I may be kinky, but I’m not crazy

S&M (sadism and masochism) references abound in popular culture, from racy rom-coms to Rihanna music videos. But psychiatric medicine seems a little behind: “Sexual sadism” and “sexual masochism” are still diagnosable mental disorders in the Diagnostic and Statistical Manual of Mental Disorders, the current list of mental disorders and criteria published by the American Psychiatric Association.

So does being kinky really mean you’re crazy?

The term “BDSM” refers to a variety of bondage/discipline, dominant/submissive and sadomasochistic behaviors, which may include pain, pleasure or both. These practices are often referred to as “kinky,” since they differ from what most consider normal sexual behavior.

But kink is or is becoming more mainstream. As far back as 1953, Alfred Kinsey found that 12 percent of women and 22 percent of men felt an erotic response to S&M stories. Janus found 11 percent of women and 14 percent of men have engaged in some form of S&M.

Discomfort toward BDSM usually stems from disbelief that pain might be enjoyable, from uneasiness around consent or from concern about safety.

Some people can like pain or even feel pain as pleasurable. It’s like picking scabs or getting a deep tissue massage.

As for consent, most BDSM practitioners are meticulous, even painstaking, in negotiating terms of consent before any sexual play. For example, “safe words” are used to stop unwanted play.

BDSM practitioners are also careful about safety. Acronyms like SSC (safe, sane, consensual) or RACK (risk-aware consensual kink) are used as guides.

BDSM is part of the whole spectrum of sexual activity and interest, ranging from tickling and ear-nibbling to whips and chains. The goals are the same, pleasure and intimacy. This is bondage as a form of bonding.

Psychiatrists who have supported the pathologization of BDSM cite psychological distress, serious health risks or non-consent. But there is little data to support these claims, and distress and non-consent are not used rigorously as criteria.

In the research that is available, BDSM practitioners experience no more psychopathology than others, and a rare minority feel distress over their interests.

As for serious health risks, one could argue then that interest in any extreme sport could also be a mental disorder and education around safety is more crucial than pathologization. Nonconsensual activity should be considered criminal, but it is not necessarily caused by sadism but rather problems with control.

These diagnoses are harmful to the BDSM community, have stigmatizing medical and legal implications and prevent open conversations with health care providers about BDSM safety and health. Fortunately, it seems that the American Psychiatric Association is moving in the right direction for the new DSM-5 in 2013, by revising “sexual sadism” to “sexual sadism disorder,” same for “masochism,” subtly shifting emphasis onto related problems rather than the sadism or masochism itself.

Whether you’re getting fuzzy handcuffs or a new sex sling, you’re not crazy. You’re just kinky, and kinky is not a mental disorder.

Perry Tsai is a columnist for The Daily Tar Heel. He is a second-year medical student from New Orleans, LA. Contact him at perrytsai@gmail.com

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