sadomasochism

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Classification according to ICD-10
F65 Sexual preference disorder
F65.5 sadomasochism
ICD-10 online (WHO version 2019)

As Masochism usually one is sexual deviance understood in a human desire or satisfaction by the addition or the experience of pain , power or humiliation feels. The name arises from a combination of the two terms sadism and masochism , which describe the respective orientation with regard to active and passive experience. A distinction can be made between inclining (lat. Inclinare : to turn) or consensual sadomasochism and non-inclining sadomasochism. In addition, there are different uses of the term, both therapeutically and colloquially, some of which differ greatly from one another and differ mainly in the question of whether sadomasochism is a sexual preference that is on an equal footing with other preferences or whether it is basically a disorder that requires treatment Sexual behavior, a paraphilia .

In the context of sexual medical diagnostics or psychoanalysis , sadomasochism is understood as requiring treatment when others are impaired or harmed, sexual satisfaction is difficult or seems impossible without sadomasochistic practices and the person affected is suffering from it. Sadomasochism is listed as part of the personality and behavioral disorders as a disorder of sexual preference in the " International Statistical Classification of Diseases and Related Health Problems " (ICD) under the code number  F65.5 .

Terms and delimitations

Concept emergence

Richard von Krafft-Ebing

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

Albert von Schrenck-Notzing introduced the term algolagnia (pain addiction) in 1892 , which probably for the first time divided the entire complex into an active (sadism) and a passive form (masochism). (Since sadomasochism can also occur without the need for physical experience, the term algolagnia cannot be applied to the entire spectrum and is not used in diagnostics.) In his view, the two forms form the two poles within an overall continuum. Both this view and that of the strict separation of the two disorders are widespread to this day and are defended with the same reasoning.

After Sigmund Freud described sadism and masochism as diseases arising from a defective development of the child's psyche in his Three Essays on Sexual Theory in 1905 and thus fundamentally influenced the further assessment of the topic for decades, the Viennese psychoanalyst Isidor Sadger finally made his mark in 1913 in his article Über the sado-masochistic complex first used the compound term "sado-masochism".

Colloquial use

Sadomasochism - represented in all its variants by the letters SM  - can also be found in the multi-layered acronym BDSM , which is made up of bondage & discipline, dominance & submission, sadism & masochism. In colloquial language , the term sadomasochism, or the abbreviations Sadomaso or SM , describes sexual practices from the field of BDSM without further specification. The name is often used to describe mixed forms of sadomasochism or BDSM with various fetishistic practices.

Medical classification and diagnostics

The medical-psychological classification follows the basic diagnostic criteria, the ICD-10-GM (GM: German Modification ) and the frequently 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 ( American Psychiatric Association published). Consensual or even secret sexual preferences for sadomasochistic practices do not usually meet the criteria for diagnosing sadomasochism in today's medical sense and are a sociologically different, but not uncommon, expression of individual sexuality. However, the transitions between individually pronounced sexuality and disorder of sexual preference cannot be reliably defined in all cases. A superimposition of sexual preference disorders through the practice of sadomasochistic practices does occur, however.

Depending on the understanding of the underlying diagnostic key, sadomasochism is viewed as a whole or in its partial aspects. The differing definitions and the vertical or horizontal arrangement of the diagnostic criteria can lead to different results, especially with statistical values ​​and descriptive publications from different countries.

ICD-10-GM F65.5

According to ICD-10 F65.5, sadomasochism is viewed as a uniform "disorder of sexual preference", whereby a separate label can be used to describe one of the two manifestations.

Sexual activities with the infliction of pain, humiliation, or restraint are preferred. If the person concerned experiences this type of stimulation, it is masochism; when she inflicts it on someone else for sadism. Often times, the person concerned experiences sexual arousal during both masochistic and sadistic activities.

The further diagnostic criteria for the need for treatment include unusual sexual fantasies or compulsive behaviors that persist over a period of more than six months, as well as the person's subjective suffering from these fantasies and behaviors and the restriction in several functional areas, for example in social contact or the Gainful employment. If another person is harmed, injured or mistreated in the process, this is sufficient for the diagnosis to be made.

Criticism of the ICD-10-GM F65.5

Within 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 paraphilia and demand that it be revised. In their opinion, these practices and ways of life are ascribed an unhealthy or pathological disorder that promotes prejudice and discrimination against the sadomasochists. As a result of these efforts, a corresponding change to the national ICD has already been implemented in Denmark , and a corresponding regulation was implemented in Sweden on January 1, 2009.

DSM IV

The American Psychiatric Association has with the appearance of the DSM IV published in 1994, more extensive diagnostic criteria. The diagnosis masochism (DSM IV 302.83) or sadism (302.84) may therefore only be made with regard to the sexually motivated manifestation of these disorders if the person concerned cannot achieve sexual satisfaction other than through the exercise of sadistic or masochistic practices, or his own sadistic or rejects masochistic sexual preferences himself and feels restricted in his living conditions or suffers in some other way. In addition, the diagnostic criteria do not differ, but are not to be understood hierarchically.

distribution

Sadomasochism occurs regardless of gender or sexual orientation . There are overlaps with other sexual preferences that deviate from the norm, for example sexual or transvestite fetishism , which are accordingly referred to as comorbidity . Within clinical diagnostics, 85 percent of the diagnosis is made in heterosexuals , which allows the conclusion that the deviation occurs equally in people of all orientations. In women, sadomasochism occurs significantly more frequently than diagnosis of other sexual paraphilias.

As with many studies on human sexual behavior and sexual fantasies, not all available studies are reliably scientifically founded, and some studies are out of date. Recent studies on the topic of dissemination of sadomasochistic fantasies and practices vary considerably in the range of their results, here sadomasochism is usually subsumed under the term BDSM and is no longer viewed in isolation. In summary, it can be stated that the vast majority of the authors assume that between 5 and 25 percent of the population regularly engage in sexual practices that are associated with the pleasure of pain or with power and powerlessness. The proportion of the population with corresponding fantasies is regularly put higher.

Causes and origins

In contrast to most other sexual preference disorders, sadomasochism is a relationship paraphilia, which is usually aimed at acting out within a relationship and requires a counterpart in each case in order to be lived out. Scientifically and clinically, a clear distinction is required between people who act sadistically and therefore criminally due to a serious psychological abnormality or disorder , on the one hand, and inclining sadomasochists, on the other, who create a partnership.

There are only a few studies that consider psychological aspects of the subject while taking modern scientific standards into account. A central study on the topic comes from the American sexologist Charles Moser and was published in 1988 in the Journal of Social Work and Human Sexuality . In this study he comes to the conclusion that no common psychopathology of sadomasochists can be formulated and no consistent picture of those affected can be derived from the clinical literature. Moser points out that it cannot be proven that sadomasochists have special psychiatric problems or problems that are based on their preferences and that only arise specifically for them and that are directly related to the sadomasochistic inclination.

There are various theories about the causes and the emergence of sadomasochism, whereby these usually relate to the respective manifestation of sadism or masochism and no general cause can be found for the emergence of sadomasochistic preferences. A connection with sexual abuse in childhood is often cited, especially in the case of violent sadistic offenders and extreme masochists. In terms of depth psychology, a disorder in detachment from the mother is suspected, which manifests itself in the fear of having to break away from the mother and, on the other hand, the fear of not being able to do so. He therefore lives out his ambivalent feelings in the sexual partner. On the masochistic side, this fear is expressed not through aggressiveness, but through subordination and punishes itself for the negative emotion towards the mother. Other theories assume an individual biographical development within the anal phase , in which the connection between pleasure and pain is experienced as pleasurable. None of these theoretical approaches could be proven according to scientific standards.

therapy

Documented experiences with the therapy of paraphilic disorders can be found in sadistic sex offenders . In the middle of the 20th century, aversion therapy and covert sensitization were used to unlearn the deviant stimulus patterns and then to perceive ideas of consensual or "conventional" sex as satisfactory through the conscious imagination of non-sadistic fantasies shortly before orgasm (which is caused by Masturbation was initiated in the laboratory situation). The combination with other therapy methods should enable generalization in everyday life, for which strategies of cognitive restructuring are used. Since the turn of the millennium, in addition to newer behavioral therapy methods, psychotropic drugs , e.g. As antidepressants of the SSRI category, used with some success. Multidimensional approaches, ie a combination of different behavioral and cognitive approaches as well as conversations seem to work best, as work is also being done on cognitive distortions and perceptual disorders, for example with regard to the alleged consent of the victims.

literature

Web links

Portal: BDSM and Fetish  - Overview of Wikipedia content on the subject of BDSM and Fetish

Individual evidence

  1. ↑ Wolfgang Frank: Psychiatry. Elsevier, 2007, ISBN 978-3-437-42601-8 , p. 185.
  2. ↑ Brigitte Vetter: Sexuality: disorders, deviations, transsexuality. Schattauer Verlag, 2007, ISBN 978-3-7945-2463-1 , pp. 233 and 237.
  3. ↑ Original text of ICD-10-GM 2007 F65.0 ( Memento of the original from August 31, 2017 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.dimdi.de
  4. ↑ On the development of the theoretical construct “perversion” by Krafft-Ebing and its relation to these terms, cf. Andrea Beckmann: Deconstructing Myths. In: Journal of Criminal Justice and Popular Culture. 8 (2) (2001), pp. 66-95.
  5. ↑ Brigitte Vetter: Sexuality: disorders, deviations, transsexuality. Schattauer Verlag, 2007, ISBN 978-3-7945-2463-1 , p. 231.
  6. ↑ a b c Peter Fiedler: Sexual orientation and sexual deviation: heterosexuality, homosexuality, transgenderism and paraphilias, sexual abuse, sexual violence. BeltzPVU, 2004, Chapter 8.2.1, ISBN 3-621-27517-7 , p. 248 ff.
  7. ↑ Isaak Sadger: About the sado-masochistic complex. In: Yearbook for Psychoanalytic and Psychopathological Research. Volume 5, 1913, pp. 157-232.
  8. ^ Diagnostic and Statistical Manual of Mental Disorders. DSM-IV. American Psychiatric Association, Washington DC 1994, ISBN 0-89042-061-0 .
  9. ↑ ICD-10-GM Version 2005.
  10. ↑ ReviseF65: Denmark withdraws SM from Diagnosis list. Retrieved February 20, 2009.
  11. ^ New regulation in Sweden, transvestites and sados ​​- no more sick. In: Express. August 17, 2008.
  12. ↑ BehaveNet: Diagnostic criteria for 302.83 Sexual Masochism. ( Memento of February 24, 2012 on the Internet Archive ) DSM diagnostic criteria in English. Last accessed February 20, 2009.
  13. ↑ BehaveNet: Diagnostic criteria for 302.84 Sexual Sadism ( Memento from July 16, 2009 in the Internet Archive ) DSM diagnostic criteria in English. Last accessed February 20, 2009.
  14. ↑ A corresponding detailed collection of the most diverse scientific studies can be found under data entry: Naked facts - statistics for number fetishists.
  15. ↑ a b Brigitte Vetter: Sexuality: disorders, deviations, transsexuality. Schattauer Verlag, 2007, ISBN 978-3-7945-2463-1 , pp. 231-233.
  16. ^ Charles Moser, in Journal of Social Work and Human Sexuality. 1988, (7; 1, pp. 43-56)
  17. ^ Brigitte Vetter: Psychiatry: A systematic textbook. Schattauer Verlag, 2007, ISBN 978-3-7945-2566-9 , p. 144.
  18. ↑ Klaus M. Beier, Hartmut AG Bosinski, Kurt Loewit, Christoph J. Ahlers: Sexualmedizin: Basics and Practice. Elsevier, Urban & Fischer Verlag, 2005, ISBN 3-437-22850-1 , p. 109.
  19. ^ Clinical Psychology - James N. Butcher, Susan Mineka, Jill M. Hooley - Google Books (pp. 132–133)
  20. ↑ Sexual disorders and disorders of gender identity  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF)@1@ 2Template: Toter Link / www.beltz.de