port psychosocial difficulties because of thei r sexual attractions or preferences for being
humiliated, beaten, bound, or otherwise made to suffer, they may be diagnosed with sex-
ual masochism disorder. In contrast, if they de clare no distress, exemplified by anxiety, ob-
sessions, guilt, or shame, about these paraphi lic impulses, and are not hampered by them
in pursuing other personal goals, they coul d be ascertained as having masochistic sexual
interest but should not be diagnosed with sexual masochism disorder.
The Criterion A time frame, indicating that the signs or symptoms  of sexual masoch-
ism must have persisted for at least 6 months, should be understood as a general guideline,
not a strict threshold, to ensure that the sexual interest in being humiliated, beaten, bound,
or otherwise made to suffer is not merely transient. However, the disorder can be diag-
nosed in the context of a clearly sustained but shorter time period.
Associated Features Supporting Diagnosis
The extensive use of pornography involving the ac t of being humiliated, beaten, bound, or oth-
erwise made to suffer is sometimes an asso ciated feature of sexual masochism disorder.
Prevalence
The population prevalence of sexual masochis m disorder is unknown. In Australia, it has
been estimated that 2.2% of males and 1.3% of females had been involved in bondage and
discipline, sadomasochism, or dominance and submissio n in the past 12 months.