BDSM and Mental Health: What the Research Actually Shows

Introduction

For much of the twentieth century, BDSM was assumed within psychiatry and popular culture to be an expression of underlying psychopathology, trauma, or dysfunction. This assumption has been directly and repeatedly tested by empirical research over the past decade, and the findings consistently point in the opposite direction. This article reviews what the peer-reviewed evidence actually shows about the mental health of BDSM practitioners. 

The Landmark Study and What It Found

The most influential study in this area was conducted by Wismeijer and van Assen (2013), published in The Journal of Sexual Medicine. The researchers compared 902 BDSM practitioners against 434 control participants on a range of psychological characteristics, using the NEO Five-Factor Inventory for personality, the Attachment Styles Questionnaire, a rejection sensitivity measure, and the World Health Organization-Five Well-being Index. 

The findings were notable. BDSM practitioners scored as less neurotic, more extraverted, more open to new experience, and more conscientious than the control group. Practitioners also showed higher subjective wellbeing and were more likely to demonstrate secure attachment in relationships. The researchers concluded that BDSM may be more accurately understood as a recreational leisure activity than as an expression of psychopathological processes (Wismeijer and van Assen, 2013). 

This finding has since been replicated. A 2025 study designed specifically to replicate and extend the original research, conducted outside Western Europe to test whether the findings generalised across cultures, confirmed the original pattern: BDSM practitioners exhibited higher secure attachment and lower neuroticism than non-practitioners (reviewed in PsyPost, 2025, reporting on the replication study). 

What Subsequent Research Has Added

Later research summarised in academic literature on BDSM identification has found that, compared to non-practitioners, BDSM practitioners are associated with better mental health and emotion regulation, and report better sexual function scores across most dimensions measured, for both men and women (cited in Research Square, 2024, drawing on multiple primary studies). 

A 2022 survey study published in European Psychiatry by Schuerwegen and colleagues investigated the psychological mechanisms underlying BDSM interest, including sensation seeking and coping strategies, in 256 Dutch-speaking BDSM practitioners compared to a matched general population sample. The study also examined stigma directly, finding that approximately 86 percent of the general population sample held stigmatising beliefs about BDSM and its practitioners, despite the absence of evidence to support those beliefs (Schuerwegen et al., 2022). 

This stigma gap is significant. The empirical research on psychological health consistently fails to find evidence of harm, while public perception continues to assume the opposite. 

Where Caution Still Applies

None of this research suggests that all BDSM practice is automatically healthy, or that psychological distress can never be present in BDSM contexts. The DSM-5 continues to classify sadomasochism as a clinical concern specifically when it causes daily distress or impairment in a person's functioning, consistent with how any sexual interest is assessed clinically. The research distinguishes between BDSM practice itself and any individual's broader psychological functioning, which depends on far more than sexual interests alone. 

What the evidence does establish clearly is that BDSM interest and practice, in itself, is not a marker of psychopathology, trauma, or poor mental health. The data points consistently in the direction of equal or more favourable psychological functioning among practitioners compared to non-practitioners. 

Conclusion

More than a decade of peer-reviewed research, replicated across different populations and cultural contexts, finds no evidence that BDSM practice is associated with psychological harm. If anything, the data consistently shows practitioners scoring favourably on measures of personality, attachment security, and emotional regulation compared to the general population. 

The persistent stigma surrounding BDSM exists in spite of, not because of, the evidence. Understanding this changes the conversation from one of pathology to one of informed, consensual practice. 

Explore This Territory With Informed Support 

If you are curious about exploring power dynamics or BDSM-adjacent practice within a grounded, evidence-informed, consent-based framework, a one-to-one session with David is the place to start that conversation. 

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References 

Wismeijer, A. A. J., & van Assen, M. A. L. M. (2013). Psychological characteristics of BDSM practitioners.. The Journal of Sexual Medicine, 10(8), 1943-1952. https://pubmed.ncbi.nlm.nih.gov/23679066/ 

Schuerwegen, A., Morrens, M., Wuyts, E., Huys, W., Goethals, K., & De Zeeuw-Jans, I. (2022). The psychology of kink: a survey study investigating stigma and psychological mechanisms in BDSM.. European Psychiatry, 65(S1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9568025/ 

PsyPost. (2025). BDSM practitioners exhibit higher secure attachment and lower neuroticism (replication study).. PsyPost. https://www.psypost.org/bdsm-practitioners-exhibit-higher-secure-attachment-and-lower-neuroticism/