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Sexual Sadism Disorder

Kathryn Patricelli, MA

What is Sexual Sadism Disorder?

Prior to the release of the DSM-5, this disorder was known as Sexual Masochism and Sadism. Sexual Masochism and Sadism has now been split into two separate disorders of Sexual Masochism Disorder and Sexual Sadism Disorder. Both are classified as Paraphilic Disorders, which requires the presence of a paraphilia that is causing significant distress or impairment, or involve personal harm or risk of harm to others.

A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one's self during sexual activity. Sometimes this sexual interest focuses on the person's own erotic/sexual activities while in other cases, it focuses on the target of the person's sexual interest.

In order to be diagnosed with a Paraphilic Disorder, the paraphilia needs to be causing significant distress or impairment, or involve personal harm or risk of harm to others. You can have a paraphilia, but not have a paraphilic disorder. It is only when it causes impairment, harm or the risk of harm that it become a clinical diagnosis.

Symptoms of Sexual Sadism Disorder include:

  • over a period of at least 6 months, a person has had recurrent, intense sexually arousing fantasies, sexual urges, or behaviors from the physical or psychological suffering of another person.
  • the individual has acted on these sexual urges with a nonconsenting person, or the fantasies and sexual urges are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Clinicians can also specify if the disorder is:

  • In a controlled environment - usually applicable to people who are living in institutions or other settings where opportunities to engage in sadistic sexual behaviors are restricted.
  • In full remission - the person has not acted on the urges with a nonconsenting person, and there has not been distress or impairment for at least 5 years while in an uncontrolled (non-institutional) environment.

How common is Sexual Sadism Disorder?

The prevalence for Sexual Sadism Disorder in the general population is unknown. According to the DSM-5, depending on the criteria for sexual sadism, prevalence varies widely from 2% to 30%. Among committed sexual offenders in the United States, less than 10% have this disorder. Among those that have committed sexually motivated killings, rates of sexual sadism disorder range from 37% to 75%.

Research in Australia estimated that 2.2% of males and 1.3% of females had been involved in bondage and discipline, or dominance and submission in a 12-month period.

Not much is currently known about the occurrence over time, but it is likely that the course of the disorder varies with age and that it will decrease as a person gets older.

What are the risk factors for Sexual Sadism Disorder?

Risk factors have not yet been identified for this disorder.

What other disorders or conditions often occur with Sexual Sadism Disorder?

Research in this area has focused on people (mostly males) who have been convicted of criminal acts involving sadistic behavior against nonconsenting individuals. This means that the co-occurring conditions found in this population might not be the same as in the general population. They typically include other paraphilic disorders.

How is Sexual Sadism Disorder treated?

Common treatments include psychotherapy and medication. Cognitive-behavioral therapy can be used where the therapist helps the person discover the underlying cause of the behavior and then works with the person to teach skills to manage the sexual urges in more health ways. This may include the use of aversion therapy and different types of imagery/desensitization in which the person imagines themselves in the situation and then experiencing a negative event, such as being arrested, to reduce future interest in participating in the sadistic activities. Cognitive restructuring (identifying and changing the thoughts that drive the behavior) and empathy training may also be used.

Various medications can be used to decrease the level of circulating testosterone in order to reduce the frequency of sexual fantasies and erections. Antidepressant medications may also be used to reduce sexual desire.