Sadism

What is sadism?

Sadism is a sexual disorder. People who have sadism are aroused by causing physical, mental, or emotional pain or suffering to another person. Sadism may be so severe that it leads to a crime.

How does it occur?

The exact cause of this disorder is not known. Experts think it may be caused by differences in the brain or nervous system. It might also be related to things such as child abuse or a family history of mental illness.

Sexual sadism is much more common in males. However, the number of female sadists is on the rise. Sadism usually begins in the teen years or by early adulthood. It may start with sadistic play or fantasies in childhood.

What are the symptoms?

People with this disorder may always need to cause pain or humiliation in order to function sexually. Or they may have normal sex at some times and sadistic sex at other times. Their sexual arousal is directly related to how much their partner suffers. Sadists often seek out masochists as sexual partners.

Some acts are physically violent, such as cutting, burning, or beating. Other acts involve domination, such as making the other person crawl or keeping him or her in a cage. Still other acts involve humiliation.

How is it diagnosed?

Your health care provider will ask about your symptoms, relationships, medical history, and substance abuse history. He or she will also ask whether you or someone close to you has a history of mental illness. Your provider may also do a physical exam and order tests to rule out medical conditions as a cause of your symptoms.

People may be diagnosed with sadism if the fantasies, urges, or behaviors cause distress or keep them from being able to function in school, on the job, or in relationships. They may be diagnosed with sadism even if partners are willing.

How is it treated?

Conditioning therapy can be an effective way to treat this disorder. There are several kinds of conditioning therapy:

Biofeedback. With biofeedback you are connected to a machine that gives you feedback with light or sound. You try to keep feedback within a certain range while you are exposed to sexually exciting material.
Covert sensitization. In this therapy, you first relax and picture scenes that excite you. Then you imagine something negative, such as getting your penis stuck in the zipper of your pants.
Assisted aversive conditioning. With this kind of conditioning, the negative event is real rather than imagined. For example, your therapist sprays a bad smell such as ammonia in the air. The goal is for you to link your behavior with something negative and avoid both.

Empathy training may help you understand and identify with the victim, so that you understand the harm that has been done.

Antiandrogens (which reduce male sex hormone levels) and medicines such as Prozac that increase the brain chemical serotonin have met with some success in treating this disorder.

When should I seek help?

If your symptoms are seriously interfering with your daily life or hurting someone else, seek help from your health care provider or a mental health therapist. At the extreme, sexual sadism involves brutal rape, torture, or death of the victim to cause sexual excitement. Many sadists do not get help until they are caught by the police and the court orders treatment. If you or someone you care about is a sadist, get help early.

For more information, contact the National Alliance for the Mentally Ill (NAMI) or the National Mental Health Association (NMHA).

NAMI's toll-free number is 1-800-950-NAMI. The Web site address is http://www.nami.org.
NMHA's toll-free Information Center number is 1-800-969-NMHA. The Web site address is http://www.NMHA.org.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File BHV3355F.HTM Release 9.0/2006