Taking a Closer Look at Sexual Sadism

A paraphilic disorder, and not the same as BDSM

Medically reviewed by Rachel Goldman, PhD, FTOS

Sexual sadism is a paraphilic disorder that causes a person to experience sexual pleasure from inflicting pain, suffering, or humiliation on others.

The term sadism can be shocking, causing people to feel strong reactions when tagged or forming misconceptions about people who fall under this umbrella.

Takeaway

However, it's crucial to note that there's a distinct difference between people who have the psychological disorder and those who engage in similar but consensual practices within the BDSM community—which at their core are more about pleasure than pain.

In everyday speak, people tend to throw the word sadism around without paying much thought to its meaning. It may be used to describe anything from a casual preference for dominance between the sheets to more severe behaviors that could cause harm to others.

This article clarifies the differences between these two scenarios by explaining in detail what makes sexual sadism a disorder and how it differs from the consensual kink that's a part of many people's healthy sex lives.

Definition of Sexual Sadism Disorder

Sexual sadism is a condition that compels a person to derive sexual pleasure from causing pain, suffering, or humiliation to others. While many people who practice consensual BDSM enjoy a variety of kinks that involve inflicting light pain on other people, there's a difference between the two.

A sexual sadist will typically experience intense and recurring fantasies or urges to inflict pain on another person in a sexual context. They may also exhibit concerning or harmful behaviors to themselves and others. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), for sexual sadism to be diagnosed as a disorder, the following criteria must be met:

• The person must have experienced persistent and intense sexually arousing fantasies, urges, or behaviors involving the physical or psychological suffering of another person for at least six months.

• These sexual fantasies urges, or behaviors must cause significant distress or impairment or involve non-consenting individuals.
  

The critical factor that separates sexual sadism disorder from consensual sexual activities that may be considered sadomasochistic is consent and the effect the resulting thoughts and behaviors have on all parties involved. With the former, all parties often don't consent to engage in sadistic activities, and the non-consenting party derives no pleasure; instead, they may feel distressed or afraid and could end up harmed. With the latter, all parties consent to the activities and enjoy them without experiencing significant distress or harm.

Related: Understanding Rape and Sexual Assault

Symptoms of Sexual Sadism Disorder

To better understand sexual sadism disorder, here are tell-tale signs that a person has gone beyond preferring dominance or rough play during sex to develop this condition.

Intense sexual fantasies or urges

People with sexual sadism disorder often have recurring, intense fantasies or urges that involve causing physical or psychological pain to their sexual partners. These aren't just occasional thoughts; they are persistent and intrusive and often cause the person to become sexually aroused.

Disturbing behaviors

Beyond having fantasies or urges, those with the disorder may act out these thoughts through behaviors that cause actual harm or significant distress to others. They may engage in non-consensual acts where they derive pleasure, particularly from their partner's discomfort or pain.

Distress or impairment

On the flip side of experiencing sexual pleasure through these fantasies and behaviors, a person with sexual sadism disorder will also feel significantly distressed by these thoughts and actions. They may be so distressed that their relationships, work, and other areas of their life are affected. 

Duration

The symptoms of sexual sadism are not fleeting. They typically persist for at least six months. Experiencing a stable pattern of these thoughts and behaviors rather than a rare occurrence indicates sexual sadism.

Lack of consent

One of the most crucial factors that distinguishes sexual sadism from other BDSM kinks is a lack of content. A person with the disorder will typically engage in activities that involve someone who hasn't consented. With BDSM, all parties must agree to the activities during or beforehand.

These symptoms set apart sexual sadism, which is a paraphilic disorder from other types of sexual expression that might seem to mirror it. Sexual sadism isn't a sexual preference or lifestyle. If you've noticed these symptoms in yourself or a loved one, getting professional help and treatment is crucial to ease distress and prevent harm to others.

Psychology Behind Sexual Sadism

Sexual sadism is a complex disorder. Since its classification as a paraphilic disorder in the DSM-5, many psychological theories attempting to explain what triggers its development have been discussed in studies and research papers at length.

Possible Development During Childhood

Some psychologists believe that sexual sadism can develop as a result of learned experiences, particularly those involving early or violent sexual experiences. Some people who fall under this category may learn to associate sex and sexual pleasure with power, dominance, or pain due to this conditioning.

Takeaway

Childhood experiences can influence adult behavior in positive and negative ways. It's not all too surprising for a person who has experienced sexual trauma, difficulty with empathy, or other early developmental issues linked to sexual and emotional dysfunction to develop sexual sadism disorder. In a 2024 study on the link between aggressive sexual fantasies and sexual coercion, researchers found a link between childhood sexual abuse, hypersexuality, and sexual coercion.

The human brain is susceptible to associations. In the same way, you may have learned to associate specific colors with feelings or a particular song with a person; some people might learn to link sexual pleasure with control or pain. However, this doesn't happen overnight, and it's not as harmless as lighting up when you see the color yellow. It develops through experiences, especially during early sexual development.

Possible Links to Brain Structure and Neurobiological Factors

Scientists haven't learned much about the neurobiological factors associated with sexual sadism. However, some research suggests that a person's brain chemistry and structure could trigger the development of sadistic behaviors. Abnormalities in regions of the brain that are associated with aggression and sexual arousal might play a role, although this isn't clear yet.

Sometimes, how a person deals with emotions can play a role. If someone struggles to connect with their own or others' emotions, they might express their feelings through control or pain, which can be linked to sex. People with personality traits that exhibit a high need for power or a tendency towards aggressive behaviors can be more prevalent in people with sadistic tendencies. 

Light Sadism in the Context of a Healthy BDSM Scenario and Knowing the Difference

Sadism in BDSM is much different than sexual sadism disorder. BDSM stands for Bondage and Discipline, Dominance and Submission, Sadism and Masochism. In this context, people may conflate the sadistic aspect with the paraphilic disorder. However, key differences make it consensual, safe, and enjoyable for those who practice it.

Consent

The first and most crucial factor is consent. With all aspects of BDSM, consent is fundamental. All parties involved in sadistic play must clearly understand what activities they're about to engage in and agree to them enthusiastically. Boundaries and safe words should be discussed beforehand to allow anyone to withdraw consent easily at any point.

Sadism is a form of sexual expression that is centered around power dynamics. Mutual consent and trust are essential to a healthy form of this sexual interaction. With mutual consent and respect for boundaries, sadism can allow a healthy exploration of fantasies, power dynamics, intimacy, as well as emotional release, says Alex Dimitriu, MD, a double board-certified psychiatry and sleep medicine specialist and founder of Menlo Park Psychiatry & Sleep Medicine.

Communication

Communication is also crucial. People who practice BDSM do so at different comfort levels. Having a conversation with your sexual partner(s) about their desires and limits leaves little room for harm and makes sure everyone is enjoying the activity. Keeping the conversation ongoing is essential as people's needs and wants can change.

"Safe, Sane, and Consensual (SSC)" or "Risk-Aware Consensual Kink (RACK) are watchwords people in the BDSM community live by. These principles emphasize the importance of knowing and understanding the risks of BDSM activities and only agreeing to what is safe and sane.

Aftercare is an essential part of BDSM activities, a concept that simply isn't considered by people with sexual sadism disorders. It involves caring for one another emotionally and physically, especially after sadomasochism activities. Aftercare helps to reinforce mutual respect and affection between participants, which is in contrast with the lack of concern a sadist with a disorder might show for their victim.

In BDSM, sadistic acts are often part of a role-play or scenario that is clearly distinguished from participants' everyday lives. Those with sexual sadism disorder may not make such distinctions, potentially letting their impulses cross into non-consensual, harmful behavior.

Light sadism within BDSM is not a disorder but a form of sexual expression. It's about exploring fantasies in a controlled, consensual, and safe way, which is fundamentally different from the pathological and often harmful behaviors linked with sexual sadism disorder.

Related: The Potential Benefits of a BDSM Relationship

Treatment Options for Sexual Sadism Disorder

Treatment for sexual sadism disorder typically begins with psychotherapy. In severe cases, medication may also be recommended. The aim of treatment is to manage urges and prevent or lessen harmful behaviors.

Therapy

Cognitive-behavioral therapy (CBT) is one of the most effective forms of treatment used to manage paraphilic disorders, such as sexual sadism. CBT focuses on helping a person with this condition identify and change unhealthy patterns of thought and behavior. It also helps them get a handle on their harmful urges.

Sometimes, people with sexual sadism disorder may also benefit from group therapy, where they can share their experiences and coping strategies that have worked for them in a safe and non-judgmental environment.

Medication

The FDA currently approves no specific medications for the treatment of sexual sadism disorder. However, healthcare providers may prescribe certain drugs off-label to help a person with the disorder manage symptoms. For instance, antidepressants may be recommended to help manage symptoms of anxiety or depression brought on by the disorder. In some cases, medications that lower testosterone levels might also be used to reduce sexual drive.

Coping strategies

Developing effective coping strategies to deter harmful behaviors is crucial for anyone with sexual sadism disorder. These strategies can include learning stress management techniques, finding healthy outlets for aggression, and engaging in regular therapeutic activities like meditation.

It's also crucial to educate one's self about consent and healthy sexual behaviors to learn how to distinguish between harmful and acceptable expressions of sexuality.

Sexual sadism disorder is a mental health condition that can't be overcome on your own. Seeking professional help to treat the disorder can prevent you from engaging in actions that can cause harm to others or result in legal consequences.

Typically, those who deal with sexual sadism only seek treatment when mandated. Treatment may involve medication to reduce sexual urges. It can also include therapy aimed at increasing empathy, understanding motivations for the behavior, and creating alternate outlets for the expression of aggression, says Sarah E. Wright, PsyD,  a licensed psychologist and AASECT certified sex therapist and Supervisor.

Resources for Further Support

If you or someone you love is looking for help with managing sexual sadism disorder, here are some places to start:

Professional organizations

• The American Psychological Association (APA) and the American Psychiatric Association have a wealth of information on the disorder. They can also help you find a qualified therapist who specializes in sexual disorders.

• The National Coalition for Sexual Freedom (NCSF) provides educational material and resources that are particularly useful for understanding the differences between consensual kinks and sexual disorders.

Books

• "Sexual Outsiders: Understanding BDSM Sexualities and Communities" by David M. Ortmann and Richard A. Sprott takes a deep dive into BDSM communities and practices, helping distinguish it from sexual disorders.

• "Perv: The Sexual Deviant in All of Us" by Jesse Bering discusses human sexuality, including paraphilic disorders, humorously.
  

Hotlines and professional help

• If you're struggling with finding a therapist, the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) provides referrals to certified professionals who have experience with sexual issues, including paraphilias.

• For those feeling overwhelmed or looking for urgent support, hotlines like the National Suicide Prevention Lifeline (1-800-273-TALK) can help.

Read the original article on Verywell Mind.