BDSM and Mental Health: The Myths and the Science

By Patrick Holmberg

Introduction

As virtually universal as sexuality and knowledge of it is among almost all adults in the world, there are a number misconceptions people have regarding sexuality. This is particularly true of sex which deviates from the mainstream conceptualization of sexuality. Too often this leads to the ostracization or pathologization of various sexual fetishes or alternative sexualities. For example an entire section of the Diagnostic and Statistical Manual of Mental Disorders 5 is written on sexualities perceived to be deviant, called paraphilias in the DSM 5. (APA, 2013) This implies that enjoying certain forms of sex which differ from the perceived norm is in some way an illness. Practitioners of BDSM, sex which involves bondage play, dominance and submission play, and sadomasochism, are particularly misunderstood to be in poor mental health or deviant from the general community.

The term S&M, short for Sadism and Masochism is also often used interchangeably with the phrase BDSM, although the former does not incorporate all of the aspects of the latter (Cutler, 2003).  Specifically the term S&M only refers to the consensual exchange of power. This term is a reference to the Marquis de Sade and is often attributed to Richard von Krafft-Ebing, although Krafft-Ebing likely hear the term through media during his time (Cutler, 2003; Encyclopedia Britannica, 2016). Another term often used to refer to and describe BDSM sexual activities is “kinky.” (Cutler, 2003)

However, when reviewing the literature on BDSM practitioners and people who engage in alternative sexualities it becomes clear that there is little empirical evidence to support the notion that such people are mentally ill in any way. (Connolly, 2006; De Visser, Grulich, Richters, Rissel, & Smith, 2008; Van Assen & Wismeijer, 2013)

The Definition of BDSM

            In order to discuss BDSM, it is first necessary to define what this term means. BDSM is an acronym for Bondage, Dominance/Submission, and Sadomasochism. It is a family of sexual activities which can involve, but is not limited to, spanking, bondage and rope play, role plays involving the exchange of power. (Bezreh, Edgar, & Weinberg., 2012) This exchange could involve taking power, giving up power, or competing for it. Another form of sexual practices which fall in the BDSM family is the use of sensations, such as sensory deprivation or play involving pain, to produce sexual arousal or stimulation.

In this article a sexual preference for engaging in BDSM activities is referred to as a sexual identity. This is because the literature suggests that rather than being a casual interest, BDSM sexual preferences make up a part of the core self of the practitioners. (Bezreh, Edgar, & Weinberg., 2012)

Societal Conceptualizations of BDSM Practices and Practitioners.

          The public perception of BDSM and BDSM practitioners is not a positive one. Currently the common perception of BDSM practitioners is that they are a damaged people. (Bezreh, Edgar, & Weinberg., 2012) It was long assumed that BDSM practitioners had been the victims of past traumatic experiences or failures in development, and that these experiences is what resulted in their sexual identity (Connolly, 2006). This is linked to another common public misconception of BDSM practitioners as being mentally ill. (Bezreh, Edgar, & Weinberg., 2012; Connolly, 2006) There is a long history of psychologists attempting to explain BDSM sexaual activity through the lens of mental illness including Sigmund Freud who argued that masochists were often people who were abused during childhood and were now attempting to gain mastery of this trauma by replicating it in a controlled environment (Connolly, 2006). This misrepresentation of BDSM practitioners is pervasive enough in our culture that the American Psychological Association has labeled it as a mental disorder (APA, 2013). Although it should be noted that according to the DSM 5 criteria a BDSM practitioner can only be diagnosed with a paraphilic disorder if it causes the client or patient distress, or if it causes the client or patient to engage in sexual conduct without a parter(s) consent.

This perception of does have a tangible effect on the stress a practitioner of BDSM encounters. One qualitative study revealed that all of 20 participants were aware of stigma related to their sexual identity as a BDSM practitioner. (Bezreh, Edgar, & Weinberg., 2012) These participants also revealed that many were subject to stigma from sexual partners. Some stated that their partners were appalled by the idea, with at least one participant’s partner claiming that kink play was “oppositional to a loving relationship.” Many of these participants reported that the public stigmatic perception of BDSM practitioners and the potential or actualized stigma faced from partners lead to anxiety being felt towards the disclosure of their sexual identities to partners or other significant persons. In short, stigma lead to an increased difficulty in being open about the participant’s sexual identity as a BDSM practitioner.

Another public perception of BDSM practitioners is that they are violent individuals engaging in abusive sexual practices. (Wright, 2006) This particularly damaging public perception of BDSM practitioners has lead to overt discrimination against the BDSM community. One literature review notes that data from several studies by The National Coalition of Sexual Freedom which suggests that many BDSM practitioners face discrimination at their place of employment as well as overt harassment and violence. (Wright, 2006)

It is worth noting the observations of Margot D Weiss (2006) who noted that in the past twenty years BDSM depictions in popular culture have become more prevalent. What was once nearly nonexistent in the public consciousness is now talked openly about in television advertisements, television programs and film, print and other forms of media. As a result the shock value which used to be associated with BDSM sexual practices has been diminished to an extent. However, this is not synonymous with the diminishing of negative public perceptions of BDSM practitioners nor the discrimination these people often face. Weiss (2006) notes that the increase in presentations of BDSM in public media do not improve the acceptance of BDSM practitioners by the sexual-normative community since these depictions often are presented in ways which reinforce the divisions between the two communities, rather than challenging the privilege of sexual normal individuals. Indeed, it is possible that this depiction of BDSM practitioners, and individuals with other alternative sexual identities, as alien and other is likely the source of such stigma.

Mental Health Outcomes of BDSM Practitioners

            Despite societal notions of BDSM practitioners as mentally ill or damaged, there is a robust literature on the mental health of such people seems to discredit this. (Connolly, 2006; De Visser, Grulich, Richters, Rissel, & Smith, 2008; Van Assen & Wismeijer, 2013)

The most recent research on the mental health of BDSM practitioners suggests that not only are BDSM practitioners not more likely that the general population to be less psychologically healthy, they are more likely to have better overall psychological health than the general population (Wismeijer & Van Assen, 2013). For this research participants from the Netherlands were administered several psychometric instruments, including the NEO Five-Factor Inventory, the Attachment Styles Questionnaire, the Rejection Sensitivity Questionnaire and the World Health Organization-Five Well Being Index. The researchers compared BDSM practitioners to non BDSM practitioners, and also compared mental health outcomes for Dominant, Submissive and Switch BDSM practitioners. What the researchers had found was that in general BDSM practitioners were in better mental health than non BDSM Practitioners. BDSM practitioners scored better on measures of subjective well being, rejection sensitivity, extraversion, openness to experience and conscientiousness. Furthermore BDSM practitioners were found to be less neurotic. BDSM practitioners did score lower than non BDSM practitioners on measures of Agreeableness. The results seem to suggest that BDSM practitioners generally score better on measures of mental health than non BDSM practitioners, with practitioners who assume dominant roles scoring better than practitioners who assume switch or submissive roles.

As previously mentioned there is a public perception of BDSM practitioners as being mentally ill, however a research study by Susan Connolly (2006) empirically tested this hypothesis. One hundred and thirty two BDSM practitioners to complete a battery of psychometric instruments designed to assess mental health. Demographic information was collected as well. The psychometric instruments the participants were assessed on included the MMPI-2, the Trauma Symptom Inventory, the Post Traumatic Stress Disorder Scale, the Multi Scale Dissociation Inventory, and the Beck Depression and Anxiety Inventories. What Connolly (2006) had found was that for measures of depression, anxiety, obsessive compulsion, or PTSD and related symptoms the vast majority of participants fell below clinically significant scores. Overall the sample was not abnormally high in these measures, though the results did vary depending on the psychometric instrument being used. Interestingly, the results showed mixed findings for measures of psychological sadism and relatively low scores on psychological masochism. The only scores shown to be relatively high compared to population means were scores on narcissism, borderline pathology and paranoia. However, even for these three personality features, the vast majority of participant’s scores did not reach clinical significance.

In a more expansive study in Australia, researchers contacted people over the telephone using computer assisted random digit dialing to interview participants about their sexual behaviors and collect demographic information about them. (De Visser et al., 2008) What the researchers had found was that of the participants who had engaged in BDSM sexual activity in the past year male practitioners were less likely to suffer psychological distress than non BDSM practitioners, and female practitioners did not differ from the general population. Furthermore, BDSM practitioners were found to be more likely to have been coerced into sex at some point in their past. This finding is significant because it counters the notion that BDSM practitioners have been damaged by a traumatic past sexual experience. The only outstanding finding in this study in regards to BDSM practitioners is that they were more likely to have a more diverse sex life in terms of the activities they had engaged in during the past year.

Discussion

            Contrary to the popular notions of BDSM practitioners presented in popular media the research seems to indicate that BDSM practitioners are no more likely than the general population to have any forms of psychological distress. (Connolly, 2006; De Visser, Grulich, Richters, Rissel, & Smith, 2008; Van Assen & Wismeijer, 2013) These studies are mostly homogenous in their findings and largely corroborated the conclusions of the researchers. This is significant for two reasons. One, it reduces the chances that the findings of any one study being due to selection bias, researcher bias, or random chance. Two, because these studies had been done in different times and locations, with one study being done in the Netherlands, and another in Australia it reduces the chances that there was a selection bias where the specific sample being studied was psychologically healthier than the general population of BDSM practitioners. However, this is not the basis of a cross cultural statement on the mental health of BDSM practitioners since all of these countries are Western, Euro/American Cultures and thus have many similarities.

Although the literature makes it clear the BDSM sexual activity itself is not linked to any increased risk in psychological distress there are some areas of concern for the well being of BDSM practitioners. First and foremost interviews from BDSM practitioners makes it clear that there is a dearth of sexual education available for people interested in engaging in such activity. (Bezreh, Edgar, & Weinberg., 2012) This is problematic because even though BDSM activity in and of itself may not lead to psychological distress, unintended harm could arise from such practices due to a lack of education on the subject. This could come in the form of physical harm, psychological distress, or both. It is evident that sexual education which is inclusive of BDSM practices, as well as other alternative sexual practices, would be beneficial for people.

Another area of concern arising from interviews of BDSM practitioners is that the social stigma attached to their sexual identity could result in psychological distress. (Bezreh, Edgar, & Weinberg., 2012) One finding from Connolly’s (2006) study which was particularly interesting was that BDSM practitioners were found to have higher levels of paranoia than the population mean. This can be partially explained by the social stigma faced by BDSM practitioners by the general public. As shown in previous literature there is a history of harassment and in some cases violence against BDSM practitioners, and being open, or potentially becoming open, about this aspect of one’s sexual identity can illicit high levels of anxiety. (Bezreh, Edgar, & Weinberg., 2012; Wright, 2006) This may have contributed to the scores the participants had on measures of paranoia in this study. This can be built upon by empirically testing if having an alternative sexual identity as well as anxiety related to being open about this identity is correlated with anxiety or other psychological problems.

Conclusion                                          

The major conclusion of the research of BDSM practitioners is that they are no more likely than the general population to have a mental illness, to suffer psychological distress, or to have suffered a sexual trauma in the past. The negative perception of BDSM practitioners in the popular media is likely a myth created due to a lack of understanding for people with this sexual identity.

References

Bezreh, T., Edgar, T., Weinberg, T. (2012) BDSM disclosure and stigma management: Identifying opportunities for sex education. American Journal of Sexuality Education, 7(1)

Connolly, P. (2006) Psychological functioning of bondage/domination/sado-masochism (bdsm) practitioners. Journal of Psychology & Human Sexuality, 18(1)

De Visser, R., Grulich, A., Richters, J., Rissel, C., Smith, A. (2008) Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (bdsm): Data from a national survey. The Journal of Sexual Medicine, 5(7)

Weiss, M. (2006) Mainstreaming kink: The politics of bdsm representation in U.S popular media. Journal of Homosexuality, 50(2/3)

Wismeijer, A., Van Assen, M. (2013) Psychological characteristics of bdsm practitioners. The Journal of Sexual Medicine, 10(8)

Wright, S. (2006) Discrimination of sm-identified individuals. Journal of Homosexuality, 50(2/3)

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