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This article offers a comprehensive exploration of the complexities of BDSM relationships and their differentiation from intimate partner violence (IPV), highlighting the historical and cultural stigmatisation of BDSM practitioners, the impact this has on kinky survivors, and the challenges faced by clinicians in understanding and supporting this community. The author critiques the diagnostic and cultural competency limitations that become barriers to care for kinky survivors, offers specific suggestions for differentiating consensual kink from IPV, provides risk assessment guidance, and introduces the “Four P's Framework” to help clients assess their relationship to power within BDSM dynamics.