Addicted to Pain: A Preliminary Model of Sexual Masochism as Addiction

Current Perspectives on Sexual Masochism

Sexual masochism is classified in the DSM-5 (APA, 2013) under paraphilic disorders and focuses on the acts performed by the masochist, including being humiliated, beaten, bound, and any other act aimed at experiencing suffering. Those acts could be inflicted by a partner or by oneself. Sexual masochism is considered chronic, with a tendency to repeat a chosen masochistic act. According to Lawrence and Love-Crowell (2008), who summarize several surveys and studies from the United States and Australia, BDSM activity in adults may be nearly as common as same-sex sexual activity. Therefore, practitioners might expect to encounter BDSM clients as they meet lesbian, gay, and bisexual (LGB) clients.

Looking into the forces driving the sadomasochistic encounter, one finds that the masochist perceives the act as means for her or his experience of intense sensation, a feeling otherwise lacking. In contrast, the masochistic environment, mainly the sadistic partner, is perceived by the masochist as experiencing little emotional response and as indestructible (Rathbone, 2001). The sadistic partner is expected to study the masochist’s physical reactions and interpret them without his or her assistance. This enables the masochist to relinquish self-control and experience the physical and emotional detachment that follows, while the sadistic partner is in charge of his or her safety (Fulkerson, 2010).

The Experience of Pain in Masochists

Examining the functionality and effect of physical pain in the literature began with the study of self-mutilation. Orbach (1994) found that participants with suicidal tendencies demonstrated a high tolerance for physical pain and an extremely low tolerance for psychological discomfort, thus creating a willingness to sacrifice the body in return for emotional or psychological relief.

The use of self-reports found that self-mutilators experience a dissociative-like state while performing self-mutilation. Following this act, their fundamental experience of emotional numbness and/or detachment is turned to a sensation more vivid, real, and better anchored in reality (Bohus et al., 2000; Favazza, 1998; Zlotnick, Mattia, & Zimmerman, 1999).

Further insights into the effects of pain were provided by Newmahr (2008), a unique, ethnographic researcher, who elected to take part in masochistic acts within a restricted sadomasochistic community to qualitatively research this experience. In her study, she reports feeling the physical blows landing on her body but without experiencing physical pain. They did however create a unique sense of focus, allowing her to think of nothing but the timing of the next blow. She found gratitude to be a central part of her experience, and when the act was over, she reports feeling “out of it,” addressing strangers with excessive intimacy, and having trouble following conversations around her. This effect on her raises questions as to the influence of pain and the ways in which it acts on the participants’ sensual experience, but was not further explored.

This Study

Previous research indicates that pleasure deriving from physical pain experienced in a masochistic context should be regarded mostly as a distorted sensation of pain, not an attribute of it. The phenomenological inquiry conducted in this study attempts to explore the perceived meaning of pain in sexual masochism and, following the notion of the rewarding and addictive qualities reported by this study’s participants in response to pain, confronts the possibility of an addiction to that altered pain experience.

Participants

Participant selection attempted to provide a representative variety of individuals who find physical pain to be a key attribute of their masochistic experience, thus relying on Glaser and Strauss’s guidelines for qualitative study formation (Glaser & Strauss, 1967). Interviews of nine participants, four females and five males who considered themselves as sexual masochists, were conducted. At the time of the interview, one female participant was in a monogamous, sadomasochistic relationship, and one male participant was married to a wife who did not share his sadomasochistic tendencies. The remaining participants were not in a relationship. The participants were between 21 and 62 years of age, and varied in personal status as well as the manifestation of their sadomasochistic acts.

Instruments

This study used a semi-constructed, in-depth interview (Berg, 2007), conducted in Hebrew and ranging between 90 min and 3.5 hr in length. The interview guide created for this task was designed to reveal the participants’ self-perceptions, the manner in which these developed, and their perception of the experience of pain. It included questions such as “What events would you say shaped your life?,” “What are the mood and sensations accompanying you during your chosen activity?,” and “Describe a recent crisis or hardship—how did you cope?” Nonetheless, the interview was mostly guided by the participants themselves, allowing them to dictate the order in which they discuss their experiences. Introjections were mostly conducted to clarify understanding.

Procedure

Seven of the participants in this study were recruited through public ads posted in sadomasochistic forums. This technique enabled this study exposure to a wide range of possible candidates, and assured that only masochistic individuals who were willing to participate made contact with the researchers. Candidates who approached us following these ads were selected to participate based on the declared significance they placed on the experience of pain in their behavior. Candidates who declared pain as unimportant, or non-existing, were not interviewed for the sake of this study. Among the 16 responses received from published ads, five were declined due to their misconception of the study, namely, interested in being watched while they practice their acts and four were rejected due to physical pain being insignificant to them in their experience. Two more participants were recruited using the “snowball” method (Patton, 1990).

The location of each interview was chosen by the participants to allow for their sense of privacy. Each interview began with an explanation of the research’s purpose and the assurance of privacy followed by the signing of an informed consent form. Participants’ consent was also requested for recording their interview. Four of the participants refused and their interviews were only transcribed by hand. One recorded interview, containing Sarit’s (alias) words, was lost due to technical difficulties; quotes presented from that interview rely on the manual notes taken during the interview.

Interview analysis was conducted using text subject–based analysis (Shkedi, 2003). This process began with reading the textual transcripts of all interviews allowing for a sense of continuity to form. Following this, we began investigating the subjects and themes presented in each separate interview. Next, the texts were revisited in parallel, allowing similar motives to emerge and different attitudes toward the same motives to be unveiled. This stage concluded in the formation of three broad themes detailed in this study’s findings.

Based on this categorical structure, a theoretical analysis of the findings was performed. Validation of this theoretical analysis was achieved by presenting them back to the studied population. Research findings were presented to Moses (alias), a sexual masochist who refers to pain as a substantial element in his experience but who did not take part in this research, as well as to both Vered (alias) and Sarit (alias), two participants of this study. Their responses confirmed our findings, and their notes were included into this final report.

Ethics

This research was approved by our Institutional Review Board. All participants were interviewed only after signing an informed consent form. Participants were assured that their identity, along with possibly identifying details, would be kept confidential. Further assurance was provided that efforts would be made to prevent any harm to them, their emotions, or their dignity.

Participants were not obligated to discuss any subject or aspect of their experience. At the conclusion of each interview, an evaluation of possible emotional distress was conducted. Two of the participants pursued further contact with their interviewer revealing a certain difficulty letting go of the sense of intimacy they had experienced during the interview. Separation of that relationship was performed after introducing the possibility of professional counseling and after receiving verbal assurance of the participants’ ability to withstand separation.

The First Time

The first incident of masochistic experience was glorified in the participants’ accounts:

Our first meeting was like an amusement park, we both came out of it completely bruised. It felt as if we were flying for half the following day. It was like an explosion, everything I thought and was curious about and knew and—he had a lot of experience—I wanted to try everything and fast and now. (Yelena)

This first experience was also characterized by an extremely detailed recollection:

I was very nervous in the beginning, my heart was pounding, it felt right, it was very exciting it felt like this is going to be an experience I’m really going to enjoy. ( . . . ) she puts you in a room, she’s standing, smiling—“do you want some water? Do you want it?” It’s only because my first time was like that. I don’t think I could’ve felt this way about anyone else, only her. I remember it in detail, even though it’s been six years. There are things I did two years ago and I don’t remember this well, I remember each move, from beginning to end. (Ronni)

Findings revealed that the first experience was elevated in quality. It was differentiated from the experiences that followed, who were never able to stand up to its standard:

I’m looking for the lift off, it had happened in the past, before I got hurt by all the relationships, and I can’t seem to get that feeling again. ( . . . ) I have this intense desire to powerfully experience everything, like it was in the beginning. (Sarit)

It was much less effective than the first time, even though the one from the first time was really bad ( . . . ) Years after that I was trying to recreate the experience I’ve had with her, so I went to someone who looks like her. (Ronni)

These accounts brought to these researchers’ minds the way a first drug use is characterized, a unique and intense sensual gratification described as “what a feeling” and “it was magical,” which propels following use in an attempt to recreate that first, singular, experience. Alas, as experienced by the participants of this study, the longing evoked by that memory cannot be gratified by the experiences that follow (Tyler, 1995; Van Zyl, 2007).

Intoxication

When describing the experience of pain, the participants often used terms linking the experience with addiction, drug use, and effect: “It’s an addiction, like to a drug that creates an emotional experience and also is very relaxing” (Ronni); “I don’t like drugs, but this is a very cool way to experience a high” (Yelena).

When presenting the sensations following a sadomasochistic encounter, participants chose drug-related language to relay their experience:

The body reacts in a certain way, it releases some endorphins, it drugs you at some point- then you become stoned, you look like a dog, lying on your back in complete euphoria ( . . . ) everything is clean. It’s like putting your head under water in the bath tub, by choice. Everything is padded, it’s fun. You lie there and you are completely limp, completely peaceful. You just sort of dive, there could be chaos around you ( . . . ) but it won’t really be what I experience. (Yelena)

I’m already losing contact with reality and the endorphins are kicking in. It feels really really good, feels like I’m flying in sub space [a term given by the sadomasochistic community to the sensation produced during a masochistic experience—authors]. I’m really out of touch with reality. (Naama)

While discussing substance consumption, Smith and Gay (1972) have quoted similar words: “After the fix, you feel the rush, and then you float around for a few hours ( . . . ) nothing can reach you, you’re safe and you feel good” (p. 145).

The sensations depicted by participants last well beyond the conclusion of the interaction: “High, a really high high, like flying, and you feel good and very tired” (Naama). “After a session I feel as though I have enough oxygen to survive for another week or two ( . . . ) I come home afterwards and sleep like a baby” (Abner). “(When the session is over) you shower, get dressed, and go outside feeling refreshed” (Ronni). “Something comes loose in your mind; you’re in another world, like you feel no pain” (Giora).

Giora’s statement seems to illustrate a sense of detachment produced by the experience of pain. This sensation has also been described as one of the motives to participate in masochistic activities:

You need to disconnect yourself from what you are experiencing. You can’t experience your reality, I can’t in any way, I can’t experience reality and . . . I run a business, I work 240 hours a month, I can’t experience peace. For 240 hours a month I can’t experience peace, I have to cut off of my reality, that’s the detachment. (Yelena)

However, the experienced intoxication is temporary. Participants described their reliance on after effects to prolong the experienced intoxication and accompany them in the time leading up to the next experience: “Touch wears off too fast. ( . . . ) tomorrow morning I’ll sit on a chair and I’ll feel this discomfort” (Vered); “Marks, pain that lingers after and you enjoy to a certain degree, the delightful memories that keep you going until the next session” (Giora).

Craving and Withdrawal

Eventually, the intoxicating effect of pain dissipates and a sense of need, of absence, arises: “I wanted it, yes, I missed it” (Ronni); “I start feeling not well, like there’s something missing. I feel restless, something is missing” (Abner). At this point, the mere mentioning of masochistic activities might spur the desire to participate in one: “I feel the want from inside, it’s an inner stimuli. It grows stronger when you talk about it—I would do it now if I could. I have this intense desire to be on all fours right now” (Abner).

When discussing sexual intercourse, the participants of this study presented their views and concerns regarding the absence of sadomasochistic elements: “Some people are so into it that they will not enjoy vanilla [without sadomasochistic elements—authors] sex” (Doron),

I realized that without pain it’s not . . . I can’t, I can’t . . . how do you say—I’m sorry but I’m not sorry. I can’t do it without it, it kills me. Somewhere along the line I realized that I can’t have regular sex, without the pain, may be without a certain amount of humiliation too. It’s like it doesn’t add up for me, it’s just not something I can do. (Naama)

It seems that at some point, the removal of the masochistic elements from their experience turns it to un-appealing. A process that brings to mind Krivanek’s (1988) discussion of the circle of addiction as a process of perceiving experiences as better when intoxicated. This mechanism becomes generalized until a point where life when not intoxicated is perceived as boring.

When pain is absent, a sense of craving is evoked: “I wanted it, yes, I missed it” (Ronni); “fierce longing” (Sarit); “I don’t feel well, something is missing and I’m restless, something is missing ( . . . ) I have to do it, if I don’t something is missing” (Abner). Accordingly, participants expressed their feeling that stopping is not possible:

It’s best not to say you’re getting out of it and not coming back, because you will come back, on all fours ( . . . ) that’s why I never said I’m done with it, because it’s impossible. It’s impossible, it’s unbearable, it’s impossible ( . . . ) it got to the point I couldn’t think, I couldn’t breathe. (Naama)

When away from a masochistic experience, the mere mention of masochistic behavior elicits the urge to participate in it:

I feel it from the inside when I feel like it, it’s an internal stimuli. It grows stronger when you talk about it – I would do it now if I could. Just a strong desire to stand on all fours. (Abner)

In times when participating in a masochistic experience is not possible, a substitute may be sought after: “Having a slave is a substitute. If you can’t be a slave be a master, it won’t completely satisfy you, but it is better than vanilla” (Giora).

Tolerance

Over time, participants reported that the mere participation in masochistic acts, albeit necessary, is not enough and the need to escalate the experienced pain arises:

From time to time the pain threshold goes up ( . . . ) they say it’s the endorphins, probably the endorphins are similar to something in drugs, it’s from the same family of chemicals . . . I was an addict, I didn’t realize it, but it’s like your body gets used to a certain amount of that stuff in the brain so your tolerance to pain goes up, you need more, more pain so that chemical will be released in your brain. And if you don’t have it in your brain you feel down, you really feel bad. (Vered)

Barriers against more extreme experiences were dissolved as the need increased: “Whips were added with time” (Giora); “In the first sessions I hardly let them hurt me, you couldn’t even mention whipping ( . . . ) I was scared of it, scared of what people would think of me” (Naama).

Pain as Control

A key element of the participants’ emotional experience during sadomasochistic encounters seems to be its ability to provide an answer to unmet emotional needs. The participant’s descriptions illustrate how, through the control of their own pain, they obtain a sense of control over themselves and experience themselves as more potent and able than their partners:

I almost never use a safety word, it’s silly in my eyes. Maybe it’s just because I never reached my limit and I’ve never even come close so I’ve never needed it. ( . . . ) usually I’m the one wearing my masters down, not them me. (Naama)

“My ex told me I was the most dominant when in the submissive position. Topping from the bottom—that’s me. I’m the most dominant when I’m submissive, that’s when I’m holding the reins the tightest” (Yelena); “I define myself as topping from the bottom. I give her the control, it is ok. With the strength of my dominance it’s not a problem, I’m not insecure” (Gideon). This perception is further strengthened by the term giving control frequently used by the participants.

An additional element of control portrayed by participants in the sadomasochistic situation has to do with the very occurrence of the situation, for the termination of an occurring situation was perceived as entirely in the masochist’s hands, and they never experience it differently. This constitutes a meaningful aspect of the experience:

I know I have the ability to stop if I wanted ( . . . ) the second one told me “you have a high threshold for pain.” It felt really good to hear that. It sounds a little bad, but I felt proud ( . . . ) if I can stand the pain than I know that I have power. (Ronni)

As introduced by Deci and Ryan (2000), the subjective perception of the self as in control of a situation serves to gratify substantial needs such as a sense of autonomy and ability, and is highly beneficial to psychological well-being.

The Pain Inducing Partner

A distinctive characteristic of the masochistic experience is its need of the sadistic partner. When discussing their partner, the participants of this study voiced an expectation that their partner would provide protection and a sense of security. The sadomasochistic encounter is expected to be an environment in which the masochist’s needs are gratified without words, in which a distance from the disheartening daily experience can be obtained:

Whoever is doing it has to feel you ( . . . ) I don’t stop, I’ve never stopped ( . . . ) I just trust her not to do it for too long, that she’ll see and understand that she has to stop. (Ronni)

“Maybe, somewhere, there’s the will that someone might show up and ignore the boundaries a little, who’d know to stretch them out a little, you know. It’s . . . He has to feel it” (Naama). When these expectations are not met, anger is experienced: “There’s anger when a blow hits too hard or in the wrong spot—‘how did he not know?’” (Sarit).

The participants’ descriptions portray an interaction that is not a part of their reality. It exists on a separate plane in which the reality principle can be bent and a space in which daily sensations cease to exist is created. Such an experience brings to mind the experience of sex addicts who describe a desperate search for connection through their behavior (Ferree, 2001) as well as the description of a “transitional object” and correlates with the way objects of addiction, human or otherwise, are characterized.

Winnicott (1971) stipulates that the transitional object is not part of the reality principle, and is used to ease the transition from the child’s omnipotent world to the real, uncontrollable, world lying beyond the self. As such, the human object of addiction, as well as the partner-subject of the masochistic experience, is not experienced as a separated individual with needs of his or her own. It is perceived as a partial object in the addict’s mind, which offers a sense of value, reassurance, and security. As such, an intimate relationship with it cannot be formed wholly; it exists only inside the “potential space.”

What Is Addiction?

Addiction is manifested by a behavior that is repeated despite adverse personal and social consequences, representing a state of dependency and acquired by a predisposed individual in an attempt to ease a chronic state of stress and suffering. Addiction can only occur following an encounter with a conductive environment—an activity that supplied the arousal correction craved in sufficient intensity and novelty. The importance of this first, addictive encounter is well presented in addicts’ account of their first time as a life-changing event (Hari, 2015; Jacobs, 1989; Peele, 1985).

For addicts, the experienced effects of the behavior or drug are a valued part of the self-capacity to function, cope, and be comforted (Achalu, 2005; Khantzian, 1990; Nixon, Solowoniuk & McGowan, 2006; Padykula & Conklin, 2009). It becomes an organizing mechanism. Priorities are rearranged, the perceived positive effects of the addiction become increasingly inclusive, and associations are formed when faced with environmental cues. The addict discovers that addiction improves a growing portion of life’s aspects, up to the point where life without addiction becomes dull and unfulfilling (Hari, 2015; Krivanek, 1988; Stimmell, 1975).

Addiction’s organizing aspects serve to evoke a sense of control over formerly uncontrollable feelings and behaviors (Peele, 1985). It is viewed as gaining present control, extended over various aspects of a currently occurring situation, and creates an assessment of the self as masterful, diminishing feelings of distress (Deci & Ryan, 2000; Frazier, Berman, & Steward, 2001; Frazier et al., 2011).

Addiction can refer to substances or to behavior (Bensimon, Baruch, & Ronel, 2013). Diagnosing substance addiction might utilize the DSM’s definition of “substance-related and addictive disorders” (APA, 2013). This includes behavioral, cognitive, and pharmacological characteristics including intoxication, known as “a high,” tolerance, and withdrawal. Another key diagnostic criterion relates to the experience of craving, an increased sensitivity to environmental cues related to the addiction and the knowledge of potential hazardous consequences.

Pain and Addiction

When aligning the phenomenological accounts presented in this study with the existing academic and diagnostic definitions of addiction, the possibility of considering masochism an addictive behavior arises. More specifically, these accounts can be examined in light of the diagnostic criteria for substance dependency provided by the DSM-5 (APA, 2013), including intoxication, craving, withdrawal, and persisting despite adverse psychological and physical effects. They also correspond to self-descriptions made by pathological gamblers (Bensimon et al., 2013).

These findings demonstrate the existence of an intoxicated-like state following the experience of pain, which includes a feeling of serenity, relaxation, and detachment. These symptoms represent a substantial change in sensation affecting awareness, mood, and consciousness. However, intoxication effects are neither constant nor stable. With time a similar sensation can be achieved solely by experiencing pain in more acute and extreme manners, whether by experiencing a greater amount of pain and/or greater versatility.

When the experience of pain is denied, anxiety appears in contrast with the experience of pain-induced intoxication. This is accompanied with a sense of craving, which further motivates participation in pain inducing acts. Eventually, and to relieve these sensations of cravings, the masochist turns to additional masochistic acts, even when facing possible harm to social stature or the integrity of family life.

There is some difficulty in addressing diagnostic criteria for addiction, which involves persisting with the selected activity despite adverse psychological and physiological effects. Physiological risk is inherent in the masochistic activity, lingering marks and physical pain are a common and even desirable aftermath, and accidental death is an occasional consequence of sexual masochism. Nonetheless, the findings of this study demonstrate that the masochistic experience displays the symptoms required to diagnose substance dependency according to the DSM (APA, 2013) and has the potential to reach a “severe” level of dependency by applying to more than six of the necessary criteria.

In addition to corresponding with the DSM 5’s definition, the findings of this research provide a phenomenological account of an experience highly compatible to that found in research of various addictions. Participants’ descriptions of their first encounters with their masochistic experiences demonstrate a linguistic comparison with those of heroin addicts’ descriptions of their initial experiences (Tyler, 1995; Van Zyl, 2007). Once this addiction is instantiated, an inclusive process takes place and sensitivity to environmental cues sets in (Krivanek, 1988; Stimmell, 1975), allowing the mere mention of masochistic behavior to become a source of arousal and craving.

The addictive pattern presented in this study suggests an association with behavioral spin as found in problem gamblers (Bensimon et al., 2013). A behavioral spin is described as a process one goes through that is characterized by a behavior growing in frequency and magnitude. As it develops, it gains its own momentum, which the individual finds almost impossible to terminate even when faced with known unwanted outcomes. This process initiates with thoughts and emotions that arise related to said behavior and beyond self-control, followed by a growing self-centeredness, which is composed of two leading motives: “I can” and “I must.” The first motive provides the legitimacy and capability to perform the behavior, whereas the second one represents the experience of an existential threat and the belief that this threat must be removed by the said behavior and its acceleration. The spin process is characterized by a feeling of diminished self-control, and it climaxes with the conducting of its core behavior (Bensimon & Ronel, 2012; Ronel, 2011).

For the participants of this study, the behavioral spin is manifested as a continuously reinforced process leading the masochist to engage in masochistic activity, perpetuating itself, and binding the addict to his or her behavior. This process finds its start in an emotion or a behavior, which ignites a chain of emotional, behavioral, and cognitive experiences that inevitably lead to the end behavior. During this process, the individual relinquishes control over its progress and begins converging inward. In this state one might become inactive and absorbed in inner thoughts and desires.

This process climaxes in participation, the conscious yielding of control and turning inward. This is a state referred to in this study as “subspace,” a state of detachment from reality and from aversive sensation as a whole, and retreatment into an inner world. When the experience is over, its lingering effects allow for the continuation of routine, until these sensations subside and the spin starts anew.

Limitations and Further Study

This research’s limitations are primarily due to its design as exploratory and to the wording utilized by this study’s participants. The research design led to a relatively small participant scope and conducted on a solely Israeli participant base, making generalization of the findings questionable. The use of the concept of “endorphins” by some of the participants may imply the influence of popular theoretical models on the way these participants conceptualized their experience. Further research into this phenomenon is required to generate a more comprehensive and sound model for addiction to pain; that is, a study of a group of participants with a different cultural and demographic background, or a study of the physiology of the so-called addiction to pain by the sexual masochists. Because this research’s design was focused on the phenomenology of the experience of pain in masochists, it is ill-equipped to relay a model that includes possible biological aspects. As such, further studies in this area of interest could incorporate a biological examination of the processes involved in the experience of pain.

When re-reading the accounts of Newmahr (2008) in light of the presented findings another field of inquiry arises. What explanation could be provided for the similarity in response to pain depicted by a seemingly unrelated participant and the participants of this study? Newmahr’s response to the experience of pain, as well as the “high” like sensations described by the participants of this study, brings to mind the question of matter. The auto-addiction opioid theory (Marrazzi & Lubi, 1986) discusses the addictive potential of the opioid neuropeptides secreted in the face of physical pain. When these encounter a biological susceptibility to opioid narcotics, these can evoke a strong, addiction-provoking, reaction (Davis & Claridge, 1998). Future research to associate this with the addiction model presented here could generate valuable information.