“Could bondage be good for you?”, is the somewhat surprising question asked on the Mail Online website.

This article is prompted by a Dutch study assessing the mental health of people into bondage-discipline, domination-submission and sado-masochism (BDSM) compared to those with more ‘vanilla’ sexual tastes.

The researchers make the case that there is an (in their view, mistaken) assumption that people who engage in BDSM practices have some sort of mental health disorder or mental distress.

They decided to test this assumption by analysing responses of nearly 1,000 Dutch BDSM ‘practitioners’ to a series of personality and wellbeing questionnaires and comparing them to a control group.

People who engaged in BDSM appeared to have a good mental health profile, and compared to control participants were:

less neurotic

more extraverted

more open to new experiences

more conscientious

less sensitive to rejection

had a higher sense of wellbeing

However, we don’t know how other Dutch BDSM participants (or the rest of the world) are faring. It could be that the people who chose to take part in this survey represent those with the best sense of health and wellbeing.

Where did the story come from?

The study was carried out by researchers from Tilburg University in the Netherlands and was published in the peer-reviewed Journal of Sexual Medicine. No sources of funding are reported and the authors report no conflicts of interest.

The Mail Online’s headline that ‘bondage could be good for you’ and that ‘S&M enthusiasts are healthier’, are not supported by this survey. A more accurate, if slightly less arresting, headline would be ‘People who choose to take part in an S&M survey claim to enjoy better psychological health’.

What kind of research was this?

This was a cross-sectional study into the sexual practices of bondage-discipline, dominance-submission and sadism-masochism (BDSM). BDSM is typified by sexual role-play involving suppression, physical restriction, games playing, ‘power exchange’, and sometimes pain.

There have been suggestions that people choose to take part in BDSM due to mental illness (psychopathology). For example, people who engage in such practices may have vulnerable mental health and could be susceptible to abuse. However, contrary previous research has shown that people who take part in BDSM have good psychological health.

The current study aimed to see how people who practice BDSM differed psychologically from a control group who did not practice BDSM. The researchers aimed to answer this through self-reported assessments of:

the ‘big five’ dimensions of personality: neuroticism, extraversion, openness to experience, agreeableness and conscientiousness

rejection sensitivity (based on whether a person overestimates the possibility of being rejected by others, as well as the emotional impact following rejection)

attachment style (the persistent and emotionally significant bond that individuals form with others)

subjective wellbeing

They were particularly interested in whether there were differences within people who engage in BDSM, depending on whether they generally took a dominant or submissive role (or switched).

What did the research involve?

This study included those who responded to an advert posted on the largest BDSM web forum in The Netherlands. The recruitment advert explained that it was a study mapping the psychology of the practice of BDSM and responses were anonymous.

Of the 1,571 who started the questionnaire, just over 902 (51% male) completed it and were included in this study. The 434 control participants were recruited via an advert in a popular Dutch women’s magazine (Viva) asking people to participate in confidential online research labelled simply ‘a study about human behaviour’. The majority of these control participants (70%) were women.

Personality was assessed using the 60-item short version of a questionnaire called the Five Factor Personality Inventory where responses were on a five-point scale from one (“not at all applicable to me”) to five (“very applicable to me”). For example, it includes an item assessing neuroticism by asking people to rate on this five-point scale the statement: “I rarely feel lonely or sad.”

Participants also completed a 40-item Attachment Styles Questionnaire. This used a five-point scale as well, and had sections on:

confidence in relationships

discomfort with closeness

relationships as secondary dimensions (for example, whether their relationships are superficial)

need for approval

preoccupation

They completed a Rejection Sensitivity Questionnaire that included 16 scenarios where the participant indicated their degree of concern or anxiety about an outcome, as well as the perceived likelihood of that outcome. For example, “How worried or anxious will you be if your classmate won’t lend you his notes?” and then, “Do you expect that this person will lend you his notes?”

The World Health Organization-Five Well-being Index (WHO-5) was also used to assess subjective wellbeing by five items asking about feelings in the last two weeks.

The researchers carried out statistical analyses looking at the relationship between responses across the different assessment tools, and how this varied between BDSM and non-BDSM control participants.

What were the basic results?

Among the people who took part in BDSM there was a clear difference in the role adopted by men and women. Among men:

a third (33.4%) were submissive

almost half dominant (48.3%)

the remainder switched roles (18.3%).

Contrary to the picture of a woman with a whip accompanying the Mail article:

the majority of women took submissive roles (75.6%)

only a small minority were dominant (8%)

with the remainder switching roles (16.4%)

After controlling for age, sex and gender, the researchers found that compared with control participants, people who took part in BDSM were generally:

less neurotic

more extraverted

more open to new experiences

more conscientious

less sensitive to rejection

had higher subjective well-being

However, BDSM practitioners were ‘less agreeable’ than control participants. In psychological terms, this means that they were less likely to get along with friends, family members and co-workers.

When the researchers looked at the effect of the role played within BDSM, if differences were observed, scores were generally more favourable for those with a dominant than a submissive role.

How did the researchers interpret the results?

The researchers conclude that, ‘BDSM may be thought of as a recreational leisure, rather than the expression of psychopathological processes’.

Conclusion

This cross-sectional research provides only a single snapshot of how the Dutch people who took part in this online survey are feeling at a single point in time. There are many components to health, and the questionnaires used by the researchers did not assess whether the participants have any diagnosed physical or mental health conditions.

These self-reported questionnaires do not give us a clear picture of the participants’ overall health, how they are functioning in everyday life, or of their longer term health outlook. Consequently, media headlines implying BDSM is good for you or has health benefits (mental or physical), while potentially true, are not actually backed up by the research in question.

Also, the responses only represent those who chose to take part in the questionnaires. For the survey respondents who took part in BDSM and knew the nature of the research, it could be that those who chose to take part in this survey represent those with the best sense of health and wellbeing.

We can’t assume that the psychological health of these people reflects those of the wider world of BDSM – who do not use this Dutch website, or who do and chose not to take part. Similarly, the control participants reflect only a very small sample of people. Also, largely by the nature of their recruitment method by a woman’s magazine, they were predominantly women. The psychological health of these 434 – mainly female – adults cannot be assumed to reflect that of the general non-BDSM population.

Overall, this research does not find that BDSM is associated with adverse psychological health or wellbeing, but this cannot be concluded with much certainty due to the way in which the study was carried out.

There is evidence that regular sex in the context of a romantic realtionship can lead to health benefits.

But should you invest in a pair of handcuffs for your health and wellbeing? Well, that would appear to be more an issue of personal preference rather than evidence-based science.

Analysis by Bazian

Edited by NHS Website