In the DSM-IV TR, sadomasochistic behavior can be diagnosed as a disorder if the patient "has acted on these urges with a non-consenting person" or "the urges, sexual fantasies, or behaviors cause marked distress or interpersonal difficulty". Consensual sadomasochism can no longer be considered a disorder unless in the patient's estimation it is negatively/severely impacting his or her life.

I have never considered myself a masochist, whether in the clinical sense of it being a disorder that has affected my life, or as a sexual preference (masochism as a BDSM-related term.) I have explored different psychosexual roles, including those related to bondage, domination, sadism, and masochism, and have found it interesting to explore new territory, but none of these have ever stood out to me as a preference, not even a preference that I have but am embarrassed about. I don't fantasize about being on the receiving end of pain or humiliation - if anything I fantasize about having more power, not less, and more pleasure, unrelated to pain - because I don't have power, including sexual power, in my life, and because I don't have much pleasure in life. I have responded sexually to pain a few times in my life, but it is not a pattern. I have also responded sexually to a very wide variety of different sexual stimuli and roles. I think the distinction is that I am drawn to psychologically new territory - so when I learn something new, it is the complication itself and the possibililty of exploring it that has been the focus, rather than any one particular fetish or role.

When it comes to self-defeating personality disorder, as described below, the criteria are rendered inaccurate if the behaviours only occur when the person is depressed.

It is not really helpful to judge a person as being his or her own worst enemy without offering insights into why it might appear that way. What would such a person get out of the behaviour or 'choice' to act in such a way? When did the behaviour first appear? Also, depending on a person's background, he or she may have unusual ideas or confused ideas about what being treated 'well' is. To me, it seems that a lot of the criteria depend upon the subjective opinions of clinicians and which might not be shared by the patients. It is unlikely that all clinicians would rate opportunities in life open to a patient as so clearly black and white. It ends up coming down to individual clinicians, and their potentially very biased preferences and opinions.

Self-defeating personality disorder is not included in the DSM, yet some clinicians do use its criteria, or otherwise list Personality Disorder NOS as the diagnosis.

Self-Defeating Personality Disorder:

A) A pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which he or she will suffer, and prevent others from helping him, as indicated by at least five of the following:

1. chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available
2. rejects or renders ineffective the attempts of others to help him or her
3. following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain ( e.g., an accident)
4. incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provoking an angry retort, then feels devastated)
5. rejects opportunities for pleasure, or is reluctant to acknowledge enjoying himself or herself (despite having adequate social skills and the capacity for pleasure)
6. fails to accomplish tasks crucial to his or her personal objectives despite demonstrated ability to do so, e.g., helps fellow students write papers, but is unable to write his or her own
7. is uninterested in or rejects people who consistently treat him well, e.g., is unattracted to caring sexual partners
8. engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice

B) The behaviors in A do not occur exclusively in response to, or in anticipation of, being physically, sexually, or psychologically abused.

C) The behaviors in A do not occur only when the person is depressed.















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