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Masochism is central to all pathologies and its relevance in clinical practise cannot be underestimated. The initial connection made by Freud was that masochism was a component or partial instinct, still operating within the pleasure principle. The relationship between masochism and the theory of drives marks a main theoretical difference in the different authors' explorations of this subject. The understanding of what is meant by 'masochism' gained complexity following Freud's postulation of a life and death drive (which is more or less contemporary with his 1924 paper on masochism) and the differences made by him between 'primary' and 'secondary' masochism. This introduction to the papers presented in this section will address some of these differences, as well as exploring the notions of primary erotogenic masochism, feminine and moral masochism. It will also look at the notion of binding /unbinding of the life/death drives, and the role of the superego. It will introduce the different papers by Novick and Novick, Bourdin, Frank and Persano on developmental perspectives, primary masochism, views on French analysts such as Benno Rosenberg and on Kleinian ideas on the subject as well as on the role of the body, pain and self harm.

Masochistic elements are puzzling entanglements for most of us in the beginning. Taking Melanie Klein's attempts to think about them thus show one way how to make sense of them. Starting from her struggles with masochistic symptoms in child analyses in the early 1920ies Melanie Klein tried to conceptualize those experiences in a way that could help to fact them in the analytic process. In this article the development is outlined, the move from thinking about them in libidinal terms to gradually grasping in greater depth their destructive quality. She speaks of an "evil principle" and then finds a conclusive solution in conceptualizing masochism as a representation of the death drive. In the next decades her followers would further work on the complexities of the countertransference issues and superego organizations in masochism in more detail as will be shown. Finally, a look in a piece of present analytic work will exemplify the clinical usefulness of the Kleinian conceptualization.

Prior limited research on entrance into BDSM divided paths of entry into external or internal factors (YostaHunter, 2012), while research on age at entry into BDSM has not considered variation by BDSM role identity, gender, sexual orientation, and other demographic differences. In this mixed-methods exploratory study, we contribute to this literature by collecting and analyzing qualitative interviews with 96 self-described practitioners of BDSM to more fully describe distinct pathways into BDSM, adding nuance to prior descriptions of entry. We also collected and analyzed surveys with 2,017 self-described practitioners of BDSM to examine patterns of age at entry into BDSM practices and fantasies, and selection into older or younger age at practice and age at fantasy by BDSM role identity, gender, sexual orientation, and other demographic characteristics. Interview respondents told "constructionist sexual stories" describing introductions to BDSM via popular culture including pornography and other media, the Internet, or a sexual partner that awaked an inherent interest, along with "essentialist sexual stories" which described self-discovery solely attributed to an inherent personality characteristic. Survey data revealed that age at fantasy and onset of behavior varied by social-environmental factors. Pathways and patterns into BDSM behavior and fantasies therefore reflect a combination of idiosyncratic interests, exposure to ideas via the media or partners, and stratified social norms and opportunities related to sexual behavior.

Background As behaviors, alternative sexual (alt-sex) (i.e., kink, bondage, discipline, dominance, submission, sadism, and masochism , consensual non-monogamy, swinging, leather, and fetish practices) practitioners often emphasize that consent and boundaries are key elements of alt-sex activities. Despite these emphases, individuals experience consent violations and sexual assault both prior to engaging and during their involvement in alt-sex activities. Purpose This study examines alt-sex practitioners’ sexual assault and nonconsensual experiences in order to highlight potential means of intervention and prevention, as well as inform clinical and legal professionals. Methods In collaboration with the National Coalition for Sexual Freedom, this study uses an international survey of adults in alt-sex communities ( N = 2996) to examine sexual assault and nonconsensual experiences both within and outside of alt-sex contexts. Results We found a lower rate of consent violations in the alt-sex community (26%) compared to sexual assault as an adult outside of alt-sex contexts (34%) and sexual assault as a minor (40%). We found significant differences by groups in sexual assault as a minor (gender, sexual orientation, age, and live in the US or not), sexual assault outside of alt-sex contexts (gender, sexual orientation, and age), nonconsensual experiences in alt-sex contexts (gender, sexual orientation, age, and race), receiving nonconsensual touch in alt-sex contexts (gender, sexual orientation, and age), giving nonconsensual touch in alt-sex contexts (sexual orientation, age, living in the US or not, and race), and being falsely accused of nonconsensual touching in alt-sex contexts (gender, age, and living in the US or not). Within the most recent consent violation, the most common behaviors were non-kink related, except for lack of aftercare. Nearly 40% of participants reported the reasons for their most recent consent violation in alt-sex contexts were being selfish or caught up in the moment. Implications Focused interventions are needed to address how different populations are experiencing assault and violations in alt-sex contexts.

Introduction BDSM is an abbreviation used to reference the concepts of bondage and discipline, dominance and submission, sadism and masochism, enacted by power exchanges between consensual partners. In recent years, attention has shifted from the idea of BDSM as a pathological and tabooed niche practice towards viewing BDSM as a healthy form of intimacy. Aim This systematic review brings together all existing literature on the biology of BDSM and places it in a broader biological context. Methods A systematic search was conducted on PubMed, Web of Science and PsycARTICLES, of which 10 articles are included and discussed in this systematic review. Results There is evidence for cortisol changes in submissives as a result of a BDSM interaction, suggesting involvement of the physiological stress system. Endocannabinoid changes implicate the pleasure and reward system. In dominants, this biologically measured pleasure seemed to be dependent on power play rather than pain play. Testosterone and oxytocin are also implicated in BDSM, though their role is less evident. Research into brain region activity patterns related to BDSM interest suggests a role for the parietal operculum and ventral striatum in the context of the pleasure and reward system, the primary and secondary somatosensory cortex in the context of pain perception, empathy-related circuits such as the anterior insula, anterior midcingulate cortex and sensorimotor cortex and the left frontal cortex in the context of social and sexual interactions. Pain thresholds are shown to be higher in submissive individuals and a BDSM interaction may cause pain thresholds to rise in submissives as well. Conclusion BDSM interactions are complex and influenced by several psychological, social and biological processes. Though research is limited, there is emerging evidence for an interaction between several biological systems involved in these types of interests and activities. This means there is an important role for future research to replicate and supplement current results.

Benno Rosenberg's work has been little translated into English. Yet, his work on masochism is a landmark in France. He set himself the goal of deploying all the richness and implications of the second Freudian drive theory and the introduction of the death drive. He therefore returns to "the Economic Problem of Masochism" to give all its value to the drive fusion that it achieves internally and which is therefore for it "guardian of life", even if it is can also be fatal. He draws consequences on the psychic construction of the ego, the superego and on that of temporality. He also describes a "work of melancholy" which is different from mourning. Thinking it necessary to push the consequences of the new theorizing further than Freud was able to do, he revisits "Inhibition, Symptom and Anxiety" to articulate the triggering of anxiety by a libidinal demand and the threat to the unity of the ego who comes from the death drive due to conflict. Starting from the psychosomatic descriptions of Pierre Marty, whose options are specified, he also proposed a metapsychology of somatization during the overflow of the psyche by the destructiveness which will then threaten the body.

The authors present a summary of sadomasochism, its centrality in all pathology and the difficulties encountered by all analysts in working with sadomasochism. An integrative model is presented with determinants and manifestations from all phases of development, including the transmission of pathology between generations. Addiction to pain and the formation of hostile omnipotent beliefs are described as components of sadomasochism that explain how resistant sadomasochism is to change and growth. The emergent idea of two systems of self-regulation is presented and its utility for technique is described. Specific focus on developmental aspects offers therapists developmental markers they can use in clinical work.

This paper attempts to address self-harm from a psychoanalytic perspective in contemporary clinical practice and their relationship with aggression, impulsiveness, violence, and masochism. Self-harm is frequent in adolescents and young people, predominantly in feminine gender. The author describes the different manifestations of self-injurious behaviors in the contemporary clinic, its manifestation in adolescents and its relationship with psychopathology. Self-harm is a way of communication, through actions, to deal with psychic pain and with the self-vulnerability. Self-harm behaviors are a manifestation of psychic tension that results overwhelming, intolerable and its discharge relieves the subject suffering, although this way is ephemeral. Suffering is linked to childhood traumatic experiences, where the self of the infant was cathected with a greater amount of aggression than erotic libido. The author states that affective aggression is triggered by emotions like anger, sadness, and emptiness. Archaic masochism is a form of identification with the aggressor and a turn against oneself aggression commonly associated with episodes of child abuse. Also, it argues that the violence linked to self-injury is intersubjective fabric in nature and requires an interdisciplinary approach.

This text presents how Freud thinks about the masochism. In 1915, it is the return of active sadism in a passive drive which is characteristic of masochism, always secondary. In 1919, he sees in masochism the genesis of perversions. And the article of 1924 knows a primary masochism and distinguishes erotogenic masochism, feminine masochism and moral masochism. After Freud, many studies of clinical forms of masochism can be noted, and in France there is a thesis about the masochism as a first psychic link (Benno Rosenberg, Marilia Aisenstein).

This article explores defensive modes of masochism based through the case study of Sarah, a 25-year-old patient who is regularly followed in psychoanalytical therapy. I will postulate the idea that fetishization of moral masochism should be seen from the perspective of melancholic processes. Drawing on several moments of her therapy, I will illustrate how the primitive idealization of the introjected and denigrated object in the melancholic process lays the conditions for a decisive moral masochism, and whose unconscious idealization defends against depressive breakdown.

Recent research has shown that a tendency to harm others goes hand in hand with a tendency to harm oneself. The present two studies further supported the notion that the joy of harming others and oneself has a common core by showing positive relationships between dark personality traits (particularly psychopathy) and sexual masochistic preferences and between general masochistic tendencies and sexual sadistic preferences. Despite the overlap between dark personality traits and general masochistic tendencies, they independently predicted the engagement in sexual sadomasochism. These relationships statistically held when controlling for the impact of basic personality (Study 1). Study 2 found that self-enhancement, openness to change, and low conservation values serve as motivators for a person's attraction to sexual sadomasochism and shed some light on the differences between sexual sadomasochism and the Dark Tetrad. Overall, people who score relatively high on dark personalities and masochism are particularly predisposed to engage in sexual sadomasochism, in both the dominant and the submissive roles.

Empirical research on the origins of kinky erotic desires (e.g., sadomasochism, bondage, domination/submission, roleplaying, sexual fetishism, etc.) has been limited and rarely rooted in the narratives of kinky people themselves. Among a sample of 260 self-identified kinky users of a kink-oriented social networking website living in 21 countries, we examined self-reported narratives of the origins of kink desires. An inductive coding process by four independent coders yielded 20 categories of responses, organized into five broad discourses about the origins of kinky desires

We examined the concordance of paraphilic interests and behaviors across 13 themes in an online sample of 1,036 men and women. Paraphilic interests were significantly and positively correlated with behaviors across all 13 themes. Associations were strongest for masochism and sadism, and weakest for pedohebephilia and frotteurism. Paraphilic interest and behavior were significantly and positively correlated after accounting for gender and sexual orientation. Moderated moderation analysis was significant for five themes. Gender was a moderator for eroticized gender, but only among heterosexual participants, where concordance was higher for heterosexual men than for heterosexual women. For both exhibitionism and frotteurism, gender was a significant moderator, but only for nonheterosexual participants, where concordance was stronger for nonheterosexual men than for nonheterosexual women. For pedohebephilia, interest was significantly associated with behavior for heterosexual men, heterosexual women, and nonheterosexual men, but not for nonheterosexual women. For zoophilia, there was a significant association between interest and behavior for heterosexual men, nonheterosexual men, and nonheterosexual women, but not heterosexual women. Additional analyses found sex drive moderated the positive associations of 7 of 13 paraphilic themes, with 5 of these 7 showing the expected effect of higher concordance of interests and behaviors at higher levels of sex drive.

Memorializes Paula J. Caplan (1947-2021). Caplan was a leading scholar in feminist psychology, and an early contributor to the feminist critique and re-visioning of psychology. In her now-classic books

The purpose of the paper was to examine Norwegians’ incorporation of seven varied sexual acts. Data were obtained from a questionnaire survey of a probability-based web sample of 2,181 men and 1,967 women aged 18–89 years. Among seven acts of sexual variety, the most common sexual experiences were trying to watch pornography with a partner, engaging in sex in unusual places, and using sex toys. Older age was negatively associated with all acts of sexual variety. Regarding more unorthodox acts of sexual variety, heterosexual men’s sexual preferences involved having and desiring group sex, whereas heterosexual women’s sexual experiences and desires involved having sex in unusual places. Lesbian, gay, bisexual (LGB) individuals generally showed greater curiosity or experience of having group sex and engaging in BDSM (bondage, discipline, dominance and submission, and sadomasochism) activities than heterosexual adults. However, while LGB men had a high preference for group sex activities, LGB women had more positive attitudes towards BDSM activity. Individuals appear to accumulate more acts of sexual variety over time, thus making the incorporation of sexual variety a function of age. This study supports the idea that sexual variety has expanded among those born from 1960 onwards.

A noteworthy number of people are interested in BDSM (bondage and discipline, dominance and submission, sadism, and masochism). Fatal outcomes while participating in BDSM activities occur. The aim of this literature review is to give a better insight into potential dangerous BDSM play by summarizing published data on BDSM fatalities. A literature search was conducted. It was searched for non-natural death related to BDSM activity. Seventeen cases were found. The age of the deceased ranged between 23 and 49 years (mean age 34.9 years). Strangulation in the course of erotic asphyxiation was the most common cause of death (88.2%). In 13 cases, a toxicology report for the deceased was mentioned, of which in eight cases (61.5%) toxicology analysis was positive. In four of these cases, the BDSM partner was also tested positive with the same substance. Drugs or alcohol was involved in 64.3% of fatal BDSM play. In nine cases, the level of experience in BDMS activity of the deceased and the partner was described, and in all of them, the deceased and the partner were not new to BDSM play. Fatal outcomes of BDSM plays are rarer than autoerotic fatalities and natural deaths related to sexual activities. Safeguards and education on medical aspects exist in the BDSM communities. If they are followed by the practitioners, the risks of BDMS play can be reduced. Cases of non-natural death connected to BDSM are rare incidents and can be prevented.

Objective Based on prior research linking masochism and antisocial behavior to sensation seeking, we hypothesized that masochistic and antisocial preferences are positively correlated. Besides sensation seeking, we tested whether disgust sensitivity (due to its inhibitory function) and shared social values (e.g., stimulation) accounted for the masochistic‐antisocial link. We additionally examined the link in relation to broad personality factors. Method Six online and laboratory studies (N = 2,999) with US‐American and European samples. Results We consistently found positive correlations between masochistic enjoyment (e.g., enjoying the burn of spicy food, disgusting jokes, pounding heart, painful massage) and antisocial traits such as subclinical psychopathy, everyday sadism, and low Honesty‐Humility. We observed behavioral correlations in that experienced pleasure of a painful event was positively related to causing another person to feel pain. Shared sensation seeking, low disgust sensitivity, and endorsement of social values such as social power, hedonism, and a stimulating life partially accounted for the masochistic‐antisocial link. Conclusion The extent to which a person enjoys threatening stimuli on the self is reliably related to how much a person enjoys and evokes others' suffering. Future research could explore the common core that underlies common masochistic and antisocial preferences beyond the mediators tested here.

Introduction Recently the guidelines for the diagnosis of paraphilic disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11), have been published. Aim This article analyzes legal, regulatory, and policy issues relevant to the potential effects of the changes for the classification of paraphilic disorders in the ICD-11 in Germany. Methods A forensic and a legal expert in Germany worked with other international experts to conduct this evaluation using an assessment guide provided by the World Health Organization. Main Outcome Measures Possible effects of the changes for the classification of paraphilic disorders in the ICD-11 on forensic practice, health systems, adjudication of individuals who have committed a sexual offense, and the provision of treatment in Germany. Results Results highlight the special situation of medical confidentiality in the German health system that facilitates the establishment of preventive networks for the treatment of pedophilic patients. The ICD-11 guidelines will help to clarify the boundary between pedophilic disorder and crimes of child sexual abuse. These will also establish a boundary with other paraphilic diagnostic concepts. We describe the central construct of criminal responsibility in the German legal system in relation to paraphilic disorders, the prominent role of expert witnesses, and the differences in the conceptualization of medical confidentiality within the health care system and within the legal system. Clinical Implications The ICD-11 proposals for paraphilic disorders provide a clearer differentiation, as compared with ICD-10, between variants of normal sexual behavior and sexual behavior that involves a non-consenting person or entity. Particular patterns of sexual preference that are not of relevance to public health, the health care system, or the legal system, such as masochism and fetishism, will no longer be named psychiatric entities and will, therefore, be regarded as private behaviors and destigmatized. Strengths & Limitations The assessment shows the specific legal situation in Germany for the treatment of paraphilic patients in a sexual medicine, psychiatric, and legal discourse. However, it was done only by a small number of experts. Conclusion A conclusion of the analysis was that the more specific and narrower definitions in the ICD-11 diagnostic guidelines, compared with those in ICD-10, particularly for pedophilic disorder and coercive sexual sadism disorder, will result in a reduction in false-positive diagnoses. It is unlikely that significant unintended and negative consequences will occur as a result of implementing the ICD-11 guidelines for paraphilic disorders.

Physical pain represents a common feature of Bondage and Discipline/Dominance and Submission/Sadism and Machochism (BDSM) activity. This article explores the literature accounting for how painful stimuli may be experienced as pleasurable among practitioners of BDSM, and contrasting this with how it is experienced as painful among non-BDSM individuals. We reviewed the available literature on pain and on BDSM, and used the findings to postulate a theory accounting for how painful stimuli are experienced as pleasurable. Our theory was then checked with BDSM practitioners. The emotional, physiological, and psychological elements of pain interact to facilitate the experience of pain as pleasure in BDSM. A multitude of interconnected factors was theorized to alter the experience of BDSM pain, including: neural networks, neurotransmitters, endogenous opioids and endocannabinoids, visual stimuli, environmental context, emotional state, volition and control, interpersonal connection, sexual arousal, and memories. The experience of pain in this context can bring about altered states of consciousness that may be similar to what occurs during mindfulness meditation. Through understanding the mechanisms by which pain may be experienced as pleasure, the role of pain in BDSM is demystified and, it is hoped, destigmatized.

This paper contrasts full passion with what I am calling empty passion. As examples of full passion, Melanie Klein's lovehate, Kristeva's maternal passion, Žižek's political passion, and the passion of friendship are discussed in relation to empty passion, a narcissistic desire to fill a lack or a hole at the center of being. This empty passion is related to the Lacanian demand to serve or to become the desire of the Other and to André Green's concept of the psychic dilemma of the Dead Mother. Clinical and literary examples of empty passion are provided as illustrations.

Bondage/discipline, dominance/submission, and sadism/masochism (BDSM) proclivity among college students is poorly characterized, in part because existing measures of BDSM proclivity highlight the consensual nature of BDSM and are appropriate for use with non-community members (e.g., those who may not understand BDSM jargon). The current study introduces such a measure, the BDSM Proclivity Scale, which characterizes BDSM proclivity among college students and evaluates relations of BDSM proclivity with other sexual attitudes and behaviors. College students (n = 552) completed measures of BDSM proclivity, sociosexual attitudes and behaviors, rape-supportive attitudes, lifetime sexual partners, and consent-seeking behavior. Two factors mapping onto attitudes and experiences related to BDSM were identified and cross-validated. Average endorsements of BDSM attitudes and experiences on a 7-point Likert scale (1 = strong disagreement, 7 = strong agreement) were 5.61 and 4.44, respectively. Structural models revealed that lifetime sexual contact and gender significantly positively correlated with BDSM attitudes and experiences, sociosexual attitudes positively correlated with BDSM attitudes, and rape-supportive attitudes positively correlated with BDSM experiences. Consent-seeking was unrelated to BDSM experiences or attitudes. College student BDSM proclivity was evident for both attitudes and experiences, highlighting the need to characterize the development of BDSM proclivity and its correlates, the sources of students' knowledge, and the nature of students' experiences. The observed associations between BDSM proclivity and relevant sexual attitudes and behaviors support its construct validity and suggest that BDSM proclivity may prove to be an important addition to the broader constructs assessed in sexual attitudinal and behavioral domains.

This national web-population study from Norway (N = 4,148) assessed 1) the prevalence of BDSM and role-play interests and behaviors, 2) the socio-demographic characteristics of the BDSM-oriented participants, and 3) the associations between a) BDSM and b) role-play interests and behaviors, and sexual satisfaction, relationship satisfaction, and relationship closeness. Over one in three study participants endorsed at least one BDSM interest or behavior variable. There were no gender nor educational level differences between the BDSM-oriented participants and their traditional "vanilla" (non-BDSM-oriented) counterparts, though BDSM and interests were more common among younger and self-identified LGBQ+ participants. Sexual satisfaction was positively associated with role-play and BDSM behaviors while interest in role-play (but not having previously engaged in it) was negatively associated with this outcome. Lower relationship closeness was associated with an interest in role-play (but not having tried it). No BDSM-related variables were significantly associated with relationship closeness. The findings suggest that BDSM interests and behaviors are relatively common and are linked with sexual and relationship satisfaction.

Background BDSM is an acronym describing bondage and discipline, dominance and submission, and sadism and masochism. Afflicting or receiving pain is usually an important part of the BDSM interaction. Aim This research will focus on better understanding the aspect of pain within a BDSM interaction. Methods Submissive and dominant counterparts of 35 couples were recruited to participate in a BDSM interaction, of which 34 dominants and 33 submissives were included in the analyses. A non-BDSM interested control group (n = 27) was included to control for social interaction, of which 24 were included in the analyses. Outcomes This research investigates the differences in (i) baseline pain thresholds, (ii) the impact of a BDSM interaction on those thresholds, and (iii) threshold moderating factors like pain cognition between submissive and dominant BDSM participants and control individuals. RESULTS BDSM practitioners have a higher pain threshold overall and a BSDM interaction will result in a temporary elevation of pain thresholds for submissives. Additionally, pain thresholds in dominants will be dependent upon their fear of pain and tendency to catastrophize pain and submissives will experience less fear of pain than the control group. Clinical Implications By further enhancing our understanding of the mechanisms behind a BDSM interaction in this way, we aspire to relieve the stigma these practitioners still endure. Strengths & Limitations This is one of the first studies of its kind with a large sample size compared to similar research, which makes it a significant contribution to the field. It must be mentioned that there is a possible selection bias because recruitment was only done through the Flemish BDSM community and specifically those who visit clubs. Additionally, pain threshold remains a subjective measurement, which must be taken into account. CONCLUSION This study helps shed further light on the biological processes behind a BDSM interaction through pain threshold measurements.

With the rise in popularity of media pieces depicting alternative sexual/relationship preferences, there has been a rise in interest in kink and BDSM (SprottBerkey, 2015), which corresponds with research suggesting that approximately 20% of Americans have been in a consensually non-monogamous relationship (Haupert et al., 2016). Despite this growing popularity, these populations are often stigmatized and misunderstood (Bettinger, 2002). The present study examined the self-reported experiences of individuals who have participated in kink, BDSM, non-monogamy, and/or polyamory. Specifically, the study used qualitative methodology to examine narratives of discrimination, harassment, coming out, being outed, consent violations, and/or sexual assault in a BDSM or non-monogamous encounter. Participants consisted of 67 adults who completed an online survey conducted by the National Coalition for Sexual Freedom and were asked to provide narratives of their experience. Data were analyzed using a modified consensual qualitative research methodology (CQR-M; Spangler et al., 2012). Results indicated 11 categories falling into three domains: navigating incidents (consent issues, negotiation of scenes or relationships, identity/beliefs about coming out, and reporting), contributing factors (role of social media/media, exacerbating factors, and beliefs about the community), and response/prevention (outcome of incident, emotions felt, lessons learned from incident by the participant, and what would be helpful from the community). This study contributes to our understanding of the experiences in this community and elucidates strategies that can be used to intervene and advocate for these populations, including education of the general public and deliberate community support.

Background Recent research has indicated that participation in BDSM (bondage-discipline, dominance-submission, and/or sadism-masochism) is not associated with psychological distress or psychopathology but that sexual roles may be associated with personality characteristics, specifically interpersonal dominance and empathy. Aim The present study examined potential differences between those who identify as dominant, switch, and submissive on interpersonal dominance and empathy. Methods Individuals who identified as members of the BDSM community were recruited online via a social networking site. Main Outcome Measures Self-reported demographic variables, the Personality Assessment Inventory, Dominance subscale, and the Interpersonal Reactivity Index Empathic Concern subscale. RESULTS Participants were well distributed across sexual roles (n = 279; 25.4% dominant, 38% submissive, 36.6% switch), identified as primarily female (59.5%), primarily heterosexual (53.4%), and the most common age group was 25-34 years (27.2%). BDSM role was associated with scores on the Dominance subscale; dominant BDSM practitioners scored significantly higher on the Dominance scale than switches, who in turn scored significantly higher than submissives (dominant mean [M] = 61.44, standard deviation [SD] = 8.26; switch M = 53.99, SD = 11.18, P < .01; submissive M = 49.41, SD = 11.46, P < .01). There were no differences on the measure of empathy between dominant, submissive, and switch BDSM practitioners. On average, individuals who identified as submissives and switches scored in the average range on the Dominance scale compared with the normative sample, and individuals who identified as dominants scored higher but not in the markedly elevated range. Clinical Implications The study provides information on the relationship between interpersonal dominance as a personality trait and dominance as a sexual role and has implications for reducing stigma related to these practices. Strengths and Limitations The study contributes to the growing literature suggesting that while BDSM roles may correspond with specific personality characteristics, they are not indicative of personalities significantly different than the general population’s. The study also included individuals who identified as switch, a group often excluded from quantitative research in the BDSM community. The sample was, however, recruited exclusively online, and findings may not be applicable to all BDSM practitioners. CONCLUSION These findings suggest that there are no differences in empathy between BDSM practitioner roles, and although there are differences in interpersonal dominance, these characteristics are not likely to be prominent in individuals’ everyday interactions.

A growing number of studies have demonstrated that BDSM (Bondage/Discipline-Domination/Submission-Sadism/Masochism) practices are not signs of mental illness. However, the reasons for engaging in such behaviors are not well understood, especially for sexual masochism or submission (m/s). A thorough review of the literature was conducted, as well as a search in Internet forums and an online survey to obtain testimonies that provide information on the origins of interest in m/s and the reasons for engaging in it. A qualitative content analysis was performed on narratives from 227 m/s practitioners. Sixteen themes emerged from this analysis, eight related to the origins of interest in m/s and eight to the reasons for engaging in m/s. The origins described were seen as either intrinsic or extrinsic. Reasons to engage in m/s were related to one of three main types of activities: use of interpersonal power; experiencing physical pain; and altering one's state of mind. These results concord with accounts found in non-academic books and small-scale studies suggesting that m/s interests are often present early in life and usually practiced to reach an altered state of mind associated with sexual arousal. Possible reasons for choosing m/s over more common means of mind alteration are discussed.

This commentary begins by describing the author's research and expert witness practice serving sex and gender minorities, especially practitioners of BDSM/kinky sex. Then, it reviews the three most common reasons that BDSM is legally prosecuted. First, consent: was this assault, rape, and/or kidnapping, or was it consensual kinky sex that either got out of hand or is now being strategically employed to punish the other partner? Second, age play: was this adult trying to have sex with children or was he (and it is virtually always men) intending to age play with an adult who is pretending to be an adolescent? Third, death by kinky sex: was this a person who murdered their lover or was this an accidental death? Finally, this article concludes with recommendations for kinksters who wish to assure consent and safe play, and for litigators involved in the prosecution of kinky sex.

Despite the gaining popularity in mainstream media of the phenomenon that is BDSM, empirical research on the motives and underlying psychological mechanisms driving BDSM practitioners is scarce. The current study focused on the potential driving roles of sensation seeking and coping styles in BDSM-related interests and behavior. A cross-sectional survey questionnaire was completed by 256 Dutch-speaking BDSM practitioners (110 men, 135 women, 7 gender fluid, 2 genderless, 1 other not specified), 1 missing (this participant did not answer the question regarding gender, but did answer all other survey items) and a matched control group lacking any BDSM interest recruited from the general Belgian population (N = 300; 135 men, 158 women, 4 gender fluid, 3 genderless). The questionnaire consisted of several items surveying different BDSM identities and interest levels of BDSM-related activities, an adapted version of the Dutch Sensation Seeking Scale, and items querying seven coping styles. Compared to controls, BDSM practitioners reported significantly higher levels of sensation seeking for all dimensions (experience seeking, thrill seeking, and distraction seeking), as well as the use of more active coping skills such as problem solving and taking action. Gender differentiated which specific coping skills were being used with women seeking out more emotional support and comfort and reaching out more for help and advice in both the BDSM and control group, and men taking more action and seeking distraction in leisure. About 40% of the practitioners reported using BDSM itself as a coping strategy. Further research is needed to explore the link between coping and sexuality in general, and to other psychological processes that drive BDSM interests in order to destigmatize and normalize consensual BDSM-related activities within the general population.

The present study attempted to understand people's desires for aggressive and humiliating sexual play, both in terms of interests and fantasy. An evolutionary framework has been developed which generated five hypotheses to be tested. Evidence from a qualitative study of 102 participants identified 13 aggressive and sexual acts which were commonly preferred. A subsequent quantitative online study of 1026 men and women asked participants to rate the desirability of these acts. The results indicated that more than 70% of participants found at least one aggressive or humiliating sexual play desirable, whereas about half of the participants found at least three such acts desirable. Significant sex differences were also found, with men desiring to engage in such play more than women. This discordance was moderated by the willingness of each party to partially accommodate each other's desires. On the basis of these findings and the proposed theoretical framework, it is concluded that aggressive and humiliating sexual play constitutes a normal variation in sexual desire.

This study sought to gain insight into the attitudes, beliefs, and values that shape bondage/discipline/sadomasochism (BDSM) activities and to explore the degree and consequences of unintended or non-negotiated harms, including physical, emotional, and sexual violence. A qualitative approach, consisting of 22 semistructured interviews and over 150 hours of observations of BDSM events and activities, was used to develop an in-depth exploration of the lived experiences of participants. Thematic analysis was employed to elucidate the ways in which participants define and in some cases experience harm. Findings suggest that individuals construct rational identities that emphasize safe practices and managing harm; however; there are instances where “boundary slippage” occurs. Implications for understanding the dynamics as well as the potential dangers of “consensual” violence are discussed.

Based on a five-year qualitative ethnographic study of Bondage and Discipline/Dominance and Submission/Sadism and Masochism (BDSM) in Sweden, this paper examines the process of becoming among BDSM practitioners. In-depth interviews were completed with 29 self-defined BDSM practitioners, and their accounts were analysed using thematic analysis. Focusing on the Deleuzian concept of becoming, BDSM is understood as a dynamic and collective phenomenon closely connected to fantasies, memories and longing, and enabled through flows of desire. Practising BDSM can be understood as a process of increasing expansion, creation and connection, in which desire is seen not as something we lack or need but rather as a process of striving and self-enhancement. Exploring the becoming process more fully can provide a better understanding as to why some people choose to practise BDSM.

The practice of bondage/discipline, dominance/submission, sadism/masochism (BDSM) sometimes is associated with giving and receiving pain. It remains unresolved how BDSM practitioners perceive the pain of other people. This study investigated whether and how the BDSM experience affects human empathy. Experiment 1 measured trait empathy and subjective empathic responses in BDSM practitioners and control respondents. The results revealed lower trait empathy scores and subjective pain intensity ratings in the female submissive group (Subs) compared to controls. Experiment 2 measured participants' neural responses to others' suffering by recording event-related potentials (ERPs) from female Subs and controls while viewing painful and neutral expressions. We found that the differential amplitudes between painful and neutral expressions in the frontal N1 (92-112ms), frontal P2 (132-172ms) and central late LPP (700-1000ms) were reduced in the submissive group versus the control group. These findings suggest that being in the submissive role during BDSM practice weakens female individuals' empathic responses to others' suffering at both the behavioral and neural levels.

Introduction Erotic asphyxiation is a sexual phenomenon in which one partner reduces the other person's brain oxygen level through strangulation. This study analyzes deaths caused by sexually-motivated strangulation to cases of homicidal choking — summarizing criminal penalties for defendants, depending on the presence of drugs, or alcohol intoxication. Methods The mode of analysis involves three sources of data. First, a retrospective chart review of our clinics' two recent cases. Second, a meta-analysis of these materials in relationship to forensic reports obtained from prosecutor's office. Third, we examine the prevalence of death due to strangulation in erotic and non-erotic cases using central court database. Lastly, we provide the summary of interviews involving the country's only forensic unit, which investigates criminal cases involving voluntary and involuntary strangulation. Results In total, we analyzed 15 cases of sexual asphyxiation — 2 of our own; 5 reported in prosecutor's archives; 8 control cases ruled as a non-sexual homicide. The two of our clinical cases describe two victims of voluntary erotic asphyxiation, involving complex sexual environment in which a sexual partner accidentally strangulated the other one during sex. The first case describes a 30 years-old female, who required all of her past sexual partners to choke her with hands in order to reach orgasm. The second case is that of a 41 years-old homosexual male, who was still a novice to kinky play and succumbed to death as a result of being tied with a set of ropes around his neck and body. By combining findings from the analysis of our clinic's cases with 5 files obtained from prosecutor's office — we are able to compare results of these cases to controls (involving homicidal suffocation using the plastic bag). In our cases, the defendants who avoid serving prison time for strangulating in course of erotic play typically exhibit these characteristics — at the time of the killing, they were not under influence of drugs; the deceased had documented (based on witness interview, review of personal items, or medical documentation) long-standing paraphilic disorder. In controls, the likelihood of being convicted of voluntary manslaughter was lower for people who acted under the influence of drugs but higher for those under the influence of alcohol. Conclusions These findings show that documented presence of paraphilic tendencies in the deceased might serve as grounds for not sentencing their sex partners for prison time if they acted to satisfy someone else's kinky needs.

This study examines how BDSM participants understand sexual experiences. Data are drawn from 32 in-depth, semistructured interviews and discussion-board threads from a large BDSM community Web site. The analysis suggests that many BDSM participants perceive sexual BDSM experiences as not only significantly different from but also better than mainstream or "vanilla" sex. Three primary differentiation mechanisms are identified. First, BDSM participants constructed sex as requiring genital contact, while framing sexual BDSM as creating sexual fulfillment not requiring normative indicators of sexual experiences (e.g., orgasm). Second, participants constructed sexual BDSM as centered on emotional and mental experiences, while perceiving sex as being centered on physical experiences. Third, participants perceived sexual BDSM experiences as facilitating deeper interpersonal connections than those available in sex. Importantly, these mechanisms serve not only a differentiating but also an evaluative function. Most participants in this study reported a strong preference for sexual BDSM over sex.

This mixed-methods study of BDSM investigates the nuances of BDSM participants' role identities, role frequencies, and role fluidities-shifts in identities and play across time, location, scene, and play partner. Data were gathered from 202 online surveys and 25 semistructured interviews about participants' roles given their gender and sexual identities. These data reveal that men tend to self-identify as Dominant, Master, Top, or Sadist (DMTS) and always perform dominant roles, while women tend to self-identify as Submissive, Slave, Bottom, or Masochist (SSBM) and always perform submissive roles. Although this would seem to support the theory that BDSM reinforces gendered dominant/submissive binaries, further analyses indicate that women and queer/pansexual individuals disrupt this binary through their Switch identities and roles. Switching and queer identities, thus, offer the possibility for transforming dominant/submissive and other binaries.

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH’s proposals for Paraphilic Disorders in ICD-11 are based on the WHO’s role as a global public health agency and the ICD’s function as a public health reporting tool. Electronic supplementary material The online version of this article (doi:10.1007/s10508-017-0944-2) contains supplementary material, which is available to authorized users.

Introduction Erotic target identity inversions (ETIIs) are poorly studied paraphilias that involve sexual arousal by the idea or fantasy of being the object of one’s sexual desires. Aim To conduct a large non-clinical online survey to investigate self-reported sexual arousal, behavioral expression, and psychological correlates of 4 proposed ETIIs. Methods A total of 736 natal males and 549 natal females responded to items about self-reported sexual arousal to the idea of acting as an animal (autoanthropomorphozoophilia) or the idea of acting as a child or infant (autonepiophilia), natal males reporting arousal to the idea of acting as a woman (autogynephilia), and natal females reporting arousal to the idea of acting as a man (autoandrophilia). Data pertaining to sexual orientation, childhood gender nonconformity, gender identity discomfort, autism, masochism, and humiliation were also collected. Main Outcome Measures The main outcome was a measure of self-reported arousal and expression of the ETIIs being explored using 4 items: arousal level (–3 to 3) when imagining being the erotic target exemplar; frequency of engagement in dressing or behaving like their preferred target (0–4); strength of feeling that they would be better off as the target (0–4); and the frequency of consideration of making physical changes to look or function more like the target (0–4). Results Mild levels of reported sexual arousal to the idea of being the preferred erotic target were common among the 4 groups, characterizing about half of them. Gender identity discomfort was associated with autogynephilia, autoandrophilia, and autoanthropomorphozoophilia. Greater gender nonconformity was associated with autogynephilia, autoandrophilia, and autonepiophilia. Autism scores were associated with autoandrophilia and autonepiophilia. Masochism was not associated with ETII scores, but humiliation was. Clinical Implications Findings suggest that it may be important to distinguish between subgroups of those with different levels and types of ETII arousal/expression. Strengths & Limitations Strengths of this study include the large, non-clinical sample of men and women for the investigation of ETIIs and the inclusion of measures of psychological correlates. The use of an Internet sample with self-report measures may be unrepresentative, although the Internet has the advantage of allowing recruitment from stigmatized or unusual groups. The cross-sectional nature limits our conclusions, as no causal inferences can be made. Conclusion The results support the concept of ETIIs as a paraphilic dimension in non-clinical samples and the possible role of gender-related psychological factors.

The bondage-discipline, dominance-submission, and sadism-masochism (BDSM) community has achieved diversity with respect to gender identity and sexual orientation yet does so to a lesser extent with respect to race and ethnicity. A total of 398 BDSM practitioners recruited in 2018 and 2019 from BDSM conferences located within the Southern, Midwestern, and Western regions of the U.S., as well as online, completed surveys asking about racial and ethnic discrimination, fetishization, and inclusivity. People of color were 16 times more likely than non-people of color to feel discriminated against at BDSM events and 17 times more likely to feel fetishized. Qualitative results included troubling stories of overt racism and offensive racial slurs, and examples of microaggressions, feelings of isolation, and feelings of being dismissed. The results suggest that organizations can increase inclusivity by understanding the unique costs faced by people of color with an awareness that these costs might be invisible to non-people of color, diversifying positions of authority and leadership, and teaching well-meaning members what types of behaviors could create a hostile environment.

Sadomasochism is the sexual interest, psychosexual deviance or sexual crimes that are sexually aroused by suffering or causing others to suffer. This study summarizes the concept, assessment and diagnosis, categories and symptoms, psychological and biological mechanisms, judicial disposition and clinical intervention strategies of sadomasochism from the perspectives of clinical medicine, law, criminology and psychology, suggests that further research should take local people with sadomasochism preference and local patients as research objects, pay attention to different types of sadomasochists, conduct bottom-up research, explore the core elements and manifestations of sadomasochism, and accurately define and classify sadomasochism, construct an effective scale, a erectile measurement sexual stimulation system and a diagnostic criteria; discuss evaluation methods combined with crime scene data; discuss the validity of masochists' consent combined with diagnosis; establish targeted criminal correction programs and a treatment and rehabilitation system to provide reference for the improvement of medical, judicial and mental health services.性施（受）虐的研究现状与局限.性施（受）虐是指通过遭受痛苦或使他人痛苦来获得性唤起的性偏好、性心理障碍或性犯罪行为。本文综述了从临床医学、法学、犯罪学、心理学等视角对性施（受）虐的概念、评估与诊断、分类与症状表现、心理学与生物学机制、司法处置与临床干预策略的研究，提出进一步的研究应以本土性施（受）虐偏好者、患者为研究对象，关注不同类型的性施（受）虐群体，开展自下而上的研究，探讨性虐行为的核心要素和表现形式，准确定义和分类性施（受）虐，构建有效的量表、勃起测量性刺激体系和诊断标准，探讨结合犯罪现场信息的评估方法，探讨结合诊断讨论性受虐者同意的有效性，建立针对性的罪犯矫治项目和治疗康复体系，为医疗、司法、心理健康服务工作的改善提供参考。.司法精神病学；性虐待；施虐癖；受虐癖；性犯罪；综述.

Consent represents a central focus in the controversial realm of BDSM—an overlapping acronym referring to the practices of Bondage and Discipline, Dominance and Submission, and Sadism and Masochism. Many authors have argued that the hallmark feature that distinguishes BDSM activity from abuse and psychopathology is the presence of mutual informed consent of all those involved. This review examines the relevant literature on consent in BDSM, including discussions on safety precautions, consent violations, North American laws pertaining to BDSM practice, and the role of the BDSM community with respect to education and etiquette surrounding consent. Practical information relevant to professionals who work toward the prevention of sexual exploitation and abuse is provided. The explicit approach to consent practiced by those in the BDSM community is proposed as a model for discussions around consent in clinical and educational contexts. Criteria for distinguishing abuse from BDSM and identifying abuse within BDSM relationships are outlined. It is our hope to demystify the consent process and add to the growing body of literature that destigmatizes consensual BDSM practices.

Introduction Non-natural deaths associated with sexual activity may occur either with or without the involvement of other persons. Aim The present study provides an overview of cases of non-natural death related to sexual activities as well as recommendations of how to handle these cases and to identify potentially dangerous pleasure-enhancing techniques. Methods This medicolegal, postmortem, retrospective, and prospective study is based on data of autopsies performed at the Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany. Main Outcome Measure Identification of circumstances, sexual practices, and gender distribution of cases of non-natural death in this context. Results Between 1993 and 2017 (25 years), 16,437 medicolegal autopsies were performed, of which 74 cases (43 males, 31 females) of non-natural death were found to relate to sexual activities (0.45%). One female and 21 males had died in the course of autoerotic practices (group I, n = 22). Nine males and 14 females had performed sexual practices with mutual consent (group II, n = 23), and 13 males and 16 females without mutual consent (group III, n = 29). The average age in group I was 45.4 years; in group II, 40.6 years; and in group III, 39.2 years. Most of the deceased were found in their own apartments. Forms of stimulation included vaginal, anal, and oral intercourse; insertion of foreign bodies; use of chemical substances; and tools for respiratory depression/hypoxia. Three cases of death occurred during sexual activities involving bondage and discipline, sadism, and masochism (BDSM). Death due to strangulation was the main cause in group I, whereas intoxications were predominant in group II. Sharp force (eg, knife) was mainly responsible for death in group III. Anogenital injuries were documented in all groups in approximately equal percentages. Clinical Implications The cases presented show a high variety of circumstances in which non-natural death connected to sexual activity may occur. Strengths & Limitations This study presents a large postmortem collection of non-natural death cases with associated sexual activity. As the main limiting factor, it must be stated that mutual consent for a sexual practice or consumption of substances was presumed based on the information provided and a lack of evidence against this assumption. Conclusion In cases of death associated with sexual activity, medical staff should perform thorough unbiased examinations and documentations. Strangulation and the consumption of stimulants should be classified as life-threatening, pleasure-enhancing techniques. Patients and young people should be informed about these risks.

BDSM is an omnibus term covering a spectrum of activities within bondage/discipline, dominance/submission, and sadism/masochism relationships. To date, BDSM practitioners experience stigma due to a general unfamiliarity with the practice and marginalization of this type of sexual behavior. Destigmatization occurs partly through knowledge expansion and identification with the stigmatized group. In this study within the Belgian population, we aimed to characterize certain aspects of socioeconomic status and specific BDSM preferences of individuals with differing BDSM experience levels. We show that individuals who perform BDSM in a community setting (BDSM clubs, events. BDSM-CP) are generally higher educated, are significantly younger when first becoming aware of their inclination toward kink-oriented sex, and have a more strict BDSM role identity (Dom vs. Sub) than individuals who engage in BDSM-related activities in a private setting (BDSM-PP). This latter group in turn display a more pronounced Dom/Sub identification than individuals who only fantasize about the practice (BDSM-F). Our data indicate BDSM interest is a sexual preference already manifesting at early age, with role identification profiles becoming gradually more pronounced based on the practitioner's contextual experience.

Introduction The term kink describes sexual behaviors and identities encompassing bondage, discipline, domination and submission, and sadism and masochism (collectively known as BDSM) and sexual fetishism. Individuals who engage in kink could be at risk for health complications because of their sexual behaviors, and they could be vulnerable to stigma in the health care setting. However, although previous research has addressed experiences in mental health care, very little research has detailed the medical care experiences of kink-oriented patients. Aim To broadly explore the health care experiences of kink-oriented patients using a community-engaged research approach. Methods As part of the Kink Health Project, we gathered qualitative data from 115 kink-oriented San Francisco area residents using focus groups and interviews. Interview questions were generated in collaboration with a community advisory board. Data were analyzed using a thematic analysis approach. Main Outcome Measures Themes relating to kink-oriented patients' experience with health and healthcare. Results Major themes included (i) kink and physical health, (ii) sociocultural aspects of kink orientation, (iii) the role of stigma in shaping health care interactions, (iv) coming out to health care providers, and (v) working toward a vision of kink-aware medical care. The study found that kink-oriented patients have genuine health care needs relating to their kink behaviors and social context. Most patients would prefer to be out to their health care providers so they can receive individualized care. However, fewer than half were out to their current provider, with anticipated stigma being the most common reason for avoiding disclosure. Patients are often concerned that clinicians will confuse their behaviors with intimate partner violence and they emphasized the consensual nature of their kink interactions. Conclusion Like other sexual minorities, kink-oriented patients have a desire to engage with their health care providers in meaningful discussions about their health risks, their identities, and their communities without fear of being judged. Additional research is needed to explore the experiences of kink-oriented patients in other areas of the country and internationally.

Introduction Recent studies have suggested that, in contrast to traditional psychopathologic explanations, bondage and discipline, dominance and submission, and sadomasochism (BDSM) could be understood as recreational leisure. However, the theoretical framing of BDSM as potential leisure has not been empirically explored. Aim To conduct an initial empirical exploration to determine whether BDSM experience fits established characteristics of recreational leisure. Methods A convenience sample of BDSM participants (N = 935) completed an online survey (9 demographic questions and 17 leisure questions) that assessed BDSM experience according to important attributes of leisure. Responses also were assessed and statistically compared as being primarily casual or serious leisure according to general BDSM identities (ie, dominants vs submissives vs switches). Main outcome measures BDSM experiences were assessed as a form of potential leisure. Results Most BDSM experiences met leisure criteria. Participants reported that "most of the time or nearly always" BDSM was associated with a sense of personal freedom (89.7% of participants), pleasure or enjoyment (98.5%), sense of adventure (90.7%), use of personal skills (90.8%), relaxation or decreased stress (91.4%), self-expression or exploration (90.6%), and positive emotions (96.6%). BDSM seemed to function as primarily serious, rather than casual, leisure, but important statistical differences were observed based on specific BDSM identities. Conclusion A leisure science perspective could be valuable to researchers and clinicians in reinterpreting the wide range of diverse BDSM motivations and practices.

Pain can be modulated by contextual stimuli. Masochists reported reduced pain in the masochistic context, and imaging revealed brain areas involved in sensory-discriminative processing. Supplemental Digital Content is Available in the Text., Pain can be modulated by contextual stimuli, such as emotions, social factors, or specific bodily perceptions. We presented painful laser stimuli together with body-related masochistic visual stimuli to persons with and without preferred masochistic sexual behavior and used neutral, positive, and negative pictures with and without painful stimuli as control. Masochists reported substantially reduced pain intensity and unpleasantness in the masochistic context compared with controls but had unaltered pain perception in the other conditions. Functional magnetic resonance imaging revealed that masochists activated brain areas involved in sensory-discriminative processing rather than affective pain processing when they received painful stimuli on a masochistic background. The masochists compared with the controls displayed attenuated functional connectivity of the parietal operculum with the left and right insulae, the central operculum, and the supramarginal gyrus. Masochists additionally showed negative correlations between the duration of interest in masochistic activities and activation of areas involved in motor activity and affective processing. We propose that the parietal operculum serves as an important relay station that attenuates the affective-motivational aspects of pain in masochists. This novel mechanism of pain modulation might be related to multisensory integration and has important implications for the assessment and treatment of pain.

To study symptoms of neurotic disorders and social masochism in chemical addicts.Thirty outpatients of the Novosibirsk Regional Clinical Addiction Dispensary were studied. Corresponding scales and questionnaires, along with a social masochism questionnaire developed by the authors, were used. Results were compared to those of 25 healthy people.A significantly higher level (Изучение проявлений невротических расстройств и социального мазохизма у больных, страдающих химической аддикцией.Обследовали 30 пациентов, наблюдающихся амбулаторно в Новосибирском областном клиническом наркологическом диспансере. Было выполнено психометрическое исследование с применением комплекса шкал, опросников, а также разработанной авторами анкеты социального мазохизма. Оценку по ним проводили в сравнении с показателями, полученными в группе 25 здоровых людей.У лиц с химической зависимостью выявлен достоверно более высокий балл по опроснику невротических расстройств для следующих групп психопатологических расстройств: истерия, тревога, депрессия, а также нарушения сна. Достаточно выраженными при химической аддикции были свойственные социальному мазохизму особенности личности и поведения (разные виды агрессии, виктимность, раздражительность, негативизм, переживания обиды и вины; самоповреждающее, гиперсоциальное, провоцирующее и некритичное поведение, ощущение роли жертвы, негативное восприятие окружающего). Также был характерен высокий общий показатель социального мазохизма. Выявлена связь между показателями аффективной сферы, проявлениями социального мазохизма и невротическими расстройствами.

Bondage and discipline, dominance and submission, sadism and masochism (BDSM) refers to a variety of primarily erotic practices. Although safety is crucial for most BDSM practitioners, there are violent forms that may cause serious injury. We present the case of 61-year-old man with no history of chronic kidney disease who developed severe acute anuric kidney injury following violent BDSM play. He had been strapped tightly onto a wooden spanking bench and then received approximately 1000 vigorous hits onto his bare buttocks and thighs. Subsequently, he developed haematuria and became anuric. Laboratory testing revealed strongly elevated serum creatinine levels. Kidney biopsy was unremarkable except mild tubulointerstitial damage. Urinary production increased spontaneously again after 4 days, and serum creatinine normalised over the course of 4 weeks. We believe that a combination of intermittent abdominal compartment syndrome and blunt kidney trauma may have been responsible for this severe acute kidney injury.

BDSM sexual practices related to sadomasochism, domination and submission, represent a vast range of possibilities in terms of paraphernalia, associated emotions, uses and applications that are as diverse as the human beings who practice it. Taking this into account, we conducted a study to understand the practices related to BDSM, under the perspective of its own practitioners. For this, a qualitative methodology was used, with an emergent and projected type of design. We covered 8 in-depth interviews on men and women from Venezuela and the data was analyzed through the constant comparison method in order to generate grounded theory, this paper comes up as part of a larger study. Among the most outstanding findings were the importance of limits, some as irrefutable an others that are meant to break, and the importance of the physical and mental health conditions in the practice.Las prácticas sexuales BDSM relacionadas con el sadomasoquismo, la dominación y la sumisión, representan un abanico vasto de posibilidades en cuanto a parafernalia, emociones asociadas y usos tan diversos como los seres humanos que lo practican. Debido a esto, realizamos un estudio para entender las prácticas sexuales relacionadas al BDSM, bajo la mirada de sus propios practicantes. Para ello se empleó una metodología cualitativa con un tipo de diseño emergente y proyectado. Se realizaron 8 entrevistas a profundidad a hombres y mujeres en Venezuela, se analizaron los datos a través del método de comparación constante con el fin de generar teoría fundamentada. Este artículo surge como parte de los resultados de un estudio mayor. Entre los hallazgos más resaltantes se encontró la importancia a los límites, algunos como irrefutables y otros que se intentan traspasar y lo primordial de la práctica en condiciones de salud física y mental.

BDSM is an overlapping acronym referring to the practices of bondage and discipline, dominance and submission, and sadism and masochism. This article reviews the psychological literature on BDSM practitioners and discusses issues concerning BDSM that are relevant to clinicians and sexual health-care providers. The literature concerning the psychological health of BDSM practitioners and clinical issues in treating BDSM practitioners was exhaustively reviewed. BDSM practitioners differ minimally from the general population in terms of psychopathology. Six clinical considerations emerged: ignoring versus considering BDSM; countertransference; nondisclosure; cultural competence; closer relationship dynamics; BDSM, abuse, and pathology.