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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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

We examined the enduring effects of predictable versus unpredictable fear conditioning early in life on memory and relearning in adulthood. At postnatal Day 17 or 25 (P17 or P25), rats either remained naive, or were fear conditioned using paired (predictable) or unpaired (unpredictable) presentations of white noise and foot shocks. At 2 months of age (adulthood), each group was fear conditioned (or reconditioned) with either paired or unpaired training, and then was tested for fear extinction the next day. Initial findings replicate previous work from our lab and others, demonstrating a difference in adult memory retention based on age of acquisition. Specifically, rats that received paired conditioning at P25, but not P17, show increased freezing to the cue when tested in adulthood. We further show that paired as well as unpaired conditioning at P17 potentiates paired conditioning in adulthood; however, paired, but not unpaired, conditioning at P25 potentiates paired and unpaired conditioning in adulthood. These findings suggest that early predictable versus unpredictable aversive learning at P17 or P25 differentially modulate memory retention and future learning. (PsycINFO Database Record

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.

Malignant self-regard (MSR) was proposed as a particular type of self-structure that may account for similarities among a set of clinically relevant Personality Disorders (PDs) such as masochistic/self-defeating and depressive PDs that yet have failed to be adequately represented in the diagnostic manuals. The investigation on the MSR may provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. The present study examines the psychometric properties of the Italian adaptation of the Malignant Self-Regard Questionnaire (MSRQ). Reliability and validity indicators are determined in a large sample of adults from general population (n = 2574). The measure was found to be reliable and valid, given its correlations with measures of depressive personality, negative affectivity, self-defeating, and vulnerably narcissistic personalities. MSR also can be meaningfully differentiated from a nomological network of related constructs, including sadness rumination, depression, neuroticism, extraversion, and grandiose narcissism. These findings suggest that MSR may be a personality component which includes a negativistic self-representation, vulnerability and hypersensitivity to judgment, sometimes compensated by perfectionistic tendencies. As a whole, results seem to support the reliability and the validity of the Italian adaptation of the MSRQ as a measure of the MSR.

This essay examines the theme of masochism in the metapsychological work of French psychoanalyst Jean Laplanche. One of the most distinctive aspects of Laplanche's work as a whole is its recursiveness: it advances by repeatedly retraversing the same themes and rereading the same Freudian texts, often after intervals of years and each time from a deepened critical perspective. The approach taken in this essay is therefore diachronic. That is, rather than seeking to present a reduced summation of Laplanche's position on masochism, it tracks the recursive evolution of his thinking about masochism, from the 1960s through to the development of his celebrated "general theory of seduction." The essay locates each of Laplanche's key interventions on masochism within the broader frameworks of his theoretical enterprise, and positions masochism as a point of orientation for understanding a number of the essential claims of his metapsychology, particularly the relationships among fantasy, pain and the drives; the economic dimensions of human desire; and the intersubjective origins of psychosexuality. Finally, the essay suggests that masochism might have a particular pertinence to psychoanalytic thinking as Laplanche conceives and practices it: that is, as a pains-taking labor whose very stimulus is the "wound" of the Freudian breakthrough.

Sadomasochistic (SM) sexual interest is reported by a wide range of individuals. Within the sex offender literature, the presence of SM interest is often viewed as a herald of criminal sexual behavior; however, research indicates that SM interests are not predictive of coercive sexual behavior. In the current study, we measured a range of sexual fantasies and behaviors, and then applied cluster analyses to determine (1) if individuals endorsed elevated SM interests also endorsed coercive fantasies and, (2) to explore cluster membership correlates using measures of sensation seeking, externalizing and antisocial behaviors, attitudes toward rape, and empathic capacity. A total of 550 participants were recruited through a variety of on-line discussion areas. A four cluster solution best fit the data with distinct clusters observed for those endorsing SM behaviors and those reporting coercive sexual behavior. Additional analyses revealed greater endorsement of victim blaming attitudes and lower empathic concern among members of the coercive sexual behavior cluster. Elevated sensation seeking and externalizing behaviors were reported by members of clusters marked by SM and coercive sexual behavior. Results provide further support for the differentiation between SM and coercive sexual behaviors as representative of individuals with divergent attitudes, traits, and behaviors.

People engaged in masochistic behaviour (MB) seek to experience pain and the pleasure it evokes in sadomasochistic (SM) sessions. The sensitivity and attitude to pain in these individuals has hardly been tested. We evaluated pain perception among these individuals and tested whether their experiences and attitudes towards pain are context-related.Thirty-four healthy subjects participated; 17 routinely engaged in MB and 17 controls. Pressure pain threshold (PPT) was measured in two body regions. A structured questionnaire on SM activities and context-related pain experiences and emotions was completed, as well as the pain catastrophizing (CAT) and fear of pain (FOP) questionnaires.PPT was significantly higher among MB individuals and positively correlated with the frequency of SM sessions. MB individuals also had lower levels of CAT, and FOP correlated negatively with the frequency of MB and the number of body regions involved. Pleasure evoked during SM sessions correlated positively with pain intensity and number of body regions involved. Pain in everyday life correlated negatively with MB activities. However, the emotional attitude to everyday pain was ambivalent: MB individuals perceived pain intensity and unpleasantness similar to the controls, but simultaneously gained pleasure from the pain.MB individuals exhibited pain hyposensitivity, presumably resulting from frequent engagement in MB. Alternatively, these subjects may have a predisposition which enables this engagement. Attitudes towards pain in MB individuals are complex. They appear to be context-related with pain experienced as pleasurable and rewarding during SM sessions, and negative but still pleasurable in everyday life.

Considering that sexuality scholars claim consensual sadomasochists experience sexual objectification differently from the general population (Califia, 1994 ; Connell, 2002 ; Nussbaum, 1995 ), this study explored self-objectification (Fredrickson & Roberts, 1997 ) and body satisfaction among 121 self-identified consensual sadomasochists, 67 of whom also self-identified as women. Participants responded to an online survey and reported their self-objectification, self-surveillance, body shame, and body satisfaction measures, along with their body mass index (BMI) and identification as dominant, submissive, or switch. The data revealed that the study participants' differed greatly in their sexual objectification experiences according to their genders, sexual orientations, and sadomasochistic identities, suggesting that consensual sadomasochism offers participants an environment partially free of the negative consequences resulting from Western beauty ideals.

Although the work of Erich Fromm is not usually associated with feminist theory, his ideas overall are more consonant with contemporary notions of gender than usually recognized. This paper identifies three aspects of Fromm's thought worth feminist revisiting. The first relates to Fromm's gender-less use of sadomasochism to describe relationships based on dominance and subordination; this framework can be applied to sexist dynamics, though not limited to this context. Second, Fromm's vision of love as presented in The Art of Loving can be seen as kindred with Simone de Beauvoir's critique of romantic love and its flaws. Third, and relatedly, Fromm's concerns about the need for recognition as well as autonomy are compatible with Jessica Benjamin's notion of mutual recognition as developed in her book The Bonds of Love. All told, Frommian and feminist thought appear to be more connected than antagonistic.

A traditionally marginalized subset of couples engage in consensual nonmonogamy (CNM: open marriage, polyamory, swinging, etc.) or alternative sexualities, such as kink or bondage/discipline, dominance/submission, and sadism/masochism. Nonmonogamous and sexually diverse individuals often experience discrimination or stigma in various domains of professional services, including mental healthcare. These cases require knowledge, skills, and awareness to provide culturally sensitive care, which is often called "kink aware therapy" or "poly-friendly therapy" within alternative sexuality communities. This article explores one application of a kink-focused and CNM-focused therapeutic framework for working with a couple who is exploring nontraditional sexualities. This case incorporates evidence-based clinical practice and identifies the limitations and significant gaps in the empirical research literature.

Willingness to lay down one’s life for a group of non-kin, well documented in thehistorical and ethnographic records, represents an evolutionary puzzle. Here wepresent a novel explanation for the willingness to fight and die for a group, combining evolutionary theorizing with empirical evidence from real-world human groups. Building on research in social psychology, we develop a mathematical model showing how conditioning cooperation on previous shared experience can allow extreme (i.e., life-threatening) pro-social behavior to evolve. The model generates a series of predictions that we then test empirically in a range of special sample populations (including military veterans, college fraternity/sorority members, football fans, martial arts practitioners, and twins). Our results show that sharing painful experiences produces “identity fusion” – a visceral sense of oneness – more so even than bonds of kinship, in turn motivating extreme pro-group behavior, including willingness to fight and die for the group. These findings have theoretical and practical relevance. Theoretically, our results speak to the origins of human cooperation, as we offer an explanation of extremely costly actions left unexplained by existing models.Practically, our account of how shared dysphoric experiences produce identity fusion, which produces a willingness to fight and die for a non-kin group, helps us better understand such pressing social issues as suicide terrorism, holy wars, sectarian violence, gang-related violence, and other forms of intergroup conflict.

Background Bondage and discipline, dominance and submission, and sadism and masochism (BDSM) is gaining popularity through the mainstream media. Nevertheless, very little is known about the prevalence of BDSM-related fantasies and activities in the general population. Aim To determine the prevalence of BDSM fantasies and behavioral involvement in four different age groups of the general population in Belgium. Methods By use of a cross-sectional survey questionnaire, the level of interest in several BDSM-related activities was investigated in a sample representative of the general Belgian population (N = 1,027). The questionnaire evaluated interest in 54 BDSM activities and 14 fetishes. Self-identification as BDSM practitioner, situational context of BDSM practice, age at awareness of these interests, and transparency to others were queried. Outcomes Individual item scores and summary scores on four BDSM categories were included in the analyses. Results A high interest in BDSM-related activities in the general population was found because 46.8% of the total sample had ever performed at least one BDSM-related activity and an additional 22% indicated having (had) fantasies about it. Interestingly, 12.5% of the total population indicated performing at least one BDSM-related activity on a regular basis. When asked whether they saw themselves as being interested in BDSM, 26% stated this to be the case and 7.6% self-identified as BDSM practitioners. Interests in dominant and submissive activities were comparable and, remarkably, were highly intercorrelated. BDSM and fetish interests were significantly higher in men than in women. The older group (48–65 years) had significantly lower BDSM scores compared with their younger peers. Of participants with a BDSM interest, 61.4% became aware of it before 25 years of age. Clinical Implications There is a high level of interest in BDSM in the general population, which strongly argues against stigmatization and pathologic characterization of these interests. Strengths and Limitations This is the first thorough study concerning prevalence of interest in and fantasies about a wide range of BDSM-related activities in the general population worldwide. Although our findings tend to argue against it, we cannot completely rule out participation bias introduced by non-interest in the non-completers. In addition, some topics might have been subject to interpretation by the respondents. Conclusion Interest in BDSM is present in most of the general population. Further research is needed to destigmatize it by confirming BDSM as a leisurely preference rather than a psychiatric affliction.

This study aims to explore personal meanings related to the constructs 'sexuality' and 'sexual pleasure' in people who choose to write in forums and blogs about their own experience with Bondage and Discipline, dominance and submission, and Sadism and Masochism (BDSM). We carried out semi-structured online interviews with 343 people, of whom 50 (24 women and 26 men) claimed to practise or to have practised BDSM, in order to investigate participants' definitions of their sexual experiences and the construction of sexuality and sexual pleasure from their personal point of view and from the perspective of the opposite sex. Data were analysed according to Grounded Theory methodology. Questions concerning the 'normality' or the 'deviance' of participants' sexual practices were reflected in the answers of the majority of BDSM practitioners. Sexuality was construed as a 'game' with specific rules, and 'pleasure' was associated with extremely intense experiences. The relationship between the partners was considered fundamental, as it gave meaning to the sexual practice. Both dominant and dominated roles were found to be tightly linked to the possession and management of power between partners, which either confirms or reverses the social construction of traditional male and female roles.

Several personality disorders (PDs) have been of interest in the clinical literature, yet failed to have been adequately represented in the diagnostic manuals. Some of these are masochistic, self-defeating, depressive, and narcissistic PDs. The theoretical and empirical relationships among these disorders are reviewed. It is proposed that a particular type of self-structure, malignant self-regard (MSR), may account for similarities among all of them and provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. Subsequently, a questionnaire to assess MSR was created and evaluated for its psychometric properties. The measure was found to be reliable (Cronbach's alpha = .93) and valid, given its correlations with measures of self-defeating, depressive, and vulnerably narcissistic personalities (rs range from .66 to .76). MSR also can be meaningfully differentiated from a nomological network of related constructs, including neuroticism, extraversion, depression, and grandiose narcissism. The utility of assessing self-structures, such as MSR, in the diagnostic manuals is discussed.

This article presents a revisionary reading of Freud's Beyond the Pleasure Principle. Recognizing the power of Freud's meditation on a universal "death-drive" in living organisms, it argues that Freud makes a greater contribution by strengthening the compulsion to repeat to a form of figurative death. We recall that after shattering the presupposition of a universal pleasure principle, Freud demonstrates an equally strong pain-principle. The pain-principle entails a return to an old image in the mind, just as Freud identifies Eros, the transfigured pleasure-principle, with the movement toward something new, "a different individual." The moving backward toward old love in opposition to the moving forward to new love is an inspired narrative application of the Oedipus complex. The repetitive backward movement is a figurative death when the observing other or self encounters a deathlike affect of despair or persecution. Less persuasive because less experience-near is the concept of the death-drive. Freud writes in different voices, and the death-drive speculation is in the mode that privileges scientific speculation over other forms of thought, even as Freud shows a variety of stylistic modes for reaching the truth. Yet it is the mode that observes human interactions and transforms them to figurative narrative that moves most profoundly to the never-fully-knowable-human-unconscious. We discover the hidden motive for repetition as a return to the original rejection or rage that was a form of previous intimacy. The genre that these figurative narratives take is close to literary romance, and death, or the special suffering that Coleridge evocatively termed "life-in-death," is the hidden object of its dark quest.

Prior studies consistently report that men's genital responses correspond to their sexual activity interests (consenting vs. coercive sex) whereas women's responses do not. For women, however, these results may be confounded by the sexual activities studied and lack of suitable controls. We examined the subjective and genital arousal responses of men and women with conventional (22 men and 15 women) or masochistic sexual interests (16 men and 17 women) to narratives describing conventional sex or masochistic sex. The aims of the studies were twofold: (1) to examine whether gender differences in the specificity of sexual arousal previously observed for gender also exist for sexual activity interests; and (2) to examine whether men and women with masochistic sexual interests demonstrate specificity of sexual response for their preferred sexual activities. Surprisingly, the pattern of results was very similar for men and women. Both men and women with conventional sexual interests (WCI) reported more sexual arousal, and responded more genitally, to conventional than to masochistic sex, demonstrating specificity of sexual arousal for their preferred sexual activities. Despite showing specificity for conventional sexual activities, the genital responses of WCI were still gender nonspecific. In contrast, women and men with masochistic sexual interests demonstrated nonspecific subjective and genital responses to conventional and masochistic sex. Indices of genital and subjective sexual arousal to masochistic versus conventional stimuli were positively and significantly correlated with self-reported thoughts, fantasies, interests, and behaviors involving masochism. The results suggest that gender similarities in the specificity of sexual arousal for sexual activity exist despite consistent gender differences in the specificity of sexual arousal for gender.

Vorarephilia ("vore") is an infrequently presenting paraphilia, characterized by the erotic desire to consume or be consumed by another person or creature. Few data exist on vore though several cases have been reported which appear to be consistent with basic vorarephilic interests. Because this sexual interest cannot be enacted in real life due to physical and/or legal restraints, vorarephilic fantasies are often composed in text or illustrations and shared with other members of this subculture via the Internet. Similarities with aspects of bondage/dominance sadomasochism interests, more specifically dominance and submission, are noted. The current case report describes a man with masochistic sexual interests which intersected with submissive vorarephilic fantasy.

Do people sometimes seek to atone for their transgressions by harming themselves physically? The current results suggest that they do. People who wrote about a past guilt-inducing event inflicted more intense electric shocks on themselves than did those who wrote about feeling sad or about a neutral event. Moreover, the stronger the shocks that guilty participants administered to themselves, the more their feelings of guilt were alleviated. We discuss how this method of atonement relates to other methods examined in previous research.

IntroductionIt has been generally thought that the practice of bondage-discipline, dominance-submission, sadism-masochism (BDSM) is in some form associated with psychopathology. However, several more recent studies suggest a relative good psychological health of BDSM practitioners.AimThe aim of this study was to compare scores of BDSM practitioners and a control group on various fundamental psychological characteristics.MethodsFor this aim, 902 BDSM and 434 control participants completely filled out online questionnaires. Associations were examined using χ2 tests of independence with φ and Cramer's V as effect size measures and eta or Pearson's correlation. Group differences were tested using analysis of covariance, with partial η2 as effect size measure. A priori contrasts were tested using α = 0.01 to correct for multiple testing; for all other tests we used α = 0.05, two tailed.Main Outcome MeasuresThe study used Big Five personality dimensions (NEO Five-Factor Inventory), attachment styles (Attachment Styles Questionnaire), rejection sensitivity (Rejection Sensitivity Questionnaire), and subjective well-being (World Health Organization-Five Well-being Index).ResultsThe results mostly suggest favorable psychological characteristics of BDSM practitioners compared with the control group; 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. Comparing the four groups, if differences were observed, BDSM scores were generally more favorably for those with a dominant than a submissive role, with least favorable scores for controls.ConclusionWe conclude that BDSM may be thought of as a recreational leisure, rather than the expression of psychopathological processes. Wismeijer AAJ and van Assen MALM. Psychological characteristics of BDSM practitioners. J Sex Med 2013;10:1943–1952.Keywords: BDSM, SM, Recreational Leisure, Paraphilia, Personality, Attachment,Subjective Well-Being

Participation in extreme rituals (e.g., fire-walking, body-piercing) has been documented throughout history. Motivations for such physically intense activities include religious devotion, sensation-seeking and social bonding. The present study aims to explore an extreme ritual within the context of bondage/discipline, dominance/submission and sadism/masochism (BDSM): the 'Dance of Souls', a 160-person ritual involving temporary piercings with weights or hooks attached and dancing to music provided by drummers. Through hormonal assays, behavioural observations and questionnaires administered before, during and after the Dance, we examine the physiological and psychological effects of the Dance, and the themes of spirituality, connectedness, transformation, release and community reported by dancers. From before to during the Dance, participants showed increases in physiological stress (measured by the hormone cortisol), self-reported sexual arousal, self-other overlap and decreases in psychological stress and negative affect. Results suggest that this group of BDSM practitioners engage in the Dance for a variety of reasons, including experiencing spirituality, deepening interpersonal connections, reducing stress and achieving altered states of consciousness.

An analysis is presented of A vida sexual (The sexual life), by Portuguese neurologist Egas Moniz, in which the author divulged medical instructions about the sexed body. Complied in two volumes - "Physiology" and "Pathology" - in 1902, it was edited 19 times until it was censored under the Portuguese military dictatorship in 1933. In the work, Moniz devises a discourse of sexual differentiation anchored in an extensive bibliography produced between the late nineteenth and early twentieth centuries in a context of intense debate about gender roles. Moniz drew on several theories to define sexuality - including eugenics and Freudian theory - to express his idea that "man is essentially sexual, woman is essentially mother."O artigo analisa a obra A vida sexual, do neurologista português Egas Moniz, que intencionava com ela divulgar instruções médicas sobre o corpo sexuado. Compilada nos tomos “Fisiologia” e “Patologia” em 1902, teve 19 edições até sua censura pelo Estado Novo português, em 1933. Nela, Moniz elabora um discurso de diferenciação sexual ancorado em ampla bibliografia produzida entre fins do século XIX e início do século XX, em um contexto de intensos debates acerca de papéis de gênero. Observa-se que seu autor recorreu a múltiplos dispositivos de significação da sexualidade – como a eugenia e a teoria freudiana – para difundir sua ideia de que “o homem é essencialmente sexual, a mulher é essencialmente mãe”.

The ways in which the analyst's desire for particular experiences with patients is inevitable and often leads to narcissistically based resistances are considered. Five propositions are examined: (1) that the analyst cannot help but have desires and want them recognized by the analysand; (2) that these desires frequently underwrite the analyst's theoretical beliefs and technical interventions; (3) that narcissistic desires and their influence are ubiquitous among practicing analysts; (4) that the patient is often on the lookout for the analyst's various agendas; and (5) that the patient often hopes the analyst will put his or her desire aside and listen so the patient can further his or her own interests. Lacan's concept of the “dual relation” is central to this discussion. The neo-Kleinian position on narcissistic resistances is explored, as is the idea of the “analytic third” as a potential solution to the problem they pose. An extended case description illustrates the main points.

Objective Bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners are at increased risk for suicidal thoughts and behaviors. We hypothesized the association between (a) lifetime frequency of BDSM-related sexual behaviors and (b) BDSM identification and suicide attempt status would be mediated by acquired capability components (i.e., fearlessness about death and pain tolerance). Gender differences were examined. Method Participants were 576 BDSM practitioners (meanage = 28.71; 66.7% male) recruited from online BDSM-related groups, cross-sectionally. Results Among males, the total indirect effect of acquired capability components in the relation between BDSM-related sexual behaviors and suicide attempt status was significant. The specific indirect effect of perceived pain tolerance in the relation between both BDSM-related sexual behaviors and BDSM identification and suicide attempt status was significant. There were no significant effects for females. Additionally, 12% reported a suicide attempt history. Conclusion Among males, BDSM-related sexual behaviors and BDSM identification were associated with increased acquired capability components, which were positively associated with suicide attempt status.