BDSM: What Is Healthy and What Is Pathological?

BDSM refers to sexual practices that incorporate bondage, domination, and sadomasochism. Many people have fantasies that involve some degree of BDSM or have engaged in some form of BDSM practice.

But BDSM exists on a continuum. Fantasies are different from practices, and practices do not necessarily constitute a lifestyle. Often those who experiment, participate occasionally, or incorporate BDSM into their relational lifestyle as well as those who engage in serial encounters are all lumped together under one umbrella, which can be confusing, particularly to individuals wondering about where they fit in.

BDSM is generally portrayed in many mainstream publications as "normal" and those who engage in practices and/or lifestyle are considered healthy individuals. BDSM proponents regularly cite one study as evidence of this claim (Wismeijer, 2013). The study, conducted in the Netherlands, revealed that “BDSM practitioners were less neurotic, more extraverted, more open to new experiences, more conscientious, less rejection sensitive, had higher subjective well‐being, yet were less agreeable (particularly among those who assumed the ‘dominant (‘dom’) role.” The study utilized the "big five" personality traits (neuroticism, extraversion, openness to experience, conscientiousness, and agreeableness) and other self-reported measures regarding sensitivity to rejection, attachment in relationships, and happiness as the basis for the inferences made about the results.

Although the research by Wismeijer is routinely cited, very little is written about the limitations of the Dutch study (McGreal 2013). The researchers clearly discuss the limitations of their own study and potentially biased outcome. They state that participants were recruited from one Dutch BDSM forum website. The control group of participants was mostly women recruited through a popular women’s magazine. The researchers state, “The psychological health of these 434—mainly female—adults cannot be assumed to reflect that of the general non-BDSM population.”

If it is widely accepted that BDSM comprises many variations of fantasies and behaviors, then it seems likely that the mental health of all these individuals may vary as well. There is limited but solid research available in clinical journals but little seems to influence mainstream understanding (Dunkley 2018).

One paper (deNeef 2019) notes that personality traits (e.g., higher levels of openness or extraversion) and the presence of a personality disorder have been associated with a heightened interest in BDSM—acknowledging, however, that evidence of a defined personality disorder is limited. Additionally, sensation-seeking levels and impulsivity seem to contribute because they presumably guide one’s drive to explore new or greater intensity seeking and non-mainstream acts.

Research on sexual abuse and BDSM concluded that the prevalence of self-reported sexual childhood abuse was higher among BDSM practitioners (8 percent men, 23 percent women), as compared with the general population (3 percent men and 8 percent women) (Nordling 2000).

BDSM relationships are entered into consensually, where the submissive partner (sub) willingly surrenders complete authority to the dominant one (dom). The sub is obedient with regard to the other's desires, sexual protocols, and commands. Pleasure is typically derived for subs through complete submission; doms typically derive pleasure through a feeling of control. Research indicates that power is at the core of BDSM interactions; pain, bondage, and humiliation are tools or methods to achieve the mutual creation of hierarchical status (Cross 2018).

Human sexuality is complex.

Sexual compatibility between couples strengthens and reinforces intimacy and the relationship overall. Most BDSM practitioners and non-practitioners who are in a committed relationship will attest to this.

However, many individuals and couples struggle with both sexual and emotional intimacy. Often, these processes coincide and collide at various points throughout the life of the relationship. Boredom, fatigue, lack of excitement, resentment, or poor communication are parallel relational processes inside and outside the bedroom. The sexual relationship often speaks the relational truth; but, sometimes it does not. Many couples whose relationship is defined by BDSM would differ vehemently and affirm that their life outside of hierarchical sex exemplifies the sharing of power between the partners.

Sometimes individuals enter treatment specifically due to relentlessness in their sex life, which has left them feeling empty, longing, self-loathing. Sexual stimulation is readily available and as accessible as alcohol or chocolate; quick fixes surround us. It is often exhaustion, deeper depression, and diminishing excitation that ultimately lead to wanting to understand what is driving one toward repeated, incessant, or compulsive sex. These issues can arise in the BDSM community, as well.

One significantly overlooked issue pertains to the quantity and intent of sexual encounters among BDSM practitioners. In cases where BDSM practices are also risky, intended to surreptitiously harm, or are compulsive, they are not "normal"—no more so than the behaviors of an individual who recklessly or compulsively engages in more traditional sexual practices.

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Let’s take a hypothetical example: John, a late middle-age corporate executive in a conservative, international financial institution, identifies as a dom, seeks out frequent anonymous BDSM encounters through a website, and crosses boundaries at work by recruiting associates, colleagues, and subordinates similarly interested in BDSM encounters. He has at least one anonymous encounter daily and speaks with pride about those who want his services and the women he "debases." He takes pictures of his much younger subs and sends them to his friends, claiming he has permission to do so. He reports that he has “important work to do as a dom," and that many women and couples seek him out.

But what if BDSM practices are integrated into a relational sex life? Another example: Daniel and Karen are a couple in their mid-30s. Both hold jobs as corporate executives. They have been in a solid marriage for five years, are good communicators, and want to introduce their BDSM fantasies into their sex life. The couple goes to a BDSM club and is intrigued and slightly aroused by being voyeurs. The couple buys BDSM paraphernalia at a sex shop. They are comfortable with the more traditional roles—Daniel is dom, and Karen is sub. On several occasions, Daniel ties Karen up, blindfolds her, gags her, and stimulates her and himself by mildly spanking Karen with a paddle and alternatively stimulating her clitoris with a feather, stopping each time she is about to climax. The couple generally ends these BDSM experiences with either traditional sex, if one or both has not climaxed, or they lay in each other's arms discussing their experience with pleasure and satisfaction. Sometimes they share newer fantasies that emerge. Sometimes they watch "traditional" or BDSM porn.

John, in the first example, is exploitive of colleagues and subordinates at work, and his role as dom may be a cover for narcissism, as evidenced by his sharing a picture with his friends of a naked and bound sub. He experiences feelings of potency and control. Through this defensive maneuver, he can ward off underlying low self-worth and profound feelings of inadequacy.

Daniel and Karen likely would be viewed by many as a healthy, loving, and communicative couple seeking to expand their sexual boundaries. As some researchers assert, the power differential may be the core motivation behind the eroticism and sexual pleasure for Daniel and Karen. Because their relationship is based on trust and safety, they routinely share their fantasies and are able to introduce them into their actual sexual practices.

Research and clinical communities have come a long way from Freud’s depiction of sadomasochism as a perversion. Increased freedom has allowed many people to actualize erotic and highly charged fantasies in their relationships and sex lives. But, like most things in life, freedom comes with responsibility and a requirement of truth. A need to understand the intent of sexual acts that may be compulsive or systematically serve to fill vacuums of low self-worth or a need to exploit is not limited to the mainstream sexual community.