Resources

BDSM/Kink FAQs for Clinicians

1.         What is kink? Are BDSM and kink the same thing?

Kink is used as an umbrella term to include a wide range of consensual sexual, erotic, intimate, pleasurable and/or self-expressive interests and/or behaviors. Kink is often used interchangeably with BDSM (Bondage/Discipline, Dominance/submission, and Sadism/Masochism) which may include the use of restraints or restriction, discipline, spanking, slapping, sensory deprivation (e.g. using blindfolds), and various roleplays and relationships such as dominant/submissive, master/slave, pet/handler, to name a few. Kink also includes erotic cross-dressing and some fetishes involving consenting adults. Kink may or may not include traditional sexual or erotic activity, while some people use kink to refer to erotic relationship styles such as consensual nonmonogamy and swinging.

2.         How common is the practice of BDSM?

 For some, kink is a fantasy only, while for others it is a behavior they intermittently engage in; while still others seem to hold kink as a central sexual identity. Research indicates that approximately 30-69% of people in the general population have fantasies that involve BDSM. A nationally representative survey conducted in the U.S. in 2015 found that between 13-30% of respondents reported engaging in bondage, spanking or whipping. Another study found 7.6% of the general population self-identified as a BDSM practitioner. When working with kinky clients, it is also important to recognize the potential compounding of cultural stigma and oppressions with intersectional identities and bodies. 

3.         Is BDSM considered a mental disorder according to current psychological and medical guidelines?

BDSM/kink is not a mental health diagnosis. There is a large body of research indicating that kinky fantasies and behaviors are not related to mental disorders, e.g., BDSM practitioners do not exhibit more psychopathology than others. Moreover, both the American Psychiatric Association’s Diagnostic and Statistical Manual – 5th edition (DSM-5) and the World Health Organization’s proposed International Statistical Classification of Diseases and Related Health Problems – 11(ICD – 11) make clear that consensual kink practices are not in and of themselves evidence of psychopathology. They only merit clinical attention when clients report substantial subjective distress and/or impairment in work or life functions attributable to their sexuality, or when behaviors are done with nonconsenting participants. 

4.         Is the practice of BDSM abusive?

BDSM is not Intimate Partner Violence (IPV). BDSM/kink activities are fully informed and consensual, and engaged in for purposes of intimacy, sexual expression, fun, or personal development, not to express anger or interpersonal aggression. Although some perpetrators of abuse may claim they are enacting consensual sexual activities, Intimate Partner Violence is completely separate and distinguishable from kink, and it is important for care providers to distinguish between the two. While kink play may appear scary to outside observers, similar to intense athletic activities, that does not make kink play a negative experience for participants.

5.         Are people practicing BDSM acting on past traumas?

BDSM is not inherently linked to trauma history or abuse. Research has indicated that the sexual abuse history and adverse childhood events (ACE scores) of people involved in kinky activities is not substantially different from those not involved in BDSM.

6.         How can one stay safer when engaging in BDSM activities?

Consent is the foundation of ethical, healthy kink activities, and educational efforts within the kink communities. When social organizations and clubs began to be formed in the kink subculture of the 1970’s, community leaders recognized the need to distinguish BDSM from psychopathology and/or violence. The issue of voluntary, informed consent was central to this effort. The 1983 mission statement of the Gay Male SM Activities (GMSMA) was the first to make this explicit by declaring that kink activities must be ‘safe, sane, and consensual (SSC)’. Since then, this phrase and several alternative phrases (e.g., RACK: Risk Aware Consensual Kink, and FRIES: Freely given, Reversible, Informed, Enthusiastic, & Specific) have been commonly used by BDSM practitioners to indicate the prime importance of consent. More recently, “Explicit Prior Permission” (EPP) became the legal framework for consent to kink, and is used in court to determine criminal cases and civil liability for injuries and nonconsensual acts (created by the American Law Institute in the revised Model Penal Code on Sexual Assault, Section 213.10 in 2022).

There are five requirements for Explicit Prior Permission for consent to BDSM:

• 1. Discussing the risks before starting
• 2. Have a way to stop at any time
• 3. Agree on what roleplay resistance is okay
• 4. You must be an adult with a capacity to freely consent
• 5. You can’t seriously injure someone. 

7.         What are some common kink community practices clinicians should be aware of?

Research has found that consent is the most important thing for service professionals to understand in regards to kink in order to assist clients. In general, consent is an informed, voluntary agreement by two or more people to engage in a particular activity or relationship. Consent is not synonymous with safety. Safety requires that the practitioners of kink are informed about safe practices, experienced, and not engaging in BDSM while under the influence of drugs or alcohol. Some practices are considered unsafe or controversial within the kink community, such as choking/asphyxiation or blood play. The kink communities have developed a number of cultural practices to facilitate consent, such as: the use of safewords to communicate a need to pause or stop an activity; negotiation between partners to agree upon limits and desires prior to engaging in activities; aftercare to address the psychological and physical needs of each partner upon conclusion of the activities; and check-ins to assess how the shared experience impacted and facilitated both partners’ intentions. These structured practices promote agency within each individual, leading to the potential for future play.