Sadistic personality disorder

Last updated
Sadistic personality disorder
A sadistic tooth-drawer using a cord to extract a tooth from Wellcome V0012039.jpg
Illustration showing the pleasure that sadistic people often have from hurting someone.
Specialty Psychiatry, clinical psychology
Symptoms Cruelty, manipulation using fear, preoccupation with violence
Complications Substance use disorder, marital, occupational and legal difficulties
Usual onset Adolescence
CausesUnclear
Risk factors Childhood abuse
Diagnostic method Based on symptoms
Differential diagnosis Antisocial personality disorder and Sexual sadism disorder

Sadistic personality disorder was a proposed personality disorder defined by a pervasive pattern of sadistic and cruel behavior. People with this disorder were thought to have desired to control others. It was believed they accomplish this through the use of physical or emotional violence. This diagnosis appeared in an appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). [1] The later versions of the DSM (DSM-IV, DSM-IV-TR, and DSM-5) do not include it. It was removed as psychiatrists believed it would be used to legally excuse sadistic behavior.

Contents

Symptoms and behaviors

Sadistic personality disorder was defined by a pervasive pattern egosyntonic sadistic behavior. Individuals possessing sadistic personalities tend to display recurrent aggression and cruel behavior. [2] [3] [4] People with this disorder will use violence and aggression in an attempt to control and dominate others. When others refuse to submit to their will, they will increase the level of violence they use. Many sadists will verbally and emotionally abuse others rather than physically, purposefully manipulating others through the use of fear or shaming and humiliating others. Some people with this disorder will not abuse others, but will instead display a preoccupation with violence. [5] [6] This disorder was thought to be caused by childhood trauma or being raised in by a family where one spouse is abused. Sadistic personality disorder was considered more common in men than women. [7]

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. [5] In contrast, sadism has also been found in patients who do not display any or other forms of psychopathic disorders. [8] Conduct disorder in childhood, and Alcohol use disorder were thought to have been frequently comorbid with Sadistic personality disorder. [5] [9] Researchers had difficulty distinguishing sadistic personality disorder from the other personality disorders due to its high levels of comorbidity with other disorders. [5]

Diagnostic criteria

According to the DSM-III-R diagnostic criteria Sadistic personality disorder is defined by a pervasive pattern of sadistic and cruel behavior that begins in early adulthood. It was defined by four of the following.

This behavior must not be better explained by sexual sadism disorder and it must be directed towards more than one person. [7] :371

Differential diagnosis

DiagnosisReason
Sexual Sadism DisorderSexual 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. [7] :370
Antisocial personality disorderThe diagnosis of Antisocial personality disorder requires a history of conduct issues in adolescence and childhood. While the diagnosis of sadistic personality disorder does not. [7] :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. [10] [11] [12] [13] [14]

SubtypeDescriptionPersonality traits
Spineless sadismIncluding avoidant featuresInsecure, bogus, and cowardly; venomous dominance and cruelty is counterphobic; weakness counteracted by group support; public swaggering; selects powerless scapegoats.
Tyrannical sadismIncluding negativistic featuresRelishes menacing and brutalizing others, forcing them to cower and submit; verbally cutting and scathing, accusatory and destructive; intentionally surly, abusive, inhumane, unmerciful.
Enforcing sadismIncluding compulsive featuresHostility 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 sadismIncluding borderline featuresUnpredictably 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. [15] 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. [16] [17] 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." [18] Researchers were also concerned about the stigmatizing nature of the disorder, and that it put patients at higher risk of abuse from prison guards. [19] [20] 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. [10]

Sub-clinical sadism in personality psychology

There is renewed interest in studying sadism as a personality trait. [3] [21] Sadism joins with subclinical psychopathy, narcissism, and Machiavellianism to form the so-called "dark triad’ of personality. [3] [22]

See also

Related Research Articles

<span class="mw-page-title-main">Conduct disorder</span> Developmental disorder

Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes theft, lies, physical violence that may lead to destruction, and reckless breaking of rules, in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as "antisocial behaviors", and is often seen as the precursor to antisocial personality disorder; however, the latter, by definition, cannot be diagnosed until the individual is 18 years old. Conduct disorder may result from parental rejection and neglect and can be treated with family therapy, as well as behavioral modifications and pharmacotherapy. Conduct disorder is estimated to affect 51.1 million people globally as of 2013.

<span class="mw-page-title-main">Narcissistic personality disorder</span> Personality disorder

Narcissistic personality disorder (NPD) is a personality disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive need for admiration, and a diminished ability to empathize with other people's feelings. Narcissistic personality disorder is one of the sub-types of the broader category known as personality disorders. It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.

Antisocial personality disorder is a personality disorder characterized by a limited capacity for empathy and a long-term pattern of disregard or violation of the rights of others. Other notable symptoms include impulsivity and reckless behavior, a lack of remorse after hurting others, deceitfulness, irresponsibility, and aggressive behavior.

<span class="mw-page-title-main">Obsessive–compulsive personality disorder</span> Personality disorder involving orderliness

Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by a spectrum of obsessions with rules, lists, schedules, and order, among other things. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations. The cause of OCPD is thought to involve a combination of genetic and environmental factors, namely problems with attachment.

<span class="mw-page-title-main">Avoidant personality disorder</span> Personality disorder

Avoidant personality disorder (AvPD) or Anxious personality disorder is a Cluster C personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy, severe feelings of inadequacy and inferiority, and an overreliance on avoidance of feared stimuli as a maladaptive coping method. Those affected typically display a pattern of extreme sensitivity to negative evaluation and rejection, a belief that one is socially inept or personally unappealing to others, and avoidance of social interaction despite a strong desire for it. It appears to affect an approximately equal number of men and women.

<span class="mw-page-title-main">Intermittent explosive disorder</span> Behavioral disorder

Intermittent explosive disorder is a behavioral disorder characterized by explosive outbursts of anger and/or violence, often to the point of rage, that are disproportionate to the situation at hand. Impulsive aggression is not premeditated, and is defined by a disproportionate reaction to any provocation, real or perceived. Some individuals have reported affective changes prior to an outburst, such as tension, mood changes, energy changes, etc.

Self-defeating personality disorder was a proposed personality disorder. As a descriptor for "Other personality disorder" it was included in the DSM-III in 1980.. It was discussed in an appendix of the revised DSM-III-R in 1987, but was never formally admitted into the manual. The distinction was not seen as clinically valuable because of its significant overlap with other personality disorders. Both the DSM-III and DSM-III-R separated the condition from sexual masochism.

Depressive personality disorder is a psychiatric diagnosis that denotes a personality disorder with depressive features.

Theodore Millon was an American psychologist known for his work on personality disorders. He founded the Journal of Personality Disorders and was the inaugural president of the International Society for the Study of Personality Disorders. In 2008 he was awarded the Gold Medal Award For Life Achievement in the Application of Psychology by the American Psychiatric Association and the American Psychological Foundation named the "Theodore Millon Award in Personality Psychology" after him. Millon developed the Millon Clinical Multiaxial Inventory, worked on the diagnostic criteria for passive-aggressive personality disorder, worked on editions of the Diagnostic and Statistical Manual of Mental Disorders, and developed subtypes of a variety of personality disorders.

Malignant narcissism is a psychological syndrome comprising an extreme mix of narcissism, antisocial behavior, aggression, and sadism. Grandiose, and always ready to raise hostility levels, the malignant narcissist undermines families and organizations in which they are involved, and dehumanizes the people with whom they associate.

Psychopathy is a mental health condition characterized by persistent antisocial behavior, impaired empathy and remorse, and bold, disinhibited, and egotistical traits. Different conceptions of psychopathy have been used throughout history that are only partly overlapping and may sometimes be contradictory.

<span class="mw-page-title-main">Psychopathy Checklist</span> Psychopathy scale

The Psychopathy Checklist or Hare Psychopathy Checklist-Revised, now the Psychopathy Checklist—revised (PCL-R), is a psychological assessment tool that is commonly used to assess the presence and extent of the personality trait psychopathy in individuals—most often those institutionalized in the criminal justice system—and to differentiate those high in this trait from those with antisocial personality disorder, a related diagnosable disorder. It is a 20-item inventory of perceived personality traits and recorded behaviors, intended to be completed on the basis of a semi-structured interview along with a review of "collateral information" such as official records. The psychopath tends to display a constellation or combination of high narcissistic, borderline, and antisocial personality disorder traits, which includes superficial charm, charisma/attractiveness, sexual seductiveness and promiscuity, affective instability, suicidality, lack of empathy, feelings of emptiness, self-harm, and splitting. In addition, sadistic and paranoid traits are usually also present.

<span class="mw-page-title-main">Dark triad</span> Offensive personality types

The dark triad is a psychological theory of personality, first published by Delroy L. Paulhus and Kevin M. Williams in 2002, that describes three notably offensive, but non-pathological personality types: Machiavellianism, sub-clinical narcissism, and sub-clinical psychopathy. Each of these personality types is called dark because each is considered to contain malevolent qualities.

Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability. The definitions vary by source and remain a matter of controversy. Official criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

In personality pathology, dimensional models of personality disorders conceptualize personality disorders as qualitatively rather than quantitatively different from normal personality. They consist of extreme, maladaptive levels of certain personality characteristics. Within the context of personality psychology, a "dimension" refers to a continuum on which an individual can have various levels of a characteristic, in contrast to the dichotomous categorical approach in which an individual does or does not possess a characteristic. According to dimensional models personality disorders are classified according to which characteristics are expressed at which levels. This stands in contrast to the traditional categorical models of classification, which are based on the boolean presence or absence of symptoms and do not take into account levels of expression of a characteristic or the presence of any underlying dimension.

Callous-unemotional traits (CU) are distinguished by a persistent pattern of behavior that reflects a disregard for others, and also a lack of empathy and generally deficient affect. The interplay between genetic and environmental risk factors may play a role in the expression of these traits as a conduct disorder (CD). While originally conceived as a means of measuring the affective features of psychopathy in children, measures of CU have been validated in university samples and adults.

Psychopathy, from psych and pathy, was coined by German psychiatrists in the 19th century and originally just meant what would today be called mental disorder, the study of which is still known as psychopathology. By the turn of the century 'psychopathic inferiority' referred to the type of mental disorder that might now be termed personality disorder, along with a wide variety of other conditions now otherwise classified. Through the early 20th century this and other terms such as 'constitutional (inborn) psychopaths' or 'psychopathic personalities', were used very broadly to cover anyone who violated legal or moral expectations or was considered inherently socially undesirable in some way.

<span class="mw-page-title-main">Sexual sadism disorder</span> Paraphilia in which a subject derives gratification from inflicting pain

Sexual sadism disorder is the condition of experiencing sexual arousal in response to the involuntary extreme pain, suffering or humiliation of others. Several other terms have been used to describe the condition, and the condition may overlap with other conditions that involve inflicting pain. It is distinct from situations in which consenting individuals use mild or simulated pain or humiliation for sexual excitement. The words sadism and sadist are derived from the French writer and libertine Marquis de Sade, who wrote several novels depicting sexualized torture and violence.

Externalizing disorders are mental disorders characterized by externalizing behaviors, maladaptive behaviors directed toward an individual's environment, which cause impairment or interference in life functioning. In contrast to individuals with internalizing disorders who internalize their maladaptive emotions and cognitions, such feelings and thoughts are externalized in behavior in individuals with externalizing disorders. Externalizing disorders are often specifically referred to as disruptive behavior disorders or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders. Externalizing psychopathology is associated with antisocial behavior, which is different from and often confused for asociality.

Passive–aggressive personality disorder, also called negativistic personality disorder, is characterized by procrastination, covert obstructionism, inefficiency and stubbornness. The DSM-5 no longer uses this phrase or label, and it is not one of the ten listed specific personality disorders. The previous edition, the revision IV (DSM-IV) describes passive–aggressive personality disorder as a proposed disorder involving a "pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance" in a variety of contexts. Passive–aggressive behavior is the obligatory symptom of the passive–aggressive personality disorder.

References

  1. Hucker, Stephen J. Sadistic Personality Disorder
  2. Chabrol, Henri; Van Leeuwen, Nikki; Rodgers, Rachel; Séjourné, Natalène (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.
  3. 1 2 3 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.
  4. "Origin and meaning of sadism". Online Etymology Dictionary. Retrieved 28 October 2019.
  5. 1 2 3 4 "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.
  6. Reidy D.E.; Zeichner A.; Seibert L.A. (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.
  7. 1 2 3 4 Diagnostic and statistical manual of mental disorders : DSM-III-R. Internet Archive. Washington, DC : American Psychiatric Association. 1987. ISBN   978-0-89042-018-8.{{cite book}}: CS1 maint: others (link)
  8. 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.
  9. 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.
  10. 1 2 Disorders of Personality: DSM-IV and Beyond, p. 482
  11. 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.
  12. 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)
  13. "The Sadistic Personality, Variations of the Sadistic Personality". Archived from the original on 2018-06-17. Retrieved 2018-09-22. ALPF Medical Research
  14. Theodore Millon; et al. (8 November 2004). Personality Disorders in Modern Life (2nd ed.). Hoboken, N.J.: Wiley. ISBN   978-0-471-66850-3.
  15. Oxford Textbook of Psychopathology, p. 744
  16. McNamara, Damian (2004-04-01). "Proposals for DSM-V need high evidence threshold: diagnostic research conferences planned". Clinical Psychiatry News. 32 (4): 1–3.
  17. Fink, Paul J. (2006-09-01). "Treating antisocial personality disorder". Clinical Psychiatry News. 34 (9): 18–19.
  18. Personality Disorders in Modern Life 2nd Ed. p.512.
  19. 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.
  20. Sprock, J. (2015). DSM-III and DSM-III-R. In The Encyclopedia of Clinical Psychology (eds R.L. Cautin and S.O. Lilienfeld).
  21. 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.
  22. 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.