Overview
Sexual Sadism Disorder comprises sexual urges, fantasies or behaviours that cause intense sexual arousal from other peopleโs physical or psychological suffering.
These acts may include beating, tying someone up or humiliating them. Some people feel guilty and ashamed about their urges. The person may admit openly about these urges or tend to hide them.
Sexual Sadism Disorder is different from Sexual sadistic interest. When the urges, thoughts and fantasies do not result in psychosocial distress for the person nor do they act on these urges then they qualify for sexual sadistic interest.
The prevalence of this disorder is not known. Research studying the prevalence has largely been in forensic settings. Thus the prevalence varies widely, almost between 2% to 30%.
Forensically, it is almost always found in men. However, a study in Australia states that the rate of people involved in โsadomasochismโ is around 2.2% in males and 1.3% in females.
Recent studies have found that there is presence of Sexual sadism in non forensic populations too. The prevalence is higher in men with a rate of almost 21.8%. Most men tend to avoid disclosing this information due to the fear of legal authorities.
Theories explaining causes of this disorder are sparse. However, some believe that sexual arousal is caused by seeing someone else in pain.
But recent research has indicated a presence of sexual arousal derived from being in a dominating and powerful role. However, empirical evidence is lacking, rendering the cause unknown.
Common Signs and Symptoms
Signs and symptoms include:
- Common Signs and Symptoms include sexual urges, thoughts or fantasies to engage in sadistic behaviours such as bondage, beating, humiliating or insulting someone and feeling sexually aroused by it.
- This behaviour may cause psychosocial distress in the form of discomfort, guilt, shame, feelings of isolation, sexual frustration, etc.
- The person has acted on these urges and fantasies with a non consenting person.
- The individual may explicitly watch pornography related to humiliating, beating, bounding someone, or otherwise made to suffer.
Risk Factors
There are no established risk factors for this disorder. Although some papers do speak about childhood sexual abuse and presence of other paraphilias. However, there are no conclusive studies reporting the same.
Diagnosis
A detailed clinical history is mandatory before diagnosis. Assessment usually consists of a detailed history of the clientโs sexual life, relationship with family, medical history, education, substance abuse, history of sexual, physical or psychological abuse, etc. Victim statements are to be considered.
Scales such as Preference for Sexual Violence (PSV) or Sex Offender Risk Appraisal Guide (SORAG) may be administered. SORAG is a 14 item inventory measuring psychopathology, atypical sexual interests, childhood maladjustment, parental relations, history of alcohol problems, etc.
Forensic scales such as the Sexual Sadism Scale (SSSS) can be used to check for Sadistic tendencies on crime scenes. SSS is an 11-item scale that delineates behaviours associated with sexual sadism.
To be diagnosed with Sexual Masochism Disorder, following criteria must be met:
- Over the past six months, there are recurrent sexual urges, fantasies and behaviour of engaging in activities of psychological or physical torture to someone else, especially someone nonconsenting, and deriving sexual arousal from it.
- The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of life.
- The person has acted upon these urges with a non consenting individual qualifying the individual for sexually offensive behaviour.
Treatment
Treatment options are generally sparse. Reason being, a lot of surveys note around 30-60% of the population engaging in sadomasochistic behaviours.
However, most treatment options for Sexual Sadistic Disorder are carried out in forensic settings. The applicability of these outside the forensic settings is not studied in detail. Recidivism rates are also high, thus finding treatment options is necessary.
Treatment objective is to reduce sexual urges and also reduce the distress associated with it. Pharmacological treatment, for paraphilias in general, are focused on individuals where victimisation rates are higher. Behavioural treatments are then supplemented alongside medication.
The group of medications often includes Serotonin Reuptake Inhibitors (SSRIs), antiandrogens and GNRH analogues. GNRH analogues have been the most effective in reducing recidivism. They lower down testosterone levels in the body reducing sexual urges and sex drive in general.
This medication should be administered under supervision and informed consent of the individual or should be mandated by the authorities.
Side effects of this medication include bone mineral loss, hot flashes, asthenia, nausea, weight gain, decreased facial and body hair growth, decreased glucose tolerance, decreased testicular volume, depressive symptoms, and mild gynecomastia.
Antiandrogenic medication such as medroxyprogesterone acetate (MPA) or cyproterone acetate (CPA) are also administered.
They lower testosterone and dihydrotestosterone and reduce sexual urges and fantasies in general. MPA has been the drug of choice especially in the USA.
Recidivism rates are shown to drop to 27% with continued treatment. Reduction in fantasies are also observed.
Psychotherapy, especially Cognitive Behaviour Therapy is usually advocated. Focus is on improving future prospects, learning self regulation, working on relationship difficulties, and limiting effects of cognitive distortions based on denial, minimisation, etc.
Differential Diagnosis
Conditions such as antisocial personality disorder, sexual masochism disorder, hypersexuality, substance use disorders can act as a differential diagnosis and a comorbidity for sexual sadism disorder. Sadistic interest, but not the disorder, may be considered in the differential diagnosis.
Comorbidity
Disorders that are commonly comorbid with sexual sadism disorder include other paraphilic disorders. The comorbidities with sexual sadism disorder are largely based on individuals convicted for criminal acts involving sadistic acts against nonconsenting victims.
Specialists
Psychologists help with psychotherapy. Sex therapists may be referred to as well.
