Are sadomasochism and hypersexuality in autism linked to amygdalohippocampal lesion?

INTRODUCTION: Pathologies of the amygdala and the hippocampus have been argued to be critically involved in autism as well as in sadomasochism. In line with Kluver and Bucy syndrome, clinical observations, animal models and a few case reports emphasize that temporal brain changes are important for the etiopathogenesis of sexual deviant behaviour. In particular, the amygdalohippocampal region has been linked to hypersexuality, transvestitism and fetishism. While cases and studies are rare, the impact of amygdalohippocampal changes in criminal behaviour remains unclear so far. AIM: To demonstrate the impact of subcortical neurobiological changes in the etiopathogenesis of autism and sadomasochism. METHODS: We report on a forensic psychiatric inpatient due to murderer with autism and sadomasochism who had amgdalohippocampal abnormalities bilaterally. Studies on the neurobiological underpinnings of autism and of sadomasochism are reviewed in particular regarding amygdalohippocampal region. RESULTS: In this patient, MRI scan showed hypointensities in amygdala-hippocampal complex bilaterally medial to both cornua inferiores corresponding to an amygdalo-hippocampal atrophy. CONCLUSIONS: In line with the literature, this case report links autism and sadomasochism to amygdalohippocampal pathology emphasising its impact in the etiopathogenesis of both disorders. Further research is needed to elucidate the interaction of amygdalohippocampal changes, disturbed emotion precessing and sex offenses.

A Systematic Scoping Review of the Prevalence, Etiological, Psychological, and Interpersonal Factors Associated with BDSM.

BDSM (bondage, discipline, dominance, submission, and sadomasochism) encompasses a diverse set of sexual interests. Research interests in BDSM have been historically underpinned by examining potential mental health issues, unhealthy fixations on specific sexual behaviors, and/or the presence of childhood trauma, as is predicted by psychopathological and psychoanalytic models. The objective of this scoping review was to provide an overview of the current landscape of BDSM research, including incidence rates, evidence for psychopathological, psychoanalytical, biological, and social etiological factors, demographics of BDSM practitioners, and the psychological correlates of those with BDSM interests. After the literature search and screening process, 60 articles were included. BDSM related fantasies were found to be common (40-70%) in both males and females, while about 20% reported engaging in BDSM. Results show little support for psychopathologic or psychoanalytic models. In the selected samples studied, BDSM practitioners appear to be white, well educated, young, and do not show higher rates of mental health or relationship problems. Research supports BDSM being used as a broadening of sexual interests and behaviors instead of a fixation on a specific interest. Future empirical research should focus on non-pathological models of BDSM, discrimination of BDSM practitioners, interpersonal relationships, and biological factors.

Masochism: a clinical and theoretical overview.

This paper will review some of the theoretical and clinical features of masochism from an eclectic point of view. The topic of masochism has been taken up by authors of many perspectives because it addresses one of the anomalous, absurd, difficult-to-explain aspects of behavior for which no psychological system has an easy answer. Therefore, a wide-ranging literature on the topic of masochism is available. However, few previous reviewers have attempted to draw from a variety of disciplines and theoretical frameworks. In this review the historical development of the term and some of the psychoanalytic conceptualizations will be presented first. Since previous reviews of masochism from a strictly psychoanalytic perspective are adequate (Brenner, 1959; Eisenbud, 1967; Fenichel, 1945; Loewenstein, 1957; Panken, 1967), our discussions of masochism will be developed employing more extensively the interpersonal, social, learning theory, and biological perspectives.

Psychotherapy of moral masochism.

The psychotherapeutic approach to sadomasochism is discussed with clinical examples. The necessary attributes of the therapist and specific therapeutic techniques are emphasized so as to avoid the destructive, uncontrollable negative therapeutic reactions. A better modulated transference can be interpreted with beneficial results.

A sadomasochistic transference: its relation to distortions in the rapprochement subphase.

The development of a rageful sadomasochistic transference early in an analysis is presented. We describe key interventions that foster its resolution and offer a reconstruction of the patient's early life, focusing on difficulty in the rapprochement phase. We believe that the intense and difficult to manage sadomasochistic transference was linked to a repudiation of both preoedipal and oedipal triangulation, resulting in the perpetuation of a hostile dependent mother-child dyad and in the patient's unconscious belief that sadomasochistic interactions were the only means of establishing and maintaining a close relationship.

Masochism and the inner mother.

My understanding and treatment of patients with severe masochistic features has evolved and changed radically over the last fifteen years. My work with John and his subsequent life led me to search for new techniques and eventually to the discovery of a different way of understanding and treating these patients. I analyzed John in accord with the classical Freudian formulation of masochism. The paternal transference was central and-while a maternal transference and work with the residues of his experience with his mother were present and partially analyzed-the real power of the inner mother was not touched. It was only when I saw him years later in a near-moribund state that I realized the centrality of what we had not analyzed: the attachment to a punishing inner mother. This led me to conceptualize masochism in a new way. Of central importance in the formation of severe masochism is the relationship between an indifferent, possessive, or rejecting mother and a helpless child in the earliest years, before object constancy. This is a time when the child is unable to differentiate between self and mother. What results is a preverbal conviction that they are ungrateful or "bad" if they think, feel, or behave differently than the mother. This leads to a powerful and rigid attachment to this early mother, internalized as a punishing inner mother. This is the precursor of masochism, not a regression from the Oedipus complex. The child will tolerate physical and mental suffering to remain attached to the needed-even though pain inducing-mother. If the child is not attached, he feels helpless and fears survival. This attachment and fear is internalized and becomes unconscious as development proceeds. Eventually, what is observed in adult patients is a person who is sensitive to others, but unable to be sensitive to him/herself. Awareness of the importance and power of the attachment to the punishing inner mother enables the analyst to hear and perceive masochistic material with a shifted focus. This shifted focus naturally leads to different psychoanalytic treatment techniques throughout the analytic process. Two other cases of masochism are used to illustrate the techniques and course of their analytic processes with this "inner mother" focus. The psychoanalytic understanding of many forms of disturbance has shifted from the oedipal period to the early years in recent years. There is also a corresponding emphasis on the actual experiences with early figures, most prominently the mother. The particular dynamics I have described is part of this general trend.

Etiology of the masochistic and narcissistic personality.

It is the premise of this article, that at least in some instances, narcissistic and masochistic characters may develop from different role assignments in the same family (i.e., families with narcissistic dynamics). It is hypothesized that the child who later becomes narcissistic becomes assigned the role of the good child, remains merged with the mother, and becomes her ego-ideal. In contrast, the mother projects the egodystonic aspects of herself onto the child who becomes scapegoated, more willful, and defiant and eventually masochistic. The author has observed among her patients that some variables that seem to have contributed to the particular role assignment of a given child in the family are birth order, temperament, gender, resemblance to grandparents or significant objects in parents' life, and/or innate talents, gifts, and differences. It is suggested that the presence of narcissistic dynamics in the families of both masochistic and narcissistic characters may account for the similarities between the two character structures previously noted in the literature. It is obviously a limitation of this article that conclusions about family members (i.e., mothers and siblings) are based on reports of patients during long-term psychoanalytic treatment rather than direct observation. It is thus recommended that future research efforts attempt to verify these hypotheses through longitudinal family studies.