Sexual Abuse and Masochism in Women: Etiology and Treatment
Abrams, Mike, Stefan, Simona, Journal of Evidence-Based Psychotherapies
A common manifestation and pattern of sexual masochism was observed in several female clients in psychotherapy. Three female clients who had all been sexually abused by a parent commencing in preadolescence are presented. All of these women demonstrate a consistent pattern of arousal from pain and humiliation inflicted during sexual encounters. An explanatory model of the origin of this paraphilia in women is presented. This model integrates Daryl Bem's EBE model of sexual preference with the theories of John Money. In effect, it is proposed that masochism is an adaptive response to abuse, wherein the rage and shame become integral to sexual arousal. Additional links between abuse and the etiology of masochism are explored and the outcome of treatment with Rational-Emotive and Cognitive Behavior Therapy (RE&CBT) is presented.
Keywords: sexual masochism, borderline personality disorder, Rational-Emotive and Cognitive Behavior Therapy
Sexual masochism, like most paraphilias, interferes with achieving meaningful sexual relationships. Masochism is a particularly vexing paraphilia, in that stimuli that are nearly universally aversive become sources of sexual delight. Humiliation, ridicule, subjugation, and pain become triggers for sexual excitement. According to Kinsey, Pomeroy, Martin, and Gebhard (1953), 22% of American men and 12% of American women acknowledged being sexually aroused by depictions of sadomasochism. Donnelly and Fraser (1998) found that 61% of college students acknowledged being aroused by fantasizing about or performing sado-masochistic acts.
Theories of Masochistic Sexuality
Theories regarding the origin of sexual masochism are abundant, as well as strikingly inconsistent with each other. Freud contended that masochism is an inherent aspect of feminine sexuality. This has been the focus of considerable criticism (Symonds, 1979); evidence shows that more men than women are aroused by masochistic fantasies or engaging in either being bound or being dominated during sex (Donnelly & Fraser, 1998).
Most sexual disorders and paraphilias are explained by psychoanalytic theorists in terms of trauma, deprivation, or excess during the late anal stage and the phallic stages of psychosexual development, during which Oedipal conflicts occur. However, the Oedipally-related theories can be questioned for good reasons as, over the past half century, there is virtually no support that an Oedipal conflict in development exists.
Of the non-Oedipal explanations of masochism, Van der Kolk (1989) proposed that traumatized persons are prone to respond to new events as though reliving the traumatic event. This unconsciously makes the current event stressful without any apparent reason. Van der Kolk (1989) proposes that abused or traumatized persons seek familiar, if painful behaviors to reduce the chronic arousal and anxiety caused by novel situations. Other less intricate theories include the proposal that masochism is the result of unresolved fears of separation or abandonment (Lego, 1992), of chronically seeing oneself as a victim (Warren, 1985), or of something as simple as a behaviorally reinforced response (Brown, 1965). Finally, Stoller (1975) posits that masochism and other sexual disorders results from early life passiveness in the face of maternal humiliation.
Alternatively, Daryl Bem's "Exotic Becomes Erotic" or EBE model of homosexuality (Bem, 2001; Bem, 1996) dovetails cogently with what might be the most evidence-based theory of masochism, set forth by noted sex researcher John Money (Money & Lamacz, 1989; Money, Annecillo, & Lobato, 1990; Money, 1991). Money formulated the concept of a "lovemap" that refers to a cognitive representation of the erotic ideal and sexual union with that ideal. In the case of a heterosexual man, the lovemap would contain the representation of a maximally attractive woman and a representation of intercourse with this ideal lover (Money, 1988). …