Sexual sadism disorder: Definition, symptoms, treatment, and more

People have different sexual preferences and fetishes are common, which create sexual excitement. In fact, they might be more common than you think: A survey conducted by CalExotics at Harvard Sex Week saw that 43% of respondents have (or believe they have) a fetish, and more than half have shared a fetish with their partner. In addition, 46% have engaged in BDSM (bondage, discipline/dominance, sadism/submission, and masochism), while 37% have engaged in role/fantasy play. 

At face value, there is nothing wrong with having or engaging in a fetish. However, if a fetish causes you and/or others harm (be it physical or psychological suffering), that’s when it becomes a problem – and maybe even a mental health disorder, such as sexual sadism disorder.

Sexual Sadism Disorder Definition

Sexual sadism disorder is a mental health disorder — more specifically, a paraphilic disorder, which is characterized by recurrent, intense sexually arousing fantasies, urges, or behaviors that cause distress or impairment to the individual and that involve inanimate objects, nonconsenting people, or suffering/humiliation of oneself or their partner with the potential to cause harm.  

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), sexual sadism disorder involves “recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.” Further, “the individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Is Being a Sadist a Mental Illness?

What’s a sadist, first off? It’s someone who gets pleasure (especially sexually) from inflicting pain/humiliation on others. 

Being a sexual sadist does not necessarily mean you have a mental illness. Those who openly acknowledge and discuss their sexual activity/interests in the physical or psychological suffering of others are referred to as “admitting individuals” – if they suffer psychosocially as a result of these interests, they may be diagnosed with sexual sadism disorder. 

On the other hand, some “admitting individuals” don’t suffer as a result of their interests nor do they act on their impulses. These individuals would be described as having sadistic sexual interests but do not have sexual sadism disorder. 

Are Sadists Psychopaths?

First, “psychopaths” is an outdated term, typically replaced by “individuals with antisocial personality disorder.” While sadists do not necessarily have antisocial personality disorder, it can cooccur with sexual sadism disorder.

“Sexual sadism disorder has an inherently sexual component to it whereas antisocial personality disorder does not,” explains Laura Harris, Licensed Clinical Mental Health Counselor at Thriveworks.

Sexual Sadism Disorder Symptoms

Sexual sadism DSM-5 criteria – which lays out the symptoms that one must display in order to be diagnosed with the disorder – is short and to the point, listed earlier in the definition. The two criteria must be present for at least 6 months and cause the individual severe distress or dysfunction. Again, these symptoms are:

  • Recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.
  • The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

When a mental health professional is assessing and/or diagnosing sexual sadism disorder, they must specify if. 

  • In a controlled environment: Whereas the individual is living in an institutional setting or another setting that restricts opportunities to engage in sadistic sexual behaviors.
  • In full remission: Whereas the individual has not acted on his or her paraphilic interests and urges with a nonconsenting person, and hasn’t felt distressed or impaired in important areas of life, within the last 5 years (or longer) while in an uncontrolled environment.

How Do I Know If I Am Sadistic?

If the symptoms above describe you, you might have sexual sadism disorder. If you just display the first symptom and don’t act on your fantasies/urges nor do you suffer as a result, you’d be described as sexually sadistic. 

What Is the Cause of Sexual Sadism Disorder?

As with most mental health disorders, there is not one specific known cause of sexual sadism disorder. However, there are several theories, such as escapism: the individual uses sexual sadism to distract themselves from or escape unpleasant realities. 

Another theory says that brain diseases and dysfunction could contribute to the development of sexual sadism disorder. Additional research has explored brain involvement and found that sexual sadists experience increased frontotemporal activation (or activation of the frontal and temporal lobes of the brain, which are associated with personality, behavior, and language) when observing others in pain.

Course and Development of Sexual Sadism

According to the DSM-5, individuals with sexual sadism are almost exclusively male. And one study found that the mean age at the onset of sadism in a group of males was 19 years old. 

Aside from this, there isn’t much data on the prevalence or the development and course of sexual sadism. That said, sexual sadism is likely a lifelong characteristic that one will have while sexual sadism disorder may fluctuate throughout one’s life depending on the distress they experience and/or their engagement in sexual sadism.

Sexual Sadism Disorder Test

A mental health professional can assess one’s symptoms and, if the individual meets the diagnostic criteria for sexual sadism disorder, make a diagnosis. Someone might seek a professional’s evaluation and help due to the distress they experience as a result of their sexual urges/fantasies. Others are required to seek psychological treatment after acting on these urges/fantasies and assaulting a non-consenting individual. 

When a professional evaluates an individual for sexual sadism disorder, they’ll also consult criteria for other mental health disorders, to ensure they make the proper diagnosis and, therefore, can help the individual in the right way. For example, sexual masochism disorder and antisocial personality disorder share symptoms with sexual sadism disorder and should be considered. 

Sexual Sadism Disorder Treatment

Once an individual receives a diagnosis of sexual sadism disorder, their counselor, psychiatrist, or both together, can create a treatment plan that will help them manage their disorder and live better with it. Treatment might include psychotherapy, medication, or a combination of the two:

  • Psychotherapy: There are many types of therapy that can help those with sexual sadism disorder. For example, cognitive behavioral therapy (CBT) can help these individuals recognize a harmful pattern of sexual behavior and learn better, healthier ways to deal with the thoughts, feelings, and urges that cause the behavior. Cognitive restructuring may also help the individual identify and overcome these harmful thought patterns.
  • Medication: Sometimes, antidepressant medications are prescribed to balance brain chemicals as well as reduce impulsive behavior. Similarly, anti-androgenic drugs are at times prescribed to suppress the individual’s sex drive.
Table of contents

Sexual Sadism Disorder Definition

Is Being a Sadist a Mental Illness?

Are Sadists Psychopaths?

Sexual Sadism Disorder Symptoms

What Is the Cause of Sexual Sadism Disorder?

Course and Development of Sexual Sadism

Sexual Sadism Disorder Test

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  • Clinical reviewer
  • Writer
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Laura Harris, LCMHC in Durham, NC

Laura Harris, LCMHC

Laura Harris is a Licensed Clinical Mental Health Counselor (LCMHC). She specializes in anger, anxiety, depression, stress management, coping strategies development, and problem-solving skills.

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Taylor Bennett

Taylor Bennett is the senior content strategist at Thriveworks. She received her BA in multimedia journalism with minors in professional writing and leadership from Virginia Tech. She is a co-author of “Leaving Depression Behind: An Interactive, Choose Your Path Book.”

We update our content on a regular basis to ensure it reflects the most up-to-date, relevant, and valuable information. When we make a significant change, we summarize the updates and list the date on which they occurred. Read our editorial policy to learn more.

  • Originally published on 08/16/17

    Author: Taylor Bennett

  • Updated on 11/22/22

    Author: Taylor Bennett

    Reviewer: Laura Harris, LCMHC

    Changes: Added an introduction for the readers; added additional info about sadists; clarified and added additional information about diagnostic criteria/symptoms; added information about how one is tested for sexual sadism disorder.

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