Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (BDSM): data from a national survey

Official link: https://pubmed.ncbi.nlm.nih.gov/18331257/


Introduction: People with sexual interests in bondage and discipline, “sadomasochism” or dominance and submission (BDSM) have been seen by many professionals as damaged or dangerous.

Aim: To examine sexual behavior correlates of involvement in BDSM and test the hypothesis that BDSM is practiced by people with a history of sexual coercion, sexual difficulties, and/or psychological problems.

Methods: In Australia in 2001-2002, a representative sample of 19,307 respondents aged 16-59 years was interviewed by telephone. Weighted data analysis used univariate logistic regression.

Main outcome measures: Self-reported demographic and psychosocial factors; sexual behavior and identity; sexual difficulties.

Results: In total, 1.8% of sexually active people (2.2% of men, 1.3% of women) said they had been involved in BDSM in the previous year. This was more common among gay/lesbian and bisexual people. People who had engaged in BDSM were more likely to have experienced oral sex and/or anal sex, to have had more than one partner in the past year, to have had sex with someone other than their regular partner, and to have: taken part in phone sex, visited an Internet sex site, viewed an X-rated (pornographic) film or video, used a sex toy, had group sex, or taken part in manual stimulation of the anus, fisting or rimming. However, they were no more likely to have been coerced into sexual activity, and were not significantly more likely to be unhappy or anxious-indeed, men who had engaged in BDSM scored significantly lower on a scale of psychological distress than other men. Engagement in BDSM was not significantly related to any sexual difficulties.

Conclusion: Our findings support the idea that BDSM is simply a sexual interest or subculture attractive to a minority, and for most participants not a pathological symptom of past abuse or difficulty with “normal” sex.

9 Things Everyone Gets Wrong About BDSM

Official link: https://www.self.com/story/bdsm-facts

Christian Grey should not be your only source for this.

By Zahra Barnes

This image may contain Human Person Hand Finger and Wrist
David McGlynn / Getty Images

Hello and welcome to almost 2017, a time when millions of people have pledged their hearts (and vaginas) to a fictional character named Christian Grey who likes to engage in BDSM. Although the 50 Shades of Grey fervor is alive and well, especially as the second movie’s premiere approaches, tons of myths about BDSM persist.

“‘BDSM’ is a catch-all term involving three different groupings,” Michael Aaron, Ph.D., a sex therapist in New York City and author of Modern Sexuality, tells SELF. First up, BD, aka bondage and discipline. Bondage and discipline include activities like tying people up and restraining them, along with setting rules and meting out punishments, Aaron explains. Then there’s DS, or dominance and submission. “Dominance and submission are more about power dynamics,” Aaron explains. Basically, one person will give the other power over them, whether it’s physical, emotional, or both. Bringing up the rear, SM is a nod to sadism, or liking to inflict pain, and masochism, liking to receive it. It’s often shortened to “sadomasochism” to make things easier.

Got it? Good. Now, a deep dive into 9 things everyone gets wrong about BDSM.

1. Myth: BDSM is a freaky fringe thing most people aren’t into.

“There’s a lot of misunderstanding about how common this is,” Aaron says. “A lot of people may think just a small minority has these desires.” But sex experts see an interest in BDSM all the time, and a 2014 study in the Journal of Sexual Medicine also suggests it isn’t unusual. Over 65 percent of women polled fantasized about being dominated, 47 percent fantasized about dominating someone else, and 52 percent fantasized about being tied up.

“It’s 100 percent natural and normal [to fantasize about BDSM], but some people come and see me with shame,” certified sex coach Stephanie Hunter Jones, Ph.D., tells SELF. There’s no need for that. “It’s a healthy fantasy to have and one that should be explored,” Jones says.

2. Myth: BDSM is always about sex.

Sex isn’t a necessary part of the action. “BDSM doesn’t have to be sexual in nature—some people like it for the power only,” Jones says. It’s possible to play around with BDSM without involving sex, but for some people, incorporating it into sex ratchets things way up.

3. Myth: You can spot a BDSM fan from a distance.

All sorts of people like BDSM, including those who seem straitlaced. For them, it can actually be especially appealing because it offers a chance to exercise different parts of their personalities. “Some of the most conservative-seeming individuals are into BDSM,” Jones says.

4. Myth: If you’re into BDSM, your past must be one big emotional dumpster fire.

“One of the biggest misconceptions is that people do BDSM because of some sort of trauma in their background,” Aaron says. People who engage in BDSM aren’t automatically disturbed—a 2013 study in the Journal of Sexual Medicine actually found that BDSM proponents were as mentally sound, if not more so, than people who weren’t into it. “We conclude that BDSM may be thought of as a recreational leisure, rather than the expression of psychopathological processes,” the study authors wrote.

5. Myth: BDSM is emotionally damaging.

When done properly, BDSM can be the exact opposite. “I often use BDSM as a healing tool for my ‘vanilla’ couples,” or couples that don’t typically engage in kink, Jones says. She finds it especially helpful for people who struggle with control and power dynamics.

To help couples dig themselves out of that hole, Jones will assign sexual exercises for them to complete at home. Whoever feels like they have less power in the relationship gets the power during the role play. “This has saved relationships,” Jones says, by helping people explore what it feels like to assume and relinquish control first in the bedroom, then in other parts of the relationship.

6. Myth: The dominant person is always in charge.

When it comes to dominance and submission, there are plenty of terms people may use to describe themselves and their partners. Top/bottom, dom (or domme, for women)/sub, and master (or mistress)/slave are a few popular ones. These identities are fluid; some people are “switches,” so they alternate between being submissive and dominant depending on the situation, Jones explains.

Contrary to popular opinion, the dominant person doesn’t really run the show. “In a healthy scene [period of BDSM sexual play], the submissive person is always the one in control because they have the safeword,” Jones says. A safeword is an agreed upon term either person can say if they need to put on the brakes. Because a submissive is under someone else’s control, they’re more likely to need or want to use it. “Whenever the safeword is given, the scene stops—no questions asked,” Jones says.

7. Myth: You need a Christian Grey-esque Red Room to participate in BDSM.

Christian should have saved his money. Sure, you can buy BDSM supplies, like furry blindfolds, handcuffs, whips, paddles, floggers, and rope. But there’s a lot you can do with just your own body, Jones explains: “You can use fingers to tickle, you can use hands to spank.” You can also use things around the house, like scarves, neckties, and stockings for tying each other up, wooden spoons for spanking, and so on. Plus, since your mind is the ultimate playground, you may not need any other toys at all.

8. Myth: If your partner is into BDSM, that’s the only kind of sex you can have.

When you’re new to BDSM but your partner isn’t, you might feel like you need to just dive in. But you don’t have to rush—people who are into BDSM can also like non-kinky sex, and it can take some time to work up to trying BDSM together. And much like your weekly meals, BDSM is better when planned. “BDSM should never be done spontaneously,” Jones says. Unless you’ve been with your partner for a long time and you two are absolutely sure you’re on the same page, it’s always best to discuss exactly what you each want and don’t want to happen, both before the scene happens and as it actually plays out.

9. Myth: BDSM is dangerous.

The BDSM community actually prides itself on physical and emotional safety. “A number of discussions around consent are integral to individuals in the community—people have negotiations around what they’re going to do,” Aaron says. People in the community use a couple of acronyms to emphasize what good BDSM is: SSC, or Safe, Sane, and Consensual, and RACK, or Risk-Aware Consensual Kink.

Of course, sometimes it’s still a gamble. “A number of things people do have some danger—boxing, skydiving, and bungee jumping are all legal—but it’s about trying to be as safe as possible while understanding that there’s some inherent risk,” Aaron says. It’s up to each person to set parameters that allow everyone involved to enjoy what’s going on without overstepping boundaries.If you’re interested in trying BDSM, don’t feel overwhelmed—you can take baby steps.

“There are a number of entry points for people,” Aaron says. One is FetLife, a social media website for people with various kinks. You can also look into Kink Academy, which offers educational videos for different payment plans starting at $20 a month. Another option is Googling for “munches,” or non-sexual meet-and-greets for kinky people in your area, along with searching for kink-related organizations in your city—most big cities have at least one major resource. They usually go by different names, like TES in New York City and Black Rose in D.C., Aaron explains, but when you find yours, you may be on the road to opening up your sex life in a pretty exciting way.

10 Enticing BDSM Statistics & Facts to Shake up Your Day


Sex is one of the basic human needs. However, our society seems to equal sex to “making love,” although it exists and manifests in many forms. If you open your mind to the world of fantasies, roleplay, pain, and pleasure, you might discover something new about yourself.

These BDSM statistics will show you that more people than you realize enjoy non-mainstream kinks and fetishes. It will introduce you to the exciting world of BDSM and its accepting community. 

Hopefully, it will help you understand the appeal, and show you the ropes of BDSM, forever eliminating the fear of something that’s actually not scary or unusual at all.

Top 10 BDSM Statistics in 2021:

  • Family court judges used to remove visitation rights and child custody from parents who participated in consensual BDSM.
  • Little known BDSM facts reveal that BDSM was classified as a mental illness in 1905, and remained so until 2013.
  • Fetish stats reveal that 30 out of 55 sexual fantasies rank as very common.
  • 23% of women add handcuffs to the list of kinks they would like to try in the bedroom.
  • If you’re wondering how many people died from BDSM, statistics say—three over the course of 25 years. 
  • 99% of practitioners associate BDSM with pleasure, according to recent statistics on BDSM.
  • 61% of Italians aren’t familiar with the BDSM community.
  • 46.8% of Belgians said they participated in a BDSM activity sometime in their lives.
  • BDSM facts reveal that it doesn’t cause more distress in sexual functioning than non-BDSM sex.
  • When it comes to mental health and BDSM, statistics indicate that practitioners are more satisfied with their sexuality.

General BDSM Statistics to Spice Up Your Day

If you’re not practicing BDSM, chances are that you know very little about it once we exclude prejudice and popular myths and misconceptions. We’re presenting you with some basic info that’s worth knowing about BDSM.

1. Little known BDSM facts reveal that BDSM was classified as a mental illness in 1905, and remained so until 2013.

(Psychology Today)

Although it remains unknown when people started practicing BDSM for pleasure, Sigmund Freud decided that this kind of kink was a sign of severe neurosis and it remained so until fairly recently. 

2. Family court judges used to remove visitation rights and child custody from parents who participated in consensual BDSM.

(The Journal of Sexual Medicine)

Before the American Psychiatric Association made a clear difference between consensual kinks and fetishes associated with BDSM and paraphilic disorders, family court judges frequently took away child custody and parents’ visitation rights. 

Discipline, bondage, dominance and submission, sadomasochism, cross-dressing, and fetishes are all part of being a sexual deviant and not related to paraphilic disorders. Positive statistics on BDSM show that the discrimination against those who practice BDSM has decreased over the years thanks to this differentiation.

3. 46.8% of Belgians said they participated in a BDSM activity sometime in their lives.

(The Journal of Sexual Medicine)

If that isn’t enough to prove how common BDSM actually is, 22% of respondents said they had fantasies about it, little known BDSM facts reveal. 12.5% of respondents said they performed BDSM regularly. 26% said BDSM interested them, while 7.6% identified themselves as BDSM practitioners.

4. 61% of Italians aren’t familiar with the BDSM community.


While the majority hasn’t heard about the BDSM community, 21% are not a part of it, nor do they want to become a part of it, according to fetish stats. Also, 7% stated they were curious about it, while 4% expressed aversion towards the BDSM community. 

Only 2% said they belonged to the community. It seems that human sexual activity is less open in Italy than in Belgium.

5. 23% of women add handcuffs to the list of kinks they would like to try in the bedroom.


21% expressed interest in using vibrators, while 20% said they would like to use BDSM equipment like ropes and whips during sex

Fetish facts say 20% wanted to use love eggs, while 18% said they would like to try using a lubricant. 15% of women said they would bring anal toys and strap-ons into the bedroom. 

21%, though, said they wouldn’t like to use any of the toys mentioned above.

6. Fetish stats reveal that 30 out of 55 sexual fantasies rank as very common.

(Wiley Online Library)

Fetish statistics clearly state that only nine were labeled as unusual, while only two were found to be rare. Fantasies concerning submission and domination were common for both genders and closely related to each other.

7. If you’re wondering how many people died from BDSMstatistics say—three over the course of 25 years. 


Of course, we have to take into consideration that the majority of these cases probably remain unreported. The study in question analyzed 74 reported cases of deaths that occured due to sexual activities and only three involved consequences of BDSM.

8. Australians are more likely to have non-mainstream sexual experiences.

(Science direct)

Kink statistics tell us that those who engaged in BDSM have also experienced oral and/or anal sex, as well as sleeping with someone other than their partner. Phone sex, watching porn, using sex toys, having group sex, rimming, and fisting, were also parts of their fetish list. 

It should be noted that these people were no more likely to be forced into sexual activity and weren’t more likely to be unhappy or anxious.

BDSM Psychology — Why Do We Like BDSM?

Even though society would have you believe that people who practice BDSM need clinical treatment, a number of studies have shown that BDSM practitioners display more favorable traits. To help break this stereotype in 2021, we give you different stats and facts to support the case. 

9. BDSM facts reveal that it doesn’t cause more distress in sexual functioning than non-BDSM sex.

(Wiley Online Library)

Mental health and BDSM statistics have shown that BDSM contexts cause the same distress in women’s sexual functioning as non-BDSM contexts do. 

When it comes to men, it was shown that there’s actually less distress in sexual functioning in BDSM contexts. 

Sexual satisfaction remained the same for both genders regardless of the context.

10. Those who practice BDSM show more favorable character traits, based on various sexual fetish statistics.

(Wiley Online Library)

Numbers on these types of kinks show they were more extraverted and conscientious, had a higher openness to new experiences and higher subjective well-being, and were less neurotic and agreeable. This proves that BDSM isn’t a way of expressing psychopathological processes but is instead a fun pastime activity.

11. When it comes to mental health and BDSM, statistics indicate that practitioners are more satisfied with their sexuality.

(The Journal of Sexual Medicine)

An important part that contributes to feelings of satisfaction (especially in dominants) is the open discussion about sex and the preferences, desires, and needs of both partners. The fact that explicit consent is required may also play a significant role in these results.

12. 99% of practitioners associate BDSM with pleasure, according to recent statistics on BDSM.

(Psychology Today)

Positive emotions follow closely with 97%. It is interesting to note that all other associations remained positive and scored high: personal freedom in 90% of cases and self expression in 91%.


What is BDSM?

(Her Campus)

The BDSM meaning is actually for bondage, dominance and submission, and sadism and masochism. The definition of bondage is to tie your partner’s limbs using restraints, the most common being handcuffs, rope, or chains. It may also include psychological restraint and physical punishment (such as spanking or whipping). 

Dominance and submission are the mental aspects of BDSM. It’s a common misconception that BDSM is all about pain, but one of the most evident BDSM facts states that it’s actually about the exchange of power. One partner is in control, while the other one agrees to give up control as much as they’re comfortable with. The key to such a relationship is consent, as the point of BDSM is for everyone to enjoy themselves.

Sadism and masochism are also very important aspects closely tied to consent. This is the exchange of emotional and physical pain between partners. Sadists draw pleasure from inflicting pain on their partner, while masochists draw it from receiving the pain.

Is BDSM sex safe?

(Her Campus) (GQ)

Safety and consent might just be the two most important aspects of submissive sex. Nobody in this community actually wants to hurt someone else; it’s all a part of roleplaying and going along with what the submissive partner is comfortable with. This is why the submissive partner can set hard limits, i.e., list the things they would not be willing to do under any circumstances.

If the submissive partner feels they just aren’t emotionally or physically comfortable at any point during the sexual forte, they can use their safe word, as S&M statistics clearly show. This is a clear sign for the dominant partner to stop immediately.

Aftercare is a consistent part of BDSM to ensure that both partners are comfortable with what happened and that nobody crossed any boundaries. Aftercare mostly focuses on the submissive partner because they are typically the ones with the emotional and physical bruises. Reassurance, gentle physical contact like cuddling, and open communication are key to sustaining a healthy and trusting BDSM relationship.

What do I need to know about DDLG?

(DDLG playground)

DDLG BDSM is an acronym for Daddy/Little Girl and a subcategory of BDSM. This is a type of BDSM relationship where one partner (Daddy or Mommy) nurtures the Little Girl/Boy or acts like their caregiver. The submissive partner plays the role of the “child.” 

This kind of relationship typically involves age regression to various extents while giving up control at the same time. That’s why it’s also called age play. Essentially, the submissive allows the dominant to take care of them in any way they’re both comfortable with. There are a lot of different variations of this fetish. In fact, sometimes the relationship doesn’t have to be sexual at all; just emotional.

(DDLG playground)

Even though a DDLG relationship may be just pure innocence combined with a deep emotional connection, it can actually be quite kinky and sexually freeing. Behaviors are rewarded and punished, depending on whether the Little Boy/Girl has played by the dom’s rules. Punishments may involve flogging, spanking, or whipping. Fetish statistics note that consent plays a huge part here too, which allows both partners to get out of their comfort zone safely and explore their sexuality together.

Orgasm denial, using various toys for pain and pleasure, and not allowing the Little to masturbate without permission can all be different types of kinks found in a DDLG relationship.


BDSM is a wonderful form of sex that lets people be who they really are and allows them to live out their wildest fantasies. It’s human nature to be curious, and these BDSM statistics show us that a lot of people have actually given in to curiosity regardless of how taboo the topic might be in their community. 

If you’re drawn to BDSM and would like to give it a try, but you are still unsure about approaching the matter without guilt or shame, we recommend BDSM dating sites as a starting place.

Expressing yourself sexually and enjoying your sexual freedom can only help you mature and live a happier life. Regardless of whether BDSM is your thing or not, we can all agree there’s something purely fascinating about it.


Nikolina Jeric

As a student of English literature, Nikolina has always been passionate about reading and writing. Whether it’s for work or pleasure, she finds she best organizes her thoughts on paper. This is evident in her poetry and short stories, but also in the articles she writes professionally. Her love for writing and educating others has motivated her to research topics she likes in extreme depth, especially love and relationships. Her new-found knowledge and reputation raised her status from amateur to expert in this field, and helped her become the co-founder of 2Date4Love.

Bondage-Discipline, Dominance-Submission and Sadomasochism (BDSM) From an Integrative Biopsychosocial Perspective: A Systematic Review

Official link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525106/



BDSM (bondage and discipline, dominance and submission, and sadism and masochism) increasingly receives attention from the scientific community. Where earlier research efforts mainly focused on epidemiologic characteristics, psychological and biologic factors driving BDSM preferences have recently gained interest as well.


To bring together all the existing scientific literature on BDSM from a biopsychosocial perspective.


Based on the PRISMA guidelines, the current systematic review brings together all the existing literature on BDSM from a biopsychosocial perspective.

Main Outcome Measure

Prevalence rates of BDSM interests were investigated in the literature, as well as the associations between BDSM interests on one hand and personality traits, adverse childhood experiences, education levels, sexual orientations and biological markers on the other.


Biologic factors such as gender identity, sex hormone levels, and the neurologic constitution of the brain’s pain and reward systems influence BDSM orientation. With regard to psychological factors, both personality traits (eg, higher levels of openness or extraversion) and the presence of a personality disorder have been associated with a heightened interest in BDSM, although only limited supporting evidence is available. Additionally, sensation-seeking levels and impulsivity seem to contribute, because they presumably guide one’s drive to explore new or more-intense kinks. Whereas attachment styles impact couple dynamics, they also influence willingness to explore limits in a BDSM context. Lastly, education levels impact relational and sexual dynamics.

Strengths and Limitations

The limitations of the current review reflect those of the topical scientific literature. Although the number of studies focused on all aspects of BDSM is exponentially growing, most of these are only descriptive, and very few focus on underlying driving processes.


From this biopsychosocial perspective, we offer a dimensional approach while integrating the factors driving the onset and evolution of BDSM interests.

De Neef N, Coppens V, Huys W, et al. Bondage-Discipline, Dominance-Submission and Sadomasochism (BDSM) From an Integrative Biopsychosocial Perspective: A Systematic Review. Sex Med 2019;7:129–144.Key Words: BDSM, Biopsychosocial, Kink, Masochism, Sadism, SadomasochismGo to:


BDSM, previously known as sadomasochism (or SM), is an overarching abbreviation of bondage and discipline, dominance and submission, and sadism and masochism and refers to a physical, psychological, and sexual role-play involving power exchange between consensual participants.123 Historically, these practices and interests have been pathologized (for review, see reference 4); Krafft-Ebing5 pioneered in classifying sadism and masochism as pathologies in his Psychopathia Sexualis, a reference work of 19th century sexology. These views were later reflected in Freud’s6 theories on sexuality. The perception of BDSM as being pathologic influenced scientific articles from the 1970s and 1980s, which tended to focus on (non-consensual) sexual sadism from a forensic perspective and incidental SM-related fatalities.789 These historical views still have an impact on the most prominent contemporary psychiatric classification systems, the International Classification of Diseases (ICD; 10th edition: ICD-10) on one hand the Diagnostic and Statistical Manual of Mental Disorders (DSM; 5th edition DSM-5) on the other.10111213 Ever since, the BDSM community is subjected to misconceptions and stigmatization.

The recent success of the Fifty Shades of Grey books and movies, among others, have led to an increased awareness of this expression of intimacy and sexuality. Contemporary mainstream interest in BDSM is mirrored in the exponential growth seen during the last decade of scientific research focusing on all kinds of BDSM aspects and, as such, has enriched the existing literature, thereby nuancing its initial pathologic classification.

This increased availability of BDSM-related scientific literature inspired us to bring together the existing literature on biopsychosocial aspects of BDSM in the current systematic review, the first in its kind. An integration of biologic, psychological, and social knowledge about BDSM may contribute to the understanding and destigmatization of this form of sexual expression, as well as challenge its place in psychopathological classifications.Go to:


The current systematic review was conducted according to PRISMA-P (preferred reporting items for systematic review and meta-analysis protocols) guidelines.14


Different sources may refer variously to individual parties involved in a BDSM interaction. In this review, solely the terms “dominant” and “submissive” are used to respectively refer to either participants providing stimulation, orders, or structure or those being physically constrained, receiving stimulation, or following orders. A “switch” is an individual who shifts between both the dominant and submissive roles, depending on the context and play partner.

Inclusion Criteria

A literature search was performed using the following inclusion and exclusion criteria: (i) research articles with a focus on BDSM generating original data were included; (ii) case reports on consensual sexual masochism and submission were included; (iii) opinion articles, (comment) letters, and essays without original data were excluded; (iv) given the focus on consensual sexual sadism or masochism, forensic articles on sexual offenders were excluded. These inclusion criteria were driven by the generally accepted scientific hierarchy of evidence.

Information Sources

A PubMed database search (1970–April 2018) for English-language articles was conducted using the following search terms: BDSM OR masochism OR sadomasochism OR sexual sadism OR bondage OR sexual submissive OR sexual submission OR sexual kink.

Study Selection

Titles and abstracts were screened to eliminate irrelevant articles. Full texts of potentially relevant articles were read and screened for further eligibility; the final selection was made in consensus by N.D.N. and M.M.. See Figure 1 for PRISMA Flow Diagram (based on reference15).

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Open in a separate windowFigure 1

Preferred reporting items for systematic review and meta-analysis protocols flowchart. PRISMA = preferred reporting items for systematic review and meta-analysis protocols.

The Pubmed database search initially generated 1,593 records. Cross-referencing further led to inclusion of 9 additional articles and book chapters. Preliminary screening of titles and abstracts resulted in 98 remaining articles to be read in full. 10 articles were found irrelevant for the current review (studies including forensic patients, opinion articles, articles related to non-BDSM sexuality), resulting in a final selection of 87 articles to be included.Go to:


Prevalence Rates of BDSM

Studies reporting on the prevalence rates of BDSM interests and practices have yielded somewhat divergent results (Table 1). An Australian study18 found that 2.2% of men and 1.3% of women between ages 16–59 years had engaged in BDSM activity during the previous year. On the other end of the spectrum, Holvoet et al3 reported a BDSM interest in as much as 46.8% of the general population (n = 1,027), who have engaged in BDSM-themed activities at least once, although the same study indicated that only 7.6% of the general population self-identified as a BDSM practitioner. Studies reporting on individuals having BDSM fantasies reveal higher prevalence rates. Holvoet et al,3 for example, found that 69% of the general population had fantasies about BDSM-related activities. In line with these prevalence rates, another study in Canadian university students showed that 72% of the men and 59% of the women had had fantasies of being tied up, and 65% of the men and 58% of the women had fantasies of tying up a partner.16 In the same group, 60% of the men and 31% of the women indicated positive thoughts of whipping or spanking someone. Similarly, Jozifkova and Flegr21 demonstrated that about half of the general population preferred unequal power dynamics in their sexual relationship.

Table 1

Prevalence rates of BDSM interests in the general population

StudySample size (M/F)PopulationAge rangeMethod of assessmentResultsRemarks
Renaud & Byers1617n = 292 (148/144)Undergraduate students (Canada)17–45Self-developed rating scale, 56 itemsMore than 90% of the group reported both positive and negative cognitions of sexual submission. Women had more frequent positive cognitions of sexual submission than men.
72% of the men and 59% of the women had fantasies of being tied up, and 65% of the men and 58% of the women had fantasies of tying up a partner; 60% of the men and 31% of the women indicated positive thoughts of whipping or spanking someone, whereas 44% of the men and 35% of the women indicated positive thoughts of being whipped.
The authors used a self-developed rating scale asking for sexual cognitions, including cognitions on sexual submission, whipping, spanking, and hurting partner. It did not ask for actual experiences with BDSM-themed practices. Only included heterosexual students (mean age = 19.8 y).
Richters et al1819n = 19.307 (9.729/9.578)General population Australia16–59Computer-assisted telephone interviews2.0% of the men and 1.4% of the women indicated to have engaged in BDSM in the last 12 months. Prevalence was higher in gay/lesbian (4.4%) and bisexual (14.2%) individualsA single question was asked in the interview: “In the last 12 months have you been involved in B&D or S&M? That’s bondage and discipline, sadomasochism, or dominance and submission”
Långström & Seto20n = 2,450 (1,279/1,171)General population Sweden18–60Self-administered questionnaire as part of larger surveySadomasochistic behavior in 2.2% of the total sampleThe survey asked about sadomasochistic behavior, and, as such, did not include bondage, discipline, dominance, and submission. Focus of analysis was on other aspects of sexuality
Jozifkova & Flegr21n= 864 (398/466)General population with access to Czech largest internet portal/Internet trap methodUnequal sexual partnership was chosen by 51% of the men and 42% of the women. Men chose submissive-woman depictions approximately 2.6 times more frequently than dominant-woman. Women chose either submissive- or dominant-man depictions with equal frequency.A banner was offered attached to the e-mail account of members of general population. After clicking on the banner, the participant had to choose an icon displaying different hierarchical positions between partners. Presumably, 0.41% of the men and 0.27% of the women participated, thus accounting for an immense participation bias. No age limits were defined for participation.
Holvoet et al3n = 1,027 (459/565)
(n= 3 indicated other sex)
General population Belgium18–65Internet survey including 54 BDSM-related activity items47% had performed at least 1 BDSM-related activity, and additional 22% had fantasies about it. 12.5% indicated performing at least 1 BDSM related activity on a regular basis. 7.6% self-identified as BDSM practitioner. When asked for activities at least experienced once, movement restriction and use of blindfold elicited highest interest (20–24%). Submissive kneeling, whipping, hitting a partner in sexual context (6–11%)The authors used a self-developed questionnaire to assess interest in a wide range of BDSM-related activities, which included items that on their own may not define a BDSM activity as such (eg, blindfolding, movement restriction, use of ice cubes, etc)
Herbenick et al22n = 2,021 (975/1,046)General population USA18–91Internet survey including some BDSM related questionsPlayful whipping (6% in past year; 15% lifetime); spanking (17.2% in past year; 31.9% lifetime); tying up/being tied up (4.5% in last year; 21.1% lifetime); gone to BDSM party (1.1% past year; 3.4% lifetime). 29.3% found tying up partner or being tied up (very or somewhat) appealing. Experiencing pain as part of sex was very or somewhat appealing to 11.4%. Use of blindfolds (very to somewhat) appealing in 34.9%.This large-scale survey focused on a broad range of sexual behavior but included some BDSM-themed questions.
Joyal & Carpentier23n = 1,040 (475/565)General population Canada18–642 survey methods: online survey (n = 543) vs telephone interview (n = 500)A desire for masochism was indicated by 23.8% (19.2% in men, 27.8% in women), whereas, for sadism, this was present in 7.1% (9.5% in men, 5.1% in women).
Actual experience (once in lifetime) was confirmed by 19.2% for masochism (men: 13.9% vs women: 23.7%), whereas this was the case in 5.5% for sadism (men: 7.4%; women: 3.9%). Levels indicated for masochism were significantly higher when assessed by internet survey compared to telephone interview.
Masochism was questioned by “Have you ever been sexually aroused while suffering, being dominated, or being humiliated?”; sadism was assessed by the question “Have you ever been sexually aroused by making someone suffer or by dominating or psychologically or physically humiliating another person?”

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B&D = bondage and discipline; BDSM = bondage and discipline, dominance and submission, and sadism and masochism; M/F = male/female; S&M = sadism and masochism; / = information not available.

This divergence might be explained by several factors. First, studies that surveyed participants on their interests using an overarching term such as “SM” or “BDSM” without specifying a definition18192425 systematically yielded lower prevalence rates, compared with studies gauging interest or practices of specific activities and dynamics (eg, “tying up,” “blindfolding,” “whipping”).3162122 This may indicate that, in general, the subjective interpretation of the definition of (BD)SM practice has a stricter connotation than when defining the practice through specific, individual acts, leading to lower prevalence rates when overarching terminology is used. This is illustrated by the fact that about half of the sample from Holvoet and colleagues3 indicated having engaged in BDSM activities, whereas, in the same sample, only 7.6% actually self-identified as a BDSM practitioner. It should be noted that no consensus exists on which activities are BDSM practices and which are not.3

A second source of divergence might stem from investigating different intensity levels of BDSM interest. As such, some studies assessed interest in or fantasies about BDSM, whereas others queried actual performance of such activities. As can be expected, the first type of studies demonstrated higher prevalence rates than the latter.

Third, the applied methodology could further account for some of the variance, because the surveys yielding higher prevalence rates32223 were held via internet channels, whereas Richter et al1819 interviewed participants through less-anonymous telephone calls. A final explanation might come from the time span covered by the different questionnaires, because the prevalence of activities in the preceding month322 was found to be much lower than lifetime experience (1.3–8.1% vs ≤32%).22

The BDSM Spectrum

Although BDSM practitioners are often considered as a homogeneous subculture of the general population, in the current review, we applied a dimensional approach toward interest in and practices of BDSM. On one end of the spectrum, BDSM-related interests translate into unexplored fantasies and, on the other, an intensive, continuous implementation of these interests in all aspects of daily life. It has been suggested that a majority of the general population has BDSM-themed fantasies, and about half has engaged in BDSM-related activities at least once.3 Joyal and Carpentier23 found interest in voyeurism, fetishism, and masochism in half of their population sample and at least 1 experience with such an activity in one-third. Additionally, engaging in at least 1 BDSM-related activity on a regular basis is reported by 12.5% of the general population.3 The latter study also demonstrated that 1% of the general community explores these interests outdoors and visits dedicated BDSM-related clubs or events. Finally, an even smaller subgroup implements BDSM in their lives on a 24/7 basis, although specific prevalence rates of these practices are not known.26 Accordingly, BDSM is seen by some as a form of leisure,27 whereas others define it as a lifestyle, an identity, or even their “orientation(s)”.23 Santilla and colleagues28 showed that these interests also seem to evolve over time, from initial milder interactions toward more extreme forms later on. For example, a practitioner may start pain play interests by experimenting with mild spanking and evolve toward more intense stimuli, such as electrical stimulation or needle play.

Literature indicates that BDSM is an umbrella term that covers an array of interactions that can be present independently or in different clusterings. A dimensional angle of approach is therefore also applicable on the nature of the interaction and the acts implemented. Generally, a shift in power dynamics is at the core of BDSM play.129 As such, in a more stereotypical setting, there is a dominant partner (D) in charge of the scene, and a submissive partner (s), who consents to being submitted to the actions of the dominant. The roles may switch, more parties may be involved, but, at each point, power exchange is at its essence. This power shift will translate in a wide range of role play possibilities, including specific rituals (kneeling, use of title to address partner), humiliation, movement restriction, or sensory deprivation. When looking at the specific nature of the activities, “softer” BDSM elements such as movement restriction or blindfolding are much more frequently implemented, compared with “harder” BDSM activities (eg, whipping).3 Based on the associations between specific BDSM activities, Alison and colleagues2 https://paperpile.com/c/ihzoih/Gpb1+egEC defined 4 clusters of BDSM-related behaviors: pain play (including spanking, caning, use of clothespins), humiliation (eg, verbal abasement, gagging), physical restriction (use of bondage, handcuffs, or chains), and hypermasculinity (eg, anilingus, use of dildo). This last category, however, presumably reflects the fact that more than half of their sample consisted of gay men and may not be representative for the broader BDSM community. Nevertheless, it demonstrates that different BDSM activities are not necessarily all present in each interaction and that certain clusterings can be established. In this line, Jozifkova et al30 suggested that D/s dynamics and affinity with bondage are 2 separate play strategies, although both may co-occur. Weierstall and Giebel31 recently developed a sadomasochism checklist containing a submission scale and a dominant scale, each containing 24 items with 6 different factors: domination, use of toys, soft play, beatings, breath play, and play involving bodily fluids. This, again, indicates that heterogeneous profiles of interest emerge within the BDSM community.

BDSM play is often perceived as a precursor to or part of sexual activities.1 Chivers et al32 demonstrated that exposing individuals with masochistic sexual interests to stories with masochistic and submissive themes elicited both subjective and genital sexual arousal responses, indicating the sexual nature of these experiences. In contrast, Newmahr33 argued that, to many practitioners, SM does not precede or replace sexual activities but is an end into itself. Both may be true, because a recent online survey of BDSM forum members (Fetlife; n = 363) conducted by our research group (unpublished results, 2019) showed that BDSM-related interests are sexual in nature in most, but not all, BDSM community members; 70% indicated they always or regularly combined BDSM play with sex, whereas 7% never combined the 2, and 23% do so only on occasion.

In the layman’s view, BDSM is subject to binary categorization, with participants being either dominant or submissive. More recently, however, more roles have been defined for BDSM community members to identify with: dominant, master/mistress, top, sadist, submissive, bottom, masochist and switch,3435 although a clear delineation between these roles does not always exist. In Martinez’s survey study,35 most of the participants (n = 185 of 202) identified with 1 BDSM identity, with 41.1% of the participants self-identifying as a submissive, slave, or bottom, 28.2% as dominant, master, or sadist, and 22.3% as switch. More than half of the population (52%) indicated maintaining the same role (dominant or submissive) throughout all interactions, whereas the other half tended to experiment with other roles as well, although men tended to be significantly less fluid in their role (43.4% of the men had at least some level of fluidity, whereas this was the case for 51.5% of the women). Nevertheless, almost all participants clearly preferred 1 role over others, because only 7.4% experienced both roles in equal amounts. In Alison’s study,2 these ratios were confirmed, with 27.0% of the subjects identifying themselves as mainly sadistic, 22.7% as both sadistic and masochistic, and 50.2% as mainly masochistic. However, it should be noted that the sample used in the latter study is far from representative for the general population, because 88% of the participants (n = 184) were male, and, additionally, more than half (51.6%) reported being homosexual.

To conclude, BDSM interests can be approached from a multidimensional perspective. In the general population, depending on the applied BDSM definition and methodology, 8–70% is BDSM-minded, with a smaller amount of practitioners seeking to take their interests outdoors. Practitioners play with varying degrees of intensity and frequency and are heterogenous in performing their activities in a sexual context. Roles adopted in the interaction occasionally are strictly dominant or submissive, but they are more flexible in the majority of the players.

Stigma Surrounding BDSM

There is a distinct stigma surrounding the spectrum of BDSM, resulting, among others, from the fact that it links sexuality to pain, power display, and humiliation, rather than to romance and tenderness, an association more commonly made by the general public. Nevertheless, it has been claimed that previous cultures (eg, ancient Egypt, ancient Rome) accepted the use of physical and mental pain play in a sexual context much more than is the case in our current western societies,13637 but insufficient data exist to verify this hypothesis. International differences in BDSM practices have been suggested,38 but large-scale studies investigating this notion have yet to be conducted. Yost39 identified 4 categories of stigmatizing attitudes: (i) BDSM is socially and morally wrong, (ii) BDSM is associated with non-consensual violence, (iii) a general lack of tolerance toward SM practitioners, and, finally, (iv) the notion that submissive or dominant traits translate to other domains in everyday life (eg, behavior toward children). Although few studies looked into the characteristics and traits facilitating these stigmatizing attitudes, stigma was found to be higher in women who were less sexually emancipated.40 In a large sample of SM-identified women, half reported they had experienced some form of physical assault or discrimination because of their SM practices, and another 30% were refused or ejected from social, recreational, political, educational, and spiritual groups.41 On the other hand, Graham and colleagues42 showed that participation in accepting environments where BDSM is stimulated and celebrated has a positive impact toward stigma management. This may partly explain why some practitioners explore their sexual interests in public BDSM communities, rather than keeping it in the privacy of their homes.

This stigmatization translates into feelings of anxiety in most to disclose their BDSM interests43 and may be in line with the elevated rates of suicidal ideation seen among BDSM practitioners, even after adjusting for depressive symptoms,4445 with 37% of them reporting non-zero levels of suicidal ideation.45 Similarly, Brown et al46 found that 12% of their large sample of BDSM practitioners (n = 576) reported ≥1 previous suicide attempts, with significantly more women (19%) indicating an attempt, whereas this was only the case for 8% of the men. This is in contrast with the general adult population, in which lower rates of suicide attempt have been reported (1.3–4.2%).4748 It may also have important consequences in the context of jurisdiction, because it is still unclear how law makers position themselves toward consensual sadomasochism.49 It is often argued that sexual behaviors should be protected under a right to privacy, and parallels have been drawn with sports in which bodily harm also incurs on a consensual base (eg, boxing). In light of the still-ongoing equivocality, Green49 argues for a similar legal treatment of sexual and sportive activities when consensual harm is involved.

Some scientific literature contributes further to stigma sustainment, for example, by focusing on fatal cases of autoerotic asphyxia, while looking into associations with masochism, bondage, or transvestism.505152 Despite these incidental cases, safety and consensual practices are core elements in BDSM interactions, and there is a lack of evidence that asphyxiophilia (ie, restriction of breathing) specifically and sexual masochism in general is actually harmful.53 Also, from a clinical perspective, it was demonstrated that most psychotherapists do not tend to see BDSM as a benign variation in sexual behavior, and almost half of these therapists were unsure whether most of the BDSM practitioners were “psychologically healthy”.54 Worryingly, some therapists were unable to differentiate between BDSM and abuse and, as a result, required clients to give up BDSM as a condition of treatment. Unsurprisingly, then, Waldura et al55 found that only 38% of their sample was able to disclose their kink orientation to their clinician. Women especially were concerned about being judged by their medical care givers for their sexual practices. Therapists experienced in working with BDSM clients, however, accentuated the importance of a non-judgmental attitude and knowledge of BDSM practices and values.5657 Moser and Levitt58 found that only 6% of BDSM participants indicated they preferred not having these interests, and a survey of sex therapists demonstrated that BDSM interests presented rarely a manifesting problem in their BDSM-practicing clients.59

Pathologizing BDSM

The inclusion of sexual sadism and sexual masochism in the Diagnostic and Statistical Manual of Mental Disorders has its roots in earlier descriptions by Freud6 and Krafft-Ebing,5 who pathologized these interests. According to Weinberg,60 they presumably had biased views on the matter because they based their ideas on literature describing extremes (eg, the works of the Marquis de Sade) that did not necessarily represent actual BDSM, as well as on conservative views on sexuality that were generally prevailing in their time, thereby further inflating aversiveness toward all kinds of sex-related activities. It should be noted that, in the latest 2 editions of the DSM (DSM-IV and DSM-5), a clear distinction is made between non-pathologic atypical sexual interest (or paraphilia) and actual paraphilic disorders that, by definition, have to cause distress or impairment to the practitioner or cause personal (risk of) harm to others.761 As such, the DSM distinguishes between normal BDSM behavior and pathology and thereby recognizes that many people are quite comfortable with their potentially non-mainstream sexual interests expressed through consensual practices. Therefore, some argue for keeping diagnoses such as sexual masochism and sexual sadism in the DSM classification system.62 Similarly, sadomasochism is included in the ICD-10 as a disorder of sexual preferences, and Reed and colleagues13 have recommended that this diagnosis be deleted in the next edition (ICD-11). They stress the importance of the consensual nature of these interactions and propose 2 new diagnoses based on this principle of consent: (i) If consensual behavior is involved, sadomasochism can be added as Other paraphilic disorder, “if accompanied by marked stress that is not entirely attributable to rejection or feared rejection of the arousal pattern by others, or by significant risk of injury or death”; (ii) A new diagnosis, “Coercive sexual sadism disorder,” is proposed when “arousal pattern focuses on the infliction of suffering on non-consenting individuals”.10

Nevertheless, several authors have criticized the presence of sexual sadism and sexual masochism in the DSM and suggested that public opinion, rather than scientific argumentation, was the main reason for paraphilias to be part of the DSM.106263 This is in line with Connolly,64 who failed to show significant psychopathology in BDSM practitioners and showed levels of psychological sadism and masochism that were comparable to control subjects. Others believe that these diagnoses deserve a place in the classification system, because they are highly prevalent in forensic populations of sexual murderers, but that it is crucial to differentiate between safe, sane, and consensual BDSM practices on one hand and pathologic, non-consensual forms of sexual sadism and masochism on the other.6465 Indeed, when practiced in a non-consensual way and when harming others or self, these interests need to be categorized as pathologic.

Additionally, Klement et al66 demonstrated significantly lower levels of sexism and rape myth acceptance in BDSM practitioners; contrasting insinuations that erotica involving sexually submissive women negatively impacts attitudes toward women and increases rape myth acceptance in men.6768 Nevertheless, 2 negative implications of incorporating BDSM as paraphilia in the DSM remain. First, the fact that sexual sadism and masochism are part of a psychiatric classification system may still fuel stigmatizing presumptions (eg, in a context of jurisdiction). Second, the fact that BDSM-related activities are classified as paraphilias implies that they are unusual or atypical; however, this stands in stark contrast with data showing that more than half of the general population has BDSM-themed fantasies.316 An internet survey69 conducted on 1,516 adults showed that only 9 of 55 sexual fantasies were deemed to be “unusual” (operationalized as being reported by <15.9%), including urine play, transgender dressing, or sexual abuse. Fantasies about sex with animals or children (age <12 years) were rare (as reported by <2.3%). Typical BDSM-related fantasies, such as being dominated, bondage, or spanking, were found to be more common (up to 34.5%), and could, thus, not be identified as unusual. Notably, some authors parallel BDSM classification to the inclusion of homosexuality in previous DSM editions.5670

Psychosocial Aspects of BDSM Interests

Some preliminary literature suggests an influence of several psychological factors and social influences driving an affinity with BDSM.

Personality and Personality Disorder

A single study scrutinized associations between personality traits and BDSM preferences.71 Compared with non-BDSM control subjects (n = 434), BDSM practitioners (n = 902) were less neurotic, more extroverted, more open to new experiences, more conscientious, and less agreeable. Moreover, BDSM practitioners differed in their attachment styles because they were less sensitive to rejection, more confident in their relationships, had lower need for approval, and were less anxiously attached compared with the non-BDSM participants. Most of these effects were driven by the female subsample of the BDSM practitioners. Frías et al72 suggested a higher prevalence of sexual masochism in subjects with borderline personality disorder (6 of 60; compared with 0 of 60 control subjects without borderline personality disorder), but, because of very limited sample size, these findings should be replicated. In this line, Connolly64 demonstrated higher levels of narcissism among practitioners (n = 32) compared with control subjects. These preliminary findings, thus, may suggest an association between cluster B personality traits and BDSM interests, but this notion should be explored in future studies.

Impact of Adverse Childhood Experiences on BDSM Interests

A study performed by Nordling et al73 showed that the prevalence of self-reported sexual childhood abuse was higher among BDSM practitioners (8% men, 23% women), as compared with the general population (3% men and 8% women). It should be noted that the sample of women in Nordling’s sample was small (n = 22) and thus not representative for female BDSM practitioners. Moreover, a recent meta-analysis on the prevalence of child sexual abuse in community and student samples showed that 7.9% of men and 19.7% of women had suffered some form of sexual abuse in childhood,74 which is more in line with Nordling’s findings among BDSM practitioners. It should be noted that earlier research has shown that women who were sexually abused in childhood were more likely to report submission fantasies than those who were not.167576 Nonetheless, although some preliminary findings suggest an association between sexual trauma and BDSM-related interests, current literature does not prove a causal relationship. Future large-scale, preferably cross-nation research should further elucidate whether an association between childhood abuse and BDSM interests is actually present. It can also be hypothesized that a report bias may exist, driving these preliminary associations, because it is possible that BDSM practitioners may communicate more openly about sexual boundaries and sexuality in general. The latter notion has not been investigated yet, so comparing the communication style between BDSM practitioners and non-BDSM control subjects may be of interest. Moreover, because BDSM practitioners frequently emphasize consent, safety, and personal boundaries within BDSM play,65 they may label certain behaviors more quickly as being sexually transgressive than non-practitioners from the general population. Further research should clarify the nature of this relationship.

Age of Awareness and Education Levels

Many BDSM-oriented individuals became aware of their kink-themed interests at a relatively young age, that is, before the age of 15.4377 Moser and Levitt58 surveyed 178 BDSM-oriented men who, on average, participated in SM at the age of 23, whereas 26% reported having a first SM experience by age 16. Similarly, Holvoet and colleagues3 found that 61.4% of the general population with a BDSM interest became aware of it before age 25. In Breslow’s sample of men,77 half recognized their SM interests by age 14. In a Finnish sample of mostly gay men, 9.3% claimed awareness of their sadomasochistic inclinations before the age of 10.78

Because these interests apparently are already present early in life, social contexts during childhood and adolescence (eg, parenting style) presumably largely influence affinity for BDSM practices. Future research should dig deeper in the potential moderating role of parenting style and power disparity in the parental couple.

Ample literature shows that BDSM practitioners are typically highly educated. Sandnabba and colleagues78 found that more than one-third had a university degree, with an additional 21% having a college degree. Wismeijer & Van Assen71 similarly found that 70% had a higher education (ie, bachelor’s or master’s degree), as compared with 34% in the general population. Martinez35 again showed that about half of their BDSM sample had a college degree, with another 33% having taken up to 1 year of college. In this line, they also had higher income levels than the general population.2 Interestingly, higher education levels were seen in participants visiting public BDSM-themed events, but not in practitioners who preferred to explore their interests at home with a less high level of intensity (Coppens et al.79; n = 1,289). These findings suggest that there is a positive correlation between the intensity with which one practices BDSM and their education level. It could be suggested that individuals with higher education levels are attracted to the psychological dynamics of BDSM play and see it as an enrichment of their relationship or sexuality, but this should be clarified by future research. It may also be that a participation bias exists, because more-educated BDSM practitioners may be more prone to participate in research or because they may have easier access to research projects through internet forums. Nonetheless, it should be noted that these findings are merely associations found between education level and BDSM interest and, thus, did not reflect causality. Future BDSM research could explore whether higher education levels may be linked to more liberal attitudes and beliefs or a more unrestricted sociosexual orientation.

Relationship Between Sexual Orientation and the BDSM Interest

Earlier research mostly included male participants and members of the lesbian, gay, bisexual, and transgender (LGBT) community,278 whereas recent research reports on more balanced samples, although men still tend to be slightly overrepresented in BDSM samples recruited online (eg, reference 44, Coppens et al.79). This parallels the evolution in the social profile of the (public) BDSM community, because in the 1980s and 1990s, initial clubs were typically part of the gay leather scene.1 More recently, BDSM-themed clubs seem to attract broader groups of BDSM aficionados.70 Moreover, the generation of online BDSM-related forums facilitates interactions with and within the community. This also has significant advantages for research in the field, because it results in a vast increase in the accessibility of the population for research purposes and thereby strongly reduces study population selection bias.

Whereas, in the general population, about 90% declare themselves to be heterosexual,3 this is the case for only about two-thirds in the BDSM community, with more members self-identifying as being bisexual (23%) or otherwise (17%).46 Cross and Matheson80 found almost half of online recruited masochists to be bisexually or homosexually oriented. More specifically, the survey by Tomassilli et al81 showed that bisexual women were more likely to have engaged in BDSM-related activities than lesbian women.

BDSM-oriented members of the LGBT community also have a significantly higher play frequency than do heterosexuals.446078 Moreover, gay men tended to have a higher ratio of university degrees and primarily held white-collar occupations, whereas the straight respondents held more blue-collar positions (eg, industry and service). Surprisingly, LGBT respondents began their BDSM related activities at a later age compared with their heterosexual peers.82 Differences were also found in the type of activities they engaged in, because gay men preferred hypermasculine-related activities (use of dildos, anal play) and tended to be more sadistically oriented, whereas heterosexuals rather preferred humiliation-related activities.2288082

BDSM as Leisure or Sexual Activity

Several studies scrutinized the sexual nature of BDSM and surveyed the role of BDSM in sexual activity of participants. A recent interview-based study83 showed that a small sample (n = 32) of practitioners indicated that their sexual BDSM experiences were primarily emotional and psychological in nature and that these were preferred over mainstream (“vanilla”) sexual interactions. In contrast, Pascoal’s small-scale survey study (n = 68)84 revealed that BDSM and non-BDSM sexual activities were experienced as equally satisfying and that most practitioners did not exclusively engage in BDSM-oriented sexual practices. Nevertheless, they accentuate how BDSM-themed sexual interactions deepen the interpersonal connection more than non-BDSM sexuality. Moreover, within the community, BDSM play is more associated with long-term relationships, and some even indicate them as being unnecessary or inappropriate in short-term sexual encounters,85 again pointing toward the bidirectional association between an emotional connection and BDSM play. Some practitioners even describe their BDSM preference as an addiction86; in this exploratory, qualitative study in which 9 individuals underwent a semistructured interview focusing on the experience of sexually masochistic acts, some subjects mentioned a rush or “high” during BDSM-oriented interactions, which could explain a state of dependency and a craving for future similar experiences. This interesting notion should be explored in future research.

Cross and Matheson80 indicate that it is power that is at the core of BDSM interactions, rather than pain, bondage, and humiliation, which are merely tools or methods to achieve the mutual creation of a hierarchical status. As such, the exchange of power in an erotic context is the driving mechanism underlying sexual pleasure. This was based on the analyses of SM interactions in progress in online SM chat rooms, followed by post-scene interviews (n = 13). An important limitation of this approach is that it was a virtual interaction, not necessarily reflecting all processes involved in a real-life interaction. This notion mirrors the fact that women having sexual fantasies of forced sex often imagine minimal physical discomfort in those fantasies,878889 suggesting that it is the power dynamics rather than a masochistic mechanism driving these fantasies.

BDSM as Identity

Although, for some, BDSM is a form of leisure or a means to spice things up in the bedroom,3365 other practitioners will argue that BDSM is their sexual identity or orientation. Some even go as far as to perpetually maintain their BDSM dynamics in their everyday lives.26 Parallels have been drawn with being part of the LGBT community. For example, a person identifying as gay will indicate that sexual orientation stands for who he or she essentially is.4390 A small-scale qualitative research study43 demonstrated that the level of identification can vary, with some framing their BDSM interests as a sexual orientation reflecting interests that started early on in life, whereas others became attracted to BDSM more gradually at a later age after dating someone with these preferences or after reading about it, without seeing these interests as fundamental part of their personality or sexuality.

The Biological Aspects of BDSM

Up to now, very few studies focused on the biologic underpinnings of BDSM practice, but some indeed have investigated effects of gender, brain activity patterns, or associations with hormonal changes.

Sex and Age Effects on BDSM Interests

Several studies looked into the association between the sex of the participant and BDSM role. In the BDSM community, men tend to be more dominant, whereas up to 75% of the women identify themselves as submissive.2771 A minority of both men and women identify as switch. Non-heterosexual participants mainly self-identified as switches (37%), with a slightly less but equal ratio of dominants and submissives (22% and 27%). As was shown by Herbenick et al22 in a large sample of the general population (n = 2,021), more women (14.2%) than men (8.5%) find experiencing pain as part of sex (very or somewhat) appealing. Women also demonstrate significantly higher interest in submissive sexual fantasies16 and express a preference for a dominant man.40 In addition to these differential affinities for BDSM roles between men and women, men apparently become aware of these interests on average 5 years earlier than women.6077

From an evolutionary point of view, male assertiveness is a characteristic valued by women in their male (potential) partners, because it may have led to increased survival chances for women and children.67 In this line, Jozifkova and Kolackova91 aimed to investigate the origin of dominance and submissiveness as sexual preferences. To do so, they investigated the hypothesis that sexual arousal induced by hierarchical imbalance between a person and his or her partner reflects a mating strategy. This was done by comparing the number of children and self-reported attractiveness of dominant men and submissive women with control subjects within the general population (n = 673). They showed that, compared with control subjects, sexually dominant men and sexually submissive women perceived themselves as being more attractive and had more biological children. This led the authors to conclude BDSM to be a successful mating strategy.91

In contemporary society, dominance is still primarily considered a masculine characteristic.6792 Gender norms urge women to associate sex with submission and subordination to men, whereas men learn to eroticize male dominant behavior.18349193 This is confirmed by a study by Sanchez and colleagues,94 with a lexical decision test that assessed implicit associations between words of dominance (eg, “power,” “strong”) or submission (eg, “comply,” “concede”) and words associated with sex (eg, “climax,” “oral”). Words referring to sex primed faster responses for submissive words in women, leading the authors to conclude that women implicitly associated sex with submission, an association not found in men. It was also demonstrated that many adolescent girls, but not boys, report assuming a submissive role during their first sexual experiences.9495 In this line, being dominated and overpowered by a man is one of the most common sexual fantasies among women.679296 Jozifkova et al97 postulated that a submissive/dominant hierarchical disparity within a couple can be an important mechanism, promoting cohesion and cooperation between the partners. Notably, Hawley and Hensley92 also demonstrated high preference rates for submissive fantasies in some men, regardless of sexual orientation or gender identity. The authors suggest differential between-gender mechanisms for these submissive fantasies. In women, interest in submission is presumably mainly driven by the need for nurturing and security, whereas, in men, this need is possibly more associated with the need to surrender to the will of another.

As noted by Holvoet et al,3 age also seems to impact role preference; they show dominant self-identification to be associated with older age, whereas younger practitioners displayed a higher interest for the submissive role. The authors note that this might not be a strictly biological phenomenon and could potentially be explained, at least partially, by cultural changes over the years. Possibly, in the BDSM community, acceptance toward more-fluid role positioning may have increased over time, although this notion should be investigated. It may also reflect a level of maturity needed to take on the dominant role and implement the responsibilities needed for the role.

Brain Activity Associated With Dynamical Pain Thresholds in BDSM Practitioners

2 studies gauging pain thresholds in masochistic subjects9899 demonstrated that masochists displayed pain hyposensitivity. This finding was corroborated by Luo and Zhang,100 who showed that submissive women have lower differential amplitudes of several event-related potentials, compared with control subjects, when looking at pictures of women with painful and neutral facial expressions. These reduced event-related potentials include the N1, P2, and long-latency potential. The N1 has been associated with the perception of threat,101 whereas the P2 has been linked to the degree of perceived pain in others.102 The long-latency potential seems to be an indicator of emotion regulation, thus assessing the emotional appraisal of stimuli by the participant.100 This, thus, seems to suggest that submissives perceive pain as less threatening and may be associated with lower (negative) emotional appraisal of pain-related stimuli. A link between painful stimulation and the experience of pleasure was investigated by Defrin and colleagues,99 demonstrating that the number of stimulated body regions—as reported by the respondents on a self-developed questionnaire including 7 body regions (including “upper back,” “lower back,” “buttock,” and “legs”; r = 0.781, P < .001)—as well as the intensity of pain during BDSM play, as scored on a visual analogue scale (r = 0.414; P < .05), correlated highly with the amount of pleasure experienced by these participants. In contrast, both masochists and non-BDSM control subjects reported equal levels of negative emotions while experiencing pain in everyday life.9899

A single functional magnetic resonance imaging study103 investigated brain activity in masochists during the administration of painful laser stimuli while viewing body-related masochistic stimuli vs other, non-masochistic stimuli. Compared with control subjects, masochistic participants reported reduced pain perception while viewing the masochistic images, which was mirrored by higher levels of positive arousal while watching the images. Interestingly, they had unaltered pain perception in other non-masochistic contexts. Brain imaging revealed that, in masochists, the functional connectivity of the parietal operculum to the left and right insulae, the central operculum, and the supramarginal gyrus is altered. Activity of the insula region specifically has been associated with aversion.104 Interestingly, all these brain regions are part of the so-called “mirror neuron system,” the brain regions that are associated with the ability to understand the mental state of others, as well as with empathy and, thus, are important in the context of social interaction. These results, thus, suggest that masochists tend to experience painful stimuli when framed in a masochistic social context as being less negative compared with control subjects. These aforementioned regions of the operculum have also been shown to be activated in non-BDSM participants when watching sexual video clips. The level of activation of these brain structures predicted sexual arousal induced by these videos.105 Because the reduced pain perception was not present when receiving painful stimuli in a non-masochistic context, it, thus, seems that masochists retrieve positive experiences from past memories when shown masochistic pictures during painful stimulation, leading them to imagine themselves in the situation with the associated positive emotions.

Hormonal Changes Associated with BDSM

Male sex hormones, especially testosterone levels, are known to be associated with sexual activity and aggression in general,105106 but it should be noted that the association between testosterone and aggressive behavior is a complex one that remains to be elucidated. Nonetheless, this association has been extrapolated to both sexual (non-consensual) sadism107 and sexual masochism.108 In a fascinating set of 2 studies,109 58 dominant or submissive practitioners underwent salivary testosterone quantification before and after BDSM interaction. Contrasting to previous results, female (but not male) submissives had increased testosterone levels after BDSM play, whereas testosterone levels remained stable in dominants. The authors hypothesized the hormonal increase in female submissives to signify an aggressive response to the SM activities, but they also suggested that testosterone was associated with increases in positive mood, although the latter is less likely, given that increases in testosterone are more associated with depressive mood.110 It should be noted, however, that a small-scale follow-up study of the same research group did not replicate these findings.111 Nonetheless, recent research associated increases in testosterone with prosocial behavior, because testosterone tended to stimulate rewarding behavior in men.112 But, more generally, effects of testosterone in women are less understood and should be further scrutinized.112

Similarly, increased levels of the stress hormone cortisol have been associated with both sadistic107 and masochistic66113 behaviors. Surprisingly, Klement and colleagues66113 found that increased cortisol levels were inversely correlated with subjective stress levels, as well as negative affect.114 The authors propose 2 mechanisms for these seemingly contradictory findings. Participants may have high pain tolerance levels and, thus, may not experience BDSM-related pain stimuli as particularly painful subjectively, although the body may have registered pain-related sensations. Another explanation may be that pain play could have a moderating effect on the link between physiological and psychological stress, by reducing negative or inducing positive emotions during these activities.

The induction of both sex and stress-related hormones in response to painful stimuli might provide an explanation for the historic notion that pain induction can be sexually arousing. Weinberg et al1 postulated that pain can act as a sexual stimulus. In addition, Kinsey et al115 pointed out that milder forms of physical aggression, such as scratching and biting, are often ingredients implemented in conventional sex and that the physiological response to pain is similar to that of orgasm. Other physical activities that may be accompanied by pain, such as long-distance running or dancing, can equally lead to a euphoric state of mind.116 Combined, these findings indicate that investigation of the potential role of biomarkers implicated in the brain reward system (eg, the dopaminergic system, cannabinoids) and their interactions with the aforementioned hormones provides a promising future research avenue.Go to:


An interest in BDSM-related intimacy and sexuality can translate into a wide range of different fantasies and activities. Kinks and related interests come in many forms and present themselves very individually. Based on the existing literature, these interests seem to stem from a variety of biological, psychological and social influences throughout one’s life. Figure 2 presents a biopsychosocial model of how all these influences may converge into the development of BDSM-oriented behavior. It should be noted that this is a tentative model, because many aspects included need further scrutiny. Biologic factors such as gender identity, as well as the constitution of the central pain and reward systems, may influence BDSM orientation, although it can also be argued that these systems change over time as a result of BDSM activities. These are interesting notions to be explored in future research. Sex hormone levels may contribute to the BDSM role identity (dominant vs submissive) and to what extent it is a sexually related interest. Psychological factors equally impact one’s positioning within the BDSM spectrum. Both personality traits, such as higher levels of openness or extraversion, as well as the presence of a personality disorder, may have a mediating effect toward a higher interest in BDSM, although only limited evidence is available with regard to the amount of impact, as well as its specificity. Sensation-seeking levels and impulsivity may guide one’s drive to explore new or more-intense kinks. Attachment styles will determine dynamics within the couple and may influence the willingness to explore limits and limitations in a BDSM context. Education levels can equally steer relational or sexual interest, because a higher percentage of BDSM practitioners have a college degree, which often comes with higher levels of responsibilities. It has been suggested that BDSM offers a framework in which these work-related responsibilities can be let go, resulting in a sense of personal freedom.26 Finally, it can also be hypothesized that the parenting style experienced in childhood, as well as the modeling of the parents as a couple, may steer one’s view on relational dynamics, but this still needs to be investigated. As such, if 1 of the parents is the authoritative figure within the couple, the child is more likely to also develop a hierarchical disparity in their future couple dynamics and sexuality.77 Also cultural factors such as a liberal environment (eg, urban living region) and potential sexually traumatic experiences contribute to a more pro-BDSM lifestyle. To what extent BDSM interests and tendencies develop over time is moderated by, among others, (sexual) partner choices and accessibility of the BDSM community (eg, online or the proximity of a club).

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Open in a separate windowFigure 2

A biopsychosocial model for BDSM interests. BDSM = bondage and discipline, dominance and submission, and sadism and masochism.

Within the BDSM spectrum, these interests develop in several dimensions. As such, they may be an inseparable part of one’s sexuality or have no sexual connotation at all. Additionally, the nature of the play elements driving the power exchange may be different, because some focus on role or power play, whereas others are more oriented toward pain play or may implement both aspects.

The limitations of the current review reflect those of the topical scientific literature. Although the number of studies focused on all aspects of BDSM is exponentially growing, most of these are only descriptive, and very few focus on underlying driving processes. The current review only included original research articles and, thus, did not implement any of the multitude of existing opinion pieces, which mostly approach BDSM from a psychodynamic angle. Another confounding factor is the extent of generalizability of data. Generally, literature can be divided into 2 categories: the first focuses on BDSM practitioners recruited from specialized settings (club members and, more recently, the online community), which inherently creates a selection bias, because these members are more actively or intensely pursuing their interests, and may not represent the general BDSM-oriented population. Alternatively, more recent studies are using large-scale survey studies to investigate several aspects of BDSM in the general population, but they tend to be more descriptive in nature.Go to:


Future research should focus more on the driving mechanisms—with a specific stress on/need for implicated biologic pathways—of BDSM practice and relationships, all the while addressing limitations of current literature, as described above. Research should not only focus on BDSM-oriented people who practice their interests in BDSM-themed clubs, but also take advantage of the increased accessibility of practitioners and more broadly, BDSM-interested individuals without experience, provided by internet forums. This will allow scrutinizing the wide spectrum of BDSM interest. Informative research venues could be driving psychological mechanisms in these interests (such as personality traits, coping skills, sensation-seeking behavior), parenting style of the parents of these individuals, relationship between BDSM and communication style in and outside intimate relationships, associations between BDSM interests and psychological or psychiatric disorders, evolutions in the perception of BDSM interests in society and associated stigma, and international differences in BDSM practices. Finally, research into biomarkers related to reward, sexuality, intimacy, and experienced stress may further our understanding of these interests.

A Systematic Scoping Review of the Prevalence, Etiological, Psychological, and Interpersonal Factors Associated with BDSM

Official link: https://www.tandfonline.com/doi/full/10.1080/00224499.2019.1665619

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BDSM (bondage, discipline, dominance, submission, and sadomasochism) encompasses a diverse set of sexual interests. Research interests in BDSM have been historically underpinned by examining potential mental health issues, unhealthy fixations on specific sexual behaviors, and/or the presence of childhood trauma, as is predicted by psychopathological and psychoanalytic models. The objective of this scoping review was to provide an overview of the current landscape of BDSM research, including incidence rates, evidence for psychopathological, psychoanalytical, biological, and social etiological factors, demographics of BDSM practitioners, and the psychological correlates of those with BDSM interests. After the literature search and screening process, 60 articles were included. BDSM related fantasies were found to be common (40-70%) in both males and females, while about 20% reported engaging in BDSM. Results show little support for psychopathologic or psychoanalytic models. In the selected samples studied, BDSM practitioners appear to be white, well educated, young, and do not show higher rates of mental health or relationship problems. Research supports BDSM being used as a broadening of sexual interests and behaviors instead of a fixation on a specific interest. Future empirical research should focus on non-pathological models of BDSM, discrimination of BDSM practitioners, interpersonal relationships, and biological factors.Previous articleView issue table of contentsNext article

Although people may use BDSM and sadomasochism interchangeably, BDSM is broader in scope, and represents three overlapping acronyms: bondage and discipline (BD), domination and submission (DS), and sadomasochism (SM). A precise definition of BDSM is difficult to generate, but it generally includes sexual behaviors that involve some sort of power exchange between two or more partners and/or the use of pain to elicit sexual pleasure, though sensations other than pain (e.g., pleasure) are also frequently used in play (Williams, 2006; see Weinberg, Williams, & Moser, 1984 for a similar definition based on qualitative data). This power exchange is rooted in affirmative consent; all parties involved consent to the behaviors taking place and can withdraw consent at any time (e.g., through the use of a safeword). It is useful to note that the experience and purpose of pain in a BDSM context differs between individuals. A behavior may be considered painful by some, but not by others. In contemporary settings, BDSM has grown into a subculture complete with events, social networks, and differing social identities (Williams, 2006), though due to it being historically pathologized, people interested in BDSM may hide their sexual proclivities from others (Freud, 1906/1953; Krafft-Ebing, 1886). Because of its basis in an exchange of power, BDSM oriented individuals choose identities within that power difference. Submissives, bottoms, and masochists are the most common identities on the side of relinquishing power, with dominants, tops, and sadists assuming power. Dominants and submissives do not necessarily enjoy giving or receiving pain, while sadists and masochists do not necessarily want to serve or be served by their partners. Switches are those that assume roles on either side, usually dependent on context and partner.

Because BDSM was historically thought of as being caused by mental illness, pathology, or complications occurring in childhood, it has been associated with paraphilic disorders. This view still partially exists, with sexual sadism, sexual masochism, and fetishistic disorder being listed in both the DSM-5 and ICD-10 (but the ICD -11 has since removed sexual masochism). Many sex researchers contest the inclusion of some of these in diagnostic manuals because they stigmatize BDSM practitioners as well as medicalize what may be relatively benign and even common sexual interests (Moser, 20182016; Seto, Kingston, & Bourget, 2014; Shindel & Moser, 2011; Wright, 2006). Having BDSM sexual interests alone no longer meet the criteria of a paraphilic disorder. In order to meet the diagnostic criteria for sexual masochism or sexual sadism disorder, an individual must have experienced clinically significant distress or impairment due to their sexual desires or must have acted on these sexual urges with a nonconsenting person (American Psychiatric Association [APA], 2013). However, these criteria are vague, and the level or cause of distress has received little clarification.

Despite the attention being paid to aspects of BDSM in individual disciplines (e.g., psychiatry, psychology), there have been no substantial reviews of the existing literature and thus there is little understanding of the current landscape of the BDSM research evidence base. The purpose of this scoping review is to help fill this gap. The review includes literature on theories of the development of BDSM, prevalence rates, BDSM specific roles and behaviors within the BDSM community, and relationship factors that affect BDSM practitioners.



We conducted a scoping review using the following research question: “What is the prevalence, etiological factors, psychological and interpersonal correlates associated with BDSM?” Scoping reviews in the behavioral and social sciences (including sex research) are well-suited for broad topic areas that contain primarily emerging literature or are in under-studied areas, behaviors or psychological traits. Such reviews differ from systematic reviews in that they aim to 1) broadly map and identify gaps in a particular field of study, 2) address broader, exploratory research questions, and 3) narratively describe the quantity and quality of research without using formal quality assessment or meta-analytic techniques (see Grant & Booth, 2009 for more information about how review styles differ). The methods for this scoping review were in accordance with the 2015 Joanna Briggs Institute methodology (Peters, Godfrey, McInerney, Parker, & Baldini Soares, 2015).

The uniqueness of scoping reviews is that they provide a methodology that allows a narrative assessment of emerging evidence (e.g., in new or rare fields) and thus offer a first step in research development. In new, under-studied, or minority fields of study (typical in sex research), a scoping review also provides more flexibility than traditional systematic reviews. It allows researchers to describe more clearly the diversity of the literature and studies using a range of methodologies that are often omitted due to the strict protocols of systematic reviews. The general scoping procedure includes identifying a specific area of emerging research, identifying the important sub-areas (or generating a series of broad research questions), identifying the relevant studies and generating appropriate inclusion and exclusion criteria, study search and extraction, charting the relevant study data (e.g., in tabular form), and summarizing and reporting the studies (Arksey & O’Malley, 2005). More specifically, scoping reviews differ from narrative reviews in that they 1) take a systematic (and comprehensive) approach to data search and extraction, 2) aim to investigate areas of research that are more focused than those found in narrative reviews (which are very open-ended and unfocused), and 3) include analysis and critique of study design and overall quality.

Inclusion and exclusion criteria

Inclusion required 1) full text papers (i.e., not a conference abstract); 2) papers published in English; 3) the paper was in a peer reviewed journal; 4) empirical studies of BDSM, sadomasochism, or fetishism in relation to the variables being investigated, as stated in the objective. Exclusion criteria were 1) exclusively qualitative studies (quantitative sections of mixed methods studies were included); 2) the article did not contain original research; 3) publication before 20001 ; 4) a sample size less than 12; and 5) a sample comprised exclusively of clinical or incarcerated populations.

Search strategy

The following databases were searched on February 26th, 2019: Embase; MEDLINE; PsycARTICLES; PsycINFO. The search was updated on June 27th, 2019. Search terms were selected based on their relevance to BDSM and the areas of interest and agreed upon by AB and QR. See Table 1 for full search methodology and terms.

Table 1. Database search terms

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Study characteristics

Before exclusion criteria were applied, 3,915 articles were identified with the search terms. Of the 3,100 that remained after deduplication, title and abstract screening eliminated 2,957. After full text scans of the remaining 76 articles and 57 articles identified through other sources, 59 articles were eligible for inclusion (see Figure 1 for full search results). All 133 articles included in the full text scan had references checked to ensure saturation of the relevant material. One additional article met inclusion criteria after the updated search, bringing the total number of articles included in this review to 60. Table 2 gives information on the samples, methods, and effect sizes of each study.

Table 2. Methodology and outcome information for articles included in review

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Figure 1. PRISMA flow diagram for search. Please note that the search was updated on June 27th, 2019 and includes one additional article.Display full size

Prevalence rates of BDSM related fantasies and behaviors

One nationally representative study found 68.8% of participants reported at least one BDSM fantasy or practice (Holvoet et al., 2017). Twenty-two percent of participants reported fantasies without acting on them; the remainder indicated engagement in at least one BDSM behavior. Submissive (9.5%) and masochistic acts (15.3% reported being hit by a partner) were more common than dominant (8%) and sadistic (11% doing the hitting) acts (cf. Joyal & Carpentier, 2017). While many reported BDSM fantasies, only 7.6% identified as BDSM practitioners. Another study found similar rates of BDSM related fantasies, with over half of all participants reporting at least one BDSM-related fantasy (Joyal, Cossette, & Lapierre, 2015).

Conversely, a nationally representative study from Australia in 2003 found that approximately 2% had participated in BDSM (Richters, Grulich, de Visser, Smith, & Rissel, 2003), and this only increased marginally (but non-significantly) in a follow up study 10 years later (Richters et al., 2014). However, researchers did not offer any examples or definitions of BDSM outside the meaning of the acronym, and thus, these rates may be underestimates.

Returning to the DSM-5’s (APA, 2013) paraphilic classifications (many of which relate to BDSM), Joyal and Carpentier (2017) asked participants about their interest in the eight paraphilias: sadism, masochism, voyeurism, exhibitionism, fetishism, pedophilia, frotteurism, and transvestism. Just over 45% acknowledged a desire for at least one paraphilic behavior, and 33.8% had engaged in a paraphilic behavior at least once in their life. Neither sadism, masochism, nor fetishism (fantasy or behavior) were statistically rare (less than a 2.3% incidence rate), and only sadism could be considered unusual (less than 15.9% incidence). Rates were even lower for engaging in behaviors consistently (>10 times over the lifetime): 3.5% for fetishism, 1.4% for masochism, and 0.3% for sadism. This highlights the importance of distinguishing between sub-groups who report different levels of desire and engagement in BDSM.

Joyal (2015) studied broader atypical sexual interests and reported that of 45 fantasies (as described by the Wilson Sex Fantasy Questionnaire [WSFQ]), the most intense fantasy was normophilic (or non-paraphilic): receiving oral sex (for both sexes). The mean intensity of the most intense normophilic fantasy did not differ significantly from the most intense paraphilic fantasy. Four of seven clusters (57%) of the entire sample reported a most intense paraphilic fantasy that was statistically as intense or more intense than their most intense normophilic fantasy. As the DSM-5 (APA, 2013, p. 685) defines a paraphilia as “any sexual interests greater than or equal to normophilic [i.e., genital stimulation] sexual interests”, these results from Joyal (2015) were taken to suggest that 57% of this sample met the criteria for having a paraphilia. Similarly, Ahlers et al. (2011) indicated that 62.4% of men reported some degree of arousal to at least one paraphilia fantasy (and 44.4% paraphilic behaviors related to at least one of these) but only 1.7% experienced distress because of it, indicating that paraphilic interests are sub-clinical for most people. These studies highlight that many non-normophilic interests (including those related to BDSM) are not statistically atypical.

Several studies indicate that BDSM interests may represent a broadening of individuals’ sexual repertoire rather than being truly “paraphilic” (e.g., Cross & Matheson, 2006; Houngbedji & Guillem, 2016; Oliveira Júnior & Abdo, 2010; Williams, Cooper, Howell, Yuille, & Paulhus, 2009). For example, Oliveira Júnior and Abdo (2010) studied 10 unusual sexual behaviors: fetish, voyeurism, incest, threesomes, exhibitionism, sadomasochism, group sex, money in exchange for sex, sexual practice with animals, and swinging. Twenty per cent of the sample reported practicing only one behavior, while 18% reported practicing two or more. Nine percent reported practicing sadomasochism and 13.4% reported fetishism. Overall, findings suggest that BDSM related fantasies and behaviors are relatively common, though behavior prevalence rates are typically lower than fantasies.

Sex differences

Although BDSM fantasies and behaviors are prevalent in both men and women, there appear to be sex differences herein (Joyal et al., 2015). For example, Zurbriggen and Yost (2004) found that men’s fantasies were more likely to include portrayals of themselves as dominant, and women were more likely to fantasize about submission. However, regardless of sex, arousal to masochism and sadism were strongly related. Dawson, Bannerman, and Lalumière (2016) found men indicated significantly more arousal than women for fetishism (28% vs 11%) and sadism (19% vs 10%). For masochism, women reported more arousal (17%) than men (15%). Similarly, Joyal et al. (2015) reported that women (64.6%) reported fantasizing about being dominated significantly more than men (53.5%), while men (59.6%) reported fantasizing about dominating someone significantly more than women (46.7%). Focusing on other aspects of BDSM play, a 2017 study  (Joyal & Carpentier) found that significantly more women (27.8%) than men (19.2%) reported desire to engage in masochism and 9.5% of men and 5.1% of women expressed desire for sadism. Fetishism was found to be an interest for 40.4% of men and 47.9% of women.

As expected, prevalence rates of BDSM behaviors were lower than the prevalence of BDSM fantasies for both males and females. In general, research has found that men are more likely than women to report engaging in unusual sexual behaviors (Holvoet et al., 2017; Oliveira Júnior & Abdo, 2010). One of the few studies that did not find any significant sex differences in prevalence rates of BDSM behaviors was an Australian study that collected data from a nationally representative sample of men and women aged 16–59. This found that 2% of men and 1.4% of women had participated in BDSM in the past 12 months (Richters et al., 2003). Researchers also asked if they had participated in role play or dressing up, to which 4% of men and 3.7% of women answered affirmatively. In relation to specific BDSM behaviors, Joyal and Carpentier (2017) found that more women (23.7%) reported experiencing sexual masochism than men (13.9%). Two studies on bisexual and gay women found that about 19% reported some engagement in sadomasochism, 33% participated in bondage and domination, 22.2% in photo or video exhibitionism, and 5.2% in breath play (Bailey, Farquhar, Owen, & Whittaker, 2003; Tomassilli, Golub, Bimbi, & Parsons, 2009).

Etiological theories of BDSM

Recent empirical literature has aimed to test the psychoanalytic, social, and bio-medical models, as well as offer new etiological theories for the development of BDSM interests. We have sequestered these areas to their own sub-sections below. However, here it is worth mentioning a key study by Cross and Matheson (2006) which tested four possible etiological theories in one study: psychopathological, radical feminist, escape-from-self, and psychoanalytic. The psychopathology model hypothesizes that BDSM interests are abnormal traits caused by physical or psychological disease and thus should covary with measures of psychopathology. The feminist model argues that participation in BDSM is inherently misogynistic, regardless of which sex assumes which BDSM role, and pleasure from degradation or torture is indicative of an internalized patriarchy. The escape-from-self theory (Baumeister, 1988) posits that masochism provides escape from excessive levels of self-control. As successful people (in career or personal life) may have high levels of self-control, this model predicts that successful individuals will tend more toward masochism than sadism because they desire to relinquish their own control. People who identify as sadistic are doing so not to relinquish the self, but out of a need to assert control and bolster their own self-concept. Psychoanalytic theory suggests that BDSM traits may be linked to sexual guilt as compensatory mechanisms for a dysfunctional superego, or that a weak superego might result in greater thrill-seeking as a compensation (Freud, 1953).

To test these competing hypotheses, Cross and Matheson (2006) compared people who identified as either a sadist, masochist, or switch, with a non-BDSM control group. None were supported. Masochists were not more prone to distress or mental instability than other groups. Authoritarianism scores were significantly higher among the control group compared to switches. In general, all groups held pro-feminist attitudes, suggesting that BDSM interests are not due to internalized patriarchal norms (cf., Shulman & Home, 2006). Another study found that BDSM practitioners, when compared to two non-BDSM control groups, did not significantly differ on hostile sexism and acceptance of sexual aggression, and had lower levels of benevolent sexism, rape myth acceptance, and victim blaming (Klement, Sagarin, & Lee, 2017b). Although one study found that women implicitly associated sex with submission, contrary to the feminist theory, men did not implicitly associate dominance with sex (Sanchez, Kiefer, & Ybarra, 2006). As for the escape-from-self hypothesis, there were no significant differences in scores on measures of risk-taking behaviors (Cross & Matheson, 2006). Sadists did not differ in employment (or success level) from non-BDSM controls, and masochists were not more inclined to engage in escapists behaviors. Sexual guilt and thrill-seeking levels did not differ between sadists, masochists, and switches, offering little empirical support for psychoanalytic predictions (Cross & Matheson, 2006).

Child abuse and trauma

Despite lack of scientific support, psychoanalytic theories for BDSM persist in popular culture. These variously take the form of a belief that a proclivity for BDSM is anchored in childhood sexual abuse (CSA, or that early abuse cascades into psychosexual, developmental or other personality dysfunction which results in BDSM; Freud, 19621924/19611938). Thus, psychoanalytic theory predicts that those with BDSM interests should have underlying psychological and personality dysfunction, as these interests are rooted in trauma that will result in mental health issues. However, studies linking CSA and sadomasochistic preferences tend to be case studies from those with other psychological problems (Blizard, 2001; Rothstein, 1991). Thus, it is difficult to tease apart the overlap between CSA, other mental health disorders, and BDSM traits.

Contrary to the prediction that most persons with BDSM interests should have experienced some form of trauma, BDSM practitioners had comparable PTSD and trauma-related phenomena scores and incidence rates of trauma similar to population averages (8%), though more submissiveness was associated with an increased PTSD symptom score (Connolly, 2006). BDSM practitioners did not show higher borderline personality or dissociative identity disorder symptoms. Similarly, a population study found no link between psychopathology, abuse, and BDSM (Richters, de Visser, Rissel, Grulich, & Smith, 2008). When comparing those who had practiced BDSM in the last 12 months to those who had not, engagement in BDSM was unrelated to having been sexually coerced before the age of 16. Men who engaged in BDSM were also significantly less likely to have psychological distress and women who engaged in BDSM did not differ significantly in psychological distress to those who had not.

Shulman and Home (2006) tested the guilt reduction theory, which hypothesizes that women with high sex guilt have more forceful sexual fantasies as the fantasies absolves them of the guilt they might experience if they initiated or said yes to a sexual scenario. Sex guilt refers to the feeling of shame or embarrassment one might experience due to participating in or fantasizing about sexual activity. Guilt reduction theory stipulates that those with high sex guilt will feel less guilty if they are in a sexual scenario where they are unable to reject sexual advances as they do not have the burden of asking for (or even saying yes to) sex. CSA may result in high levels of sex guilt, which would then cascade into fantasies of force (related to the domination and submission aspects of BDSM). However, results indicated that CSA was not directly related to sex guilt but did have a direct path to erotophilia (an individual’s general propensity to respond to sexual cues). Most notable was the finding that low levels of sex guilt and high levels of erotophilia predicted forceful sexual fantasies. Stronger feminist beliefs coupled with low levels of guilt were also related to erotophilia and more sexual experience. This indicated that, although CSA may be related to forceful sexual fantasies, it is not the only potential origin of these fantasies.

Nordling, Sandnabba, and Santtila (2000) tested the hypothesis that BDSM practitioners who experienced CSA would seek out sadomasochistic relationships because they viewed violence as a normal part of sexuality, show greater psychological distress, and have poorer social adjustment. Both male and female BDSM practitioners were more likely to have experienced CSA than the general population (7.9% males in the current sample compared to 1-3% in the population; 22.7% to 6-8% for females, respectively). However, it is important to note that most (90.4%) BDSM practitioners in this study reported no abuse at all, providing little support for the theory that most BDSM practitioners have previously experienced abuse. The association between CSA and BDSM should also be interpreted with caution given the small sample size of abused participants. More recently, a study focused on investigating the role of childhood trauma in kinky sexual behavior in adults found that trauma did not significantly predict either dominance or submissive sexual behaviors within a sample of kink-identified participants, indicating that trauma is not a common precipitating factor of BDSM interests (Hillier, 2019).


Some psychodynamic accounts propose that children who are abused develop poor attachment, which results in masochistic or sadistic ego states used to preserve their self-concept and attachment to parents. One study on 164 men from two BDSM clubs indicated that attachment (based on retrospective descriptions of parental relationships) to the mother (but not the father) was significantly correlated with BDSM orientation. Specifically, sadistic participants were more likely to have avoidant attachment and less likely to have secure attachment, and masochistic participants were more likely to have secure attachment and less likely to have avoidant attachment (Santtila, Sandnabba, & Nordling, 2001). The distributions of attachment styles in this sample were similar to population samples. Wismeijer and Van Assen (2013) reported similar results (i.e., no significant differences in attachment styles between BDSM sub-groups and controls; see also Connolly, 2006; Richters et al., 2008). Overall, the findings offer weak support for attachment hypotheses.


In a less psychopathology-focused study, Lammers and Imhoff (2016) put forth the disinhibition hypothesis, which states that having social power leads to behavioral disinhibition; powerful people are more likely to act impulsively because they can. Consistent with the disinhibition hypothesis, men, who had more social power (determined by their position at their job, with managerial or leadership roles ranked as being higher in social power than hourly-wage or non-leadership positions), were significantly more aroused by sadistic thoughts. Results demonstrated that social power was positively related to arousal by sadistic thoughts, and this effect was moderated by gender (controlling for age). The same was found for women and masochism. Position of power increased arousal to sadistic thoughts among women but not men. Additionally, there was a small positive effect of social power on masochistic arousal for men, indicating that men’s increase in social power was linked with arousal to female-associated masochism.

A related hypothesis argued that BDSM preferences may be related to a compensation for a lack of power in childhood (Damon, 2003). Individuals who perceive a lack of power in daily life may seek out opportunities to show dominance by exerting control over others. Contrary to the hypothesis, submissives, not dominants, were found to have lower levels of self-esteem and higher levels of sexism (Malovich & Stake, 1990; Valentine, 1998). Thus, the hypothesis of using dominance as a way to compensate for low levels of self-esteem also appears unsupported.

Neurological and biological differences

Also critical of the psychopathological model, Luo and Zhang (2018a) quantified neural empathetic responses of BDSM practitioners. The use of pain in BDSM led early researchers to view these practices as linked to psychopathy, which has been related to diminished empathy, and antisocial, and borderline personality disorder (Soderstrom, 2003). Luo and Zhang (2018a) found that female submissives showed reduced trait empathy and subjective empathetic response and more BDSM experiences were associated with even more reduction in empathy. Frequent exposure to pain inflicting situations may diminish empathic responses over time, as has been demonstrated in medical professionals frequently exposed to seeing those in pain (Cheng et al., 2007).

Luo and Zhang (2018b) then looked at the potential influence of humiliation (via wearing a ball gag) and bondage on female submissives’ empathetic neural response. Results showed that the subjective feeling of humiliation and objective loss of ability to move facial muscles due to the gag decreased their empathetic response, suggesting that the lower empathetic response was context dependent. Thus, any diminished empathetic response may be due to, instead of the cause of, BDSM practices.

Other studies have found relationships between neurodevelopmental factors and paraphilic preferences in men. Rahman and Symeonides (2008) found that greater paraphilic interests were associated with greater non-right handedness and numbers of older brothers (a potential marker of prenatal events which may influence brain development, such as maternal immune responses) in men. However, the associations were small and Dawson et al. (2016) did not replicate the association between paraphilic interests and non-right handedness. Conversely, it was weakly, but non-significantly, associated with paraphilic interest in women. This may be because neurodevelopmental markers may be related to paraphilic disorders (like pedophilia) rather than to low-level atypical sexual interests. However, we found no literature (using our criteria) on genetic (e.g., twin studies), hormonal (e.g., studies on the role of sex steroids) or other psychobiological correlates.


One study tested the novel theory that BDSM may simply be a leisure or recreational activity (Williams, Prior, Alvarado, Thomas, & Christensen, 2016). Leisure is defined as an activity, context, or time period with positive psychological benefits that is also personally meaningful, freely chosen, and intrinsically motivated (Kleiber, Walker, & Mannell, 2011). Similarly, recreation involves engaging in pleasurable activities, usually during one’s leisure time. The notion of BDSM as leisure could help explain why some people, like those that identify as asexual, do not view their participation in BDSM as erotic or sexual. Because BDSM practitioners frequently refer to their practices with terms like toys, games, play, or fantasy, it is conceivable that this can be seen as leisure and have no deeper, pathological, etiological origin for many practitioners. Participants were not given definitions of either recreation or leisure but were simply asked whether they considered BDSM to fit into either of these categories. Sixty-four percent of participants reported that BDSM participation was recreational and 58% reported that it was leisure most or all of the time. Dominant participants were significantly more likely than submissives to rate BDSM activities to be more serious, rather than casual, on four of the six items related to this continuum. This may be due to their need to master certain skills (like handling of whips) and their responsibility to keep their submissive safe during a scene.

Evolutionary hypotheses

Other causal hypotheses include evolutionary accounts which argue that sexual arousal by a power difference between partners is a successful mating strategy. Arousal by a higher ranking and dominant male can facilitate mating with a partner with good genes and good resources (Gangestad, Simpson, Cousins, Garver-Apgar, & Christensen, 2004; Llaurens, Raymond, & Faurie, 2009). In support, Jozifkova, Bartos, and Flegr (2012) cited findings where hierarchically incongruent pairs had more offspring than those with equal status, regardless of which gender partner was higher ranking. If this strategy does not work, individuals may also adopt an alternative, opportunistic strategy in order to maximize their potential for reproductive success. Thus, dominance and submission may come from a dominance strategy, and preference for bondage may come from an opportunistic strategy (i.e. putting a sexual partner in a position where they are physically unable to get away from the encounter). As predicted, for males, dominance scores correlated with questions pertaining to a desire for hierarchical disparity between partners, but the opportunistic score (representing a preference for bondage) was not correlated with any of the items. In women, dominance only correlated significantly with two of the eight questions asking about preference for hierarchical disparity in relationships and no questions about hierarchical disparity preference correlated significantly with opportunism scores.

A model based on evolutionarily advantageous resource control was also tested (Hawley & Hensley, 2009). People were categorized as having either 1) coercive strategies, where people gain access to resources by simply taking them as a show of social dominance, 2) prosocial strategies, where people gain access to resources through cooperation, or 3) a combination of the two (bi-strategic). The researchers predicted that women who are more dominant (or adopt a coercive strategy) would show more forceful sexual fantasies than submissive women because they are drawn to dominant men that they themselves are competitive enough to win over. The first study found that women’s predilection for forceful submission was greater than men’s preference to fantasize about forceful domination. Bi-strategic women showed the greatest divergence between preferences: they preferred to be dominated more than they preferred to dominate, supporting the initial hypothesis. As predicted, dominant men were more likely to entertain dominance fantasies.

Sex drive

Although some research (Lammers & Imhoff, 2016) points to BDSM being associated with subversion of gender norms, sex differences remain. Men are consistently found to report a higher incidence of atypical sexual interests, including BDSM (Dawson et al., 2016; Joyal et al., 2015). The exception appears to be masochism, in which more women than men report having this fantasy (Joyal et al., 2015). Dawson et al. (2016) found the men reported arousal to sadistic sexual interests more often than women, consistent with other studies. However, sex drive was an important mediator of these associations, indicating that higher sex drive is a possible etiological factor in the development of BDSM interests.

As has been demonstrated, it seems to be highly unlikely that there is a single cause of BDSM interests. There is good evidence that BDSM practitioners do not suffer from more psychological problems than the general population (Connolly, 2006; Cross & Matheson, 2006; Richters et al., 2008) and do not show levels of empathetic neural responses associated with psychopathy (Luo & Zhang, 2018a2018b), as is predicted by psychopathological and psychoanalytic models. If CSA is a contributing etiological factor in a small subset of BDSM practitioners (Nordling et al., 2000), it is more likely to be related to hypersexuality or erotophilia than BDSM interests themselves (Shulman & Home, 2006). Though many of the studies reviewed were limited by the use of self-selected sampling, those with large, representative samples (Richters et al., 201420082003) have reached similar conclusions.

In sum, causal factors may include BDSM engagement for leisure (Williams et al., 2016), influence of high sex drive (Lammers & Imhoff, 2016) to mate selection techniques (Jozifkova et al., 2012) and positions of social power (Hawley & Hensley, 2009). However, the cross-sectional nature of these studies makes causal pathways difficult to determine and the use of self-selected samples limit generalizability. Notable is the lack of good research on genetic, hormonal, and neural correlates. Collectively, data suggest there is no singular causal factor of BDSM, but rather multiple factors.

Demographic characteristics of BDSM practitioners

The majority of studies on BDSM practitioners have found that they are typically white, well-educated, and young (e.g., Brown, Roush, Mitchell, & Cukrowicz, 2017; Connolly, 2006; Damon, 2003; Hébert & Weaver, 2014; Lodi-Smith, Shepard, & Wagner, 2014; Oliveira Júnior & Abdo, 2010; Pascoal, Cardoso, & Henriques, 2015; Richters et al., 2014). Only two studies diverged from this demographic pattern (Joyal, 2015; Wismeijer & Van Assen, 2013, although the latter still reported greater education levels).

Additionally, BDSM practitioners have higher rates of non-monogamy. One study found 40% reported some form of non-monogamous relationship (Rehor, 2015), another found that 31.4% practiced BDSM with someone other than their primary romantic partner (Hébert & Weaver, 2014), a third found that 32.7% identified as non-mongamous or polyamorous (Connolly, 2006), and a fourth reported rates of polyamory of around 14% (Botta, Nimbi, Tripodi, Silvaggi, & Simonelli, 2019). This may be related to findings by Wismeijer and Van Assen (2013) that non-BDSM females scored significantly lower on confidence in relationships than the female BDSM practitioners. However, because BDSM is a niche sexual interest, it may lead to higher rates of being single as it becomes more difficult to find a partner with shared interests (Ahlers et al., 2011).

Identifying as non-heterosexual is also related to BDSM. One study found that women with masochistic interests reported greater same sex attraction than women with conventional sexual interests (Chivers, Roy, Grimbos, Cantor, & Seto, 2014). Another study found that BDSM involvement was significantly more likely for bisexual men and gay men and women, and those with any BDSM experience were more likely to report bisexual experiences (Richters et al., 2008). Hébert and Weaver (2014) found that 30.7% of BDSM practitioners identified as bisexual, while 4.9% identified as homosexual. Connolly (2006) found that 34.1% identified as exclusively heterosexual, while Botta et al. (2019) reported that 39.7% of men and 30.4% of women identified as exclusively heterosexual.

Sexual experience and functioning

When it comes to sexual experience, the results indicate that BDSM practitioners typically have more partners over their lifetime (Oliveira Júnior & Abdo, 2010; Richters et al., 2008), have more sexual experience, and have sex at an earlier age (Oliveira Júnior & Abdo, 2010; Tomassilli et al., 2009). There is little evidence for an association between BDSM practices and sexual difficulties (Richters et al., 2008). For example, BDSM-identified men reported significantly lower levels of sexual distress, and arousal did not differ between BDSM and non-BDSM sexual contexts (Pascoal et al., 2015). Women reported significantly less distress about maintenance of arousal in BDSM contexts than non-BDSM contexts, though overall sexual satisfaction did not differ.

However, Långström and Hanson (2006) reported an association between impersonal sex, hypersexuality, and paraphilic interests, such that hypersexuality was related to the deliberate use of pain during sex. Oliveira Júnior and Abdo (2010) also reported that those with at least one atypical sexual behavior reported higher rates of STIs, and men reported a higher incidence rate of HIV/AIDS. Another study in a gay leather community found that those who identified as leather men were 61% more likely than a non-leather control group to be HIV positive (Moskowitz, Seal, Rintamaki, & Rieger, 2011). Those who identified as submissive were also more likely to be HIV-positive than non-leather identified participants. Further investigations are needed on the relationship between BDSM involvement and physical and sexual health.

BDSM identification, engagement, and behaviors

Arousal Patterns

Previous research (Chivers, Seto, & Blanchard, 2007; Suschinsky, Lalumière, & Chivers, 2009) has indicated that heterosexual women do not show gender or activity specific arousal patterns, unlike men (Seto, Lalumière, Harris, & Chivers, 2012). One study tested whether or not activity-specific genital arousal was different for men and women who reported masochistic interests (Chivers et al., 2014). Men with masochistic interests reported significantly greater subjective and genital arousal to masochistic sex than neutral stimuli but did not differ in their subjective ratings of conventional and masochistic sex narratives. Women with masochistic interests showed the greatest subjective arousal to conventional and masochistic sex (with no significant differences between them). Both men and women with masochistic interests showed more subjective and genital arousal to masochistic sex than any participants with conventional interests. Overall, participants with sexual interests in masochism, regardless of gender, showed nonspecific arousal patterns, responding similarly to both conventional and masochistic sex, once again supporting the notion that BDSM interests are not used as a complete replacement of conventional sexual behaviors

Individuals can also broaden their interests once already within the BDSM community. Typically, this is done by altering their role identification and/or adopting new or more extreme behaviors. Klement, Sagarin, and Lee (2017a) reported on data from a BDSM event centered on the extremes of sadomasochism (where participants insert needles, hooks, or hang heavy weights from the skin). It was found that engaging in these behaviors increased sexual arousal and decreased both negative affect and stress levels.

Role identification

One study of BDSM participants asked about BDSM identity and fluidity and found BDSM role identification showed a significant relationship to gender and sexual identities (Martinez, 2018). As expected, women were more likely to be in the submissive category, and men were more likely to be in the dominant category. This gender/BDSM identification divide was also found in other studies (Botta et al., 2019; Yost & Hunter, 2012). Genderqueer participants were more likely than men or women to identify as switches, and switches were significantly less likely to be heterosexual than dominants (Martinez, 2018). Queer and pansexual participants had the highest rate of equally sharing role frequencies, followed by lesbians/gays, bisexuals/heteroflexibles, and heterosexuals. Genderqueer individuals had higher role fluidity than women, and women had higher fluidity than men. Results support findings that suggest that, for a sub-set of BDSM participants, BDSM role can liberate individuals from, not reinforce, gender roles (Lammers & Imhoff, 2016).

BDSM behaviors

Exemplifying the broad spectrum of sexual behaviors that may be adopted by BDSM practitioners was a study by Rehor (2015) looking at the behaviors of women who identified with the kink community. More than 50% reported they had participated in sadomasochistic activities like breast play, paddling, flogging, pinching, whipping, and caning. Over half indicated that they had engaged in verbal or physical humiliation, exhibitionism, sensory deprivation, physical punishment, breath play, obedience training, domestic service/submission activities or forced activities for their own sexual gratification. Over 87% engaged in at least 1 of 10 role play scenarios- in order from most to least common: master/slave, fear play (e.g., kidnapping), occupation (e.g., boss), animal play, medical play, age regression, religion, incest, age progression, and necrophilia. About 75% indicated arousal by an object in at least one of five fetish categories (clothing, body parts, fabrics, uniforms, body fluids). Other research (Connolly, 2006) found the most preferred BDSM activities were whipping, caning, and flogging, followed by bondage and spanking. Botta et al. (2019) reported that 58.9% of male and 54.4% of female BDSM practitioners listed bondage as one of their most favorite BDSM activities, 73.8% of males and 90.4% of women favored physical pain, and 56.7% of men and 59.2% of women enjoyed humiliation (cf. Pascoal et al., 2015).

Regarding the extremity of behaviors, 14.4% categorized themselves as being light players, 39% as medium players, 30.5% as heavy, and 15.3% as edge (the most extreme) players (Connolly, 2006). Regardless of the intensity, 90.5% stated they used safe words. Most participants still had non-BDSM sex, with only 11.2% indicating that BDSM was their only form of sexual activity. About 13% had also reported occasionally paying for BDSM services from professional dominants or submissives. The majority (88.4%) of all participants reported engaging in sexual activity without elements of BDSM before they had their first experience with BDSM (Nordling, Sandnabba, Santtila, & Alison, 2006)

With respect to the structure of these diverse behaviors, Alison, Santtila, Sandnabba, and Nordling (2001), similar to other studies, reported 27% of BDSM practitioners identified as sadistic/dominant, 22.7% as switches, and 50.2% as masochistic/submissive. Analysis revealed four domains of behavior: hypermasculinity, administration of pain, humiliation, and physical restriction. Women engaged in significantly more humiliation (e.g., use of gags) than men, whereas men engaged in more hypermasculine behaviors than women. Gay men preferred hypermasculine behaviors (e.g., rimming, penis binding, fisting) and straight men preferred humiliation (see also Nordling et al., 2006). It is possible that these behaviors take on different meanings based on an emphasis on humiliation or hypermasculinity (Alison et al., 2001). Thus, BDSM play can be viewed as a set of behaviors that take on different meanings to individuals based on partner and context. In all four domains, a significant underlying, nonrandom, structure emerged, suggesting that the 29 behaviors investigated were clustered in a predictable way (Santtila, Sandnabba, Alison, & Nordling, 2002). Participants tended to engage in behaviors with increasing intensity, with less extreme behaviors typically preceding more intense behaviors, indicating that, over time, BDSM practitioners adopt more intense behaviors.

Further analysis focused specifically on the 162 males in the above three studies (Sandnabba, Santtila, & Nordling, 1999). The median age of first awareness of BDSM interest was 18–20, and the median age of first BDSM experience was 21–25, again with gay men being older than heterosexual men for both of these. Gay men became aware of their BDSM interests and had their first BDSM experience at an older age than the exclusively heterosexual men (Nordling et al., 2006). When asked about the intensity of their BDSM scenes, a significant number of participants indicated that they had lighter sessions than they wanted (Sandnabba et al., 1999). Moreover, participants believed they preferred heavier sessions than their partners wanted, regardless of BDSM role identity.

When asked about the place of BDSM behaviors, one study found that 85.5% reported doing so at home (Holvoet et al., 2017) and another found that 83.8% reported practicing BDSM at home, while only 4.4% of BDSM activities were reported to take place in BDSM clubs (Pascoal et al., 2015). This points to a potential sampling bias, as many studies on BDSM recruit from BDSM clubs and events, though the behaviors of those who practice in and out of the home appear similar.

Collectively, results from each of these studies indicate that BDSM identification and behaviors can change over time, though the fluidity of these differ between individuals. They also show that, for a majority, BDSM behaviors are in addition to, not a replacement of, more typical sexual behaviors (Alison et al., 2001; Chivers et al., 2014; Rehor, 2015; Sandnabba et al., 1999; Sandnabba et al., 2002). This supports non-pathological models of atypical sexual interests that focus on the broadening of sexuality (Cross & Matheson, 2006).

Psychological correlates

Mental health and clinical considerations

In general, BDSM practitioners are comparable to the general population in terms of mental health (Connolly, 2006; Cross & Matheson, 2006; Richters et al., 20082003). For example, it was found that BDSM practitioners reported lower depression scores, but typical levels of anxiety, compared to population norms (Connolly, 2006). However, some studies have found sub-groups of BDSM practitioners report more psychological problems. On measures of dissociation, submissiveness was related to reported memory disturbance and depersonalization, regardless of gender (Connolly, 2006). Another study found that men and women who engaged in these behaviors were more likely to show posttraumatic symptoms than those who did not engage in these behaviors, and both men and women who reported engaging in at least one atypical sexual behavior were significantly more likely to be a victim of sexual violence (Oliveira Júnior & Abdo, 2010). However, participants did not differ from population norms on depression, anxiety, panic, or phobias.

Other studies indicated that BDSM participants with a history of sexual abuse may be at risk of mental health issues (Nordling et al., 2000). For instance, Nordling et al. (2000) found that BDSM practitioners with a history of CSA were more likely to have ever attempted suicide, had more hospital psychological treatment, and were more likely to visit a physician regarding BDSM related injuries. Brown et al. (2017) investigated the potential risk of suicide attempts, based on the interpersonal theory of suicide, in which an acquired capability for suicide develops via habituation to exposure to painful or traumatic events (Van Orden et al., 2010). As participating in or watching a BDSM scene could be considered painful and/or emotionally provocative, participants may habituate over time, and thus increase their risk of suicide. For males, (no association was found for females) more engagement in BDSM was associated with an increased chance of a suicide attempt, but only when this relationship was mediated by both fearlessness about death and perceived pain tolerance. Twelve percent reported at least one suicide attempt; a rate higher than the general population. Roush, Brown, Mitchell, and Cukrowicz (2017) reported 37.4% (higher than the estimated 3.7% of US adults) of the BDSM practitioners reported some level of suicide ideation in the past two weeks. However, feelings of thwarted belongingness and perceived burdensomeness mediated the relationship between shame and suicidal ideation in this sample, suggesting that the stigmatization of BDSM (not BDSM itself) may be a causal factor for depressive symptoms.

Although some of this research points to mental health issues, it does not indicate that most practitioners suffer from clinically significant psychological problems. A sub-section of BDSM practitioners, perhaps those who suffered non-BDSM related trauma, may be at an increased risk of psychological distress. Studies that point to mental health problems have used small sample sizes (Nordling et al., 2000) or included other sexual interests, like pedophilia (Oliveira Júnior & Abdo, 2010) in their results. There is greater need to separate comorbid problems and diagnostic versus symptom-based definitions of poor psychological health.


Hébert and Weaver (2014) found that BDSM practitioners did not differ from population norms on honesty-humility, emotionality, extraversion, agreeableness, conscientio-usness, desire for control, self-esteem, life satisfaction, and empathy. However, dominants and submissives scored lower on altruism. When compared to other BDSM orientations, submissives scored higher on openness to experience and emotionality, and dominants scored higher on desire for control and extraversion. Compared to controls, results from another study found that BDSM participants scored higher on openness to experience, extraversion, and conscientiousness, and lower on rejection sensitivity, neuroticism, agreeableness (Wismeijer & Van Assen, 2013). When comparing across orientations, switches and dominants scored higher on openness than submissives and submissives scored higher on agreeableness than dominants. Additionally, a 2019 study found that neither extraversion or neuroticism were predictors of dominant or submissive role identification (Hillier, 2019).

Dawson et al. (2016) found that hypersexuality, sexual compulsivity, impulsivity, and sensation seeking were positively related to paraphilic interest scores. Generally, measures associated with excessive or compulsive sexual behavior, along with sociosexuality, were correlated with paraphilic interests. As previously mentioned, Shulman and Home (2006) found that erotophilia predicted fantasies involving submissiveness and force and was negatively related to sex guilt. Rye, Serafini, and Bramberger (2015) reported that erotophilia was positively related to personal feelings about BDSM and comfort in discussing BDSM.

Some research has studied Dark Triad traits (psychopathy, narcissism, and Machiavellianism) and personality disorder characteristics in relation to BDSM. One such study using the WSFQ reported that while psychopathy was significantly related to all four fantasy domains (intimate, exploratory, impersonal, and sadomasochism), it was most strongly correlated with impersonal fantasies (Baughman, Jonason, Veselka, & Vernon, 2014). Sadomasochism appeared most strongly and significantly related to psychopathy, followed by narcissism, and Machiavellianism (which was not significant; see also Williams et al., 2009). One study of adults with sub-clinical paraphilic interests found that, out of the Big 5 and the Dark Triad, only openness predicted sadomasochism in men, and openness, low conscientiousness, and Machiavellianism predicted sadomasochism in women (Lodi-Smith et al., 2014). Connolly (2006) found dominants scored higher on measures of narcissism and histrionic symptoms than the normative values, but this effect was greater in men. BDSM participants did not score significantly above non-clinical population norms for histrionic, avoidant, or dependent personality disorder symptoms, though submissives did have significantly higher dependence scores than dominants (see also Watts, Nagel, Latzman, & Lilienfeld, 2019).

Interpersonal relationship factors

Due to social stigma, BDSM participants may be hesitant to disclose their interests in personal and clinical settings. On disclosure, 34.1% reported feeling they could tell most of the adults in their lives about their BDSM interests, 52.4% said they could tell some people in their lives, 9.5% said they did not feel comfortable disclosing to anyone, and 4% reported they had to permanently hide their interests (Connolly, 2006). The majority (53.7%) felt uncomfortable by the prospect of their BDSM interests being discovered by others; 1.6% of these individuals said it terrified them. Another study found that fewer than 5% had disclosed to a family member, 25.6% to a friend, and 3.8% to a colleague (Holvoet et al., 2017).

Research on attitudes toward BDSM found that as participants reported more prejudice toward sadomasochists, they also reported more homophobia and social and sexual conservativism (Yost, 2010). Endorsement of false statements about rape was also related to the belief that BDSM practitioners were violent and dangerous. However, as knowledge about BDSM, involvement in BDSM, or knowing individuals involved in BDSM increased, prejudice decreased. Pre-existing beliefs about BDSM was also found to shape attitudes toward BDSM more than media portrayal (Rye et al., 2015).

These mixed social attitudes toward BDSM can lead to lack of disclosure in clinical contexts, with many BDSM practitioners being worried about disclosure during therapy (Kelsey, Stiles, Spiller, & Diekhoff, 2013; Roush et al., 2017). A study of licensed mental health professionals found that 76% reported having at least one client that engaged in BDSM (Kelsey et al., 2013). Sixty-seven percent agreed that it could be part of a healthy relationship, and 70% disagreed that it should be treated through therapy. Therapists who had more experience with BDSM clients had significantly more positive attitudes about BDSM. However, over half (52%) did not consider themselves competent enough to see BDSM clients, and 64% reported having no graduate training mentioning BDSM. Research on psychotherapist perceptions suggest that there may be more bias against male clients who disclose dominant or sadistic sexual interests, seeing them as more dangerous (Fuss, Briken, & Klein, 2018). Those trained in psychoanalysis also pathologized sadistic behaviors more than those trained in cognitive behavioral therapy, fitting with the etiological theories supported by psychoanalytic thought.

Contrary to some stereotypes, research suggests that BDSM can be beneficial to both social and romantic relationships. Drawing primarily from a sample of BDSM practitioners who attended related events, almost 90% said they held a membership at one or more BDSM organizations, 73% indicated they attended events regularly, 70.9% indicated this involvement provided them with an avenue for social support, 85% said it helped them make friends, and 83.4% said it gave them educational opportunities (Connolly, 2006). For BDSM practitioners in committed relationships, dyadic adjustment scale scores on consensus, satisfaction, and cohesion subscales did not differ between BDSM orientations (Rogak & Connor, 2017).

Another study found that there were no significant differences in relationship communication anxiety between those who did and did not participate in spanking, bondage, submissive behaviors, and BDSM in general (Kimberly, Williams, & Creel, 2018). Engagement in BDSM was related to a significant increase in sexual communication comfort, though it did not relate directly to an increase in relationship satisfaction. Other studies using biomarkers such as cortisol levels also reported that BDSM engagement may be associated with greater couple bonding (Sagarin, Cutler, Cutler, Lawler-Sagarin, & Matuszewich, 2009). High relationship satisfaction was also found in what some consider to be the most intense BDSM relationship- the “Master/slave” relationship. For example, 88% of participants in Master/slave relationships stated that they were satisfied or completely satisfied with their relationship (Dancer, Kleinplatz, & Moser, 2006). Overall, empirical research has demonstrated that BDSM relationship functionality and satisfaction is not significantly different from the general population (Kimberly et al., 2018; Rogak & Connor, 2017).


There is a disparate literature on various aspects of BDSM, including potential origins, psychological and relationship correlates. However, this literature is often placed under the umbrella of “paraphilias”, and there are no reviews which offer a coherent overview of these segments of the BDSM literature. The purpose of this review was to address this gap. Despite the difficulties in generalizing across studies which differ in methodological approach, population characteristics, and analyses, we are able to make some broad conclusions and directions for future inquiry. There appears to be little support for psychoanalytic or psychopathological theories of BDSM development (e.g., Cross & Matheson, 2006; Connolly, 2006; Richters et al., 2014). Feminist models, which imply that BDSM power dynamics are related to sexism, are also not supported (e.g., Klement et al., 2017b; Shulman & Home, 2006). There was no strong evidence for models that suggest that BDSM participants have increased risk of CSA or maladaptive attachment styles (Richters et al., 2008; Santtila et al., 2001), although CSA may play a role in a sub-set of individuals (Nordling et al., 2000). Empirical evidence was shown for theories that regard BDSM as a form of leisure (Williams et al., 2016), a facet of sex drive (Lammers & Imhoff, 2016), or as a broadening of sexual repertoire (e.g., Cross & Matheson, 2006; Tomassilli et al., 2009). The primary etiological finding of this review challenges the historical psychopathological model of BDSM interests, suggesting that future research should instead focus on looking into new, more complex etiological pathways for the development of specific sexual interests.

Studies on prevalence of BDSM interests differ, with reports ranging from 2% (Richters et al., 2003) to close to 70% (Holvoet et al., 2017). This range is most likely due to differing definitions, classifications, and sampling biases (e.g., from self-selected samples), although most research agrees that BDSM interests are not statistically rare (defined here as less than a 2.3% prevalence rate; Joyal et al., 2015; Zurbriggen & Yost, 2004). While interests and fantasy rates are quite high, engagement in BDSM is lower, usually around 20%-30% (Bailey et al., 2003; Joyal & Carpentier, 2017; Tomassilli et al., 2009). Thus, is it important to note that having these sexual fantasies do not mean that individuals necessarily enact them. This distinction is sometimes obscured in the literature we reviewed.

Individuals who participate in, and identify with, BDSM tend to be white, well educated, young, and are more likely than the population to be non-heterosexual, though most studies presented here do not draw from representative samples (Hébert & Weaver, 2014; Richters et al., 2014; Tomassilli et al., 2009). They also tend to have higher rates of non-monogamous relationships and report more sexual partners and experience (Oliveira Júnior & Abdo, 2010; Richters et al., 2008). Men are more likely to identify as dominants, tops, or sadists, while women are more likely to identify as submissives, bottoms, or masochists, but this pattern is not as strong in non-binary or non-heterosexual practitioners (Martinez, 2018; Zurbriggen & Yost, 2004). Importantly, BDSM does not appear to replace normophilic behaviors (Cross & Matheson, 2006; Houngbedji & Guillem, 2016; Williams et al., 2009). Findings here imply that there is a need to reframe the current scientific view of what is considered “atypical” in sexuality with more comprehensive research on prevalence rates of sexual fantasies and behavior both in the population and BDSM communities. Additionally, results from this review indicate a need to investigate the complex relationships between sexual orientation, relationship style preferences, gender, and sexual interests.

While there is some evidence (e.g., Baughman et al., 2014) for BDSM practitioners showing higher levels of narcissism and psychopathy, these levels did not warrant a clinical diagnosis (Mahmut, Homewood, & Stevenson, 2008). A small sub-set of BDSM practitioners may be at a higher risk of suicide (e.g., Brown et al., 2017). In contrast to pathology-focused models, BDSM practitioners are less sexist (Connolly, 2006; Klement et al., 2017b; Shulman & Home, 2006), more open to new experiences (e.g., Hébert & Weaver, 2014; Lodi-Smith et al., 2014), more extraverted (Wismeijer & Van Assen, 2013), and better at relationship communication (Kimberly et al., 2018; Rogak & Connor, 2017). Though there is little evidence for a link between psychopathology and BDSM, this review has identified potential sub-groups of BDSM practitioners who may be at a higher risk for developing mental health issues. Research should focus on identifying characteristics of these subgroups, as it may provide clinically important information about BDSM-identified individuals who experience psychological distress.

One of the larger findings of this review was that BDSM may be an expansion of unusual sexual fantasies and behavior (e.g., Cross & Matheson, 2006; Houngbedji & Guillem, 2016). This suggests that further work should focus on better understanding the psychometric structure underlying this trait. For example, BDSM interests and behavior may be part of a latent factor of paraphilic interests, form a factor on its own, or be part of a hierarchical structure linked by a third factor such as general atypical sexual interests or sex drive. Future research should also focus on a broader range of measures of mental health, the investigation of biological factors, the relationship between BDSM and sexual orientation, and discrimination of BDSM-identified people.

Limitations of this scoping review include restriction of the literature to peer-reviewed articles published between 2000 and 2019, and omitting articles which used only qualitative approaches. Including qualitative studies may have helped provide new observations based on BDSM practitioner experiences in some of the topics (e.g., relationships). We also restricted sample sizes in studies to 12 or more. The sample of literature also focused on that which was published in Western and English-language journals and so does not fully reflect the research priorities or cultural contexts of other locations. Understanding the basic prevalence, developmental factors, psychological, and relationship correlates of BDSM is a prerequisite for informing future research directions.

In sum, our results highlight the field’s interest in prevalence of BDSM interests and behaviors, psychological factors implicated in the development of BDSM (e.g., personality traits), the influence on relationship processes, and particularly the focus on BDSM as a broadening of sexual interests and behavior. Results also highlight important definitional limitations in the extant literature, and lack of attention to sampling and selection biases in studies. There is a notable lack of work on the development and use of psychometrically validated measures of BDSM and on biological correlates which are implicated in the development of atypical sexual interests (Seto, 2017).