Psychologist Anywhere AnytimePsychologist Anywhere Anytime

Sadism and masochism (sadomasochism) are two of the behaviors in a group of sexual problems called paraphilias. Paraphilias are associated with sexual arousal in response to stimuli not associated with normal sexual behavior patterns.

Understanding Sadomasochism

Sadism is the sexual pleasure or gratification in the infliction of pain and suffering upon another person.

The counterpart of sadism is masochism, the sexual pleasure or gratification of having pain or suffering inflicted upon the self, often consisting of sexual fantasies or urges for being beaten, humiliated, bound, tortured, or otherwise made to suffer, either as an enhancement to or a substitute for sexual pleasure.

Sadists enjoy inflicting pain whether or not it is sexual in nature. Masochists enjoy receiving pain, which, again, may or may not be sexual. Dominance and submission is a way of looking the the sadistic-masochistic distinction, a power dynamic rather than a set of acts. Not all masochists are submissive, and not all submissives enjoy pain. Not all sadists are dominant, and not all who enjoy dominating others are sadists.  There is frequently a strong emotional aspect to the sexual desires, taking the form of a need for domination (to control another) or submission (the desire or to be controlled) as opposed to a simple desire for pain (which is technically known as algolagnia). The words sadistic and masochistic are now commonly used to describe personality traits in an emotional, rather than sexual sense.

Paraphilias and Sadomasochism

Sexual sadism

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the prevailing resource for diagnostic criteria of paraphilias, describes the diagnostic criteria for sexual sadism are as follows:

The patient reports recurrent and intense sexual urges and sexually arousing fantasies involving the act (real, not simulated) in which the psychological or physical suffering (including humiliation) of one person is sexually arousing to another person. Symptoms must be present for at least 6 months. The fantasies, urges, or behaviors cause significant distress or impairment in social, occupational, or other important areas of functioning. Sadistic fantasies or acts may involve activities such as dominance, restraint, blindfolding, beating, pinching, burning, electrical shock, rape, cutting, stabbing, strangulation, torture, mutilation, or killing. Sadistic sexual fantasies are likely present in childhood. Onset of sadistic activities commonly occurs by early adulthood, and it tends to be chronic. Some individuals do not increase the severity of their sadistic acts; however, severity of the sadistic acts does usually increase over time.

No clear lines divide sexual sadism and sexual masochism, and the predispositions are often interchangeable. The conditions may coexist in the same individual, sometimes in association with other paraphilias. This relationship is supported by the finding that those who entertain masochistic fantasies also engage in sadistic fantasies.

Sadism involves causing physical or psychological pain or suffering to another person. As long as it occurs with a consenting partner, it can be argued that sexual sadism is not considered to be a psychological disorder. It is certainly considered a disorder when it causes unhappiness to the person with it, causes problems with work, social setting, or family, or when there is potential danger to another individual.

Like some masochists, some sadists require the pain or humiliation in order to function sexually. Others may engage in more typical sexual activities at some times and sadistic activities at other times. Sadists often seek out masochists as sexual partners. The sexual arousal in sadism is directly related to the suffering of the other person.

Some acts involve actual physical violence, including cutting, burning, or beating. Other acts involve domination, such as making the other person crawl or keeping him or her in a cage. Still other acts involve humiliation.

Sexual masochism

The essential features of this disorder as described by the DSM-IV-TR include the following:

The patient reports recurrent and intense sexual urges and sexually arousing fantasies involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer. Symptoms must be present for at least 6 months. The fantasies, urges, or behaviors cause significant distress or impairment in social, occupational, or other important areas of functioning. Masochistic acts commonly involve a wide range of activities, such as restraint, blindfolding, beating, electrical shock, cutting, piercing, and humiliation (e.g., being urinated or defecated on, forced to bark, verbally abused, forced to cross-dress). Some sexual masochists inflict pain through self-mutilation, and some engage in group activity or use services provided by prostitutes.

Hypoxyphilia is a dangerous form of masochism that involves sexual arousal by oxygen deprivation achieved by means of chest compression, noose, ligature, plastic bag, mask, or chemicals. Oxygen deprivation may be accomplished alone or with a partner. Data from the United States, England, Australia, and Canada indicate that 1-2 deaths per million population are reported each year.

Some sexually masochistic males also exhibit fetishism, transvestite fetishism, or sexual sadism. Masochistic sexual fantasies are likely present in childhood. Masochistic activities commonly begin by early adulthood, tend to be chronic, and the same act is generally repeated. Some individuals increase the severity of the act over time, which may lead to injury or death.


Sadism and masochism, often interrelated (one person obtaining sadistic pleasure by inflicting pain or suffering on another person who thereby obtains masochistic pleasure), are collectively known as S&M or sadomasochism. BDSM is a short-hand acronym for many subdivisions of the culture: (B&D) bondage and discipline, (D&S) domination and submission, (S&M) sadism and masochism. The term BDSM describes the quite common activities between consenting adults that contain sadistic and masochistic elements. Many behaviors such as erotic spanking, tickling and love-bites that many people think of only as "rough" sex also contain elements of sado-masochism.

The DSM-IV-TR  list of other paraphilias includes:

Exhibitionism: the recurrent urge or behavior to expose one's genitals to an unsuspecting person.

Fetishism: the use of non-sexual or nonliving objects or part of a person's body to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body.

Frotteurism: the recurrent urges or behavior of touching or rubbing against a non consenting person.

Voyeurism: the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities, or may not be sexual in nature at all.

Transvestite fetishism: a sexual attraction towards the clothing of the opposite gender.

Chronophilias such as Infantophilia: the sexual attraction to infants, Pedophilia: the sexual attraction to prepubescent children, Gerontophilia: the sexual attraction to the elderly.

Other paraphilias: includes rarer behaviors such as telephone scatalogia (obscene phone calls), necrophilia (corpses), partualism (exclusive focus on one part of the body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), urophilia (urine).

For additional "paraphilias", visit the page List of Paraphilias.

Causes of Sadism and Masochism

There are a number of reasons commonly given for why a sadist or masochist finds the practice of S&M enjoyable, and the answer is largely dependent on the individual. For some, taking on a role of compliance or helplessness offers a form of therapeutic escape; from the stresses of life, from responsibility, or from guilt. For others, being under the power of a strong, controlling presence may evoke the feelings of safety and protection associated with childhood. They likewise may derive satisfaction from earning the approval of that figure. A sadist, on the other hand, may enjoy the feeling of power and authority that comes from playing the dominant role, or receive pleasure vicariously through the suffering of the masochist. It is poorly understood, though, what ultimately connects these emotional experiences to sexual gratification, or how that connection initially forms.

It is usually agreed on by psychologists that experiences during early sexual development can have a profound effect on the character of sexuality later in life. Sadomasochistic desires, however, seem to form at a variety of ages. Some individuals report having had them before puberty, while others do not discover them until well into adulthood. According to one study, the majority of male sadomasochists (53%) developed their interest before the age of 15, while the majority of females (78%) developed their interest afterwards.  Like sexual fetishes, sadomasochism can be learned through conditioning—in this context, the repeated association of sexual pleasure with an object or stimulus.

Treatment of Sadism and Masochism

Unfortunately, a person with sexual sadism or masochism rarely asks for help until someone becomes an unwilling partner or is injured. The seriousness and intensity of these behaviors often increase over time. the outlook for improvement varies depending on the depth of the underlying dynamics and the motivation of the patient. As with other types of problems, improvement is largely dependent on the persons desire for, and willingness to, change.

Several different types of therapy have been found helpful in treating sadomasochism including psychotherapy, cognitive behavioral therapy, aversion and positive behavioral therapy approaches, reality therapy, medications, hormonal treatment, reconditioning and restructuring techniques. 

Another treatment method that is often offered is social skills training. It is thought that some people develop sadistic and masochistic behavior may, in part, do so because they do not know how to form healthy relationships, whether sexual or nonsexual, with other people. Although social skills training is not considered a substitute for medications or psychotherapy, it appears to be a useful adjunctive treatment. Twelve-step programs for sexual addicts has been shown to be very helpful in many cases. Couples therapy or family therapy is particularly helpful for patients who are married and whose marriages and family ties have been strained by their disorder.

Additional Information

For more information about sadism, masochism, or other sexual problem, please click on the linked websites listed below and the visit the glossary that is listed after these websites.

 Education and support group: The Eulenspiegel Society
 The Eulenspiegel Society: promoting sexual liberation for adults

Would You Like Personal Assistance?

If you really want help dealing with your feelings and emotions, changing your behavior, and improving your life and the approach and office hours of typical therapists and counselors do not fit your life style or personal needs, I may have a solution.

By using very flexible office appointments, telephone consultations, email, teleconferences, and the willingness to travel and meet with you personally in your home, office, or other location, I can be available to help you anytime and anywhere.

Feel free to contact me now for your free initial consultation. Once you become an existing client, you will be given a pager number where you can reach me whenever you need.

Psychologist Anywhere AnytimePsychologist Anywhere Anytime