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The DSM Diagnostic Criteria for Sexual Masochism

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I reviewed the empirical literature for 1900–2008 on the paraphilia of Sexual Masochism for the Sexual and Gender Identity Disorders Work Group for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Masochism, the assessment of Sexual Masochism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Masochism using the DSM in non-forensic populations. I concluded that the diagnosis of Sexual Masochism should be retained, that minimal modifications of the wording of this diagnosis were warranted, and that there was a need for the development of dimensional and structured diagnostic instruments. It should be noted that this summary reflects my original literature review. Subsequently, interactions with other members of the workgroup and advisors have resulted in modification of these initial suggestions.

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Acknowledgments

This article was prepared with the assistance of Dr. Meg Kaplan. The author is a member of the DSM-V Workgroup on Sexual and Gender Identity Disorders (Chair, Kenneth J. Zucker, Ph.D.). I wish to acknowledge the valuable input I received from members of my Paraphilias subworkgroup (Ray Blanchard, Marty Kafka, and Niklas Långström) and Kenneth J. Zucker. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.

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Authors and Affiliations

  1. Sexual Behavior Clinic, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 45, New York, NY, 10032, USA

    Richard B. Krueger

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Correspondence to Richard B. Krueger.

Appendices

Appendix 1: Sexual Masochism in the DSM

Diagnostic Criteria for Sexual Masochism from DSM-I to DSM-IV-TR.

DSM-I (American Psychiatric Association, 1952)

There is no mention of Sexual Masochism in DSM-I.

DSM-II (American Psychiatric Association, 1968)

The only mention of Masochism occurs under the categorization of Sexual Deviations (302.7):

Sexual Deviations. This category is for individuals whose sexual interests are directed primarily towards objects other than people of the opposite sex, toward sexual acts not usually associated with coitus, or toward coitus performed under bizarre circumstances as in necrophilia, pedophilia, sexual sadism, and fetishism. Even though many find their practices distasteful, they remain unable to substitute normal sexual behavior for them. This diagnosis is not appropriate for individuals who perform deviant sexual acts because normal sexual objects are not available to them. (p. 44)

DSM-III (American Psychiatric Association, 1980)

Sexual masochism is classified as one of the paraphilias, with one of the following criteria necessary for the diagnosis:

  1. (1)

    A preferred or exclusive mode of producing sexual excitement is to be humiliated, bound, beaten, or otherwise made to suffer.

  2. (2)

    The individual has intentionally participated in an activity in which he or she was physically harmed or his or her life was threatened, in order to produce sexual excitement.

DSM-III-R (American Psychiatric Association, 1987)

The diagnostic criteria for sexual masochism were revised as follows:

  1. A.

    Over a period of at least six months, recurrent intense sexual urges and sexually arousing fantasies involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.

  2. B.

    The person has acted on these urges, or is markedly distressed by them.

DSM-IV and DSM-IV-TR (American Psychiatric Association, 1994, 2000)

See Table 4.

Appendix 2: Sexual Masochism in the ICD

The ICD-9 and ICD-10 Criteria for Sexual Sadism and Sexual Masochism and the ICD-10 Diagnostic Criteria for Research for Sadomasochism

The ICD-9-CM Diagnostic Criteria for Sadism and Masochism (World Health Organization, 1989) (p. 229) are:

  1. 302.8

    Other specified psychosexual disorders

    1. 302.83

      Sexual masochism

    2. 302.84

      Sexual sadism

The ICD-10 International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (World Health Organization, 1992) (p. 367) criteria are:

  1. F65

    Disorders of sexual preference

    1. Includes:

      Paraphilias

    2. F65.5

      Sadomasochism

      A preference for sexual activity which involves the infliction of pain or humiliation, or bondage. If the subject prefers to be the recipient of such stimulation this is called masochism; if the provider, sadism. Often an individual obtains sexual excitement from both sadistic and masochistic activities.

      Masochism

      Sadism

The ICD-10 Classification of Mental and Behavior Disorders Diagnostic criteria for research (World Health Organization, 1993) are:

  1. F65.5

    Sadomasochism (p. 137)

    1. A.

      The general criteria for disorders of sexual preference (F65) must be met.

    2. B.

      There is preference for sexual activity, as recipient (masochism) or provider (sadism), or both, which involves at least one of the following:

      1. (1)

        pain;

      2. (2)

        humiliation;

      3. (3)

        bondage.

    3. C.

      The sadomasochistic activity is the most important source of stimulation or is necessary for sexual gratification.

  2. F65

    Disorders of sexual preference (p. 135)

    1. G1.

      The individual experiences recurrent intense sexual urges and fantasies involving unusual objects of activities.

    2. G2.

      The individual either acts on the urges or is markedly distressed by them.

    3. G3.

      The preference has been present for at least 6 months.

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Krueger, R.B. The DSM Diagnostic Criteria for Sexual Masochism. Arch Sex Behav 39, 346–356 (2010). https://doi.org/10.1007/s10508-010-9613-4

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