Domination and submission are not paraphilic because

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Try out PMC Labs and tell us what you think. Learn More. 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. 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.

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. 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. The limitations of the current review reflect those of the topical scientific literature. Although domination and submission are not paraphilic because 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. Sex Med ;— BDSM, ly known as sadomasochism or SMis 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. The perception of BDSM as being pathologic influenced scientific articles from the s and s, which tended to focus on non-consensual sexual sadism from a forensic perspective and incidental SM-related fatalities.

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. The current systematic review was conducted according to PRISMA-P preferred reporting items for systematic review and meta-analysis protocols guidelines. Different sources may refer variously to individual parties involved in a BDSM interaction. Domination and submission are not paraphilic because 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. 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.

Preferred reporting items for systematic review and meta-analysis protocols flowchart. The Pubmed database search initially generated 1, 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. Studies reporting on the prevalence rates of BDSM interests and practices have yielded somewhat divergent Table 1. An Australian study 18 found that 2. Studies reporting on individuals having BDSM fantasies reveal higher prevalence rates.

Similarly, Jozifkova and Flegr 21 demonstrated that about half of the general population preferred unequal power dynamics in their sexual relationship. This divergence might be explained by several factors. This is illustrated by the fact that about half of the sample from Holvoet and colleagues 3 indicated having engaged in BDSM activities, whereas, in the same sample, only 7.

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It should be noted that no consensus exists on which activities are BDSM practices and which are not. 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 for some of the variance, because the surveys yielding higher prevalence rates 32223 were held via internet channels, whereas Richter et al 1819 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 month 322 was found to be much lower than lifetime experience 1. 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. Additionally, engaging in at least 1 BDSM-related activity on a regular basis is reported by 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.

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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 partnerhumiliation, movement restriction, or sensory deprivation. 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. Weierstall and Giebel 31 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.

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BDSM play is often perceived as a precursor to or part of sexual activities. In contrast, Newmahr 33 argued that, to many practitioners, SM does not precede or replace sexual activities but is an end into itself. Nevertheless, almost all participants clearly preferred 1 role over others, because domination and submission are not paraphilic because 7. To conclude, BDSM interests can be approached from a multidimensional perspective.

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.

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 cultures eg, ancient Domination and submission are not paraphilic because, 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. Yost 39 identified 4 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. 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 is in contrast with the general adult population, in which lower rates of suicide attempt have been reported 1.

In light of the still-ongoing equivocality, Green 49 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. 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.

The inclusion of sexual sadism and sexual masochism in the Diagnostic and Statistical Manual of Mental Disorders has its roots in earlier descriptions by Freud 6 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-5a 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. Therefore, some argue for keeping diagnoses such as sexual masochism and sexual sadism in the DSM classification system. 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.

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. Additionally, Klement et al 66 demonstrated ificantly 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.

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.

Typical BDSM-related fantasies, such as being dominated, bondage, or spanking, were found to be more common up to

Domination and submission are not paraphilic because

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Defining “Normophilic” and “Paraphilic” Sexual Fantasies in a Population‐Based Sample: On the Importance of Considering Subgroups