Psychiatry has an insensitive history in the area of BDSM. There have been many involvements by institutions of political power to marginalize subgroups and sexual minorities. Mental health professionals have a long history of holding negative assumptions and stereotypes about the BDSM community. Beginning with the DSM-II, Sexual Sadism and Sexual Masochism have been listed as sexually deviant behaviours. Sadism and masochism were also found in the personality disorder section. This negative assumption has not changed significantly which is evident in the continued inclusion of Sexual Sadism and Sexual Masochism as paraphilias in the DSM-IV-TR. The DSM-V, however, has depathologized the language around paraphilias in a way that signifies "the APA's intent to not demand treatment for healthy consenting adult sexual expression". These biases and misinformation can result in pathologizing and unintentional harm to clients who identify as sadists and/or masochists and medical professionals who have been trained under older editions of the DSM can be slow to change in their ways of clinical practice.