Sexual Masochism Disorder
Written by: THE BALANCE
Medically reviewed by Dr. Sarah Boss, MD
Last updated: January 19, 2026
Fact checked
Quick Summary
  • Sexual Masochism Disorder is a paraphilic disorder that involves sexual arousal through pain.
  • It is prevalent in both sexes and can be linked to several psychological, social, and environmental factors.  Masochistic individuals must learn more about this disorder to help them deal with it effectively.
  • Masochism is a state where a person gains sexual satisfaction from the act of suffering or being humiliated.
Reading time: 16 min

Sexual Masochism Disorder is a paraphilic disorder that involves sexual arousal through pain. Although some individuals may participate in masochistic activities during consensual sexual encounters, this disorder is diagnosed when the desires cause distress or interfere with daily functioning. 

It is not a mere inclination; rather, it can have detrimental effects on interactions and mental health. It is prevalent in both sexes and can be linked to several psychological, social, and environmental factors. 

Masochistic individuals must learn more about this disorder to help them deal with it effectively.

Masochism is a state where a person gains sexual satisfaction from the act of suffering or being humiliated. The term originates from Leopold von Sacher-Masoch, a 19th-century Austrian writer whose stories were characterized by the portrayal of male submission to females. In a broader context, masochism refers to a behavior or a tendency where a person actively looks for situations that will cause them physical or emotional pain, not necessarily in the context of sexual activity.

What Is Sexual Masochism Disorder

As much as masochism is acceptable in some consensual adult relationships, it becomes a disorder when it interferes with one’s functioning. Sexual Masochism Disorder is a diagnostic category in the DSM-5 that is assigned to people who have a strong and persistent sexual desire to be dominated, beaten, restrained, or otherwise abused, in a way that causes personal suffering or interferes with daily life. However, when the masochistic behaviors are involuntary, produce suffering, or hinder the person from enjoying a satisfactory life, this disorder is diagnosed [1].

How Does Masochism Develop

Masochism is not something that a person is born with but rather is the result of psychological and social processes, which can be supplemented by biological ones. According to some theories, masochism can be learned as a way of functioning in the world. For instance, the patient who has been traumatized might feel that such actions give them power or relieve them in a controlled setting. This may develop into a liking of conditions where they are exposed to suffering or embarrassment [1].

Another theory is the conditioning theory. If a person always links certain painful or humiliating experiences to positive outcomes, then they may start looking forward to such experiences to gain positive emotions or bodily responses. For example, a person who gets care and attention after feeling pain may begin to link the feeling of discomfort with care and affection.

There is also a psychoanalytic view that masochism may be the result of repression of guilt or desire to punish oneself. In this view, a person may inadvertently look for ways to be punished in a bid to reduce guilt or shame.

Sexual Masochism Vs Masochistic behavior

Sexual masochism on the other hand is more specific in that it involves getting sexual pleasure from pain, suffering, or humiliation. This can include spanking, whipping, tying up, or using verbal abuse on the partner. Some of these activities are consensual such as BDSM which is an acronym for Bondage, Discipline, Dominance, Submission, Sadism, and Masochism, and where consent is critical [1].

However, not all self-berating behavior is sexual, and it is, therefore, wrong to associate all such behavior with sexual perversion. 

A person may have non-sexual masochism where they may self-harm, continue staying in toxic relationships, or place themselves in positions where they know they will not succeed or will be emotionally harmed. These behaviors may not result in sexual arousal but may give a psychological or even an emotional discharge just like in sexual masochism.

Examples Of Sexual Masochistic Behavior

An individual who experiences sexual masochism may willingly get involved in practices like bondage or whipping with a consenting partner, and derive sexual pleasure from the act. On the other hand, a person with a masochistic personality may continuously engage in a dysfunctional relationship, not for sexual gratification, but due to the pleasure derived from the pain.

Here we will take a brief look at the recent facts and figures about the less-known concept of Masochism: 

About 23.7% of women and 13.9% of men have tried masochism, and 1.4% of people practice masochism daily [2].

Masochistic fantasies are present in 15-28% of the population; Women (17-27.8%) have them more often than men (15-19.2%) [2].

Approximately 32.7% of masochists are in open or polyamory relationships.

About 80% of the participants in masochism stated that they preferred to practice masochism at home and not in clubs.

About 52% of the masochists interviewed said they feel uncomfortable or scared if their BDSM preferences are out in the open.

As for interests, only 5% of respondents have ever discussed them with a family member, 25.6% with a friend, and 3.8% with a colleague [2].

Speaking of sexual orientation, 34.1% of masochists are exclusively bisexual, 30.7% as exclusively homosexual, and 4.9% as exclusively homosexual [2]. 

In general, masochists’ mental health is comparable to that of the general population, but some subtypes are more likely to experience psychological problems.

Sexual sadism is identified in less than 10% of rapists but in 37-75% of people who committed sexually related murders.

Masochistic interests have no unique root; possible causes are leisure pursuits, sex drive, mate choice, and social dominance.

Now let’s have a brief look at the mechanisms and root causes of Masochism.

Psychological Mechanisms

Masochism can be a result of several psychological processes that are not always easy to understand. There is one theory that indicates that it develops as a way of dealing with a particular type of pain that is emotional pain or trauma. Persons who have undergone emotional or physical abuse may feel that taking control of their pain in the same way as the offender did makes them feel powerful. For example, a person who was abused as a child may look for opportunities in which they can turn the pain into something they decide upon instead of a situation that was forced on them [3].

The other psychological theory is founded on the principle of conditioning. If a person always gets a positive response – love, attention, or relief – after suffering, they may start linking the two. In the long run, this creates a positive association between pain and preference and therefore one may develop a preference for situations that involve pain. For instance, if a child was only comforted by parents when he or she was injured, the child may develop into an adult who expects to be punished before being rewarded with love.

Masochism can also be associated with guilt or low self-esteem. Some people may have this thought process that they should be punished and this may be in their conscious mind or sub-conscious mind. This may be due to some deep-seated feelings of inferiority or shame. Thus, they may look for situations in which they are humiliated or hurt to satisfy an unconscious desire for punishment that relieves guilt for a while.

Social And Environmental Factors

Another cause of masochism is social and environmental factors which are also known as external factors. The people around an individual or the society in which one lives will influence the actions and even the wishes of a person. For example, a person who grew up in a home that was very disciplined and controlled may learn that it is good to be compliant and be a subordinate. This might result in the development of submissive or masochistic tendencies in the later years of the person’s life [3].

In some instances, the social conditioning to which an individual is subjected also plays a role in the development of the masochistic personality; for instance, when one is exposed to social environments that promote pain, endurance, or submission. For example, a person surrounded by a particular group of people may start thinking that masochistic behaviors are appropriate.

Biological And Neurological Factors

It is also possible to find some data that biological and neurological factors might play a role in the development of masochism. Some research has suggested that some people may be more susceptible to dopamine, the chemical in the brain that is involved in the experience of pleasure. In such cases, the reward system of the brain may be triggered more easily by experiences that are painful or humiliating, which would explain the desire of such people to engage in such activities more often.

Moreover, it has been established that the physical pain and the emotional pain are handled in the same manner in the brain. This overlap of the neural pathways might be the reason some people get comfort or pleasure from feeling physical pain.

Early Experiences

Other factors that are associated with the development of masochistic tendencies include early childhood experiences, including attachment and relationships. For example, children who have been raised by parents who did not shower them with love and affection may grow up to look for partners who will mistreat them. This could be because they have been trained to link love with pain or because they think that the only way to get love is by suffering [1].

In some cases, early conditioning to masochistic behaviors or media portraying such behaviors can also be blamed. For instance, if a child listens to stories where pain is glorified or valued, then when he or she grows up, he or she will have a tendency to engage in masochistic behaviors.

Sexual Masochism Disorder is usually characterized by the following symptoms in the affected individuals. These symptoms may vary in intensity but generally fall into certain categories:

Recurrent And Intense Sexual Arousal Disorder

Persistent Fantasies: The person often has sexual thoughts about being assaulted, degraded, or made to endure pain. These are rather persistent and involuntary fantasies [1].

Sexual Urges: The individual has marked desires to perform the masochistic behaviors. These impulses can be so strong that they take over the individual’s mind and interfere with their ability to attend to other areas of existence.

Behavioral Acting Out: The person may continue to practice activities that cause pain, humiliation, or suffering to gain sexual arousal. Such behaviors may involve engaging in reckless activities that would likely hurt them, like cutting themselves, or dating violent partners [1].

Distress Or Impairment

Emotional Distress: The individual may experience discomfort when they have masochistic feelings. They may have feelings of shame, guilt, or confusion as to why they get aroused by pain or humiliation. This distress causes anxiety, depression, or other related mental health complications.

Interference with Daily Life: The disorder can cause the person to be unable to perform his or her daily activities. For instance, they may have difficulties in interpersonal relationships, jobs, or social interactions because of their preoccupation with masochistic fantasies.

Relationship Issues: Sexual Masochism Disorder causes relationship problems. The person may have a challenge in locating partners who are okay with the fantasies or may force partners into uncomfortable positions that are likely to lead to conflict or result in harm. This can lead to a cycle of broken relationships and being alone.

Risky Or Harmful Behavior

Self-Harm: People with Sexual Masochism Disorder may also use self-harm like cutting, burning, or using any other method to harm themselves to get an erection. This behavior can be risky and result in severe physical injury [3].

Engaging in Dangerous Situations: A person can consciously put himself in conditions where he may be abused, beaten, or embarrassed, even if the conditions are dangerous or criminal. This could include meeting with strangers to have a dangerous meeting or engage in activities that may result in serious injuries.

Ignoring Consent: Sometimes a person with Sexual Masochism Disorder may try to force his/her partners into engaging in practices that they know the other partner will not like or that are unethical. This can lead to non-consensual acts which are wrong and can be unlawful depending on the circumstances.

Psychological Symptoms

Compulsion: The person may have an urge to act in a self-destructive manner, even if they know that it can harm themselves or others. This compulsion can be hard to manage and may cause a progression of actions over time [3].

Inability to Achieve Sexual Satisfaction Without Pain: The individual may discover he or she cannot have sex without experiencing pain and humiliation. This can develop a sort of reliance on these behaviors and it becomes difficult to have a healthy sexual relationship.

Additional Considerations

Duration of Symptoms: To be diagnosed with Sexual Masochism Disorder, these symptoms should be present for at least six months and cause marked distress or significant social, occupational, or other important functioning impairment.

Non-Consensual Acts: One must understand that Sexual Masochism Disorder is not the same thing as consensual BDSM. The disorder is characterized by distress, impairment, or non-consensual acts whereas consensual BDSM is consensual, safe, and non-violent.

Sexual Masochism Disorder can significantly impair daily functioning. It is crucial to seek treatment for the symptoms and improve the quality of life of patients. The treatment often includes therapy, medication, and changes in daily routines and habits.

1. Psychotherapy

Talk therapy or psychotherapy is usually the first treatment that is offered to patients with Sexual Masochism Disorder. Psychotherapy is useful in treating anxiety disorders and various types of psychotherapy can be used depending on the type of disorder present and the severity of the disorder.

Cognitive-Behavioral Therapy (CBT): CBT is one of the most used therapies for SMD. It assists people in modifying the negative patterns of thinking and behaving that are linked with masochistic wishes. For instance, CBT can assist a person in identifying the causes of their desires and learning better ways of dealing with the issues [4]. Methods such as cognitive restructuring, in which negative thoughts are replaced with rational ones, and behavior modification which involves the changing of undesirable behavior patterns are employed.

Psychoanalytic Therapy: This type of therapy focuses on the client’s unconscious and the reasons for certain behaviors in the present, such as abuse or upbringing. When these profound problems are identified, people can help themselves and decrease their dependence on self-harming for emotional or sexual release.

Group Therapy: Group therapy enables the client to engage with other people who have similar issues. Thus, sharing in a supportive setting can help decrease the sense of shame or isolation and get information on how to handle the disorder. Group therapy also allows for the sharing of ideas and ways of dealing with issues that people have come across.

2. Medical Treatments

In certain circumstances, pharmacological interventions may be required for the treatment of Sexual Masochism Disorder if psychotherapy does not suffice.

Medication: Selective serotonin reuptake inhibitors (SSRIs) are commonly used to manage the symptoms associated with the disorder. These medications can be useful for decreasing the strength of sexual impulses and the related discomfort. SSRIs are prescribed because they reduce sexual desire and this may be useful for patients with pathological sexual obsessions [4].

Hormonal Treatments: In more severe cases, hormonal treatments may be used to decrease the patient’s sex drive. Drugs that reduce testosterone levels reduce the strength of sexual desire and help people control their actions. However such treatments have severe side effects and are used when other treatments do not work or are contraindicated.

3. Lifestyle Changes

Besides therapy and medications, the patient’s lifestyle can be a significant determinant in the management of Sexual Masochism Disorder.

Developing Healthy Relationships: It is also crucial to establish and sustain relationships that are not only consensual but also healthy. People should look for a relationship in which there is honesty and both parties understand each other’s limits. This assists in lessening the desire of the offender to repeat the act that is non-consensual or harmful in some way.

Stress Management: Stress can also worsen the condition of a patient diagnosed with Sexual Masochism Disorder. Some of the methods include taking a break and practicing mindfulness, meditation, and exercise to minimize stress. Knowing how to handle stress is a very helpful thing, as it helps to avoid succumbing to bad habits.

Avoiding Triggers: It is recommended not to expose oneself to situations or stimuli that may cause the desire to be a masochist. This might include avoiding specific media, settings, or people that trigger such behaviors.

Building a Support System: Friends, family, or support groups can also motivate people to adhere to the prescribed treatment plan and not deviate. Support systems can also provide accountability that helps in avoiding such behaviors as well.

Engaging in Positive Activities: Engaging in hobbies, interests, and activities that are enjoyable and meaningful can also help redirect the focus from masochistic behaviors. Positive activities can help build up self-esteem, and offer other sources of satisfaction.

4. Monitoring and Ongoing Care

Sexual Masochism Disorder may be a chronic condition that needs to be managed for a long time with a risk of relapse. It is also important to have follow-up visits with the therapist or the doctor to confirm that the treatment is effective. It may be required to modify the therapy or medication from time to time to cope with any new issues or changes in the symptoms.

FAQs

Is Sexual Masochism Disorder The Same As BDSM?
No, Sexual Masochism Disorder is not the same as BDSM. BDSM (Bondage Discipline Dominance Submission Sadism and Masochism) refers to a variety of sexual activities and interpersonal roles that involve the use of power in a consensual manner between adults. 
Sexual Masochism Disorder, on the other hand, is a mental disorder in which a person’s suffering is sexually arousing and causes distress or impairment. 
In BDSM, practices are agreed upon and are generally not associated with marked discomfort or dysfunction in various spheres of life, while in SMD, these features are the main criteria for diagnosis.
Is It Possible To Treat Sexual Masochism Disorder Without Using Drugs?
Indeed, it is possible to treat Sexual Masochism Disorder without using drugs depending on the severity of the condition. Psychotherapy is the main treatment and CBT is the most common. Psychotherapy can assist a person in learning how to control their desires, find better ways to deal with the stressors in their lives and treat any psychological disorders that may be present. However, in severe cases, medication may be required to manage extreme preoccupations and associated discomfort.
How Is Sexual Masochism Disorder Diagnosed?
Sexual Masochism Disorder is a clinical diagnosis made by a mental health worker using the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). The diagnosis is usually made when a person obtains sexual pleasure from being abused or dominated and when these urges bring about considerable discomfort or limit the person’s capacity to work. 
The symptoms must be present for at least six months and the person must report that they are unable to resist the impulse. The clinical interview and possibly psychological testing are typically involved in the diagnostic process.

The Article

+

References

+

About This Article

+

Do you need help?

Sister Topics

Anxiety And Erectile Dysfunction Autism And Sex Depression And Erectile Dysfunction Exhibitionism Heavy Threads: Remnants of Sexual Abuse Hypersexual Disorder Hypersexuality And Trauma Love Avoidance Love Bombing Low Sex Drive Obsessive Love Disorder Orgasm And Depression Pedophilia Pornography And Depression Premature Ejaculation Sex, Love & Porn Addiction Sexual Frustration Symptoms Sexual Performance Anxiety Sexual Trauma Stress And Erectile Dysfunction What is Obsessive Love Disorder