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People may have sexual interests that are not typical in their society. These interests are often called kinks. They may explore these interests in a relationship that involves negotiation and consent and avoids harm.
Forensic mental health practitioners should understand that various types of kink are normal behaviour for most people, who practise them. This is similar to how practitioners view sexual orientation and gender identity, said Dr. Stefani Goerlich, in a presentation for the International Forensic Psychiatry Lecture Series.
Practitioners should be careful diagnosing a paraphilic disorder, which is stigmatizing and can affect people’s lives. They should also assess any concerns about the risks for the person or people around them and rule out any differential diagnosis that may accurately describe the behaviour.
Photo by Sonny Ravesteijn on Unsplash
What Is Kink and How Common Is It?
Kink is a broad term for sex and relationships that are not what people think of as typical for their culture and society at that time. There are two broad types of kink: BDSM and fetishes.
BDSM includes bondage and discipline (B&D), domination and submission (D&S), and sadism and masochism (S&M). These practices involve one person giving their partner power or authority, or partners giving and receiving physical sensations.
Fetishes involve a strong sexual interest in objects or parts of the body that are not usually considered sexual, such as feet and armpits. They may involve objects or clothing that are not usually considered erotic but are used in a sexual context.
These types of kink can often overlap, with people practising more than one type of BDSM or combining BDSM with fetishes.
Studies show that about half of people in the United States have tried at least some form of BDSM, and about a third engage in BDSM at least once a month. A much smaller proportion — two to eight per cent of people around the world — say that BDSM or kink is a core part of their erotic identity.
Misconceptions and Reality
There are many misconceptions about kink and people who engage in it.
Three quarters of clinicians (for example, clinical and forensic social workers, sex therapists) say they have had a client who engaged in some form of BDSM. Yet only about half of clinicians have had training about kink. A third of people who engage in kink say they have experienced stigma from their mental and medical health care providers. For example, a health care provider may refuse to work with a person unless they stop their behaviour, or they may report the person’s partner for intimate partner violence.
Kink is not self-harm nor intimate partner violence. It is not necessarily unsafe, although it may involve higher-risk activities in some cases. In kink, people may act on urges considered unusual or even frightening in a way that is consensual and safe.
People who enjoy kink do not have low self-esteem. Those who like to dominate may be slightly more narcissistic but still within the normal range. Those who like to be submissive do not have poor boundaries (setting limits to protect physical and emotional well-being).
Fewer than one in five people who engage in kink think their interest is related to a traumatic life event. Many of them consider their kink as a positive way of moving past and healing from traumatic experiences. Studies find no significant difference in childhood trauma between people who engage in BDSM and those who do not.
In fact, people involved in kink are more conscientious, less neurotic, more extroverted and agreeable, more open to experiences, and stronger collaborative communicators than other people. They are also more likely to think that consent is important. There is no evidence that they have any form of psychological disturbance. In fact, they seem to be mentally and emotionally well-adjusted.
Assessing Risk in Someone Engaging in Kink
Kink itself is not a risk factor, but some activities have a higher risk of potential injury. These include:
- restricting someone’s breathing (for example, choking);
- using sharp objects to stimulate or pierce the skin;
- using electrical sources to cause sensation, which can affect the heart;
- striking a partner in ways that can damage organs and nerves;
- binding others with rope, which can damage nerves, cut off blood flow, or stop someone’s breathing in certain positions; and
- engaging in kink in public, which may lead to arrest, conviction, or sex offender status.
Forensic mental health practitioners should look for signs that the person’s behaviour could cause harm. These include a lack of emotional insight; disdain for their partner; behaviour that is deliberately not consensual; intentional injury or cruelty; crimes; attitudes against women, gay, or trans people; excuses for aggression; and intrusive or invasive behaviour, such as internet stalking.
An atypical sexual interest or behaviour on its own does not require clinical diagnosis or treatment. A paraphilic disorder is when the person’s atypical sexual behaviours make them feel distress, impair them in some way, harm them, or risk harming others.
Forensic mental health practitioners should check for many other disorders before diagnosing paraphilic disorder. These include other mental health disorders, like obsessive-compulsive disorder, autism spectrum disorder, social phobia, conduct disorder, conversion disorder, sexsomnia, and personality disorders. These also include physical conditions, like hormone dysregulation, intellectual disabilities, traumatic brain injury, seizures, medication side effects, and dementia.
Dr. Goerlich asks clients whether they feel distress about their behaviours and why. She asks whether the clients’ behaviours are causing other people distress. And she asks whether the behaviours are affecting the clients’ daily activities, such as work, parenting, relationships, sleep, and hygiene.
For more details, watch the recording of the June 11, 2026, lecture “Contextualizing Kink: Understanding, Affirming, and Assessing Erotic Minorities.”
Written by Carolyn Brown and approved by Dr. Stefani Goerlich.
