Consenting to constraint: BDSM therapy after the DSM-5

Abstract

ObjectiveBDSM is a overlapping acronym that refers to the practices of bondage and discipline, dominance and submission, sadism and masochism. The American Psychiatric Association “depathologized” kinky sex – including cross-dressing, fetishism, and BDSM –, despite retaining a clinical justification, in the fifth edition of its Diagnostic and Statistical Manuel of Mental Disorders (DSM-5). Henceforth, the paraphilias are considered “other sexual interests.” MethodWe analyze several psycho-sexological studies that treat sadomasochistic practices as psychic case studies. BDSM practices are no longer considered deviant behaviors, but, on the contrary, “common” behaviors that have been adopted by a large number of individuals. These individuals use contractualization in a specific context. ResultRather than considering BDSM practice to be a perversion by assimilating it to homosexuality, current research in gender and psychiatry and in the psychology of subsexualities has moved beyond the analysis of “deviance,” preferring a scientific study of the effects of BDSM practice, particularly of their positive effects on mood, stress, or depression. DiscussionThe BDSM and Therapy Project is concerned with articulating the possible risks of BDSM play and with clarifying situations where BDSM play is neither safe nor helpful. Members of the BDSM community have expressed the following points: the development of barriers between community members; the risks of alienation and isolation through stigmatization; having one's limits violated during a scene; the potential risk of dehumanization and destruction. ConclusionBDSM therapy, in a therapeutic setting as well as within the community, is based on consent. BDSM can be a form of psychotherapy for the subject. BDSM therapy would consist in the modification of the meaning of physical suffering by transforming it into voluntary pain, through consensual constraint. A functional BDSM therapeutic practice requires at least three conditions: (1) the SM relationship involves a willing dominant and a willing submissive; (2) this erotic duo exists in a codified setting; (3) the dominant is a “therapizer” in her/his display of empathy for the submissive; (4) a two-way flow of reciprocal benefits in terms of post-session well-being.