Sadistic personality disorder is a diagnosis which only appeared in an appendix of the revised third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). The current version of the DSM (DSM-IV) does not include it, so it is no longer considered a valid diagnostic category. As an alternative, the diagnosis Personality disorder not otherwise specified may be used instead. However, the disorder is still studied for research purposes.
Causes (etiology)
There appears to be a genetic component to the disorder.
Diagnosis
Proposed DSM III-R criteria
Sadistic personality disorder is:
A) A pervasive pattern of cruel, demeaning, and aggressive behavior, beginning by early adulthood, as indicated by the repeated occurrence of at least four of the following:
- Has used physical cruelty or violence for the purpose of establishing dominance in a relationship (not merely to achieve some noninterpersonal goal, such as striking someone in order to rob him/her).
- Humiliates or demeans people in the presence of others.
- Has treated or disciplined someone under his/her control unusually harshly.
- Is amused by, or takes pleasure in, the psychological or physical suffering of others (including animals).
- Has lied for the purpose of harming or inflicting pain on others (not merely to achieve some other goal).
- Gets other people to do what he/she wants by frightening them (through intimidation or even terror).
- Restricts the autonomy of people with whom he or she has a close relationship, e.g., will not let spouse leave the house unaccompanied or permit teenage daughter to attend social functions.
- Is fascinated by violence, weapons, injury, or torture.
B) The behavior in A has not been directed toward only one person (e.g., spouse, one child) and has not been solely for the purpose of sexual arousal (as in sexual sadism).
Exclusion from DSM-IV
This disorder was dropped from DSM-IV for two reasons:
- because of scientific concerns, such as the relatively low prevalence rate of the disorder in many settings
- for political reasons – sadistic personalities are most often male and it was felt that any such diagnosis might have the paradoxical effect of legally excusing cruel behaviour.
Sexual sadism that “causes clinically significant distress or impairment in social, occupational, or other important areas of functioning” is still in DSM-IV.
Millon’s subtypes
Theodore Millon identified four subtypes of sadist. Any individual sadist may exhibit none, one or many of the following:
- explosive sadist – including borderline features
- tyrannical sadist – including negativistic (passive-aggressive) features
- enforcing sadist – including compulsive features
- spineless sadist – including avoidant features.