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Contemporary participants define BDSM as an umbrella term for alternative sexual activities that may be considered non-normative by others. This correlates to the large emphasis on self-identification and self-expression in the BDSM community. People in the BDSM community practice BDSM for a variety of reasons that do not require sexual interaction, and the community itself has grown into a strong subculture. There are many sexual identities included within BDSM, but three identities that are commonly found among the community are dominants, submissives, and switches. The switch role is represented by a person who enjoys representing both dominant and submissive roles, and they will alternate roles in relationships, scenes, and activities depending on their mood, partner, or the situation.

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It has been suggested that a majority of the general population has BDSM-themed fantasies, and about half has engaged in BDSM-related Male submissive masochist pics at least once. Notably, Hawley and Hensley 92 also demonstrated high preference rates for submissive fantasies in some men, regardless of sexual orientation or gender identity. Sick fantasies that drove a sadist to rape murder and mutilate. As such, some studies assessed interest in or fantasies about BDSM, whereas Male submissive masochist pics queried actual performance of such activities. Sex Med ;— Pretty much nothing seems worth Havant Adult Discipline Spanking. Sadomasochistically oriented behavior: Diversity in practice and meaning. Serious sadomasochism: A protected right of privacy?

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BDSM bondage and discipline, dominance and submission, and sadism and masochism increasingly receives attention from the scientific community. Where earlier research efforts mainly focused on epidemiologic characteristics, psychological and biologic factors driving BDSM preferences have recently gained interest as well. To bring together all the existing scientific literature on BDSM from a biopsychosocial perspective.

Prevalence rates of BDSM interests were investigated in the literature, as well as the associations between BDSM interests on one hand and personality traits, adverse childhood experiences, education levels, sexual orientations and biological markers on the other. With regard to psychological factors, both personality traits eg, higher levels of openness or extraversion and the presence of a personality disorder have been associated with a heightened interest in BDSM, although only limited supporting evidence is available.

Whereas attachment styles impact couple dynamics, they also influence willingness to explore limits in a BDSM context. Lastly, education levels impact relational and sexual dynamics.

The limitations of the current review reflect those of the topical scientific literature. From this biopsychosocial perspective, we offer a dimensional approach while integrating the factors driving the onset and evolution of BDSM interests. Sex Med ;— BDSM, previously known as sadomasochism or SM , is an overarching abbreviation of bondage and discipline, dominance and submission, and sadism and masochism and refers to a physical, psychological, and sexual role-play involving power exchange between consensual participants.

The perception of BDSM as being pathologic influenced scientific articles from the s and s, which tended to focus on non-consensual sexual sadism from a forensic perspective and incidental SM-related fatalities.

The recent success of the Fifty Shades of Grey books and movies, among others, have led to an increased awareness of this expression of intimacy and sexuality. Contemporary mainstream interest in BDSM is mirrored in the exponential growth seen during the last decade of scientific research focusing on all kinds of BDSM aspects and, as such, has enriched the existing literature, thereby nuancing its initial pathologic classification.

This increased availability of BDSM-related scientific literature inspired us to bring together the existing literature on biopsychosocial aspects of BDSM in the current systematic review, the first in its kind. An integration of biologic, psychological, and social knowledge about BDSM may contribute to the understanding and destigmatization of this form of sexual expression, as well as challenge its place in psychopathological classifications.

The current systematic review was conducted according to PRISMA-P preferred reporting items for systematic review and meta-analysis protocols guidelines.

Different sources may refer variously to individual parties involved in a BDSM interaction. A literature search was performed using the following inclusion and exclusion criteria: i research articles with a focus on BDSM generating original data were included; ii case reports on consensual sexual masochism and submission were included; iii opinion articles, comment letters, and essays without original data were excluded; iv given the focus on consensual sexual sadism or masochism, forensic articles on sexual offenders were excluded.

These inclusion criteria were driven by the generally accepted scientific hierarchy of evidence. Titles and abstracts were screened to eliminate irrelevant articles.

Full texts of potentially relevant articles were read and screened for further eligibility; the final selection was made in consensus by N. Preferred reporting items for systematic review and meta-analysis protocols flowchart.

The Pubmed database search initially generated 1, records. Cross-referencing further led to inclusion of 9 additional articles and book chapters. Preliminary screening of titles and abstracts resulted in 98 remaining articles to be read in full.

An Australian study 18 found that 2. Studies reporting on individuals having BDSM fantasies reveal higher prevalence rates. Similarly, Jozifkova and Flegr 21 demonstrated that about half of the general population preferred unequal power dynamics in their sexual relationship.

This divergence might be explained by several factors. This is illustrated by the fact that about half of the sample from Holvoet and colleagues 3 indicated having engaged in BDSM activities, whereas, in the same sample, only 7.

It should be noted that no consensus exists on which activities are BDSM practices and which are not. A second source of divergence might stem from investigating different intensity levels of BDSM interest. As such, some studies assessed interest in or fantasies about BDSM, whereas others queried actual performance of such activities. As can be expected, the first type of studies demonstrated higher prevalence rates than the latter. A final explanation might come from the time span covered by the different questionnaires, because the prevalence of activities in the preceding month 3 , 22 was found to be much lower than lifetime experience 1.

Although BDSM practitioners are often considered as a homogeneous subculture of the general population, in the current review, we applied a dimensional approach toward interest in and practices of BDSM.

On one end of the spectrum, BDSM-related interests translate into unexplored fantasies and, on the other, an intensive, continuous implementation of these interests in all aspects of daily life. It has been suggested that a majority of the general population has BDSM-themed fantasies, and about half has engaged in BDSM-related activities at least once. Additionally, engaging in at least 1 BDSM-related activity on a regular basis is reported by Literature indicates that BDSM is an umbrella term that covers an array of interactions that can be present independently or in different clusterings.

A dimensional angle of approach is therefore also applicable on the nature of the interaction and the acts implemented. Generally, a shift in power dynamics is at the core of BDSM play. This power shift will translate in a wide range of role play possibilities, including specific rituals kneeling, use of title to address partner , humiliation, movement restriction, or sensory deprivation. Nevertheless, it demonstrates that different BDSM activities are not necessarily all present in each interaction and that certain clusterings can be established.

Weierstall and Giebel 31 recently developed a sadomasochism checklist containing a submission scale and a dominant scale, each containing 24 items with 6 different factors: domination, use of toys, soft play, beatings, breath play, and play involving bodily fluids. This, again, indicates that heterogeneous profiles of interest emerge within the BDSM community.

BDSM play is often perceived as a precursor to or part of sexual activities. In contrast, Newmahr 33 argued that, to many practitioners, SM does not precede or replace sexual activities but is an end into itself. To conclude, BDSM interests can be approached from a multidimensional perspective. Practitioners play with varying degrees of intensity and frequency and are heterogenous in performing their activities in a sexual context.

International differences in BDSM practices have been suggested, 38 but large-scale studies investigating this notion have yet to be conducted. Yost 39 identified 4 categories of stigmatizing attitudes: i BDSM is socially and morally wrong, ii BDSM is associated with non-consensual violence, iii a general lack of tolerance toward SM practitioners, and, finally, iv the notion that submissive or dominant traits translate to other domains in everyday life eg, behavior toward children. Although few studies looked into the characteristics and traits facilitating these stigmatizing attitudes, stigma was found to be higher in women who were less sexually emancipated.

This may partly explain why some practitioners explore their sexual interests in public BDSM communities, rather than keeping it in the privacy of their homes. This is in contrast with the general adult population, in which lower rates of suicide attempt have been reported 1. In light of the still-ongoing equivocality, Green 49 argues for a similar legal treatment of sexual and sportive activities when consensual harm is involved. Some scientific literature contributes further to stigma sustainment, for example, by focusing on fatal cases of autoerotic asphyxia, while looking into associations with masochism, bondage, or transvestism.

Women especially were concerned about being judged by their medical care givers for their sexual practices. Therapists experienced in working with BDSM clients, however, accentuated the importance of a non-judgmental attitude and knowledge of BDSM practices and values. The inclusion of sexual sadism and sexual masochism in the Diagnostic and Statistical Manual of Mental Disorders has its roots in earlier descriptions by Freud 6 and Krafft-Ebing, 5 who pathologized these interests.

According to Weinberg, 60 they presumably had biased views on the matter because they based their ideas on literature describing extremes eg, the works of the Marquis de Sade that did not necessarily represent actual BDSM, as well as on conservative views on sexuality that were generally prevailing in their time, thereby further inflating aversiveness toward all kinds of sex-related activities. It should be noted that, in the latest 2 editions of the DSM DSM-IV and DSM-5 , a clear distinction is made between non-pathologic atypical sexual interest or paraphilia and actual paraphilic disorders that, by definition, have to cause distress or impairment to the practitioner or cause personal risk of harm to others.

Therefore, some argue for keeping diagnoses such as sexual masochism and sexual sadism in the DSM classification system.

Nevertheless, several authors have criticized the presence of sexual sadism and sexual masochism in the DSM and suggested that public opinion, rather than scientific argumentation, was the main reason for paraphilias to be part of the DSM. Others believe that these diagnoses deserve a place in the classification system, because they are highly prevalent in forensic populations of sexual murderers, but that it is crucial to differentiate between safe, sane, and consensual BDSM practices on one hand and pathologic, non-consensual forms of sexual sadism and masochism on the other.

First, the fact that sexual sadism and masochism are part of a psychiatric classification system may still fuel stigmatizing presumptions eg, in a context of jurisdiction. Some preliminary literature suggests an influence of several psychological factors and social influences driving an affinity with BDSM.

A single study scrutinized associations between personality traits and BDSM preferences. These preliminary findings, thus, may suggest an association between cluster B personality traits and BDSM interests, but this notion should be explored in future studies. Future large-scale, preferably cross-nation research should further elucidate whether an association between childhood abuse and BDSM interests is actually present. The latter notion has not been investigated yet, so comparing the communication style between BDSM practitioners and non-BDSM control subjects may be of interest.

Further research should clarify the nature of this relationship. Many BDSM-oriented individuals became aware of their kink-themed interests at a relatively young age, that is, before the age of Similarly, Holvoet and colleagues 3 found that Because these interests apparently are already present early in life, social contexts during childhood and adolescence eg, parenting style presumably largely influence affinity for BDSM practices.

Future research should dig deeper in the potential moderating role of parenting style and power disparity in the parental couple. Ample literature shows that BDSM practitioners are typically highly educated.

In this line, they also had higher income levels than the general population. These findings suggest that there is a positive correlation between the intensity with which one practices BDSM and their education level. It could be suggested that individuals with higher education levels are attracted to the psychological dynamics of BDSM play and see it as an enrichment of their relationship or sexuality, but this should be clarified by future research.

Nonetheless, it should be noted that these findings are merely associations found between education level and BDSM interest and, thus, did not reflect causality. This parallels the evolution in the social profile of the public BDSM community, because in the s and s, initial clubs were typically part of the gay leather scene.

This interesting notion should be explored in future research. Cross and Matheson 80 indicate that it is power that is at the core of BDSM interactions, rather than pain, bondage, and humiliation, which are merely tools or methods to achieve the mutual creation of a hierarchical status. As such, the exchange of power in an erotic context is the driving mechanism underlying sexual pleasure. An important limitation of this approach is that it was a virtual interaction, not necessarily reflecting all processes involved in a real-life interaction.

This notion mirrors the fact that women having sexual fantasies of forced sex often imagine minimal physical discomfort in those fantasies, 87 , 88 , 89 suggesting that it is the power dynamics rather than a masochistic mechanism driving these fantasies.

Although, for some, BDSM is a form of leisure or a means to spice things up in the bedroom, 33 , 65 other practitioners will argue that BDSM is their sexual identity or orientation. Some even go as far as to perpetually maintain their BDSM dynamics in their everyday lives. For example, a person identifying as gay will indicate that sexual orientation stands for who he or she essentially is.

Up to now, very few studies focused on the biologic underpinnings of BDSM practice, but some indeed have investigated effects of gender, brain activity patterns, or associations with hormonal changes. Several studies looked into the association between the sex of the participant and BDSM role. Women also demonstrate significantly higher interest in submissive sexual fantasies 16 and express a preference for a dominant man.

From an evolutionary point of view, male assertiveness is a characteristic valued by women in their male potential partners, because it may have led to increased survival chances for women and children. To do so, they investigated the hypothesis that sexual arousal induced by hierarchical imbalance between a person and his or her partner reflects a mating strategy.

This led the authors to conclude BDSM to be a successful mating strategy. In contemporary society, dominance is still primarily considered a masculine characteristic. Words referring to sex primed faster responses for submissive words in women, leading the authors to conclude that women implicitly associated sex with submission, an association not found in men.

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