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Sexual Sadism Disorder

By George R. Brown, MD, Mountain home VAMC, Johnson City, TN;East Tennessee State University

Sexual sadism involves acts in which a person experiences sexual excitement from inflicting physical or psychologic suffering on another person. Sexual sadism disorder is sexual masochism that causes significant distress, substantially interferes with daily functioning, or harms another person.

Sexual sadism is form of paraphilia. Most people with sadistic tendencies do not have sexual sadism disorder.

Some amount of sadism and masochism is commonly play-acted in healthy sexual relationships, and mutually compatible partners often seek one another out. For example, the use of silk handkerchiefs for simulated bondage and mild spanking during sexual activity are common practices between consenting partners and are not considered sadomasochistic.

Most sadists interact with a consenting partner, who may have sexual masochism. In these relationships, the humiliation and beating are simply acted out, with participants knowing that it is a game and carefully avoiding actual humiliation or injury. Fantasies of total control and dominance are often important, and sadists may bind and gag their partner in elaborate ways.

In contrast, sexual sadism disorder involves one or more of the following:

  • People are distressed by their behavior or unable to function because of their behavior.

  • They take these acts to an extreme, sometimes causing severe bodily or psychologic harm or even death.

  • The acts involve nonconsenting partners.

When practiced with nonconsenting partners, sexual sadism is considered a crime and is likely to continue until the sadist is apprehended.

Sexual sadism is not synonymous with rape, a complex mixture of sex and power over the victim. Sexual sadism is diagnosed in fewer than 10% of rapists but in 37 to 75% of people who have committed sexually motivated homicides.

Sexual sadism is particularly dangerous in people who also have antisocial personality disorder.

Treatment of sexual sadism disorder is usually ineffective.

* This is the Consumer Version. *