Psychological Correlates

Sadomasochism was originally construed as a perversion and remains categorized as a paraphilia. With the important exception of Freud, early psychoanalysis theorized that sadomasochism was comorbid with a wide range of other pathologies and personality traits. Baumeister (1988a) captures some of the flavor of this writing:

“Stekel...linked masochism to cannibalism, criminality, vampirism, mass murder, necrophilia, epilepsy, pederasty, and the like. He actually said that all sadists (and therefore all masochists, who are sadists in his view) are murderers, and in a temporary lapse of therapeutic fervor he described their company as “the kingdom of hell.”...Reik said that all neurotics are masochists...”

On the strength of these assumptions, many early case studies of BDSM make little or no attempt to catalog comorbid disorders, even when it would have clearly been clinically useful to do so (Kilmann et al 1982). The assumption was simply that other disorders were surely present, or at least incipient. Freud had taken a contrary view, arguing at several points that a defining feature of paraphilias was how compartmentalized they were. For instance (pp. 15, 27):

“Many people are abnormal in their sexual life who in every other respect approximate to the average, and have, along with the rest, passed through the process of human cultural development.”

“But even in such cases [coprophilia and necrophilia] we should not be too ready to assume that people who act in this way will necessarily turn out to be insane or subject to grave abnormalities of other kinds. Here again we cannot escape from the fact that people whose behavior is in other respects normal can, under the domination of the most unruly of all instincts, put themselves in the category of sick persons in the single sphere of sexual life.”

These two contrary ideas form the poles of later research: Kink co-ccurs with a wide range of other mental conditions, or else it does not.

Evidence Against Co-Occurence

The first empirical study to address these questions is Spengler (1979). Meyer-Bahlburg (1980) writes:

“Spengler's data indicate that a subject's orientation does not permit stringent conclusions as to overall psychopathology; in fact, most of them seem to lead generally well-adjusted, inconspicuous lives. Moreover, in most cases, even sexual satisfaction is not limited to SM practices. This reminds one of the discrepancies between findings from clinical and non-clinical samples of homosexuals, and the resulting consequences for theoretical formulations.”

Later authors would reinforce this claim. Moser and Levitt (1987) could find no difference in a psychological function between their kinky sample and a control group. It also seems that relatively few kinky people voluntarily seek treatment for their kink: no study suggests a figure higher than 16%. Alison et al (2001) and Richters et al (2008) both found low levels of psychological distress, at least among kinky males. The latter study, famously, found that kinky men have a significantly lower level of psychological distress than the general population.

The most focused study on this topic to date has been Cross and Matheson (2006), which used a control group and compiled a large battery of psychiatric inventories designed to address major theories of kink etiology. These batteries included the stress, social potency, danger-seeking, and authoritarianism subscales of the DPQ; the neuroticism subscale of the EPI; the SCL-90-R; the Dissociative Experiences Scale; the RSES; the SBI; the RPI; the day-dream subscale of the IPI; the ICMI; the DCI; the LOC scale; an index of drug use; an index of sexual guilt; and various others.  Cross and Matheson's results roundly rejected any correlation between kink and neuroticism, psychopathy, sexual guilt, low self-esteem, authoritarian personalities, escapism, day-dreaming, or drug use.  (Notably, this study focused on masochists and sadists separately, eliminating a possible pitfall in this sort of research: masochists might have low scores, while sadists have high scores, and kinky people as a whole have average scores.)

More inferentially, our demographic information on kink (such as we have) typically fails to reject the null hypothesis. Kink does not seem to be closely related to urban or rural habitation, relationship status, level of education, or political viewpoint. The general trend is to suggest that is not all that closely related with gender, either. Richters and colleagues (2008) did not find any correlation between BDSM and having piercings or tattoos. These variables are not, per se, psychological, but if there was a strong association between kink and some particular psychopathology, it would be unusual to find no trace of it in variables such as these.

Finally, Klein and Moser (2006) point to the lack of concrete evidence against the claim for normalcy made by Freud and Spengler. They argue that, after fifty years of research, any meaningful co-occurences between BDSM and mental illnesses should be well-established in the empirical literature. While it is true that no such assocations are well-established, they are not non-existent. The following studies attempt to demonstrate such links.

Evidence for Co-Occurence with Other Aspects of Sexuality

There is a very robust argument that kinky people tend to have a more diverse sexual practice than non-kinky people. In the first place, kinky people are far more likely to be bisexual or homosexual. But more generally, people with a sexual focus on BDSM are apt to have a more exploratory sexual range than others.  (Cross and Matheson 2006; Richters et al 2008).

Following Freud (p. 33) and many other authors, the DSM-IV asserts that paraphilics “not uncommonly” have more than one paraphilia (the others currently being exhibitionism, fetishism, frotterurism, pedophilia, transvestism, voyeurism, and "not otherwise specified"). More specifically, they claim an association between sadism, masochism, fetishism, and transvestism (p. 529), and the same set of associations is made in the ICD-10 (F65.5). Kinsey et al (1953, p. 681) suggests a narrower correspondence between male masochism and transvestism. While this conclusion seems to be based on substantial survey work, they do not provide statistical corroboration that it's significant. However, it seems to fit nicely into accounts of “forced feminization” as a male masochistic scripts. (Baumeister 1988b makes the observation that male masochistists with a forced-feminization kink are, in terms of text analysis, somewhat dissimilar from other masochists of either gender.)

The most robust findings from the Richters survey are that self-identified BDSM practioners are likely to have engaged in a wider range of sexual exploration than their non-kinky peers, even where ostensibly non-kinky sex acts are concerned. This includes vaginal, oral, anal or phone sex; fisting; rimming; digital anal stimulation; sexual non-exclusivity while in a relationship; higher numbers of lifetime sex partners; surfing internet sex sites; using toys; having group sex. Kinky men were also more likely to have had multiple sex partners, to have paid for sex at some point in their life, to masturbate, and to watch pornographic movies or videos. Kinsey, Pomeroy, and Martin (1948) note that masochists have unusually diverse masturbation scripts (p. 510).

Evidence for Co-Occurence with Non-Sexual Conditions

Here we do not have any clear or consistent thesis. Clinical and criminal studies often suggest a relationship between kink and other psychopathologies, such as antisocial personality disorder, but these samples are almost certainly non-representative (Weinberg 2006). However, Richters et al (2008) found that for women, the experience of having been imprisoned at some point in the last 15 years was positively correlated with BDSM. We could imagine many patterns of causality to explain that finding, which clearly deserves more research.

Wise et al (1991) looking at a small group of paraphilic males within a larger clinical study, find high levels of neuroticism, low agreeability on the NEO-PI, elevated levels of fantasy, and low conscientiousness. Their sample, however, seems to include pedophiles, voyeurs, and exhibitionists as well as clinically presenting sadists and masochists.

The most focused research in this area have been etiological attempts to link kink to childhood sexual abuse@. If such a link could be established, it would be possible to infer that kink is related in some way to post-traumatic stress disorder or similar conditions: clearly a number of authors assume that this is the case. At the moment, though, this explanation does not seem to hold for most kinky people.

Connolly and her colleagues apparently conducted two purposive studies of mental health within BDSM communities, which ought to contribute significantly to this literature, but as far as I know they have not actually been published as of October, 2009.

Updated 11/19/2008