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Sadistic personality disorder

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Sadistic personality disorder
Illustration showing the pleasure that sadistic people often have from hurting someone
SpecialtyPsychiatry, clinical psychology
SymptomsCruelty, manipulation using fear, preoccupation with violence
ComplicationsSubstance use disorder, marital, occupational and legal difficulties
Usual onsetAdolescence
CausesUnclear
Risk factorsChildhood abuse
Diagnostic methodBased on symptoms
Differential diagnosisAntisocial personality disorder and Sexual sadism disorder
Personality disorders
Cluster A (odd)
Cluster B (dramatic)
Cluster C (anxious)
Not otherwise specified
Depressive
Others

Sadistic personality disorder is an obsolete term for a proposed personality disorder defined by a pervasive pattern of sadistic and cruel behavior. People who fitted this diagnosis were thought to have a desire to control others. It was believed they accomplished this through use of physical or emotional violence. The diagnosis proposal appeared in the appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)[1], however it was never put to use in clinical settings and later versions of the DSM (DSM-IV, DSM-IV-TR, and DSM-5) had it removed. Among other reasons, psychiatrists believed it would be used to legally excuse sadistic behavior.

Comorbidity with other personality disorders

Sadistic personality disorder was thought to have been frequently comorbid with other personality disorders, primarily other types of psychopathological disorders.[2] In contrast, sadism has also been found in patients who do not display any or other forms of psychopathic disorders.[3] Conduct disorder in childhood, and Alcohol use disorder were thought to have been frequently comorbid with Sadistic personality disorder.[2][4] Researchers had difficulty distinguishing sadistic personality disorder from the other personality disorders due to its high levels of comorbidity with other disorders.[2]

Diagnostic criteria

According to the DSM-III-R, the diagnostic criteria were defined by a pervasive pattern of sadistic and cruel behavior that began in early adulthood. It was defined by 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.

This behavior couldn’t have been better explained by sexual sadism disorder and it had to have been directed towards more than one person.[5]: 371 

Differential diagnosis

Diagnosis Reason
Sexual Sadism Disorder Sexual sadists will engage in sadistic behavior, however they do so for sexual pleasure, while people with Sadistic personality disorder do so for regular pleasure and to control others.[5]: 370 
Antisocial personality disorder The diagnosis of Antisocial personality disorder requires a history of conduct issues in adolescence and childhood. While the diagnosis of sadistic personality disorder does not.[5]: 371 

Millon's subtypes

Theodore Millon claimed there were four subtypes of sadism, which he termed enforcing sadism, explosive sadism, spineless sadism, and tyrannical sadism.[6][7][8][9][10]

Subtype Description Personality traits
Spineless sadism Including avoidant features Insecure, bogus, and cowardly; venomous dominance and cruelty is counterphobic; weakness counteracted by group support; public swaggering; selects powerless scapegoats.
Tyrannical sadism Including negativistic features Relishes menacing and brutalizing others, forcing them to cower and submit; verbally cutting and scathing, accusatory and destructive; intentionally surly, abusive, inhumane, unmerciful.
Enforcing sadism Including compulsive features Hostility sublimated in the "public interest," cops, "bossy" supervisors, deans, judges; possesses the "right" to be pitiless, merciless, coarse, and barbarous; task is to control and punish, to search out rule breakers.
Explosive sadism Including borderline features Unpredictably precipitous outbursts and fury; uncontrollable rage and fearsome attacks; feelings of humiliation are pent-up and discharged; subsequently contrite.

History

Sadistic personality disorder was developed as forensic psychiatrists had noticed many patients with sadistic behavior. It was introduced to the DSM in 1987 and it was placed in the DSM-III-R as a way to facilitate further systematic clinical study and research.[11] It was removed from the DSM for numerous reasons, including the fact it could be used to legally excuse sadistic acts. Sadistic personality disorder also shared a high rate of comorbidity with other disorders, implying that it was not a distinct disorder on its own.[12][13] Millon writes that "Physically abusive, sadistic personalities are most often male, and it was felt that any such diagnosis might have the paradoxical effect of legally excusing cruel behavior."[14] Researchers were also concerned about the stigmatizing nature of the disorder, and that it put patients at higher risk of abuse from prison guards.[15][16] Theorists like Theodore Millon wanted to generate further study on SPD, and so proposed it to the DSM-IV Personality Disorder Work Group, who rejected it.[6]

Sub-clinical sadism in personality psychology

Main article: Everyday sadism

There is renewed interest in studying sadism as a personality trait.[17][18] Sadism joins with subclinical psychopathy, narcissism, and Machiavellianism to form the so-called "dark tetrad’ of personality.[17][19]

See also

References

  1. ^ Hucker, Stephen J. Sadistic Personality Disorder
  2. ^ a b c "Sadistic Personality Disorder and Comorbid Mental Illness in Adolescent Psychiatric Inpatients". Jaapl.org. 2006-01-01. Archived from the original on 2013-04-15. Retrieved 2012-12-30.
  3. ^ Reidy; Zeichner; Seibert (2011). "Unprovoked Aggression: Effects of Psychopathic Traits and Sadism". Journal of Personality. 79 (1): 75–100. doi:10.1111/j.1467-6494.2010.00691.x. PMID 21223265.
  4. ^ Reich, James (1993). "Prevalence and characteristics of sadistic personality disorder in an outpatient veterans population". Psychiatry Research. 48 (3): 267–276. doi:10.1016/0165-1781(93)90077-T. PMID 8272448. S2CID 24066628.
  5. ^ a b c Diagnostic and statistical manual of mental disorders : DSM-III-R. Washington, DC: American Psychiatric Association. 1987. ISBN 978-0-89042-018-8.
  6. ^ a b Disorders of Personality: DSM-IV and Beyond, p. 482
  7. ^ Theodore Millon; Carrie M. Millon; Sarah Meagher (June 12, 2012). Personality Disorders in Modern Life. Seth Grossman, Rowena Ramnath. John Wiley & Sons. pp. 512–515. ISBN 978-1-118-42881-8.
  8. ^ Million, Theodore, D.Sc. "Personality Subtypes: Sadistic Personality Subtypes". Institute for Advanced Studies in Personology and Psychopathology. Archived from the original on 2017-06-21. Retrieved 2015-05-17.{{cite web}}: CS1 maint: multiple names: authors list (link)
  9. ^ "The Sadistic Personality, Variations of the Sadistic Personality". Archived from the original on 2018-06-17. Retrieved 2018-09-22. ALPF Medical Research
  10. ^ Theodore Millon; et al. (8 November 2004). Personality Disorders in Modern Life (2nd ed.). Hoboken, N.J.: Wiley. ISBN 978-0-471-66850-3.
  11. ^ Oxford Textbook of Psychopathology, p. 744
  12. ^ McNamara, Damian (2004-04-01). "Proposals for DSM-V need high evidence threshold: diagnostic research conferences planned". Clinical Psychiatry News. 32 (4): 1–3.
  13. ^ Fink, Paul J. (2006-09-01). "Treating antisocial personality disorder". Clinical Psychiatry News. 34 (9): 18–19.
  14. ^ Personality Disorders in Modern Life 2nd Ed. p.512.
  15. ^ Foulkes, Lucy (March 13, 2019). "Sadism: Review of an elusive construct". psyarxiv.com. Archived from the original on 2022-07-24. Retrieved 2022-07-24.
  16. ^ Sprock, J. (2015). DSM-III and DSM-III-R. In The Encyclopedia of Clinical Psychology (eds R.L. Cautin and S.O. Lilienfeld).
  17. ^ a b Buckels, E. E.; Jones, D. N.; Paulhus, D. L. (2013). "Behavioral confirmation of everyday sadism". Psychological Science. 24 (11): 2201–9. doi:10.1177/0956797613490749. PMID 24022650. S2CID 30675346.
  18. ^ O'Meara, A; Davies, J; Hammond, S. (2011). "The psychometric properties and utility of the Short Sadistic Impulse Scale (SSIS)". Psychological Assessment. 23 (2): 523–531. doi:10.1037/a0022400. PMID 21319907.
  19. ^ Chabrol H.; Van Leeuwen, N.; Rodgers, R. & Sejourne, N. (2009). "Contributions of psychopathic, narcissistic, Machiavellian, and sadistic personality traits to juvenile delinquency". Personality and Individual Differences. 47 (7): 734–739. doi:10.1016/j.paid.2009.06.020. Archived from the original on 2019-01-10. Retrieved 2016-08-14.
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