Sexual sadism: present state of knowledge and coding according to DSM-5-TR and ICD-11

Abstract

The term sexual sadism describes the lustful arousal through experiencing control or causing humiliation or pain to another person. Nowadays, psychiatric classification manuals focus on coercion and non-consent in order to distinguish the forensic variant of sexual sadism from its consensual counterpart of sado-masochistic role play (bondage discipline/dominance submission/sadism masochism, BDSM). Furthermore, sexual sadism has to be differentiated from so-called trait sadism or everyday sadism as a personality trait. The present article elucidates the modern nosology of forensically relevant, coercive sexual sadism disorder according to ICD-11. The sexual sadism scale is described as a diagnostic aid for expert witness assessment. Results on criminal recidivism are highlighted. The diagnosis as such is not significantly associated with violent or sexual reoffending. Nonetheless, there is a strong link with most grievous index offenses (i.e., sexually motivated homicide). As current literature reviews show, there are no treatment studies available from recent years.