This post is a summary of Nancy McWilliam's chapter on Masochistic personalities in her book Psychoanalytic Diagnosis
Trying to create a theory to explain why some people have patterns of behavior that include seemingly deliberately causing self-harm has a been challenging. Earlier psychoanalytic explanations have fallen by the wayside. Contemporary analysts point our the natural masochistic drive of mothers (maybe the male analysts of the 1800's and 1900's found it easy to overlook this). Other's point out those who exhibit cutting-behavior without suicidal intent. Regarding these points, there may be several categories of masochism: psychotic self-mutilation, moral (religious) masochism, palliative masochism (to reduce a greater suffer).
Since everyone has some masochistic behaviors (drinking to excess knowing tomorrow will bring a hangover, running and exercise) considering a spectrum of masochism is necessary, like with all psychopathology. Being masochistic doesn't mean someone loves feeling pain, but rather that the behaviors are enacted out of a wish for some preferred outcome. For example, those in domestic violence situations don't stay because they like to be hit, they endure it because of other beliefs regarding a greater good or fulfillment of need. Since every personality disorder can be considered masochistic--the person suffers great relational harm with their characterological armoring--masochistic personalities are distinguished from the others in the way that the masochistic behaviors are primary not merely side-effects. Masochistic personalities can also be distinguished from depressive personalities because masochistic people can more readily feel outrage and slight on their own behalf.
It is not uncommon to learn from masochistic patients that the only time a parent was emotionally invested in them was when they were being punished.
Masochistic personalities commonly use similar defenses as depressive personalities: introjection, turning against the self and idealization. However, acting out is a differentiator and a defining defense. Masochists, like others, will reenact patterns of experience. For example, someone who lived in a household where calm was always followed by an explosive outburst by a father, may unconsciously behave in ways to create anger in a partner right when the relationship seems like it's going well.
Moralizing is another common defense. The masochist would rather have a painful story to tell with righteous indignation than to actually solve the problem. Having the problem generates some emotional supply from others. To eliminate the problem would be to eliminate a valuable emotional resource.
There is nothing more toxic to a therapist's self-esteem than a client who radiates the message, "Just try to help me - I'll only get worse."
Masochistic patients may reenact the patterns of childhood where they can only get attention if they make the caretaker see how much they are suffering. A patient who acts helpless and injured and is always in need of sympathy from the therapist may also have lived in a household where his needs were ignored unless he were sick or in trouble of some kind. As a result, compared with a depressive patient, trying to bend boundaries to make the masochostic patient feel more cared feel may only make the symptoms worse.
Personality Analysis of the Masochistic Personality References
McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.