recovering from their condition when compared to people affected by many other paraphilic disorders.