Merck Manual

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Sexual Sadism Disorder

By

George R. Brown

, MD, East Tennessee State University

Last full review/revision Jul 2019| Content last modified Jul 2019
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Sexual sadism is infliction of physical or psychologic suffering (eg, humiliation, terror) on another person to stimulate sexual excitement and orgasm. Sexual sadism disorder is sexual sadism that causes significant distress or significant functional impairment or is acted on with a nonconsenting person.

People with sexual sadism disorder have either acted on the intense urges or have debilitating or distressing fantasies with sexually sadistic themes. The condition must also have been present for ≥ 6 months.

Sexual sadism is a form of paraphilia, but mild sadistic sexual behavior is a common sexual practice between consenting adults, is usually limited in scope, is not harmful, and does not meet the clinical criteria for a paraphilic disorder, which require that a person's behavior, fantasies, or intense urges result in clinically significant distress or functional impairment or cause harm to others. However, in some people, the behaviors escalate to the point of harm. When sadism becomes pathologic is a matter of degree.

Most sexual sadists have persistent fantasies in which sexual excitement results from suffering inflicted on the partner, consenting or not. When practiced with nonconsenting partners, sexual sadism constitutes criminal activity and is likely to continue until the sadist is apprehended. However, sexual sadism is not synonymous with rape, a complex amalgam of sex and power over the victim. Sexual sadism is diagnosed in < 10% of rapists but is present in 37 to 75% of people who have committed sexually motivated homicides.

Sexual sadism is particularly dangerous when associated with antisocial personality disorder. This combination of disorders is particularly recalcitrant to any form of psychiatric treatment.

Diagnosis of sexual sadism disorder is based on specific clinical criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

  • Patients have been repeatedly and intensely aroused by the physical or psychologic suffering of another person; arousal is expressed in fantasies, intense urges, or behaviors.

  • Patients have acted on their urges with a nonconsenting person, or these fantasies or urges cause significant distress or impair functioning at work, in social situations, or other important areas.

  • The condition has been present for ≥ 6 months.

Sexual sadism disorder may be diagnosed in patients who deny that they have fantasies or urges related to sexual arousal triggered by the pain or suffering of others if these patients report multiple sexual episodes of inflicting pain or suffering on a nonconsenting person.

Treatment of sexual sadism disorder is usually ineffective.

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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