The idea that practising BDSM reflects a psychological problem is not supported by the studies gathered here.
The main limitation
Almost all are one-off surveys and many recruit from communities of practitioners, so they reflect those who choose to take part.
In practice
The results describe groups, not the safety of a particular practice: that depends on what is done and how it is agreed between the people involved.
What kind of studies there are
Syntheses of studies 1
Descriptive or expert opinion 5
We classify each study by its design. A synthesis of many studies or a randomised trial supports firmer conclusions than a survey or an expert opinion. The design does not tell you whether a result is good or bad.
What the studies say overall
The idea that practising BDSM reflects a psychological problem is not supported by the studies gathered here.
A large representative survey in Australia found no evidence that those who had practised it had experienced more sexual coercion or were more unhappy or anxious than everyone else, and one review concludes that people who practise it differ little from the general population in psychopathology.
The studies also show that it is a more common interest than is usually thought: in a representative sample from Belgium, almost half had at some point taken part in a related activity and a further share had had fantasies.
Among practitioners, more sensation seeking and more active coping strategies were observed, and in a survey of people in the United Kingdom, satisfaction in the relationship was associated with sharing those interests.
A systematic review records changes in cortisol in submissive people after a BDSM interaction, which suggests that the physiological stress system is involved.
Where they disagree
There are no major disagreements, but there are gaps. The cortisol studies are few and their meaning is unclear: a hormonal change does not in itself say whether the experience is good or bad for the person.
Limits of the evidence
Almost all are one-off surveys and many recruit from communities of practitioners, so they reflect those who choose to take part. They measure what each person reports and cannot tell us what causes what.
The studies concern consenting adults; they say nothing about non-consensual practices.
The studies, one by one
We have gathered 6 verified studies. Each summary is our own; the quotation in inverted commas is taken word for word from the original abstract, in English.
What they found: In a representative sample of 19,307 Australians, those who had practised BDSM were no more likely to have experienced sexual coercion or to be unhappy or anxious than everyone else. (Richters et al., 2008)
Population Australian adults aged 16 to 59JournalJ Sex Med
Verbatim quotation from the original abstract (in English)
“they were no more likely to have been coerced into sexual activity, and were not significantly more likely to be unhappy or anxious” Richters et al., 2008
What they found: In a representative sample of 1,027 people from the Belgian population, 46.8% had taken part in some BDSM activity and a further 22% had had fantasies about it. (Holvoet et al., 2017)
Population General population of BelgiumJournalJ Sex Med
Verbatim quotation from the original abstract (in English)
“A high interest in BDSM-related activities in the general population was found because 46.8% of the total sample had ever performed at least one BDSM-related activity and an additional 22% indicated having (had) fantasies about it.” Holvoet et al., 2017
What they found: In 256 BDSM practitioners compared with a control group, practitioners showed more sensation seeking and more active coping strategies, such as problem solving. (Schuerwegen et al., 2021)
Population Dutch-speaking BDSM practitioners and controls from the Belgian populationJournalArch Sex Behav
Verbatim quotation from the original abstract (in English)
“Compared to controls, BDSM practitioners reported significantly higher levels of sensation seeking for all dimensions (experience seeking, thrill seeking, and distraction seeking), as well as the use of more active coping skills such as problem solving and taking action.” Schuerwegen et al., 2021
What they found: In an anonymous survey of 470 people in the United Kingdom with paraphilic interests, such as BDSM, satisfaction in the relationship was associated with sharing those interests with the partner. (Brown et al., 2026)
Population People in the United Kingdom with interests in BDSM, pet play, age play, furries or balloon fetishismJournalJ Sex Res
Verbatim quotation from the original abstract (in English)
“Relationship satisfaction correlated with shared paraphilic interests.” Brown et al., 2026
What they found: A systematic review of 10 articles found changes in cortisol in submissive people after a BDSM interaction, suggesting involvement of the physiological stress system. (Wuyts et al., 2022)
Verbatim quotation from the original abstract (in English)
“There is evidence for cortisol changes in submissives as a result of a BDSM interaction, suggesting involvement of the physiological stress system.” Wuyts et al., 2022
The results describe groups, not the safety of a particular practice: that depends on what is done and how it is agreed between the people involved.
The fact that it is a relatively common interest does not mean it is for everyone. The studies neither recommend trying it nor avoiding it.
If you share this interest with your partner, in the UK survey it was associated with greater relationship satisfaction; that is an association, not a guarantee.
