Severe Sexual Sadism—An Underdiagnosed Disorder? Evidence from a Sample of Forensic Inpatients

Abstract

Severe sexual sadism is a disorder of sexual preference that focuses on humiliation and subjugation of the victim, sometimes causing grievous injury or death. Sexual sadists pose a particular risk. However, the diagnosis as such is unreliable and prevalence estimates vary. In a sample of male high-security forensic inpatients who had committed sexual offenses, we found two-thirds of sexual sadists had not been identified as such prior to commitment. Possible reasons for missing the diagnosis are many fold. Present data support the notion that unrecognized sexual sadists more closely resembled non-sadistic sex offenders than accurately diagnosed sadists. In particular, initially unrecognized sexual sadists had less severe previous convictions, less vocational training, and experienced a less supportive upbringing than their correctly identified sadistic counterparts. The latter, in contrast, more often reached media coverage through their offense(s). We conclude that severe sexual sadism is likely an underdiagnosed, yet forensically highly relevant disorder.

Increased Frontotemporal Activation During Pain Observation in Sexual Sadism

“…The prevalence of sexual sadism is unknown, and estimates have varied widely, from 5–11% to 45–50% of sexual offenders 1,2,3,4 . Sexual sadism is highly relevant to the assessment of sexual offenders, and may be underdiagnosed in forensic settings 5 .…”

A Young Man with Substance Abuse and Comorbidity of Multiple Paraphilia: A Case Report

“…Likewise, in our case sexual deviation started with pedophilia, voyeurism, exhibitionism, and after a period of time, sexual sadism. There are noticeable research evidence at present showing that multiple paraphilias should be considered in every case of sexual offense (9). To prevent further aversive consequences of the aggregation of paraphilia, devising a treatment plan for such patients would avoid devastating conditions.…”

Die latente Struktur sexueller Präferenzstörungen am Beispiel des Sadismus und der Pädophilie

“…Nitschke et al 2012), während im Hinblick auf die Diagnose Pädophilie durchaus gute Übereinstimmungswerte berichtet worden sind (Levenson 2004;Wilson et al 2011). Möglicherweise legen verschiedene Beurteiler bei einem dimensionalen Phänomen wie dem Sadismus implizit unterschiedliche Schwellen für die Zumessung der Störung an, was auch das Unterdiagnostizieren der Störung im klinisch-forensischen Kontext zumindest teilweise erklären könnte (Nitschke et al 2009a).…”