Masochism

Masochism is the deriving of sexual pleasure or gratification from being humiliated, beaten, bound, or otherwise made to suffer at the hands of another. In contemporary psychiatry the term names both a common, non-disordered erotic interest, woven through much of consensual BDSM, and, when it causes the individual clinically significant distress or impairment, the formal diagnosis of Sexual Masochism Disorder in the DSM-5-TR. This article traces the term's literary origin, its clinical lineage from Victorian sexology to modern depathologisation, and what surveys and community life reveal about how widely the interest is shared.

Definition & scope

Is masochism a disorder?

Masochistic interest on its own is not a disorder. Modern psychiatry draws a firm line between a widespread erotic interest in receiving sensation, restraint or humiliation and the narrow clinical disorder, which is diagnosed only when the same pattern causes the person genuine distress or impairs their functioning. Most people with masochistic desires fall on the benign side of that line. In kink settings the masochistic role is often called "bottoming" or submission, and it pairs with sadism, its active counterpart; the two together form sadomasochism. The behaviour is distinguished from harm by consent, negotiation and the bottom's ability to stop the scene.

History & origins

A name borrowed from a novelist

The word masochism is unusual in clinical vocabulary for being coined from a living author's surname. The German-Austrian psychiatrist Richard von Krafft-Ebing introduced it in Psychopathia Sexualis (1886), naming it after the Austrian novelist Leopold von Sacher-Masoch (1836–1895). Sacher-Masoch's 1870 novella Venus in Furs dramatised a man's voluntary submission and the pleasure of suffering and degradation at a beloved woman's hands; the author, who had lived out such arrangements, objected to having his name medicalised. Krafft-Ebing paired masochism with sadism, coined after the Marquis de Sade, and treated both as pathologies of the sexual instinct.

• 1870: Sacher-Masoch publishes Venus in Furs, the literary template for erotic submission.
• 1886: Krafft-Ebing names masochism in Psychopathia Sexualis, pairing it with sadism.
• 1892: the physician Albert von Schrenck-Notzing introduces algolagnia (Greek álgos, "pain," + lagneía, "lust") as a general term for the pleasure of pain, of which masochism is the passive form.
• 1905: Sigmund Freud, in Three Essays on the Theory of Sexuality, treats sadism and masochism as paired components of sexuality rather than wholly separate disorders.
• 1913: the Viennese analyst Isidor Sadger fuses the pair into the single compound sadomasochism.

Sexology beyond the clinic

The British sexologist Havelock Ellis, in his Studies in the Psychology of Sex, questioned a rigidly pain-centred reading and stressed the roles of emotion, surrender and love rather than suffering for its own sake, an early move away from viewing the interest purely as pathology.

Clinical lineage: from deviation to distress

Successive editions of the American Psychiatric Association's diagnostic manual steadily narrowed the clinical scope:

• DSM-I (1952) listed sexual sadism among the "sexual deviations" but did not separately name masochism.
• DSM-II (1968) added masochism as a sexual deviation.
• DSM-III (1980) through DSM-IV-TR (2000) used the label sexual masochism and emphasised real rather than merely fantasised pain or humiliation.
• DSM-5 (2013) renamed it Sexual Masochism Disorder (recurrent, intense arousal from being humiliated, beaten, bound, or otherwise made to suffer, over at least six months) and made the crucial distinction that a diagnosis requires clinically significant distress or functional impairment, with an asphyxiophilia specifier for the dangerous practice of restricting breathing for arousal.
• DSM-5-TR (2022) retained that framework, formalising the split between a widespread, benign masochistic interest and the disorder.

The World Health Organization's ICD-11 went further still: where ICD-10 had filed sadomasochism under "disorders of sexual preference," ICD-11 removed consensual masochism as a mental disorder entirely, on the principle that a private arousal pattern, absent distress or harm to others, is not in itself a disease. Together these revisions reflect a broad late-20th- and early-21st-century depathologisation of consensual kink.

In practice

In its non-disordered form the interest is expressed through negotiated scenes involving impact, restraint, intense sensation, or psychological surrender, in which, counter-intuitively to outsiders, the receiving ("bottoming") partner typically sets the limits and holds a safeword. It overlaps heavily with bondage, spanking and broader pain play. The clinical disorder is distinguished not by the activity itself but by associated distress, dysfunction, or escalation toward seriously self-endangering practices such as breath restriction, which carries the asphyxiophilia specifier.

Psychology

What causes masochism?

Proposed mechanisms for the appeal of masochistic experience include release from control and responsibility, an intense present-focused narrowing of attention sometimes likened to flow or "subspace," endorphin and sympathetic-arousal responses to managed sensation, and the symbolic meaning of trust, care and surrender within a chosen relationship. Why a minority experience associated distress or impairment is not well understood and likely reflects a mix of temperament, learning history, and personal or social conflict about the interest rather than the interest itself. The evidence base for any single causal account remains thin and contested.

Prevalence & culture

How common is masochism?

Masochistic interest is among the more commonly reported paraphilic interests, while the diagnosable disorder is far rarer.

Notably, in Joyal & Carpentier (2017) masochistic interest was associated with greater satisfaction with one's own sex life rather than distress. Community presence is large and visible, with extensive masochism- and submission-themed groups on FetLife and kink forums, and the theme is deeply embedded in mainstream culture, from Venus in Furs to contemporary bestsellers and film. Research attention remains high owing to the interest's formal diagnostic status.

Safety, consent & law

Consensual masochistic activity between adults is legal in most jurisdictions and, absent distress or impairment, not a clinical concern. Safe practice centres on informed negotiation, explicit safewords, risk-aware technique and aftercare. Clinical attention is appropriate only when the interest causes the person genuine suffering, impairs functioning, or trends toward serious self-endangerment, and care is supportive rather than punitive. A persistent legal caveat is that in some jurisdictions consent does not extend to the infliction of serious bodily injury, so activity that causes lasting harm may attract liability regardless of agreement.