Sexual Masochism Disorder

What is Sexual masochism disorder?

Sexual masochism disorder can be referred to as the intense feeling of sexual arousal or climax that results from humiliation, bondage, and suffering such as psychological and physical pain.

These sexual acts are played out, not limited to the imagination, either alone or with a partner. Someone with this disorder, a masochist, may want to engage in sexual activities that include beating, rape, cutting, mutilation, whipping, deprivation of oxygen, as well as psychological degradation or humiliation. Individuals with this disorder commonly engage in behaviors that are either mild or extremely dangerous and favor submission, be it sexual or mental.

Additionally, masochists may act out their imagination on their partners like burning, cutting, or piercing their skins. Among consenting adults, sadomasochist activities and fantasies are common. However, there are many situations where the abuse and humiliation are acted out in fantasy. The participants understand the behavior is a game since the actual injury and pain is deluded.

Other ways masochists release their fantasies include:

  • Applying electric shocks
  • Blindfolding
  • Spanking
  • Causing humiliation by defecating or urinating on partners
  • Forced crossdressing
  • Flagellation

There is a possibly harmful, if not fatal, masochist activity that is called autoerotic partial asphyxiation. This is a case where someone makes use of plastic bags, nooses, or ropes, to interrupt breathing (asphyxia) during orgasm. This is expected to enhance orgasm, but sometimes the act leads to death.

Along with sexual sadism disorder, sexual masochism disorder can be classified as a paraphilic disorder since paraphilia is present for causing significant personal harm, impairment or distress, or harm to others.

Though the fantasy of sexual masochism disorder may not be unusual, it is the performing of these fantasies that can bring about the risk of actual peril.

Sexual masochism characteristics:

  • The subject has an intense sexual fantasy, urge, or behaviors relating to the real act of being humiliated, bound, beaten, or otherwise made to suffer.
  • The result for this is clinically meaningful distress or impaired personal or social functioning.

Not only does this disrupt occupational and social functioning, but there is also equally a risk of threat to physical safety. For instance, hypoxyphilia consists of cutting off of oxygen supply for sexual stimulation. Despite cases of minor sexual masochism, there are also those who increase the hazard to safety that mostly results in serious injury.

Facts about sexual masochism disorder

  • People with the disorder are educationally well-rounded and are usually upper-middle class
  • Research presents that masochists are not individuals with anti-feminist beliefs
  • Asphyxiophilia or asphyxiation, also referred to as hypoxyphilia, has caused the deaths of many people, even celebrities across the world.

Someone is a sadomasochist when such an individual cannot refuse the offer of playing out abnormal sexual activities that cause pain. Also, if someone enjoys pain enough to orgasm, tolerates people that hurt or humiliate them, or holds onto painful feelings for the benefit of enjoyment, the person may have the potential of being a masochist.

Statistics on sexual masochism disorder

According to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), 19 is the median age for the development of sexual masochism disorder. And the disorder may happen as early as 12 years old for others that are sexually stimulated by violence and embarrassment.

  • At least half of the adults that take on consensual sex are bitten or scratched
  • 12 per cent of males and an estimated 5 per cent of females engage in sexual fantasy connected to masochism
  • The number of adults related to the disorder is still not known
  • An estimation of 12 per cent of females and about one-quarter of males are sexually stimulated by material around masochism as the fantasy about masochism is not unusual.

Symptoms of sexual masochism disorder

Mild behaviors are not prevalent in the span of sexual masochism disorder. Because of that, this type of behavior may not occur outside of mental disorder. This is typical of consenting partners that are in a relationship.

As a result, sexual masochism may not lead to debilitating side-effects that interfere with daily lifestyle. But when the individual is subject to intense psychological humiliation or becomes the victim of (or perhaps starts to desire) physically harmful masochistic acts, a mental disorder may arise.

Symptoms include:

  • Meddling with regular, daily routine as a result of psychological and physical suffering
  • Disruption of occupational, social, and other contexts that results from the fixation on sexual masochism
  • Sexual excitement received from receiving mental and physical torment from partners or by self
  • Desire to be physically hurt or humiliated in some way
  • Recurring extreme sexual urges that involve physical humiliation
  • An abnormal amount of time imagining sexual activities that include being humiliated or physically hurt
  • Distress
  • Relationship and social problems
  • When undergoing physical pain and shame, sexual excitement happens
  • Reading or viewing materials that involve extreme pornography or masochism.

A person may inflict pain on themselves during sexual intercourse or masturbation. In the case of others, the strains are administered on their partner in a domineering role. Apart from these behaviors carried out generally behind closed doors, there are some psychological signs such as the problem with the various relationship and social situations.

A distinction must be made between the injuries that are not connected to sexual excitement and the masochistic behavior that was inflicted on oneself. Research shows that individual who consents to milder masochism, be it discipline and bondage, dominance, submission, sadomasochism that have a consistent sexual behavior of domination and giving up, are not considered to have the disorder.

Causes of sexual masochism disorder

The actual cause of sexual masochism disorder is not known. Research connected the disease to social responses to a particular stimulus that individuals may not deem as pleasant. In most cases, paraphilic fantasies start in adolescence or later childhood and continue throughout adult life.

The occurrence and intensity of these fantasies vary and usually decrease as people get older. Psychological upbringing and brain chemical imbalance play a role in mental disorders.

The causes of sexual masochism disorder may include:

  • Diversion: many times, sexual masochism disorder includes fantasy and role playing games. Most people opt for alternative realities or engage in behavior that gives them something they think they do not possess under normal circumstances
  • Authority: in a situation where an individual has the conflict of reaching a healthy balance between domination and submission, they subject to or learn to prefer the insult or pain of sexual masochism.
  • Suppressing sexual fantasy: a person who is initially having sexual fantasy may continue with it in secret even if the act is contained before. The persistent fantasy results in arousal and confusion. When the fantasy is finally carried out, it is always accompanied by a blend of pleasure and pain. Research continues to link masochistic behavior with sex.

Some theories suggest that paraphilias were invented as a result of inappropriate sexual fantasies that are suppressed. At the same time, they get stronger as they are forbidden. In the situation of acting upon them, people are in a state of considerable arousal or distress. In the cases of sexual masochism disorder, masochistic behavior converts indistinguishable associated or connected with the sexual disorder.

Another research posits that sadomasochistic behavior is a form of escape. These individuals feel different and new by acting out fantasies. Other research that originates from psychoanalytic camp suggests that childhood trauma such as sexual abuse or significant childhood experiences may manifest in a paraphilic disorder.

Diagnosis of sexual masochism disorder

The diagnosis of sexual masochism disorder must have signs of interference with an individual’s occupation, social, and lifestyle for at least six months. Emotional and physical pain as a result of significant stress is an indication of a mental disorder. A sense of differentiation between self-mutilation other than sex and sexual masochism is important.

For proper diagnosis, sexual masochism may not be the only one, as people with the disorder need to be subjected to another diagnosis as well. Clinicians need to distinguish between the following disorders that must be ruled out to ascertain an accurate diagnosis.

Disorders include:

  • Dementia
  • Schizophrenia
  • Maniac episode
  • Mental retardation

Treatments of sexual masochism disorder

The major treatment for sexual masochism disorder is medication and psychotherapy. The psychotherapy has the goal to work through or uncover the underlying distress through behavior. Two important therapies fall under cognitive therapies that consist of empathy training and cognitive restructuring distortions.

Restructuring cognitive distortions can be done by rectifying the subject’s beliefs that can lead to acting on evil thoughts. Empathy training consists of aiding the masochist on the perspective of the victim to know the harm that has been done and recognize them. Another vital treatment role of cognitive therapy is to help masochists manage their sexual urges in healthier ways.

The general strategies of psychotherapy include several types of desensitization or imaginary techniques and aversion therapy where the subject imagines themselves engaging in sexual masochism and then the subsequent negative experience to reduce the urge for future participation.

Various medications can be used to reduce sexual and fantasy impulse for those that favor mental and extremely dangerous masochism. Antidepressant medications and similar drugs can be used to lessen the level of circulating testosterone in the body to decrease the frequency of sex drive or erections.

Prevention of sexual masochism disorder

It is still not clear whether sadomasochistic behavior falls within the realm of indicative of a diagnosis or standard experimentation of sexual masochism and therefore, the issue of prevention is tricky. In most cases, preventing masochism disorder is done primarily by involving only the simulation of chronic pain. This method is carried out with the consent of the partners to be familiar with each other’s limitations.

Prevention may also be difficult since the masochistic behavior in adulthood originated from the urges and fantasies in childhood. Also, people may find it hard to discuss their sadistic fantasy or divulge their urges to the physician as part of treatment.


Treatments for sexual masochism disorder are often hard because of the uncertainty of its causes and its chronic effects. Apart from that, treatments are difficult because of the socially unacceptable factor. For many mental health professionals, treating sexual masochism disorder is often a sensitive subject. Professionals with years of experience must be referred to treat complicated and severe cases of sexual masochism disorder.

Some complications can arise during treatment because of health issues relating to sexual behavior. There may be the presence of sexually transmitted diseases and other medical problems; therefore, treatments can be complicated. Also, individuals engaging in hypoxyphilia and other dangerous behaviors can suffer chronic pains and even death.

On the other hand, the patient can be made to acquire the culture of keeping a diary of masturbation, sexual fantasy, or arousal. During the constant visit to the therapist, the patient can discuss the contents of the journal. In return, the therapist has the obligation of enhancing sexual education and social skills. An insight-focused therapist will also assist the patient to examine his needs within and outside such individual’s sexuality.

Also to develop new ways of behavior, a behavioral therapist will be greatly helpful. Unfortunately, in the case of behavioral patterns, patients rarely consult a therapist or physician unless one of their partners becomes unwilling or is injured. And in most cases, the intensity or seriousness of these behaviors increases.

Last Reviewed:
September 12, 2017
Last Updated:
September 12, 2017