Sadism and Personality Disorders.

PURPOSE OF REVIEW: Sadistic pleasure-the enjoyment of harm-infliction to others-can have devastating interpersonal and societal consequences. The goal of the current review is to illuminate the nomological net of traits related to sadism. We aim to achieve an understanding of the current empirical status on the link between sadism and personality disorders, psychopathy, the Dark Triad, and basic personality traits in clinical and community-based samples. RECENT FINDINGS: The field is dominated by self-report studies on the Dark Triad with convenience samples. The link with DSM personality disorders has hardly been empirically studied. Existing evidence shows that sadism is most strongly related to increased psychopathic personality traits. Sadism can originate both from the interpersonal, affective, and behavioural basis of dark personality traits. There are diverging ideas on the differential status between sadism, psychopathy, and other dark traits. Research is needed on the causal impact of the broader range of personality disorders on sadism, in more diverse samples, including behavioural assessments of sadistic pleasure, as well as on the interplay of such personality traits with situational and affective aspects, and victim attitudes.

Paraphilic Interests Versus Behaviors: Factors that Distinguish Individuals Who Act on Paraphilic Interests From Individuals Who Refrain.

Little is known about distinct factors linked with acting on paraphilic interests or refraining from engaging in paraphilic behaviors. Participants from Canada and the United States (N = 744), aged 19-42 years (M = 29.2; SD = 3.18), were recruited through Amazon's Mechanical Turk. Participants completed questionnaires about their paraphilic interests and behaviors, as well as potential key factors linked to behavioral engagement (i.e., perceptions of consent, sexual excitation/inhibition, impulsivity, moral disengagement, empathy). Results indicated that higher moral disengagement and impulsivity, lower sexual control (i.e., high sexual excitation, low sexual inhibition), and maladaptive understandings of consent were best able to differentiate individuals who reported highly stigmatized (e.g., hebephilia, pedophilia, coprophilia) or Bondage and Dicipline, Dominance and Submission, Sadism and Masochism(BDSM)/Fetish paraphilic interests and engagement in the paraphilic behaviours associated with these interests relative to individuals who did not report such paraphilic interests or behaviors. Moreover, higher moral disengagement, impulsivity, and maladaptive perceptions of consent were best able to differentiate non-consensual paraphilic interests and behaviours (e.g., voyeurism, exhibitionism) compared to individuals who did not report these paraphilic interests or behaviours. These results provide future directions for the exploration of mechanisms that may contribute to engagement in paraphilic behaviors and may be targets for intervention aimed at preventing engagement in potentially harmful paraphilias.

Enthusiastic Acts of Evil: The Assessment of Sadistic Personality in Polish and Italian Populations.

Subclinical sadism has received substantial attention in recent research as a trait that predicts a variety of malevolent behaviors. The objective of this study was to assess the 'psychometric robustness and portability' of the Assessment of Sadistic Personality (ASP). We examined the convergent and discriminant validity, and invariance of translated versions of the ASP within community samples of Polish and Italian individuals. The study included 568 individuals (340 women and 228 men) residing in Italy (Mage = 23.57, SDage = 2.55) and 556 individuals (411 women, 144 men, 1 other) residing in Poland (Mage = 23.48, SDage = 4.60). For cultural invariance purposes, data from a Canadian sample comprising 638 students were used. To establish convergent and discriminant validity, participants completed measures of sadism, the Dark Triad, the Big Five, interpersonal reactivity, and maladaptive traits described in the DSM-5. Across both samples, convergent and discriminant validity were supported. Configural and partial metric invariance were satisfied, and following implementation of alignment optimization, latent mean differences were evaluated between countries. Results of the study supported the psychometric qualities of the ASP across different cultures and languages, and the utility of the ASP as a valid measure extending beyond university samples.

Sexual Sadism Among Sex Offenders in Switzerland.

The Sexual Sadism Scale (SeSaS) was developed to assist in the diagnosis of sexual sadism, and it revealed adequate psychometric properties in prior research. This study cross validated the SeSaS in Switzerland using a sample of 179 male sex offenders. Specifically, the SeSaS conformed to a Mokken model of double monotonicity (scalability coefficient [H] = .46, coefficient of reproducibility [CR] = .89), indicating that it measures a unidimensional construct of sexual sadism with hierarchically ordered items. The reliability of the scale was acceptable to high (ρ = .80, λ2 = .75, κ = .88). In addition, the SeSaS was strongly associated with sexual sadism diagnoses based on mental health manuals (rpb = .60, odds ratio [OR] = 13.02, area under the curve [AUC] = 1) but not with recidivism. The results suggest that the use of the SeSaS may improve the validity and reliability of sexual sadism diagnoses, therefore playing a role in the assessment and management of sex offenders.

Current Legal Situation for Patients with Paraphilic disorders and Implications of the ICD-11 for Paraphilic Disorders for Germany.

INTRODUCTION: Recently the guidelines for the diagnosis of paraphilic disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11), have been published. AIM: This article analyzes legal, regulatory, and policy issues relevant to the potential effects of the changes for the classification of paraphilic disorders in the ICD-11 in Germany. METHODS: A forensic and a legal expert in Germany worked with other international experts to conduct this evaluation using an assessment guide provided by the World Health Organization. MAIN OUTCOME MEASURES: Possible effects of the changes for the classification of paraphilic disorders in the ICD-11 on forensic practice, health systems, adjudication of individuals who have committed a sexual offense, and the provision of treatment in Germany. RESULTS: Results highlight the special situation of medical confidentiality in the German health system that facilitates the establishment of preventive networks for the treatment of pedophilic patients. The ICD-11 guidelines will help to clarify the boundary between pedophilic disorder and crimes of child sexual abuse. These will also establish a boundary with other paraphilic diagnostic concepts. We describe the central construct of criminal responsibility in the German legal system in relation to paraphilic disorders, the prominent role of expert witnesses, and the differences in the conceptualization of medical confidentiality within the health care system and within the legal system. CLINICAL IMPLICATIONS: The ICD-11 proposals for paraphilic disorders provide a clearer differentiation, as compared with ICD-10, between variants of normal sexual behavior and sexual behavior that involves a non-consenting person or entity. Particular patterns of sexual preference that are not of relevance to public health, the health care system, or the legal system, such as masochism and fetishism, will no longer be named psychiatric entities and will, therefore, be regarded as private behaviors and destigmatized. STRENGTHS & LIMITATIONS: The assessment shows the specific legal situation in Germany for the treatment of paraphilic patients in a sexual medicine, psychiatric, and legal discourse. However, it was done only by a small number of experts. CONCLUSION: A conclusion of the analysis was that the more specific and narrower definitions in the ICD-11 diagnostic guidelines, compared with those in ICD-10, particularly for pedophilic disorder and coercive sexual sadism disorder, will result in a reduction in false-positive diagnoses. It is unlikely that significant unintended and negative consequences will occur as a result of implementing the ICD-11 guidelines for paraphilic disorders. Briken P, Boetticher A, Krueger RB, et al. Current Legal Situation for Patients with Paraphilic disorders and Implications of the ICD-11 for Paraphilic Disorders for Germany. J Sex Med 2019;16:1615-1622.

Coercive Sexual Sadism: a Systematic Qualitative Review.

PURPOSE OF REVIEW: Coercive sexual sadism can be distinguished from consensual BDSM (bondage discipline/dominance submission/sadism masochism) role-play and from everyday sadism, a personality trait. The purpose of this paper is to provide a systematic qualitative review of the pertinent literature on coercive sexual sadism from the last three years. RECENT FINDINGS: Clinical assessment of sexual sadism can be made more objective through behavioral checklists based on crime scene actions. The latent structure of sexual sadism is likely dimensional, placing the disorder at the upper end of a continuum of sexually aggressive behavior. Sexual sadism does not seem to increase the risk of violent offense recidivism (including sexual contact offenses) above and beyond the risk implied by established risk factors of delinquency. Coercive sexual sadism denotes a disposition for sexually aggressive behavior. Whether this disposition is put into practice is likely due to other trait and state variables. Treatment studies are completely lacking in the recent literature.

Sadistic Offender or Sexual Sadism? Taxometric Evidence for a Dimensional Structure of Sexual Sadism.

Severe sexual sadism is a disorder of sexual preferences that focuses on humiliation and domination of the victim, sometimes causing grievous injury or death. Because offenders with high levels of sadism represent a risk to both reoffend and cause considerable harm should they reoffend, a diagnosis of sexual sadism has serious implications. The actual diagnosis of sexual sadism is fraught with problems (i.e., low reliability and validity) and exhibits poor consistency across assessments and studies (Levenson, 2004; Marshall, Kennedy, & Yates, 2002a). Various authors have proposed that sadism should be reconceptualized and have suggested that a dimensional approach may be more effective than a classificatory one for diagnosing sexual sadism (e.g., Marshall & Kennedy, 2003; Nietschke, Osterheider, & Mokros, 2009b). The dimension versus taxon question also impacts debates about the etiology and treatment of sadism. We assessed the taxonicity of sexual sadism by conducting a taxometric analysis of the scores of 474 sex offenders from penitentiary settings on the MTC Sexual Sadism Scale, using Meehl's taxometric methods (Meehl & Yonce, 1994; Waller & Meehl, 1998). Findings indicated that sexual sadism presents a clear underlying dimensional structure. These results are consistent with earlier research supporting a dimensional assessment of sexual sadism and indicate that the diagnosis of sexual sadism should be reconceptualized. The theoretical and clinical implications of these findings are discussed.

Convergent Validity of Three Measures of Sexual Sadism: Value of a Dimensional Measure.

Sexual sadism can be described as the sexual pleasure produced by acts of cruelty and bodily punishment. The most common method for evaluating sexual sadism is clinical evaluation, that is, evaluation based on the diagnostic criteria of nosological instruments such as the Diagnostic and Statistical Manual of Mental Disorders ( DSM) or the International Classification of Diseases (ICD). It is also possible to evaluate sadistic sexual preferences by phallometry, which provides a physiological measure of sexual excitation by deviant and nondeviant scenarios. The most recently developed evaluation method is the Severe Sexual Sadism Scale (SESAS), a dimensional instrument that has been empirically validated. Despite the availability of all these measurement techniques, very little research has been conducted on their degree of convergence. Consequently, the aim of the current study was to assess the relationship between these three measures of sexual sadism. Our analyses were conducted on a sample of rapists ( N = 72), assessed in a maximum-security penitentiary. There was no significant relation between phallometric scores and other measures of sexual sadism. There was, however, an important correlation between SESAS scores and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) sexual sadism diagnosis. Our results are consistent with other phallometric studies, which reported no difference in the penile responses of individuals diagnosed as sadists and those not diagnosed as sadists. Results and implications for future research are discussed.

The Sadomasochism Checklist: A Tool for the Assessment of Sadomasochistic Behavior.

Various scientific disciplines devoted to the study of sexual behavior are concerned with the understanding of sadomasochistic (SM) practices. However, only a fragmented body of theories, opinions, and studies is available, which limits the systematic study of this field. Empirical studies and tools for the assessment of SM tendencies are particularly sparse. Our aim was to develop a comprehensive tool for the assessment of an individual's engagement in SM practices. A comprehensive 24-item checklist of different types of SM play was generated with the assistance of members of the German SM community, covering both a dominance scale and a submission scale. The sadomasochism checklist was administered in an online study to a sample of 652 adults (345 female, 307 male), with 527 participants being active members in the SM community. Both the frequency of SM behavior and the attraction to the types of SM practices were assessed. Results revealed a one-factor structure for the dominance as well as the submission scale. The distinction between different types of practices (soft play, domination/submission, beating, toys, breath and bodily fluids) was confirmed using principal component analysis. Cronbach's alpha was appropriate. The total scores for the dominance and the submission scale distinguish between participants with different preferences for dominant and submissive practices. The newly developed scale is a reliable and valid tool for the assessment of the frequency of and attraction to SM behavior. It aims to provide the basis for future systematic studies on sadomasochism.

Sadism and Violent Reoffending in Sexual Offenders.

A diagnosis of sadism in sexual offenders is commonly regarded as indicative of high risk for violent reoffending. The purpose of the current two studies was to evaluate whether sadism is indeed associated with higher rates of violent (including sexual) reoffending. In Study 1 (meta-analysis), the rate of violent and sexual recidivism was assessed across seven samples of male sex offenders (total N = 2,169) as a function of diagnoses of sexual sadism. In Study 2 (N = 768) the outcome (violent recidivism yes/no) was regressed on sadism, along with behavioral indicators of sexually sadistic offending, and scores from violence risk assessment instruments. In Study 1 (meta-analysis), the overall risk of sadists compared with nonsadists with respect to violent (including sexual contact) reoffending was slightly elevated (by a factor of 1.18), yet not significantly increased. Similarly, the risk of sexual reoffending among sadists was slightly, but not significantly, higher than among nonsadists (factor 1.38). According to Study 2, only a measure of sadistic behavior, not the clinical diagnosis, was associated with violent reoffending. This association, however, was not present once age and customary risk assessment instruments for violence risk were included in the regression. A clinical diagnosis of sexual sadism and behavioral measures of sadism are related to the risk of violent reoffending in sexual offenders. These associations, however, are weak and do not hold once variables relevant for the prediction of violence are controlled for. At the individual level, the risk for future violence in sadists can therefore be adequately described by customary risk assessment instruments.

Consensual sadomasochistic sex (BDSM): the roots, the risks, and the distinctions between BDSM and violence.

When practiced consensually, sadomasochistic sex is being increasingly accepted as an alternative sexuality. Here I suggest the possible evolutionary roots of the preferences, draw distinctions between violent, abusive and "healthy" practitioners' partnership, provide clear behavioural markers of the respective situations, and underline some specific problems connected to this sexual preference. Some of the problems are well-known in the community of its practitioners, although they have not yet been described in medical nor scientific sources.

The DSM diagnostic criteria for sexual sadism.

I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Sadism for the Sexual and Gender Identity Disorders Workgroup for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Sadism, the assessment of Sexual Sadism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Sadism using the DSM in non-forensic populations. I conclude that the diagnosis of Sexual Sadism should be retained, that minimal modifications of the wording of this diagnosis are warranted, and that there is a need for the development of dimensional and structured diagnostic instruments.

Evidence regarding the need for a diagnostic category for a coercive paraphilia.

Evidence relevant to a potential diagnosis of Paraphilic Coercive Disorder is reviewed. Salient cues indicating that their partner is feeling coerced normally at least partially inhibit male sexual arousal while cues indicating mutual interest heighten arousal. However, for a minority of males, this pattern reverses with salient coercion cues leading to heightened arousal. This unusual pattern of arousal and fantasy is associated with a self-reported willingness to rape among non-convicted samples and is more common among convicted rapists than in other offender groups. It is inconsistently associated with Sadism as defined by the DSM-IV-TR and only weakly associated with psychopathy or general criminality. Evidence for it as an abnormal and persistent sexual interest comes from behavioral patterns, self-reported sexual fantasy, and laboratory tests. Two possible ways of incorporating it into a future version of the DSM are outlined.

Is a diagnostic category for paraphilic coercive disorder defensible?

There is a proposal to establish a paraphilic coercive disorder as a new paraphilia in the DSM-V. The empirical data do not, however, support the hypothesis that a distinct syndrome exists that comprises males who are sexually aroused by the coercive elements of rape per se. Purported evidence for this syndrome has centered on the results of phallometric studies. Higher plethysmographic responses of rapists to coercive rape scenarios may, however, be better explained by the failure of coercive elements to inhibit arousal to sexual aspects of the stimuli rather than by arousal specifically to the coercive elements. In addition, sexual fantasies about forcing sex and about struggling victims are highly correlated with sadistic fantasies and have not been shown to identify a syndrome that can be discriminated from sadism. Finally, taxometric evidence strongly supports the hypothesis that the underlying components of rape are distributed as dimensions and do not constitute a separate taxon. Consequently, the criteria purported to categorize rapists into the proposed syndrome would have to be arbitrarily determined. Not only does there seem to be little empirical justification for the creation of this new syndrome, the inclusion of this disorder among the paraphilias would have serious potential for misuse. It would imply endorsement of Paraphilia, NOS, nonconsent, which is currently inappropriately employed in civil commitment proceedings to justify commitment.

Malignant Narcissism: from fairy tales to harsh reality.

INTRODUCTION: Malignant Narcissism has been recognized as a serious condition but it has been largely ignored in psychiatric literature and research. In order to bring this subject to the attention of mental health professionals, this paper presents a contemporary synthesis of the biopsychosocial dynamics and recommendations for treatment of Malignant Narcissism. METHODS: We reviewed the literature on Malignant Narcissism which was sparse. It was first described in psychiatry by Otto Kernberg in 1984. There have been few contributions to the literature since that time. We discovered that the syndrome of Malignant Narcissism was expressed in fairy tales as a part of the collective unconscious long before it was recognized by psychiatry. We searched for prominent malignant narcissists in recent history. We reviewed the literature on treatment and developed categories for family assessment. RESULTS: Malignant Narcissism is described as a core Narcissistic personality disorder, antisocial behavior, ego-syntonic sadism, and a paranoid orientation. There is no structured interview or self-report measure that identifies Malignant Narcissism and this interferes with research, clinical diagnosis and treatment. This paper presents a synthesis of current knowledge about Malignant Narcissism and proposes a foundation for treatment. CONCLUSIONS: Malignant Narcissism is a severe personality disorder that has devastating consequences for the family and society. It requires attention within the discipline of psychiatry and the social science community. We recommend treatment in a therapeutic community and a program of prevention that is focused on psychoeducation, not only in mental health professionals, but in the wider social community.

[Medea syndrome: the sadistic fate of impaired mourning of love]. / Le syndrome de Médée, parcours sadique de la perte d'amour.

This work investigated the Medea syndrome, an harassment behaviour endorsed from a spouse suppressing access to children from his partner. The Medea myth adds a psychopathological background to the Parental Children Alienation construct focusing on using children to inflict a revenge, sadistic mourning of love, return of sacrificial rites associated with realm of primitive superego figures among people with severe personality disorder confronting traumatic love. The clinical, diagnostic and legal aspects of the disorder will be presented as well as a range of treatment strategies allowing valuable medical decision. Overall, the Medea syndrome appears to be an extremely destructive reaction with major negative impact on both children and adults. New law roles should be introduced to discourage such behaviour and improve victims protection.

MTC Sadism Scale: Toward a Dimensional Assessment of Severe Sexual Sadism With Behavioral Markers.

Sadism was initially described as the experience of sexual pleasure produced by acts of cruelty and bodily punishment. Sadism was conceptualized as if sadists were fundamentally different from nonsadists. Recent studies have suggested that sadism is distributed as a dimension rather than as a category. The aim of the current study was to assess the psychometric properties the MTC Sexual Sadism Scale. Our analyses were conducted on a sample of 486 sexual offenders assessed at a correctional institution in Massachusetts. In summary, the results indicate that the MTC Sexual Sadism Scale possesses good psychometric properties for the dimensional assessment of severe sexual sadism with behavioral markers. Moreover, the scale captures a wide range of intensity of sadism among sexual offenders. These results are consistent with prior research and support the current consensus to move toward a dimensional interpretation of sadism. Implications both for clinical assessment and for research on the development of sadism are discussed.

Sadism among sexual homicide offenders: Validation of the Sexual Sadism Scale.

Sexual sadism is assumed to be a crucial factor in sexual homicide. Prevalence estimates vary greatly due to differences in the definition of sexual sadism. A nationwide sample of 350 male perpetrators who had committed a sexual homicide offense against a female 14 years of age or above in England or Wales was assessed based on archival records. Sexual sadism was assessed using the Sexual Sadism Scale (SeSaS). Item response theory (IRT) analyses were conducted focusing on the 2-parameter logistic model. The single-factor structure of the SeSaS Part 1 was tested using confirmatory factor analysis. Estimates of both internal consistency and interrater agreement were satisfactory to substantial. IRT analysis showed that the Part 1 items captured moderate to severe levels of the latent construct (i.e., theta levels >0). Based on the Posterior Probability of Diagnosis index, the prevalence of the disorder was estimated at 37% in the sample. The substantial correlation between the SeSaS Part 1 total score and original clinical diagnoses of sadism confirms the criterion validity of the scale. Exertion of control and infliction of torture were among the more informative items. In sum, the results support the usefulness of the SeSaS instrument for assessing forensically relevant forms of sadism. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Emotional deficits in psychopathy and sexual sadism: implications for violent and sadistic behavior.

While both psychopaths and sexual sadists engage in acts of predatory violence, little empirical work has examined the relationship between the two disorders. This paper outlines the constructs of psychopathy and sexual sadism and reviews the literature investigating the emotional lives of individuals with these disorders, paying particular attention to how emotional deficits might facilitate instrumental violence. Specifically, it is hypothesized that the emotion recognition and emotional experience deficits found among psychopaths, and perhaps present in sexual sadists, may lead to deficits in their ability to empathize with others, resulting in an increased likelihood for perpetrating instrumental violence. The relationship between empathy and aggression in psychopaths and sexual sadists is discussed, and distinctions are drawn between the two disorders with respect to their capacities to experience cognitive and affective empathy on a global level. Gaps in the literature are identified and additional areas of inquiry are suggested.