Is S&M Dangerous? Let’s Look at the Evidence

Science, technology, and life.
July 10 2013 10:50 AM

Spank You Very Much

Is S&M dangerous? Let’s look at the evidence.

Aiden is voluntarily dominated by women at a dungeon party during the domination convention.
A dungeon party at a domination convention in Los Angeles

Photo by David McNew/Getty Images

Earlier this year, I wrote two articles about BDSM—bondage, dominance/submission, and sadomasochism. I argued that BDSM, unlike homosexuality, was inherently problematic and wasn’t an orientation. Defenders of BDSM—Dan Savage, Jessica Wakeman, Clarisse Thorn, Jillian Keenan, and dozens of Slate commenters—wrote back, rejecting these arguments. Then, two months ago, Dutch psychologists published a study of kinksters and mental health. I started digging around. There isn’t much quantitative research on this population, but I found a few decent studies that can help us clarify the debate. Is BDSM sick? Let’s look at the evidence.

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

1. How many people do BDSM? There’s only one good random-sample survey on this question. It was taken in Australia a decade ago. Nearly 20,000 people between the ages of 16 and 59 were interviewed by phone. In the whole sample, 1.8 percent of men and 1.2 percent of women answered yes to the question, “In the last 12 months, have you been involved in B&D or S&M?” (The question went on to explain, “That’s bondage and discipline, sadomasochism, or dominance and submission.”) Among respondents who were sexually active, the BDSM minority barely increased, to 2 percent of men and 1.4 percent of women. Among those who had a sexual partner in the previous year, the figure was 2.2 percent of men and 1.3 percent of women.

That’s roughly equivalent to the sexually active gay population, as measured by similar self-reporting. In the Australian survey, the authors reported “less than 2 per cent of men and women” said they’d “had sex with a same-sex partner in the past year.” The percentage of respondents who said they’d ever had a gay sexual experience (not just in the last year) was higher—6 percent of men, 9 percent of women—and presumably the same is true of BDSM. In the Dutch study, for instance, 448 respondents accessed and completed a BDSM survey through a website devoted to personal secrets. Of these, 3 percent “indicated having had previous BDSM experience.”

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2. Is it an orientation? Previously, I argued that homosexuality is fixed (an orientation) but that BDSM is flexible (a lifestyle). Kinksters replied that BDSM, too, is an orientation. What do the data show? Mostly flexibility. In a study of Finnish BDSM enthusiasts, 27 percent “endorsed a statement suggesting that only sadomasochistic sex could satisfy them,” but only 5 percent “no longer practiced ordinary sex.” Furthermore, 40 percent had changed their “preference” or “behavior” (in the authors’ words) from sadism to masochism or vice versa. In another study, conducted in southern California, “32% of the sample indicated that BDSM play occurred less than half the time they spent in sexual activity with partners, and just 11.2% indicated that BDSM play was their only form of sexual activity.” The core group, dedicated to BDSM, seems vastly outnumbered by dabblers.

3. Is it physically dangerous? That depends on what you’re doing. In the Finnish study, bondage and flagellation were standard: More than 80 percent of the sample had done them in the preceding 12 months. The riskier stuff was far less common:  piercing (done by 21 percent of the sample), skin branding (17 percent), hypoxyphilia (suffocation games, also known as breath play—17 percent), electric shocks (15 percent), and knives or razor blades (13 percent). The California study found a similar pattern: Bondage, flogging, and spanking were standard (more than 80 percent had done them), but other practices—“fire play” (20 percent), “piercing play” (20), cutting (14), branding (9), and scarification (5)—were rarer. Some potentially dangerous activities were surprisingly common—“electric play” (42 percent), “knife scenes” (40), and “breath play” (27)—though in many cases, the implements were probably just props. It looks as though about 20 percent of these folks are actually cutting, burning, zapping, or partially suffocating each other.

That’s a minority, but it’s still worrisome. In the Finnish sample, those who said they’d previously suffered sexual abuse—23 percent of the women, and 8 percent of the men—were particularly problematic. According to the authors, “Visits to a physician because of injuries obtained during sm-sex were significantly more common among the abused respondents (11.1%) than among the non-abused respondents (1.8%).”

BDSM community leaders preach the importance of “safe words”—prearranged signals that the restrained, flogged, or dominated participant can use to withdraw consent and stop the action. In the Finnish study, 90 percent of the sample said they “sometimes” incorporated such words in their encounters. But less than half did so “without exception.” That, too, is a problem.

4. Is it mentally unhealthy? For the most part, no. The surveys vary, so let’s take them one by one. The California study, conducted by Pamela Connolly of the California Graduate Institute, found a “significantly higher level of narcissism” in its BDSM sample than in the general population. Connolly estimated that 30 percent of people in the sample were clinically significant on that scale. Theoretically, a high narcissism score implied “little interest in give-and-take in social life,” but Connolly cautioned that it could signify “personality strengths as well as personality pathology.” Only two of the 132 participants met the criteria for pathological narcissism, and Connolly noted an “absence of borderline pathology.”

Likewise, the sample “scored relatively highly on almost all of the scales” related to dissociative symptoms, suggesting a “higher prevalence of a dissociative syndrome.” Yet only one respondent met the criteria for dissociative identity disorder. Compared with the general population, the sample showed a “significantly higher level of histrionic features,” which increased the risk of “fear of genuine autonomy,” “a need for repeated signs of acceptance and approval,” and an “indiscriminate search for stimulation and affection.” But Connolly added that this result might have been skewed by geography, since the Los Angeles BDSM community favored and fostered exhibitionism.

Connolly reported no significant differences on “most measures of PTSD, on obsessive-compulsion or on depression or anxiety.” She emphasized that “no evidence was found to support the notion that clinical disorders—including depression, anxiety, and obsessive-compulsion—are more prevalent” in the BDSM population.

A Canadian study published that same year (2006) also defended BDSM. “Masochists were not found to be more prone to psychological distress or mental instability than the other groups,” the authors wrote, and “we found no support for the idea that masochists were more inclined to engage in escapist behaviors such as drug-taking.” Furthermore, “the SM participants scored equivalent to or lower than the non-SM comparison group on Authoritarianism.” But the authors conceded that their small sample—93 people—made it statistically difficult to find differences.

The Dutch study, which drew hundreds of BDSM respondents from an online forum, found that kinksters were, if anything, healthier than a vanilla control group. “The BDSM group scored higher than the control group on Extraversion, Openness to Experience, and Conscientiousness, and lower on Neuroticism and Agreeableness,” the authors reported. The BDSM group was also less sensitive to rejection (even submissives scored no higher on this factor than the control group did), and all three BDSM subsets—dominants, submissives, and “switches”—outscored controls on “subjective well-being,” though the difference was significant only for dominants. Measures designed to assess healthy attachment “showed the same pattern; if scores were different, then the control group had the lowest scores, followed by the subs, the switches, and finally the doms with the highest scores.” What stood out most in this study was the difference between dominants and everybody else: They scored higher on subjective well-being and lower on anxious attachment, rejection sensitivity, and need for approval.

All these studies should be taken with a grain of salt. They drew their BDSM samples from a few clubs and online forums that didn’t really match the control groups—the BDSM samples, for instance, were older, more male, and more educated—and might not represent kinksters generally. From the way the papers were written, it’s obvious that the researchers sympathized with BDSM and interpreted their data accordingly. But the Australian study, with its more trustworthy random population sample, backs them up. “Engagement in BDSM was not associated with higher levels of psychological distress (i.e., feeling sad, nervous, hopeless, etc.),” the authors reported. “Indeed, among men who participated in BDSM, the levels were significantly lower. Among women, they were apparently higher but this did not reach statistical significance.” For women in the Australian survey, “engagement in BDSM was significantly related to having been imprisoned within the past 15 years.” But that wasn’t true for men.

5. Is it exploitative? In the Dutch sample, men were primarily tops (48 percent classified themselves as dominant, 33 percent as submissive) while women were primarily bottoms (76 percent submissive, 8 percent dominant). In the California sample, 61 percent of men were exclusively or mainly dominant (26 percent were exclusively or mainly submissive), while 69 percent of women were exclusively or mainly submissive (30 percent were exclusively or mainly dominant). The smaller Canadian sample showed no such difference, and the authors said they “could not find evidence that sadomasochists are anti-feminist.” But the gender gap bears watching. If it shows up in other studies, it will raise hard questions about the subordination of women, either by culture or by nature.

What does all this research add up to? Here are a few tentative ideas. First, BDSM isn’t a single practice or population. It’s an amalgamation of different people and fetishes. The spankers are different from the branders. Most people who like collars want nothing to do with choking. The populations sampled in the existing studies were largely soft-core—the Canadian sample, for instance, was recruited from sites such as alt.personal.spanking and alt.sex.bondage—and this tilt, while probably representative of BDSM as a whole, makes it difficult to discern whether the heavy stuff is mentally healthy or physically safe.

Second, the soft-core majority of kinksters might be defined less by fetish than by sheer appetite. In the Australian study, “Engagement in BDSM correlated strongly with a large number of sexual practice measures associated with greater sexual activity and interest in sex.” The authors of the Canadian paper agree:

“Sadomasochists in this research reported having had more sex partners and a greater likelihood of having explored non-heterosexual experiences. They were also more likely to be sexually active relative to non-sadomasochists. One might wonder, on the basis of these findings, whether sadomasochists are simply individuals for whom sex and sexuality play a relatively important role. One might wonder whether SM ought to be understood best as a game explored by the sexually sophisticated and adventurous … ”

Third, what makes BDSM safe and mentally healthy for most of its players is a combination of self-awareness, communication, and rules. Subjective well-being, as the Dutch paper points out, is known to benefit from recognition of “one’s own sexual identity and desires” as well as the ability “to adequately and explicitly communicate these to sexual partners. As BDSM play requires the explicit consent of the players regarding the type of actions to be performed, their duration and intensity, and therefore involves careful scrutiny and communication of one’s own sexual desires and needs, this may be one possible explanation for the positive association between BDSM practitioning and subjective well-being.” Community helps, too: According to the Finnish paper, “social well-being appears to be associated with levels of integration in sadomasochistic subcultures.”

In short, BDSM is a lot like other practices and communities. It works when it’s well-governed and when its constituents are well-formed. When they aren’t, and when the rules are unclear, the dangerous ingredients at the core of this culture—domination, exploitation, violence—can inflict serious harm. In the Finnish study, the authors reported that kinksters who had previously been abused “visited a physician more often because of injuries inflicted in sm-sex. This may suggest that they had difficulties in setting appropriate limits.” The researchers concluded that “a small subgroup of sm-practitioners seem to be both psychologically and socially maladjusted.”

For these people, BDSM is a pathology. But for most of its practitioners, it’s just a game. Our job is to keep it that way, by encouraging the community—and allowing it—to police itself.

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