Disclaimer: This article was written for educational purposes. Do not self-diagnose. If you have questions or concerns, please reach out to a professional.
Because of media, we have come to associate masochism with sexual behaviors such as BDSM. But, within the concept of psychiatry, its meaning and application is wider. The term first appeared in Richard Von Kraftt-Ebing’s 1866 book Psychopathia Sexualis. The term’s etymology was inspired by German nobleman and novelist Leopold von Sacher Masoch. His famous novel Venus in Furs portrays a man who experiences sexual pleasure at the hands of oppressive women (Fuller, 1986). Similarly, the term sadism, which refers to someone who derives pleasure from inflicting pain on others, was also inspired by a 19th-century nobleman and writer Marquis de Sade.
After the publication of Krafft-Ebing’s book, many scholars attempted to further the concept. Havelock Ellis, a famous sexologist from the turn of the century, stated masochism was inherent in the female approach to sexual behavior since she is the “receiver” throughout the sexual act. Men, on the other hand, are naturally sadistic since they are the “inflictors” during the sexual act (Ellis, 1954). Havelock Ellis’s ideas regarding masochism created the controversy and stigma that is still attached to this personality disorder.
Most psychologists studied the term within the context of sexual psychology and peculiarity. This association is still persistent today. However, Freud, while studying sexual development, struggled to see masochism’s role and tried to divorce it from its sexual connotation. His initial theories stated that masochism and sadism were the reverse representation of the same neurotic issue where sadism controlled hostile impulses and masochism was the unconscious adaptation of those impulses.
In his book, Beyond the Pleasure Principle, Freud re-worked on his incomplete definition. He argued that masochism was born out of an internalized death wish (thanatos). His interpretation of masochism broadened the concept and allowed for other psychoanalysts to study the behavior beyond sexual meaning.
Freud’s later work, The Economic Problem of Masochism, gave way to three different interpretations of masochism: erotogenic, feminine, and moral. The term and definition of moral masochism provided the blueprint for the study and analysis of masochistic personality disorder. Freud’s definition of moral masochism applies to those who seek suffering due to guilt.
Freud’s definition inspired psychoanalysts like Horney, Fromm, Reik, Berliner, Menaker, and Ferenczi to further study the source of moral masochism. They provided important notes which would later be used to define masochistic personality disorder.
The definition of masochistic personality disorder (now referred to as self-defeating personality disorder) that Fromm, Horney, Berliner, and Menaker outlined is the normal and neurotic escape from unbearable aloneness that is expressed as feelings of inferiority that stems from a source of suffering or guilt (Horney, K 1939). It is part of a defense mechanism or ego function (Berliner, 1948) which is derived from an early phase of symbiotic object relations and a struggle for survival due to a loss of identity or increased worthlessness (Menaker, 1979). Moral masochism manifests itself as tendencies to devalue oneself in interpersonal relationships.
The contributions made by Berliner, Fromm, Horney, and Menaker aided Wilhelm Reich. Though he believed that masochism was derived from a sexual instinct, he saw it as a self-defense mechanism against past or perceived dangers that manifests in many different ways.
All personality disorders share patterns of maladaptive, repetitive, and self-detrimental behaviors. Similarly, moral masochism/masochistic personality disorder is somewhat common to personality disorders.
The APA, chaired by Robert Spitzer, included the criteria for masochistic personality disorder in the DSM-3. The criteria for masochistic personality disorder is:
Feelings of martyrdom and self-defeating behavior as indicated by at least six of the following:
1. Remains in relationships in which others exploit, abuse, or take advantage of him/her, despite opportunities to alter the situation.
2. Believes that he or she almost always sacrifices own interests for those of others.
3. Rejects help, gifts, or favors so as not to be a burden on others.
4. Complains, directly or indirectly, about being unappreciated.
5. Responds to success or positive events by feeling undeserving or worrying about not being able to measure up to new responsibilities.
6. Always pessimistic about the future and preoccupied with the worst aspects of the past and present.
7. Thinks only about his or her worst features and Ignores positive features.
8. Sabotages his or her own intended goals.
9. Repeatedly turns down opportunities for pleasure.
Because of the clinical features overlap with other personality disorders, specifically with dependent and passive-aggressive personalities, many psychoanalysts wondered if it was necessary to include new diagnostic criteria for masochistic personality disorder in the DSM.
Another source of contention regarding the inclusion of masochistic personality disorder in the DSM was its source. Usually, this personality disorder was associated with female submissiveness and used to blame women who found themselves in domestic violence situations.
Due to the controversy surrounding the disorder, its subjective criteria, and difficulty distinguishing it from other disorders, the APA decided to discard the disorder from the DSM.
However, many psychoanalysts believe that the subject deserves further study and attention. In her book, Psychoanalytic Psychotherapy, Dr. Nancy McWilliams, presents a guide for treating self-defeating personality disorder. She urges psychoanalysts and psychotherapists to be careful about exuding empathy as it reinforces beliefs that pain a good route to establish a relationship, to dispassionately observe the price they pay for their behavior, to wonder aloud what motivated such choices, and to not model masochism because the patient needs to identify with someone who embodies patterns of self-care.
Berliner B: On some psychodynamics of masochism. Psychoanal Q 16:459- 471, 22.23. 1948
Freud, S., & Jones, E. (Ed.). (1922). International psychoanalytical library: Vol. 4. Beyond the pleasure principle (C. J. M. Hubback, Trans.). London, England: The International Psycho-Analytical Press.
Fromm E: Escape from Freedom. New York, Avon Books, 1941
Fuller, K. (1986). Masochistic personality disorder: A diagnosis under consideration. Jefferson Journal of Psychiatry, 4(2), 7-20.
Horney K: New Ways in Psychoanalysis. New York, WW Norton and Co, 1939
Huprich, Steven K et al. “Should self-defeating personality disorder be revisited in the DSM?.” Journal of personality disorders vol. 20,4 (2006): 388-400. doi:10.1521/pedi.2006.20.4.388
Lerner L: Masochism and the Emergent Ego: Selected Papers of Esther Menaker.New York, Human Sciences Press, 1979
McWilliams, Nancy. Self-Defeating Personality Disorder: Recognition and Treatment. 27 July 2012, www.psychiatrictimes.com/view/self-defeating-personality-disorder-recognition-and-treatment.
Moshe Bergstein, The wish for annihilation in ‘love–death’ as collapse of the need for recognition, in Wagner’s Tristan und Isolde, The International Journal of Psychoanalysis, 10.1111/1745-8315.12056, 94, 4, (747-766), (2013).
Reik T : Masochism in Modern Man . New York, Farror, Straus and Co, 1941