Guides

Sadism and masochism: what they mean, the disorders, and why pain can feel good

Sadism is taking pleasure in giving pain or humiliation; masochism is taking pleasure in receiving it. Together, between consenting adults, they make up sadomasochism, the SM in BDSM. Psychiatry once treated both as illnesses. Today the diagnoses only apply where there's real distress, impairment or, for sadism, a victim who didn't consent, and the World Health Organization no longer lists consensual sadomasochism at all. This page explains the words, including the forgotten one, algolagnia, sets out exactly when psychiatry calls it a disorder, looks at the research on why pain can feel good, and separates sadism from dominance and from everyday cruelty. For the history of the names, see what BDSM means.

Sadism, masochism and sadomasochism

Wikipedia defines sadomasochism as deriving pleasure from inflicting or receiving pain or humiliation, and adds the line that matters most: consent distinguishes consensual sadomasochistic activity from coercive sexual violence. The two words were joined into one compound by the psychoanalyst Isidor Sadger in a paper of 1913. Freud, writing in 1905, had already described the two as linked, and as the result of aberrant development, a view psychiatry has long since abandoned.

In practice the roles mix. A masochist isn't necessarily submissive, a sadist isn't necessarily dominant, and plenty of people switch. What unites them is that pain, given or received inside an agreed frame, becomes something other than suffering.

Algolagnia and algophilia

Before sadism and masochism became the standard words, doctors tried others. The French physician Charles Féré used algophilia, meaning love of pain. Around 1892 the German psychiatrist Albert von Schrenck-Notzing proposed algolagnia instead, from the Greek for pain and lust, because he argued the feeling was lust rather than love. Medical dictionaries went on to describe active algolagnia as sadism and passive algolagnia as masochism, and the English word was in use by the early 1900s. It's archaic now, but it's still a precise word for a pain fetish, and it turns up in searches for exactly that reason.

When is it a disorder?

Under the American Psychiatric Association's current manual, DSM-5-TR, as summarised by the MSD Manual, the two diagnoses use different tests.

The MSD Manual notes that mild sadistic sexual behaviour is a common practice between consenting adults, estimates masochistic interests at around 10 to 30% in Western populations against fewer than 5% for the disorder, and says treatment of masochism isn't necessary if someone doesn't have clinically significant distress.

The WHO went further. Its ICD-11, in force since 2022, removed the old sadomasochism category; its working group did not consider these arousal patterns in themselves to be mental disorders when they involve consensual or solitary activity without inherent harm. The only remaining diagnosis is coercive sexual sadism disorder, which concerns non-consenting people and specifically excludes consensual sadism and masochism. Some countries moved earlier: a Norwegian campaign group, ReviseF65, reports that Denmark dropped sadomasochism from its national list in 1995 and Norway in 2010.

Why pain can feel good

Pain that's chosen and safe isn't experienced the way an accident is, and research is starting to show why. In 2013 the psychologist Paul Rozin and colleagues described "benign masochism": the enjoyment of negative bodily reactions and feelings in a context of feeling safe. Across 29 initially unpleasant experiences, from sad films to painful massages, people sought out intensities just below what they couldn't tolerate. Nearly two thirds of their participants rated the burn of spicy food above 50 on a 100-point liking scale. The researchers deliberately left sex out of their questionnaire, but the principle is the same one a masochist knows well.

Relief is part of it. A 2011 brain-imaging study by Leknes and colleagues found that the relief when pain stops works as a reward, tracked by activity in the nucleus accumbens, a key part of the reward system. Context matters too: a 2016 study by Kamping and colleagues found that people with masochistic preferences rated the same laser pain as substantially less intense and less unpleasant when it came with masochistic imagery, with their brains processing the pain more as sensation and less as emotion. A 2022 review of BDSM physiology by Wuyts and Morrens found changes in endocannabinoids, part of the body's own reward system, and higher pain thresholds in submissives. The popular idea that it's all endorphins hasn't actually been demonstrated.

Sadism is not the same as dominance

People use the words interchangeably, and they shouldn't. Dominance is about power and control; sadism is about pleasure in giving pain. The 2022 review found that dominants' pleasure was linked to power play rather than pain play, and plenty of dominant women never lift a crop, preferring rules, tasks and psychological control. Equally, a masochist may want sensation without any submission at all. If you want both, say so; if you want one without the other, say that too. Our pages on impact play and sensation play cover the physical side, and our guide to D/s relationships covers power without pain.

Everyday sadism is a different thing

Psychologists also study sadism as a personality trait, and it has nothing to do with consensual kink. In 2013 Buckels, Jones and Paulhus proposed adding everyday sadism to the so-called Dark Triad of psychopathy, Machiavellianism and narcissism, making a Dark Tetrad. In one study, students could choose between unpleasant tasks: 26.8% chose to kill bugs, another 26.8% to help kill them, 33.8% to clean toilets and 12.7% to endure ice water. The bugs were in fact never harmed. In another, only people high in sadism chose to blast an innocent opponent with louder noise, and only they would do extra work for the chance. An older proposal for a sadistic personality disorder, floated in a 1987 appendix to the DSM, was never adopted. The common thread is cruelty without consent, which is the opposite of what happens in a negotiated scene.

The sadistic woman

Female sadists exist, and Wikipedia notes they're simply less visible than male ones, adding that sex may not be what determines the preference. In femdom the sadistic mistress is a recognised style: strict, exacting, and fond of the reaction pain produces, always inside the limits she and her sub have agreed. Many performers list strict, whips or corporal discipline among their styles, and our page on strict mistress cams covers what to expect.

Pain play safely

The rules are the ones that keep all BDSM safe: negotiate before anything starts, agree a safeword, build intensity slowly, and stop when the safeword is used. The MSD Manual warns that some people escalate and stop using the safeword, which can lead to serious injury. In England and Wales consent isn't a legal defence to actual bodily harm, so marks that last are a legal risk as well as a physical one; our guide to BDSM consent models explains the law. And plan aftercare, because a body that's been through an intense scene needs looking after. This page is general information, not medical or legal advice.