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The term "kink" has been claimed by some who practice sexual fetishism as a term or synonym for their practices, indicating a range of sexual and sexualistic practices from playful to sexual. He also says that twice in the past year he has started dating a woman he liked, only to break up with her because the stress of his compartmentalized sexual life felt overwhelming to him.

Moreover, it is causing significant and ongoing stress and anxiety, affecting both his social and work life. However, the behavior is clearly a primary element of Kevins sexual life, elevating BDSM the level of a fetish. Unfortunately, many therapists and clients are uncomfortable discussing sexual issues.

Fetishes are nontraditional sexual interests or behaviors kinks that are, for a particular individual, a deep and abiding and possibly even necessary element of sexual arousal and activity. Moreover, it is only when the behavior is taken to an extreme that results in negative life consequences that its viewed as a disorder. If BDSM was something Kevin engaged in occasionally with his partner s for a little bit of extra fun during sex, we would say hes got a kink.

Paraphilias are fetishes that have escalated in ways that have resulted in negative life consequences. Recognizing this, I find it useful to incorporate a few very basic sex-related questions into the initial assessment with every client. By posing queries and nonjudgmentally following up as indicated, we give clients permission to talk about their sex life and the ways in which it might be affecting them.

Again, I will use alcohol as an analogy. We do not say that drinking alcohol is inherently pathological because plenty of people do it without any problems at all. Rather, it is the way in which it affects Kevin that is pathologized. The basic behavior, consuming alcohol, is the same, but the underpinnings, impact, and long-term effects are quite different depending on the person.

Every therapist encounters, at least occasionally, a client seeking help with sexual issues of one ilk or another. He says he wants to continue dating this woman, but he also wants to continue with the dominatrix.

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Consider as an analogy the difference between a casual drinker, a heavy drinker, and an alcoholic. He also feels like his performance at work is suffering because of his anxiety. A kink, a fetish, and a paraphilia can involve the same behavior, but the role that behavior plays and the effects it has can be very different depending on the person. In my work, I tend to define kinks as nontraditional sexual behaviors that people sometimes use to spice things up, but that they can take or leave depending on their partner, their mood, etc.

As such, it is important for any initial queries to sound as neutral as possible.

While people often use the terms "fetish" and "kink" interchangeably, a kink means an activity or behavior that someone enjoys that exists outside the "norm" of "traditional" sex, .

More often, sexual issues lurk in the background, hiding behind depression, anxiety, fear of rejection, shame, and similar problems. At this point, some readers may be wondering exactly what I mean when I use the words kink, fetish, and paraphilia. We let them know that its OK safe to discuss their sexual life in treatment, however much shame they may be feeling about it. Typically, these individuals are either overtly or covertly worried about too much sex, not enough sex, no sex, strange sex, addictive sex, cheating sex, bad sex whatever bad meansetc.

Notably, it is not the behavior itself that is pathologized. A few non-threatening questions I typically ask are:. Sometimes these concerns are their primary presenting issue, but usually not. When asked a few basic questions about his sex life, he says that for the last several years he has been hiring a dominatrix a few times per month, paying her to physically and verbally humiliate him.

He says he does not become physically aroused while this is occurring, but after the dominatrix leaves he masturbates furiously. In such cases, a clients sexual concerns might only come to light while exploring the clients self-esteem, failed relationships, substance abuse, unresolved early-life trauma, mood disorders, etc. Asking these simple, straightforward questions generally ensures that a clients important sexual concerns issues that might underlie and drive more obvious problems like depression and anxiety arent overlooked.

He is unwilling to tell his new girlfriend about his sexual arousal patterns, and this is creating a great deal of stress and anxiety. Kevin, a year-old attorney, enters therapy for severe anxiety. And with good reason, because if you search the internet youll find a wide variety of definitions with quite a lot of overlap. He also says that he has recently started dating a woman he met through another attorney, and he is afraid that if they have sex she will notice the many marks and bruises that he nearly always has on various parts of his body.