Sexual Masochism Disorder

Sexual masochism disorder is a condition in which someone is sexually aroused by being bound, beaten, or otherwise made to suffer physical pain or humiliation. This desire can cause a significant amount of distress.

The disorder falls under the psychiatric sexual disorders category of paraphilias, which involve recurrent, intense, sexually arousing fantasies, urges, or behaviors that are distressing or disabling and have the potential to cause harm to oneself or others. Sexual masochism refers to engaging in or frequently fantasizing about being beaten, bound, humiliated, or otherwise made to suffer, resulting in sexual satisfaction. If people with this sexual preference also report psychological or social problems as a result, they may be diagnosed with sexual masochism disorder.

The type of distress that people with this disorder may experience includes severe anxiety, guilt, shame, and obsessive thoughts about engaging in sexual masochism. If a person has a masochistic sexual interest but experiences no distress and is able to meet other personal goals, then they would not be diagnosed as having a disorder.

One specific type of sexual masochism is called asphyxiophilia, whereby a person receives sexual satisfaction by having their breathing restricted. While some people engage in this practice with partners, others prefer to restrict their breathing while they are alone, and accidental death may happen as a result.

Sexually masochistic behavior is usually evident by early adulthood, and sometimes begins with masochistic or sadistic play during childhood.


To be diagnosed with sexual masochism disorder, a person must experience recurrent and intense sexual arousal from being beaten, humiliated, bound, or experience some other form of suffering. These types of urges, fantasies, or behaviors must be present for at least six months and cause clinically significant troubles or difficulty in social, occupational, or other important areas in life.


There is no universally accepted theory explaining the root of sexual masochism. However, some theories attempt to explain the presence of sexual paraphilias in general. One theory suggests that paraphilias originate because when inappropriate sexual fantasies are forbidden, they may become stronger as they are suppressed. When they are finally acted upon, a person is in a state of considerable distress and/or arousal. In the case of sexual masochism, masochistic behavior becomes associated with and inextricably linked to sexual behavior.

Another theory suggests that sadomasochistic behavior is a form of escape. Through acting out fantasies, these individuals feel new and different. Theories stemming from the psychoanalytic camp suggest that childhood trauma such as sexual abuse, or other significant childhood experiences, can manifest in a paraphilic disorder.


Treatment for sexual masochistic disorder typically involves psychotherapy and medication.

The goal of psychotherapy may be to uncover and work through the underlying cause of the behavior that is causing distress. Cognitive therapies include restructuring cognitive distortions and empathy training. Restructuring cognitive distortions involves correcting any beliefs a patient has that may lead them to act on harmful thoughts. Empathy training involves helping an offender take on the perspective of a victim to identify with them and understand the harm that has been done. Cognitive-behavioral therapy can also help an individual learn skills to manage their sexual urges in healthier ways.

Common psychotherapy strategies include aversion therapy and different types of imagery/desensitization techniques in which individuals imagine themselves in a situation where they are participating in sexual masochism, and then experience a negative event to reduce future desire to participate in that activity again.

Various medications can be used to decrease the level of circulating testosterone in the body with the aim of reducing the frequency of erections. Antidepressant medications may also be used to reduce sex drive.


  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • Current Diagnosis & Treatment in Psychiatry
  • DSM-IV™ Made Easy: The Clinician's Guide to Diagnosis
  • Treating Mental Disorders: A Guide to What Works

Last reviewed 02/22/2019