Sadistic Personality Disorder - Aggressive / PsychNet UK

This disorder is characterized by cruel, aggressive, manipulative, and demeaning behavior directed towards others. Abusiveness and violence are common in the sadist's social relationships, because the sadist lacks concern for people and derives pleasure from harming or humiliating others. There are similarities between sadistic PD and the more aggressive antisocial PD, however, the antisocial person does not generally hurt others just for pleasure. There may also be an association between sadistic PD and sexual sadism, in which the person derives sexual arousal and satisfaction from sadistic acts like beating and humiliating someone.

 Maladaptive patterns of motivated behaviour, usually evident for at lease several years.  

 Is fascinated by violence, weapons, martial arts, injury, or torture 

 Enduring, pervasive, maladaptive patterns of behaviour which are usually recognised before or during adolescence. 

 It is long-standing and its onset can be traced to adolescence or early adulthood, but is not due to drugs (of abuse or medication) or to a medical condition eg head injury. 

 The behaviour pattern is inflexible across all personal and social situations and significantly impairs their social or occupational functioning. 

 Has used physical cruelty or violence for the purpose of establishing dominance in a relationship (not merely to achieve some noninterpersonal goal, such as striking someone in order to rob him or her). 

 Humiliates or demeans people in the presence of others, 

 Has treated or disciplined someone under his or her control unusually harshly, e.g., a child, student, prisoner, or patient, 

 Is amused by, or takes pleasure in, the psychological or physical suffering of others (including animals), 

 Has lied for the purpose of harming or inflicting pain on others (not merely to achieve some other goal) 

 Gets other people to do what her or she wants by frightening them (through intimidation or even terror), 

 Restricts the autonomy of people with whom he or she has a close relationship, e.g., will not let spouse leave the house unaccompanied or permit teen-age daughter to attend social functions. 

 DSM-IV Code: Not Specified

Differential Diagnosis:

Some disorders have similar or even overlapping symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Antisocial Personality Disorder.
Schizoid Personality Disorder.
Schizotypal Personality Disorder.
Paranoid Personality Disorder.
Personality Change Due to a General Medical Condition.
Symptoms that may develop in association with chronic substance use.

Cause:

There is no clear cause for sadistic personality disorder; some theories suggest that it is a function of how one is brought up, but biological factors are likely as well. 

Treatment:

Treating a personality disorder takes a long time. Personality traits such as coping mechanisms, beliefs, and behavior patterns take many years to develop, and they change slowly. Changes usually occur in a predictable sequence, and different treatment modalities are needed to facilitate them. Reducing environmental stress can quickly relieve symptoms such as anxiety or depression. Behaviors, such as recklessness, social isolation, lack of assertiveness, or temper outbursts, can be changed in months. Group therapy and behavior modification, sometimes within day care or designed residential settings, are effective. Participation in self-help groups or family therapy can also help change socially undesirable behaviors.

Counseling and Psychotherapy [ See Therapy Section ]:

Although treatment differs according to the type of personality disorder, some general principles apply to all. Family members can act in ways that either reinforce or diminish the patient's problematic behavior or thoughts, so their involvement is helpful and often essential. 

Pharmacotherapy [ See Psychopharmacology Section ] :

Drugs have limited effects. They can be misused or used in suicide attempts. When anxiety and depression result from a personality disorder, drugs are only moderately effective. For persons with personality disorders, anxiety and depression may have positive significance, ie, that the person is experiencing unwanted consequences of his disorder or is undertaking some needed self-examination.