Masochism by itself is not a mental disorder. The key distinction in modern psychiatry is between having masochistic interests and having a diagnosable condition called sexual masochism disorder. The difference comes down to one question: does it cause you significant distress or interfere with your ability to function in daily life? If the answer is no, it’s considered an atypical sexual interest, not a disease.
The Line Between Interest and Disorder
The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) draws a clear boundary between paraphilias and paraphilic disorders. A paraphilia is a persistent, atypical sexual interest. It only becomes a paraphilic disorder when it causes clinically significant distress, impairs someone’s ability to function, or involves harm or risk of harm to others. This distinction was introduced specifically to avoid labeling uncommon sexual preferences as mental illness.
For a diagnosis of sexual masochism disorder, three things must be true. The person experiences recurrent, intense sexual arousal from being humiliated, restrained, beaten, or otherwise made to suffer. The pattern has lasted at least six months. And, critically, it causes marked personal distress or meaningful problems in work, relationships, or other areas of life. If someone has masochistic interests but isn’t distressed by them and functions well, no diagnosis applies and no treatment is needed.
Most people with masochistic interests do not meet the criteria for a disorder. Surveys of sexual behavior in the U.S. and Australia suggest that somewhere between 1% and 5% of the general population reports masochistic sexual experiences. In one U.S. survey of over 2,000 people, 2.5% of men and 4.6% of women said they had obtained sexual pleasure from receiving pain. These numbers far exceed the rate of clinical diagnoses, which reinforces that the interest itself is common enough to be unremarkable in psychiatric terms.
How International Standards Have Shifted
The World Health Organization took an even stronger position when it released the ICD-11, its most recent classification of diseases. The previous version, ICD-10, listed sadomasochism as a named diagnostic category. The ICD-11 deleted it entirely. The reasoning was straightforward: people who practice sadomasochism typically do so consensually, and consensual sexual behavior between adults doesn’t belong in a disease classification.
Under the ICD-11, a person with masochistic interests can only receive a diagnosis if the pattern is associated with marked distress that isn’t simply caused by social rejection or fear of stigma, or if the behavior carries a significant risk of injury or death (such as breath restriction during arousal). This added safeguard prevents someone from being diagnosed simply because their family or culture disapproves. The distress has to come from within, not from external judgment.
The DSM-5 still includes sexual masochism disorder as a named condition, so there’s a gap between the two major classification systems. In practice, though, both point in the same direction: the interest alone is not pathological.
BDSM and the Role of Consent
Much of what people think of as “masochism” in everyday life falls under the umbrella of BDSM, a set of consensual practices involving bondage, dominance, submission, and sadomasochism. Research consistently finds that BDSM interactions are overwhelmingly non-compulsive and built around negotiated consent. Participants establish boundaries, use safe words, and treat the experience as a shared activity rather than something driven by uncontrollable urges.
This consensual, controlled nature is exactly what separates typical BDSM from a clinical concern. Clinicians trained in kink-affirming practice recognize that enjoying pain or restraint in a sexual context, with a willing partner and clear communication, doesn’t signal psychological dysfunction. A disorder is only considered when the behavior becomes compulsive, causes genuine internal suffering, or puts someone at real physical risk they can’t manage.
When Masochism Overlaps With Other Conditions
In some cases, masochistic behavior shows up alongside other mental health conditions, and clinicians need to figure out what’s driving what. One study of 120 women found that sexual masochism disorder was ten times more common in women with borderline personality disorder compared to women with other personality disorders (10% versus 0%). Among those women, higher rates of childhood sexual abuse, difficulty forming secure attachments, and greater sensation-seeking were all part of the picture. In these situations, the masochistic behavior may be tangled up with broader patterns of emotional dysregulation rather than existing on its own.
There was also once a separate diagnosis called self-defeating personality disorder, sometimes informally called “masochistic personality disorder,” which described people who seemed to repeatedly sabotage their own well-being. It was proposed for the DSM-III-R but ultimately removed because the evidence didn’t support it as a reliable or valid diagnosis. Studies found it overlapped heavily with depression, anxiety, and borderline and avoidant personality disorders, and it didn’t predict impairment any better than those existing diagnoses already did.
What Treatment Looks Like When It’s Needed
For the small number of people who do experience genuine distress from masochistic urges, or whose behavior puts them at serious physical risk, treatment options exist. Talk therapy is the most common starting point, helping someone understand the roots of their distress and develop strategies for managing urges that feel out of control. Cognitive behavioral approaches are often used to address compulsive patterns.
In more severe cases, medication may be added. Certain antidepressants that affect serotonin levels have shown effectiveness at reducing paraphilic symptoms while also improving co-occurring depression and anxiety. Research suggests that combining therapy with medication tends to produce better outcomes than either approach alone. A minimum follow-up period of three months is typical to assess whether symptoms are genuinely improving or just temporarily suppressed.
The goal of treatment is never to eliminate someone’s sexual preferences. It’s to reduce suffering and restore functioning. If a person with masochistic interests seeks therapy not because they’re distressed but because someone else disapproves, most modern clinicians would focus on helping them navigate that social pressure rather than trying to change their sexuality.
Everyday “Masochism” Is Universal
Outside the sexual domain, the human tendency to enjoy mildly painful or unpleasant experiences is so common that psychologist Paul Rozin coined the term “benign masochism” to describe it. Eating painfully spicy food, watching horror movies, running until your legs burn, drinking bitter coffee, taking scalding hot showers: these are all forms of seeking out discomfort for pleasure. Rozin’s research identified at least eight categories of this kind of enjoyment, spanning sadness, fear, disgust, physical pain, exhaustion, and more.
What makes it “benign” is the awareness that there’s no real danger. You know the horror movie isn’t real. You know the hot sauce won’t actually harm you. That sense of safety is what allows the brain to flip the experience from threatening to pleasurable. This capacity appears to be uniquely human. No other animal has been observed deliberately seeking out aversive experiences for enjoyment. So in the broadest sense, a taste for discomfort is one of the most ordinary things about being a person.