by Caroline Boyd-Rogers
University of Iowa
Bondage/discipline, dominance/submission, sadism/masochism (BDSM) is commonly associated with a sexual preference for consensually giving or taking control during a sexual encounter.
Though commonly seen as a “niche” sexual interest, 76% of a large sample of therapists reported working with at least one client with a history of engaging in BDSM. However, only about half of those providers perceived themselves to be competent in this area (Kelsey et al., 2012). Thus, it is important for clinical scientists to have a greater understanding of the profile of BDSM-practicing individuals for purposes of both clinical practice and research with sexual minority populations.
Mental Health Profile: BDSM-related behaviors have been historically pathologized in the Diagnostic Statistical Manual (DSM) until the publication of the DSM-5 in 2013. However, mental health research comparing BDSM practitioners to community samples have not found many differences. Both male and female practitioners ranked higher on subjective well-being, conscientiousness, openness to new experience, and extraversion while scoring lower on measures of rejection sensitivity, and neuroticism, when compared to a non-BDSM identifying control group (Wismeijer & van Assen, 2013). Relative to non-BDSM samples, male practitioners show less psychological distress and female practitioners show no significant difference (Richters et al., 2008). Thus, BDSM behaviors are not necessarily linked to negative mental health outcomes, a history of sexual trauma, or distress, as historically thought.
BDSM and LGBTQIA+: Members of the LGBTQIA+ community are more likely than their heterosexual counterparts to endorse engagement in BDSM (Richters et al., 2008). From a Minority Stress perspective, (Meyer 2003), BDSM practice could operate as another source of minority stress, given the maintained stigma around these behaviors (Stockwell et al., 2010; Weiss, 2006). However, active membership in a BDSM community may also provide a source of social support and community resilience. From a research perspective, assessing potential BDSM identity and subsequent risk and resilience factors could provide a more nuanced view of the intersectional experience of some members of this population.
Recommendations: Qualitative research with BDSM practitioners has led to two primary recommendations for cultivating an affirming clinical environment for BDSM-identifying individuals. First, practitioners endorsed the importance of clinicians not focusing excessively on BDSM when concerns were unrelated to BDSM engagement (Dunkley & Brotto, 2018; New et al., 2021). Second, therapists working with a BDSM practitioner should do their own research on BDSM so that they are positioned to understand the nuances of the community and appreciate the stigma associated with holding this identity (Dunkley & Brotto, 2018; New et al., 2021) without assuming that identity centrality and stigma-sensitivity are necessarily consistent across practitioners. Further, clinical scientists are more likely to encounter BDSM practitioners when working with other sexual and gender minority populations and should assess both the potential minority stress and resilience features of the client’s BDSM experience when assessing how this operates within an individual’s own life.
Finally, formal practitioners of BDSM participate in communities with several psychological and physical safety nets in place. However, for those who play outside of these formal spaces, these safety mechanisms are not necessarily in place and the use (or lack thereof) of these safety mechanisms should be assessed in future research. Because of the thematic overlap between consensual BDSM engagement and nonconsensual sexually aggressive behavior, it also is critical for clinical scientists to draw a distinction between these two phenomena, both when inquiring about client experiences in clinical care (Dunkley & Brotto, 2018) as well as when assessing consensual BDSM in research settings.
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References
Dunkley, C. R., & Brotto, L. A. (2018). Clinical considerations in treating BDSM practitioners: A review. Journal of Sex & Marital Therapy, doi:10.1080/0092623X.2018.1451792
Gemberling, T. M., Cramer, R., & Miller, R. S. (2015). BDSM as a sexual orientation: a comparison to lesbian, gay, and bisexual sexuality. Journal of Positive Sexuality, 1, 56-62.
Hebert, A. & Weaver, A. (2015). Perks, problems, and the people who play: A qualitative exploration of dominant and submissive BDSM roles. The Canadian Journal of Human Sexuality, 24(1): 49-62. doi: 10.3128/jchs.2467
Kelsey, K., Stiles, B. L., Spiller, L., & Diekhoff, G. M. (2013). Assessment of therapists’ attitudes toward BDSM. Psychology & Sexuality, 4(3). 255-267. https://doi.org/10.1080/19419899.2012.655255
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull, 129(5): 674-697. doi: 10.1037/0033-2909.129.5.674
New, C. M., Batchelor, L. C., Shimmel-Bristow, A., Schaeffer-Smith, M., Magsam, E., Bridges, S. K., Brown, E. L. & McKenzie, T. (2021). In their own words: getting it right for kink clients. Sexual and Relationship Therapy, https://doi.org/10.1080/14681994.2021.1965112
Richters, J., de Visser, R. O., Rissel, C. E., Grulich, A. E., & Smith, A. M. A. (2008).
Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (BDSM): Data from a national survey. International Society for Sexual Medicine, 5, 1660-1668. doi: 10.1111/j.1743-6109.2008.00795.x
Sprott, R., & Williams, D. J. (2019). Is BDSM a sexual orientation or serious leisure? Current Sexual Health Reports, 11: 75-79. https://doi.org/10.1007/s11930-019-00195-x
Stockwell, F. M. J., Walker, D. J., & Eshleman, J. W. (2010). Measures of implicit and explicit attitudes toward mainstream and BDSM sexual terms using the IRAP and questionnaire with BDSM/fetish and student participants. The Psychological Record, 60, 307-324.
Weiss, M. D. (2006). Mainstreaming kink: the politics of BDSM representation in the U.S. popular media. Journal of Homosexuality, 50, 103-130. doi: 10.1300/J082v50n02_06
Williams, D. J., Prior, E. E., Alvarado, T., Thomas, J. N., & Christensen, M. C. (2016). Is bondage and discipline, dominance and submission, and sadomasochism recreational leisure? A descriptive exploratory investigation. The Journal of Sexual Medicine, 13, 1091-1094. doi: 10.1016/j.jsxm.2016.05.001
Wismeijer, A. A. J. & van Assen, M. A. L. M. (2013). Psychological characteristics of BDSM practitioners. International Society for Sexual Medicine, 10, 1943-1952. doi: 10.1111/jsm.12192
Disclaimer: The views and opinions expressed in this newsletter are those of the authors alone and do not necessarily reflect the official policy or position of the Psychological Clinical Science Accreditation System (PCSAS).