Verified by Sexual Sadism Disorder
Sexual sadism disorder is characterized by taking sexual pleasure from humiliation, fear, or another form of mental harm to a person. Sadistic acts include restraint (such as ropes, chains, or handcuffs), imprisonment, biting, spanking, whipping, or beating. When someone repeatedly practices these sadistic sexual acts without consent from their partner(s), 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.
Sexual sadism disorder falls under the category of paraphilic disorders, which are characterized by sexual interests, preferences, fantasies, urges, and behaviors considered to be "atypical." These interests, preferences, and behaviors 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.
Healthy sexual activity can include a wide array of behaviors and activities, which, when fantasized about or experienced between consenting adults can bring people pleasure. The majority of individuals who are active in BDSM (Bondage/Discipline, Dominance/Submission, and Sadism/Masochism) relationships or communities do not express any dissatisfaction with their sexual interests, and their be­havior would not meet the criteria for sexual sadism disorder. In fact, many who engage in BDSM, (sometimes referred to as "kink") within the context of romantic relationships report that it brings them closer to their partner(s) due to increased feelings of trust that result from setting and respecting boundaries, as well as the emotional safety that comes from being able to explore less conventional sexual interests without judgment.
According to the DSM-5, 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.
BDSM, sometimes referred to as "kink", often involves sexual fantasies and behaviors that may include elements of domination and the infliction of pain upon one's partner. The difference is that relationships involving BDSM can be loving, trusting, and healthy. Studies have found that between 30 and 47 percent of people have tried spanking, dominant/submissive roleplay, or another aspect of BDSM during sexual activity. There is also no reason to believe that BDSM is a recent phenomenon. There is a long history of consensual role-play of domination and submission. For instance, the Kama Sutra, thought to be written more than 2,000 years ago, describes beating techniques that were intended to increase sexual drive.
Sexual sadism disorder is diagnosed when those engaging in the sadistic parts of these behaviors also report dysfunction in social, professional, or other aspects of life as a result, including obsessive thoughts, overwhelming anxiety, shame, or guilt.
According to the DSM, the prevalence of sexual sadism disorder is unknown and is largely based on individuals in forensic settings. Depending on the criteria for sexual sadism, prevalence varies widely, from 2 percent to 30 percent of the population. Among civilly committed sexual offenders in the United States, fewer than 10 percent have sexual sadism. Among individuals who have committed sexu­ally motivated homicides, rates of sexual sadism disorder range from 37 percent to 75 percent.
It’s important to distinguish between a sexually sadistic tendency or kink, which is common in the general population, and pathological sexual sadism, which is a psychiatric disorder. The large majority of sexual sadism diagnoses are either self-reported through the answers to various tests, including the Severe Sexual Sadism Scale, or come subsequent to a forensic investigation and analysis of a crime scene. One way of physically measuring a person’s sexually sadistic urges is the phallometric evaluation (penile plethysmography), which measures a subject’s level of sexual arousal while presented with images or audio descriptions of various sexual behaviors in which the victim’s consent level, constraints, and level of violence are manipulated.
According to the DSM-5, the average age of onset of sadism in males is 19.4 years.
There is evidence to support an association of sexual sadism disorder with criminal sexual behavior. Samples of criminal sexual offenders show as many as 10 percent of rapists diagnosed with the disorder. Among criminals convicted of sexual homicide, samples have shown about 32 percent diagnosed with sexual sadism disorder. Overall, studies of sexual offenders have varied widely in their findings from 10 percent to as many as 50 percent receiving diagnoses of sexual sadism disorder. These diagnoses have limited reliability, as they are often given after the crime by analyzing evidence from the crime scene.
It is unclear whether sexual sadism plays more of a role in these acts than other mental disorders, such as psychopathy.
Psychopathy is a descriptor for one form of antisocial personality disorder, which is characterized by a disregard for, and violation of, the rules of society and the rights of others. Psychopaths are often seen to have a lack of anxiety and a high degree of attention-seeking behavior. There is a relation between psychopathy and sexual sadism disorder in that the most common co-occurrence in those with sexual sadism disorder is antisocial personality disorder. Sadism is such a common behavior in the antisocial constellation of traits that it once had its own classification, in fact.
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.
Recent research suggests that engaging in sadistic sexual behaviors is driven by a desire for feelings of power and dominance, in addition to simply sexual pleasure. This is true for those in the general population with a sexually sadistic fetish and for those with a severe enough condition to be diagnosed with sexual sadism disorder.
According to an fMRI brain scan of 15 violent sexual offenders, sadists showed greater amygdala (a part of the brain associated with sexual arousal) activation when viewing images depicting pain. Sadists also rated these images as showing higher levels of pain than did non-sadists in the group. Further, sadists showed more activity in anterior insula (a pain processing part of the brain) than did non-sadists.
The relationship between sexual sadism and sadistic pornography is unclear. There is evidence that pornography may encourage the conversion of sexual fantasy to sexual offense, while other research suggests that those with sexually sadistic desires seek out sexually sadistic pornography.
A study of 512 men and women in Mozambique showed that men’s frequent exposure to pornography was correlated with sadistic behavior by men towards women.
On the whole, it is not clear whether sadistic pornography use is a cause of sexual sadism disorder or a symptom of it.
There is a link between testosterone and sexual sadism disorder, however, there is not substantial evidence for a causal relationship. Testosterone-reducing drugs are a primary treatment for many paraphilic sexual disorders. Various studies have found that testosterone-lowering treatment in sex offenders leads to a decrease in sexual interest, fantasies, desire, and to a lower frequency of masturbation and sexual intercourse. In general, higher testosterone in men is believed to correlate to higher levels of aggression and sexual arousability, but this is far from a causal link. Some research has shown sexual sadists to engage in homosexual activity and dressing as women, neither of which are correlated with higher testosterone levels. One study of rapists (not necessarily those with sexual sadism disorder) found their testosterone levels to be within the normal range for men.
It is uncommon for people with sexual sadism disorder to seek treatment on their own. Instead, those found guilty of a sexual offense are required by law to get professional help from a psychologist or psychiatrist, who may perform an evaluation. Treatment for sexual sadism disorder typically involves psychotherapy and medication.
Cognitive-behavioral therapy can help an individual recognize patterns of sexual arousal and learn new and healthier responses to their urges. A therapeutic technique known as cognitive restructuring can help an individual identify and overcome distorted thinking patterns. Antidepressant medications that reduce impulsive behavior or anti-androgenic drugs that suppress sex drive may also be used to treat sexual sadism disorder.
Treatment for sexual sadism can be pharmacological or behavioral, or, likely, both. The drugs used most often to treat the condition are antidepressants (SSRIs) and testosterone blockers (anti-androgens and GnRH analogs). Psychotherapies often focus on relationship difficulties and self-regulation. It has also been found that advancing age correlates with a decrease in sexually sadistic desires.
