The Theory of Planned Behaviour as a predictor of intention to engage in BDSM and vanilla 
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doi:10.21203/rs.3.rs-1952191/v1

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The Theory of Planned Behaviour as a predictor of intention to engage in BDSM and vanilla Sex

https://doi.org/10.21203/rs.3.rs-1952191/v1

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The authors postulate that the Theory of Planned Behaviour (TPB) offers a hypothetically valuable framework for investigating Bondage, Discipline, Dominance, Submission and Sadomasochism (BDSM) and non-BDSM sexual behaviours, i.e. “vanilla” sex. This is because it examines attitudes, beliefs, subjective norms, intention, and perceived behavioural control over exhibited behaviours. Online cross-sectional data were gathered from participants classified as “BDSM” (n = 61) and “vanilla” (n = 41). Measures included the Theory of Planned Behaviour Questionnaire (TPB Constructs), as well as Anxiety (GAD–7), Depression (PHQ–9), and Self-Efficacy questionnaires. Findings revealed that the constructs of attitude towards vanilla sex predicts the person’s intention to engage in this behaviour (β = .42, p = .005). Similarly, perceived behavioural control predicts intention to engage in paraphilic or BDSM sex (β = .47, p < .001). This study concludes that the TPB is a useful model for predicting BDSM and vanilla sexual behavioural intention. Future research could uncover additional underlying determining or correlating factors associated with BDSM and vanilla sex, such as mental illness and childhood experiences. Having this understanding of the role that social cognition plays in the development and behaviour of different sexual practices, would benefit the development of sexual wellbeing programmes.

BDSM

Paraphilia

vanilla sex

theory of planned behaviour

depression

anxiety

self-efficacy.

The Theory of Planned Behaviour (TPB) (1) is a social, cognitive, and affective theory of health-related behaviour. It is employed to explain intentions of engagement in behaviour and the individual’s ability to exert self-control using the role of attitudes, subjective norms, and perceived behavioural control over specific behaviours. TPB consists of four constructs. To expand, the first construct is behavioural intention, which refers to the individual’s level of motivation that influences the degree of engagement in that behaviour. The second aspect within this model is the attitude towards a particular behaviour, which is based on behavioural beliefs and the (positive or negative) evaluation or appraisal of the expected outcome. This third construct is subjective norms, which are associated with the social pressure to engage in a particular behaviour. The final construct within this model is perceived behavioural control, which refers to the person's perception of the ease or difficulty of performing a particular task (1)

Self-efficacy is akin to perceived behavioural control and is linked to the belief in one’s ability to successfully complete a task. Indeed, how confident a person is in their ability to perform a task has a direct impact on the performance of that behaviour (2). Likewise, the TPB suggests that perceived behavioural control is thought to reflect past experiences and perceived obstacles, along with existing beliefs associated with how control impacts behavioural outcomes (1, 3).

The TPB was developed in the early 1990s. Early applications to health and wellbeing issues centred on health behaviours such as substance abuse such as smoking cessation (4), adolescent and adult condom use (5) and weight loss (6). To date, the application of the TPB to mental health issues, including paraphilia, remains scarce (7). Nevertheless, Miller (7) did propose its application to the proximal and distal basis of sexual offending. The logic to this lies in the conceptualisation that sexual offending is a cognitive affective behaviour reflecting an offence process. For example, the role that past childhood abuse might play in the development of adult sexual offending, as postulated in the abused-abuser hypothesis (8) focuses on the distal aetiology of perpetrator behaviour (7). It has been proposed that the TPB is a useful framework in our understanding of the distal and proximal processes of sexual offending via the attitudes towards behaviour (behavioural beliefs), in their subjective norms (normative beliefs) and in their perceived behavioural control (7).

The diagnostic definition of paraphilia in the DSM-5 (9) refers to any intense and persistent sexual interest and arousal towards objects, situations, or individuals which are atypical, equal to and/or greater than normophilic sexual interests (9). These disorders can be specified or unspecified, and include exhibitionism, fetishism, paedophilia, sexual masochism, sexual sadism, transvestic fetishism and voyeurism, all of which possess at least one formal diagnostic criterion (9). BDSM (Bondage, Discipline, Dominance, Submission and Sadomasochism) is a non-clinical grouping of paraphilia, often referred to as “kink”, which encapsulates a wide range of sexual behaviours among diverse sexualities (10). Kinsey et al. (11) have long argued that the practice of BDSM is relatively common among all genders and sexualities. Indeed, out of a sample of 94 men, 11.7% and 5.3% reported fantasies of humiliation and (consensual) abuse respectively (12). In contrast to these sexual behaviours, “vanilla” sex refers to conventional sex or sexual acts that do not include kink, BDSM or fetishism. Typically, therefore, it does not go beyond the scope of oral, vaginal, and/or anal sex.

In terms of previous research, when considering wellbeing, one study compared individuals’ personality traits and levels of depression and anxiety among those who engaged in BDSM with those in a vanilla control group (13). In this study, a group of 902 BDSM-practising participants were compared to 434 control participants. The study used four surveys to capture data: the NEO-Five-Factor Inventory (14), Attachment Styles Questionnaire (15), Rejection Sensitivity Questionnaire (16), and Five Wellbeing Index (17). The results indicated lower levels of neurosis, higher levels of extraversion, and being open to new experiences among the BDSM-practising group, who also exhibited less sensitivity towards rejection and higher levels of subjective well-being.

The aim of this study is to understand the relationship between BDSM and vanilla sex and self-efficacy, anxiety, and depression. To the best of our knowledge, the TPB had yet to be applied to paraphilia, such as fetishism, voyeurism, or sadomasochism. This study aimed to address this deficiency by establishing whether the TPB constructs can significantly predict engagement in these sexual behaviours. Additionally, the study aimed to determine whether levels of depression and anxiety vary between those who engage in paraphilic or vanilla sex. In relation to terminology, the terms vanilla sex and BDSM have been adopted throughout for consistency, and participants were deemed non-clinical in relation to their sexual preferences.

Design

A cross-sectional, correlational design was employed here to determine the extent to which the constructs of the TPB (including attitudes, behaviour, subjective norms, beliefs, and intentions) could predict paraphilic and vanilla sexual behaviours.

Participants

The participants were 102 adults who met the inclusion criteria for participation, of which 61 identified as paraphilic and 41 as vanilla. These crieria includeded being aged 18 years or above and who had engaged in one of the sexual behaviour categories that were of interest in this study, i.e.BDSM and vanilla. This sample comprised 50 women and 52 men, 46% of which belonged to the vanilla group, 25% to fetishism, 23% to sadomasochism and 6% to voyeurism.

Materials

A bespoke Google Form online survey was developed for this study. It consisted of 40 items and it was accessible on any electronic device. The questionnaire consisted of questions relating to general demographics of age, ethnicity, gender, sexuality and relationship status. This was followed by eight areas adapted from the Theory of Planned Behaviour Questionnaire (1). The Theory of Planned Behaviour Questionnaire assesses each of the theory’s constructs including intention, attitudes, beliefs, subjective norms, and perceived behavioural control. A seven-point adjective or Likert scale was employed consisting of: 1 (bad) – 7 (good), 1 (pleasant) – 7 (unpleasant), 1 (agree) – 2 (disagree), 1 (likely) – 7 (unlikely), 1 (true) – 7 (false), 1 (agree) – 7 (disagree), 1 (unlikely) – 7 (likely), and 1 (true) – 7 (false) options. The Cronbach alpha for the complete TPB measure in this study was moderate to high, α = 0.79.

The Self-Efficacy Questionnaire (Cronbach alpha ranging from α = 0.76 to α = 0.90) is a measure of perceived self-efficacy and the ability to cope with mundane challenges as well as varying life events (18). The questionnaire consists of 10 questions and four scaled responses: “not at all true”, “hardly true”, “moderately true”, and “exactly true”. The Cronbach alpha for this measure in this study was high, α = 0.92.

Anxiety was measured using the Generalized Anxiety Disorder Questionnaire (GAD-7) (19). This 7-item scale requires participants to specify how often, during the last 2 weeks, they had been disturbed by each symptom, e.g., “feeling nervous, anxious or on edge”. Response options are “not at all,” “several days,” “more than half the days,” and “nearly every day,” and are scored as 0, 1, 2, and 3 points respectively. Overall scores of 5, 10, and 15 correspond to mild, moderate, and severe anxiety. The reliability of the GAD-7 was found to be excellent (α = 0.92). The Cronbach alpha for this measure in this study was high, α = 0.89.

The Patient Health Questionnaire (PHQ-9) (20) was used to measure levels of depression in the participants. The PHQ-9 is used to recognise and diagnose the most common mental disorders in primary care patients, with a good internal reliability of α = 0.86–0.89. The 9-item questionnaire invites participants to rate the frequency of life difficulties during the past two weeks, e.g., “Trouble falling or staying asleep or sleeping too much”. The total score range is 0–27. This indicates the absence or presence of depression and its severity, with scores of 5, 10, 15, and 20 indicating mild, moderate, moderately severe, and severe depression, respectively. The Cronbach alpha for this measure in this study was high, α = 0.90.

Procedure

Ethical permission was gained from London Metropolitan University’s REC and this study conforms to the British Psychological Society Code of Ethics and Conduct (21). Further permissions were sought from website administrators of websites accommodating paraphilic behaviours. The questionnaires outlined in the materials were uploaded onto the following websites: https://www.kink.com/, https://www.colfet.com/, https://fetlife.com/, https://www.fetster.com/, https://iitap.com/. The questionnaire was accessible via a link. The link took each participant to the digital survey pack, which included an information sheet, a consent form, the creation of a four-digit code necessary for withdrawing from the study anonymously, the demographics questionnaire, the Theory of Planned Behaviour Questionnaire (1), the Self-Efficacy Scale (18), the Generalized Anxiety Disorder Questionnaire (GAD-7) (19), the Patient Health Questionnaire (PHQ-9) (20) and a debrief form that included an explanation of the nature of the study and support links. It was estimated that this online survey took no longer than 15 minutes to complete. Upon completion, participants were thanked for their participation and assured of their anonymity and confidentiality. Data was securely stored online in a Google Drive and in a password protected computer (22).

Statistical analysis

An initial Cronbach alpha was calculated for all measures. A correlation of all variables (TPB constructs, vanilla, fetishism, voyeurism and sadomasochism, GAD-7, PHQ-9, self-efficacy) was run prior to multiple regression analyses. The independent variables included behavioural intention, attitudes, beliefs, subjective norms, perceived behavioural control, self-efficacy, depression, and anxiety. The dependent variables included BDSM and vanilla sex. A one-way analysis of variance (ANOVA) was used to identify any potential differences between sexual preference and levels of depression, anxiety, and self-efficacy.

With reference to the BDSM group, a positive, low to moderate relationship was found between intention and attitude, (r (61) = 0.031, p = 0.014) perceived power, (r (61) = 0.321, p = 0.012) and perceived behavioural control, (r (61) = 0.474, p = 0.001). No other construct was significant with intention (p > 0.05). When looking at TPB constructs and depression, anxiety and self-efficacy, there was a positive low to moderate relationship between control beliefs and self-efficacy, (r (61) = 0.346, p < 0.001). In contrast, for the vanilla group, there was a positive low to moderate relationship between intention and attitude, (r (41) = 0.459. p = 0.003) and perceived behavioural control, (r(41) = 0.326, p = .037) but not perceived power (p > 0.05). No further construct was significant with intention. When looking at TPB constructs and depression, anxiety and self-efficacy no significant relationship was identified (p > .05). A linear regression aimed to establish how much variance in intention was explained by attitudes, perceived power, and perceived behavioural control. Regression equation produced a moderate fit with the data explaining 53% of the variance. The overall model was significant (F(3, 57) = 7.58, p < 0.001). It was found that perceived behaviour control (β = 0.47, p < 0.001) was a significant predictor of intention to engage in paraphilic sex. Both attitude and perceived behavioural control were non-significant (p > 0.05). A further multiple linear regression aimed to establish the amount of variance in intention could be explained by attitude and perceived behavioural control. Regression analysis produced a moderate fit with the data explaining 53% of the variance. The overall model was significant (F(2, 38) = 7.31, p = 0.002). It was found that attitude (β = 0.42, p = 0.005) was a significant predictor in the intention to engage in vanilla sex. Perceived behavioural control was non-significant (p > 0.05).

When exploring differences between depression, anxiety and self-efficacy for the BDSM and vanilla groups, the mean and standard deviation values were found to be very similar. To expand, self-efficacy among the paraphilic group was (M = 35.36, SD = 4.07), anxiety (M = 11.77, SD = 5.06) and depression (M = 13.61, SD = 5.45). For the vanilla group, self-efficacy was (M = 35.76, SD = 3.97), anxiety (M = 11.34, SD = 4.53) and depression (M = 12.90, SD = 4.78). One-way ANOVA yielded no significant differences between sexual preferences and depression (F (3, 98) = 1.51, p = 0.271), anxiety (F (3, 98) = 1.53, p = 0.212) and self-efficacy (F (3, 98) = 0.42, p = 0.741).

The aim of this study was to understand the relationship between BDSM and vanilla sex and self-efficacy, anxiety, and depression. This study also offers further insights into the individual constructs of the TPB and its behaviour predicting framework. The evidence demonstrates that the hypotheses were partially supported. Among the BDSM group a significant positive relationship exists between intention, attitude, perceived power, and perceived behavioural control. Perceived behavioural control was the only predictor in the intention to engage in BDSM sex. Indeed, this group reported confidence in engaging in paraphilic sex. Furthermore, there was a relationship between intention, attitudes, and perceived behavioural control among those who engaged in vanilla sex. With this group, attitude was the only variable to predict intention to engage in vanilla sex. The vanilla group in this study had an overall positive attitude towards engaging in this sex.

According to Miller (7), TPB has a direct relationship with perceived behavioural control and intention, suggesting that fantasies can influence behaviour directly. However, fantasies cannot predict behaviour, but can only be predicted by the construct of intention. This critical examination of TPB benefits the current study to establish whether perceived behavioural control would be a key predictor in TPB or not. Along with the results of this study, it confirms that that intention alone is a predictor of behaviour. However, previous research has examined the application of TPB in the context of sexual offending, so these findings would need replicating with all paraphilias and BDSM sexual behavirours. Notably, a key difference between sexual offending and BDSM behaviours is consent. Indeed, consent plays a central role in BDSM and is an important consideration in destigmatizing consensual BDSM practices (10). BDSM also offers a more nuanced understanding of sexual consent that may influence perceived power and control (23).

Attitude is a learned behaviour based on experience that is reinforced by the outcomes of that experience (1). Thus, attitudes are determined by the beliefs surrounding a particular behaviour, such as sex (1). According to this theory, repeat sexual performance such as vanilla sex results in a perceived known outcome. Iif this outcome is positive, as reported by the participants in this study, arguably, vanilla sex reinforces further vanilla sex. It could be argued that the perception of engaging in BDSM sex does not possess the stability that vanilla sex possesses in terms of performance measures. Indeed, higher levels of perceived behavioural control among those who engage in BDSM sex might reflect the perceptual confidence associated with engaging in different sexual practices and performance behaviours. However, this is speculative and further research would need to consider more closely the attitudes along with the other TPB constructs in this context. A specific example would be long-term couples where sexual routine might override other sexual prefernces, whether kinky or vanilla.

Furthermore, it was hypothesised in the present study that there would be higher levels of self-efficacy and lower levels of depression and anxiety among the BDSM group compared to the vanilla group. This was based on the findings of Wismeiier and Van Assen’s study (13). Additionally, previous work has suggested that a person’s confidence in their abilities to perform a behaviour has a direct influence on that behaviour (2) and that their sense of perceived behavioural control is thought to reflect both past experiences as well as anticipated obstacles (1, 3). In addition, sexual function is associated with a higher understanding of sexual self-efficacy and perceived behavioural control and self-efficacy are also linked (1). Therefore, the non-significant outcomes for self-efficacy, depression, and anxiety between these groups was not anticipated. Nevertheless, there are both limited and inconsistent study outcomes in terms of the role that sexual efficacy plays in sexual functioning (24).

Whilst self-efficacy and perceived behavioural control are conceptually similar, they are measured as separate constructs (25). Since the TPB is a constructed, non-standardised questionnaire, it is inevitable that variation will exist in the reliability and validity of the assessment tools used (25). Therefore, it could be necessary to distinguish between perceived behavioural control and self-efficacy (26). One such study found that perceived behavioural control was better predicted by self-efficacy than by intentions, and that intentions were more associated with self-efficacy than attitudes, perceived behavioural control, or subjective norms (26). Perhaps a larger sample size in the current study might have yielded different outcomes.

When looking at the relationship between mental illness and sexual behaviour, our findings are contrary to Wismeijer and Van Assen’s study (13), where BDSM practitioners were less neurotic, more extraverted, more open to new experiences, less sensitive to rejection, and had higher levels of subjective wellbeing. However, our findings are comparable to both Richters et al’s., (27) and Cross and Matheson’s, (28) research in that no differences between levels of depression, anxiety, or subjective happiness among those who engaged in sadomasochism or vanilla sex could be found. This may have been due to participants in these studies engaging in sadomasochism only rather than a diverse array of sexual behaviours included in Wismeiier and Van Assen’s, study (13). Also, it is worth noting that the sample size (n = 902 BDSM and n = 434 control) was significantly larger in Wismeijer and Van Assen’s (2013) research (13), suggestive of a more representative sample.

For most practitioners, BDSM is not a pathological symptom of past experiences or of difficulty engaging in conventional vanilla sex (27). Further, sadomasochists were examined and found not to have any mental health differences (28). So far, studies have been based in the Netherlands, the US, and Australia and a greater understanding of cultural differences may strengthen these findings. Previous research has suggested that partaking in BDSM is associated with higher vulnerability to abuse (29), being psychologically damaged, and even considered dangerous (27, 30). This interpretation stems from the psychopathology dispute of the 19th Century (31, 32), which remains predominant in some frameworks. BDSM is pathologized in the DSM-5 (9) considering sexual sadism/masochism as paraphilias and paraphilic disorders if they cause distress or impairment to the individual. The DSM-5 further states that many paraphilia have been identified and named and that almost any of them could, by their negative consequences, result in paraphilic disorder (9). Ultimately, linking all paraphilic behaviours to a disorder dismisses any of the benefits and pleasure garnered by those engaging in these behaviours. This limits current appreciation for developing sexual wellbeing interventions based on the benefits of different sexual behaviours.

Findings associated with wellbeing and subjective happiness for both BDSM and vanilla groups remain inconclusive. Nevertheless, our findings do highlight that kinky sexual behaviour does not necessarily always result in distress or impairment, as the DSM-5 suggests. The DSM-5 can be further critiqued as it can encourage medical and mental health professionals to misdiagnose paraphilic disorders. The implications of discovering a paraphilia and diagnosing a paraphilic disorder are vital to de-pathologizing consensual alternative sex. Debately, consensual paraphilic sex is as close to a mental health disorder as vanilla sex is to rape. Separating behaviours from disorders is the first step in depathologizing consensual paraphilic behaviour. Another necessary factor is to define exactly what constitutes clinically significant distress, which is a diagnostic criteria in the DSM-5 (33). Lastly, the pathologizing of alternative sexual practices has discouraged individuals from seeking treatment for unrelated mental health problems (33).

This study has limitations. Owing to the small sample size within the BDSM group, it can be problematic drawing comparisons between groups. This study also grouped vanilla sex, which is arguably a diverse term covering different sexual practices. This also warrants a more detailed analysis when understanding wellbeing and planned sexual behaviour. Indeed, including a wider range of BDSM and kink behaviours, on bipolar scales, for example, from foot fetish to coprophilia and vanilla behaviours, would be of interest. This drastic difference would give deeper insight into the levels of anxiety and depression, whether levels differed throughout all “paraphilic” tendencies; as well as further investigating changes in the individual constructs of TPB (1). Since engagement in BDSM may involve factors such as mood and past experiences (34, 35), these constructs should be observed through additional questionnaires. Abel et al., (1) suggests that the engagement in just one paraphilia is rare and that individuals will partake in multiple paraphilias of interest, which is referred to as multiplex. Research by Abel et al., (1) examined paraphilias offering a valuable insight into interpreting the results of the current research. Voyeurs and fetishists disclose a history of paraphilic interests in different types of paraphilia. Sadists and masochists also had experiences in other categories of paraphilia. Therefore, if individuals rarely partake in just one paraphilia, future study should examine multiplex paraphilia rather than singular (36). Additionally, further research might wish to examine the difference between gender, culture, and ethnicity, specifically whether TPB constructs and severe mental illness vary among those engaging in multiple paraphilia and varying vanilla sexual practices (37). Finally, self-report questionnaires can be biassed, as participants are more likely to report experiences which are considered socially acceptable and correlation analysis cannot prove causality (38).

In conclusion, this study offers a new and insightful look at how the theory of planned behaviour can be used to better understand BDSM and vanilla sexual behaviour. Aligning with previous studies, those who partake in BDSM and vanilla sex did not report any differences in self-efficacy, depression, or anxiety. In a society fixated on pathologizing paraphilia, one can easily become confused by the countless definitions and diagnoses. The slowly changing perception of these behaviours requires extensive detailed research and appropriate speculation. Beginning with the simple action of de-pathologizing paraphilia will pave the way for more accurate interpretations and further willingness to explore. Thus, challenging the DSM-5 in its position towards paraphilic behaviour is key. To date, limited research has centred on the mental health of individuals who partake in kinky sexual behaviour. This research takes this a step forward and aims to inform the development of wellbeing interventions, for vanilla and BDSM-loving individuals, so everyone can have safe and consensual sex.

There is no conflict of interest

Data Availability Statement: The published article with its supplementary files, would be submitted to LMU repository.

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There is NO conflict of interest to disclose.

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The Theory of Planned Behaviour as a predictor of intention to engage in BDSM and vanilla Sex

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