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What Is Sexually "Normal?" Rethinking Pain and Pleasure

Exploring sexual health and controversies.

Lord Byron once said, “The great art of life is sensation, to feel that we exist, even in pain.”

When I digest this quote, my mind is an ocean of ideas. Shall we discuss the tyrannical reign of positivity? Whether the willingness to express negative emotions is helpful in romantic relationships? How an inability to tolerate pain is a risk factor for psychological problems?

Perhaps we can combine all three. A deep, beautiful, elegant idea in psychology is that a preference for pleasure over pain influences much of what humans do. This is why kids forego apple slices for a side of french fries when ordering a McDonalds happymeal. This is why books on the science of happiness and love outsell those on complaining, teasing, and other annoying behaviors. When an idea is this widely touted, I tend to be skeptical because human beings are complex creatures and there is great heterogeneity in what motivates people to take action.

A large minority of people are willing to subject themselves to pain because this is what brings them the greatest pleasure. I am talking about the sexual practices of bondage and discipline, as well as sadism and masochism (in brief, BDSM). These are people whose pleasure and pain circuitry is intertwined. As of 2014, according to the current system for defining psychological disorders—the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—you meet criteria for a diagnosis of sexual masochism disorder or sexual sadism disorder if you

Feel personal distress about your interest, not merely distress resulting from society’s disapproval;


Have a sexual desire or behavior that involves another person’s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.

Here’s a question for the overlords of psychiatry: How do you parse out the distress of being viewed as deviant by society from the internal generation of distress? After all, part of our identity is the internalization of cultural standards of acceptable behavior. As with all psychiatric diagnoses, we must grapple with the notion of whether a person experiences clinically significant distress and/or impairment. But defining distress/impairment is tricky in the context of sex (with consenting adults); sex is usually regarded as an indicator of healthy psychological functioning that contributes to relationship satisfaction and well-being.

What if you feel guilty about engaging in such behaviors after the fact? What if you wish you could speak openly to your friends and loved ones about your sexual experiences/desires but feel as though you can’t? What if someone bruises your ass so badly that it restricts your physical activity for the next week? What if you incur bodily harm that necessitates medical attention? What if you engage in sexual acts that are not sexually gratifying because your dominant partner “orders” you to do so? Would these experiences qualify as distress and/or impairment? It’s hard to say.

These are not trivial issues. As pointed out by Dr. Susan Wright (2010) in Archives of Sexual Behavior:

Legal complications and interpersonal difficulties are common consequences of the stigma and discrimination against BDSM practices. In the Second National Survey of Violence & Discrimination Against Sexual Minorities, a total of 1,146 (37.5%) of the participants indicated that they had either been discriminated against or had experienced some form of harassment or violence (Wright, 2008). As a result, 60% of the 3,000 respondents are not ‘‘out’’ about their BDSM interests; the stress of being closeted and/or coming out promotes distress and impairment in these individuals, similar to that experienced by homosexuals. In addition, once a Paraphilic Disorder is diagnosed, can it ever be in remission? If so, what are the mechanisms for determining that? If the distress and impairment are resolved, does the individual go back to the ascertainment category? As of now, once a mental disorder is diagnosed, it appears to apply for the lifetime of the individual.

A similar statement was made by Drs. Charles Moser and Peggy Kleinplatz (2005) in the Journal of Psychology and Human Sexuality:

It is not their sexual interests, but the manner in which they are manifest that can be problematic at times and is a more appropriate focus for therapy. The confusion of variant sexual interests with psychopathology has led to discrimination against all ‘‘paraphiliacs.’’ Individuals have lost jobs, custody of their children, security clearances, become victims of assault, etc., at least partially due to the association of their sexual behavior with psychopathology.

Roy Baumeister put forth a theory suggesting that masochism is essentially a strategy to escape from the self, or at least a high level of self-awareness. More specifically, “awareness of the self as a symbolic, schematic, choosing entity is removed and replaced with a low-level of self as a physical body and locus of immediate sensations, or with a new identity with transformed symbolic meaning” (Baumeister, 1988). In this way, masochism is not unlike intense physical exercise (think crossfit, extreme sports), intoxication, or meditation, all of which facilitate a partial loss of self-awareness. Nonetheless, unlike these activities, masochism is linked to physical pain and sexual pleasure. People often seek to escape the “burden of selfhood” - the stress, anxiety, and personal responsibility surrounding difficult, everyday decisions, the attempts to project and maintain a positive self-image to others, and the navigation of often demanding social situations. Could it be that those suffering from psychopathology experience higher levels of stress due to this “burden of selfhood”, or at the very least are more motivated to seek an escape from the self, especially unwanted thoughts and feelings?

Freud described masochism/BDSM as the “most significant of all perversions” (Freud, 1920). He believed that masochism and sadism were both present in those who practiced BDSM and that all of these individuals derived great pleasure from giving and receiving pain. Other researchers followed suit, linking masochism to cannibalism, vampirism, mass murder, necrophilia, epilepsy, and other seriously disturbing behaviors (Stekel, 1953). Perpetuating these unusual connections, others have held that women trauma survivors who engage in BDSM practices are actively maintaining a “life trauma syndrome” in which engaging in these power dynamics arouses a persecutory alter ego (Putnam, 1989).

Despite the presence of a small number of studies on the psychological well-being of those who engage in BDSM, there is evidence that these individuals are more psychologically normal than abnormal. In a large study of 902 people engaging in BDSM and 434 “normal” adults, Wismeijer and his colleagues (2013) found that, compared to controls, BDSM practitioners rated themselves as less neurotic and sensitive to rejection and more extraverted, open to new experiences, and conscientious (but less agreeable). This was especially true for self-described dominants, who were more psychologically healthy than submissive counterparts (but even self-described submissives’ psychological adjustment slightly exceeded the general population). This study is one of many revealing that people who engage in BDSM aren’t necessarily suffering from psychopathology and that, while pain is a primary aim of many of these encounters, injury/insult is not.

From the vantage point of recent research, people who practice BDSM are highly stigmatized by therapists as well as mainstream society. For the majority, it appears as though BDSM serves as a personalized sexual pastime as opposed to a manifestation of psychopathology, and their life problems are likely to be as common as the average single man who has sex 1.7 times per month in a missionary position, is rather quiet and awkward, and lasts for 178 seconds before gasping for air.

**** This blog post was co-authored with my graduate student at George Mason University, Jenny Poon - a great, young, critical thinker with diverse research interests that have nothing to do with sexuality ****

Baumeister, R. F. (1988). Masochism as escape from self. Journal of Sex Research, 25(1), 28-59.

Freud, S. (1920). A child is being beaten: A contribution to the study of the origin of sexual perversions. International Journal of Psychoanalysis, 1, 371-395.

Moser, C., & Kleinplatz, P. J. (2006). DSM-IV-TR and the paraphilias: An argument for removal. Journal of Psychology & Human Sexuality, 17(3-4), 91-109.

Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. Guilford: New York.

Stekel, W. (1953). Sadism and masochism. Vision Press.

Wismeijer, A. A., & Assen, M. A. (2013). Psychological characteristics of BDSM practitioners. The Journal of Sexual Medicine, 10(8), 1943-1952.

Wright, S. (2010). Depathologizing consensual sexual sadism, sexual masochism, transvestic fetishism, and fetishism. Archives of Sexual Behavior, 39(6), 1229-1230.

NOTE: This post has several things in common with my new book, available now

Dr. Todd B. Kashdan is a public speaker, psychologist, and professor of psychology and senior scientist at the Center for the Advancement of Well-Being at George Mason University. His new book, The upside of your dark side: Why being your whole self - not just your “good” self - drives success and fulfillment can be pre-ordered. If you're interested in speaking engagements or workshops, go to:

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