The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published in 2013 has proved to be particularly interesting in the field of sexuality. It introduced a number of significant changes in the definition of sexual norms, among them a widely discussed distinction between paraphilias and paraphilic disorders. The key criterion separating the abnormal sexual interests from the disordered ones is clinically significant distress resulting directly from sexual behavior and/or the risk of suffering or harm to another person as a result of one’s sexual behavior. In the case of masochism – which addresses the phenomenon of suffering quite particularly – this distinction is troublesome. Using the example of autoerotic asphyxia – a behavior from the masochism spectrum – the authors critically examine the proposed DSM-5 method of defining the standards of sexual behavior. Interesting in this regard has been a comparison between autoerotic asphyxia and free diving – a nonsexual activity which, although also associated with possible loss of life by reduction of oxygen, has not been pathologized.