Sadism and masochism (as medical terms)

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This article is about sadism and masochism as medical terms only. For sadism and masochism as aspects of BDSM and other consensual behavior, see Sadomasochism. For Disorder of Sadism, see Sadistic personality disorder.

In psychiatry, the terms sadism and masochism describe a personality type characterized by the individual deriving pleasure and gratification from either inflicting or receiving physical pain and/or humiliation, respectively. In some cases the pleasure and gratification may be sexual but in others sexual pleasure is not experienced, and it may involve deriving the pleasure from masochistic or sadist behaviour towards the opposite gender or same gender as self. Some individuals appear to be exclusively sadist and others exclusively masochistic in deriving their pleasure, but many alternately derive pleasure from sadist and masochistic thoughts and experiences involving themselves and others.

The term sadomasochism denotes the co-occurrence of sadism and masochism in one person, as discrete mental disorders. Some contend masochism to be the spiritual inner self-punishment for acts inwardly acknowledged to be sadism. In psychiatric theory, the term "sadomasochism" may be used exclusively. The medical definitions (denotations and connotations) of "sadism" and "masochism" have been modified as required by medical progress, since the Austrian psychiatrist Richard Freiherr von Krafft-Ebing (1840–1902) introduced the terms to psychiatry in the 19th century. This article presents the development of "sadism" and "masochism" as medical terms, leading to their contemporary definitions as a paraphilia in the Diagnostic and Statistical Manual of Mental Disorders (DSM). As erotic practices, the sadomasochistic subculture, and related matters, are noted historically.

Early descriptions[edit]

Sadomasochism: Fanny Hill (1748), illustration by Édouard-Henri Avril.

Sadistic and masochistic sexual behaviors were known before Dr. Krafft-Ebing named them in psychiatry. The Italian Renaissance philosopher Giovanni Pico della Mirandola (1463–1494) described a man who required flogging to achieve sexual arousal and thus be able to copulate. In 1639, the German physician Johann Heinrich Meibom introduced the first theory of masochism in A Treatise on the Use of Flogging in Medicine and Venery; per the 17th-century understanding of human anatomy, in fact the infliction of pain may simply have served to subdue very strong controls over active sexuality, flogging a man’s back warmed the semen in his kidneys, which sexually aroused him when it flowed into his testicles.[1] Fifty years later, in 1698, Kristian Frantz Paullini modified the sexual theory of flogging, by substituting blood for semen as descending from the kidneys to the testicles in aiding sexual arousal. In 1788, François Amédée Doppet expanded the theory of masochistic sexual arousal to include women, by presuming that flogging exercised a like effect upon the woman’s genitalia and her consequent venery. Women can lose their degree of sexual arousal through some degrees of inflicted physical pain, while otherwise they may be tempted to use their sexual responses to physically reduce pain. Thus was the theoretic, causal relation between flogging and human sexual arousal, until Krafft-Ebing’s analysis and theorizing upon this aspect of human mental health.

As a sexual practice, literature recorded sadomasochism before the works of the Marquis de Sade (1740–1814) provided its name. In Asia, the sexual practices manual Kama Sutra (c. 2nd century AD), describes consensual, erotic slapping. The British novel of sexual adventure Fanny Hill (Memoirs of a Woman of Pleasure, 1748), by John Cleland, presents an episode occurred in a brothel, wherein the heroine whips a young man to sexually arouse him.[2] In the autobiographic Confessions (1782), the French philosopher Jean-Jacques Rousseau described his unhappiness for having masochistic fantasies. Some sado-sexual practices may in fact stem from an instinctive wish to punish the object of sexual attraction for provoking sexual arousal as a perceived lack of respect, even female animals can have this reaction.[citation needed][relevant? ]

Krafft-Ebing and the Psychopathia Sexualis[edit]

Sadomasochism: Psychopathia Sexualis (1886), by Dr. Richard von Krafft-Ebing.

In 1886, Richard von Krafft-Ebing published the first edition of Psychopathia Sexualis (Sexual Psychopathy), a collection of sexual case histories and sex-crimes; later editions introduced the terms sadism and masochism. He derived “sadism” from his knowledge of the life and literature of the Marquis de Sade; before the posthumous publication of important portions of de Sade’s literature, such as The 120 Days of Sodom (1785). “Masochism” derives from the sexual practices described in the contemporary (19th century) works, such as Venus in Furs (1870), of the Austrian writer Leopold von Sacher-Masoch (1836–1895). Furthermore, as so defined, “sadism” and “masochism” stem from different sexual and erotic logics, as do the denotations in the literatures of de Sade and Sacher-Masoch; Gilles Deleuze presented this distinction in his work about Sacher-Masoch.

Krafft-Ebing’s basic presumption was that recreational sexual intercourse was a perversion. The French physician Bénédict Morel described sadistic and masochistic behaviors in a theory of degeneration, wherein preference for such sexual behaviors (e.g. masturbation) was presented as an inheritable character trait, that would lead to the deterioration of the human gene pool.[3] Thereby, Krafft-Ebing perceived basic, natural tendencies to sadism in men, and to masochism in women, a perspective later expanded by psychoanalysis.[citation needed] Nonetheless, Krafft-Ebing’s contemporaries were skeptical of his findings, and suggested modifications. The British physician Havelock Ellis (1859–1939) noted that the enjoyment of pain was restricted to the erotic context[4] In 1892, Albert von Schrenck-Notzing introduced the Greek term algolagnia (algos + lagnia, “pain” + “lust”) as an alternative to “masochism” in describing a person’s enjoyment of the pleasure of pain.[5] In the event, Sigmund Freud (1856–1939) adopted Krafft-Ebing’s theories to psychoanalysis, thereby ensuring their integral predominance in classifying and defining human sexual personalities.

Freud and psychoanalysis[edit]

Sigmund Freud made masochism and sadism integral to psychoanalysis, thus, in Three Essays on the Theory of Sexuality (1905), he described the tendency to inflict and receive pain during sexual intercourse as “the most common and important of all perversions”, and that both psychosexual tendencies usually occur in the same person. That masochism is a form of sadism against the Self, and that sadism and masochism are manifested variously as “primary masochism” and “secondary masochism”, and as the subordinate forms of “feminine masochism” and “moral masochism”. In the Freudian theory of psychosexual development, guilt is integral to sadistic and masochistic sexual tendencies, signalling either an incomplete or an incorrect sexual development of the child.

In the event, Freud’s successors, Carl Jung, Wilhelm Reich, and Theodor Reik, modified and developed his ideas with new terms and supporting concepts. Elsworth Baker attributed the origin of masochistic character to parental inconsistency. Helene Deutsch postulated that women are naturally of masochistic character, reinforcing the theories of Krafft-Ebing and Freud. The Freudian theory of sadomasochism and the philosophy of the Marquis de Sade were developed by intellectuals, such as Simone de Beauvoir and Gilles Deleuze, whose writings influenced the popular, mainstream perception of sadism, masochism, and sadomasochism in the mid–20th century.

Empirical research[edit]

Sadomasochism: Sexual Behavior in the Human Male (1948).

Beyond psychoanalysis, the study of practicing sadomasochists changed societal perceptions of sadomasochism in the late 20th century. In Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953), the sexologist Alfred Kinsey reported the sadomasochistic tendencies of men and women in the U.S. Moreover, in 1972, Robert Litman was the first sexual behavior researcher to describe the extant sadomasochistic subculture of the U.S. In 1977, using questionnaires to obtain the elementary data, the German psychiatrist Andreas Spengler conducted the first, large-scale empirical study of sadomasochism. The results reported in Sadomasochisten und ihre Subkulturen (Sadomaschists and their Subcultures, 1979) contradicted most of the earlier work about sadomasochism, especially that of the psychoanalysts, from which Spengler concluded that the previous research was “heavily burdened with prejudice and ignorance”. When the statistician and medical researcher Norman Breslow expanded upon Spengler’s work, he discovered the existence of only five previous, empirical studies of sadomasochism in the scientific literature, which included Spengler’s study. Furthermore, Breslow was the first researcher to show that normal women (who are not prostitutes) were a great proportion of the sadomasochistic sexual subculture of a society. None of the extant studies presented causal links between sadomasochistic tendencies and violence, violent crime, or sociopathic behavior that were presumed since the time of Krafft-Ebing, in the 19th century. The acceptance of sadomasochism without cultural norms, can further psychopathic or fake psychopathic crime of a type which fails to be prosecuted or charged.[citation needed]

The understanding that many more people practice sadomasochism than was previously believed, and the existence of sadomasochistic sexual subcultures, prompted the investigations of non-medical researchers. The American sexologist and anthropologist Paul Gebhard described the cultural contexts of sadism and masochism. The German Thomas Wetzstein conducted a large-scale sociologic study of the local sadomasochistic subculture that confirmed and expanded upon the results of the Spengler study, Sadomasochisten und ihre Subkulturen (1979). The investigations revealed that sadomasochistic women practice the sexually dominant sadistic role and the sexually submissive masochist role in equal measures.[citation needed] Yet sadomasochistic women may also be in fact the few committed moralists and monogamists committed to chastity. Much modern sexual research of sadomasochism describes the psychologic characteristics and dynamics of the tendencies rather than seeking to establish their psychic origins.

Modern perspective[edit]

The results of the studies and increased societal toleration of sexual minorities led to sadomasochists organizing in groups such as the Eulenspiegel Society in 1971 in the U.S. This is especially true in countries where consensual, adult sadomasochism is legal, such as in Germany and Norway.[6][7][8] Resultantly, sadomasochism entered the mainstream cultures of the West and of Japan, via the works of Maria Marcus in Denmark, Patrick Califia in the U.S., Vanessa Duriès in France, and Kathrin Passig in Germany. The reportage of the new studies allowed the elimination of sadism and masochism as categories of sexual and mental illness. The latter may be to adjust standards to the new exigencies of anti-extremism, to law enforcement´s liberties in the field of body-searching all suspects irrespective, and to adjust the real standards of non-Christian nations across all continents. Moreover, the BDSM subculture presented social and legal discrimination as further reasons to eliminate said mental illness categories, by noting the precedent of homosexuality having been eliminated from the list of sexual and mental disorders.[6]

In 1994, the American Psychiatric Association responded by modifying the denotative criteria defining “sadism” and “masochism” in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV); thus, consensual sadomasochistic behavior no longer is considered a sexual disorder. Furthermore, in the textual revision of the DSM-IV TR (2000), sadomasochistic behavior is a sexual and mental disorder if the patient “has acted on these urges with a non-consenting person” and if “the urges, sexual fantasies, or behaviors cause marked distress or interpersonal difficulty”.[9][10] Elsewhere, in 1995, Denmark became the first country to delete “sadomasochism” from its medical disorders system of classification.[11]


Millon's subtypes[edit]

Theodore Millon identified four subtypes of masochist:[12]

Subtype Description Personality Traits
Virtuous Including histrionic features Proudly unselfish, self-denying, and self-sacrificial; self-ascetic; weighty burdens are judged noble, righteous, and saintly; others must recognize loyalty and faithfulness; gratitude and appreciation expected for altruism and forbearance.
Possessive Including negativistic features Bewitches and ensnares by becoming jealous, overprotective, and indispensable; entraps, takes control, conquers, enslaves, and dominates others by being sacrificial to a fault; control by obligatory dependence.
Self-undoing Including avoidant features Is “wrecked by success”; experiences “victory through defeat”; gratified by personal misfortunes, failures, humiliations, and ordeals; eschews best interests; chooses to be victimized, ruined, disgraced.
Oppressed Including depressive features Experiences genuine misery, despair, hardship, anguish, torment, illness; grievances used to create guilt in others; resentments vented by exempting from responsibilities and burdening “oppressors.”

Subclinical sadism and the dark tetrad[edit]

See also: Dark triad

There is presently renewed interest in studying subclinical sadism as personality trait.[13] Everyday sadism joins with subclinical psychopathy, narcissism, and Machiavellianism to form the so-called "Dark Tetrad" of personality.[13][14]

See also[edit]


The German BDSM-group Datenschlag has an extensive online research bibliography of publications on sadomasochism and related topics[15] as well as a detailed timeline.[16] Both were consulted for this article based on the permission granted in the Datenschlag-license.[17]

  • Baker, Elsworth. 1980. Man in the Trap. MacMillan Publishing Company.
  • Boileau, Jacques. 1700. Historia flagellantium: de recto et perverso flagrorum usu apud christianos. Paris: Anisson.
  • Breslow Norman et al. 1985. "On the prevalence and roles of females in the sadomasochistic subculture: Report of an empirical study". In: Archives of Sexual Behavior Vol. 14
  • Califia, Pat (Name since changed to "Patrick"). 1980. Sapphistry. The Book of Lesbian Sexuality. Naiad Press: Tallahassee.
  • Deleuze, Gilles. 1967. Présentation de Sacher-Masoch. Paris: Editions de Minuit.
  • Deutsch, Helene. 1930. "The Significance of Masochism in the Mental Life of Women" in International Journal of Psychoanalysis, Vol. 11 and later publications
  • Doppet, François Amédée. 1885. Traité du fouet et de ses effects sur le physique de l'amour. London, no publisher given. Reprinted and expanded version of the 1788 edition.
  • Ellis, Havelock. 1967. My Life London: Spearman. First published 1939
  • Duriès, Vanessa. 1993. Le Lien. Spengler ISBN 2-909997-03-0
  • Farin, Michael. 1990. Lust am Schmerz: Texte und Bilder zur Flagellomanie. Munich: Schneekluth
  • Freud, Sigmund. 1996. Drei Abhandlungen zur Sexualtheorie Fischer: Frankfurt am Main. Reprint of the 1905 edition.
  • Gebhard, Paul H. 1968. "Fetishism and Sadomasochism." In: Dynamics of Deviant Sexuality. Edited by Jules H. Massermann. New York: Grune and Stratton
  • Grosskurth, Phyllis. 1980. Havelock Ellis: A biography. New York: Alfred Knopf
  • Krafft-Ebing, Richard Freiherr von. 1901. Psychopathia sexualis. Mit besonderer Berücksichtigung der conträren Sexualempfindungen. 11th edition. Stuttgart: Ferdinand Enke.
  • Krafft-Ebing, Richard Freiherr von. 1901. Psychopathia Sexualis, with Especial Reference to Antipathic Sexual Instinct: a Medico-Legal Study. Edited by F.J. Rebman, based on the 10th German edition. New York: Rebman Company
  • Litman, Robert E. and Swearingen, Charles. 1972. "Bondage and Suicide". In: Archives of General Psychiatry Vol. 27
  • Lolme, Jean Louis de. 1777. The History of the Flagellants, or The Advantages of Discipline: Being a Paraphrase and Commentary on the "Historia Flagellantium" of the Abbé Boileau, Doctor of the Sorbonne. London: M. Hingeston. Translation of (Boileau 1700).
  • Maleson, Franklin G. 1984. "The Multiple Meanings of Masochism in Psychoanalytic Discourse", in: Journal of the American Psychoanalytic Association, Vol 32 (2)
  • Marcus, Maria. 1974. Den Frygtelige sandhed. En brugs-bog om kvinder og masokisme. Copenhagen: Tiderne Skifter
  • Meibom, Johann Heinrich. 1718. A treatise of the use of flogging in venereal affairs. Edited by Giles Jacob. London: E. Curll[18]
  • Mirandola, Pico della. 1498. Disputationum adversus astrologos libri duodecim. Venice: Bernhardinus Venetus. Cited by (Farin 1990).
  • Morel, Bénédict. 1857. Traité des Dégénérescences physiques, intellectuelles et morales de l'espèce humaine et des causes que produisent ces variétés maladives. Paris: J.B. Baillière
  • Nakakuki, Masafumi. 1994. "Normal and Developmental Aspects of Masochism: Transcultural and Clinical Implications". In: Psychiatry Vol. 57
  • Passig, Kathrin and Strübel, Ira. 2000. Die Wahl der Qual. Handbuch für Sadomasochisten und solche, die es werden wollen. Hamburg: Rowohlt
  • Schrenck-Notzing, Albert von. 1892. Die Suggestions-Therapie bei krankhaften Erscheinungen des Geschlechtssinnes. Stuttgart: Enke
  • Spengler, Andreas. 1977. "Manifest Sadomasochism of Males: Results of an Empirical Study" in Archives of Sexual Behavior Vol 6
  • Spengler, Andreas. 1979. Sadomasochisten und ihre Subkulturen. Frankfurt/New York: Campus. Full German version of Spengler's results
  • Weinberg, Thomas S. (ed) 1995. Studies in Dominance & Submission. Amherst: Prometheus
  • Wetzstein, Thomas A. 1993. Sadomasochismus. Szenen und Rituale. Hamburg: Rowohlt


  1. ^ In fact the degree of pain or trauma may cause involuntary reactions in the male reproductive system producing discharge of the seminal fluids, which was exploited by pagan Hellenic flagellant rituals involving boys, possibly in consequence of a prohibition on masturbation, considered to guarantee better physical robustness, and interesting the early Aryans/Indo-Europeans were very strong indeed. Elsewhere circumcision may be supposed to be a deterrent but in fact it may later due to the trauma and organic incompleteness create problems in overall robustness. The Use of Flogging A TREATISE ON THE USE OF FLOGGING IN MEDICINE AND VENERY
  2. ^ [1]
  3. ^ Morel 1957
  4. ^ Ellis 1939, 1967
  5. ^ This appears to be a very serious problem arising in male sexual dysfunction. app The pleasure of pain.
  6. ^ a b [2]
  7. ^ [3]
  8. ^ [4]
  9. ^ Sexual Sadism
  10. ^ [5]
  11. ^ [6]
  12. ^ Millon, Theodore - Personality Subtypes
  13. ^ a b Buckels, E. E.; Jones, D. N.; Paulhus, D. L. (2013). "Behavioral confirmation of everyday sadism". Psychological Science. doi:10.1177/0956797613490749. 
  14. ^ Chabrol H., Van Leeuwen, N., Rodgers, R., & Sejourne, N. (2009). Contributions of psychopathic, narcissistic, Machiavellian, and sadistic personality traits to juvenile delinquency. Personality and Individual Differences, 47(7), 734-739.
  15. ^ [7]
  16. ^ [8]
  17. ^ [9]