Fifty shades of Belgian grey: the prevalence of BDSM-related fantasies and
activities in the general population
Lien Holvoeta, Wim Huysb, Violette Coppensa,c, Jantien Seeuwsd, Kris Goethalsb,c, Manuel
Accepted for publication in Journal of Sexual Medicine
!" University Department of Psychiatry, Campus Duffel, Stationsstraat 22c, B-2570
#" University Department of Psychiatry, Campus University Hospital Antwerp (UZA),
Wilrijkstraat 10, B-2610 Antwerp, Belgium.
$" Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine
and Health Sciences, University of Antwerp (UA), Universiteitsplein 1 , B-2650
%" Ruimte, Tentoonstellingslaan 92, B-9000 Ghent, Belgium.
Manuel Morrens; University Department of Psychiatry, Campus Duffel, Stationsstraat 22c,
B-2570 Duffel, Belgium. firstname.lastname@example.org
Background: Bondage and discipline (B/D), dominance and submission (D/S), and
sadism and masochism (S/M), or BDSM, is gaining popularity through the mainstream
media. Nevertheless, very little is known about the prevalence of BDSM related fantasies
and activities in the general population.
Aim: The current study aimed at determining the prevalence of both BDSM fantasies and
behavioral involvement in four different age groups of the general population in Belgium.
Methods: By use of a cross-sectional survey questionnaire, the level of interest in several
BDSM-related activities was investigated in a subject sample representative for the
general Belgian population (n=1027). The questionnaire evaluated interest in 54 BDSM
activities and 14 fetishes. Self-identification as BDSM-practitioner, situational context of
BDSM practice, age of awareness of these interests and transparence to others were
Outcomes: &'%()(%*!+ item scores and summary scores on four BDSM categories were
included in the analyses.
Results: A high interest in BDSM-related activities in the general population was found as
46.8% of the total sample had ever performed at least one BDSM-related activity, and an
additional 22% indicated having (had) fantasies about it. Interestingly, 12.5% of the
total population indicated performing one or more BDSM-related activities on a regular
basis. When asked if they saw themselves as being interested in BDSM, 26% revealed
this to be the case, and 7.6% self-identified as BDSM-practitioner. Interests in dominant
and submissive activities were comparable and, remarkably, were highly intercorrelated.
Both BDSM and fetish interests were present significantly higher in men than in women.
The older age group (48-65y) had significantly lower BDSM-scores compared to their
younger peers. Of the participants with a BDSM interest, 61.4% became aware of it
before the age of 25.
Clinical Implications: There is a high level of interest in BDSM in the general population,
which strongly argues against stigmatization and pathological characterization of these
Strengths & Limitations: This is the first thorough study concerning prevalence of interest
in and fantasies about a wide range of BDSM-related activities in the general population
worldwide. Although our findings tend to argue against, we cannot completely rule out
participation bias introduced by non-interest in the non-completers. In addition, some of
the topics may have been subject to interpretation by the correspondent.
Conclusion: BDSM interest is present within the majority of the general population.
Further research is needed to destigmatize it by confirming BDSM as a leisurely
preference rather than a psychiatric affliction.
BDSM, a combination of the abbreviations B/D (bondage and discipline), D/S (dominance
and submission), and S/M (sadism and masochism), refers to (sexual) experiences
where, in mutual consent, physical restraint, intense sensorial feeling and/or fantasy
about dominance and submission play a key role, often experienced in role play [1, 2]. A
related phenomenon is fetishism, implying the use of a specific non-living object, non-
genital part of the body or a certain act in attaining sexual arousal.
An increasing ambivalence surrounds the general perception of practices and interest in
BDSM-related activities. On one hand, the field is gaining attention in popular media,
literature and art, as evidenced by the huge commercial success of the recent Fifty
Shades of Grey books and movies. On the other, there is a distinct stigma surrounding
the spectrum. Practitioners of BDSM or related behaviors commonly report being
stigmatized and discriminated , often resulting in them concealing their BDSM related
preferences, with self-protection or protection of others most often stated as reason for
this concealment . This is mirrored in the fact that BDSM related activities are included
in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) , thus labeling
them as potentially deviant (e.g. sexual masochism disorder or sexual sadism disorder).
Including these behaviors in a psychiatric classification system may have societal
consequences of importance, e.g. in context of custody cases . In this light,
comparisons have been made with homosexuality, which was also a DSM diagnosis
before it was removed from the DSM-III in 1973 . Moser and Kleinplatz  proposed
the removal of several sexually related disorders from the DSM, including those based on
activities within the BDSM spectrum, because of changing cultural and historical factors
and more importantly, because of the lack of objective data to support their
characterization as a mental disorder.
A lack of knowledge about the nature and prevalence of the BDSM spectrum occupations
within the general population may fuel the above mentioned stigmatization. Up to now,
there is globally no proper investigation on the prevalence of interests, fantasies and
practices on different domains of BDSM. One study based on telephone interviews
questioned about various sexual practices, included a stand-alone question about having
performed BDSM-oriented sex within the last 12 months  and found less than 5% of
these respondents to have engaged therein. On the other hand, an older Canadian study
demonstrated that 65% of university students fantasized about being tied up by a sexual
partner . The divergent results of these two studies may reflect inherent population
differences and/or a potential gap between having fantasies and actually playing them
out. A study gauging 184 individuals active in the BDSM community indicated that most
individuals only engage in certain actions but not in others . Thus, interest may be
focused on a limited set of activities in a wider range of possible BDSM-related behaviors.
Other research suggested different preferences in BDSM–oriented activities in women
and men [12-14], with potential impact of age. As such, the BDSM spectrum may be a
cluster of very heterogeneous, independent profiles of interest.
To our knowledge however, no study has ever combined exploration of both interest in
and the level of practice of different aspects of a wide spectrum of BDSM related actions
in the general population. The current study therefore aimed at determining the
prevalence of both BDSM fantasies and behavioral involvement in different age groups of
the general population in Belgium.
A cross-sectional survey was carried out from February 2017 to March 2017. A digital
invitation for participation to the survey was e-mailed out to 8041 subjects by iVox, a
market research and polling agency with access to a panel of 150.000 Belgian citizens,
representative for the general population. Data of 1027 residents were collected, divided
over four age groups (see Table 1; group 1: 18-27y; group 2: 28-37y; group 3: 38-47y
and group 4: 48-65y).
The invitation contained the following minimal information: duration of time needed to
complete the survey (15 minutes), potential reward for participation (gift card) and the
mention that the questionnaire topic concerned ‘a special theme’. Invitees opening the
link were categorized as responders, those not opening the link as non-responders. To
minimize participation bias in the non-responders, an explanation of the content of the
study and an informed consent form were presented only after opening the link.
Subsequently, socio-economical status (age, gender, education, occupation) as well as
general information concerning sexuality (sexual orientation, sexual habits) were
requested. Next, a list of 54 BDSM related activities was presented, including items both
from the dominant (e.g. hitting a sexual partner with a whip) and the submissive
perspective (e.g. being hit by a sexual partner with a whip). On each of these items,
participants had to indicate their level of interest: 1) ‘I would never do this’, 2) ‘It doesn’t
seem to interest me, but I’m open to it’, 3) ‘Never thought of it, but I’d like to try’, 4) ‘I
have fantasized about it once, but have never tried it’, 5) ‘I fantasize about it regularly,
but have never tried it’, 6) ‘I have put it into practice, and I didn’t like it’ 7) ‘I have put it
into practice, and I liked it’ 8) ‘I do this regularly’ and finally 9) ‘It is indispensable for
me’. In addition to these individual responses, three response patterns were created for
analysis: 1) ‘No Interest’ 2) having fantasies about the activity, but never having put it
into practice (‘Fantasies’) and 3) having actually carried out the BDSM-related activity in
reality (‘Put Into Practice’).
After these 54 items, interest in 14 fetish-related activities was gauged by use of a 5-
item Likert scale. Finally, participants had to indicate to what extent they identified
themselves as BDSM-interested, and answer 11 questions concerning the situational
conditions where these activities had been performed, when they became aware of their
interests, and whether they had shared these interests with anyone.
Based on a factor analysis of the same questionnaire taken in a sample of 353 members
of the BDSM-community (ten Brink et al., in prep.), 4 BDSM-related categories were
defined: 1) dominance (including 18 items such as ‘blindfolding a partner’, ‘impose rules
to partner’, ‘hitting a partner’), 2) submission (including 23 items such as ‘kneeling
before a partner’, ‘being hit by a partner’, ‘Use a title to address partner’), 3) visual play
(including 7 items like ‘watching people getting hit’, ‘watching people being tied’ or
‘fireplay’) and 4) attributes (including items like ‘use of medical attributes’ and
‘penetration using big objects’). In addition, a fetishism score was calculated (exemplary
fetish categories are ‘shoes’, ‘latex’, ‘nylon’, ‘feet’ and ‘leather’). Corresponding summary
scores were calculated for each of these 5 categories by summation of the item scores
that primarily loaded on each of the factors.
Of the 8041 invitees, 2764 participants opened the survey (34.4% responders) of which
1.027 (37.2%) completed it, leaving 1.737 non-completers and 5.277 non-responders.
--INSERT TABLE 1 ABOUT HERE –
Profiling the participants concerning their BDSM fantasies and practice
All 1027 participants completed the 54-item BDSM questionnaire, as well as the 14-item
fetish questionnaire, gauging their level of interest in each of the BDSM-related activities
and fetishes respectively.
--INSERT TABLE 2 ABOUT HERE –
Table 2 presents the prevalence rates of both BDSM related fantasies and actual
practices from factors dominance, submission, visual play and attributes. Prevalence of
interest in dominance and submission was comparable in men and women, but men
demonstrated higher interest in visual play (p=.001) and attributes (p<.001).
Only 31.2% (n=320) of the completers reported no BDSM-related fantasies or practices
in either BDSM category. Fantasies without putting these into practice were reported by
22% (n=226), whereas 46.8% (n=481) participants indicated they had engaged in one
or more of the BDSM-related activities at least once. When looking at those participants
to engage in BDSM-related activities on a regular basis, 12.5% indicated to do so for at
least one of these activities, 7.5% in at least two different activities, 5.3% in at least
three of them, and 3.3% in at least 4 of these activities.
With regard to the 4 factorial BDSM categories, 9.5% engaged in at least one submissive
act on a regular basis, whereas this was the case in 8% for dominant behavior; for visual
play and attributes this was 2.5% and 1.7% respectively. Note that engaging in one of
the categories does not exclude engagement in any of the other categories.
--INSERT FIGURE 1A and 1B ABOUT HERE --
Figure 1 presents fantasies and practiced activities of the 15 most prevalent BDSM-items
in the general population, both from the dominance and the submission perspective.
When looking at the specific acts, movement restriction (by use of handcuffs, rope,…),
using a blindfold and using ice cubes elicited the highest interest, as these had each been
put into practice by 20-24% of our sample, both in a dominant and a submissive role
(see figure 1). Very few stated they didn’t like the experience (2.1%; 1.4%; 3.9%
respectively). On the other hand, only an equal minority indicated they performed these
activities on a regular basis (2.2%; 2.2%; 1.6%) and for each of these acts, less than
1% found them to be indispensable in their lives.
Submissive kneeling has been experimented with by 9.9% of the subjects, of which most
(78%, i.e. 7.7% of the total sample) stated they enjoyed it and 2.6% of the total sample
indicated to do this often. Hitting a partner in a sexual context was done by 11% of the
respondents in the dominant role, while 15.3% had been hit by a sexual partner. Both
from the acting (i.e. dominant role; 82% of affirmative item responses or 9% of the total
sample) and the receiving perspective (i.e. submissive role; 85% of affirmative item
responses or 13% of total sample), respondents stated they liked it, with 3-4% of the
total sample integrating it in their life on a regular basis. With regard of hitting attributes,
6% had used a whip or flogger on a partner and equally 6% had been hit with a whip or
Profiling fetishism in the participants
Prevalence rates of ,-.(/01('.-2-/./1!/1%-,('-%1#31!1/$42-14,15142161are reported in Table 3.
--INSERT TABLE 3 ABOUT HERE –
Prevalence rates of these interests were typically 2- to 3-fold higher in men than in
women. Interests in materials and clothing objects tended to intercorrelate: latex
correlated with leather (Spearman’s coefficient = .579; p<.001), nylon (r=.374;
p<.001), shoes (r=.288; p<.001) and furry costumes (r=.210; p<.001). Similarly, body
part fetishes intercorrelated as interest in buttocks correlated with breasts (r=.504;
p<.001) and to a lesser degree with feet (r=.146; p<.001). Of note, arousal by piercings
did not display any correlations of interest with any of the other fetishes.
Fetishism correlated mildly with BDSM interest: Latex fetishism correlated with all 4
BDSM-categories (range Spearman = 0.22-0.29; all p<.001), as did leather (spearman
range 0.20-0.33; all p<.001) and nylon (0.19-0.30; p<.001). Other categories correlated
as well, albeit more modestly.
Interrelationships between the BDSM domains
Somewhat surprisingly, calculated BDSM-category scores for submission and dominance
scores intercorrelated significantly (r=.816, p<.001), suggesting that respondents with
an interest in performing dominant activities were equally intrigued by experiencing the
submissive role. Submission scores also correlated with Visual scores (r=.706, p<.001)
and the Humiliation scores (r=.718, p<.001) and to a lesser degree with the Fetishism
score (r=.387, p<.001).
BDSM identity and awareness
When asked if subjects judge themselves as having any interest in BDSM, 26% of the
respondents affirmed. Of this subgroup, 29.2% (i.e. 7.6% of the total sample) identify
themselves as actual BDSM practitioners. Most of these practitioners (85.5%) report the
activities being performed at home, whereas the minority state to enjoy their activities
out-of-doors (BDSM-club, hotel,…).
Of the subjects reporting an interest in BDSM, 61.4% became aware of this interest
before the age of 25 and surprisingly, 8% before the age of 15. Less than 5% told a
family member about their interest, whereas 24.6% told a friend. Telling a colleague was
only done by 10 out of 264 subjects (3.8%).
Associations with sex, age and sexual orientation
Age had a significant impact on BDSM category scores. When comparing the four age
groups, the oldest group (48-65y) had significantly lower submission scores compared to
the first (18-27y: p<.001), second (28-37y, p<.001) and third age groups (38-47y,
p=.017) as well as significantly lower dominance scores (all p=.001 or lower). None of
the other category scores (visual, attributes) differed between the eldest and the other
age groups. Male participants systematically had significantly higher summary scores
compared to their female counterparts (dominance: F=44.32, p<.001), submission:
F=10.00, p=.002; visual: F=34.93, p<.001 and attributes: F=59.24, p<.001). These
significant differences remained present after controlling for age.
Participants with a sexual orientation other than heterosexuality had higher scores for
dominance (F=19.1, p<.001), submission (F=33.8; p<.001), visual (F=18.8; p<.001)
and attributes (F=40,5; p<.001) but not for fetishism (F<1).
Exploring the impact of dropout
A subgroup (n=141; 8.1%) of the non-completers answered at least the first 18 BDSM-
related items before dropping out (partial completers), making them interesting for
further analysis of the participation bias.
When entering all 18 BDSM items in a multivariate GLM analysis comparing completers
versus partial completers (n=114), no significant differences were found (F=1.310;
p=.167). When looking at item-level however, a moderate significant difference was
found in two items: ‘wearing a gag’ (F=5.35; p=.021) and ‘being locked up in a cage’
(F=5.930; p=.015). Interestingly, these scores were higher in the partial completers.
Thus, these findings might argue against the idea of a participation bias leading to
overrepresentation of BDSM-minded subjects. Of note, no differences were found in age,
sex or sexual orientation between completers and partial completers, although the group
of partial completers tended to have more women (60.4% versus 55.4% in the
A high interest in BDSM-related activities in the general population was found as half of
the total sample had ever performed at least one BDSM-related activity, and an
additional 22% indicated having (had) fantasies about it. When asked if interested in
BDSM, 26% revealed this to be the case, and 7.6% self-identified as BDSM-practitioner.
Interests in dominant and submissive activities were comparable and, remarkably, were
highly intercorrelated. Both BDSM and fetish interests were present significantly higher in
men than in women.
Compared to previous research, these prevalence rates seem high and are in contrast
with the findings of Richters and colleagues , who found less than 5% of the general
population to have engaged in BDSM-oriented sex. However, it should be noted that in
this study, only one broad question addressed BDSM interest, leaving ample room for
interpretation, and addressed a limited time period. The lower rate is rather more
comparable with the rate of correspondents from our sample who identify themselves as
BDSM practitioners (i.e. 7,6%), which is also in line with Bakker and Wesenbeeck ,
who reported 7% of the population in the Netherlands to act upon their SM-desires. The
use of an extensive list of specific BDSM activities (including potentially ‘milder’ activities)
may also explain the higher prevalence percentages in our sample compared to some
In addition to the 46.8% who have practiced BDSM to some extent, another 22% has at
least once fantasized about one or more BDSM related activities. Reynaud and Beyers
 found that 65% of college students had ever fantasized about either tying someone
else up or being tied up themselves in a sexual context. Very similarly, the recent study
of Joyal and Carpentier , also found that in a large sample of the general population
(n=1040) nearly half (45.6%) had interests in paraphilic behavior (including sadism,
masochism and fetishism). These findings are thus comparable with our cumulative
prevalences for both enactment and fantasizing and indicate that at least some degree of
interest in BDSM is found in about 70% of the population.
Regular BDSM practitioners tend to participate more in submissive and dominant
behavior (9.5% and 8% respectively) rather than in visually stimulating acts (2.5%) or
use of BDSM-related attributes (1.7%). Surprisingly, respondents with an interest in
submissive roles were highly likely to have an interest in a dominant role as well. This is
in contrast with a study within the BDSM community [4, 14], that demonstrated a more
clear-cut preference for either role. These seemingly contrasting findings could result
from the fact that participants from the general population are exploring their interests,
experiment more with BDSM activities, and as a result, are more likely to still have no
well-defined interest or identity within the spectrum. It may also be that within the BDSM
community a more well-defined categorical identity (dominant, submissive or switch) is
expected or sometimes even required. This is in line with the study of Alison  that
demonstrated that subjects participating in a certain number of specific BDSM acts
tended to avoid other BDSM activities.
Older participants (i.e. 48-65y) had lower submission and dominance scores compared to
their younger peers, whereas no other age effects were found. This is remarkable, as
these participants had more time to explore their interests. Quite possibly, these
differences reflect cultural and generational differences as older generations may have
experienced a higher amount of stigma. Additionally, access to literature and other
BDSM-related media on the subject may have been more restricted and it might have
been more difficult to connect with peers, ultimately having allowed fewer people to
develop and explore their interests.
The majority (61.4%) of the completers with a self-proclaimed interest in BDSM became
aware of this interest before the age of 25. Bezreh and colleagues  demonstrated
awareness at an even younger age (85% before the age of 20) within a small sample of
the BDSM community. Similarly, Floyd and Bakeman  demonstrated first awareness
of same-sex attraction was reported around the age of 13.2 years old and self-
identification as being gay/lesbian/bisexual came at an age (19.7y) which is comparable
with our findings concerning BDSM interests.
The majority of participants felt uncomfortable revealing their BDSM interests, more to
family members or colleagues than to friends. Stiles and colleagues  found
resembling data as 38% of their research sample completely concealed their interest,
whereas 11-25% only told some close friends or family members. In contrast, talking
about sexuality in general to family members was done by 58-75% of teenagers .
This could reflect the stigma and the feelings of shame and guilt associated with BDSM
When looking at fetish interests, most people who were found to be sexually aroused by
a certain clothing fabric, were likely to be aroused by other materials as well. Comparable
associations were seen for interest in body parts. It should be noted that the survey only
gauged arousal by / interest in a certain fetish domain; it did not verify whether the
objects were per se required to get sexually aroused as is the case for some people with
a specific fetish. Thus, similar to BDSM practice, fetishism could also be categorized as a
spectrum ranging from “some interest in” or “arousal by” an object/body part to
“absolutely indispensable to achieve sexual arousal”.
The study has some limitations. A market research and polling agency collected the data
to ensure a study sample representative for the general population, but due to our study
design only participants between the age of 18 and 65 with internet access entered the
study. Nevertheless, apart from those limitations, we feel our sample is indeed
representative. Although 37.2% invitees knowledgeable about the study topic completed
the survey and while we did not find significant lower BDSM interest in non-completers
versus completers, we cannot completely rule out participation bias introduced by non-
interest in the non-completers. Also, although the survey was anonymous, the fear of
being exposed in some way may have contributed to dropout during completion of the
survey. In addition, some of the topics may be subject to interpretation by the
correspondent (e.g. categorizing an object or body part as sexually stimulating). Finally,
no specific information was requested on timing of specific acts. As a result, no
distinction can be made between a subject referring to an act performed recently versus
decades ago; thereby potentially impacting age group-related correlations.
To conclude, there is a high level of interest in BDSM in the general population, which
strongly argues against pathological characterization and stigmatization of these
interests. Further research is needed to confirm BDSM as a leisurely preference rather
than psychiatric affliction to destigmatize it within the population. This quest might
benefit from exploring comparisons between BDSM profiles from the general population
and those from the BDSM community.
Table! 2:! Prevalence! rates! of! lack! of! interest,! fantasies! about! and! practicing! of! BDSM-