It’s not all sex addiction: A clinical look at BDSM fetish

When I started working nearly exclusively in the sex addiction field, sex addiction was not very widely known and even less widely accepted.  Those seven years have brought a great deal of recognition to the addiction as well as a large amount of attention in the press and public eye.  The increased attention to sex addiction is, in part, a great thing.  However, there is a down side as well.  The moniker sex addict now seems to be tossed around rather lightly or as an excuse for sexual behavior in which politicians and celebrities are caught engaging in behind someone’s back.  In my opinion, this is a detrimental development.  First, it minimizes the pain and suffering experienced by someone who truly has a sex addiction.  Secondly, it has the potential to demonize aspects of sexuality because they are “outside the box.”

As a clinician, supervisor and trainer, I try to emphasize the importance of correctly diagnosing a client’s behavior.  I do not throw the label sex addict around lightly. I also understand that there are things that people do that are outside of the comfort zone of societal norms.  This does not necessarily make a person a sex addict.  I struggle with the idea that one can sometimes hear espoused that anything that is outside the norm of traditional heterosexual sex stereotypes is addiction.  In this, and a series of writings to follow, I will take a look at behaviors that are often labeled addictive even when they may not be so.  Just because it may make someone uncomfortable, does not make it addictive.

The inspiration for this first article comes from my brother, Christopher Weeks, who is a professional photographer (http://black-cat-studios.tumblr.com/) in Tampa, Florida.  He recently posted photography work he had done at an event called Fetish Divine (www.fetishdivine.com).  Fetish Divine is an organization that hosts pan-sexual play parties at a club in Tampa.  When my brother photographs these events (as an invited professional) he often gets complaints from others about the photographs being lewd or pornographic.  The famous Supreme Court opinion by Justice Potter Stewart on obscene material has been quoted by the masses for years.  “I know it when I see it.”  However, isn’t that dependent on the view of the seer?

This discussion with my brother started me thinking about how we view S&M in the sex addiction treatment community.  There are some that would always categorize this type of behavior as addictive.  The DSM-V (the diagnostic bible for mental health practitioners) places sadomasochism in the paraphilia section of disorders.  Sexual Masochism disorder is defined by a person, for at least 6 months, obtaining recurrent and intense sexual arousal from the act of being humiliated, beaten, bound or otherwise made to suffer, as manifested by fantasies, urges or behaviors.  Sexual Sadism Disorder is defined by a person, for at least 6 months, obtaining recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges or behaviors.  The key to both of these diagnoses is the B section.  For Sexual Masochism, the fantasies, urges or behaviors must cause significant distress or impairment in social, occupational, or other important areas of functioning.  For Sexual Sadism, the individual has to have acted on these urges with a non-consenting person, or the sexual urges or fantasies must cause clinically significant distress or impairment in the same categories listed above.  From a purely clinical point of view, engaging in BDSM only becomes an issue if it impairs a person’s functioning or if it is with a nonconsensual partner.

From the perspective of Sexual Addiction (a diagnosis that does not exist in the DSM-V), we look at BDSM as behavioral categories or scales according to one instrument (the Sexual Dependency Inventory).  This means that someone who is a sex addict may engage in behaviors involving pain exchange or humiliation and/or domination.  In addiction treatment, as in the DSM criteria for SMD or SSD, we look at the effects of engaging in this behavior on the person.  Does it cause distress on any level?  Has the person ever tried to stop engaging in the behavior?  Do we see an escalation of the behavior in order to get the same feeling or high?  If the answer to these and similar questions is no, then we cannot unequivocally say that the person who is engaging in the BSDM is a sex addict.

When discussing any fetish with a client, I don’t approach it as right or wrong, or addictive or not.  We try to frame the fetish with the question “is it healthy or not.”  Is the engagement in the fetish consensual for all parties?  Consent, for me, is critical.  Consent is different from coercion or compliance.  If a person is consenting, they fully wish to participate in the behavior.  They are not doing so because they are pressured by a partner or feel they are obligated to do so for some reason.  If I engage in the behavior because I fear my partner will leave me if I do not, then this is not true consent.

Another aspect we look at when discussing fetishes is psychological distress.  Does engaging in the behavior cause any type of psychological distress to the person?  Does it create strain on relationships?  Does it interrupt normal life functioning?  Does the person feel ashamed of the behavior they are engaging in or aroused by?  Again, if the answer to these questions is no, then it is not my place as a therapist to label the behavior as dysfunctional, addictive or wrong.

As I move into my 8thth year of working nearly exclusively with sexual addiction, I fear that our community, as well as the public, has a tendency to pathologize non-traditional sexuality.  I also have a fear that well-meaning therapists will impose their own sexual beliefs and views onto others, particularly clients, and end up doing more harm to a person than good.  As therapists who deal with sex on a daily basis, it behooves us to know our own boundaries with sex but also be open to other forms of sexuality that others enjoy.  Can we work to reframe sexuality, sexual addiction and “deviance”, moving away from right and wrong, good and bad to “is it healthy for you?”  If it is, then perhaps we don’t need to pathologize it. If it is not, then we can help our client to work through their issue.

2 thoughts on “It’s not all sex addiction: A clinical look at BDSM fetish

  1. I think your ‘summary’ question is fair, but it must be hard to determine in different individuals, and how they ‘raise the bar’ on pain levels, degredation, etc..? I wonder what percentage of ‘addicts’ are more dependent on the imagined ‘affirmation’ that comes with sex. Please excuse the way i’ve expressed myself, I’m ignorant of, but extremely interested in this subject!

    1. John
      This is a very valid question. The name Sex Addiction is a bit of a misnomer when you look at the root of addiction. In my opinion, Sex Addiction truly has nothing to do with sex. It is about a search for connection that often comes from ruptured attachments. One of the core beliefs about sex that many sex addicts have is that sex is love. Sex and love get fused somewhere along the line. Therefore, your thought about an addict becoming dependent on the affirmation from sex is dead on. A downward spiral often ensues. I need sex for validation/love but perhaps feel shameful about my sexual behavior. That fuels my negative self beliefs about being bad and unlovable. Those feelings are intolerable so I try to fill the emotional hole and use sex to do so. The spiral ensues. If I only feel validated or affirmed through sex but feel bad about my behavior, I am bound to escalate both the behaviors and bad feelings. Thanks for your comment. Jennifer

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