Is Masochism Addictive?

Disclaimer

I am not a health professional. I have no advanced degrees.

I wrote this in the Fall of 2012. While I might have made minor changes to the language of the article and made some corrections to spelling and gramar, I have not updated the substance of the article since then.

Introduction

The BDSM and Leather communities have long perceived that the medical and academic communities have demonized sadomasochism instead of studying it objectively and empirically. The insular sadomasochist communities believe that the medical and legal communities have generally accepted the popular culture bias --- of sadomasochism being an unhealthy and destructive behavior --- without objective study. (Much like the medical community defined homosexuality was a mental disorder until 1973.)

Take for example, The Loving Dominant by John Warren published in 1994. It is was the definitive "How to" books for the BDSM community at the time. In it, Mr. Warren illustrates the academic prejudice about sadism:

During the conference that followed publication of the "Playboy Foundation Report" in the 1970s, researchers had a chance to differentiate sadism from dominance. W.B. Pomeroy, one of Kinsey's collaborators, describes a segment of a filmed scene which depicted a waxing. He had noticed the "sadist" was watching, not just the place where the wax was falling, but also the expression on his partner's face. When this "sadist" detected that she was getting close to the edge, he raised the candle to reduce the intensity of the stimulation. Pomeroy commented, "it suddenly occurred to me that the masochist was almost literally controlling the sadist's hand."

"Sadly, a less imaginative colleague pooh-poohed the idea and insisted that "genuine" sadists are not interested in a willing partner. (Warren 25)

Warren is complaining here that the medical establishment starts with the conclusion that sadomasochism is abusive and evaluates all evidence in light of that conclusion. Warren's concerns have some justification. It can be argued that the bias was actually institutionalized. In the DSM-III --- published in 1980 --- sadomasochism was defined as a paraphilia --- a sexual disorder, something unhealthy by definition.

However, in the DSM-IV --- published in 1994 (the same year that The Loving Dominant was released) --- the diagnosis of sadomasochism as a paraphilia required that "the fantasies, sexual urges, or behaviors" must "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning." The DSM-IV TR (2000) further clarifies the diagnosis of paraphilia by requiring that activity must be the sole means of sexual gratification for a period of six (6) months and either the activities be non-consensual or that "the urges, sexual fantasies, or behaviors cause marked distress or interpersonal difficulty." It's been reported that both homosexuality and sadomasochism will be removed from the DSM in the upcoming DSM V. (Clearly the mental health community has reevaluated its assumptions about sadomasochism in much the same way it has reevaluated its assumptions about homosexuality.)

The Question

In a fair and balanced paper on the topic, D. J. Williams writes, "Certainly, if our organization is about the 'advancement of sexual health,' we need to continue to include this topic in our training repertoire, and we should consider the real possibility that both healthy and addictive sexuality can exist in a number of different relationship structures, including alternative lifestyles such as BDSM." (Williams, 344) Interestingly the author notes "I have heard several individuals in SM lifestyles complain that clinicians don’t understand their relationships and would be quick to label their unconventional practices as pathological." (334)

But despite the over all tone of acceptance Williams repeatedly mentions the possibility of addiction in the BDSM and Leather community: "It is suggested that SM potentially may be enriching and beneficial to many who safely participate, or it sometimes may be considered pathological and destructive." (Williams 333) Later in the article Williams writes "Clinicians may wonder how to discern when BDSM may be healthy and safe, and when it may be addictive and destructive." (342) And still later Williams continues on this theme: "Is BDSM simply a form of tolerable serious leisure, or has it become intolerable due to safety considerations, or progressed to a full-blown addiction?" (343)

Williams asks a valid question. However no research, evidence, or case studies of addiction are offered. It can be easy to assume that Williams is arguing that the risk of masochistic addiction is real. But Williams is merely being cautious in acknowledging that addiction is a possibility. Williams is not assuming that there have been any instances of sadomasochistic additions --- nor that there are none.

However, at least one other professional academic has stated authoritatively and unambiguously that the phenomenon does exist. In Investigating Religious Terrorism and Ritualistic Crimes (2003) --- her forensic textbook on religious terrorism --- philosopher turned criminologist Dawn Perlmutter argues that "blood rituals are addictive -- both psychologically and physiologically when a person experiences pain, endorphins (natural pain killers) are released; however, eventually more pain is needed to achieve the same endorphin high." (p. 165) This is a strong statement but she does not offer any supporting evidence or cite a source for her assertion.

The specific experience that Perlmutter is referring to is well known in the BDSM and Leather communities as "sub space." It is the "natural high" resulting from the body's release of endorphins in response to the pain resulting from sadomasochistic "play." It is the equivalent to "runner's high" but without all of the benefits or difficulties of physical exercise.

Is "sub space" addictive in the way Perlmutter describes? For that matter, is the "runner's high" addictive? Should sadomasochism be viewed as a consensual pleasurable activity or a risk for addiction?

Addiction Defined

As with many controveral issues, the answer to the question is dependant on the definition of the key term --- in this case addiction.

In the (online) Oxford Reference, Addition is defined as "a state of dependence produced either by the habitual taking of drugs or by regularly engaging in certain behaviors (e.g. gambling)." (Oxford Reference)

The American Society of Addictive Medicine has posted the following definition on their web site:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. (ASAM)

In the Psychiatric Glossary of the American Psychiatric Association addiction is defined as:

Dependence on a chemical substance to the extent that a physiologic need is established. This [need] manifests itself as withdrawal symptoms ... when the substance is removed.

Psychiatric Glossary defines drug dependence as:

Habituation to, abuse of, and/or addiction to a chemical substance .... The term thus includes not only the addiction (which emphasizes physiologic dependence), but also drug abuse (where the pathologic craving for drugs seems unrelated to physical dependence).

In one introductory college psychology textbook, addiction is defined as "when someone becomes dependent on a psychoactive drug to the point that life resolves around the drug and interpersonal relationships suffer." (Wortman, 434) Furthermore "people can develop addictive disorders with regards to ... marijuana, hallucinogens such as LSD, and stimulants such as cocaine and amphetamines." (Wortman, 434)

More specifically, the Oxford reference defines drug addiction as "Chronic physical craving or compulsion to continue to take a drug to avoid the unpleasant physical effects resulting from withdrawal of the drug." (Oxford Reference)

The different defintions of addictions can be separated into two groups:

1. non-chemical compulsions to deleterious behaviors or pathological craving to chemicals
2. physiologic chemical or substance dependence (E.G. drug addiction) leading to withdrawl sympotoms (E.G. sweats, tremors, convulsions, and hallucinations) when the chemical is withheld

Between the two types of defintions, physiologic chemical dependence most closely matches Perlmutter's use of the term. According to Perlmutter the pain addict must get increasingly greater doses of endorphins like a chemical addict needs more alcohol or metamphetamines. So for the purpose of this article, we will define addiction narrowly in terms of substance addiction (I.E. drug or chemical addiction) despite the fact that unlike drug addiction, the euphoria caused by pain is a "natural high" that is caused by chemicals naturally occurring in the human body.

Sexual Addiction

There is another controversial type of addiction that --- like pain addiction --- is said to caused by chemicals naturally occurring in the human body. For people unfamilar to the BDSM and Leather communities, the theory of addiction to pain might closely resemble the theory of sexual addiction.

The theory of "Sexual Addiction" was introduced to the writing of Patrick J. Carnes Ph.D.. He popularized the concept in 1983 with his book Out of the Shadows: Understanding Sexual Addiction. Here is is definition from the 3rd edition (2001):

A way to understand sexual addicts ... is to compare them with other types of addicts. A common definition of alcoholism or drug dependency is that a person has a pathological relationship with a mood-altering chemical. The alcoholic's relationship with alcohol becomes more important than family, friends, and work. The relationship progresses to the point where alcohol is necessary to feel normal. To feel "normal" for the alcoholic is also to feel isolated and lonely, since the primary relationship he depends upon to feel adequate is with a chemical, not other people.

Sexual addiction is parallel. The addict substitutes a sick relationship to an event or a process for a healthy relationship with others. The addict's relationship with a mood-altering experience becomes central to his life.

Later he adds "addicts are people who cannot stop their behavior which is crippling them and those around them."

It is important to note that the theory of Sexual Addiction has been widely criticized. Crooks and Baur point out that detractors of the sexual addiction theory point to a "tradition in the sex addiction literature of forgoing empirical research and presenting conjectures as fact." (Crooks p. 476) The terms "Sexual Addiction" and hypersexuality are not included in the most recent DSM. (Crooks p. 476)

In "The Myth of Sexual Addiction"William A. Henkin, Ph.D. writes:

There is nothing inherently pathological in the conduct that is labeled sexually compulsive or addictive. Rather than referring to actual clinical entities, sexual addiction and compulsion refer to learned patterns of behavior that are stigmatized by dominant institutions ....

Psychological health is advanced through increased awareness of personal responsibility for one’s feelings, thoughts, beliefs, and behaviors. By couching sexual behavior in terms of addiction, the psychological meaning of a person’s erotic experience is diminished and his or her personal responsibility for that experience is demeaned.

On an individual basis the lack of personal responsibility that is thus encouraged, formalized by organizational structures, and given credence by professional caregivers with a great deal to gain by identifying a whole new bailiwick of illness, encourages people who are distressed or confused by their sexuality to think of themselves as impotent in the face of their own problems.

Socially, rapists and other sexually abusive individuals are provided with a sanctioned legal defense for their dangerous practices – "I couldn’t help it, I’m an addict" – while people who read erotic literature or watch erotic theatre are stigmatized for their harmless ones. Thus, the safety, psychological health, and civil liberties of us all are jeopardized by a cultural ideal that encourages both the suppression and the repression not only of people's behaviors, but of their thoughts and feelings as well, in private and in public, in the names of social service and our own good.

Licensed marriage and family therapist and certified sex therapist Marty Klien writes:

So here’s my evaluation of almost everyone who is diagnosed as a sex addict—by themselves, their loved ones, or an addictionologist: it’s someone who is unhappy with the consequences of their sexual choices, but who finds it too emotionally painful to make different choices. You know, the way some of us are with cookies, new sweaters, or watching the Kardashians on TV.

Which is to say, it’s not about the sex. It’s about the immature decision-making.

Runner's High

But despite the highly charged sexual nature of sadomasochism (SM), the experience of masochism --- of "Going Under" or of entering "Bottom Space" or "Sub Space" --- is less akin to sexual relations and sex than extreme sports.

Recently a study performed on lab rats found that the "Runner’s high" --- a sense of euphoria caused by extreme physical exertion such as running in Olympic marathons --- is caused by the release of chemicals in the brain that mimic the same sense of euphoria in opiate use. (Werme, pgs. 2967-2974) Furthermore, the exercise can become "habit forming" in a way that "justifies comparison with drug-induced addictive behaviors." (Werme pgs. 2967)

The Oxford Reference defines Exercise Addiction as "An unhealthy reliance on exercise for daily functioning. The exercise often becomes the main mechanism for coping with everyday stresses." (Oxford Reference) (But that begs the definition of "unhealthy.")

Considering how closely "Runner’s high" resembles "Bottom Space," we can cautiously argue that the findings about the addictive qualities of the former might apply to the latter. But we need more research before making conclusions to that effect.

Conclusion

There does seem to be some evidence --- however slight --- that masochism can --- theoretically at least --- be addictive. But that evidence results mostly from applying the findings of studies of Exercise Addiction to Pain Addiction. Unfortunately, there were no experiments made or case studies examined of Pain Addiction to date. However the lack of evidence by itself is not enough to disprove the theory, only a warning that communities (medical or otherwise) should be cautious in their conclusions.

Also, the term addiction --- as applied here to a behavior such as sex, running, gambling, and consensual sadomasochism --- must be differentiated from poor impulse control. Otherwise we will are in danger of defining as addictive any behavior that people regularly engage in and which the majority doesn't approve.

References

American Psychiatric Association (1984). The American Psychiatric Association's Psychiatric Glossary. Washington, DC: American Psychiatric Press, Inc.

American Society of Addictive Medicine (ASAM) (2011, April). Definition of Addiction. Retrieved November 24, 2012, from http://www.asam.org/for-the-public/definition-of-addiction

Carnes, Patrick J. (2001). Out of the Shadows: Understanding Sexual Addiction (3rd ed.). Center City, MN: Hazelden.

Crooks, R. L., & Baur, K. (2010). Our Sexuality (11th ed.). Blemont, CA: Wadsworth Publishing.

Definition of Addiction. The American Society of Addictive Medicine. http://www.asam.org/for-the-public/definition-of-addiction

Henkin, William A., Ph.D., "The Myth of Sexual Addiction" http://www2.hu-berlin.de/sexology/BIB/SexAddiction.htm

Klein, Marty (2012, July / August). You’re Addicted to What?: Challenging the Myth of Sex Addiction. The Humanist (http://thehumanist.org/july-august-2012/you%E2%80%99re-addicted-to-what/)

The Oxford Dictionary of Sports Science & Medicine (2012). Drug Addiction. Retrieved November 28, 2012, from http://www.oxfordreference.com/view/10.1093/acref/9780198568506.001.0001/acref-9780198568506-e-2069

Perlmutter, D. (2003). Investigating Religious Terrorism and Ritualistic Crimes. Boca Raton, FL: CRC Press.

Warren, J. (2000). The Loving Dominant. San Francisco, CA: Greenery Press.

Werme, M., Thoren, P., Olson, L., & Brene, S. (2000, August). European Journal of Neuroscience, 12(8), 2967-2974.

Williams, D. J. (2006). Different (painful!) strokes for different folks: A general overview of sexual sadomasochism (SM) and its diversity. Sexual Addiction & Compulsivity, 13, 333-346.

Wortman, C., Luftus, E., & Marshall, M. (1981). Psychology (3rd ed., Rev.). New York, NY: Alfred A. Knopf.

Updates

I did not read the following articles and books before writting my article. Either I was unaware of them at the time or they were published after the Fall of 2012. I cannot comment on them.