I include sadomasochistic relationships in defining perversions because in my experience they always go together, and although you may not see many actual sexual perversions in your practice, I am certain that you see sadomasochistic relationships all the time. Now Freud and many early analysts did not seem to think that perversions were necessarily coupled with other pathology like disturbed object relations, but I have never seen an instance where they were not, although I am probably defining disturbed object relations much more widely than Freud did.