Neuroscience of Kink
Throughout history, sexuality has been important to the continuation of our species. During this month of pride, we explore when we've turned sexuality into a diagnosis and where expressions of sexuality can be harmful or feel shameful.
Cultural influences such as Rihanna's song "S&M," TikTok's 'book-tok' community's love of books with dominant characters, and "50 Shades of Gray" have all continued to bring more diverse sexual practices into the mainstream. Research has shown about 20% of people have some interest in kink.
So why is this a diagnosis? Should it be?
In this month's episode, Laine walks us through findings from Elise, Wuyts, Manuel, Morrens, and many others to help us better understand why the appeal for kink exists, when it can be harmful, and when it can be healthy. And helps explore:
What is our understanding of sexual desire?
What can we learn from alternative sexual practices?
What does this mean for the field of mental health and the power mental health professionals wield?
**Though this episode covers an adult topic, it does not have explicit content.
As mentioned at the beginning of this episode, we've also started a Patreon! We value all of our listeners and want to get continue to grow this incredible work. Thank you so much to all our supporters and if you want to know more ways to be part of our Brain Blown Community, head to www.patreon.com/brainblownpodcast to learn about our offers!
RESOURCES
https://www.esmeljames.com/
Elise Wuyts Manuel Morrens -- The biology of BDSM: a systematic review
Kristina Gupta -- Protecting Sexual Diversity: Rethinking the Use of Neurotechnological Interventions to Alter Sexuality
Siyang Luo, Xiao Zhang -- Embodiment and Humiliation Moderation of Neural Responses to Others' Suffering in Female Submissive BDSM Practitioners
Umit Sayin -- DSM Controversies, Defining the Normal and the Paraphilia: Sexual Pleasure Objects, Fantasy, Variations, Soft-BDSM, ESR, Hypersexuality, Sex Addiction and Nymphomania
Cara R. Dunkley, Anne Barringer, Silvain Dang, Lori A. Brotto -- Dispositional Mindfulness among BDSM Practitioners: A Preliminary Investigation
Gautami Polepally Ashok -- Childhood Trauma, BDSM, and Self-Esteem: An Exploration of the Impact of Childhood Trauma on Sexual Behavior and the Effects to Self-esteem
Ashley Brown -- A Systematic Scoping Review of the Prevalence, Etiological, Psychological, and Interpersonal Factors Associated with BDSM
General Outline of Episode
The Neuroscience of Kink/ (some) Paraphilic Disorders
We should mention that this has been highly requested. Like wow, do I get bugged for it.
This is the neuroscience of Kink.
Paraphilic Disorders in the DSM 5 are a listing of a few diagnoses that include voyeuristic disorder, exhibitionistic disorder, frotteurism disorder, sexual masochism disorder, sexual sadism disorder, pedophiliac disorder, fetishistic disorder, and transvestic disorder. To quote the DSM 5 “Many dozen distinct paraphilias have been identified and named, and almost any of them could, by virtue of its negative consequences for the individual or for others, be said to the level of a paraphilic disorder.
The diagnosis of other specified and unspecified paraphilic disorders are therefore indispensable and will be required in many cases….The term paraphilia denotes any intense or persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal physically mature consenting human partners…(in other cases) the term paraphilia may be defined as any sexual interest greater than or equal to normophilic sexual interests”
What does that mean?
The category of all these diagnoses is too much. We can not research all of them. First off, as of today, I am not comfortable right now looking into any diagnosis that does not allow for nonconsent. I don’t feel I could record them with enough focus on science and not make them very opinionated. And we do try to stick to the science as best we are able (we are only human) and let you make your choices for yourself. I do need to clarify specifically, that children, animals, and nonconscious individuals can not consent. And also the category is too big. So we are going to stick with the most commonly thought of for the diagnosis for at least this episode. So we will only be looking at Sexual Sadism Disorder, Sexual Masochism Disorder (If you have an interest in us researching the neuroscience of Fetishistic Disorder, Transvestic Disorder, voyeurism, and exhibitionism, please feel free to contribute to our Patreon and we will try to get to it as soon as we can)
LAINE
Prevalence - though less is known about how many people are diagnosed with this, as per the DSM, and research varies widely from 2 percent to 30 percent of the population due to the criteria being subjective.
In 2019, a study stated “A new Kinsey Report among American people revealed that 22% of men and 12% of women had BDSM fantasies, while most of them had at least one BDSM experience. According to the Janus Report (1993) 14% of males and 11% of females practiced BDSM.
Holvoet et al., 2017 found nationally “68.8% of participants reported at least one BDSM fantasy or practice. Twenty-two percent of participants reported fantasies without acting on them; the remainder 160 indicated engagement in at least one BDSM behavior. Submissive (9.5%) and masochistic acts (15.3% reported being hit by a partner) were more common than dominant (8%) and sadistic (11% doing the hitting) acts (cf. Joyal & Carpentier, 2017). While many reported BDSM fantasies, only 7.6% identified as BDSM practitioners.
According to Brown who has done a comprehensive analysis - context differs between individuals.
What may be considered to be BDSM might be one thing to one person but not everyone. As one practitioner once stated to a room of medical professionals “If you like anal sex, have liked slapping someone behind or having yours slapped, or have ever bitten someone - congratulations - you might be kinky”
Brown reminds us that “In contemporary settings, BDSM has grown into a subculture complete with events, social networks, and differing social identities, though due to it being historically pathologized, people’s interests in BDSM may hide their sexual proclivities from others” and states “However, researchers did not offer any examples or definitions of BDSM outside the meaning of the acronym, and thus, these rates may be underestimates. Several studies indicate that BDSM interests may represent a broadening of individuals’ sexual repertoire rather than being truly “paraphilic” (as defined by a study in 2006;2009; 2010 and 2016).
In other words, hard to find prevalence when there is a lot of subjectivity and a lot of shame, and pathologization
(colloquially) - This is known colloquially as BDSM. According to Elis Wuyts Manuel and Morrens “BDSM is an abbreviation used to reference the concepts of bondage and discipline, dominance and submission, sadism and masochism, enacted by power exchanges between consensual partners.
They will also clarify that BDSM - sexual activity is not necessary.
(clinically) - Sexual Sadism disorder - six months, recurrent and intense sexual arousal from physical or physiological suffering of another person as manifest by fantasies, urges, and behaviors. And the individual has acted on these sexual urges with a nonconsenting person OR the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Sexual Masochism Disorder - six months - recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer as manifested by fantasies, urges, or behaviors. The fantasies, urges, and behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
PART 1: Terms & Background Info (5-10 minutes)
We don’t have caveman recordings of this, but we do have recordings of what today we consider non-normative behaviors often connected to sexual interaction as early as ancient Mesopotamia around 3100 BC. Specifically, there are descriptions of sexual sadism and sexual masochism.
And it is prevalent throughout history since that recording - showing up in more places than most would think.
If you want to know more about all the many places this exists in history - feel free to check out Dr. Esme Lousie James, who is both an author and a podcast specializing in this.
PART 2: What About Neuroscience (5 minutes)
Why are we looking at THIS TOPIC through this lens?
What unique perspective will Neuroscience show us regarding this topic?
Gupta “A number of authors have argued that the category of paraphilic disorders simply reflects a pathologization of nonnormative sexual desires and activities, including fetishism, cross-dressing, and consensual sadomasochism (BDSM) (see Moser and Kleinplatz 2005). According to Margaret Nichols, some individuals with “kinky” sexual interests develop self-hatred as a result of social stigma”
Why Neuroscience - because this is a complicated topic.
Throughout history, we have defined something as nonnormative. With that comes both a counterculture and a culture around shame. We are humans constantly trying to identify the good and the bad and using all tools around us to do this. The queer community has experienced this for over a hundred years.
And yet, the reality of the BDSM community is that there is also a big complication - without consent this is harm, this is assault.
Why does consent change everything?
**BREAK**
PART 3: The Science (30-35 minutes)
There is a lot to cover here - much like music - some stuff lights up a lot of our brain.
It should surprise no one that we see a response within the stress system of the brain. - of which we are talking about your HPA axis, cortisol, etc. There is a difficulty in replication of studies in this however, specifically that we see higher levels of cortisol but they are then impacted by higher levels of oxytocin and vasopressin.
Why - cortisol is telling you that something is wrong - someone is hurting you, however, consent, touch, eye contact, care, sexual contact - all of this releases oxytocin - which has been shown to be higher than in participants. Specifically, Sagarin et al showed that cortisol rose during a BDSM interaction for the receiver, and testosterone rose for both, but when there was a connection and positive interaction and positive feeling significant reduction of both of these was shown, with other studies reporting a high level of oxytocin and/or vasopressin - which we know from many episodes counteracts cortisol. Sagarin will say this is not a perfect study because it was harder to obtain a control group.
Additionally, a study of 52 individuals where there was a blood draw post interactions, specifically shortly post what is called aftercare, found higher levels of beta-endorphins, endocannabinoids, cortisol, testosterone, estrogens, vasopressin, and oxytocin. Higher levels of endocannabinoids in those who bottom, likely correlating that it was rewarding and pleasurable. There were higher levels of endocannabinoids in impact play for bottoms and higher levels of endocannabinoids in play where the top was using power play.
Elise Wuyts Manuel Morrens argues that part of our biology is to interweave pain and pleasure. More on that will be covered in our next mini-episode. Specifically, endocannabinoids are released in both pain and pleasure, often as a part of our reward center. “As such, stressful activities have often been associated with pleasurable effects. A few examples of this are extreme sports, roller-coaster riding, watching horror films, long-distance running, and body modification. These leisure activities could be likened to BDSM, in the sense that the generally unpleasant aspect of pain or stress is interpreted as pleasurable and desirable in those specific contexts.”. They go on to say we find similar results in BDSM practitioners as thrill seekers, people who like extreme sports, spicy flavors, and intense exercise. All of which can increase the likelihood of what is often called a runner’s high. Which is “a subjective euphoric state induced by long-distance running and is an example of a physically stressful situation with a pleasurable effect. Cortisol increases are seen after high-intensity exercise, suggesting a stress response from the body. Similarly, increases in both endorphins and endocannabinoids have also been found in long-distance running, suggesting a pleasurable feeling that is subjectively reported by runners as well. These hormonal changes are very similar to those found in our group of BDSM practitioners, which also demonstrated an association between cortisol and endocannabinoid levels.”
So all these things lead to high levels of endocannabinoid levels which is a feeling of reward and a euphoric state - practitioners will oftentimes call this subspace or top space.
In regards to oxytocin - this is found during sexual activity but can also be found during close contact sports - which impacts our social bonding. This link between a decrease in cortisol and an increase in oxytocin with connection implicates social bonding. Research stated this would be an interesting avenue of further research. Oxytocin across multiple studies has been inconclusive since it does seem to depend on the type of interaction both what is done and what the individual’s experience of it is.
A study by Kamping et al found activity in the Parietal Operculum - The operculum completely covers your insula. Your insula is located deep within the hemispheres of your brain, sitting on top of your midbrain -make a fist, your fingers are wrapping around your thumb - that is your operculum and your insula - it fires when there is sensory, motor, and automatic and cognitive processing. - so sensation to the body - not a surprise that this is firing
However when we specifically see “tactile stimulation involving the parietal operculum…has also been associated to the activity of the Ventral Striatum” - the ventral striatum is connected to your limbic system (our amygdala, hippocampus, thalamus, hypothalamus, anterior insula, and your anterior cingulate cortex) (controls base emotion and drive) - it sits center just above and behind your ears - conglomeration of several areas of the brain together and consists of the nucleus accumbens which are collecting a whole lot of Domaine input and celebrating it. It's been implemented high in reward-related behavior. This was a cross-study looking at images of this interaction, with non-bdsm people reporting disgust from images, and BDSM people showing activation in the ventral striatum. Umit Sayin also saw data from this area.
Umit Sayin also looked at the anterior cingulate and insula, which have been shown to be active during orgasm or pain, and hypothesized that “pain and orgasms may be using similar or the same spinothalamic pathways” also as we remember from the neuroscience of orgasm, orgasms can have pain-reducing effects and increase the feelings of ”endogenous opioids”
Also shown within research was covered in the neuroscience of pain which impacts your anterior insula and your interior cingulate context, as well as your somatosensory context because of body sensations. As to why that becomes pleasurable, more information will be covered in our next mini episodes focusing on where the body naturally turns pain into pleasure - otherwise called endorphins - such as what we feel when we exercise. Also, Endorphin release means we also get a huge rush of dopamine when that is released (more on that soon)
Dunkley, Barringer, Dang, and Brotto also state that increased pain means a decrease in other areas of the brain, which can produce altered consciousness (like runners high) This can cause a reduced blood flow to the dorsolateral prefrontal cortex which they argue might allow for disinhibitions from social constructs, and it specifically alternate attention. This can cause what BDSM practitioners report as an altered state of consciousness. This was argued to be caused by “Tops during BDSM scenes involving intense mental focus or concentration, and by Bottoms as a result of “intense rhythm- mic sensation, sensation or pain itself, unrelenting focus on a particular task or concentrated effort to endure a sensation or circumstance” as stated by a study from Newmahr.
An important note from Elise Wuyts Manuel Morrens “Erickson and Sagarin did demonstrate that BDSM sadists demonstrate prosocial sadism (e.g. where consent is explicit) and not everyday sadism. More generally, research on sexual offending finds abnormalities in frontal, temporal, and limbic regions. This suggests the presence of more bottom-up driven behavior in coercive sadists, associated with cognitive impairment, reductions in impulse control, and emotional regulation problems that are thus far not seen in BDSM participants. Additional research on dominant behavior within the BDSM context may help with illustrating further differences between consensual sexual dominance or sadism on one hand and coercive sadism on the other.
We want to learn WHY we do what we do as humans, and we’ve looked to the brain for explanations…
According to Dunkley, Barringer, Dang, and Brotto there is emerging research on the well-being of BDSM. Specifically, it has wellness aspects associated with it. Their study specifically focused on preliminary research looking at how individuals who take part in BDSM are in fact practicing mindfulness when they are engaging in it. This research also shows that people in engage in BDSM, despite common belief are not more mentally unhealthy than the general population. According to Wismeijer and Van Assen “With respect to personality, research has found BDSM practitioners to not differ relative to non-BDSM practicing individuals, or when differences were observed, the psychological characteristics of BDSM practitioners have generally been found to be more favorable” They also found in their study in 2013 that “BDSM practitioners to be less neurotic, more extraverted, more open to new experiences, more conscientious, less rejection sensitive, and have higher subjective well-being than non-BDSM practitioners. The authors made an argument that to engage in the practice of BDSM successfully, there is a need to be more self-aware, there is an incredible increase in communication, there is a value in explaining personal boundaries and wishes, and the need to build trust and consent. Thus engaging in this (as they called it) “leisure activity” required good practitioners to build these skills.
Dunkley, Henshaw, Henshaw, and Brotto state “The altered states of consciousness sometimes produced by tactile BDSM play have been theorized to involve mindfulness. Mindfulness is a practice that emphasizes non-judgmental awareness and acceptance of emotions, thoughts, and physical sensations in the present moment. Flow and mindfulness are conceptually similar and theoretically interconnected, particularly in regard to the aspect of focused concentration”. This was supported by multiple studies that have shown that mindfulness practitioners have increased pain tolerance and lower pain sensitivity. Largely because “pain activates the areas of the brain involved in sensory processing for both meditators and non-meditators; however, the neural networks involved in evaluation, judgment, and emotion are subsequently activated in non-meditators but not mindfulness meditators (Grant, Courtemanche, & Rainville, 2011 ). In this way, mindfulness practitioners naturally limit the experience of pain to physical sensations, while nonpractitioners first experience the physical sensations of pain, and then automatically experience an emotional aversion to the physical sensations.”
They go on to argue that safe BDSM requires a certain state of mindfulness - specifically acting with awareness, working in nonjudgmental and nonreactivity. “: A Bottom must be aware of their internal experience and communicate any problems with that experience to the Top, who in turn must be able to understand what the Bottom is communicating. This is often accomplished through the use of safewords, which are commonly used by BDSM practitioners to signal the desire to stop or change the activities taking place. “
Consistent with their study BDSM participants reported a higher level of overall dispositional mindfulness than the control group. And ends their findings with “The study of mindfulness as it applies to BDSM practitioners may help to decrease stigma surrounding this area of sexual diversity, and whether BDSM may contribute to psychological well-being for some individuals who engage in this practice.”
**BREAK**
PART 4: TAKEAWAYS (10-15 minutes)
Throughout this season, when we decided to tackle the neuroscience of the DSM, we have been consistently identifying problems within the mental health community including but not limited to - many of our diagnoses and treatments that have not changed since Hippocrates, we have over/miss diagnosed a lot of people or underdiagnosed others - and sometimes our diagnosis does not seem to fit with what is actually going on in the brain.
We are human. We don’t always get things right. But importantly we do have to try.
IN 1952, the American Psychiatric Association classified homosexuality as sexual deviation. Instead of the category of Paraphilic Disorders, it was at that time labeled under sociopathic personality disturbances. Also included under sociopathic personality disturbances were homosexuality, transvestism, pedophilia, fetishism, and sexual sadism.
I’m not saying this is not complicated. Sexual acts against children is never and will never be ok. Wanting to hurt someone in a way they don’t consent to is not and never will be ok.
And diagnosing someone, as we have shown throughout history, carries with it power and privilege. How do we do this right? How do we do this better? What counts? What doesn’t?
Looking to Neuroscience - As Elise Wuyts Manuel Morrens states we see differences in the brains of those who are using saidism without consent and those who are, however, they argue that because research often lumps participants together, there is a need for clearer data. Which with pathologization, is tricky to obtain. Luo and Zhang also argue this in their study on the moderation of neural responses.
Dunkly et al’s study starts to make some of the cases for reducing stigma by researching the positive effects of consensual engagement but continues to state “The study of mindfulness as it applies to BDSM practitioners may help to decrease stigma surrounding this area of sexual diversity, and whether BDSM may contribute to psychological well-being for some individuals who engage in this practice.”
Gautami Polepally Ashok states in regards to the results of their research that it “emphasizes the importance of new and relevant empirical data to address the various facets of BDSM and aiding in a more holistic understanding of sexual deviance in general and BDSM in specific. This is relevant not only for academic pursuits but also informs clinical practices, as it is evident that cultural competence related to working with sexual deviance is undermined and understudied. A radical change in how BDSM is represented in the commonplaces like media and popular literature is vital to inform the general population of how deeply troubling the current perceptions are. Understanding that more people engage in sexually unconventional behavior is necessary in order to educate children and young adults about the importance of consent and safe sexual practices. While all these changes may seem radical, they are necessary to foster a healthy and inclusive society where people feel safe to express their individuality without fearing ridicule, can ask for help when in psychological or emotional distress, and are not legally prosecuted for what they prefer in the privacy of their homes.”
Brown states that clinically we still have far to go “Because BDSM was historically thought of as being caused by mental illness, pathology, or complications occurring in childhood, it has been associated with paraphilic disorders. This view still partially exists, with sexual sadism, sexual masochism, and fetishistic disorder being listed in both the DSM-5 and ICD-10. Many sex researchers contest the inclusion of some of these in diagnostic manuals because they stigmatize BDSM practitioners as well as medicalize what may be relatively benign and even common sexual interests Having BDSM sexual interests alone no longer meets the criteria of a paraphilic disorder.”
For clinicians - we need to be very thoughtful about the power we wield. To meet the diagnosis one must have clinically significant dress (transgender, anxiety, etc). But what is clinically significant distress? Who decides?
