Masochistic personality disorder is a proposed but never officially accepted psychiatric diagnosis describing a persistent pattern of self-defeating behavior, where a person repeatedly ends up in situations that cause them suffering, even when better options are available. The American Psychiatric Association’s Work Group proposed it in 1985 during the revision of the DSM-III, but it was ultimately included only in the appendix (as “self-defeating personality disorder”) and later dropped entirely from the DSM-IV in 1994. It has never appeared as an official diagnosis since.
Why It Was Proposed and Then Removed
Clinicians in the 1980s observed a recurring pattern in some patients: they seemed drawn to relationships and situations that caused them pain, rejected help or opportunities for improvement, and undermined their own success. The proposal for masochistic personality disorder aimed to give this pattern a formal name and diagnostic criteria. Researchers at the time found that the pattern could not simply be explained by existing diagnoses like dependent or avoidant personality disorder. The conditions appeared “fairly clearly separate,” based on validity studies of the proposed criteria.
The diagnosis became deeply controversial almost immediately. Critics argued it would pathologize victims of abuse, particularly women in abusive relationships, by framing their responses to mistreatment as a personality flaw rather than a consequence of their circumstances. Feminist psychologists and advocacy groups pushed back hard. One research study specifically tested whether the diagnosis carried a sex bias and concluded it did not, but the political and ethical concerns persisted. The APA ultimately decided the risks of misuse outweighed the clinical utility, and the diagnosis was removed.
What the Behavioral Pattern Looks Like
Even without an official diagnosis, the pattern that masochistic personality disorder attempted to describe is well documented in clinical literature. The core feature is a pervasive tendency toward self-defeating choices. In validity research, the single most useful criterion was a pattern of being taken advantage of by others. People fitting this profile consistently find themselves in exploitative relationships, workplaces, or social dynamics, and they stay in them even when they recognize the harm.
Other features of the proposed pattern include:
- Rejecting help or pleasure: Turning down opportunities, sabotaging success, or feeling uncomfortable when things go well.
- Choosing suffering over available alternatives: Gravitating toward people or situations likely to cause disappointment, mistreatment, or failure, even when healthier options exist.
- Provoking rejection or anger: Behaving in ways that reliably lead to negative responses from others, then feeling hurt by the outcome.
- Excessive self-sacrifice: Giving up personal needs for others to a degree that goes beyond generosity into self-harm, though researchers found this criterion was actually one of the least useful in identifying the pattern.
Importantly, these behaviors are not occasional bad decisions. The proposed diagnosis required a persistent, long-standing pattern that began by early adulthood and showed up across multiple areas of life: relationships, work, friendships, and daily choices.
How It Differs From Sexual Masochism
The name creates confusion, but masochistic personality disorder and sexual masochism disorder are entirely different conditions. Sexual masochism involves experiencing sexual arousal from being humiliated, restrained, or physically hurt. It only qualifies as a disorder when it causes significant distress or interferes with daily functioning, and acts result in severe bodily or psychological harm. Most people with some masochistic sexual preferences do not have the disorder. Mild role-playing involving simulated power dynamics is common in healthy sexual relationships and is not considered pathological.
Masochistic personality disorder, by contrast, describes a broad life pattern that has nothing inherently to do with sex. In fact, when researchers tested the proposed criteria, they found that the criterion involving sexual arousal from being hurt was one of the least useful in identifying people who actually fit the overall pattern. The personality type is about emotional and interpersonal self-defeat, not sexual preference.
Overlap With Other Personality Disorders
One reason the diagnosis struggled to gain acceptance is that some of its features overlap with recognized personality disorders. Dependent personality disorder involves clinging to relationships and tolerating mistreatment to avoid being alone. Avoidant personality disorder involves pulling back from positive experiences out of fear. Borderline personality disorder can involve chaotic relationships and self-sabotage. Research did find that some criteria from dependent, histrionic, and avoidant personality disorders were related to the self-defeating pattern, but the conditions were distinguishable from each other in clinical testing.
The self-defeating pattern also overlaps significantly with depression. People in a depressive episode often lose motivation, withdraw from opportunities, and tolerate bad situations passively. The key difference is that depression is episodic, while the proposed personality disorder described a lifelong, stable trait that existed even outside depressive episodes.
Where the Concept Stands Today
Without an official diagnosis, clinicians who encounter this pattern typically address it through the lens of other recognized conditions or through general psychotherapy frameworks. Psychodynamic therapists, in particular, still use the concept of masochistic or self-defeating personality styles when formulating how a patient relates to themselves and others. Cognitive behavioral approaches might frame the same pattern as deeply held negative beliefs about self-worth that drive self-sabotaging choices.
The removal from the DSM does not mean the behavioral pattern doesn’t exist. It means the psychiatric community decided, for a mix of scientific and political reasons, that formalizing it as a standalone diagnosis created more problems than it solved. If you recognize this pattern in yourself, the most productive framing is usually not the label itself but the specific behaviors: difficulty accepting good outcomes, gravitating toward harmful relationships, or undermining your own goals. Those are patterns that respond well to therapy, particularly approaches that explore why suffering feels familiar or safe and help build tolerance for things actually going well.