Sadism and masochism

• TYPE OF PSYCHOLOGY: Psychopathology
• Sadism and masochism can exist as normal sexual variations, but "sexual sadism" and "sexual masochism" refer to specific paraphilic disorders, as defined by modern psychiatry. The causes for these disorders are not known, and treatments have not been very effective.

Introduction

The terms sadism and masochism, collectively called sadomasochism, refer to a variety of behaviors by both clinicians and laypersons, resulting in considerable confusion as to what they actually are. Although sadism and masochism can fall within the range of normal variations in sexual behavior, the medical terms “sexual sadism disorder” and “sexual masochism disorder” refer to paraphilic disorders, as defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).

Sexual sadism disorder, as defined in the manual, consists of recurrent sexual fantasies, urges, or behaviors involving the psychological or physical suffering of another. To meet the clinical diagnostic criteria, these behaviors must be ongoing and present for at least six months. Behaviors engaged in may include, but are not limited to, dominating, beating, restraining, whipping, burning, cutting, strangulation, torture, mutilation, and killing. Also, to meet the diagnostic criteria, the fantasies, urges, or behaviors must cause significant distress, interpersonal difficulty, employment disruption, or have been inflicted on a non-consenting person.

Sexual masochism disorder, as defined in the manual, consists of recurrent sexual fantasies, urges, or behaviors. These must occur over at least six months, and the fantasies, urges, or behaviors must cause significant distress, interpersonal difficulty, or employment disruption. Sexual sadism and sexual masochism are frequently seen in the same individual.

Sexual sadism and sexual masochism disorders are both classified as paraphilias, which means that the individual is sexually attracted to deviant stimuli. Among other paraphilic disorders are pedophilic (arousal from children), exhibitionistic (arousal from exposing one’s genitals), (arousal from objects such as shoes or leather), and frotteuristic (arousal from rubbing up against strangers) disorders. It has been noted in clinical practice that an individual is likely to exhibit not only both sexual sadism and sexual masochism but also other paraphilias as well.

History of the Disorders

The terms “sadism” and “masochism” were first introduced by Richard von Krafft-Ebing in his work Psychopathia Sexualis: Mit besonderer Berücksichtigung der conträren Sexualempfindung—Eine klinisch-forensische Studie (1886; Psychopathia Sexualis: With Especial Reference to Contrary Sexual Instinct—A Medico-legal Study, 1892). He discussed a variety of sexual perversions. According to Krafft-Ebing, sexual perversion was any action that could not result in procreation. He saw a basic tendency toward sadism in men and masochism in women. Interestingly, both “sadism” and “masochism” were derived from the names of authors (the Marquis de Sade and Leopold von Sacher-Masoch) whose writing seems to exemplify the terms. Although the terms are derived from the writing of these individuals, it should be noted that behavior that could be labeled “sadistic” or “masochistic” was known long before this time.

The Marquis de Sade was born to a noble family in France. He served in the military but spent much of his life living as a libertine. He enjoyed the company of many prostitutes and apparently physically and psychologically abused a number of them. Although best known for his sexual writings that exemplified his lifestyle, Les 120 journées de Sodome (written 1785, published 1904; The 120 Days of Sodom, 1954) and Justine (1791; English translation, 1889), he also wrote on philosophical topics. These writings include Philosophy in the Bedroom (1795) and Juliette (1799). Due to his lifestyle and the condemnation of his family, Sade spent much of his life incarcerated.

Leopold von Sacher-Masoch was born in the Austrian Empire. He was a professor and wrote extensively on the history of his homeland; however, he is most known for his stories that dealt with his fetishes of dominant women. Like the Marquis de Sade, Sacher-Masoch attempted to live out his fantasies during his life with a number of women. It is believed that Sacher-Masoch spent the end of his life mentally ill.

Sigmund Freud expanded on masochism and, to a lesser extent, sadism in his psychosexual theory, identifying three types of masochism. He postulated that masochism was a perversion that arose out of guilt caused by sexual desire for the opposite-sexed parent. Because the child could not have the parent sexually, they desired to be beaten by that parent. This served both as punishment for the inappropriate feelings but also as sexual satisfaction. Freud’s theory held that masochism was a common perversion and indicative of improper sexual development. He viewed women as inherently masochistic.

Philosopher Jean-Paul Sartre saw both sadism and masochism as being examples of what he termed “bad faith,” which consists of misleading the self about relationships. Both sadism and masochism are part of what he termed “being-for-the-other.” In masochism, the self becomes an object of the other. In sadism, the other becomes an object for the self.

Possible Causes

There is no definitive cause of sexual sadism and sexual masochism disorders, but researchers have investigated genetic predisposition, biophysical influences, personality development, learned behavior, and brain studies. Freud believed that masochism and sadism were the result of improper psychosexual development, generally in the of development. Object-relations theorists maintain that all paraphilias are caused by domineering and frustrating parenting. The child responds to being powerless with a need for power.

Learning and reinforcement may play a significant role in sadistic and masochistic behavior. Children who grow up in an environment with sadistic or masochistic models may themselves repeat such behaviors. Orgasm is a strong , and any behavior that accompanies an orgasm is likely to be repeated.

Some brain studies show that individuals may seek to give or receive pain to increase stimulation in a brain that is not receiving enough stimulation. Individuals who are sensation seekers engage in dangerous behaviors to increase their level of stimulation and arousal.

Diagnosing Sexual Sadism and Sexual Masochism

Previously, all forms of sadism and masochism were considered mental disorders. Now, only sadistic acts practiced on unwilling partners or sadistic and masochistic acts that cause mental anguish to the individual are considered to be pathological. Masochistic behavior is generally brought to clinical attention when it has resulted in patient self-harm, which may result from acts of consent or from self-induced harm to the point wherein the patient can no longer self-regulate the sexual experience.

Sadistic behavior is considered pathological only once it crosses certain legal and medical boundaries of harm with nonconsenting partners, children, or animals. Illegal behaviors include coercing partners through acts of rape and molestation. Sexual sadists may even kill a partner—either accidentally or intentionally.

Individuals who practice sadism and masochism as forms of sexual expression seem to be significantly different from those individuals who are seen clinically for the treatment of sexual sadism and sexual masochism disorders. These sadists do not seek to hurt others outside of sexual play and administer only forms of pain that the masochist has agreed on. Masochists enjoy pain only in a sexual setting, but it is not coercive pain, such as rape, and it is generally pain that they maintain control over through agreement with a partner. Sadists and masochists can engage in a wide range of behaviors, which are often referred to as “play.” Very often, their fantasies are highly structured and, in fact, very safe. Some individuals may engage in sadomasochistic fantasies only and not act them out. Others may use playful spanking or light bondage; some may engage in whipping and even forms of minor mutilation. Like any other interest, individuals’ involvement levels vary. There are those who only engage in some sadomasochistic activities with their partner, and others who live a master-slave relationship full time. Sadists and masochists can find others who share their interests at clubs in most major cities, on websites and chatrooms, and through magazines.

One potentially very dangerous practice of sadists and masochists is erotic asphyxiation (referred to as "autoerotic asphyxiation" when practiced alone). In erotic asphyxiation, one partner deprives the other of oxygen to increase sexual pleasure during orgasm. However, the inability to judge when to stop oxygen deprivation has resulted in accidental deaths. In some instances, when the evidence is inconclusive, the surviving partner has been charged with murder.

Clinical Issues

A variety of personality disorders have been associated with sexual sadism and sexual masochism disorders. Although not an official diagnosis, self-defeating personality disorder, also referred to as "masochistic personality disorder," has been used by some clinicians and researchers to describe a cluster of extremely self-defeating personality traits. People with this disorder may interpret positive events and actions in a negative light or behave in such a way as to engender a negative response from others and then feel unreasonably hurt when that response is forthcoming. These individuals seem to choose situations or relationships that are disappointing, self-defeating, negative, and even harmful. They are drawn to abusive, hateful individuals. In some cases, they will avoid pleasurable experiences or experiences that are likely to lead to success and even react negatively to individuals who treat them well.

Sadistic personality disorder was classified as a disorder in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) but does not appear in the revised fourth or fifth editions. People with sadistic personality disorder are cruel, manipulative, and aggressive. They can be physically violent and enjoy harming others. Individuals with sadistic personality disorder may enjoy humiliating others and use intimidation and violence to get what they want. The behavior must be directed toward more than one person and is not used for sexual arousal.

Antisocial personality disorder (ASPD) is found in the DSM-5-TR. People with this disorder are marked by a disregard for the rights and feelings of others. They may break laws and may be deceitful, impulsive, aggressive, and irresponsible. Although they are often superficially charming, they have difficulty maintaining a job or relationship. They tend to lack remorse for their behaviors. These individuals have often been diagnosed with conduct disorder in childhood.

Some clinicians and researchers have created a subcategory of rapists known as "sadistic rapists." Although some might argue that all rapists, because of the act of coerced sex, are sexual sadists, many rapists use little force during their crimes. Sadistic rapists are more deviant than other rapists. They seem to reoffend more rapidly than other rapists. They tend to use much more force than is necessary to control their victims. However, caution should be taken when assigning rapists to this category. Just because force was used during a rape—or even if the victim was killed—it cannot be assumed that the rapist is a sadistic rapist. Also, some rapists who do not use extreme force still engage in sadistic fantasies that would classify them as sadistic rapists.

Treatment Options

Sexual sadists and sexual masochists rarely present themselves for treatment unless their behavior is causing them significant psychological distress or they are mandated into treatment for coercing others into sexual behavior. Although there are treatment options, none has had overwhelming success. Pharmacological treatment options include antiandrogen steroids and gonadotropin-releasing hormone agonists, which use medications that act on and other androgen hormones. Psychotherapeutic approaches may use dialectical behavior therapy, internal family systems therapy, and psychodynamic therapy. These approaches aim to improve the patient's self-control and self-regulation of behavior; whether paraphilic interests, such as sadism or masochism, can change remains subject to debate. Involving a sexual partner in treatment can increase the chances of success, but overall, these patients are difficult to treat.

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