Sexual Sadism Disorder

Definition

Sexual sadism disorder is one of several psychiatric sexual disorders categorized as paraphilic disorders. Paraphilic refers to sexual interests, preferences, fantasies, urges and behaviors outside the norm; these are considered symptoms of a disorder only if they are acted upon in ways that have the potential to cause distress or harm to oneself or others, especially others who have not given consent.

Sexual sadism refers to causing pain, humiliation, fear, or some form of physical or mental harm to another person to achieve sexual gratification. Sadistic acts include restraint (such as with ropes, chains, or handcuffs), imprisonment, biting, spanking, whipping, or beating. If a person has sadistic sexual interests that cause no distress, dysfunction, or harm to consenting others, then they would not be diagnosed as having a disorder. When someone repeatedly (at least three times) practices these sadistic sexual acts without consent from their partner(s), however, or when sadistic fantasies or behaviors cause social, professional, or other functional problems, sexual sadism disorder may be diagnosed. Extreme sexual sadism can be criminal, and lead to serious harm or even the death of another person.

Symptoms

To be diagnosed with sexual sadism disorder, a person must experience persistent and intense sexual arousal from causing or fantasizing about the physical or mental suffering of another person, with or without their consent. These symptoms must be present for at least six months and cause severe distress or dysfunction in social, professional, or another significant area of the person’s day-to-day life. When combined with traits of antisocial personality disorder—poor impulse control, dishonesty, and lack of empathy and remorse—sexual sadism can be especially dangerous and difficult to treat.

Causes

While no specific causes have been determined for sexual sadism disorder, there are several theories. These include escapism, or a feeling of power for someone who normally feels powerless in day-to-day life, release of suppressed sexual fantasies, or progressive acting out of sadistic sexual fantasies over time. Other psychiatric or social disorders may be diagnosed along with sexual sadism disorder, though they are not necessarily the cause.

Treatments

It is uncommon for people with sexual sadism disorder to seek out treatment on their own. Instead, those caught committing a related crime are required by law to get professional help—a psychologist or psychiatrist who can perform an evaluation and provide a referral to another specialist, if necessary. Treatment for sexual sadism disorder typically involves psychotherapy and medication.

Cognitive-behavioral therapy can help the individual recognize patterns of sexual arousal and learn new and healthier responses. At the same time, a therapeutic technique known as cognitive restructuring can help the individual identify and overcome distorted thinking patterns. Antidepressant medications that balance brain chemicals and reduce impulsive behavior or anti-androgenic drugs that suppress sex drive may be used to treat sexual sadism disorder.

References

Brown, George R. Sexual Sadism Disorder. Merck Manual website. June 2015.http://www.merckmanuals.com/professional/SearchResults?query=sexual+sadi...

American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.

First MB. DSM-5 and Paraphilic Disorders. Journal of the American Academy of Psychiatry and the Law. 2014. 42:191-201http://jaapl.org/content/jaapl/42/2/191.full.pdf

Last reviewed 03/06/2018