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.

Clinical Considerations in Treating BDSM Practitioners: A Review.

BDSM is an overlapping acronym referring to the practices of bondage and discipline, dominance and submission, and sadism and masochism. This article reviews the psychological literature on BDSM practitioners and discusses issues concerning BDSM that are relevant to clinicians and sexual health-care providers. The literature concerning the psychological health of BDSM practitioners and clinical issues in treating BDSM practitioners was exhaustively reviewed. BDSM practitioners differ minimally from the general population in terms of psychopathology. Six clinical considerations emerged: ignoring versus considering BDSM; countertransference; nondisclosure; cultural competence; closer relationship dynamics; BDSM, abuse, and pathology.

Alternative or Nontraditional Sexualities and Therapy: A Case Report.

A traditionally marginalized subset of couples engage in consensual nonmonogamy (CNM: open marriage, polyamory, swinging, etc.) or alternative sexualities, such as kink or bondage/discipline, dominance/submission, and sadism/masochism. Nonmonogamous and sexually diverse individuals often experience discrimination or stigma in various domains of professional services, including mental healthcare. These cases require knowledge, skills, and awareness to provide culturally sensitive care, which is often called "kink aware therapy" or "poly-friendly therapy" within alternative sexuality communities. This article explores one application of a kink-focused and CNM-focused therapeutic framework for working with a couple who is exploring nontraditional sexualities. This case incorporates evidence-based clinical practice and identifies the limitations and significant gaps in the empirical research literature.

Beating phantasies: Mourned and unmourned.

This paper intends to explore the organizing function and fate of sado-masochistic phantasies in their fixed form, in the psychic life of patients who have suffered early traumas, due to environmental vicissitudes and maternal psychopathology. The theoretical starting point is provided by the Novicks' research into transitory and permanent beating phantasies in adult and child patients, their onset and their psychic function, based on an examination of Freud's paper 'A child is being beaten'. In this text Freud achieves an unprecedented syncretism, locating the phantasy at the intersection between the oedipal complex, which is a vertical structure organizing sexual and generational differences, and the fraternal dimension, which is horizontal and organizes the lateral relationship with that similar but different other who is the sibling. Reporting in some detail material from the analyses of two young women, whose clinical presentation and early traumas show some similarities, the author puts in the context of the analytic work the emerging of the sado-masochistic phantasies, emphasizing their use and function in the transference-countertransference interplay. The beating phantasies shore up a precarious sense of self, threatened with psychic depletion and death, in identification with the absent mother of early infancy. An overly close relationship with a sibling, experienced as a narcissistic double, compounds the clinical picture, to establish the triangle formed by the parent(s) and two children which features in the beating phantasy. Finally, the author explores the contribution of ameliorating factors, such as alternative identificatory figures, constitutional endowment and capacity for sublimation, to account for the different fate of the fixed beating phantasies.

Narcissism and sadomasochistic relationships.

People with narcissistic vulnerabilities often relate to others sadomasochistically-either exerting power, or submitting to others, or both-in order to manage their vulnerabilities and protect themselves from feelings of abandonment. Sadomasochistic experience often involves concrete thinking and limited playfulness or ability to use metaphor. In therapy, these difficulties are often actualized in the patient-therapist relationship so that usual verbal interpretations may be of limited value, and the therapist needs to work to maintain a mutually respectful relationship even as the patient tries to draw him/her into sadomasochistic interactions. Because these difficulties have roots in early childhood and are repeatedly reinforced by later experience, long-term treatment that provides ongoing opportunities for new experience and understanding will be most helpful. These ideas are illustrated with two case examples.

Exploratory study of the relations between sadistic traits and suicidality in a nonclinical sample of adolescents.

The present study explored the relations between sadistic traits and suicidality in nonclinical adolescents. Participants were 615 high-school students who completed self-report questionnaires. Hierarchical multiple regression analyses showed that self-reported sadistic traits explained unique variance in self-reported suicidality among both genders. This result is confronted with the psychodynamic hypothesis linking sadism turned inward and suicidality.

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.

The concept of the death drive: a clinical perspective.

This paper discusses Freud 's theory of the death drive in the light of clinical experience with severely self-destructive personality disorders, and contemporary object relations theory. Repetition compulsion, sadism and masochism, negative therapeutic reaction, suicide in depressed and in non-depressed patients, and destructive group processes are explored from this perspective. The paper concludes that the concept of the death drive is clinically relevant, but that this condition needs to be traced to the general dominance of aggressive affects as the primary etiological factor; only under severely pathological circumstances does this dominance lead to a focused drive to self-destruct.

Sadism, sadomasochism, sex, and violence.

The true prevalence of sexual sadism (and its variants) is unknown. However, all clinicians will knowingly or unknowingly encounter patients with this disorder. Regretfully, few programs offer adequate education in normal sexuality and even less provide training in the assessment and treatment of pathologic sexual interests. This review synthesizes current theories about possible etiologies of criminal sexual sadism and the resulting implications for diagnosis and treatment of this sexual disorder. Included is a review of theories of criminally sadistic sexual motivations, response patterns, and physiology, including possible neurophysiologic factors and more complex interactions. This review focuses primarily on published English-language scientific studies of sexual sadism. It should be noted that my use of the term sadism refers to nonconsensual sexual aggression.

The paedophile and his inner world: theoretical and clinical considerations on the analysis of a patient.

The main feature of the treatment of the paedophile is the distance that separates the analyst from the patient. However hard the analyst tries to understand his patient, the paedophile's world appears to him, especially at the beginning of the treatment, incomprehensible, disheartening and distant. This paper describes the analytic therapy of a paedophile patient. The psychopathological organization that dominates his inner world originates from a delusional nucleus in which an object (a child or an adolescent) is idealized and worshipped in place of the parents. This object promises all manner of pleasure and happiness. The positive outcome of this patient leads one to believe that, if analytically treated, some paedophile patients are open to therapeutic transformation.

Two systems of self-regulation and the differential application of psychoanalytic technique.

Out of our work over the years on child development, clinical technique, and sadomasochism, we have begun to formulate a model of development that describes two possible ways of responding to feelings of helplessness in the face of the challenges of internal and external experience. Any psychoanalytic model has implications for how we think about technique and can be tested on the basis of its utility in generating technical ideas and enhancing our therapeutic repertoire. At this juncture in the history of our field, it is crucial for us to demonstrate that psychoanalytic techniques are effective in helping people enter treatment, change, and finish in a way that consolidates their gains. In this paper we explore the utility of our two-systems model for expanding the discourse about psychoanalytic technique.

"What do I know?": perspectives on what must not be known when change means loss.

Some patients use many ways of not knowing and so not feeling murderous rage at actual and internalized parents they long for and are terrified of losing. They stubbornly resist the liberating psychoanalytic changes that they consciously seek. Hope, promise, and success have come to threaten unbearable loss and catastrophic anxiety. These terrible expectations must become responsibly felt and owned by the patient.

Psychoanalysis in later life.

After decades of heeding Freud's admonition against taking patients older than fifty years of age into psychoanalytic treatment, psychoanalysts began to treat them and to report encouraging experiences. This essay is another in a series of case reports that confirms and extends the nature of changes possible in the analytic treatment of elderly patients. In order to demonstrate both specific changes and the possibility of satisfactory terminations with patients of advanced age, the author describes his analytic work with a woman who first consulted him when she was sixty-eight years old.

Recognition and management of addictive sexual disorders: guide for the primary care clinician.

With greater awareness of sexual exploitation, professional sexual misconduct, and the sexual issues of public figures, a growing awareness of the problem of sexual addiction is emerging. As a result of public awareness, more cases will be brought to the attention of primary care providers. When primary care providers are confronted by problematic sexual behavior that fits the parameters of addictive illness, they should know what the implications are in order to make appropriate clinical decisions and to evaluate treatment approaches. The purpose of this article is to summarize the nature of the problem, to review critical issues in assessment, to provide treatment options, and to suggest critical factors for monitoring progress.

The management aspect of psychotherapy with aggressive children.

Psychotherapy with an aggressive child may require the imposition of rather firm limitations over aspects of the patient's aggressive behavior. The nature of this management strategy is determined by the individual child's psychopathology. The management aspects of the psychotherapy with two aggressive boys are illustrated in detail. In one case, stringent limitations were imposed when it was discovered that the boy's behavior was regressive and represented an effort to sadistically control people in his environment. In the other case, the behavior was initially left almost unchallenged; this boy's aggressive and delinquent behavior reflected an effort to achieve a sense of order in an inconsistent external and potentially chaotic internal environment.

Psychotherapy of moral masochism.

The psychotherapeutic approach to sadomasochism is discussed with clinical examples. The necessary attributes of the therapist and specific therapeutic techniques are emphasized so as to avoid the destructive, uncontrollable negative therapeutic reactions. A better modulated transference can be interpreted with beneficial results.