Pain addiction

DEFINITION: Pain addiction involves the infliction of pain or physical injury to the body in order to release pleasure-causing endorphins. The addiction is usually regarded as pathological only if it results in injury from illegal and unwanted aggression. Pain addiction exists at the nexus of pleasure and pain, most notably for sexual stimulation. Experts continue to debate whether the infliction of pain in search of pleasure is a true addiction.

• ALSO KNOWN AS: Algolagnia, nonsuicidal self-injury (NSSI)

Background

From the days of René Descartes, philosophers including Baruch Spinoza and Jeremy Bentham have speculated that pain and pleasure are connected. The biological sciences provide strong evidence that the neurochemical pathways used for the sensation of pain and pleasure are related.

After an injury, the body releases endorphins to counteract pain. This connection has long been exploited for sexual stimulation that derives pleasure from the infliction of pain. These forms of stimulation include bondage, sadomasochism, “erotic spanking,” and “love biting.”

Sadomasochism (or S&M) as a concept originated with the French aristocrat Marquis de Sade in the late eighteenth century and with writer Leopold von Sacher-Masoch in the nineteenth century. Both explored relations between people who enjoy giving pain (sadists) and those who enjoy receiving pain (masochists). A sadomasochist can fill both roles.

Sadomasochism may fall short of the clinical definition of paraphilias, but a medical diagnosis may follow the infliction of clinically significant distress or impairment. Usually, sadomasochism involves mutual consent, in contrast with criminal acts involving sexual violence or other forms of illegal aggression.

The sexual tendency that derives sexual stimulation and pleasure from the infliction of physical pain is called algolagnia, so named in 1892 by psychiatrist Albert von Schrenck-Notzing. Algolagnia is regarded as a physical phenomenon in which a person’s brain interprets pain signals as pleasurable. This tendency is at the root of sadomasochism, which has been refined since the early nineteenth century into several variants, including bondage and discipline (B&D).

Individuals with addictions to pain often also present with borderline personality disorder, antisocial personality disorder, eating disorders, alcohol and substance use disorders, and autism. However, further research is required into the neurochemical processes associated with this addiction to properly assess, diagnose, and treat individuals who present with such addictions.

Potential Risks

No significant connection has been found between algolagnia or the related forms of sadomasochism and violent crime. However, pain addiction can be connected to accidents, sometimes fatal, and to depression and suicide. Some people with pain addiction may scar themselves or cut their wrists, legs, arms, or necks.

Algolagnia is not listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR), but sexual masochism is listed as a paraphilic disorder. Additionally, the DSM-V lists nonsuicidal self-injury (NSSI) as a condition needing further study. The intentional infliction of pain is called “active algolagnia” in Mosby’s Medical Dictionary and is considered a form of sadism. Mosby’s also lists a form of masochism as “passive algolagnia.” Neither is regarded as pathological unless it involves inflicting pain on nonconsenting persons or if it causes “marked distress or interpersonal difficulty.”

Physically, a person does not become addicted to the pain itself, but to the hormone-like endorphins released by the body to control pain’s effects. These affect the body much like opiates, such as morphine and heroin, producing an anesthetizing numbness. Vigorous exercise, emotional pain, and other forms of stress also release endorphins. Pain addiction is progressive, requiring increasing, sustained stimulus over time to maintain endorphin levels. Increasing the intensity of pain (emotional, physical, or both) stimulates additional endorphin release. Pain also can force family and friends to focus attention on the individual with an addiction.

Both emotional and physical pain may become addictive. Feelings of worry, anger, depression, grief, or fear may become so habitually familiar that an individual believes they cannot live without those emotions. There are physical and mental reasons for emotional pain addiction. Someone who is often stressed by emotional pain may develop a dependence on stress-related biochemistry. Changing these habitual pain-related patterns may become as difficult as “kicking” an addiction to nicotine, alcohol, cocaine, or heroin. Much of this behavior becomes unconscious, a major reason many people maintain painful relationships or habits despite negative consequences.

An individual with an addiction may seek to maintain pain more fiercely as the addiction intensifies, and may do so in many ways. An individual with a pain addiction may even attribute pain to the will of a higher power or as punishment for past misbehavior. Pain may even be regarded as a refuge from a stressful family life.

Group support for individuals in recovery from pain addiction is rare; there are no “pain addicts anonymous” groups. Anger, criticism, and the provocation of guilt usually do not aid in recovery for pain addicts; such strategies may even drive a person to seek more intense pain. Aid from a therapist familiar with addictive behavior and the chemistry of the brain may be necessary to break this cycle.

Bibliography

Cipriano, A., et al. "Nonsuicidal Self-injury: A Systematic Review." Frontiers in Psychology, vol. 8, no. 8, 2017, doi:10.3389/fpsyg.2017.01946. Accessed 20 Sept. 2024.

Elia, Josephine. "Nonsuicidal Self-Injury (NSSI) in Children and Adolescents." Merck Manuals, Oct. 2025, www.merckmanuals.com/professional/psychiatric-disorders/suicidal-behavior-and-self-injury/nonsuicidal-self-injury-nssi. Accessed 24 Nov. 2025.

Gill, Gurtej. "'I Burn Myself to Get High': How Pain Can Be an Addiction." Psychiatrist, 25 May 2023, www.psychiatrist.com/pcc/i-burn-myself-to-get-high-how-pain-can-be-an-addiction. Accessed 24 Nov. 2025.

Levinthal, Charles F. Messengers of Paradise: Opiates and the Brain—The Struggle over Pain, Rage, Uncertainty, and Addiction. Anchor, 1988.

O'Toole, Marie T. Mosby's Medical Dictionary. 11th ed., Elsevier, 2023.

White, J. M. “Pleasure into Pain: The Consequences of Long-Term Opioid Use.” Addiction and Behavior, vol. 29, no. 7, 2004, pp. 1311–24.