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EDUCATION POLICY | RESEARCH ARTICLE
Level of awareness of BDSM on attitudes towards
BDSM practitioners among a Malaysian
population
S. Q. A. Huang
1
and Victor Weng Yew Goh
1
*
Abstract: This study aims to examine the effect of the level of awareness about
BDSM on the attitudes towards BDSM practitioners in a conservative country such as
Malaysia. A total of 124 Malaysian participants were recruited. Over 5 weeks, the
experimental group underwent educational interventions, whereas the control
group received neutral, unrelated information. The Attitudes about
Sadomasochism Scale was used to record responses from both groups before and
after the experiment. Results indicated that the experimental group showed
a greater reduction in stigmatizing attitudes towards BDSM practitioners after the
intervention period, demonstrating that the level of awareness of BDSM significantly
affects participants' stigmatizing attitudes towards BDSM practitioners. In conclu-
sion, educational interventions might be essential to reduce stigmatizing attitudes.
Subjects: Multidisciplinary Psychology; Psychological Science; Mental Health
Keywords: BDSM; Malaysia; sexual stigma; sadomasochism; awareness
1. Background to study
Safe, sane, and consensual—this motto is the cornerstone of BDSM values, yet it is so unheard of
for the general public in this regard. If you ask an inexperienced individual what they think BDSM is,
they might think of whips and chains, or even possibly abuse. BDSM is an acronym that encom-
passes three categories: Bondage-Discipline, Dominance-Submission, and Sadomasochism
(Ansara, 2019). The acronym is used when referring to consensual role-play (either sexual, psy-
chological, or physical—or all at once) involving some form of power exchange (De Neef et al.,
2019). Sadomasochism refers to those who get sexual pleasure and gratification from giving
(sadism) or receiving (masochism) pain, but not all people who participate in BDSM are sadists
or masochists. Although BDSM activities are depicted as pleasurable and leisurely especially by
practitioners, BDSM is not favourably looked upon in society at large (Newmahr, 2010). The
subtypes of BDSM were previously categorized as sexual deviances and paraphilias in the
Diagnostic Statistical Manual (DSM), but the American Psychological Association (APA) is now
taking steps to demedicalize them (Bezreh et al., 2012). According to Waldura et al. (2016),
while the DSM-III initially considered anyone who acted on their kink urges to be mentally ill,
subsequent editions added a requirement for the individual to be distressed to classify it as an
illness as well as clearly differentiating paraphilic disorders and non-pathologic paraphilias. Even
so, it does not seem like the public’s attitudes have changed much as it is still not deemed as
something “normal” (Stiles & Clark, 2011).
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Received: 07 February 2023
Accepted: 01 October 2023
*Corresponding author: Victor Weng
Yew Goh, Department of Psychology,
HELP University, Kuala Lumpur,
Malaysia
E-mail: victor.goh@help.edu.my
Reviewing editor:
Arif H Kabir, Institute of Education
and Research, University of Dhaka,
Bangladesh
Additional information is available at
the end of the article
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribu-
tion, and reproduction in any medium, provided the original work is properly cited. The terms on
which this article has been published allow the posting of the Accepted Manuscript in
a repository by the author(s) or with their consent.
The BDSM community has criticized portrayals of BDSM in popular media like Fifty Shades of
Grey as it is more depictive of an abusive relationship rather than a healthy one (Bezreh et al.,
2012; Chen, 2021); however, this criticism is not known to the public and is assumed to be an
accurate representation of what BDSM is (Chen, 2021; Tripodi, 2017). This is further com-
pounded by findings that suggest countries which include sexual education in the school
syllabus do not include kink education, especially in countries like Malaysia (Khalaf et al.,
2014; Talib et al., 2012). As Sand (2019) mentioned, even though there is an increase in
attention towards BDSM as of recent, it cannot be said the same for the public’s understanding
nor acceptance of BDSM practices or kinky behaviours. This lack of education—and subse-
quently, awareness—of the topic at hand is dangerous as prejudice and stigmatization due to
misconceptions against the so-called “abnormal” community can then lead to discrimination
towards the group.
This is especially unfortunate, as BDSM culture has been shown to be linked to personal
empowerment and resilience (Damm et al., 2017; Williams et al., 2017), it is also known to be
cathartic or therapeutic to some people who practice it (Carlström, 2019; Hébert & Weaver,
2015; Newmahr, 2010; Williams et al., 2016). Nonetheless, despite these findings, awareness of
its benefits remains lacking due to the permeation of stigma towards BDSM activities.
Increasing awareness is thus important as it can help reduce misconceptions and stigmatizing
attitudes, allowing BDSM practitioners to feel safer and comfortable in practicing what is
arguably a healthy sexual lifestyle (Newmahr, 2010; Williams, 2015; Wismeijer & Van Assen,
2013), as well as receive the care they need without being judged or discriminated (Kelsey
et al., 2013; Waldura et al., 2016).
2. Literature review
2.1. Theoretical framework
The Social Identity Theory (SIT) suggests that intergroup hostility and prejudice come from the
tendency to find negative aspects in out-groups and focuses on them (Makashvili et al., 2018). As
misinformed individuals deem BDSM a dangerous activity, BDSM practitioners might be seen as
a threat. This misinformation is elaborated on later in this paper, but negative perceptions spread
via mainstream culture, outdated views in medical and mental health care, and biased wording in
scientific papers contribute to this narrative where BDSM practitioners have abnormal urges and
are likely to be abusers (Hansen-Brown & Jefferson, 2022; Hughes & Hammack, 2019; Nichols,
2006; Sprott & Randall, 2017). This then connects to the Integrated Threat Theory (ITT), as the
theory proposes that when people anticipate threats from an external group, it might foster
prejudice (Makashvili et al., 2018).
Stigma comes in many forms and can present itself at different levels and have differing conse-
quences (i.e., perceived stigma versus institutionalized stigma). This means that a combination of
these two theories mentioned supports why BDSM practitioners are stigmatized by not just the general
public, but even in more serious environments like health care Social stigma is further propagated by
prior information presented to the general public via possibly disreputable sources extracted from the
internet and widespread media (Weiss, 2006). Institutionalized stigma is harmful when medical
professionals use existing policies or beliefs to provide unequal treatment towards the other party
(Clair et al., 2016). This then leads to discrimination being perpetuated against the stigmatized group.
Mainstream culture has indirectly contributed to negative perceptions not by outright condemn-
ing BDSM practices, but by omitting important values that BDSM practitioners stand by, such as
consent, safety, and communication between everyone involved (Drdová & Saxonberg, 2020). The
portrayal of only certain excerpts or inaccurate representations of BDSM practices in mainstream
culture has had a negative effect as well (i.e. public libraries in Florida banning Fifty Shades of Grey
and labelling it as deviant) and this would in turn lead to the public perception of BDSM being
tainted (Drdová & Saxonberg, 2020; Wismeijer & Van Assen, 2013). Weiss (2006) puts it this way:
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BDSM acts and communities have been depicted as something “abnormal” whenever shown in
mainstream media, reinforcing that it is still a deviant act and reinforcing that BDSM practitioners
are of an out-group.
Similarly, in existing healthcare literature, BDSM practices are depicted as a paraphilic dis-
order instead of a paraphilia, framing it in a deviant light (Sprott & Randall, 2017). To elaborate,
scientific articles from the 1970s and 1980s focused on non-consensual sadism and perceived
BDSM as pathologic because of it (De Neef et al., 2019). According to Williams (2015), many
journal editors and reviewers from the field of social work also refuse to accept literature
submitted on the topic of BDSM, thus limiting the exposure or awareness of it. This institutio-
nalized stigma is seen more prominently in court cases where an individual’s involvement in
BDSM activities can be a determining factor in child custody hearings. Wright (2018) has also
mentioned that there were over 800 cases brought up to the National Coalition for Sexual
Freedom (NCSF) for parents asking for assistance in their child custody hearing, where
a determining factor was their involvement in BDSM and an alternative lifestyle. The previous
edition of the DSM was used by people in power involved in the cases to justify why their cases
were denied, and it was only until the DSM-5 was provided in further hearings that they could
have a fair chance where their BDSM activities were not brought into consideration anymore
(Wright, 2018).
2.2. Discrimination towards BDSM practitioners
When social stigma is strong and discrimination is prominent towards a particular group, indivi-
duals who identify themselves with the said group will be hesitant to disclose their association
with them due to fear of negative consequences; this causes them to be more cautious in opening
up (Stiles & Clark, 2011). The need to conceal your own identity (especially a stigmatized one) leads
to negative outcomes in various forms, like a lower sense of self-regard and the feeling of isolation
Figure 1. SPSS Cronbach’s alpha
output (ASMS scale).
Figure 2. SPSS descriptive sta-
tistics output.
Figure 3. SPSS KMO and
Bartlett’s test (EFA) output.
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(Camacho et al., 2020). To illustrate further with an example: if an individual withholds information
regarding an important part of their life (in this case, practicing BDSM), they might not be aware
that their long-term individual work can be compromised negatively as their therapeutic journey
may be ineffective (Nichols, 2006).
Figure 4. SPSS eigenvalues
table (EFA) output.
Figure 5. SPSS assumption of
normality output.
Figure 6. SPSS assumption of
homogeneity of variance &
T-Test.
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Since concealment of identity is necessary for most BDSM practitioners to feel safe and secure,
non-disclosure tends to happen whenever they are in a vulnerable position, like during an interview
or when they are seeking help from others (Sprott et al., 2021). Current laws and systems do not
protect the rights of BDSM practitioners; their relationships with friends and families can be
destroyed due to inappropriate disclosure (Nichols, 2006; Stiles & Clark, 2011; Wright, 2008). For
example, medical providers can report an individual for engaging in domestic abuse when they see
bruises and marks on their partner even though it was a result of a consensual BDSM scene
(Waldura et al., 2016). In certain cases, BDSM practitioners have lost jobs and even custody of their
children because of inappropriate disclosures and misunderstandings (Bezreh et al., 2012).
Sometimes in perceived domestic abuse cases or child custody proceedings as mentioned before,
an individual’s psychotherapist might get called to testify against them by affirming that their
desires and actions confirm them to be dangerous (Bezreh et al., 2012). There were also similar
reports by Bezreh et al. (2012), like a respondent knowing a consensual kink practitioner having to
serve 3 years in prison for “assault” and another who had to disclose to his son after his neighbour
notified social services of his BDSM activities. When health professionals are not aware and given
proper education on BDSM, consensual scenes might get mistaken with their abusive counterparts,
thus reinforcing the negative stigma surrounding the BDSM community.
Furthermore, healthcare and mental health services are known to discriminate against sexual
minorities, including BDSM practitioners (Damm et al., 2017; Rao et al., 2019); many said health-
care providers do not receive kink education as part of their training (Shindel & Parish, 2013; Sprott
& Randall, 2017). People have also reported being denied care from health professionals when
their identity or their activities were disclosed (Sprott & Randall, 2017). The cumulative conse-
quences of these various forms of discrimination towards BDSM practitioners only serve to further
endanger this particular demographic.
2.3. Consequences of BDSM discrimination
Fear of stigma might prevent BDSM practitioners from not getting the health care they need
(Kelsey et al., 2013). In the mental health area especially, therapists who hold negative miscon-
ceptions or are unequipped with the proper education on kink have perpetuated negative out-
comes for their clients, as they are unable to provide the proper support to counterbalance the
stigma and shame that is faced by the community, and provide needed support and validation
(Ansara, 2019; Clair et al., 2016; Nichols, 2006). To emphasize, BDSM practitioners have mentioned
that they would rather refer to other practitioners in the community for advice and help on
medical information related to their activities as compared to seeking out help from healthcare
providers (Sprott et al., 2021; Waldura et al., 2016). Some practitioners have also reported
instances of direct judgement or discrimination from healthcare providers in the form of micro-
aggressions whenever seeking help (Waldura et al., 2016).
Sometimes, BDSM practitioners seeking therapy may disclose their involvement in BDSM as it is
an essential part of their identity. However, this disclosure can derail their therapeutic journey if
mental health professionals lack understanding about BDSM. Practitioners sometimes spend more
time than necessary clarifying aspects of their BDSM identity and lifestyle in paid sessions rather
than focusing on therapeutic work (Ansara, 2019; Nichols, 2006; Waldura et al., 2016). In more
extreme situations, these clients feel exasperated that therapists incorrectly perceive BDSM to be
the root or a contributing cause of an issue (i.e. they might assume that someone who is into
verbal humiliation might have low self-esteem) and centre their therapy sessions around that,
even though it was never a goal of the session (Nichols, 2006).
As mentioned previously, BDSM practitioners resort to engaging in protective measures like con-
cealing their identity even though it may lead to detrimental outcomes as they fear being discrimi-
nated against (Stiles & Clark, 2011). This stigma management via concealment is usually for the sake
of improving both interpersonal and psychological outcomes of the individual, as they fear they would
not get the support and companionship that they need otherwise (Stiles & Clark, 2011). Specifically,
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BDSM practitioners who feel stigmatized might deliberately withhold information from both their
physical and mental healthcare providers for fear of being negatively perceived, which may result in
adverse consequences to both their mental and physical health. Research indicates that individuals
who feel the need to conceal parts of their sexual identity and orientations are at higher risk of
internalizing mental health problems (Pachankis et al., 2020) as well as engaging in physically
detrimental activities such as alcohol and drug abuse (Hatzenbuehler & Pachankis, 2016). Even though
it is possible for them to find a community in which they feel safe and validated in, it might be difficult
to source out these safe spaces without having people to direct them, especially individuals who are
new to the lifestyle or the BDSM scene. This loops back to the issue of concealment versus disclosure as
well—in order to receive help or guidance, they must first feel safe enough to disclose their identity
and risk being discriminated against (Camacho et al., 2019).
2.4. Importance of increased awareness of BDSM
Extant research on the challenges facing BDSM practitioners highlights the importance that
educational interventions might have in reducing stigma and increasing awareness among the
public (Yamaguchi et al., 2011). According to Clair et al. (2016), there are a few conditions that
need to be fulfilled to reduce stigma, among which are that the public must see the information
presented as credible, especially from someone with a good social status. Proper education on this
topic is one way to reduce stigmatizing attitudes, especially at the societal level (Gronholm et al.,
2017; Rao et al., 2019); with a particular focus on formal education. These educational interven-
tions have been suggested to be effective in increasing awareness in the public and thus reduce
stigmatizing attitudes as they have been shown to reduce misunderstandings regarding the
dangerousness of the stigmatized group (Yamaguchi et al., 2011). This is especially true in
Malaysia, where the primary focus of sex education still hinges on abstinence-only policies and
a strict restriction of young people’s access to sexual education resources (Khalaf et al., 2014).
3. Research gap: will awareness interventions work, especially in a country like Malaysia?
As mentioned above, literature focusing on BDSM practitioners are centered around the positive
impacts of engaging in BDSM activities (Damm et al., 2017) and the attitudes people (e.g. therapists)
have of them (Kelsey et al., 2013), but not much on stigma management or how to reduce discrimi-
nation. Stigma-reduction interventions in this area have yet to be investigated but have been done on
the stigmatization of other instances, like on the taboo surrounding mental health and HIV patients.
Much research on BDSM in the past has been conducted in Western countries, but none in Asian
countries like Malaysia where sexual education is deemed unnecessary and is limited and filtered
(Talib et al., 2012). In a comprehensive review of the quality of sex education in Malaysia, it was
found that sex education as a whole remained plagued with systemic issues, resulting in basic
knowledge about sex being at suboptimal levels, not to mention additional sex levels such as
healthy BDSM practices (Adanan, 2019).
Furthermore, as a primarily Muslim-dominated country, sexual minorities like the LGBTQ+ com-
munity are openly discriminated against and criminalized by the public and the government (Asia
Pacific Transgender Network, 2020; Human Rights Watch, 2021; Tan et al., 2021). Damm et al.
(2017) suggested that systems of oppression that impact BDSM practitioners might come from the
same systems that oppress other minorities (e.g. race or sexuality), leading to further contribution
of shame and secrecy when it comes to taboo topics, consequently causing individuals to be afraid
to be overly open even with healthcare professionals. According to Sprott and Randall (2017),
BDSM practitioners are not currently identified as a sexual minority; however, literature showing
the pattern of mental health issues related to stigma and minority stress of BDSM practitioners
seem to be similar to those observed in the LGBTQ+ population, supporting the idea that they
might be considered a sexual minority. Based on this, we can anticipate BDSM practitioners to face
much of the same pressures as other sexual minorities in Malaysia such as the LGBTQ+
community.
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With such entrenched views on BDSM, either due to a lack of education or the prevalence of
societal stigma, it remains to be seen if awareness interventions might have a role to play in
changing attitudes towards BDSM in a conservative Muslim country like Malaysia.
4. Current study
This study aims to determine if increasing awareness about BDSM can have a positive effect on the
attitudes about BDSM practitioners in the Malaysian context. This study focuses on replacing
previously understood misinformation and misconceptions with reliable information in the form
of educational interventions, whereby it is proposed that raising awareness may have effects in
reducing stigma (Yamaguchi et al., 2011).
RQ1: “Will participants who experience a higher level of awareness via educational interventions
end up having lower stigmatizing attitudes towards BDSM practitioners as compared to their
counterparts?”
Hypothesis 1: It is hypothesized that the experimental group which would undergo awareness
intervention will have lower stigmatizing attitudes towards BDSM practitioners as compared to the
control group which will not be undergoing the awareness intervention.
5. Method
5.1. Participants
Participants who were recruited in this study are undergraduate students at a private university via
the IPSY portal, where students are allowed to participate in experimental studies in exchange for
extra course credit. Convenience sampling was used in the current study as the experiment was
posted on the portal and participants were offered 0.5% extra credit for complete participation.
Based on a-priori calculations, the recommended minimum number was 128 participants (Faul
et al., 2007). Initial recruitment of participants willing to join the study yielded 149 signups.
Because the study took place over a 5-week period, some participants failed to attend sessions,
possibly due to fatigue. Some participants also reported that study emails went into their spam
folder, denying them notification. We dropped these participant datasets from the final analysis to
preserve the integrity of the data, resulting in a total of 124 participants at the end of the study,
with 63 of them in the intervention group and 61 in the control group.
The participants were aged between 19 and 27 (M = 21.11, SD = 1.24), with the majority being
aged 21 (47 participants), followed by 20 (32 participants) and 22 (31 participants). There were 109
participants identifying as female, 13 identifying as male, 1 who preferred not to disclose their
gender and 1 under the “others” category.
5.2. Measures
The Attitudes about Sadomasochism Scale (ASMS; Yost, 2010) was utilized to measure the levels of
stigmatizing attitudes of participants towards BDSM practitioners. As this study wanted to inves-
tigate if educational interventions made a difference in participants’ stigmatizing attitudes, it was
provided as both a pretest and as the posttest after the intervention period was concluded.
The ASMS is a 23-item Likert scale, with participants scoring their agreement/disagreement with
the statements provided on a scale from 1 to 7, with 1 being “disagree strongly” and 7 being
“agree strongly.” Some of the items on the scale were reverse-scored (items 18 through 21). The
average of the total score of each participant was taken, with a higher average score indicating
a higher stigmatizing attitude towards BDSM practitioners.
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Subscales within the ASMS include the Socially Wrong subscale, the Violence subscale, the Lack
of Tolerance subscale, and the Real Life subscale. As this study looked at stigmatizing attitudes in
general, the whole scale was used to provide a holistic overview. Examples of the statements
provided include “SM rarely exists in a psychologically healthy individual” and “A Dominant is more
likely to rape a stranger than the average person.” The Cronbach’s alpha coefficient of each
subscale within the whole scale was between .78 and .92, demonstrating good internal consis-
tency (Yost, 2010). The ASMS scale used in this study reported a Cronbach’'s alpha value of .95
(refer to Figure 1).
The infographics on BDSM that were provided to the participants were created by combining and
consolidating information from various research papers on BDSM as they were considered to be
credible sources. Each infographic was an A4 page long and had references listed down on the
following page. These infographics were provided to all the participants (both experimental and
control) at the end of the experiment as it was deemed beneficial for all parties to have the
information as well.
Week 1’s infographic was on the fundamentals of BDSM, with explanations of what the acronyms
stand for and what they meant, the link between childhood trauma and interest in BDSM, at what age
were BDSM practitioners aware of their interests and BDSM practitioners’ scoring on the Big Five as
compared to their counterparts. Week 2’s infographic was on general safety, consent, and etiquette
within BDSM scenes. Common safety philosophies, levels of consent, safewords, and aftercare were
among the information provided that week. Week 3 detailed roles in BDSM scenes. It explained who
was in charge of the scenes, how the social hierarchy works, the link between feminism and BDSM,
the different headspaces BDSM practitioners can get into, and if it was reflective of who they were
outside the bedroom. Week 4 revolved around BDSM scenes and play; definitions of what a scene
was, how BDSM was like leisure, if practitioners always received sexual fulfillment, how costly it was,
and how boundaries were enforced were detailed that week. Further information regarding the
infographics used in this study can be found in the attached appendix (Appendix A).
5.3. Procedure
Participants were required to fill out a Google Form containing demographic details and an
informed consent form to sign up for a session on IPSY where the details of the study and amount
of extra credit were indicated. For every 10 signups, their details were put into an online rando-
mizer to determine if they were in the intervention or control condition. They were then assigned
a corresponding unique participant ID tag in order to log their attendance throughout the study.
Then, an email was sent to the participants with the ASMS scale (pretest) along with the
respective materials for the first week and their unique ID. Over the course of the subsequent 4
weeks, participants were provided with further information depending on the condition that they
were assigned to, with the intervention condition being provided additional infographics on BDSM
which were created through collating credible information from academic articles related to BDSM
and safe practices.
The control conditions were given a series of random, unrelated videos to watch. We took care in
ensuring that the videos were not related to any social issues or anything that might be related to
the topic at hand, including the variables. These videos were linked to YouTube and were all around
10 min long as it was estimated that it would also take the participants in the intervention group
the same amount of time to digest each week’s infographic.
Participants in both groups were required to input their unique ID tag and verify that they have
read the infographic/watched the video by ticking the checkbox on the page at the end of the
Google Form which they submitted on a weekly basis.
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In the fifth week, participants were sent one last email with the link to the ASMS for the posttest
section of the study. Completing the ASMS marked the conclusion of their participation in the
study.
The entirety of this study’s procedures and materials were reviewed, and ethical approval was
obtained for this study from the Ethics Review Board of the Department of Psychology in HELP
University.
6. Results
6.1. Instrument validity testing
An exploratory factor analysis (EFA) was conducted on the ASMS as the instrument was relatively
new to the population that was sampled. The Kaiser–Meyer–Olkin measure of sampling adequacy
was .93. Bartlett’s test of sphericity was also significant (χ
2
(253) = 2616.69, p < .001) (refer to
Figure 3). The EFA yielded four factors with an eigenvalue of >1, indicating that there were at least
four factors in the ASMS, similar to the factor structure reported by Yost (2010) (refer to Figure 4).
This gave the researchers confidence that despite the ASMS being rarely (if ever) used on
a Malaysian population, it would still be able to capture the essence of BDSM stigma despite
possible existing cultural differences. Reliability measures for the ASMS were also calculated, with
a Cronbach’s alpha of .95 suggesting robust internal consistency of the measure in this study.
6.2. Assumption testing
As there were 124 participants, Shapiro-Wilk was used to test for the assumption of normality. The
assumption of normality of the stigmatizing attitudes towards BDSM practitioners was met for
both experimental (Shapiro-Wilk(63) = .98, p = .376) and control (Shapiro-Wilk(61) = .98, p = .334)
groups (refer to Figure 5 in Appendix F(iv)). The overall assumption of normality was assumed,
indicating that the sample distribution is normal.
The assumption of homogeneity of variances was tested using Levene’s test and is also met,
F = 2.32, p = .130 (refer to Figure 6 in Appendix F(v)).
6.3. Data collation and descriptive statistics
The difference in scores from pretest ASMS and posttest ASMS was calculated by subtracting the
posttest scores from the pretest scores for each participant in both the intervention and control
conditions. These individual scores were then analysed using SPSS, specifically with the t-test, in
order to determine if the difference in scores between pre-intervention and post-intervention was
significantly different for participants who underwent the intervention condition compared to their
peers in the control group.
Descriptive statistics showed that participants in the experimental condition showed a greater
reduction in their ASMS scores (M = 0.88, SD = 0.68) compared to the control condition (M = 0.27,
SD = 0.60), indicating that there on the surface, the intervention worked to reduce the overall
stigma participants had towards BDSM (refer to Figure 2).
6.4. Inferential statistics
Independent t-test results indicated that the level of awareness of BDSM on stigmatizing attitudes
towards BDSM practitioners was significant, t(122) = 5.30, p < .001, 95% CI [0.382, 0.838] (refer to
Table 1), suggesting that the difference in scores between the intervention and control group was
indeed statistically significant.
Participants who were in the experimental group showed a greater reduction in stigmatizing
attitudes (M = 0.88, SD = 0.68) than those who were in the control group (M = 0.27, SD = 0.60) (refer
to Table 2).
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The hypothesis that there is a significant effect of awareness of BDSM on stigmatizing attitudes
towards BDSM practitioners was supported.
7. Discussion
7.1. Summary of findings
The exploratory factor analysis indicated that there were four factors present within the ASMS
scale, consistent with the original scale which had four subscales (refer to Appendix B). This
indicates that the ASMS can be applied within the Malaysian context. Both descriptive and
inferential statistics further showed that the experimental group showed a greater reduction in
stigmatizing attitudes towards BDSM practitioners after the intervention period, which indicated
that the level of awareness on BDSM significantly affected participants' stigmatizing attitudes
towards BDSM practitioners.
7.2. Discussion of findings
7.2.1. Importance of credible interventions
The participants in the experimental group were presented with infographics aimed at tackling
common misconceptions and were guided by the statements provided in the ASMS (e.g.,
a statement in the scale said, “submissives are passive in other aspects of their lives,” and Week
4’s infographic touched on the reflectiveness of BDSM practitioners in the bedroom versus how
they are in real life). Participants were also provided references, possibly contributing to an
increased acceptance of the information as truth as it provided credibility (one of the conditions
for reducing stigma; Clair et al., 2016). The results of this study demonstrate that being able to
portray credible information is integral and effective in reducing discriminatory views among the
Malaysian population. These findings are particularly encouraging, as they demonstrate that the
current lack of education about sexual health and BDSM in Malaysia is not necessarily a major
barrier towards attitude change.
Nonetheless, according to the National Academies of Sciences, Engineering, and Medicine
(2016), there are times when stigma-reduction interventions might unintentionally increase stig-
matizing attitudes as it focuses on the differences rather than the similarities between the
stigmatized and non-stigmatized groups. This happened in the current study as there were
a few participants in the experimental group who had worse views in the posttest as compared
to their pretest results. Several participants also showed no difference in their scores. There is
a possibility that these individuals “double-downed” on their beliefs once presented with
Table 1. Independent T-Test results comparing stigmatizing attitudes towards BDSM practi-
tioners between the control and experimental group
95% Confidence Interval
t df Sig. (2-tailed) Lower Upper
Stigmatizing
Attitudes
Towards BDSM
Practitioners
5.30 122 .000 0.382 0.838
Table 2. Group statistics indicating the mean and standard deviation in reduction of stigma-
tizing attitudes between the two groups
Group N M SD
Experimental 63 0.88 0.68
Control 61 0.27 0.60
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conflicting information inconsistent with their own views - a form of coping and resolving the
cognitive dissonance they might have felt when processing the information given, similar to the
dissonance reduction strategies proposed by McGrath (2017). Two of the reduction strategies
mentioned might be relevant in this case, which is “distraction and forgetting,” as well as
“trivialization and self-affirmation.” Unfortunately, there was no further questioning on their
beliefs in this study.
These findings also reflect extant literature, such as those found in Gronholm et al. (2017) study
where healthcare professionals who went through anti-stigma interventions were reported to have
enhanced knowledge on the topic at hand and more positive behavioural intentions/clinical
competence. The APA also advocates for proper guidelines on BDSM cultural competence to be
established to further support the requirement of proper education and training in the health
sectors (Damm et al., 2017).
7.2.2. Importance of increased awareness and education about BDSM
In the study conducted by Yost (2010), the more participants were educated about BDSM practices,
the more positive their attitudes towards them. Even though our study did not involve participants
with prior knowledge on BDSM, the results of the experimental group indicated similar results to
the aforementioned study. When the participants were educated on BDSM, their attitudes changed
as they were exposed to new information. That being said, if sexuality educators in schools are
able to start educating the public about BDSM in a healthy manner, it might reduce stigmatizing
attitudes towards BDSM practitioners as there would be lesser misconceptions and practitioners
might not be viewed with a discriminatory lens (Sand, 2019).
Awareness and proper education about BDSM is equally important for not just the public, but
also for individual’s understanding. When proper information in relation to BDSM is not easily
accessible, individuals who are interested in exploring BDSM might not be inclined to pursue
further as they fear their desires make them a dangerous person (Bezreh et al., 2012). These
individuals can feel an increase in self-judgement and shame as well based on negative cues from
the environment. If provided with trustworthy channels to explore and understand BDSM safely,
individuals will also be more inclined to carry out their practices with caution, unlike if they were
under the guidance of pornography (Bezreh et al., 2012).
When BDSM practitioners are allowed to disclose their identity without fear of stigma or
discrimination, it increases their confidence and allows them to feel supported alongside providing
them the opportunity to also support others (Damm et al., 2017). As stated in the study done by
Sprott et al. (2021), having a stronger sense of belonging (within a kink community) also increased
the chances of BDSM practitioners disclosing to healthcare professionals. Therapists who are kink-
aware are essential especially towards newbies in the community, they might have been brought
up in a judgmental environment so these therapists will be able to properly provide information on
existing BDSM organizations and will be able to provide them with the proper reassurance instead
of continuing the cycle of shame and guilt as perpetuated by society and the current systems in
play (Damm et al., 2017; Nichols, 2006; Williams et al., 2017). As the literacy of health profes-
sionals increases, the help-seeking behaviour of stigmatized individuals might increase as well.
Apart from that, being more kink-aware will ensure that healthcare professionals can better
understand and distinguish differences between consensual BDSM and abuse, which were also
a reason why BDSM practitioners delayed getting health care (Sprott et al., 2021). Understanding
that BDSM is frequently not associated with psychopathology will hinder inaccurate theories or
assumptions being made about a practitioner’s mental wellbeing when they reach out for help
(Williams et al., 2017). Encouraging the importance of educating healthcare professionals and
social workers might then also open the gateway to more research on BDSM being accepted into
journal publications (Williams, 2015).
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7.2.3. Similarities in factor structure of the ASMS — hope for a generalized panacea?
As stated previously, an exploratory factor analysis of the ASMS found a similar 4-factor structure
among the study’s current population as the original study did (Yost, 2010), indicating that both
the Malaysian undergraduate sample and their Western counterparts held a largely similar per-
spective towards ASMS. While not the primary aim of the research, this additional finding also
sheds further light on the construction of BDSM and its awareness, revealing a possible cross-
cultural similarity in how it is perceived. This also serves to further highlight the importance of
accessibility to credible information with the aim to de-stigmatize BDSM—if cross-cultural aware-
ness is similar, it is also logical to assume that the interventions that work in one particular culture
(i.e. this study) would also have similar effects in a different (Western) culture as well. Nonetheless,
the researchers acknowledge that a confirmatory factor analysis (CFA) should ideally be conducted
with a population drawn from a Malaysian sample as well in order to further validate the factor
structure of the ASMS in a Malaysian context.
8. Limitations
As this experiment was conducted online and over the course of 5 weeks, there were a few
limitations that presented itself due to the nature of the study. While the intervention appears
to have been effective in reducing stigmatising attitudes towards BDSM, we have no indication of
what participants thought of when processing the intervention, such as what about the info-
graphics that changed their mind, or even if this change in attitude would hold across a longer
period of time. Further follow-up studies analyzing the factors that might have played a part in
changing the participants’ views would be helpful to further flesh out how and why information-
based intervention works and for how long.
The experiment was also unavailable to be conducted in a controlled environment, so participants in
the control group might have accessed information regarding BDSM purely out of curiosity subsequent
to completing the first ASMS scale. Nonetheless, we do not believe this to have significantly contrib-
uted to the validity of the study’s findings, as the control group still reported less change in attitudes
post intervention. Furthermore, the age range of participants in this study was quite limited, with
participants primarily reporting ages between 21 and 30. The participants of this study were also from
a private university. One of the limitations of using an undergraduate sample due to convenience
sampling is that their cognitive behaviours are unlikely to be similar to those of the general population
due to being young adults at peak cognitive conditioning (Wild et al., 2022). Studies that recruit from
a more diverse population with regard to age might yield more insightful answers in determining if
these interventions are as effective among adults from an older age range.
Even though this study showed that educational stigma-reduction interventions also work in reducing
stigma of BDSM practitioners, it is important to note that stigma is a multi-level phenomenon and large-
scale stigma interventions are complex and difficult to structure and implement in society (Rao et al.,
2019). The intervention in the current study only tackled the interpersonal/societal level; structural and
institutional stigma also ultimately plays a role in influencing other lower levels as well and, if it is not
addressed, small-scale interventions will not be enough to cause change in the system as a whole.
9. Implications and conclusion
As stated earlier (see Khalaf et al. (2014)), Malaysia does not even see the need for the imple-
mentation of proper sexual education in schools. This further perpetuates stigma within the public
and causes topics like this to still remain taboo, possibly even unintentionally making it more
difficult for healthcare professionals to digest information like this in later stages and thus react in
a negative manner when being exposed to it (Nichols, 2006). This study clearly demonstrates that
a clear, information-based intervention does have a role to play and suggests that instead of
disengaging from BDSM-specific knowledge in an attempt to safeguard our youth, as seems to be
the modus operandi for the Malaysian education system, an increase in engagement with credible,
scientific information might be a better way to achieve a state of healthy sexual knowledge and
practices.
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Furthermore, one of the main strengths of this study can be found in its cost-effectiveness and
relative efficiency. As the results indicate, significant attitude changes towards BDSM and its
practitioners were found after only 4 weeks of undergoing the treatment condition. This is
particularly surprising to the researchers, as extant literature suggests that attitude changes
typically happen over a period of months or even years in certain cases (Briñol et al., 2015). That
the participants in this study were able to change their minds to the extent that it was statistically
significant after only four sessions over 4 weeks, and with the simple employment of credible,
informational materials suggest that the path towards improving attitudes towards marginalized
communities and reducing stigma may be less challenging than most would presume.
Providing interventions and education especially towards medical healthcare providers will poten-
tially contribute to said providers being able to distinguish consensual kink behaviours from domestic
abuse (Waldura et al., 2016). For a community in Malaysia that is already facing the pressures of
stigmatisation and misunderstanding, the beneficial effects of a simple, yet effective intervention such
as this might hold the key towards improving the standards of mental and physical care that BDSM
practitioners are able to access, in addition to possibly laying the groundwork for future policy changes
towards BDSM practitioners that can only come about from increased understanding.
Acknowledgments
This research was conducted under the auspices of the
Department of Psychology, Faculty of Behavioural Sciences,
Education, and Languages, HELP University Malaysia, and
supported by a grant from the Research Management
Centre of HELP University Publication of this work was sup-
ported by HELP University, Malaysia [Publication Charge
Support Grant 23-10-002], as well as the Department of
Psychology, HELP University ARC Fund.
Funding
The work was supported by the HELP University [Publication
Charge Support Grant 23-10-002].
Author details
S. Q. A. Huang
1
Victor Weng Yew Goh
1
E-mail: victor.goh@help.edu.my
ORCID ID: http://orcid.org/0000-0001-6157-3732
1
Department of Psychology, HELP University, Kuala
Lumpur, Malaysia.
Correction
This article has been corrected with minor changes. These
changes do not impact the academic content of the article.
Disclosure statement
The authors declare that they have no known competing
interests in the writing and publication of this study, either
from a financial, professional or personal aspect that
could have influenced the work reported in this paper.
Citation information
Cite this article as: Level of awareness of BDSM on atti-
tudes towards BDSM practitioners among a Malaysian
population, S. Q. A. Huang & Victor Weng Yew Goh, Cogent
Education (2023), 10: 2266900.
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Appendices
Appendix A: Infographics
Week 1 Infographic
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Week 2 Infographic
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Week 3 Infographic.
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Week 4 Infographic.
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Week 1 Infographic References.
Week 2 Infographic References.
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Week 3 Infographic References.
Week 4 Infographic References.
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