Sexual Sadism Disorder: Causes, Symptoms, Treatment DSM-5 302.84 F65.52

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), sexual sadism disorder concerns individuals who freely admit to having the discussed paraphilic interests and those who deny having any sexual interest in the suffering, physically or psychologically, of another individual despite substantial objective evidence that they do. If these individuals do openly acknowledge and discuss their sexual interest in the physical or psychological suffering of others, they are designated as “admitting individuals”. And if they also report psychosocial difficulties related to these sexual preferences for the physical and/or psychological suffering of another, they may be diagnosed with sexual sadism disorder. On the contrary, if these “admitting individuals” deny experiencing any distress (which may be characterized by anxiety or guilt) due to these paraphilic interests and their histories do not indicate that they act on the impulses, they they may have sadistic sexual interest but do not meet criteria for sexual sadism disorder.

Diagnostic Criteria for Sexual Sadism Disorder DSM-5 302.84 (F65.52)

The DSM-5 sets forth a couple diagnostic criterion, which must be met in order for a diagnosis of sexual sadism disorder to be made. These include:

• For 6 months or more, the individual has experienced intense sexual arousal from the physical or psychological suffering of another, as manifested by fantasies as well as behaviors.
• The individual has acted on these sexual fantasies with a nonconsenting person, OR the fantasies have caused clinically significant impairment in important areas of life (at one’s job or in his or her personal relationships).

It’s also important to specify if sexual sadism disorder is…

• in a controlled environment, whereas the individual is living in an institutional setting or another setting which restricts opportunities to engage in sadistic sexual behaviors.
• in full remission, whereas the individual has not acted on his or her paraphilic interests and urges with a nonconsenting person, and hasn’t felt distress or impairment in important areas of life, within the last 5 years (or longer) while in an uncontrolled environment.

Development and Course of Sexual Sadism Disorder DSM-5 302.84 (F65.52)

Based on forensic samples, individuals with sexual sadism are almost exclusively male. However, a representative sample of Australia’s population showed that 2.2% of men and 1.3% of women said that they engaged in bondage, “sadomasochism”, or dominance and submission practices in the last 12 months. There is not much other data on the prevalence or the development and course of sexual sadism disorder. But one study did find that females reported becoming aware of their sadomasochistic interest as young adults, while another showed that the mean age at onset of sexual sadism in males was at about 19 years. Though it is important to recognize that there is a difference between sexual sadism and sexual sadism disorder.

Is There Treatment for Sexual Sadism Disorder?

It is actually very unlikely for people with sexual sadism disorder to seek out treatment for the illness on their own. Instead, individuals with the disorder caught committing a crime related to their paraphilic interests are required by law to get profession help. This typically involves undergoing psychotherapy and being prescribed medication.

• Psychotherapy: More specifically, cognitive-behavioral therapy can help these individuals recognize patterns of sexual arousal and learn better, healthier ways to deal with them. Cognitive restructuring may also help the individual identify and overcome these harmful thought patterns.
• Medication: Sometimes, antidepressant medications are prescribed to balance brain chemicals as well as reduce impulsive behavior. Similarly, anti-androgenic drugs are at times prescribed to suppress the individual’s sex drive.

Differential Diagnosis

There are a few conditions that may be differential diagnoses for sexual sadism disorder. Consequently, it’s important to carefully evaluate the diagnostic criteria and evidence of sexual sadism disorder, while also keeping the following possibilities in mind:

• Antisocial personality disorder
• Sexual masochism disorder
• Hypersexuality
• Alcohol and substance use disorders

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