Sexual Masochism

Sexual masochism is a disorder in which one is sexually aroused by being bound, beaten, or otherwise made to suffer physical pain or humiliation.


Sexual masochism falls under the psychiatric sexual disorders category of paraphilias, meaning "abnormal or unnatural attraction." Sexual masochism refers to engaging in or frequently fantasizing about being beaten, bound, or otherwise made to suffer, resulting in sexual satisfaction. Blindfolding, spanking and humiliation in the form of defecation, urination, or forced imitation of animals are other methods used by these patients. Masochists may inflict their own pain through shocking, pricking or choking. Approximately 30 percent also participate in sadistic behavior.

One particularly dangerous method is called hypoxyphilia (near-asphyxiation) caused by reducing oxygen level in the brain. This results in the accidental death of one or two per million people per year. To achieve near-asphyxiation, masochists might place a noose around their necks, chest compression, put airtight bags over their heads or use amyl nitrates ("poppers").

Sadomasochistic relationships tend to be well planned, with partners deciding on a special word the masochist will use to indicate that the sadist should stop.


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

The fantasies, sexual urges, or behaviors 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, or sadomasochism. However, some theories attempt to explain the presence of sexual paraphilias in general. One theory suggests that paraphilias originate because inappropriate sexual fantasies are suppressed, and they become stronger as they are forbidden. 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. There is also a belief that masochistic individuals actually want to be in the dominating role, which causes them to become conflicted and thus submissive to others.

Another theory suggests that sadomasochistic behavior is a form of escape. Through acting out fantasies, these people feel new and different. Some theories stem from the psychoanalytic camp. They suggest that childhood trauma (for example, sexual abuse) or significant childhood experiences can manifest as exhibitionistic behavior.

Nathan, Gorman, and Salkind provide the following survey of theories on the topic: Behavioral learning models suggest that a child who is the victim or observer of inappropriate sexual behaviors learns to imitate and is reinforced for these behaviors. These individuals may be deprived of normal social sexual contacts and thus seek gratification through less acceptable means. Physiological models focus on the relationship between hormones, behavior, and the central nervous system with a particular focus on the role of aggression and male sexual hormones.


Treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior.

Nathan, Gorman, and Salkind provide the following explanations regarding medication as treatment: Level of sex drive is not consistently related to the behavior of paraphiliacs, and high levels of circulating testosterone do not predispose a male to paraphilias. That said, hormones such as medroxyprogesterone acetate (Depo-Provera) and cyproterone acetate decrease the level of circulating testosterone, reducing frequency of erections, sexual fantasies, and initiations of sexual behaviors including masturbation and intercourse. Hormones are typically used in tandem with behavioral and cognitive treatments. Antidepressants such as fluoxetine (Prozac) have also successfully decreased the sex drive yet they do not effectively target sexual fantasies.

Research suggests that cognitive-behavioral models are effective in treating paraphiliacs: Aversive conditioning uses negative stimuli to reduce or eliminate a behavior. Covert sensitization entails the patient relaxing, visualizing scenes of deviant behavior and then immediately experiencing a negative event such as getting his penis stuck in the zipper of his pants. Assisted aversive conditioning is similar to covert sensitization except the negative event is most likely in the form of a foul odor pumped in the air by the therapist. The goal of aversive behavioral reversal (commonly known as "shame therapy") is to shame the offender into stopping the deviant behavior. For example, the offender might be made to watch videotapes of their crime with the goal that the experience will seem offensive to them. Vicarious sensitization entails showing videotapes of deviant behaviors and their consequences such as victims describing desired revenge or perhaps even watching surgical castrations.

Nathan also describes positive conditioning approaches centering on social skills training and alternate behaviors the patient might adapt. Reconditioning techniques center around providing the patient with immediate feedback so behavior will change quickly. A person might be connected to a biofeedback machine that is hooked up to a light and taught to keep the light within a specific range of color while the person is exposed to sexually stimulating material. Or masturbation training might focus on separating pleasure in masturbation with the deviant behavior.

Cognitive therapies include restructuring cognitive distortions and empathy training. Restructuring cognitive distortions involves correcting any beliefs a patient has which may lead to errors in behavior, such as seeing a victim and constructing erroneous logic that the victim deserves to be party to the deviant act. Empathy training involves helping the offender take on the perspective of the victim and in identifying with them, understand the harm that has been done.

Prognosis is good although often there are other issues that may surface once the behaviors are extinguished. If this is the case, these issues must be worked through as well.


  • Diagnostic and statistical manual of mental disorders
  • Introductory Textbook of Psychiatry
  • Current Psychiatric Diagnosis & Treatment
  • Philadelphia
  • 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 02/17/2015