176 Sexual Sadism (302.84)
DSM-IV-TR criteria
- Over a period of at least 6 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.
- The person has acted on these sexual urges with non consenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
- Sexual Sadism is severe and is associated with Antisocial Personality Disorder. The sexually sadistic individual may either seriously injure or kill the victim or partner.
Associated features
- The paraphilic focus of Sexual Sadism involves acts in which the individual derives sexual excitement from psychological or physical suffering (including humiliation) of the non-consenting victim. It is the suffering of the victim that is sexually arousing. Sadistic fantasies or acts may involve activities that indicate the dominance of the person, such as forcing the victim to crawl or keeping the victim confined. Such fantasies may also involve restraint, blindfolding, paddling, spanking, whipping, pinching, beating, burning, electrical shocks, rape, cutting, stabbing, strangulation, torture, mutilation, or killing. Some individuals with this Paraphilia feel empowered by their sadistic fantasies; this feeling may be invoked during sexual activity but not otherwise acted upon. Some individuals with SS may engage in sexual acts for many years without the need to increase the potential for inflicting serious physical damage; however, usually the severity of their sadistic acts increases over time. When SS is severe, or when it is associated with Antisocial Personality Disorder, the individual with SS may seriously injure or kill the victim.
- The urges must have been recurrent for at least six months for a diagnosis to be made or attempted. Achieving sexual excitation or orgasm is dependent on the other individual’s being humiliated or receiving pain. Some individuals are bothered by these fantasies, which may occur during the sexual excitation and activity but are otherwise not carried out; thus, they remain fantasies. The partner (victim) may very well be terrified of the anticipated act, especially if the behavior involves total control or domination. Some individuals with SS may act out their fantasies on unwilling partners or victims. Typical sadistic fantasies involve dominance over the partner/victim, and the fantasies were most likely present during the individual’s childhood.
- Sexual Sadism is often linked with Sexual Masochism.
Child vs. adult presentation
Sadistic sexual fantasies are likely to have been present during childhood and it is likely that individuals with SS were abused as children, both sexually and physically. Adult presentation is usually expressed in early adulthood about the time that the sexually sadistic activities appear, and the disorder is usually chroni