The Neurobiology of BDSM Sexual Practice

How can one experience physical or emotional pain as pleasurable?

By now, everyone’s got an opinion about 50 Shades of Grey: It's trash; it’s fun fantasy-fodder; it’s
misogynist; it’s empowering for women; it’s silly. While the 50 Shades media saturation has grown
tiresome, one must admit that it’s compelled a societal discussion of sexual practices involving
bondage, discipline, sadism, and masochism (BDSM) that are otherwise not broadly considered.
Leaders of the BDSM community are quick to point out that 50 Shades is not an accurate
representation of BDSM sexual practice where “safe, sane, and consensual” are the watchwords and
that the term “BDSM” is broad, like the term “sports.” It includes people with highly divergent sexual
desires and personae. Just because you like to be flogged doesn’t mean that you necessarily like to
be humiliated as well.

For those outside of this group, a failure to understand the appeal of BDSM practice usually comes
down to this: How can one experience pain, either the physical pain of a smack on the tush or the
emotional pain of humiliation, as pleasurable? Aren’t pain and pleasure diametrically opposed?

You don’t have to be a masochistic sex enthusiast to know that pleasure and pain can be felt
simultaneously: think of the pleasures of a delicious meal laden with spicy chili peppers or the
blissful ache following a long-distance run. In the lexicon of cognitive neuroscience, both pleasure
and pain indicate salience, that is, experience that is potentially important and thereby deserving of
attention. Emotion is the currency of salience and both positive emotions like euphoria and love and
negative emotions like fear and disgust signal events that we must not ignore.

How is salience built into neural pathways? We have an evolutionarily ancient and highly
interconnected pleasure circuit in our brains. When neurons in a brain region called the ventral
tegmental area become electrically active, thereby triggering the release of dopamine in a structure
called the nucleus accumbens, this evokes the feeling of pleasure from both our vices (eating food
when hungry, having an orgasm, drinking alcohol) and our virtues (meditation, learning, giving to
charity).

Here are the key findings that help to explain the pleasure-pain connection. When subjects in a brain
scanner received in injection into the jaw muscles that produced a protracted aching type of pain,
this triggered dopamine release in the nucleus accumbens and the greatest release was seen in
those subjects who rated the pain as most unpleasant. In rats, one can examine this phenomenon in
greater detail. Electrical recordings from single dopamine neurons of the ventral tegmental area
revealed that all of these neurons responded to the presentation of a tasty sugar-droplet, yet some
of these neurons responded to a brief painful footshock with a decrease in their ongoing rate of
activity while others responded with an increase. In other words, these latter dopamine-using
neurons were salience detectors, releasing dopamine in response to either pleasure or pain. We also
know, from different experiments, that protracted physical pain and protracted emotional pain
(resulting from social rejection) can cause the release of endorphins, the brain’s own morphine-like
molecules and that these endorphins can activate dopamine neurons in the ventral tegmental area.
The end result is that there is an innate rewarding component to both pleasurable and painful
experiences.

How then, can we account for individual differences? Why do surveys reveal that only 5 to 10
percent of people enjoy receiving pain in a sexual context? The short answer is that we don’t entirely
know. Understanding how sexual kinks develop has not been a funding priority for government
agencies and biomedical research charities. There are variant forms of dopamine receptor genes
that attenuate the experience of pleasure and increase risk-taking and novelty-seeking behavior.
However, it’s not clear that these gene variants or any others (such as those related to endorphin
signaling or pain perception) are linked to the practice of sexual masochism.

Perhaps the best hypothesis for sexual masochism comes by analogy from studies of another painful
practice: chili pepper consumption. If you grow up in a community where chili peppers are readily
eaten, you will reject them as an infant, but by about age 5, you will almost certainly develop a taste
for these painful foods. Rats and mice, by comparison, cannot be trained to choose chili peppers in
their food no matter how their upbringing is manipulated by scientists. It is likely that there is a
human predisposition to learn to find certain forms of pain to be rewarding. This seems to be the
case when pain is survivable and doesn’t lead to permanent damage as in both masochistic sexual
practice and chili pepper eating. However, it is only when that human predisposition is combined
with aspects of one’s particular life experience (as influenced by cultural and religious ideas) that the
brain’s neural salience circuits are modified to forge the pleasure-pain connection in a sexual
context.

What's Dangerous About BDSM?

BDSM: Loving, dangerous, or deviant?

Sadomasochism can be considered a type of sexual play, preference, or identity where an individual
derives satisfaction from receiving pain, inflicting pain, or both. Often called "S&M," sadomasochism
is part of a large category of consensual sex practices and lifestyles called BDSM. BDSM is an
acronym for "bondage and discipline," "dominance and submission," and "sadism and masochism."

Sadomasochism can be difficult for people to understand, and for some it can seem downright scary.
For individuals who prefer a more "vanilla" sexual life with no kink, it can seem odd that there are
people who want to be whipped, uncomfortably chained to a cross, caned, or otherwise tortured.
Equally as disturbing can be imagining oneself being the person who enjoys doing these things to
others. For many people, the practices associated with sadomasochism can bring up strong
reactions, one of them commonly being, "That's dangerous!"

In an article published by ABC News last year, and in other articles from mainstream news sources
over the past few years, this seems to be the reaction. The ABC article, entitled, "Love Hurts:
Sadomasochism's Dangers," discusses a 67-year old man who was rushed to the emergency room
after losing consciousness in a sex club. He had passed out during an S&M scene that involved him
hanging by his arms from a cross, and the damage was so severe that it took him a few days to
regain consciousness. The article discusses how lucky the man is to be alive, and goes on to talk
about the more unfortunate individuals who have died while engaging in S&M practices. Not
surprisingly, the article's main message, as expressed by the sex experts they quote in the article,
seems to be that people shouldn't get into dangerous sex.

It's true that some sex practices can be dangerous, and that people should always take precaution
when experimenting with a new practice. But people can get injured or die from a variety of
activities. A SCUBA diving death is not uncommon, nor is a rock climbing death. Even dying during
sex isn't uncommon after a certain age. What makes BDSM injuries and deaths so newsworthy is
that they occurred during alternative sex practices that are not widely well understood. The mystery
surrounding these practices allows people to be easily frightened, and it can make judgment seem a
little more OK.
In the ABC News article, it seems like the reaction expressed ("That's dangerous!") is thinly masking a
judgment toward BDSM. If the message is really just that S&M (and hence BDSM) can be dangerous
for some people at some times, then it would make sense to give tips about how to reduce the
danger (other than full abstinence). For instance, the dangers associated with BDSM can be greatly
reduced by consensually playing with a caring, experienced partner, using safe words, and clearly
defining boundaries ahead of time. There are many safety precautions taken by those who engage in
BDSM, and nearly none of that information is presented in this article, which makes individuals who
are into BDSM practices appear to be universally irresponsible and negligent.

In addition, the article appears to pathologize individuals who prefer BDSM to more normative sex
practices, assuming them to be incapable of love. As quoted in the article, Judy Kuriansky, a sex
psychologist, says, "There is a triumvirate of guilt, embarrassment, and fear of intimacy for these
people ... It's rare that all of the sudden they can give up on being interested in pain and suddenly
capable of being loved." It seems that while the article started with one reaction, that BDSM is
dangerous, it ends with a judgment that BDSM is a shameful, rarely curable pathology that afflicts
those who cannot experience love and intimacy. By asserting that the inclusion of S&M in sex
precludes a person from experiencing love, the article is endorsing the idea that there is only one
way to love. However, many individuals in BDSM communities vehemently disagree, and maintain
that they do love, and that BDSM allows them to do this more fully. To quote Lee, the main
character in the S&M-themed movie "Secretary": "I feel more than I've ever felt and I've found
someone to feel with. To play with. To love in a way that feels right for me."

So what's dangerous about BDSM? Is BDSM dangerous because it is bad for our health, or because it
is non-normative and threatening to traditional views on love? Is BDSM only for deviants who can't
love, or is BDSM just a different way of loving? Before deciding, it can be useful to take a look at the
other side of the issue, from the perspective of those who enjoy BDSM in their lives. A few websites
that explain pro-BDSM views are below.

BDSM: What Is Healthy and What Is Pathological?

A relational look at BDSM.

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

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

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

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

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

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

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

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

Human sexuality is complex.

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

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

Sometimes individuals enter treatment specifically due to relentlessness in their sex life, which has
left them feeling empty, longing, self-loathing. Sexual stimulation is readily available and as
accessible as alcohol or chocolate; quick fixes surround us. It is often exhaustion, deeper depression,
and diminishing excitation that ultimately lead to wanting to understand what is driving one toward
repeated, incessant, or compulsive sex. These issues can arise in the BDSM community, as well.
One significantly overlooked issue pertains to the quantity and intent of sexual encounters among
BDSM practitioners. In cases where BDSM practices are also risky, intended to surreptitiously harm,
or are compulsive, they are not "normal"—no more so than the behaviors of an individual who
recklessly or compulsively engages in more traditional sexual practices.

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

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

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

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

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

What Is Kink?

Kink behaviors generate a power dynamic through sexual activities.

The writer Jillian Keenan reflected, “Kink can be such an orienting force that, for many of us, it even
overpowers gender. The term BDSM might be more familiar than kink to readers, especially those
older than millennials. BDSM refers to 'consensual practices that involve, but are not limited to,
bondage and discipline (B&D), dominance and submission (D&S), and sadomasochism (S&M) … [and]
comprised of a power dynamic between partners enacted through various activities.'” (Gemberling
et al., 2015.)

Today’s youths and young adults generally call BDSM kink: “engaging in behaviors that generate a
certain power dynamic, experiencing attraction towards acts with a certain power dynamic, and
adopting an identity that conveys a certain power dynamic.” (Keenan, 2014.) Kink thus contrasts
with vanilla, conventional, or normative sex. Kink groups have formed on many college campuses to
provide support and social activities to kinksters, and to provide information to the larger audience,
including college administrators. Many groups give educational presentations to college classes and
groups (e.g., sororities, fraternities, athletic teams) and to the community.

According to a large-scale survey a decade ago by Susan Wright, the most frequent kink behaviors
engaged in by 75% to 90% of practitioners were bondage, discipline, dominance, submission,
spanking, leather, role-playing, exhibitionism, polyamory, clothing fetish, and voyeurism.

In the public mind, kink is often equated with “weird sex,” which they don’t understand and usually
don’t approve of. However, it is critical from a kink perspective that what kinksters do is not just
about sex but, more importantly, about enhancing intimacy between partners. Thus, kink is usually a
partnered rather than a solo activity. The sex heightens not only pain/pleasure but also the intimacy
between partners. And, it is essential to remember that kink sex is always consensual sex.

The general public sometimes views such power-oriented activities as a sign of mental illness, a
history of sexual abuse, bad parenting, or adherence to cultural crazies. As a result, some respond
with harassment, violence, and discrimination. Kinksters report considerable negative effects from
exposure to others who share adverse views that range from shaking heads to physical violence. In
the Wright study, nearly 40% of respondents indicated that “they had either been discriminated
against, had experienced some form of harassment or violence, or had some form of harassment or
discrimination aimed at their BDSM-leather-fetish-related business.”

Science has yet to reach a consensus on BDSM’s nature and development. As psychologist Tess
Gemberling and colleagues summarized:

"Specifically, although theories describing its origin abound, it remains unclear whether BDSM is best
conceptualized as a sexual behavior, sexual attraction, sexual identity, and/or sexual orientation for
those who practice for sexual purposes … Consistent with a sex-positive framework, BDSM may be
best conceptualized as another form of sexual orientation for a percentage of practitioners."

Representing the prevailing view that kink is an orientation, Keenan argued:

"Kink is often so fundamental to our sexual identities that it has to be, at least in some cases, an
orientation … Our orientation is so deeply rooted that many of us feel we were born with it. For us,
kink mixes language, ritual, trust, power, pleasure, pain, and identity in a way that can’t be captured
by a stereotype … If you accept this definition, then my kink is my sexual orientation. It’s not my
choice. It’s not my illness. And it's definitely not my hobby."

That is, kink is both an identity (if recognized and accepted as such) and an orientation, which means
one can hide it, not practice it, and renounce it—but it’s not going away. The implication for non-
practitioners is that they need not fear being lured into a kink lifestyle.
The fact that kink appears so developmentally early in the lives of individuals is one piece of
evidence suggesting kink is an orientation. I interviewed the 19-year-old Tait about his earliest
memories—it was a dream he had at age 5 that he now sees as early proof of his adult kink.

"So I’m in this weird hospital room … It wasn’t explicitly sexual. Nothing actually sexual was
happening, but I would file it under that. It was kind of this clean sterile hospital room. There were
these hydrant-like things with these nozzles. Call it phallic if you want. Whatever. All very kind of
alien and clinical. And there were these people who were walking around with these surgical masks
and running things. There was me, he was a little small thing, and a bunch of other people. And we
were all somehow on these toilet seats or something. And there was this plastic webbing that was
keeping us there and we were stuck … But it was this really weird feeling that came over me. Like I
wouldn’t necessarily say it was arousal but it was some kind of a stress mixed with fear and
apprehension. I was like, ‘What am I doing here?' … And even to this day, the image, I have no clue
where it came from necessarily."

Taking the DSM out of BDSM

A more detailed exploration of the difference between kink and abuse

It is a fact worth facing that many of us desire things in the bedroom at night that we would march in
protest against during the day. There is no contradiction here. This dichotomy is healthy for people
who can tell the difference between fantasy and reality. For those that cannot see this difference—
their psychosis alone is cause for concern and has no necessary connection to any set of sexual
practices or preferences.

If the human species has a unique selling point on this good green earth, it is this: we alone create
symbolic representations of the world. We are Homo Exemplar. The species that tells stories, paints
pictures, dances dances, dreams, fantasizes, and builds models.

If these models are satisfying descriptions of the world—we call them art. If they make satisfying
predictions about the world we call them science. Some activities partake in both art and science—
but that’s not the point I want to make today. The crucial point…the really really important point…
the point, the ignoring of which makes some of you so very very cross, is… and I want some of you
(you know who you are now!) to really pay close attention at this juncture…is this:

There we go. That wasn’t so hard, was it? Symbolic representations of things are not the things
themselves. This has implications. For example, fantasy is not reality. Now—there is a caveat here.
Fantasy is reality for some people. These people are psychopaths, religious fanatics, post-
modernists, and similar deviants. But for most of us—we can pull ourselves back from the brink and
reliably tell the difference between what exists only in our head and what does not.

BDSM: “where ‘no’ means ‘yes’ and ‘banana’ means ‘no.’”

Some find these facts hard, almost impossible, to face. Perhaps this is because they do not have a
kinky bone in their body—nor do they want one. Some, for example, find it impossible to tell the
difference between real world abuse and fantasy consensual sexual power exchange. Many BDSM
practitioners never use practices such as corporal punishment in their sex play, but some do.
Recognizing the difficulty that such people might have in accepting these desires, the following
comparison checklist is offered.
The checklist can also function as a forensic tool in analysis of the probable nature of an apparently
violent situation. It could assist in terms of resource allocation, investigative priorities, the need for
enforced separation of parties and the likelihood of wider BDSM community support of participants
on the grounds of personal liberty and consensuality.

Typical users could include rape and violence counselors, police officers, emergency medical
personnel, and legal prosecutors. This analytic tool functions independently of Battered Wife
Syndrome, Stockholm Syndrome, and, in almost all cases is valid regardless of which party is claiming
the “consensuality” objection—abuser or abusee.

The Checklist
As a final note--in two independent studies (King & Belsky 2012; Puts et al 2012), partner dominance
predicted orgasmic response in females. This implies a possible biological importance to this sort of
signalling.

The Surprising Psychology of BDSM

Who does it, what do they do, and how does it affect them?

“A pervert is anybody kinkier than you are.” (Wiseman, 1996, p. 23).

The novel Fifty Shades of Grey introduced BDSM into polite public discourse. Since its publication,
hallowed papers such as The New York Times have published articles on bondage and discipline,
dominance and submission, and sadism and masochism. Harvard University now hosts a student
group for undergraduates interested in consensual S&M. And Cosmo’s sex tips have taken a
distinctly kinky turn.

With the Fifty Shades movie now coming to theaters, it seems like a good time to take stock of what
we know, scientifically, about BDSM: Who does this stuff? What do they do? And what effects do
these activities have on the people who do them?

1. How many people are into S&M?

According to researchers, the number likely falls somewhere between 2 percent and 62 percent.
That’s right: Somewhere between 2 percent and 62 percent. A pollster who published numbers like
that should be looking for a new job. But when you’re asking people about their sex habits, the
wording of the question makes all the difference.

On the low end, Juliet Richters and colleagues (2008) asked a large sample of Australians whether
they had “been involved in B&D or S&M” in the past 12 months. Only 1.3 percent of women and 2.2
percent of men said yes.

On the high end, Christian Joyal and colleagues (2015) asked over 1,500 women and men about their
sexual fantasies. 64.6 percent of women and 53.3 percent of men reported fantasies about being
dominated sexually—and 46.7 percent of women and 59.6 percent of men reported fantasies about
dominating someone sexually. Overall, we can probably conclude that a substantial minority of
women and men do fantasize about or engage in BDSM.

2. Are they sick?

For Freud, the answer was a clear yes: Anyone interested in S&M was in need of treatment—
treatment that, by fine coincidence, he and his contemporaries were qualified to provide.

But recent research tells a different story.

Pamela Connolly compared BDSM practitioners to published norms on 10 psychological disorders.

Compared to the normative samples, BDSM practitioners had lower levels of depression, anxiety,
post-traumatic stress disorder (PTSD), psychological sadism, psychological masochism, borderline
pathology, and paranoia. (They showed equal levels of obsessive-compulsive disorder and higher
levels of dissociation and narcissism.)
Similarly, Andreas Wismeijer and Marcel van Assen compared BDSM practitioners to non-BDSM-
practitioners on major personality traits. Their results showed that in comparison to non-
practitioners, BDSM practitioners exhibited higher levels of extraversion, conscientiousness,
openness to experience, and subjective well-being. Practitioners also showed lower levels of
neuroticism and rejection sensitivity. The one negative trait that emerged? BDSM practitioners
showed lower levels of agreeableness than non-practitioners.

This is not to say that everyone into sadism or masochism is doing so for psychologically healthy
reasons. The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) still
includes Sexual Sadism Disorder and Sexual Masochism Disorder as potential diagnoses. But a
diagnosis now requires the interest or activities to cause “clinically significant distress or impairment
in social, occupational, or other important areas of functioning” (or to be done with a non-
consenting partner). BDSM between consenting adults that "does not cause the participants
distress" no longer qualifies.

3. What do they do?

Both researchers and practitioners (Wiseman, 1996) have developed categories of BDSM activities.
For example, Alison and colleagues have categories for physical restriction (bondage, handcuffs,
chains); administration of pain (spanking, caning, putting clothespins on the skin); humiliation (gags,
verbal humiliation); and a category related to sexual behavior.

4. What effect does BDSM have on the people who do it?

This is one of the central questions my research team has been investigating. In a BDSM scene, the
person who is bound, receiving stimulation and/or following orders is called the bottom. The person
providing the stimulation, orders or structure is called the top. We measured a range of physiological
and psychological variables in bottoms and tops before and after their scenes.

Both bottoms and tops reported increases in relationship closeness and decreases in psychological
stress from before to after their scenes, but bottoms also showed increases in physiological stress as
measured by the hormone cortisol. We found this disconnect between psychological stress and
physiological stress to be very interesting, and we wondered whether it might indicate that bottoms
have entered an altered state of consciousness.

To test this theory, we ran a study in which we randomly assigned switches (BDSM practitioners who
sometimes take on the top role and sometimes take on the bottom role) to be the top or the bottom
in a scene. The results revealed that both bottoms and tops entered altered states of consciousness,
but they entered different altered states.

Bottoms entered an altered state called “transient hypofrontality”, which is associated with
reductions in pain, feelings of floating, feelings of peacefulness, feelings of living in the here and now
and time distortions. Tops, in contrast, entered the altered state known as “flow” (Csikszentmihalyi,
1991), which is associated with focused attention, a loss of self-consciousness and optimal
performance of a task. We believe that these pleasurable altered states of consciousness might be
one of the motivations that people have for engaging in BDSM activities.

Sexual Satisfaction in BDSM

Yet again, dominant players in BDSM show a mental health advantage.

BDSM (bondage and discipline, dominance/submission, sadism-masochism) seems to be a topic of
immense fascination for laypeople and social scientists alike. In the past, the practice has been
stigmatized as deviant, and a reflection of psychopathology, but there is now growing evidence that
consensual BDSM practices may actually be a healthy way that many people express their inner
sexual desires and fantasies. A recent study (Botta, Nimbi, Tripodi, Silvaggi, & Simonelli, 2019)
examined sexual satisfaction and functioning among BDSM practitioners and found that not only do
practitioners appear to be well-adjusted, some, particularly those who prefer the dominant role,
appear to be more satisfied with their sexuality than non-practitioners. The reasons are not yet
understood, but it may be because those in the dominant role have personality traits that are
particularly conducive to good mental health.

A growing body of research has explored the psychological aspects of BDSM. I have reviewed a few
of the relevant studies in previous posts here and here. BDSM encompasses a wide range of
practices typically associated with control, humiliation, physical restriction, and role-playing (Botta et
al., 2019). Typically, practitioners adopt particular roles during their activities, most commonly either
as a “dominant” who exerts control over others, or a “submissive” who consents to be controlled.
Some people have a fixed preference for either role, while some people are “switches” who prefer
to alternate between these roles. The actual practices people may engage in are extraordinarily
diverse, and while some practitioners may only engage in a few preferred activities, others may
experiment flexibly with a wide array of scenarios. Although there seems to be a popular idea that
BDSM is something only a few odd individuals engage in, surveys have shown that it is far more
common: Between 10 and 50 percent of people surveyed have admitted to engaging in some form
of it, and many more at least fantasize about it (Coppens, Brink, Huys, Fransen, & Morrens, 2019).

One study found that BDSM practitioners in some respects appeared to have better mental health
than individuals in the general population, although when looked at in more detail, the findings
showed that it was those who preferred the dominant role who enjoyed these particular benefits
(Wismeijer & van Assen, 2013). For example, dominants had higher subjective well-being and lower
rejection sensitivity than submissives or switches and a control group of people drawn from the
general population. A more recent study (Botta et al., 2019) looked at sexual satisfaction and
functioning, and the findings were comparable to those of previous studies, as it found that
dominants seemed to be particularly well-off in terms of the study outcomes, although they found
positive outcomes for switches as well, in contrast to previous findings.

The study recruited 266 Italian BDSM practitioners (141 men and 125 women) through ads on
websites, Facebook, BDSM forums, and BDSM meetings. The control group consisted of 200 people
with similar demographic characteristics. All participants answered questions about potential sexual
complaints in the last six months, as well as their sexual satisfaction, and other personal information.
Practitioners also indicated their preferred role during BDSM (dominant, submissive, or switch) and
provided detailed information about their sexual behaviors and practices.

The study found that people engaged in a wide range of practices. The most prevalent fell in the
category of dominance/submission, which were engaged in by over 90% of men and women.
Sadism/masochism practices were noticeably less prevalent, engaged in by just over 50 percent of
men and women. Despite this, practices involving physical pain (including giving or receiving) were
popular with both men (73.8 percent) and women (90.4 percent), with women having a significantly
higher preference. Additionally, bondage was moderately popular (men: 58.9 percent; women: 54.4
percent), as were humiliation (men: 56.7 percent; women: 59.2 percent) and non-permanent
ownership signs (objects, collars, etc.) (men: 67.4 percent; women: 82.4 percent; a significant
difference).

Regarding roles, physical pain was popular in all three groups, although this was somewhat more
preferred in dominants (88 percent) and submissives (82 percent) than switches (72 percent),
suggesting that dominants and submissives had a somewhat stronger preference for more extreme
practices. There were also a host of what appeared to be niche practices, such as “pony play”
(dressing up as a horse and being led around on reins), as well as too many others to go into, that
were enjoyed by a minority of practitioners of both sexes, which shows the enormous diversity and
creativity within BDSM. In line with previous studies, men were more likely to take the dominant
role, and women the submissive, as shown in the diagram below. Additionally, about 43 percent of
male practitioners and about 66 percent of females were in an “ownership/belonging” relationship.
This refers to an arrangement in which the dominance/submissive relationship is more or less a full-
time practice rather than restricted to specific “games.” In roughly two-thirds of cases, this
corresponded to the person’s actual committed romantic relationship.

Regarding sexual satisfaction, dominants of both sexes were more satisfied than both the control
group and the submissives. Switches had higher sexual satisfaction than the control group only.
Further, participants in ownership/belonging relationships were more satisfied than those who were
not, especially when this relationship corresponded to their committed romantic one. (Whether the
dominant partner in such relationships had higher satisfaction than the submissive partner was not
specified.) Similarly, for sexual complaints, dominants of both sexes reported fewer sexual problems
and less overall sexual distress than the control group or submissives. These findings are generally in
line with previous findings that dominants reported better mental health in several respects than
either submissives or a control group drawn from a community sample (Wismeijer & van Assen,
2013).

Wikimedia Commons

Pony play: one of the more unusual activitiesSource: Wikimedia Commons

The authors of this study suggest that control (being in the dominant role) and versatility (the switch
role) may increase sexual satisfaction and sexual health. Findings from previous research suggest
that dominants may also have particular personality traits that are associated with better sexual
health as well as better mental health generally. Specifically, in the study by Wismeijer and van
Assen (2013), dominants were lower in neuroticism (a trait associated with a host of emotional
problems) and rejection sensitivity and had higher subjective well-being than those in the submissive
and control groups. Similarly, another study (Hébert & Weaver, 2014) found that dominants were
lower in emotionality (a trait from the HEXACO personality model that is similar to neuroticism) and
higher on extraversion and desire for control than submissives. Previous research has found that
both low neuroticism and high extraversion are associated with fewer sexual problems and higher
sexual functioning (Allen & Walter, 2018), as well as with higher subjective well-being generally
(Steel, Schmidt, & Shultz, 2008).

It is worth noting that in the Italian study (Botta et al., 2019) that I have been discussing, both
submissives and the control group scored in the normal range on the measures of sexual satisfaction
and sexual problems compared to general population norms. Hence, the findings were not that
these groups were particularly distressed compared to dominants, but rather that dominants were
functioning unusually well. People who feel comfortable in the dominant role may have a higher
sense of agency and self-confidence than those who prefer the submissive role, and even people
more generally. This is consistent with my suggestion in a previous post that BDSM practitioners may
prefer roles that suit their personalities rather than seeking compensatory roles that contrast with
their usual personality.

The finding that switches had higher sexual satisfaction than the control group is new in that a
previous study that examined switches (Wismeijer & van Assen, 2013) did not find any particular
advantage for switches in terms of subjective well-being or neuroticism, with dominants scoring
better than all other groups in that study. Hence, it may be worth investigating if the versatility of
the switch role is associated with any advantages in other populations of BDSM practitioners.

Moreover, that people in an ownership/belonging relationship had higher sexual satisfaction than
those who were not, especially when this was in the context of a committed romantic relationship,
appears to be a new finding. Botta et al. suggested that people in such relationships might be freer
from sexual stigma and benefit from a heightened trust and emotional connection. It could also be
that people enter into such an arrangement when they see it as a good fit for their personal
psychosexual needs. This would be consistent with the increasingly accepted view that BDSM
activities are not a pathological aberration or an expression of difficulties with normal sex, but simply
an alternative that some people find attractive (Richters, Visser, Rissel, Grulich, & Smith, 2008).

BDSM as Harm Reduction

Research indicates that BDSM behavior can have positive mental health benefits

As I've written about numerous times, I am a strong believer that when it comes to sexuality, the
field of psychotherapy is moving away from a more authoritarian top-down lens (and I would
consider sex addiction to fall into this category) to a more humanistic, harm reduction approach. To
further along this body of work, I, along with colleagues Dulcinea Pitagora and Markie Twist, have
initiated research to better understand the motivations and subjective experiences of individuals
that engage in sexual behaviors that have historically been marginalized and pathologized.
More specifically, we are on the verge of completing a study on the differences between those who
engage in high impact play as part of a BDSM scene and those who engage in non-suicidal self-
injuring (NSSI) behaviors, and we are currently crunching the numbers. Our rationale for this study is
that for many clinicians in the mental health field, those who engage in intense sensation play of
BDSM (bondage and discipline, dominance and submission, sadism and masochism) are often co-
mingled and conflated with behaviors of those who engage in self-harming behavior. As a result,
individuals who belong to the BDSM subculture are often pathologized and misunderstood in clinical
settings, and so may find themselves without adequate psychological care.

Here is a brief overview of our methodology. We recruited subjects via online networks and
professional listservs. Information was obtained from respondents via an online survey, consisting of
roughly 12 qualitative questions about the individual's motivation and experiences engaging in
either BDSM or NSSI (or both), as well as three psychological instruments, the Experiences in Close
Relationships Scale- Short Form (ECR-S), which measures attachment style: Adverse Childhood
Experiences Scale (ACE), which measures level of childhood trauma; and The Big Five Inventory (BFI),
which measures personality traits. The qualitative section asked about the individual's motivation as
well as subjective experiences before, during, and after engaging in self-injury, BDSM sensation play,
or both.

Sample questions included (in the case of BDSM, but with different terminology for NSSI):

"—What are your expectations or motivations for engaging in intense sensation play?"

"What kinds of thoughts and feelings do you typically experience prior to intense sensation play?"

"What kinds of thoughts and feelings do you typically experience during intense sensation play?"

"—What kinds of thoughts and feelings do you typically experience after intense sensation play?"

"—How does intense sensation play affect how you feel in relation to others?"

—"How does intense sensation play affect how you feel about yourself?"

As we have begun to crunch our numbers, a variety of fascinating trends have emerged. First, the
individuals that struggled with NSSI experienced overwhelming negative feeling states prior to self-
injury, then felt a wave of relief and distraction, followed by deep regret and shame afterwards. The
BDSM group however stated that they felt excitement and anticipation ahead of time, a sense of
excitement and pleasure during the encounter, and a wave of deep connection to their partner
afterward, as well as a stronger sense of self-empowerment and authenticity.

Most importantly, the cohort that experienced NSSI and BDSM reported the same experiences. They
had started NSSI at an early age (typically adolescence) and then had stopped, but then continued
on with BDSM sensation play as adults, enjoying all of the same benefits as the BDSM only group. So
this leads to an important question. For the group that experienced both NSSI and BDSM, does
BDSM offer a better, healthier alternative than self-injury? If this is the case, then BDSM would serve
as a healthy and healing harm reduction alternative to self-injuring behavior. (Note: As of a few
months ago our number of respondents for each cohort was BDSM only- 172, NSSI only- 34, and
both BDSM and NSSI- 129. I will continue to update this as we add to our data.)

Before jumping to conclusions, let's take a look at other possible scenarios and explanations. It's
quite possible that for the NSSI and BDSM cohort, they independently stopped engaging in NSSI
once they resolved some underlying emotional issues and then at a later point in time discovered
that they enjoyed BDSM, and these two activities stand alone and have absolutely no connection to
each other. I would not be surprised if this was the case for a majority of respondents. Indeed, a
number of them had mentioned they had stopped NSSI due to age (growing out of it) or having
resolved their emotional issues in other ways, such as removing themselves from a bad living
situation or working through the difficulties in therapy.

However, some did indicate that BDSM served as a transition to more evolved coping methods. In
this case, BDSM would both be therapeutic (helping to deal with, manage or overcome deeper
emotional disturbances), as well as serve in a harm reduction capacity by providing safer and more
connective ways of dealing with those same difficulties. I want to be cautious here of not overstating
this conclusion. As I've indicated in a number of other articles, recent robust research has found no
correlation between BDSM and pathology, and indeed the research that attempted to connect
BDSM to trauma often had underlying deeply flawed and biased methodologies, such as cherry
picking respondents and only using a small number of subjects (one study only had three).

For a distinct population however, BDSM may serve as both a healing and harm reduction approach
to trauma and emotional pain. I have presented before, for example, in a lecture entitled The
Healing Potential of Psychological Edge Play at the 1st Annual AltSex NYC Conference, a case study in
which one of my clients used BDSM edge play to re-enact a rape experience, and in this way
resolved her sexual anxieties in the process.

Let's finally move beyond outdated and arbitrarily socially constructed views of how people should
behave, especially with their sexuality. Research shows that not only is BDSM not pathological, but it
can also be used in a therapeutic sense, both in trauma healing and for some, as a harm reduction
approach.

Is BDSM/Kink a Hobby or a Sexual Orientation?

New research helps us better understand the nature of kinky and BDSM interests.

What does it reveal about you if you’re into kinky or BDSM sex? Is it a serious leisure activity, or is it
an innate aspect of your sexuality? Could the answer be different for different people? A recent
article published in the journal Current Sexual Health Reports grapples with these fascinating and
important questions [1].

On the one hand, it could be argued that kink/BDSM is a form of serious leisure, one that requires a
lot of time, that necessitates a certain level of skill and expertise, and that may even affect self-
identification. Research has found that kink/BDSM often fits this bill and that it overlaps with a lot of
the characteristics of the concept of leisure more generally.

For example, as the authors of this paper report: In a study of hundreds of BDSM practitioners, the
"general properties of leisure were overwhelmingly endorsed by participants, including the following
items reported being present most or nearly always by 90 percent or more of the total sample:
positive emotions, a sense of freedom, pleasure and/or enjoyment, sense of adventure, stress relief
and/or relaxation, self-expression, and BDSM enjoyed for itself (intrinsic motivation)."

By the same token, other research suggests that kink/BDSM can potentially be thought of as a sexual
orientation. However, this depends on how you define the term sexual orientation, and different
scientists think about this in different ways. Some define it in very narrow terms, looking at it
specifically as something that orients us to partners based on sex or gender; however, others take a
more expansive view.
For example, some argue that we have multiple sexual orientations and that the characteristics of
these orientations are as follows: “(a) sexual attraction that is strong and persistent; (b) relative
immutability/fluidity of sexual attraction or arousal that is beyond conscious control; (c) early onset,
developmentally, in childhood or adolescence; (d) significant psychological consequences to
denying, exploring, fulfilling, or repressing sexual attraction and arousal; and (e) lifelong patterns of
sexual attraction and arousal” [2].

If you view kink/BDSM through this lens, some research does support the idea that it may be
orientation. For example, research finds that the vast majority of BDSM practitioners report that
their sexual interests developed relatively early in life, specifically before the age of 25. Further, a
minority of these folks (7 to 12 percent across studies) report that their interests developed around
the time of puberty (between ages 10 to 12), which is when other traditional aspects of sexual
orientation develop (e.g., attraction based on sex or gender).

Ultimately, the authors of this paper don’t advocate for one perspective or the other, and they argue
that the leisure and sexual orientation views of kink/BDSM are not mutually exclusive. In other
words, perhaps both of them may be correct, meaning that kink/BDSM could be a leisure activity for
some, but more of an orientation for others.

The paper is a fascinating read, because it addresses important questions raised by thinking of
kink/BDSM as leisure or as an orientation. For example, what are the potential legal, therapeutic,
and health care implications? There’s a lot to be gained by better understanding kink/BDSM, but we
clearly need a lot more research on the subject to know whether it is best characterized as leisure,
orientation, or both.

The Truth About BDSM Relationships

The myth: It’s abusive. Actually, it’s about trust and communication.

In the child’s game, Trust Me, one person stands behind the other. The one in front falls backward,
trusting the other to catch them before crashing to the floor. Trust Me contains an element of
danger, the risk of not getting caught and getting hurt. The person falling places great trust in the
person catching. When the falling player trusts the catcher enough to let go completely, and the
catch happens as planned, both players experience a moment of exhilaration that’s difficult to
duplicate any other way.

It’s About Trust

BDSM is similar. The myth is that it’s abusive and weird—whips and chains! Actually, it’s about trust.
When trust trumps the possibility of harm, the result can feel incredibly intimate and erotic.

There are several terms for BDSM: power-play or domination-submission (Ds) because one lover has
control over the other, at least nominally; sado-masochism (SM), which involves spanking, flogging
or other types of intense sensation; and bondage and discipline (BD), which involves restraint. But
the current term is BDSM.

Many people consider BDSM perverted, dehumanizing, or worse. But aficionados call it the most
loving, nurturing, intimate form of human contact and play. People can have sex without
conversation, negotiation, or any emotional connection. But in BDSM, the players always arrange
things in advance with clear, intimate communication, which creates a special erotic bond.
DeSade and Sacher-Masoch

Ancient Greek art depicts BDSM. The Kama Sutra (300 A.D,) touts erotic spanking, and European
references date from the 15th century. But BDSM flowered during the 18th century, when some
European brothels began specializing in restraint, flagellation and other “punishments” that
“dominant” women meted out to willingly “submissive” men.

In 1791 the French Marquis de Sade (1740-1814) published the first SM novel, Justine, which
included whipping, flogging, nipple clamping, and restraints. His name gave us “sadism.” DeSade was
imprisoned for criminal insanity, one reason many people consider the sexual practices he
popularized crazy.

In 1870, Leopold von Sacher-Masoch (1836-1895), published the novel, Venus in Furs, about male
sexual submission. His name inspired “masochism.”

In 1905, Freud coined the word, “sadomasochism,” calling its enjoyment neurotic. The original
Diagnostic and Statistical Manual of Mental Disorders (DSM-I, 1952) classified sexual sadism as a
“deviation.” DSM-II (1968) did the same for masochism. DSM-IV (1994) lists SM as a psychiatric
disorder.

Just Another Way to Play

But all available evidence shows that the vast majority of BDSM enthusiasts are mentally healthy and
typical in every respect—except that they find conventional (“vanilla”) sex unfulfilling and want
something more intense and intimate. Before condemning BDSM, remember that not too long ago,
oral sex and homosexuality were considered “perverse.”

Two to 3 percent of American adults play with BDSM, most occasionally, some often, and a few
24/7. That’s around 5 million people. Meanwhile, around 20 percent of adults report some arousal
from BDSM images or stories.

There are public BDSM clubs and private groups in every major metropolitan area and throughout
rural America. Many cities have several.

Never Abusive

If you’re repulsed by BDSM, don’t play that way. But BDSM imagery pervades society. Henry
Kissinger once called power “the ultimate aphrodisiac.” Kings and nations have fought to dominate
others. Capitalism assumes a dog-eat-dog world where succeeding means exerting control. And in
sports, players strive to “humiliate” opponents.

But what kind of person feels sexually aroused by pain? Many people who are perfectly normal in
every other respect. Again, consider sports: When football players make brilliant plays, teammates
often slap their butts, punch them, or slap their helmets. Recipients accept this “abuse” gratefully as
a sign of appreciation and affection. Or consider a hike up a mountain. You get sunburned. Thorns
scratch your legs. And by the time you reach the summit, you’re aching and exhausted. Yet you feel
exhilarated.

Sadly, media BDSM has grossly distorted the pain that submissives experience. It’s more theatrical
than real. When performed by ethical, nurturing dominants (“doms” or “tops, ), BDSM is never
abusive.

“It’s always consensual,” says Jay Wiseman, author of SM 101. “Abuse is not.” You don’t need
restraints, gags, or whips to abuse someone. In loving hands, the equipment heightens sensual
excitement, allowing both players to enjoy their interaction, or “scene,” as good, clean, erotic fun.”
When BDSM inflicts real pain, it’s always carefully controlled with the submissive (“sub” or
“bottom”) specifying limits clearly beforehand.

Subs are very particular about the kinds of pain—many prefer to call it intense sensation—that bring
them pleasure. “They experience the pain of bee stings or a punch in the face exactly like anyone
else,” Wiseman says, “and dislike it just as much.”

“Safe” Words

BDSM is more theatrical than real. Participants carefully choreograph their moves in advance.

First, participants agree on a “safe” word, a stop signal that the sub can invoke at any time. The safe
word immediately stops the action—at least until the players have discussed the reason the bottom
invoked it, and have mutually agreed to resume. A popular safe word is “red light.”

Some terms should not be used as safe words: “stop,” “no,” or “don’t” because both tops and
bottoms often enjoy having subs “beg” tops to “stop,” secure in the knowledge that they won’t.

Any top who fails to honor pre-arranged safe words violates the bottom’s trust and destroys the
relationship. Tops who fail to honor safe words are ostracized from the BDSM community.

Subs Are in Charge

Although bottoms feign subservience, the irony of BDSM is that the sub is in charge. Bottoms can
invoke the stop signal and tops vow to obey immediately. Meanwhile, tops act dominant, but they
must also be caring and nurturing, taking bottoms to their agreed-upon limit, but never beyond it. In
this way, BDSM provides an opportunity for everyone to experiment with taking and surrendering
power, while always feeling safe and cared for. People who enjoy BDSM say it results in amazing
erotic intensity.

Learning the Ropes

Before experimenting with BDSM, get some instruction. Read a book, take a class, visit Web sites or
clubs.

It takes extensive negotiation to arrive at mutually agreeable BDSM play. Wiseman says that before
every scene, players must negotiate all aspects of it, from the players to safe words to everyone’s
limits.

How to Begin

First, decide if you're more into S&M or B&D. If the former, then spanking is the way many people
begin. If the latter, blindfolding the sub can be fun.

What Is Intimacy?

Relationship authorities define intimacy as clear, frank, self-revealing emotional communication. But
many people equate “intimacy” and “sex.” To be intimate is to be sexual and visa versa. Only it isn’t.
It’s quite possible to be sexual with a person you hardly know, the “perfect stranger.”

Most couples don’t discuss their lovemaking very much, which diminishes intimacy. But BDSM
absolutely requires ongoing, detailed discussion. Players must plan every aspect of their scenes
beforehand and evaluate them afterward. Many BDSM aficionados say that pre-scene discussions
are as intimate, erotic, and relationship-enhancing as the scenes themselves. And couples who enjoy
occasional power play but who are not exclusively into BDSM often remark that it enhances their
non-BDSM “vanilla” sex because the practice they get negotiating scenes makes it easier to discuss
other aspects of their sexuality. The skills required for BDSM include trust, clear communication,
self-acceptance, and acceptance of the other person. Those same skills that enhance relationships
and sex—no matter how you play.

What Kind of People Enjoy BDSM?

BDSM players are as sexually and emotionally healthy as the general population.

Italian researchers recently surveyed the sexuality of 266 Italian men and women who enjoy
bondage, discipline, and sado-masochism (BDSM). The study population ranged in age from 18 to 74
and averaged 41. The researchers also surveyed 200 demographically similar men and women not
involved in BDSM.

The two groups reported similar feelings about their sexuality, but the BDSM players reported less
sexual distress and greater erotic satisfaction. The researchers said they hoped their study would
“reduce the stigma associated with BDSM.”

How Popular Is BDSM?

In 2015, Indiana University researchers surveyed a representative sample of 2,021 American adults.
Many said they’d tried some elements of BDSM: spanking (30 percent), dominant/submissive role-
playing (22 percent), restraint (20 percent), and flogging (13 percent).

In 2017, Belgian scientists surveyed a representative sample of 1,027 Belgian adults. Those who
admitted experimenting with BDSM—almost half (47 percent). Thirteen percent said they played
that way “regularly.” Eight percent said they felt “committed” to BDSM sexuality.

What Fifty Shades of Grey Got Right—and Wrong

In fantasy, BDSM is even more popular. In the Belgian study just mentioned, 69 percent of
participants admitted having BDSM fantasies, some quite extreme.

In 2011, a unique window into the popularity of BDSM fantasies and play opened with the
publications of the Fifty Shades of Grey trilogy by English author E.L. James. The three novels follow
Christian Grey, a brash, young billionaire dominant (dom, top) and his initially naïve lover, Anastasia
Steele, as she becomes his submissive (sub, bottom), at first hesitantly, then willingly, and finally
enthusiastically.

By 2019, Fifty Shades had sold 150 million copies worldwide in 50 languages, the only book to ever
to sell that many copies that quickly. The Fifty Shades film series has grossed more than $1 billion.
And when the trilogy hit the bestseller list, hardware stores reported an unusual surge in sales of
rope.

Fifty Shades got one aspect of BDSM horribly wrong. It depicts Christian Grey as the product of
horrendous child abuse and implies that his years of suffering propelled him into kink. Actually,
BDSM players are no more likely than anyone else to have suffered child abuse or sexual trauma.

Otherwise, James depicted BDSM quite realistically:

Communication: Before Grey lays a hand on Steele, they discuss their play in great detail.

Contracts: Grey hands Steele an extensive contract proposal, and they discuss it point by point. Steel
agrees to some clauses, modifies others, and nixes a few. Not all BDSM players use written
contracts, but many do.

Limits: Grey quizzes Steele on the hard boundaries she can’t conceive of crossing and the soft limits
she might cross under the right circumstances. Both players declare their limits and pledge to honor
the other’s.

Safeword: Grey tells Steele she is always free to invoke their safe word, the “stop” signal that
immediately suspends play. No matter how anything looks or feels, subs always retain total control
over BDSM play. That’s the great irony of BDSM. It looks like the doms control the subs. Actually, it’s
the other way around.

Intimacy: Steele is astonished by the depth of self-revelation involved in BDSM, and how emotionally
close it brings her to Grey. Committed BDSM players often say that kinky intimacy goes “way beyond
sex.”

Is BDSM Mentally Healthy?

A substantial research literature shows that BDSM players are no more likely than the general
population to suffer psychiatric problems, and they have no psychological disorders unique to their
kinky proclivities:

A Los Angeles investigator administered standard psychological tests to several hundred BDSM
aficionados and concluded they were mentally healthy.

Australian researchers surveyed 19,370 Aussies aged 16 to 59. Among the 2.2 percent of men and
1.3 percent of women who called themselves committed to BDSM, all tested psychologically healthy
and reported no disproportionate history of childhood sexual abuse or any sexual trauma.

University of Illinois scientists took before and after saliva samples from 58 BDSM players, measuring
their levels of the stress hormone cortisol. After BDSM scenes, their cortisol levels decreased
significantly, showing that their BDSM play had reduced their stress.

Dutch researchers gave standard personality tests to 902 BDSM players and 434 controls. The same
proportions of both groups tested psychologically healthy, but the kinksters were “less neurotic,
more conscientious, more extraverted, more open to new experiences, less sensitive to rejection,
and showed greater subjective well-being.” Those who scored most mentally healthy were the
doms, followed by the subs, and in the last place, the conventionally sexual (vanilla) controls.

Finally, researchers at Idaho State University asked 935 kinksters what BDSM meant to them:
personal freedom (90 percent), adventure (91 percent), self-expression (91 percent), stress relief (91
percent), positive emotions (97 percent), and above all, pleasure (99 percent).

BDSM players are a cross-section of the population, the people next door, mentally healthy and
typical in every respect—except that they find vanilla sex unfulfilling and want something more
exciting and intimate.

Officially Mentally Healthy

No one knows when humanity discovered BDSM, but ancient Greek art depicts what looks like it. In
1905, Sigmund Freud declared that “sado-masochism” signaled severe neurosis. For more than a
century, mental-health professionals agreed.

The first edition of the American Psychiatric Association’s bible of mental illness, the Diagnostic and
Statistical Manual of Mental Disorders (DSM-I, 1952), classified sexual sadism as a “deviation.” The
DSM- II (1968) pathologized masochism. And the DSM-IV (1994) listed BDSM as a psychiatric
disorder.

But in 2013, based on hundreds of 21st-century studies, the DSM-V removed BDSM from its list of
mental illnesses, calling it just another way for psychologically normal, healthy people to play.

What do you think? Is BDSM mentally healthy? Have you ever played that way? And if so, how
committed do you feel to kinky sex?

BDSM, Personality, and Mental Health

BDSM practitioners prefer roles that fit their personalities.

A recent study on the psychological profile of BDSM (bondage-discipline, dominance-submission,

sadism-masochism) practitioners has attracted a great deal of media attention, with headlines
proclaiming that “S&M practitioners are healthier and less neurotic than those with a tamer sex life.”
Although BDSM has often in the past been thought to be associated with psychopathology, the
authors of the study argued that practitioners are generally psychologically healthy, if not more so in
some respects, compared to the general population. However, it should be noted that most of the
apparent psychological benefits of being a practitioner applied to those in the dominant rather than
the submissive role. Additionally, the study findings need to be treated with some caution because it
is not clear that the comparison group is a good representation of the general population.

BDSM involves a diverse range of practices usually involving role-playing games in which one person
assumes a dominant role and another person assumes a submissive role. These activities often
involve physical restraint, power plays, humiliation, and sometimes but not always, pain. The person
playing the dominant role (or ‘dom’) controls the action, while the person in the submissive role (or
‘sub’) gives up control. Many people have a preferred role they play most of the time, although
some people enjoy switching between roles (‘switches’).

Is BDSM normal?

The practice of BDSM carries with it a certain amount of social stigma (Bezreh, Weinberg, & Edgar,
2012), although the recent popularity of Fifty Shades of Grey1 might be a sign of increased
mainstream acceptance. Health professions have long had a tendency to view the practice as
pathological and even perverted. Common assumptions about people who participate in BDSM are
that they are psychologically anxious and maladjusted; that they are acting out a past history of
sexual abuse; and that they are attempting to compensate for sexual difficulties. However, the small
amount of research evidence available suggests that these assumptions are probably not true. For
example, a telephone survey conducted in Australia found that people who had participated in
BDSM in the previous year were not more distressed than others; were not more likely than others
to have ever been sexually coerced; and did not report more sexual difficulties (Richters, De Visser,
Rissel, Grulich, & Smith, 2008). However, BDSM practiced between consenting persons who are
happy with what they are doing is not officially considered pathological.

What are BDSM practitioners like?

There has not been a great deal of research examining the psychological characteristics of BDSM
practitioners, so the aim of a recent study (Wismeijer & van Assen, 2013) was to compare BDSM
practitioners with people from the “normal” population on a range of personality traits. A good
description and critique of the study can be found here. BDSM practitioners were recruited from a
Dutch BDSM web forum. Comparison participants were recruited through notices concerning “online
secrecy research.” These were obtained through a variety of sources including a popular Dutch
women’s magazine and a website that allows visitors to post their secrets. I have some concerns
about whether the comparison group is a good representation of the general population, which I will
return to in due course.

The study compared the BDSM practitioners and the control group on the Big Five personality traits
– neuroticism, extraversion, openness to experience, conscientiousness, and agreeableness – as well
as on rejection sensitivity, relationship attachment styles, and subjective well-being (happiness) in
the past two weeks. People in the BDSM group were also broken down into ‘doms’, ‘subs’, and
‘switches’, based on their respective preferences, to allow further comparisons. There were
noticeable gender differences in how people assorted into these roles, which are illustrated in the
pie charts below. Among females, over three-quarters were subs, switches were a distant second in
popularity, while doms were very much in the minority. Roles were a little more evenly spread
among the males, although doms were most popular (who made up nearly half), followed by subs
(just over a third) and then switches. This suggests that female BDSM practitioners are more likely
than males to prefer gender-typical roles.

Comparing the BDSM group as a whole with the controls gives a rather favorable impression of
practitioners. The BDSM group as a whole were on average more extraverted, open to experience
and conscientious, and less neurotic, as well as less sensitive to rejection, more securely attached,
and higher in subjective well-being than the comparison group. On the less favorable side though,
the BDSM group was less agreeable. High extraversion and low neuroticism tend to be associated
with greater overall happiness, so it is not surprising that people with these traits appear
psychologically secure and to have high subjective well-being. However, an overall comparison
between practitioners and non-practitioners is actually misleading to some extent because when
doms, subs, and switches were compared to the control group, and with each other, the results
were more uneven. A more detailed examination of these differences shows some interesting
patterns.

Openness to experimentation

Each of the three BDSM groups scored higher than the controls on openness to experience, so it is
fair to say that practitioners generally tend to be more open-minded. This is not surprising, as
openness to experience is associated with a willingness to experiment with unusual and
unconventional behaviors. Openness to experience is also associated with a trait called sexual
sensation-seeking which relates to a desire to be sexually uninhibited and to explore novel sexual
experiences (Gaither & Sellbom, 2003). I find it interesting in this regard, that the Australian survey
mentioned earlier found that people who participated in BDSM had experienced a wider range of
sexual practices, and had a greater number of lifetime sexual partners compared to non-participants.
In fact, BDSM participants were significantly more likely to claim to have had 50 or more sex
partners in their lives and to have participated in group sex. This would indicate that people into
BDSM tend to be very open to sexual experimentation generally (or perhaps that they are prone to
wild exaggeration!).

Love of discipline?

Both doms and subs, but not switches for some reason, scored higher than controls on
conscientiousness. Conscientiousness is a broad trait related to self-discipline and has two major
aspects related to orderliness and achievement striving respectively. The study did not examine
whether either of these aspects was more prominent in BDSM practitioners. However, I would
suspect that people who are attracted to BDSM probably have a high need for orderliness, and have
a fond appreciation of rules and boundaries. Whether they have a high need for achievement or not
remains to be seen. Going further, perhaps subs are the sort of people who prefer to have discipline
and order provided for them, while doms are the sort who like imposing rules and structure on
others. This difference in preference for controlling or being controlled may well relate to
differences in agreeableness between these two groups.

Disagreeable dominants, sweet submissives

Agreeableness is related to overall pleasantness and consideration for the comfort of other people.
Subs and switches actually did not differ from the control group in agreeableness. However, doms
were lower than both the controls and the subs in agreeableness. People who are low in
agreeableness tend to be tough rather than tender-minded, are willing to make hard decisions, and
tend to be bossy and demanding in the way they relate to others. Thus it would seem that people
who are into BDSM generally prefer the role that fits their own level of agreeableness. Tough,
domineering people would seem to prefer the dominant role, while those who are more tender and
willing to please naturally fit into the submissive role. I found this particularly interesting because it
suggests that doms have found a way to express their disagreeableness in a way that is actually
welcomed and appreciated by their submissive partners. This is in contrast to more ordinary
disagreeableness in everyday life which is usually seen as annoying and rude.

I have elsewhere come across the idea that people into BDSM like to explore roles that are the
opposite of their day-to-day roles, e.g. those who are accustomed to ordering people around are
attracted to the submissive role (see here for example). The thinking behind this is that such people
like to have a way of compensating for the pressure of command and experiencing a sense of relief
from the burden of being responsible for others. However, the findings in this study would seem to
suggest that the majority of practitioners are drawn to roles that reflect rather than compensate for
their normal personalities. Perhaps, there is a minority subgroup of people who go against this
trend, but more detailed studies would be needed to test if this is true.

Regarding extraversion, the only significant difference was that subs were more extraverted than the
control group. Extraversion is related to both sociability and assertiveness. I therefore found it
surprising that the doms were not higher on extraversion (due to the assertiveness component) than
other groups. Why subs were higher on extraversion is not totally clear. Perhaps they have a
particularly friendly outgoing nature. Extraversion is also related to excitement seeking, so perhaps
subs find the attention they receive and the unpredictability of participating in role-playing satisfies
this need for excitement. More detailed surveys would make this clearer.

Calm and in control

The Big Five personality trait that has been most strongly linked to mental health versus pathology is
neuroticism (Malouff, Thorsteinsson, & Schutte, 2005). As an illustration, in the BDSM study,
neuroticism had large positive correlations with anxious attachment, need for approval, and
sensitivity to rejection, and a large negative correlation with subjective well-being. Perhaps the most
striking finding of this study is that the doms were significantly lower in neuroticism than all the
other groups, and this was the statistically largest difference between groups. Doms also scored
lower in rejection sensitivity and need for approval compared to subs and the control group, while
the latter two groups did not differ from each other in either of these measures. Furthermore, the
doms scored higher in subjective well-being than all the other groups as well. Subs and switches did
not differ from the control group in neuroticism or subjective well-being. Rejection sensitivity and
need for approval, like neuroticism, are negatively correlated with subjective well-being, so the fact
that doms scored low on these measures may well account for their high levels of subjective well-
being.

High neuroticism is associated with self-conscious emotions, such as guilt, shame, and
embarrassment, as well as a host of other negative emotions. People who are low in neuroticism
therefore tend to be relatively untroubled by these feelings. Perhaps people who prefer the dom
role tend to be those who are relatively shameless, self-confident, not easily embarrassed, and who
do not feel guilty or shy about inflicting punishments during their role-plays. Additionally, they do
not seem to be overly concerned about seeking other people’s approval but instead may expect
other people to gain their approval instead. This would seem to fit well with the role they play in
BDSM where they demand obedience from the sub.

What about honesty-humility?

The desire to obey and be subjugated leads to consideration of a personality trait not discussed by
Wismeijer and van Assen’s study. Some researchers have proposed that there is a sixth factor of
personality, known as honesty-humility, that is separate and distinct from the more well-known Big
Five factors (Bourdage, Lee, Ashton, & Perry, 2007). One intriguing possibility is that subs might
score particularly high on this factor. Subs seek self-abasement and humiliation in their role-playing.
Although humiliation and humility are not the same thing, it seems intuitively plausible that they are
related. Furthermore, doms might be the opposite, possessing a desire to feel superior to others.
Research could confirm whether subs are higher than average, or indeed whether doms are lower
than average in this important trait.

But did the control group provide a fair comparison?

To summarise briefly, the findings of the BDSM study suggest that practitioners in general are open-
minded about having unusual experiences, and tend to be self-disciplined people. However, most of
the psychological benefits claimed to be associated with BDSM, such as low neuroticism, more
secure attachment and higher subjective well-being belong to doms rather than subs or switches.
However, subs were more extraverted than the other groups. On the other hand, doms appear to be
more disagreeable than other people, which seems to suit them in their preferred role. This seems
all well and good, however I am concerned that the control group might or might not be a good
representation of the general population. The control group was largely drawn from a website
recruiting people for research into secret keeping. There are all sorts of reasons that people keep
secrets, and generally speaking, it is normal to do so occasionally. However, some people have
particularly secretive personalities where they feel that there are parts of themselves that they
would prefer not to reveal to other people due to shame or fear of rejection. The trait of being
secretive in this way, known as self-concealment, is associated with high neuroticism and low
subjective well-being (Wismeijer & van Assen, 2008). It is possible that people who feel drawn to use
websites where they can post secrets anonymously or who are willing to participate in secrecy
research might have elevated levels of self-concealment. If this was the case, it is possible that the
control group in the BDSM study might have had higher than average levels of neuroticism and
associated traits such as rejection sensitivity. If so, this would imply that the BDSM groups who did
not differ from the control group, especially the subs might also have high levels of neuroticism,
rejection sensitivity and so on. This would imply that the doms were not especially unusual in their
personality traits, because they were being compared to a group with high averages. Currently, we
do not know if any of these concerns apply to the control group or not so the study findings need to
be treated with a degree of caution.

Future research should aim to confirm the findings of the BDSM study with a more representative
control group, along with a broader range of measures of mental health (e.g. screening for drug use
and abuse) to explore to what extent people into BDSM really do enjoy better mental health than
other people. Researchers could also investigate how well-adjusted practitioners are in their lives
and relationships in general. For example, are doms, being low in agreeableness, particularly
antagonistic in their relationships in general, outside of BDSM? Additionally, considering the sexual
promiscuity of BDSM practitioners revealed in a previous survey, it would be important to examine
their attitudes towards risky sexual practices and whether they are at higher than usual risk of
sexually transmitted diseases. BDSM encompasses a wide range of practices in a variety of contexts,
e.g. in committed relationships, as well as more casual settings. Future research might consider more
specific aspects of how people participate in BDSM to provide a richer understanding of the
psychology of this intriguing area of human life.

Personality Traits of BDSM Practitioners: Another Look

A recent study provides another glimpse into the world of BDSM.

Recently, the practice BDSM (bondage and discipline, dominance/submission, sadism-masochism)

has generated a great deal of interest among lay-people and academics alike. The best-selling novel
Fifty Shades of Grey and the new film of the same name have helped bring an otherwise stigmatised
phenomenon into mainstream awareness. However, this book is apparently not a particularly
accurate portrayal of how BDSM is practiced in real life (for example, see this post by sex researcher
Justin Lehmiller). Fortunately, this increased interest in the subject has also been accompanied by
some new scientific studies that may help to provide more accurate insight into these practices. In a
previous post, I discussed a 2013 study that suggests that BDSM practitioners are generally
psychologically healthy and that they tend to prefer roles that fit their personalities. In this post, I
discuss a newer study that also examined the personality traits of BDSM practitioners using a
somewhat different personality model. Some of the findings were highly similar, although there
were some differences as well that may be worth exploring further to shed more light on the
psychology of BDSM.

For some people, servitude is a special pleasure

For some people, servitude is a special

BDSM encompasses a diverse range of activities that include but not are limited to the exercise of
power and control by one person over another, physical and psychological restraint, and infliction of
pain and humiliation. These activities may or may not occur in a sexual context. Typically, someone
in a dominant role, known by a variety of terms, including ‘top’, ‘dom or dominant’ or ‘sadist’, will
direct the actions of someone in a submissive obedient role, known by such terms as ‘bottom’, ‘sub
or submissive’ or ‘masochist’. All activities are consensual and practitioners will negotiate
beforehand what they consider acceptable. Many participants have a preferred role they assume in
most or all activities, while some prefer to switch roles as desired. Participation in BDSM can range
from occasional casual role-playing to a preferred orientation and even to a whole lifestyle with 24/7
role enactments (Hébert & Weaver, 2014).

As discussed in my previous post, there has been some quite interesting research looking into the
psychological characteristics of BDSM practitioners. Contrary to what has often been assumed, there
is no evidence that BDSM practitioners in general suffer from any particular form of psychological
disturbance and in fact they seem to be mentally and emotionally well-adjusted (Richters, De Visser,
Rissel, Grulich, & Smith, 2008; Wismeijer & van Assen, 2013). I was particularly interested in the
findings of a study of Dutch BDSM practitioners (Wismeijer & van Assen, 2013) which included an
assessment of their personality traits according to the Big Five model. The five factors in this model
are neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. These
are broad personality characteristics that subsume a larger number of narrower more specific traits.
According to this study, practitioners in general, including both dominants and submissives, tended
to be higher in openness to experience and conscientiousness compared to a comparison sample
from the general population. Additionally, participants who preferred the dominant role tended to
be lower in agreeableness and neuroticism compared to submissive participants and to the general
population, while, submissives tended to be more extraverted than the general population.
Additionally, dominants tended to have higher subjective well-being and were less sensitive to
rejection compared to the general population, suggesting that people drawn to the dominant role
may be particularly psychologically well adjusted.

A more recent study (Hébert & Weaver, 2014) has also examined the personality traits of BDSM
practitioners, but this time using the six-factor HEXACO model rather than the Big Five. The HEXACO
model has emerged in recent years as a theoretical rival of the Big Five. The most salient difference
between the two models is the addition of a sixth factor called Honesty-Humility which subsumes
some characteristics (e.g. straightforwardness and modesty) that have sometimes been associated
with agreeableness. There are also some other subtle differences, e.g. the equivalent of neuroticism
is known by the more neutral name of emotionality. In the Big Five, neuroticism includes a trait
known as angry hostility, but in the HEXACO this is associated with low agreeableness. As well as
assessing the HEXACO traits, participants in Hébert and Weaver’s study were assessed on self-
esteem, satisfaction with life, altruism, empathy, and desire for control. Self-esteem and satisfaction
with life are closely associated with subjective well-being. I was therefore interested to compare the
findings from this study with the Dutch one, which also assessed subjective well-being.

The study by Hébert and Weaver recruited a sample of 270 DSM practitioners through the website
Reddit and particularly focused on comparing those who identified primarily as either dominant or
submissive. Those who liked to switch between roles were not considered to simplify the
comparisons. Much like the Dutch study, there were striking gender differences in preferred role
orientations, although these were more marked in this case. As can be seen in the graph I have
created below, the vast majority of females in the study preferred the submissive role, suggesting
that female dominants may be rather uncommon (and presumably in high demand). The majority of
males, on the other hand, preferred the dominant role, although quite a substantial proportion was
submissive.

Regarding personality traits, dominants compared to submissives were lower in emotionality, higher
in extraversion, and equal in agreeableness, conscientiousness, openness to experience, and
honesty-humility. Additionally, dominants had higher self-esteem, satisfaction with a life, and a
greater desire for control, but did not differ from submissives in empathy or altruism. The authors
compared the participants’ scores to normative data and found that they were within the ‘normal
range’ on honesty-humility, emotionality, extraversion, agreeableness, and conscientiousness.
However, submissives but not dominants scored higher than the normative data on openness to
experience. The ‘normative data’ in this case are based on Canadian university students from a
previous unrelated study (Lee & Ashton, 2004). This is not an ideal comparison sample but will have
to do for the time being. I did my own statistical comparisons with the normative data and found
that both dominants and submissives had significantly higher scores in openness to experience
compared to the normative data and submissives were significantly higher in conscientiousness.[1]

Some of these results are similar to those of the Dutch study, although there are a few differences.
For example, Wismeijer and van Assen (2013) found that BDSM practitioners were high in openness
to experience and in conscientiousness compared to the general population which is similar to what
was found here. As I noted in my previous article, high openness to experience is associated with
willingness to experiment with unusual and unconventional behaviours and in particular with a
desire to be sexually uninhibited and to explore novel sexual experiences (Gaither & Sellbom, 2003).
Conscientiousness is associated with self-discipline and a liking for orderliness, and rule-following.
These characteristics seem well-suited to people who are into something like BDSM. In the Dutch
study the statistically largest difference between dominants and submissives was in neuroticism,
while in Hébert and Weaver’s study, the statistically largest difference between them was in
emotionality, which is highly similar to neuroticism. According to Hébert and Weaver dominants
consider it important to remain calm and keep a level head during scenes. People low in
neuroticism/emotionality tend to be naturally calm and not easily upset, so this would be helpful in
the dominant role.

However, the differences between the Dutch study and Hébert and Weaver also need to be
addressed. Extraversion is associated with social assertiveness and willingness to take charge in
social situations so it makes sense that dominants might be higher in these characteristics than
submissives. However, Wismeijer and van Assen (2013) actually found that submissives had the
highest extraversion scores in their sample. Additionally, I have previously argued that it would make
sense for dominants to be lower in agreeableness than submissives, which was what Wismeijer and
van Assen found, because people low in agreeableness tend to be tough and domineering, and that
this would naturally suit them to taking charge during a BDSM scene. However, Hébert and Weaver
found no difference at all in agreeableness in their study. The reasons for these differences are not
known. However, there are subtle differences in the measures used to assess extraversion and
agreeableness in the two studies, and it is possible that these might be reflected in the results.

The Dutch study by Wismeijer and van Assen (2013) used a measure of the Big Five called the NEO-
FFI, while Hébert and Weaver used a measure called the HEXACO-60. Close examination of the items
used to measure extraversion and agreeableness respectively in each of these instruments reveals
some noticeable differences in the way these traits are conceived. Items assessing extraversion in
the NEO measure mainly focus on sociability and positive emotions, only one item mentions social
assertiveness and none concern social self-esteem. The HEXACO-60 extraversion scale on the other
hand has three items relating to social assertiveness and three items assessing social self-esteem. In
regards to agreeableness, the NEO agreeableness scale contains items related to tough-mindedness
(e.g. “I’m hard-headed and tough-minded in my attitudes”), willingness to manipulate others, and
self-aggrandisement. The HEXACO-60 agreeableness scale on the other hand, seems to place more
emphasis on forgiveness versus anger, and on general kindness. Although there are important
similarities between the scales, they seem to subtly emphasise somewhat different qualities that
make up extraversion and agreeableness respectively.

Regarding extraversion firstly, perhaps dominants differ from submissives in regards to being more
willing to take charge in social situations and having a more favourable opinion of themselves rather
than in regards to being more sociable as such. Note that Wismeijer and van Assen (2013) also found
that dominants were less sensitive to rejection, had a lower need for approval than submissives, and
that male dominants were more socially confident than submissives. This seems to fit with the
notion that dominants are more sure of themselves in their relations with other people. Also
relevant is that Hébert and Weaver found that dominants had higher self-esteem and satisfaction
with their lives compared to submissives. Self-esteem and satisfaction with life both had large
positive correlations with extraversion and with each other in this study. Interestingly, Hébert and
Weaver performed an analysis statistically controlling for differences in extraversion and found that
dominants and submissives no longer differed in either self-esteem or satisfaction with life. This
suggests that these apparent differences were due to the higher extraversion among dominants.

Regarding agreeableness, perhaps the fact that the Dutch study found that dominants were more
disagreeable while Hébert and Weaver’s study did not, because dominants may differ from
submissives in regard to having a more tough-minded attitude and their willingness to engage in
psychological manipulation. On the other hand, dominants might not differ particularly from
submissives in regards to anger or willingness to forgive. Furthermore, Hébert and Weaver point out
that negotiation of a BDSM scene requires open communication and therefore both parties need to
be able to cooperate effectively to create a mutually satisfying outcome and cooperativeness is an
agreeable trait. Of course, these conjectures on my part are quite speculative, and it is also possible
that dominants and submissives really do not differ that much at all in regards to these traits. More
nuanced research using measures of more specific traits such as assertiveness, anger, tough-
mindedness, and so on would be needed to determine if these subtle differences are actually
present.

For some, bondage has become an art form.

For some, bondage has become an elaborate art

Hébert and Weaver’s study also examined a number of traits that have not been investigated before,
namely honesty-humility, desire for control, empathy and altruism. They expected that dominants
and submissives would differ in all of these respects, but the only significant difference was that
dominants expressed a greater desire for control. Hébert and Weaver (2014) mention that they had
conducted a small qualitative study (not yet published at the time of writing) and learned that
dominants "expressed great pleasure in being able to control the situation and reported this as one
of the main benefits of BDSM." They note that dominants fell within the ‘normal range’ of desire for
control, hence they suggested that BDSM scenes provide an outlet for a person’s typical desire for
control, rather than an expression of an abnormal need to keep control. Hébert and Weaver also
considered that submissive abasement in scenes might be an expression of a sense of humility,
something which I also speculated about in my previous post. However, this does not appear to be
the case. Similarly, the authors thought that submissives might be higher on empathy and altruism,
because in their qualitative study submissives described themselves as people-pleasers. However,
this was also not the case. On the other hand, this suggests that those in the dominant role are not
lacking in empathy either. In fact having empathy might help them to understand and meet the
needs of submissives during scenes.

Hébert and Weaver’s study helps contribute to understanding the psychological profiles of those
who participate in BDSM. Those drawn to the dominant role appear to be self-confident, assertive,
and comfortable taking control. Those who are drawn to the submissive role appear to be more
introverted and emotional and enjoy surrendering control. Dominants seem to have a better opinion
of themselves and to be more satisfied with their lives compared to submissives, which might be
accounted for due to greater extraversion. People of both orientations are open to new experiences
and are probably self-disciplined and appreciate structure and rules. Hence, it would seem that
people drawn to BDSM choose roles that fit their personalities to a certain extent, although
questions remain, such as about the role of more specific traits that are subsumed by the broad
factors in the Big Five and HEXACO models. Considering the diverse range of practices involved in
BDSM, future research might compare and contrast practitioners with diverging interests in order to
foster a deeper of this fascinating area of human life

Therapy with Kink: An End to Shame

New recommendations describe best practices for clinical work with kinky people.

In 1886, German psychiatrist Richard Freiherr von Krafft-Ebing published Psychopathia Sexualis, one
of the first clinical works which described, labeled, and diagnosed unusual sexual behaviors. The
book was one of the first to clinically describe male homosexuality and is the origin of terms such as
masochism and sadism. Von Krafft-Ebing presented three categories of sexual disturbance, including
pathologically exaggerated sexual instincts, absence of sexual instinct, and perversions of sexual
instinct. He based these categories on 238 case studies, presenting sexual deviance as a form of
mental pathology, which could be treated and cured. This view has shaped clinical approaches to
any sexual behaviors which may be considered outside the norm, whatever we think the norm is.

In 2016, Quebec psychologist and researcher Christian Joyal published remarkable research, based
on a randomized sample survey of Quebec’s general population. The study found that nearly half of
the sample reported interest in at least one or more sexual behaviors which von Krafft-Ebing would
have described as deviant and pathological. Around one-third of the sample had pursued these
behaviors at least once, and many so-called deviant interests, such as voyeurism, fetishism,
masochism were reported by participants at levels above what could be considered statistically
unusual. In many of these sexual interests, there were no differences between men and women, and
interest in sexual masochism was significantly linked with higher levels of life satisfaction. Joyal’s
remarkable research turns von Krafft-Ebing's theories on their head and shatters many clinical
assumptions about sexuality.

How can it be that nearly half of the general population have sexual interests once considered
deviant? And how can it be that clinicians and therapists view these sexual interests as unusual,
uncommon, and usually unhealthy, when anonymous research finds that these sexual interests may
in fact represent the norm? Research by Keely Kolmes suggests that it is clinician bias, our
assumptions of deviance, disturbance, and pathology, which lead to people keeping their sexual
interests secret from their therapists.

Kolmes’ research, as well as further research by many other clinicians, has revealed that people
experience sad, dismaying, and harmful responses from therapists when they share their sexual
interests with therapists who are poorly trained on sexual diversity. Patients report being "fired"
from therapy for being kinky, having Adult Protective Services called for engaging in consensual
sexual behaviors, losing custody of their children, and generally being shamed and told that they are
sick by therapists who believe, as von Krafft-Ebing did, that these sexual interests represent mental
disturbance.

Sadly, good training and information on kinky sexual behaviors for therapists has been remarkably
hard to find. Many therapists are ignorant. Many dominant clinical approaches, from sex addiction
to attachment therapies, view interest in sexual kink as signs of pathology and trauma. Patrick
Carnes, the founder of modern sexual addiction treatment, wrote that sadomasochism was sexually
addictive behavior, where “victims may perceive their feelings towards their torturer as loving, but
there is no genuine trust or intimacy when a relationship is based on hurting one another.” Therapist
ignorance, bias, and lack of training has led to harmful, shaming practices which have forced patients
to shamefully hide their sexual interests from everyone, including the professionals who are
supposed to be nonjudgmental and healing.

Luckily, things have changed. Starting in 2010, a group of clinicians who work closely with these
sexually stigmatized groups have been developing a set of guidelines for therapists who want to
work from a place of knowledge and health, as opposed to ignorance and shaming. At an annual
clinical conference, now known as The Multiplicity of the Erotic, in 2012, the first steps towards
defining these clinical guidelines were outlined. A research and clinical group was formed, with the
goal of summarizing and documenting research and best practices, and a second group was created
to solicit information from stakeholders in the process, including people who have kinky sexual
interests and have sought clinical services. After nearly a decade’s work, these comprehensive
guidelines are now available. They may be found at www.kinkguidelines.com (A Safe For Work
website!).

The 62-page document is thorough, comprehensive, and informative. Twenty-three clinical

guidelines are laid out, with explanations, justifications, tips, and suggestions. They start with
educating clinicians about the term “kink” itself, as an umbrella term which encapsulates a wide,
evolving range of consensual sexual behaviors, fantasies, and interests, and go on to set forth the
critical importance that clinicians must recognize their competence (or lack thereof) when it comes
to working with these sexual issues.

The guidelines underscore the important fact that von Krafft-Ebing, and a century of clinical
assumptions, were wrong. These sexual interests are not unusual, not uncommon, not caused by
trauma, and not a sign of mental illness. Consensual kinky sexual interests don’t predict bad
parenting or disturbed sexuality; ultimately, they can be healthy. Guideline 15 directs therapists to
understand that their attempts to change or alter a person’s kinky sexuality may be unethical, ill-
informed, and harmful to their patient. Guideline 17 highlights the very real damage and harm
caused to patients by unexamined biases in the clinician themselves, directing therapists to do their
own work, confronting and examining their moral and sexual values, and holding therapists ethically
responsible for the impact of these biases in their clinical work.

Given the sad history of the field of mental health’s approach to sexuality, I believe that many
therapists can’t truly be blamed for their ignorance. Social stigma forced sexual interests into dark
closets, where clinicians' biased ignorance was either confirmed or unchallenged. Because clinical
research and writing on these topics was inaccessible, or biased as well, ethical and concerned
therapists had few resources on which to base an affirmative, health-focused, and accepting clinical
approach to sexual diversity. This is no longer the case.

In my view, these guidelines should be read by EVERY mental health clinician. They should not be
relegated to only the clinicians who work with sexual populations or those who identify as kinky.
Remember—half the general population has these interests, and they express across the age range,
and across social and demographic groups. Every clinician IS most likely working with kinky people,
whether they know it or not.

It is every clinician’s ethical responsibility to correct their ignorance, confront their biases, reject
outdated and stigmatizing clinical beliefs, and serve their patients in an accurate, ethical and
empirically-grounded manner. The Clinical Practice Guidelines for Working with People with Kink
Interests lay the foundation for a new era of clinical work, where our patients should no longer feel
forced to keep parts of themselves secret from us, or fear being shamed.