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A Discussion of Sexual Fetishism and MasochismAllan N. Schwartz, LCSW, Ph.D. Updated: May 20th 2008 One of the most difficult and frustrating conditions for patients and therapists to treat are those involving sexual fetishism and masochism.
Definitions: According to the Diagnostic and Statistical Manual of Mental Disorders, Edition IV, Sexual Masochism involves the act of being humiliated, bound or otherwise made to suffer. The criteria for Sexual Masochism is that the need to have this done lasts for at least sex months, the urge to do this is recurrent and engaging in this behavior is sexually arousing and intense. Also, these sexual urges and behaviors cause enough distress or impairment in occupational, social and other areas of functioning (page 529, DSM IV). Sexual Fetishism involves sexually arousing fantasies, urges and behaviors involving the use of non living objects, such as female undergarments (panties, bras, shoes, boots, etc). The individual often masturbates while holding and rubbing the particular garment of choice. Once established, fetishism is chronic and can interfere with functioning in social, occupational and other areas of functioning (page 526, DSM IV). Causes: It is not clear what causes people to develop these sexual problems except there appears to be histories of sexual and physical abuse in the backgrounds of many of these people. I will describe a couple of fictionalized case studies below. It is theorized that these individuals also suffer from one of the many varieties of personality disorder. It is often not surprising to find an accompanying depression and anxiety disorder along with the sexual difficulty and personality disorder. What is also significant is that many of these individuals experience periods of low libidinal energy that is stimulated only in the presence of the fetish and/or fantasy. Fictionalized Case:
(Details are completely fictional in order to protect the privacy of any involved people). Mr. G., a legal immigrant from somewhere in the world consulted me for psychotherapy because of an anxiety disorder.
He was married with two small children and had a full time job. It soon emerged that Mr. had a serious problem that was interfering with his life and that of his family. Mr. G. liked to cross dress in women's clothing, including wearing women's underwear. Even when he did not fully dress in women's clothes, he wore undergarments which, at times, stuck out beneath his shirt and pants so that it was visible to neighbors and strangers. He remembered that, as a small boy, his mother liked to dress him in girl's clothes and makeup. If that was not bad enough, she would also whip, spank and humiliate him at every opportunity. He actually grew up believing this was normal. As a boy, he continued to cross dress without his mother's prompting. This continued into adolescence when he discovered that it was sexually exciting for him to cross dress. He started to frequent department stores where, with great excitement, he would shop for and purchase women's underwear, telling sales people that it was for his mother or girl friend. As a married man, his wife joined him in his sexual fantasies that included acts of sadism. Incredibly, she would dress in men's clothes during their love making while wore women's undies and she would act out a scene in which she was physically punishing him. This excited them both. The problem was that their children were aware of strange noises coming form their bedroom. Mr. G's neighbors became suspicious of his transvestism. Among other things, his children were teased and humiliated and the family was often the recipients of disgusting and threatening mail. Mr. G.'s sexual and masochistic symptoms were extremely chronic. However, he was made more aware that his symptoms were bringing shame on his children because he was not keeping his cross dressing private. His rationale was that he never went out dressed in women's clothes. Yet, he admitted to wearing women's undergarments in public, from time to time. More aware of how his behavior was affecting his children, he stopped shopping in department stores and cross dressing. He and the family soon moved away and I lost track of his progress. Treatment: These cases are difficult to treat because they are chronic in nature and share a lot in common with the addictions as a result of the pleasure involved and the reinforcing nature of sexual pleasure. Some of the techniques practitioners use are Cognitive Behavioral Therapy, Behavior Modification, and Medications, usually the anti depressants in order to dampen the impulsive nature of the urges. Treatment takes a long time, a lot of patience and real dedication on the part of the patients afflicted with these problems. It is important to caution the reader that sexual behavior and taste is extremely varied. Therefore it is not fair to label some sexuality as sick or abnormal unless the sexual behavior: 1. Is detrimental to life and limb. For example, asphyxiation, is sometimes used in masturbation and often results in death. 2. Involves children and minors (They are not able to give consent). 3. Involves adults who are not consenting 4. Invades the privacy of non consenting people, such as voyeurism. 5. Any type of force against the will of another person, such as rape. Within the privacy of their bedroom, two consenting adults who are not bothering anyone else, can engage in the types of sexual activity that gives them pleasure. Your comments are welcome and encouraged. Allan N. Schwartz, PhD Therapeutic Spanking - Spanked Calm - Aug 24th 2009
I wonder if you've seen this story about Russian therapists studying the effects of spanking on anxiety and depression.
http://bit.ly/rusp
I've been interested in researching this because my own experience of being spanked by my husband and then having a sense of calm and peace of mind come over me afterward has been profound.
There is definitely something chemical going on here and it has piqued my intellectual curiosity. My husband, a very scientific mild-mannered type, doesn't get pleasure in smacking me. But the results have convinced him that this is worth pursuing further.
I would be very interested in your thoughts on this.
Thanks I don't see a problem with what they do - Lauren - Jul 29th 2009
question - Lynn - May 22nd 2008
So you are saying that bdsm between adults who claim to like it, if they don't bother anyone else with it, is perfectly fine? It doesn't matter what may have caused it? The sadist shouldn't worry if it was child abuse that made his/her partner like to be hurt during sex?"
If it's a one-time play session, the cause of the masochist's desire for pain isn't really cause for the sadist's concern. If it's a long-term relationship, then the cause for the masochist's desire is more of the sadist's concern. But as long as what the adults do is safe, sane, and consensual, it doesn't affect their abilities to be well-functioning members of society or their health, and their activities do not cause psychological damage to any party(ies) that may be involved, I don't see a problem with what they do. Masochistic Self-Harm - - Jun 30th 2009
Masochistic self-harm as not been specified here:
When I was a toddler, I was molested. Then when I was smacked by my parents, the pain stimulated me sexually. The continued childhood discipline smacking with the associated pain and humiliation, acerbated the effects of the sexual abuse. I began to self-harm masochistically that began in my formative years, following the molestation. The resulting intense shame, secrecy and anxiety surrounding this addictive behaviour became very long-term. This has left permanent physical and psychological scars. Later in life it led to two suicide attempts.
This outcome has devastated my life. What if? - Mr Hyde - May 17th 2009
Can it be that all these -ism:esis incl narcissism submit to no one else but the big unconsciousness? When children play they don't know why and sometimes not even with whom. to Lynn - becca - Mar 29th 2009
Yes, you should not worry. I am a submissive masochist. I was abused as a child. One might have caused the other, or not. It could be in my genes. It does not matter which, because it is who I am now, it gives pleasure and meaning to my life (in the form of my relationship to my Dom), and it is not causing anyone harm. It is not causing me harm because I am ultimately in control -- we use a "safe word" and if I utter it, the dom stops whatever he is doing to me. It is not causing him harm because it provides a safe setting for him to test out different types of sexuality with a very willing partner. It does not cause others harm because he does not repeat this behaviour outside of our relationship. If any behaviour is done between two consenting adults, does not cause either permanent harm (pain being momentary and not defined as harm if voluntary), and does not interfere with professional life or family life, it does not belong in the next version of the DSM. Spanking - Raymond - Dec 18th 2008
This is good stuff here. I am surprised it has stopped. I trailed the internet about it and mostly it's people who don't even question the behaviour and keep feeding it. I think I picked it up from when I was four watching someone being spanked, buttock unclother otk by a nurse and was terrified that it might be me next. I am almost sure that that is where it came from. I am of the view that it's the punishment scenaro that is damaging and not necessarily just spanking which can be arousing for some. I think if the punishment thing is dealt with then it seems a lot healthier in my view. Raymond Response to Editor's Note - Laura - Oct 3rd 2008
I'm pretty sure the point M was trying to make was that, if a normal, healthy state of being such as homosexuality can be included in the DSM, then the fact that masochism is included in the DSM does not necessarily mean it should be treated as a disease. The discipline of psychology has a history of medicalizing ways of being that make mainstream society uncomfortable, and this takes much-needed attention away from genuine mental health problems. You said that being sexually abused as a child sometimes leads to interest in BDSM, and I was curious about that, so I did some research. As far as I can see, about 10% of BDSM practicioners were sexually abused as children. In the general world population, I found that about 5-10% of men and 25% of women were sexually abused as children (25% of women! Isn't that insane?). This seems to mean that, if anything, sexually abused people are slightly less likely to practice BDSM. I had difficulty finding very reliable statistics--if anyone knows where I can find better information on this, I'd be interested. Quackery - M - Sep 29th 2008
So you are saying that gay sex between adults who claim to like it, if they don't bother anyone else with it, is perfectly fine? It doesn't matter what may have caused it? The gay man shouldn't worry if it was child abuse that made his partner like to take it up the arse? Indeed, homosexuality was also once considered a mental illness in the DSM. We also have this nonsense about cross-dressing - yet it's considered perfectly fine by society for a woman to dress up in erotic clothes, indeed it's expected. Quackery like this article gives a bad name to treatment and investigation of genuine mental illnesses. Editor's Note: Homosexuality was indeed once listed as a disorder in DSM. Then some time ago, the APA figured out that it was wrong and eliminated the "disorder" from the DSM. Today, it is widely recognized by professionals that homosexuality is not an illness or disorder of any kind, but rather a naturally occurring (in both humans and animals) form of sexual preference. As for your comment about the effects of child abuse on adult sexuality, it is true that sexual abuse can affect adult sexuality but this does not occur in predictable ways, in my experience. If there are sexualizing events that "make people gay" (as opposed to them being born that way) they are not the primary mechanism through which people become gay. And sexualizing events in childhood also result in alternative outcomes, for instance some percentage (I don't know how many) of people attracted to extreme forms of heterosexuality such as BDSM have been sexually abused as children. Finally, your suggestion that our normalization of homosexuality represents quackery is more a reflection on your own devience from the accepted understanding today and lack of tolerance for differences than a sign of something wrong with the mental health establishment. sexual diversity vs. Addiction - Louman - Sep 28th 2008
Well, if 2 consenting adults want to experiment to add a little variety to their sex life, I think that as long as both are in agreement, boundaries are set, and no one is hurt in the process, then it's ok. If S&M is the only way that an individual can be aroused, then where does it stop? It could possibly progress into more intense activities which could be damaging to both partners, addictive, and affect the intimacy in the long run. Disgusting!! - Kristi - Sep 28th 2008
Worthless POS!!! Separate Issues - Laura - Sep 27th 2008
It seems to me that there are two separate questions involved here: a) is a person who likes to be hurt during sex probably in need of psychological treatment? and b) is a person who has been seriously abused as a child probably in need of psychological treatment? Based on my own experience, I am reasonably sure that the answer to "question a" is no. I am a masochist. I have never been abused in any way, I have an unusually good relationship with both of my parents, and I am in a very healthy long-term relationship in which all of my desires, conventional and otherwise, are fulfilled. SM sex can be a very sensual, and at times spiritual, experience in itself. However, I also believe that sex of all kinds can be a healthy and useful way to playfully work out personal interests and issues (for example, one's need to feel accepted, one's relationship to one's body, or one's understanding of one's partner). I happen to be particularly interested in power dynamics, and SM can be a fun and productive way to explore that interest. The subject in the case study probably began his unconventional sexual interests, which clearly mirror his experience of abuse, because sex was a relatively safe way for him to start exploring his feelings about his past. However, when someone has experienced the degree of abuse that is described in the case study, I can imagine that their recovery will require a great deal more attention than a few sex games. Maybe this is why he began to act out his sexual desires to the extent that they damaged the rest of his life--if what he was doing wasn't helping enough, it would make sense for him to want to do it more. Maybe, if he starts to address the issue of his abuse, his SM and crossdressing desires will disappear, or maybe they won't. If they do not, however, he will probably be in a state of mind that will allow him to make better decisions and keep his activities hidden from people who will not be able to accept them. The issue of control - Brainwoman - Aug 22nd 2008
I have difficulty with this viewpoint in relation to those who engage in sexual masochism or BDSM in the context of a borderline personality disorder, especially when the sexual fixation seems to have been started as the result of prolonged sadistic rape and/or sexual abuse in early childhood. In such cases I do not believe that the individual is in control of the experience or that it is as harmless as suggested. Those who complain that SM and BDSM should not be considered to be a treatment-orientated mental disorder are generally operating (or like to believe that they are operating) from within the confines of an otherwise normal personality structure. Thanks - Lynn - Jun 1st 2008
Thank you very much for sharing your story with me. I'm sorry you had to go through that. Thank you VERY much for the advice. I really appreciate it. Kinky ex-partner - Ryszard - May 31st 2008
I had an ex-partner. He was a dom who needed to spank others to become aroused. Before we got together, I told him that I could not let myself be beaten, because I was physically abused as child. It would be too emotionally painful. When he and I had gotten together, he had said that recognized that he was an S&M dom, but he promised he would not need that in the future any more. He also promised to be monogamous with me. It turns out that he lied to me, and he lied to himself. He was almost continually out on the internet finding kiny S&M sex. After 5 years of working hard on my own to save this relationship it finally became clear to me that our relationship could not be saved. My advice is never get together with a kink unless you, yourself, are a kink. question - Lynn - May 22nd 2008
So you are saying that bdsm between adults who claim to like it, if they don't bother anyone else with it, is perfectly fine? It doesn't matter what may have caused it? The sadist shouldn't worry if it was child abuse that made his/her partner like to be hurt during sex? | 
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Readers in the Boulder, Colorado metro area (or Denver area people willing to drive) may contact Dr. Schwartz for face-to-face consultation and psychotherapy. Email him at dransphd@aol.com for details.