All tied up in BDSM, not an illness

Trigger warning: This content includes information about sexual trauma and childhood abuse.

Spanning across many countries and continents, BDSM exists in numerous spaces. The widely popularized Fifty Shades trilogy by E. L. James and its movie series consist of a contractual relationship based on BDSM. Earlier this month, Netflix Korea released the movie Love and Leashes based on the comic Moral Sense, challenging Korea’s socially conservative values and shocking many with its highly controversial theme: BDSM. Many may have heard of the term but only know about it vaguely. BDSM refers to bondage and discipline, dominance and submission, sadism and masochism and involves roleplay with contrasting power dynamics of consensual partners (Wuyts & Morrens, 2022).

BDSM consists of dominant (sadist) and submissive (masochist) roles. As the dominant party holds greater power than the submissive, an imbalance of power is established. A BDSM interaction, or play, involves physical, psychological, and/or emotional pain-inducing acts, often in sexual contexts (Dunkley et al., 2019). There are a variety of practices, including physical restriction with bondage or handcuffs, verbal humiliation, and aggression (Ambler et al., 2017). What might be so pleasurable about experiencing pain?

The key players here may involve the chemicals dopamine and cortisol (Wuyts & Morrens, 2022). Neurons sending signals in the brain from the ventral tegmental area (VTA) to the nucleus accumbens (NA) release dopamine, commonly referred to as a happy hormone, when people experience pleasure, such as during sexual interactions.

projection of a neuron from the VTA to NA

Interestingly enough, pain is related to the same system, as dopamine reduces pain perception by acting on more dopamine-releasing neurons (Dunkley et al., 2019). Thus, the combination of sexual arousal and pain may lead to the feeling of pain as pleasurable.

In addition, pain causes the release of cortisol, a hormone released during times of stress by the hypothalamus, a gland in the brain that monitors the body’s hormone system (Wuyts & Morrens, 2022).

BDSM play is associated with physiological stress and high cortisol levels, but studies found decreases in negative emotions and psychological stress after play (Dunkley et al., 2019).

It’s almost like an illusion because there’s actually an underlying balance of power: submissive individuals must consent to the play directed by dominant individuals. People may actually relieve stress through play because they experience and administer pain based on their own volition. In other words, people may divert focus from other life stressors to the present sensations. Pairing the effects of dopamine and cortisol, during BDSM interaction, pain and stress may likely be perceived by the body as less painful, cathartic, and most importantly, pleasurable.

Although contractual relationships to the extent seen in Fifty Shades of Grey and Love and Leashes may be an uncommon experience, approximately 10% of the general population has engaged in BDSM activities (De Neef et al., 2019). Note: Not everyone who practices BDSM has the same backstory as Christian Grey or Jung Ji-hoo.

Psychiatrists previously suspected that BDSM practitioners suffered from mental illnesses, sexual trauma, and childhood abuse (Ambler et al., 2017; De Neef et al., 2019). However, recent studies determined that interest in and practices of BDSM are not necessarily associated with coping strategies for trauma experienced in early life (Ten Brink et al., 2021). In fact, BDSM practitioners showed lower levels of mental disorders (e.g., depression, anxiety, posttraumatic stress disorder) compared to non-practitioners (Ambler et al., 2017). People who practice BDSM also feel more secure in their relationships (Ten Brink et al., 2021). As long as involved parties maintain mutual consent and understanding, BDSM activity should be viewed as a personal preference.

Previously considered highly taboo, BDSM has emerged in recent years through pop culture and research. BDSM still carries a stigma, largely due to its unfamiliarity. The truth is, over 60% of college-aged individuals have had BDSM fantasies (Damm et al., 2017; Powls & Davies, 2012). You know the saying: you always want what you can’t have.

from the Korean web comic Moral Sense

References

Ambler, J. K., Lee, E. M., Klement, K. R., Loewald, T., Comber, E. M., Hanson, S. A., Cutler, B., Cutler, N., & Sagarin, B. J. (2017). Consensual BDSM facilitates role-specific altered states of consciousness: A preliminary study. Psychology of Consciousness: Theory, Research, and Practice, 4(1), 75–91. https://doi.org/10.1037/cns0000097

Damm, C., Dentato, M. P., & Busch, N. (2018). Unravelling intersecting identities: Understanding the lives of people who practice BDSM. Psychology & Sexuality, 9(1), 21-37. https://doi.org/10.1080/19419899.2017.1410854

De Neef, N., Coppens, V., Huys, W., & Morrens, M. (2019). Bondage-discipline, dominance-submission and sadomasochism (BDSM) from an integrative biopsychosocial perspective: A systematic review. Sexual Medicine, 7(2), 129-144. https://doi.org/10.1016/j.esxm.2019.02.002

Dunkley, C. R., Henshaw, C. D., Henshaw, S. K., & Brotto, L. A. (2020). Physical pain as pleasure: A theoretical perspective. The Journal of Sex Research, 57(4), 421-437. https://doi.org/10.1080/00224499.2019.1605328

Powls, J., & Davies, J. (2012). A descriptive review of research relating to sadomasochism: Considerations for clinical practice. Deviant Behavior, 33(3), 223–234. https://doi.org/10.1080/01639625.2011.573391

Ten Brink, S., Coppens, V., Huys, W., Morrens, M. (2021). The Psychology of Kink: a Survey Study into the Relationships of Trauma and Attachment Style with BDSM Interests. Sexuality Research Social Policy, 18, 1–12. https://doi.org/10.1007/s13178-020-00438-w

Wuyts, E., & Morrens, M. (2022). The biology of BDSM: a systematic review. The Journal of Sexual Medicine, 19(1), 144-157. https://doi.org/10.1016/j.jsxm.2021.11.002

8 thoughts on “All tied up in BDSM, not an illness

  1. Very interesting blog post, Erica! Something that’s interesting is that stress also induces dopamine release.

    Also, regarding the point that dopamine is often called the “happy” or “pleasure” hormone, there’s actually a lot of mixed research on this. Dopamine plays many roles in behavior. It may be worth reading the article “Dopamine, learning, and motivation” by Dr. Roy Wise (doi:10.1038/nrn1406). Dr. Wise formulated and popularized the dopamine hypothesis of anhedonia. I really love that review article. If you don’t have time to read all of it, I advise at least looking at the section about the anhedonia hypothesis.

    Lastly, congratulations on your first blog post!

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  2. Hello Erica,

    Your blog post was engaging. I did not know that people who engage in BDSM reported lower levels of depression, anxiety, and post-traumatic stress disorder. I also found it intriguing that the controlled, short-term stress and high cortisol levels that occur in BDSM play can decrease negative emotion and psychological stress after play.

    I was wondering if one reason why people who participate in BDSM reported lower levels of mental illness is because of the decreased negative emotion and stress they experience after play. Reflecting on the two-hit hypothesis, stress can be the second hit that causes a person to develop a mental illness. So, maybe decreasing stress (which seems to happen in BDSM play) could prevent people from developing a mental illness.

    Great blog post!
    Sincerely, Bashaina (Shasha)

    Liked by 1 person

  3. WOW! What a great post Erica! Prior to this reading I was unaware that dopamine inhibits pain perception. I thought only endorphins did that or could do that. I wonder how endorphin levels change when one engages in BDSM play?

    Sex therapy is often not discussed in my academic circles and I’m really interested to know if and how BDSM is discussed within those spaces since your blog post mentioned BDSM practitioners being less likely to experience mental disorders. Would a sex therapist encourage an individual or couple to engage in BDSM as means of alleviating certain mental issues?

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  4. Great post Erica! I love how you included the statistics on how individuals who participate in BDSM have lower levels of mental disorders and potentially could be in more secure relationships. Before reading this, I would have assumed that some sort of trauma / thought process would have caused an individual to turn to BDSM. I would be interested to know whether there is a correlation with a certain personality type and BDSM. Also, I wonder why over half of college students have fantasized about BDSM. A part of me wonders if this is a higher number than before due to the release of 50 Shades of Grey, or there was always a substantial group of people interested in BDSM that flew under the radar.

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  5. Hi!
    This blog post is so interesting! The way society responds to anything in the realm of pain and pleasure tends to be so polar, but your explanation of the role of mental illnesses (or lack thereof) in BDSM practitioners demonstrates the lack of foundation in these polarizations. Perhaps non-practitioners have the trauma which they assumed drove people to BDSM in the first place. I wonder if there’s any research suggesting why some people are so disturbed by BDSM or why the prejudice developed in the first place? My other thought is religion, although lots of devices have been used to pain the body to compensate for sins, so I’m not sure if there’s anything there. I was also interested in the role of the nucleus accumbens which I studied briefly in the context of learning, which helped contextualize the power of that part of the brain. Thanks for your insight!

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  6. I really enjoyed reading this blog! It was interesting that people believe there must be an association between interest in BDSM and childhood trauma or depression. Since those factors do not correlate too wanting to engage in BDSM I wonder what does? Do people who suffer from lower levels of dopamine and cortisol have less interest in BDSM, and those with higher levels are more attracted to the act. Also I wonder if pain has to be activated in a similar context to where pleasure would usually happen for that connection to occur in the first place.

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  7. Hi Erica!

    Great blog post! I often wonder why there are so many taboos around the pleasure and pain of sexual preferences and your post concerning BDSM is a great first look. While reading your post, I wonder how strong the brain’s illusion is after partaking in play. You mentioned that the body perceives pain and stress as less painful and more pleasurable, is this exclusive to during the activities or does this “illusion” persist? And if so, is that rosy retrospection the motivation to continue to participate or is it more getting used to the pain/stress? Is it both? Something else?

    Great work!

    ~Aicha

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  8. I enjoyed viewing this. It was so illuminating and refreshing. I also liked the connection to Fifty Shades series. I find it interesting how social taste and acceptability change over time and the reasons behind their acceptance. As you mentioned, BDSM was taboo in the past but can be seen dominating the media talk and even considered an appropriate talk topic with one’s lover.

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