Ask the Therapist
Could Sadomasochistic Tendencies Be a Form of Self-injurious Behavior
Dear Mr. Formica,
Could sadomasochistic tendencies be a form of self-injurious behavior as
listed under the DSM-IV criteria for the disorder?
You need to be a bit more clear in your question. When you say "the
disorder" are you referring to S&M or BPD? I assume from your subject
line you are referring to S&M as it relates to BPD, but S and M are also classified
as disorders and I don't want us to get off on the wrong track. Could you kindly clarify, as I have opinions on both
questions. And, at the risk of sounding salacious, a bit more specific
information might be helpful to my perspective, as well.
Thank you for your prompt reply. I was referring to BPD as the disorder. I
did not realize sadism and masochism were officially disorders.
I know that self-injurious behavior is an indication of BPD when combined
with the other criteria. If someone has participated in S&M for the purpose
of feeling pain, would that qualify as self-injurious behavior? From what I
have read, a person cuts or burns him or herself in order to feel
something - it brings a certain relief. I am wondering if masochistic
tendencies serve that same purpose, but I have not seen anything about it in
the literature.
Complicated question.
Let's see...yes and no. The self-injurious behavior associated with BP is generally a gesture in a bid for attention. Although some BPs are genuinely suicidal (self-injurious behavior being a para-suicidal behavior), the intention of this aspect of BP is different than "hurting oneself". A subtle difference, but an important one.
The psychodynamic intention of masochism is less self-injurious, and more about power and control...specifically relinquishing control. S&M is most often thought of as a bid for reclaiming or relinquishing control in order to play out a past trauma, hyper-dominant Super-ego (the part of the ego that makes the rules) or fix some past trauma...I had a 48 yo patient who, upon coaxing his partner into playing out a submissive rape fantasy where he was the victim, was able to (1) process his submissive nature and activate his assertiveness, (2) work through and let go of having been incested by his brother at age 6, (3) heal his relationship with his brother, (4) diminish his taste for "kink" and (5) develop said taste for "kink" into a "healthier" aspect of his sex life....all within the space of 6 months, after having been a serious devotee of S&M for 30-odd years!
Here's where it gets complicated. The fundamental nature of the relationships developed by BPs is socio-emotionally sado-masochistic. Could the desire to be involved in a physically sado-masochistic situation be a symbolic representation of this interior BP dynamic?...most assuredly. Could that SM relationship be an intentional aspect of the self-injurious tendencies of the BP...less likely, because the BP uses para-self-injurious and para-suicidal behavior as a manipulation -- you can't really exercise manipulation in a situation for which you are volunteering, yes?
