Understanding Sexual Masochism with Asphyxiaphilia

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Sexual Masochism Disorder with Asphyxiophilia (SMD with asphyxiophilia) is listed in the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) as a paraphilic disorder. SMD with asphyxiophilia is when someone is aroused by being humiliated, beaten, bound, or made to suffer, especially with the restriction of breath. This disorder is thought to be caused by many different underlying issues such as, repression of previous trauma, escape from reality, and even suppression of sexual urges. There is no set treatment as each person with the disorder has varying degrees of the disorder, but options are available. Treatment options often include medicine to dull the urges, or therapy to help the patient understand when and how urges come to be a problem, and to instead use healthier options. Even though both sexes have stated an interest in trying breath restriction, in reports of death from autoerotic asphyxiation the main victims were Caucasian males.

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While Sexual Masochism with Asphyxiophilia is not a new disorder there seems to be a lack or research done to enhance what was previously researched. Not much has changed from the first installment in the second version of the DSM. Though SMD with asphyxiophilia is a dangerous disorder, many people have been exposed to the practice from movies, television shows, and even books. If we are able to show representation of this disorder to the public for entertainment purposes, they should also be aware of the danger and the mental problems this disorder it can cause.

What is Sexual Masochism Disorder with Asphyxiophilia

According to the latest version of the DSM, Sexual Masochism is the arousal associated with partaking in bondage, wherein the subject is humiliated, beaten, or bound. When asphyxiophilia is specified with it SMD, it is adding that the restriction of breath is the most pleasurable form of abuse to the subject. Sexual Masochism Disorder alone can be dangerous in the sense that it is detrimental to one’s mental, emotional, and psychological state.

What Type of Disorder is Sexual Masochism with Asphyxiophilia

SMD with asphyxiophilia is labeled in the DSM-5 as a Paraphilic Disorder, which is then broken down more into a Courtship Disorder. A courtship is useful because these disorders are similar, though extreme, and misconstrued, to human courtship behavior. A Paraphilic Disorder can only be diagnosed if the subject meets both of the criteria. Criterion A is that you must have the qualitative nature of paraphilia. For example, in SDM with asphyxiophilia the paraphilia would be asphyxiation. Criterion B is that the paraphilia must cause a clinically significant impairment. The courtship that Sexual Masochism Disorder falls into also includes Sexual Sadism Disorder, simply because both of them include the pleasure in inflicting or receiving pain and suffering.


SDM with asphyxiophilia can be cause by a variety of things, as each case is unique in its own way. Some causes include repression of a past trauma such as rape or molestation. When the subject pushes the trauma down into their subconscious it works its way out in unhealthy coping mechanisms. Another cause could be confliction in understanding one’s true sexual desires. An example is “Dominance” in which the subject is not able to figure out if they are more dominate or submissive. If they are not able to find a “healthy balance” between them the subject may take to experimenting with pain and suffering finding it pleasurable. A third cause could be suppression. When sexual urges are suppressed by people whose judgment matters to the subject, the urges get warped with confusion and when finally acted upon tend to create a pleasurable pain in which causes masochistic behavior then becomes associated with sex.


Symptoms from someone who suffers from SDM with asphyxiophilia would generally, but not always include distress, hyper sexuality, and psychosocial impairment. When the subject is suffering from distress they have many levels that contribute to the overall feeling. One of the contributors is guilt. Guilt is felt because the subject may feel like they are the cause of the confusing, their own suffering or someone else’s suffering. A second contributor to distress is shame. They feel shameful for enjoying pain during sex, and for being abnormal from societal perspective. A third contributor in distress can be sexual frustration. When they do not want to talk about what their sexual preference is with potential partners, they may be left feeling unsatisfied. Throwing shame on top or guilt truly creates a concoction fit for frustration of any type. Being unable to achieve the level of pain pleasurable to the subject on their own can lead to more sexual frustration as well as frustration with one’s self. Adding all of these together we can see why loneliness is also a factor in distress. Not having anyone to talk to or being generally unhappy can cause the subject to feel isolated and lonely. Another symptom is hyper sexuality. Hyper sexuality is defined as “dysfunctional preoccupation with sexual fantasy, often in combination with the obsessive pursuit of casual or non-intimate sex; pornography; compulsive masturbation; romantic intensity and objectified partner sex.” If the subject cannot get a grasp on the urges, they may end up excessively masturbating, or having casual sex at an alarming rate to try and satiate those desires. Psychosocial impairment or when you no longer feel like you can socialize normally, can happen when factored in with the distress and the hyper sexuality. Alcohol and drug abuse often form as a result of psychosocial impairment.

Treatments and Who is at Risk

Though each case and subject will vary, as will the degree in which they experience SDM with asphyxiophilia, there are options when it comes to treatment. One option is medication. Medication can help reduce the sexual urges as well as any anxiety and depression that may be stemming from the subject’s distress. Another treatment option is cognitive-behavioral therapy which is a type of therapy that “boosts happiness by modifying dysfunctional emotions, behaviors, and thoughts.” Though most people notice the urges at the age of nineteen, the most common victim of death by SDM with Asphyxiophilia is Caucasian males, causing them to be the ones most at risk for developing the disorder.

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