Sexual sadism disorder DSM 5

Sexual sadism is an official mental disorder in DSM, which is the single source of authority when it comes to diagnosing mental disorders in the USA. 

Let’s consider different criteria of sexual sadism disorder from DSM and ICD

Criteria of sexual sadism disorder from DSM-IV9

A. Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person. B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criteria of sexual sadism disorder from DSM-IV-TR10

A. Over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person. B. The person has acted on these urges with a nonconsenting person, or the sexual urges, or behaviors cause marked distress or interpersonal difficulty.

Criteria of sexual sadism disorder from ICD-1018

A preference for sexual activity which involves the infliction of pain or humiliation. If the subject prefers to be the recipient of such stimulation this is called masochism. If the provider, sadism.

Sexual sadism disorder definition

Richard von Krafft-Ebing was the first scientist  who described the phenomenon of sexual sadism in 1999. He defined it as a sexual preference disorder that is focused  on the infliction of suffering, pain, or humiliation. Richard von Krafft-Ebing offered the following characteristics of sexual sadism: recurrent and intense sadistic fantasies, urges, and behaviors that require the infliction of psychological or physical suffering to achieve sexual arousal.

Some research on sexual sadism disorder revealed the following elements that relate to sadistic behavior.

Actions

Severe sexual sadists tend to be emotionally detached, so they intentionally torture and humiliate their victims. Sexual sadism disorder means that one restrain and abduct a sexual partner as well as subject him/her to various highly intrusive sexual acts that might involve anal intercourse and bondage.

Fantasies

According to numerous interviews with sexual sadists, they often fantasize about offending before their crimes. Sometimes, they even rehearse their behavior. Before offending, they typically feel depressed or angry, so they often engage in self-provocation that boosts their aggressive behavior.

The difference between sadism and rape

Unfortunately, rape and sadism are often confused. In some cases, people don’t distinguish between the rare, specialized, preferred violence accompanying sadism and the common, nonspecific, occasional violence of tape. For psychologists, it’s crucial to make a distinction between these two in order to avoid inaccurate diagnosis. To prevent this, mental health professionals must rely on the information from DSM. This way, they can understand the steps of making an accurate diagnosis and apply all relevant criteria. Otherwise, well-intentioned psychologists may misclassify non-sadistic rapists with a wrong diagnosis of sexual sadism.

In fact, sexual sadism applies to a very small number of rapists. Rapists and sadists are similar only superficially, in reality, the difference between them is fundamental.

                           Rapists                              Sadists

Motivation    to insure sexual   to cause pain and suffering                           compliance                     in the victim

Means             violence and                       cruelty and                                       control                             humiliation

Goal                    sex act                             domination

Sexual sadism disorder treatment

Sexual sadism disorder is associated with big treatment challenges in both pharmacologic and psychotherapeutic avenues since it is really difficult to identify.

To treat sexual sadism disorder, mental health professionals often use cognitive-behavior therapy (CBT) that includes management and conditioning of arousal patterns as well as cognitive restructuring. Social skills training is also applied for patient treatment. 

Individuals with SSD sometimes may take medication as a part of their treatment, especially those who exhibit behaviors dangerous to others. Typically, the medications used for sexual sadism disorder treatment are female hormones. They speed up the clearance of testosterone from the patient’s bloodstream. Another type of medicine used in such cases are Antiandrogen medications. They act by effectively blocking the body’s uptake of testosterone. Moreover, SSRIs might be used for people struggling with this disorder. 

Unfortunately, sexual sadism disorder has a chronic course and uncertain causes, so its treatment is very difficult. In addition, the fact that sadistic fantasies are socially unacceptable makes people with this disorder avoid or drop out of treatment. In general, treating SSD is a sensitive subject for many psychotherapists. Difficult cases of it should be better referred to a specialized clinic or to professionals with experience in treating them.

Anton Kurapov

Anton Kurapov

PhD, a professor assistant at Taras Shevchenko National University of Kyiv. Fascinated by the role of psychology in lives of people and simply astonished by the complexity of the brain and its functions.

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