What Personality Testing Reveals About Sadomasochism and Sexual Addiction

What Personality Testing Reveals About Sadomasochism in Sexual Addiction Treatment

Sadomasochistic behaviors, often referred to as S&M, exist on a wide spectrum, from mild role play involving humiliation or loss of power to high-risk practices such as sexual asphyxiation. Clinicians who work with sexual addiction have long recognized that these behaviors show up in treatment populations, yet the underlying personality and psychological patterns associated with them have remained poorly understood. A study published in Sexual Addiction and Compulsivity brings much-needed data to this question.

The study, titled MMPI-2 Correlates of Sadomasochism in a Sexual Addiction Sample: Contrasting Men and Women, was conducted by Tiffany A. Hopkins, Corey A. Brawner, Monica Meyer, Laci Zawilinski, Patrick J. Carnes, and Bradley A. Green.

A Largely Unexamined Clinical Question

The researchers point to an important gap in prior work. While some clinicians, including Williams in 2006, have recommended that practitioners assess for sexual addiction and high-risk behaviors when working with clients who engage in S&M, no study up to that point had examined differences between individuals engaging in these behaviors at different levels of risk. In other words, the field had general guidance to be cautious, but little specific data on what actually distinguishes lower-risk S&M practices from higher-risk ones, or what personality patterns might predict each.

This study set out to change that by applying rigorous psychological assessment to a clinical population already in treatment for problematic sexual behavior.

Using the MMPI-2 to Map Personality and Psychopathology

To explore these questions, the research team turned to the Minnesota Multiphasic Personality Inventory, 2nd Edition, widely known as the MMPI-2, one of the most established and well validated personality assessment tools in clinical psychology. The study examined how scores on the MMPI-2 related to engagement in S&M behaviors within a sample of individuals presenting for treatment of problematic sexual behavior or sexual addiction.

The researchers distinguished between two categories of behavior. Low-risk presentations included behaviors such as seeking out humiliation or a loss of power during sexual experiences. High-risk presentations included more physically dangerous practices such as sexual asphyxiation. Profiles were then developed separately for men and women, allowing the researchers to see whether the personality correlates of these behaviors differed by sex.

A Clear Signal: Trauma Predicts Risk Across the Board

Using a series of correlation and multiple regression analyses, the team identified a striking and consistent finding. A specific MMPI-2 scale measuring trauma related symptoms, known as the PK scale, predicted both high-risk and low-risk S&M behaviors, and this pattern held true across both sexes.

This finding carries real clinical weight. It suggests that underlying trauma may be a common thread running beneath sadomasochistic behavior in this population, regardless of whether the behavior itself falls on the lower-risk or higher-risk end of the spectrum, and regardless of whether the client is male or female. For clinicians, this points toward the importance of trauma-informed assessment and treatment when working with clients who present with these behaviors, rather than focusing on the behavior in isolation.

Why This Research Matters

Findings like these help move the field beyond simple behavioral checklists and toward a more complete psychological understanding of why certain sexual behaviors show up in a treatment population, and what might be driving them. If trauma related symptoms consistently predict engagement in these behaviors, that has direct implications for how clinicians approach treatment planning, prioritizing trauma processing alongside any work focused on the behavior itself.

The researchers were candid in framing this as exploratory work, an important and appropriately cautious stance given how little prior research existed on this specific question. Exploratory findings like these lay the groundwork for future, more targeted studies that can build directly on what this research uncovered.

Supporting Research That Connects Trauma and Sexual Addiction

AFAR is committed to advancing research that uncovers the deeper psychological roots of compulsive and high-risk sexual behavior, including the role trauma plays across different presentations and populations. Studies like this one move the field closer to treatment approaches that address root causes rather than symptoms alone.

If you would like to support AFAR's continued investment in this kind of research, consider making a donation today.

Make a donation to support this research

Source: Hopkins, T. A., Brawner, C. A., Meyer, M., Zawilinski, L., Carnes, P. J., & Green, B. A. (2016). MMPI-2 Correlates of Sadomasochism in a Sexual Addiction Sample: Contrasting Men and Women. Sexual Addiction & Compulsivity, 23(1), 114-140.