Sadomasochism: consensual pain, power and erotic practice

Origin of the term

The terms sadism and masochism were first used in a scientific context by Richard von Krafft-Ebing in 1886 in Psychopathia sexualis. He refers here to the works of the writers de Sade, whose novels mix pornographic content with violent fantasies, and Sacher-Masoch, who in several works depicts the gain of pleasure through pain and submission.

Albert von Schrenck-Notzing introduced the term algolagnia (addiction to pain) in 1892, which was probably the first to divide the entire complex into an active (sadism) and a passive form (masochism). (However, since sadomasochism can occur without the need for physical experience, the term algolagnia is not applicable to the entire spectrum and is not used in diagnosis). In his view, the two expressions form the two poles within an overall continuum. Both this view and that of the strict separation of the two disorders are still prevalent today and are defended with the same reasoning.

After Sigmund Freud had presented sadism and masochism as diseases arising from a defective development of the infantile psyche in his Three Treatises on Sexual Theory in 1905, thus fundamentally influencing the further assessment of the subject for decades to come, the Viennese psychoanalyst Isidor Sadger finally coined the compound term "sado-masochism" for the first time in his 1913 article On the Sado-Masochistic Complex.

Colloquial use

Sadomasochism - in all its variants represented by the letters SM - is also found in the multi-layered acronym BDSM, which is composed of Bondage & Discipline, Dominance & Submission, Sadism & Masochism. In colloquial language the term Sadomasochism, respectively the abbreviations Sadomaso or SM, describes without further specification sexual practices from the area of BDSM. Often the term is also used to describe mixed forms of sadomasochism or BDSM with various fetishistic practices.

The medical-psychological classification follows the basic diagnostic criteria, the ICD-10-GM (GM: German Modification) and the often cited Diagnostic and Statistical Manual of Mental Disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which is published in the United States by the American Psychiatric Association. Consensual or even secret sexual preferences for sadomasochistic practices usually do not meet the criteria for the diagnosis of sadomasochism in today's medical sense and are a sociologically different, but not uncommon expression of individual sexuality. However, the transitions between individually expressed sexuality and sexual preference disorder cannot be defined with certainty in all cases. However, an overlap of sexual preference disorders by the exercise of sadomasochistic practices does occur.

Depending on the understanding of the underlying diagnostic code, sadomasochism is considered as a whole or in its partial aspects. Due to the differing definitions and the vertical or horizontal arrangement of the diagnostic criteria, deviating results may occur, especially in statistical values and descriptive publications from different countries.

ICD-10-GM F65.5

According to ICD-10 F65.5, sadomasochism is considered a unitary "disorder of sexual preference," although separate labeling may be done to describe either of the two expressions.

Sexual activities involving the infliction of pain, humiliation or bondage are preferred. If the person suffers this type of stimulation, it is masochism; if they inflict it on someone else, it is sadism. Often the person experiences sexual arousal during both masochistic and sadistic activities.

The other diagnostic criteria for the need for treatment include unusual sexual fantasies or urge-like behaviors that persist over a period of more than six months, as well as the subjective suffering of the person affected by these fantasies and behaviors and the restriction in several areas of functioning, for example in social contact or employment. If another person is harmed, injured or abused in the process, this is already sufficient for the diagnosis.

Criticism of ICD-10-GM F65.5Within the
subcultural BDSM scene, various organizations, for example the German Federal Association of Sadomasochism and the international ReviseF65,
oppose the classification of erotic and consensual sadomasochism in the ICD as a paraphilia and demand a revision of it. In their view, this ascribes an unhealthy or pathological disorder to these practices and lifestyles, which promotes prejudice and discrimination against sadomasochists. As a result of these efforts, a corresponding amendment to the country's own ICD has already been enforced in Denmark, and a corresponding regulation was implemented in Sweden on 1 January 2009.

ICD-11

In the ICD-11, which is due to come into force on 1 January 2022, the section has been fundamentally revised. A new diagnosis of "Coercive Sadism Disorder" was introduced. For this diagnosis, sexual arousal must relate to non-consensual sadistic fantasies or acts. The diagnosis "Sadomasochism", on the other hand, has been dropped altogether and no special diagnosis code is provided for consensual acts anymore.

DSM 5

With the publication of the DSM-5 in 2013, the American Psychiatric Association has once again revised the diagnostic criteria. In principle, paraphilias are now only attributed disease value if there is pressure to suffer or if they are not socially acceptable.

Accordingly, a Masochistic Disorder (DSM-5 302.83) can be diagnosed if the corresponding fantasies lead to relevant suffering or restrictions in important areas of life. Furthermore, Sadistic Disorder (DSM-5 302.84) is additionally present when the person acts out the fantasies on other people without their consent.