Sexual Masochism Disorder

Sexual masochism is a disorder in which an individual becomes sexually aroused from fantasies, desires, or behaviors related to being degraded, humiliated, or engaging in sexual acts that result in pain. 

Overview

Sexual Masochism Disorder is a category of paraphilic disorders. A paraphilia is a strong sexual interest in abnormal sexual activities that cause stress, functional disturbances, and harm to oneself or others.  Anyone who has masochistic interests fantasizes or becomes involved in sexual activity which induces humiliation, being degraded, tied up, beaten, or made to suffer. Sexual play including the experience of being hurt or having pain inflicted on oneself does not automatically categorize the individual and having a Sexual Masochism Disorder, but it is important to assess if the required safety measures are taken or not.

Sexual masochism belongs to the category of the common term BDSM (Bondage, Dominance, Discipline, Sadism, Submission & Masochism), which comprises a partner who has all of the power and control take charge of the other partner who is completely submissive and enjoys being hurt, tied up, humiliated, or degraded. BDSM urges are their normal manifestation of sexual arousal.

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Asphyxiophilia:

While assessing sexually masochistic interests, one of the concerns should be if the individual becomes sexually excited by practicing asphyxiophilia. This is the act of restricting someone’s breathing through choking, suffocating, or other measures. It is an extremely high-risk behavior that can cause serious injury or death without the intention of causing that level of harm to the person. Protection of the individual’s trachea is critical if this type of sexual play is practiced and direct pressure should never be placed to the front of the throat because it can cause damage to the windpipe and death. 

Symptoms of Sexual Masochism Disorder:

The criteria for Sexual Masochism Disorder is that a person must have repeated and strong sexual arousal by getting beaten, shamed, being bound, or from some other type of suffering. These types of impulses, fantasies, or behaviors must be experienced for at least six months and cause clinically significant distress or difficulty in one’s social, work-related, or other important areas of life. The widespread usage of pornography, including the act of being humiliated, beaten, bound, or in any other way being made to suffer is sometimes a linked feature of the disorder.

Causes & Triggers of Sexual Masochism Disorder:

The extensive use of pornography is considered to be a contributing factor, but there is actually no certain evidence about what causes or triggers Sexual Masochism Disorder. 

Sexual masochism disorder usually starts during young adulthood, with the average age of onset at 19. Nonetheless, it is not uncommon for diagnosed individuals to experience sexually masochistic fantasies during childhood or post-puberty. As a person gets older, there may be a drop in masochistic interests as with other paraphilic disorders.

There is no greater prevalence of the disorder among individuals who experienced childhood sexual abuse. Studies have also shown that more men compared to women are aroused by masochistic fantasies.

How Is Sexual Masochism Disorder Diagnosed?

Sexual Masochism Disorder is usually diagnosed through self-report of disturbing masochistic fantasies, urges, or behaviors. Diagnosis is based on specific criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

  • The individual has been recurrently and extremely aroused by being disgraced, beaten, bound, or being abused in any other way, arousal is expressed as intense urges, fantasies, or behaviors.
  • Their fantasies, intense urges, or behaviors cause noteworthy stress or disturb their functioning at work, in social situations, or in other important areas.
  • The condition has been present for at least 6 months.

Treatment of Sexual Masochism Disorder:

Psychotherapy is the treatment of choice for those who find their masochistic preferences are causing distress, guilt, shame, or issues within interpersonal relationships. It is recommended that the individual seek counseling with a therapist who specializes in sexual paraphilias. This will provide the individual with a well-informed and non-judgmental environment to explore the root causes, triggers, and thoughts associated with this type of sexual paraphilia. 

Medication:  

Although there is no medication therapy for this disorder, many times the disorder coincides with other psychological problems, for example, depression. In these cases, medication might be helpful. 

Antidepressants:

Selective Serotonin Reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) can help with mood disorders occurring with the ongoing disorder, such as anxiety or depression, while concurrently dropping the sex drive. A decreased sex drive can help with the impulsivity related to masochistic behaviors and thoughts, but it will not directly help masochistic urges.

Antiandrogens:

Cyproterone acetate and Medroxyprogesterone acetate are members of a class of medication that decreases testosterone levels, which in turn, decreases sex drive and allows for more efficient therapy. These drugs help to reduce the levels of circulating testosterone in the blood and may lower compulsive behavior or sexual impulsivity.