Stephen J. Hucker, MB, BS, FRCP(C), FRCPsych
  Consultant Psychiatrist,
  Professor, Division of Forensic Psychiatry, University of Toronto

       Forensic Psychiatry. ca


Sexual Sadism

What is Sexual Sadism?
It is important to distinguish between "Sadism", which is the term used in conjunction with Sadistic Personality Disorder, and "Sexual Sadism" which may be associated with SPD yet is classified as one of the paraphilias because of the specific sexual component. The two are most certainly related and an understanding of sadism is paramount to the understanding of sexual sadism but this particular section deals only with the paraphilia of sexual sadism.

Sexual sadism refers to the derivation of sexual pleasure from the infliction of pain, suffering and/or humiliation upon another person. The pain and suffering of the victim, which may be both physical and psychological, is pivotal to the sexual arousal and pleasure. The ICD-10 (World Health Organization, 1992) defines sadism as "preference for sexual activity that involves bondage or infliction of pain or humiliation."

Official Criteria:
Current diagnostic criterion from the DSM-IV-TR requires the following criteria be met:

1. Recurrent, intense sexually arousing fantasies, sexual urges, or behaviours involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting for the person, have been present for at least 6 months.

2. The fantasies, sexual urges, or behaviours cause clinically significant stress or impairment in social, occupational or other important areas of function.

While the criteria may appear to imply that the impairment must be perceived by the person in question to be applied, this is not the case. Ie. sadistic behaviour resulting in harming someone would be interpreted as an impairment of function.

Historical Context:
The term "sadism" derives from French medical literature of the early 19th century in connection with the writings of the Marquis de Sade whose novels depict scenes of torture, cruelty and killing for erotic purposes.

Krafft-Ebing, in his 1886 Psychopathia Sexualis, later defined sadism as: "The experience of sexual, pleasurable sensations (including orgasm) produced by acts of cruelty, bodily punishment afflicted on one's person or when witnessed in others, be they animals or human beings. It may also consist of an innate desire to humiliate, hurt, wound or even destroy others in order, thereby, to create sexual pleasure in ones self" (p.109).

The term was more fully developed in the literature over the next 100 years to the point of today's comprehensive definition:

  • Schrenck-Notzing (1895) coined the term algolagnia (pain craving) and divided the category into active and passive forms, conceptualizing them as two poles of the same disorder (ie sadism and masochism respectively).

  • Eulenberg (1911) expanded this definition to include psychological as well as physical pain (ie. humiliation).

  • Karpman (1954, p. 10) proposed that, in the sadist, "the will to power is sexually accentuated" and that "he revels in the fear, anger and the humiliation of the victim." Hence, pain is not that important in and of itself but because it symbolizes power and control.

  • Fromm (1977) suggested that the "core of sadism ... is the passion to have absolute and unrestricted control over living beings, ... whether an animal, child, a man or a woman. To force someone to endure pain or humiliation without being able to defend himself is one of the manifestations of absolute control, but it is by no means the only one. The person who has complete control over another living being makes this being into his thing, his property, while he becomes the other being's god" (p.383-4). Dietz, Hazelwood and Warren (1990, p. 165) reported a strikingly similar personal account given by a sadist.

  • Brittain (1970) and MacCulloch, Snowden, Wood & Miller (1983) also emphasized the central importance of the eroticized feelings of power and control.

Manifestation:
--Types of Sexual Sadism:
Krafft-Ebing (1886/1965) sub-classified sexual sadism into several categories including:

  1. Lust-murder. Here he included cases in which there was a connection between sexual arousal and killing which may extend to anthropaphagy or cannibalism (eating body parts of the victim). Among examples he included "Jack the Ripper" and similar types of homicide
  2. Mutilation of corpses or necrophilia
  3. Injury to females (stabbing, flagellation etc.,)
  4. Defilement of women
  5. Other kinds of assaults on women - symbolic sadism in which, for example, the perpetrator cuts the hair of his victim rather than harming them directly
  6. Ideal sadism or sadistic fantasies alone without acts
  7. Sadism with other objects, for example, whipping of boys
  8. Sadistic acts with animals

Those eight basic types can be roughly categorized into two main groups of Sexual sadism: Mild sadism in a consensual sexual relationship (eg. S&M) and the major category involving injury or worse, usually in a non-consensual relationship. In both, the element of pain to the victim is the sexual stimulus.

--Characteristics/Predominate Features - Mild Sexual Sadism;
Mild sadism, referred to as S&M, bondage & discipline, or dominance & submission is a specialized subculture in the homosexual community and in large cities networks exist for those who have this interest. It is not, however, limited to this group. Sexual sadists of both sexes often seek out masochistic partners. Sexually sadistic behaviour in these consensual cases may involve:

  • role playing with dominant and submissive roles: master-slave, governess-pupil, etc.
  • the dominant partner placing the submissive one in a position of helplessness and then applies some form of discipline or punishment, usually accompanied by verbal degradation
  • use of gags and blindfolds to render the submissive partner helpless and immobile
  • the administration of pain, humiliation or bondage is effected through such acts as whipping or flagellation, usually applied to the buttocks
  • cross-dressing the submissive partner
  • treating the submissive like an animal and/or making him/her crawl
  • confining the submissive to a cage
  • humiliated by being forced to wear a diaper or lick the dominant's boots.
  • binding or clamping the breasts/nipples/penis of the submissive
  • urinating or defecating on the submissive and forcing ingestion on the victim

--Characteristics/Predominate Features - Major Sexual Sadism;
Major sexual sadism, on other other hand, is usually not consensual and involves injury or death to the victim. The element of fear in the victim and complete control of the victim is the major sexual stimuli in major sexual sadism. Some of the more severe activities involved in this behavior may include:

  • severe beatings
  • torture
  • burning, cutting,
  • stabbing in the breast or buttocks (piquerism)
  • rape (see Sadistic Rape)
  • murder (see Sadistic or Lust Murder)
  • vampirism
  • necrophilia

Prevalence:
The prevalence of sexual sadism is difficult to gauge accurately, given that most individuals who practice in these activities do not self report although several studies have been conducted over the several decades:

  • Kinsey et al (1953): determined that 3-12% of women and 10- 20% of men admitted to responding sexually to sadomasochistic narratives
  • Crepault and Couture (1980): found a 14.9% incidence of fantasies of humiliating a woman and 10.7% of beating up a woman when they surveyed a group of men in the general population
  • Arndt, Foehl and Good (1985) found that 33% of women and 50% of men had sexual fantasies of tying up their partner. Note: It is not clear whether these represent sustained, preferred activities or part of a repertoire of activities that may be carried out from time to time.
  • Hunt (1974) found that 5% of men and 2% of women reported they obtained sexual gratification from inflicting pain

If commercially available pornography can be used as an indicator of levels of sexual sadism in the general public, research has shown that 10 - 20% of pornographic magazines feature bondage and discipline themes (Dietz & Evans, 1982; Gayford, 1978).

Demography:
Sexual sadism is found predominately in males and usually onsets with puberty although sadistic behaviour may be evident earlier in children. In all male cases, it becomes evident by early adulthood. Sexual sadism may begin with fantasies and, in some cases, these may never be acted upon or, be acted out in the more mild forms of consensual relationships. In non-consensual cases, the behavior usually continues and often escalates over time as the perpetrator experiences a need for increased violence in order to stimulate the sexual response.

In cases of female sexual sadism, onset is often later and often triggered by relationships with men who want to be dominated.

Paradoxically, while sexual sadism is more common in men, there appears to be a predominance of female domatrixes found in sadomasochistic pornography (Weinberg, 1984, 1987).

Causes:
There are several different theories about the origins of sexual sadism.

--Psychodynamic Theories
There have been a number of psychodynamic theories about the root of sadism over the years. Most have been based on a small, select number of case studies, however, and the results generalized from them. Later authors have challenged these theories. Some of the early ones include:

Freud's views on sadism and masochism changed over the course of his professional life, making it sometimes difficult to trace the evolution of his thought. Initially, he conceptualized the association of aggressiveness with sexuality as a combination of "mental impulses" but later he suggested a possible explanation was the child's witnessing the "primal scene", coming to view his parents having intercourse as an act of ill treatment or subjugation. In 1920, he suggested that, rather than deriving from the pleasure principle, sadism derived from the "death instinct". This theory does not explain why some develop sadism while others do not, however, or why the aggression is reflected as sadism in some and as masochism in others.

Sadger (1926) proposed that children developed a tendency to sadism when their caretakers both bring sexual pleasure and deny it when initiating toilet training or preventing masturbation.

Friedberg (1956) suggested that teething is the root of sadism.

--Behavioural Views
Most of the behavioural literature has dealt with treatment issues as opposed to cause or etiological issues and has not distinguished between sexual sadism and sexual masochism.

Some have suggested that an individual develops a psychic imprinting during some early sexual experience. In this way, Raymond (1956) explained the the development of a fetish for female stockings,for example, to the point when the individual sees his mother's stockings hanging in the bathroom while he is masturbating. In fairness, however, he also suggested that some individuals have a predisposition to this type of imprinting given that most people do not develop fetishes so quickly.

Others suggested a simi liar, slower process of pairing in which the individual has some experience in which he is sexually excited and then incorporates it into masturbation fantasies which are later modified and reinforced (McGuire et al., 1965).

Interestingly, many male sexual sadists, when interviewed, are able to identify particular incidents in childhood or early adolescent that triggered this response.

--Endocrine Abnormalities
Some researchers have considered whether sadism could be the result of a hormonal or chromosomal abnormality.

Bain et al., 1987, looked at a group of 20 sadists and found that there were no differences on 9 different hormones, including sex hormones when compared to 9 control studies. On the other hand, some individuals had undoubted chromosome or endocrine abnormalities such as Klinefelter's syndrome (see also Money, 1990; Money & Lamacz, 1989).

Although few in number, these studies suggest possible subtle abnormalities and investigation of brain levels of sex hormones or LH-RH challenge testing may be worth pursuing in further studies of sadists.

--Brain Abnormalities
Although some researchers (Money,1990) have suggested that sexual sadism is a brain disease, evidence to support this is not conclusive since most paraphiliacs do not show evidence of brain damage or disorder.

Sporadic reports of brain abnormalities in those with sexual anomalies (especially fetishism) have been reported from time to time, however (e.g. Kolarsky, Freund, Machek, Polak,1967; Langevin, 1990).

In studies by Graber, Hartmann, Coffman, (1982), Langevin et al., (1988) and Hucker et al., (1988) using CT scanning and neuropsychological assessments, there have been statistically significant associations between sadism and right temporal horn damage although the individuals with abnormalities on different measures did not overlap completely.

In addition, Gratzer & Bradford (1995) have indicated that 55% of their sadists showed neurological abnormalities, primarily in the temporal lobe.

Co-morbidity:

Sadism is commonly found in association with other paraphilias. Many authors have considered sadism and masochism as complementary anomalies and his is supported by the finding that individuals with masochistic fantasies often have sadistic fantasies as well. Hucker and Blanchard (1992) also found an association between asphyxiophilia (extreme masochism).

One particularly interesting study on multiple paraphilias found that, on average, paraphiliacs with one diagnosis have two or three others as well, often not initially admitted or recognized. Thus, 18% of sadists were also masochistic, 46% had also engaged in rape,21% in exhibitionism,25% each in voyeurism and frottage and 33% in pedophilia (Abel et al., 1988). This study guaranteed the confidentiality of the participants and thus feedback could be considered quite accurate.

Other authors have noted an overlap between sadism, masochism, fetishism and transvestism. Among much more serious sadistic offenders, transvestism and fetishism are strongly represented (Dietz et al., 1990; Prentky et al., 1985).

Sexual sadism, when combined with Anti-Social Personality Disorder can be particularly dangerous.

Treatment Options:

An individual with sexual sadism may never come to the attention of the criminal justice system or the mental health system, the two systems where treatment would be initiated if viable. If the individual practices mild forms of sexual sadism within a consensual sexual relationship may never seek help or treatment for it, for example.

Of those who come to the attention of the criminal justice system, the sexual sadism has usually manifested itself in dangerous activity that has harmed others. The same may or may not be true of those presenting to medical or mental health facilities.

As with sexual behaviour in general, sexual sadism is difficult to modify with behavioural techniques and treatments. Pharmacological treatments may be of some benefit, depending upon the individual. In such cases, treatment would be long-term. In some cases, treatment has included surgical castration and steroatactic neurosurgery.


Further Reading:
Mokros, A., Osterheider, M., Hucker, S.J., & Nitscke, J. (2011) “Psychopathy and sexual sadism.” Law & Human Behavior, 35(3), 188-199.

Hucker, S.J . (2009) “Manifestations of Sexual Sadism: Sexual Homicide, Sadistic Rape and Necrophilia”. In: Sexual Offenders. Saleh, F., Bradford, J., Brodsky, D. (eds). Oxford University Press.

Yates, P, Hucker, S.J., and Kingston, D. (2008) “Sexual sadism: Theory and Psychopathology”. In: Sexual Deviance: Theory, Assessment & Treatment, 2 nd Edition. Laws, R. & O’Donohue, W. (eds). Guilford Press.

Marshall, W. & Hucker, S.J. (2006). “Severe sexual sadism: Its features and treatment”. In: Sex and Sexuality, Volume 3 of Sexual Deviation and Sexual Offences. McAnulty, R.D., & Burnette, M.M. (eds). Praeger

Marshall, W.L. & Hucker, S.J. (2006). “Issues in the Diagnosis of Sexual Sadism”. Sexual Offender Treatment. Volume 1, Issue 2. Online at http://www.iatso.org/ejournal/.

Hucker, S.J., (1997). “Sexual sadism: psychopathology and theory”. Ch. 6 in Sexual Deviance: Theory, Assessment and Treatment. Laws, R. & O'Donohue, W. (eds). New York: Guilford Press.

Sado-masochism: Harmless or Ominous? Part 1 of an Exclusive Series on Sadomasochism. The Forensic Echo, Behavioral & Forensic Science in the Courts. Vol 5, Issue 1, January 3, 2001.

When Fantasies Turn Lethal Part II of an Exclusive Series on Sadomasochism. The Forensic Echo, Behavioral & Forensic Science in the Courts. Vol 5, Issue 3, March 5, 2001.

Hucker, S.J., (1997). “Sexual Sadism: Psychopathology and Theory”. Ch. 6 in Sexual Deviance: Theory, Assessment and Treatment. Laws, R. & O'Donohue, W. (eds). New York: Guilford Press.

Sheridan, P., & Hucker, S.J., (1994). Rape: Paraphilic, statutory, conquest & the sado-masochistic Paraphilias. In J. Krivacska & J. Money (Eds.). Handbook of Forensic Sexology. Buffalo, N.Y.: Prometheus Books.

Fiester, S. (1991) Sadistic Personality Disorder: A review of data and recommendations for DSM-IV. Journal of Personality Disorders, 5(4), 376-85.

Breslow, N. (1989). Sources of confusion in the study and treatment of sadomasochism. Journal of Social Behavior and Personality, 4(3), 263-274.

Langevin, R., Bain, J., Wortzman, G., Hucker, S. J., Dickey, R. & Wright, P. (1988). Sexual sadism: Blood, brain and behaviour. Annals of New York Academy of Sciences, 528, 163-171.

Gosselin, C.C. (1987) The sadomastic contract. In G.D. Wilson (ed), Variant Sexuality: Research and Theory (pp 229-257). Baltimore, MA: John Hopkins University Press.

Freund, K., Scher, H., & Hucker, S. J. (1984). The courtship disorders: A further investigation. Archives of Sexual Behaviour, 13, 133-139.

Freund, K., Scher, H., & Hucker, S. J. (1983). The courtship disorders. Archives of Sexual Behaviour, 12, 769-779.

McConaghy, N. (1993) Sexual Behavior: Problems and management. New York: Plenum Press.

Gosselin, C.C. & Wilson G.D. (1980). Sexual variations. London: Faber & Faber.

Hirschfeld, M. (1956). Sexual Anomalies. New York: Ermerson.

Schad-Somers, S.P. (1982). Sadomasochism: Etiology & treatment. New York: Human Sciences Press.

Studies Referred To In Text:

Abel, G.G., Becker, J.V., & Cunningham-Rathner, J., Mittelman, M.S. & Rouleau, J.L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law., 16, 153-168.

Arndt, W., Foehl, J., & Good, F. (1985). Specific sexual fantasy themes: A multidimensional study. Journal of Personality and Social Psychology., 48, 472-480.

Breslow, N. (1989). Sources of confusion in the study and treatment of sadomasochism. Journal of Social Behavior and Personality, 4(3), 263-274.

Brittain, R. (1970). The sadistic murderer. Medicine, Science and the Law, 10, 198-207.

Crepault, E., & Couture, M. (1980). Men's erotic fantasies. Archives of Sexual Behavior, 9, 565-581.

Dietz, P., Harry, B., & Hazelwood, R. (1986). Detective Magazines: Pornography for the sexual sadist? Journal of Forensic Science, 31, 197-211.

Dietz, P. & Evans, B. (1982). Pornographic imagery and prevalence of paraphilia. American Journal of Psychiatry, 139, 1493-1495.

Eulenberg, A. von. (1911) Sadism and masochism. New York: Bell.

Freud, S. (1961). On sexuality. Markham, Ont: Penguin Books.

Friedenberg, F.S. (1956). A contribution to the problem of sadomasochism. Psychoanalytic Review, 43, 91-6.

Fromm, E. (1977). The anatomy of human destructiveness. Markham, Ont.: Penguin Books.

Graber, B., Hartmann, K., Coffman, J., et al (1982). Brain damage among mentally disordered sex offenders. Journal of Forensic Science, 27, 127-134.

Gratzer, T., & Bradford, J., (1995) Offender and Offense Characteristics of Sexual Sadists: A Comparative.

Hucker, S.J. & Blanchard, R. (1992). Death scene characteristics in 118 fatal cases of autoerotic asphyxia compared with suicidal asphyxia. Behavioral Sciences and the Law, 10, 509-523.

Hucker, S.J., Langevin, R., Wortzman, G., Dickey, R., Bain, J., Handy, L., Chambers, J., & Wright, P. (1988). Cerebral damage and dysfunction in sexually aggressive men. Annals of Sex Research, 1, 33-47.

Hunt, M. (1974). Sexual Behavior in the 1970's. New York: Playboy Press.

Karpman, B. (1954). The sexual offender and his offenses: Etiology, pathology, psychodynamics and treatment. New York: Julian Press.

Kolarsky, A., Freund, K., Machek, J. & Polak, O. (1967). Male sexual deviation: Association with early temporal lobe damage. Archives of General Psychiatry , 17, 735-43.

Krafft-Ebing, R. von. (1965). Psychopathia sexualis. New York: Stein & Day. (Original work published in 1886)

Langevin, R. (1990). Sexual anomalies and the brain. In W.L. Marshall, D.R. Laws, & H.E. Barbaree (eds), Handbook of Sexual assault: Issues, theories, and treatment of the offender (pp 103-113). New York: Plenum Press.

MacCulloch, M., Snowden,P., Wood,P. & Mills, H. (1983). Sadistic fantasy, sadistic behavior, and offending. British Journal of Psychiatry, 143, 20-29.

McGuire, R.J., Carlisle, J.M., & Young, B.G. (1965). Sexual deviation as a conditioned behavior: A hypothesis. Behavioral Research and Therapy, 2, 185-190

Mees, H.L. (1966). Case histories and short communications; sadistic fantasies modified by aversive conditioning and substitution: A case study. Behavioral Research and Therapy, 4(4), 317-320.

Money, J. & Lamacz, M. (1989). Vandalized lovemaps. Buffalo, NY: Prometheus.

Money, J. (1990). Forensic Sexology: Paraphilic serial rape (Biastrophilia) and lust murder (Erotophonophilia). American Journal of Psychotherapy, xliv(1), 26-36.

Prentky, R.A., Cohen, M.L., & Seghorn, T.K. (1985). Development of a rational taxonomy for the classification of sex offenders: Rapists. Bulletin of the American Academy of Psychiatry and the Law, 13, 39-70.

Raymond, M.J. (1956). Case of fetishism treated by aversion therapy. British Medical Journal, 2, 854-857.

Sagder, J. (1926). A contribution to the understanding of sadomasochism. International Journal of Psychoanalysis, 7, 484-491.

Schrenck-Notzing, A. von. (1956). The use of hypnosis in psychopathia sexualis. New York : Julian Press. (original work published in 1895).

Weinberg, T.S., Williams, C.J. & Moser, C. (1984). The social constituents of sadomasochism. Social Problems, 31, 379-389.

Weinberg, T.S. (1987). Sadomasochism in the United States: A review of recent sociological literature. Journal of Sex Research, 23, 50-69.

Other Resources:
Therapy for Sexual Impulsivity: The Paraphilias and Paraphilia-Related Disorders. Martin Kafka, MD, Psychiatric Times (on-line)


© Stephen Hucker, MB,BS, FRCP(C), FRCPsych, 2004 - 2011
This material is provided for personal use only. Any other use is strictly forbidden without the express written permission of the author

 

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