The essential feature of sexual sadism is a feeling of sexual excitement resulting from administering pain, suffering, or humiliation to another person. The pain, suffering, or humiliation inflicted on the other is real; it is not imagined and may be either physical or psychological in nature. A person with a diagnosis of sexual sadism is sometimes called a sadist. The name of the disorder is derived from the proper name of the Marquis Donatien de Sade (1740-1814), a French aristocrat who became notorious for writing novels around the theme of inflicting pain as a source of sexual pleasure.
The Diagnostic and Statistical Manual of Mental Disorders , also known as the DSM , is used by mental health professionals to give diagnoses of specific mental disorders. In the 2000 edition of this manual— the Fourth Edition, Text Revision, also known as DSM-IV-TR — sexual sadism is listed as one of several paraphilias . The paraphilias are a group of mental disorders characterized by obsession with unusual sexual practices or with sexual activity involving nonconsenting or inappropriate partners (such as children or animals). The paraphilias may include recurrent sexually arousing urges or fantasies as well as actual behaviors.
In addition to the sexual pleasure or excitement derived from inflicting pain and humiliation on another, a person diagnosed with sexual sadism often experiences significant impairment or distress in functioning due to actual sadistic behaviors or sadistic fantasies.
With regard to actual sadistic behavior, the person receiving the pain, suffering, or humiliation may or may not be a willing partner. Whether or not the partner is consenting, it is the very real suffering they are experiencing that is arousing to the sadist. When the sexual activity is consensual, the behavior is sometimes referred to as sadomasochism. The consenting partner may be given a diagnosis of sexual masochism . Like sadism, masochism is a term derived from a proper name; in this instance, from Leopold von Sacher-Masoch (1836-1895), an Austrian novelist who described the disorder in his books.
The sadistic acts performed or fantasized by a person with sadism often reflect a desire for sexual or psychological domination of another person. These acts range from behavior that is not physically harmful although it may be humiliating to the other person (such as being urinated upon), to criminal and potentially deadly behavior. Acts of domination may include restraining or imprisoning the partner through the use of handcuffs, cages, chains, or ropes. Other acts and fantasies related to sexual sadism include paddling, spanking, whipping, burning, beating, administering electrical shocks, biting, urinating or defecating on the other person, cutting, rape, murder, and mutilation.
In extreme cases, sexual sadism can lead to serious injury or death for the other person. According to the DSM these catastrophic results are more likely when the paraphilia is diagnosed as severe, and when it is associated with antisocial personality disorder , a personality disorder that may include psychotic symptoms.
Causes and symptoms
There is no universally accepted cause or theory explaining the origin of sexual sadism, or of sadomasochism. Some researchers attempt to explain the presence of sexual paraphilias in general as the result of biological factors. Evidence for this viewpoint comes from abnormal findings from neuropsychological and neurological tests of sex offenders.
Some researchers believe that paraphilias are related to such other problems as brain injury, schizophrenia , or another mental disorder. Often, people with sexual disorders or symptoms of paraphilia are diagnosed with other mental disorders.
Another theory about paraphilias is derived from learning theory. It suggests that paraphilias develop because the person is required to suppress, or squelch, inappropriate sexual fantasies. Because the fantasies are not acted out initially, the urge to carry them out increases. When the person finally acts upon the fantasies, they are in a state of considerable distress and/or arousal. This theory is not accepted by forensic experts at the Federal Bureau of Investigation (FBI) and other researchers who study sexual offenses. Rather than suppressing fantasies, most people who are eventually arrested for crimes involving sexual sadism begin with milder forms of acting on them and progressing to more harmful ways of acting out. For example, the FBI's database indicates that these people— almost always males— start out by collecting pornographic materials that depict sadistic acts, or they may draw ropes and chains on the photographs of models in swimsuit or lingerie advertisements. They then typically progress to following women at a distance, to hiring a prostitute in order to act out the fantasy, and to asking a girlfriend or other willing partner to cooperate with their fantasy. In other words, the severity of sadistic acts tends to increase over time.
Individuals with sexual sadism derive sexual excitement from physically or psychologically administering pain, suffering, and/or humiliation to another person, who may or may not be a consenting partner.
They may experience distressed or impaired functioning because of the sadistic behaviors or fantasies. This distress or impairment may be due to the fact that the partner is not consenting.
Although sadistic sexual fantasies often begin in the person's childhood, the onset of active sexual sadism typically occurs during early adult life. When actual sadistic behavior begins, it will often continue on a chronic course for people with this disorder, especially if they do not seek help.
Sexual sadism with consenting partners is much more common than with nonconsensual partners. When consenting partners are involved, the sadist and the masochist may be either male or female. When non-consenting partners are involved, the sadist is almost always a male.
Sadomasochism involving consenting partners is not considered rare or unusual in the United States. It often occurs outside of the realm of a mental disorder. Fewer people consider themselves sadistic than masochistic.
The diagnosis of sexual sadism is complicated by several factors, beginning with the fact that most persons with the disorder do not enter therapy voluntarily. Some are referred to treatment by a court order. Some are motivated by fear of discovery by employers or family members, and a minority enter therapy because their wife or girl friend is distressed by the disorder. The diagnosis of sexual sadism is based on the results of a psychiatrist's interview with the patient. In some cases, a person with sexual sadism may be referred to a specialized clinic for the treatment of sexual disorders. In the clinic, he will be given questionnaires intended to measure the presence and extent of cognitive distortions regarding rape and other forms of coercion, aggression, and impulsivity.
DSM-IV-TR criteria for sexual sadism include recurrent intense sexual fantasies, urges, or behaviors involving real acts in which another person is suffering psychological or physical suffering, pain, and humiliation. The victim's suffering, pain, and humiliation cause the person with sexual sadism to become aroused. The fantasies, urges, or behaviors must be present for at least six months.
The diagnostic criteria also require either that the person has acted on these urges or fantasies with a nonconsenting person, or that the person has experienced noticeable distress or interpersonal problems because of these urges or fantasies.
Sexual sadism must be differentiated from normal sexual arousal, behavior, and experimentation. Some forms of mild aggression, such as "love bites" or scratching, are within the range of normal behavior during sexual intercourse. Sadism should also be differentiated from sadomasochistic behavior that involves only mild pain and/or the simulation of more dangerous pain. When these factors are present, a diagnosis of sexual sadism is not necessarily warranted.
Other mental disorders, such as the psychotic disorders, may include elements of sadism or other paraphilias. For example, patients with psychotic symptoms may perform sadistic acts for reasons other than sexual excitement. In these cases, an additional diagnosis of sexual sadism is not warranted.
Persons diagnosed with sexual sadism may have other sexual disorders or paraphilias. Some individuals, especially males, have diagnoses of both sexual sadism and sexual masochism.
Behavior therapy is often used to treat paraphilias. This approach to treatment may include the management and conditioning of arousal patterns and masturbation. Therapies involving cognitive restructuring and social skills training are also often utilized.
Medication may be used to reduce fantasies and behavior relating to paraphilias. This form of treatment is especially recommended for people who exhibit sadistic behaviors that are dangerous to others. The medications that may be used include female hormones (most commonly medroxyprogesterone acetate, or MPA), which speed up the clearance of testosterone from the bloodstream; antiandrogen medications, which block the body's uptake of testosterone; and the selective serotonin reuptake inhibitors, or SSRIs.
Nonconsensual sadistic behavior often leads to problems with the criminal justice system. Issues related to legal problems may impair or delay the patient's treatment. Persons with sexual sadism may be reluctant to seek or continue treatment because they fear being reported to the police or being named in a lawsuit by an unwilling partner.
Treatment of sexual sadism may also be complicated by health problems related to sexual behavior. Sexually transmitted diseases and other medical problems may be present, especially when the sadistic behavior involves the release of blood or other body fluids.
Because of the chronic course of sexual sadism and the uncertainty of its causes, treatment is often difficult. The fact that many sadistic fantasies are socially unacceptable or unusual leads many people who may have the disorder to avoid or drop out of treatment. Treating a paraphilia is often a sensitive subject for many mental health professionals. Severe or difficult cases of sexual sadism should be referred to a specialized clinic for the treatment of sexual disorders or to professionals with experience in treating such cases.
As was noted previously, acts of sexual sadism tend to grow more violent or bizarre over time. As males with the disorder grow older, however, their ability to commit such acts begins to decrease. Sexual sadism is rarely diagnosed in men over 50.
Because it is sometimes unclear whether sadomasochistic behavior is within the realm of normal experimentation or indicative of a diagnosis of sexual sadism, prevention is a tricky issue. Often, prevention refers to managing sadistic behavior so it never involves non-consenting individuals and it primarily involves the simulation of pain and not real pain.
Also, because fantasies and urges originating in childhood or adolescence may form the basis for sadomasochistic behavior in adulthood, prevention is made difficult. People may be very unwilling to divulge their urges and discuss their sadistic fantasies.
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Ali Fahmy, Ph.D.