Editor’s Note: This feature on BDSM and mental health was originally published in July 2019.

The stigmatization of kink is as old as the practice itself. The kinky population has undergone a rocky journey to have their sexual practices and identities de-pathologized and divorced from associations with “perversion” or dysfunction. In the past, BDSM-related identities or predilections have been used against kinky folks in divorce court, criminal proceedings, employment situations and child custody trials.After a long uphill battle, the fifth version of the DSM (Diagnostic and Statistical Manual of Mental Disorders, published 2013) removed kink from its diagnostic criteria and clarified that kink itself is neither an indication nor a symptom of mental illness.

And it’s about time. Numerous studies have gathered overwhelming evidence that kink is, if anything, a normal variance in human sexuality, and could even indicate good mental health. Kinksters have scored higher than their “vanilla” counterparts on sexual satisfaction, sexual pleasure, openness to experience, conscientiousness, happiness and freedom from conflict in their relationships. At the same time, such BDSM fans haven’t exhibited higher rates of depression, proneness to violence, paranoia, low self-esteem, distress, or post-traumatic stress than the general population.

Kink-aware psychotherapist Asha Gray, LPC, who has worked extensively with kinky couples and individuals—as well as trauma survivors, ethnically non-monogamous partners and members of the LGBT population—says that one of the primary misconceptions about kink is that it’s inextricably tied to trauma. She tells Playboy, “Many people falsely assume that if someone is kinky, something has happened to them—that they’ve been abused in some way.”

Assumptions are often replicated by popular media depictions of kink rooted in an individual’s troubled past. For instance, Maggie Gyllenhaal’s character in Secretary (2002) reforms her long-term practice of self-harm and persistent suicidal ideation by a single command and subsequent entry into a dominant/submissive relationship; in Fifty Shades of Grey (2015), Christian Grey develops his sexual interests after long-term sexual abuse by an older woman.

The shame many feel in regard to BDSM may come from mental health professionals themselves. A 2008 survey conducted by the National Coalition for Sexual Freedom showed that nearly 40 percent of respondents had experienced prejudice or shaming from a mental health professional about their sexual practices.

“I think there are some other therapists—who don’t interact with the kink community, and just don’t understand it—who consider it a problem, or even refuse to treat people who are actively practicing kink,” Gray says. “People sometimes still assume it’s a problem you want to get fixed.” Instead, most kinky individuals who seek therapy do so for the same reasons others do: depression, anxiety, stress, and relationship and family issues, for example. According to Gray (and the newest version of the DSM), as long as kink doesn’t lead to significant distress or interfere with everyday life, it’s likely unrelated to any mental health issues.

Kink is not therapy or a replacement for therapy, but some trauma survivors have found their own empowerment via kink.

Still, the relationship between kink and trauma is tricky. Some scholars have theorized that kink can be compared to a flow state—a pathway to full psychological and physical immersion and energetic focus. Others have conceived of kink as a serious leisure activity or creative subculture and as a source of community and camaraderie in an isolating society. Perhaps most controversial is the claim made by some BDSMers that kink has healing properties, particularly in the aftermath of sexual trauma.

While trauma certainly isn’t a prerequisite for kinky interests, some kink practitioners do report using BDSM to work through past emotional, physical or sexual abuse. Earlier this year, S. Nicole Lane wrote for HelloGiggles about how masochism helped her in her recovery from a sexual assault. She expressed that controlling the narrative rather than being subjected to it against her will was nothing short of “revolutionary.” Gray agrees that some of her clients who’ve experienced sexual assault have used kink to their emotional benefit.

“Kink is not therapy or a replacement for therapy,” she clarifies, “but some trauma survivors have found their own empowerment via kink.” As the bottom in a planned kink scene, Gray says, “you’re in charge from the beginning to the end. So you can re-experience what they went through, but in a safer and more pleasurable way.” In that case, the structure of the BDSM scene is serving as a container through which some survivors can gain mastery over their trauma, experiencing it consensually with a trusted partner and helping to replace negative memories. What’s more, the close personal attention, high level of expertise and skill, and explicit consent required by healthy BDSM interactions are all hallmarks of healthy sexuality for anyone, BDSMer or not.

Kink requires a wide variety of skills—and not just how to wield a flogger. Though popular depictions might paint it as all fun and games (or, rather, whips and chains), the ethical practice of kink requires forethought and self-awareness. “How do you negotiate agreements with people? How do you communicate your needs, wants, and worries to your partner?” Gray asks. “These are questions you have to ask yourself if you want to participate in kink.”

Start slow and find local classes or munches (meetups, usually in restaurant settings) before venturing into the deep end. Get your hands on resources like Tristan Taormino’s The Ultimate Guide to Kink and get to know others well before jumping into intense relationships. Particularly for trauma survivors practicing kink (whether as bottoms, tops, or both), it’s important to know baggage and triggers and to communicate those to the chosen partner effectively.

Simply put: It’s time to extricate kink from its historical burdens of shame because, like any other sexual interest or relationship style, BDSM can be healthy or unhealthy, toxic or healing—it all depends on who’s doing it and how.