As human beings, we have a great deal of empathy and compassion, but when we think about cases like Dahmer, Hilter, or Mengele, we see images of people who clearly lack these traits. 

Adolf Hilter orchestrated the genocide of millions of people. Jeffrey Dahmer brutally tortured and killed 17 men and boys. Josef Mengele performed inhumane experiments on people. What was the motivating factor for this cruel behavior? How can anyone think of these acts and perform them?

Defining Sadistic Personality Disorder

Sadistic personality disorder (SPD), simply called Sadism is a rare and controversial condition that involves a persistent pattern of cruel, demeaning, and aggressive behavior towards others. People with SPD derive pleasure from inflicting pain, suffering, or humiliation on others, and often have little empathy or remorse for their victims.

Sadistic personality disorder (SPD) is controversial because the current diagnostic manual states that SPD is a personality disorder or a lifestyle choice, not a mental illness. However, some experts argue that SPD should be considered a distinct personality disorder.

There are a lot of myths and misunderstandings about SPD. Some of the most common is that it’s a result of childhood abuse, it’s always sexual or violent, or it’s the same as psychopathy. These aren’t always true, and each person’s case is unique regarding cause, symptoms, and treatment.

So, let’s look at the characteristics of SPD and possible treatment approaches.

How to Recognize a Person With Sadistic Personality Disorder

Hollywood’s portrayal of sadistic personality disorder often falls into harmful stereotypes. While some individuals with the disorder may exhibit violent tendencies, it’s important to remember that not all do. Sadistic behavior can manifest in many different ways, some of which are far less obvious than a sinister grin and a thirst for physical harm.

Let’s look at the typical characteristics of people with sadistic personality disorder:

Behavioral Patterns of People With Sadistic Personality Disorder

People with SPD often exhibit it in different ways, but the focus of their behavior is a lack of empathy and amusement for people’s suffering.

Common Traits of SPD Include:

• Cruelty and Domination: The most visible aspect of SPD is the active pursuit of power, dominance, and control through cruelty for satisfaction. This can range from verbal abuse, threats, emotional blackmail, and humiliation to harm or manipulate others. 
• Lack of Empathy and Remorse: People with SPD lack empathy, which is the foundation of human connection. Most people’s first reaction when they see someone in pain is to comfort and ease their pain. In the case of people with SPD, however, their pain becomes a source of amusement or even satisfaction.
• Grandiosity and Narcissism: Sadists are characterized by a high level of self-esteem and an intense need to be admired.  They may manipulate situations to appear powerful and in control, seeking to impress or intimidate others. This inflated self-esteem fuels their need for power and reinforces their belief that others are just tools or objects to be manipulated.
• Preoccupation With Violence: They are fascinated by violent images, movies, games, or stories much more than the average person does. They may also fantasize about hurting or killing others.
• Callous Disregard for Safety and Boundaries: Morality and ethical considerations hold little weight for individuals with SPD. They disregard the safety and well-being of others, readily violating boundaries and exploiting vulnerabilities for their gratification.

Beyond the Stereotypes: Traits Often Missed in People With SPD:

Some traits that are often missed or overlooked in people with SPD are

• • Not all Sadists are Monsters: While violence and aggression are often associated with SPD, not all people with this condition go around wielding knives and gleefully inflicting physical harm. Some sadists enjoy the act of controlling others through more subtle manipulation, or even in professional settings where there are inherent power dynamics.
  • Charisma and Charm: Contrary to the typical portrayal, sadists can be incredibly charming and charismatic. They can easily manipulate others by appearing friendly, polite, helpful, and trustworthy, only to exploit that trust for their sadistic amusement.
  • The Mask of Vulnerability: Some sadists may even present themselves as vulnerable or in need of help, drawing others in with a facade of weakness. This vulnerability is often a calculated performance, used to gain sympathy and control over their unsuspecting victims.

• Sadists Can Adapt: They can adjust their behavior to different situations or people. They may also mimic emotions or expressions to blend in or avoid detection

Why Is SPD Difficult to Diagnose?

• Lack of Recognition: SPD is not officially recognized as a personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the primary source of diagnostic information for mental disorders. As a result, it is not well-known or studied by many mental health professionals.
• Lack of Definitive Test:  SPD is a very rare disorder and research is still in its early stages. Because of this, there is no specific biological marker or test to diagnose SPD, unlike many other forms of mental health disorders. Diagnosis is heavily dependent on clinical interviews and observed behaviors, making it prone to subjectivity and bias.
• Low Self-Awareness: People with SPD usually do not see anything wrong with their behavior or attitude. Therefore, they are unlikely to seek help or admit their problems. They may also deny or minimize their symptoms or blame others for their actions.
• High Comorbidity: SPD is often related to other personality disorders such as Antisocial personality disorder (ASPD) and narcissistic personality disorder (NPD). This makes it difficult to differentiate them or recognize SPD’s distinctive characteristics.
• Fear of Disclosure: People with sadistic personality disorder tend not to want to talk about their symptoms because of the stigma and legal issues associated with the condition, which makes it harder to diagnose and treat.

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Can Sadistic Personality Disorder Be Cured?

Like most personality disorders, sadistic personality disorder can be challenging to treat. One of the biggest challenges in treating SPD is that the people affected often don’t understand what they’re doing; they don’t see it as wrong or damaging and are therefore not motivated to seek treatment.

While treating SPD requires a lot of effort and dedication from the patient, it’s not impossible. Here are some of the most common treatment options:

Psychotherapy

• Behavior Therapy (BT): Recognizing the harmful impact of their behavior is crucial for individuals with SPD. BT helps them recognize triggers and find alternative ways to cope with sadistic behavior. This includes learning new ways to connect with others, forming healthy relationships, and fostering empathy.
• Cognitive Behavioral Therapy (CBT): CBT focuses on the relationship between thoughts, feelings, and actions. Through CBT, clients learn how their distorted thinking patterns and emotions play a role in their sadistic behavior. This helps them challenge their negative thinking patterns and build healthier coping skills to react constructively to situations.
• Dialectical Behavioral Therapy (DBT): This approach focuses on mindfulness, emotional regulation, and distress reduction, building tools to navigate challenging situations without resorting to sadistic behavior. DBT equips individuals with skills to manage intense emotions, improve distress tolerance, and strengthen interpersonal relationships. 

Rehabilitation

Treatment for SPD extends beyond weekly sessions at the therapist’s office. These programs offer extra support and structure to help people re-socialize and learn healthy coping skills in the real world. These programs may include:

• Social Skills Training: This involves learning healthy ways to interact with others and build positive relationships. These programs can teach them how to express emotions appropriately, listen actively, and avoid manipulative or controlling behavior.
• Life Skills Training: This includes managing finances, finding employment, maintaining healthy relationships, fostering independence, and reducing reliance on others—all these help to provide structure and purpose to the individual life.
• Anger Management: Addressing anger issues is often a key component of rehabilitation. Individuals with SPD learn healthy ways to manage their anger and frustration, reducing the risk of outbursts that could harm others.

Legal Implications- Addressing the Boundary Between Disorder and Crime

Although SPD is a mental health condition, people who commit crimes of violence must be held accountable because the law must protect vulnerable people. This is a powerful motivator to manage symptoms of SPD once diagnosed. If this condition is left unmanaged, individuals diagnosed with SPD may commit crimes that harm others or put people at risk.

However, it’s equally important to understand that people shouldn’t be punished for actions they haven’t committed. Being diagnosed with SPD doesn’t mean the individual is a criminal or will ever commit a crime.

Destigmatizing Mental Health

While it’s important to recognize the damage that SPD can cause, neglecting the individuals living with it only perpetuates fear and prevents people who live with it from getting the help they need.

Here are some common ways to Destigmatize SPD:

Raising Awareness

The first step towards understanding is knowledge. Openly discussing SPD, without sensationalism or demonization, is a major key to destigmatizing it. This means:

• Open Dialogue: Public conversations about SPD, facilitated by mental health providers and people with SPD, can help to explain the disorder and clear up misunderstandings. Also, sharing personal stories with empathy and understanding can humanize the experience and foster compassion.
• Media Representation: The media often portrays individuals with SPD as one-dimensional villains, fueled by a lust for cruelty.  We need to move beyond these sensationalized stereotypes. The media accurately showcasing the complexities of SPD and highlighting the paths to recovery can help challenge harmful narratives and promote informed public discourse.
• Educational Initiatives: Integrating information about SPD into mental health education programs can equip healthcare professionals, educators, and the general public with the knowledge to recognize the disorder, offer support, and prevent themselves from harm.

Breaking Stereotypes

While some individuals with SPD may exhibit aggression, many display the disorder through subtler forms of manipulation and control. People living with SPD can lead fulfilling and productive lives with proper care and support.

We can challenge the negative stereotypes by speaking up against stigma to prevent harmful generalizations and promote empathy.

Keep in mind that the goal of destigmatizing SPD isn’t to minimize its impact or condone harmful behavior. It’s about creating an environment of understanding, support, and responsible intervention, while also ensuring the safety and well-being of those around them.

Final Thoughts

Understanding the characteristics of Sadistic Personality Disorder is not about sensationalizing or demonizing those who live with it. It’s about lifting the veil on a complex and challenging condition. Not only will this result in a more accurate diagnosis, and more effective treatment, but it will also help to prevent the serious consequences of SPD.

To treat this condition, the first step is to get help without fear of judgment or stigmatization. Therefore, as a counselor, you need an effective data collection tool like encrypted psychotherapy forms. Encrypted psychotherapy forms help people with SPD to come forward with their symptoms without fear of stigmatization or stereotyping, allowing you to identify symptoms of the condition and provide the necessary care.

References

• Degges-White, S., Ph.D., LCPC, LPC, LMHC, NCC, & Abulhosn, R., MD (2023, June 15). Sadistic Personality Disorder: Signs, Traits, & Treatment. Choosing Therapy. Retrieved January 18, 2024, from https://www.choosingtherapy.com/sadistic-personality-disorder/
• COUNSELING NOW (2022, December 22). Sadistic Personality Disorder: Definition, Causes, Types, and Interventions. Retrieved January 18, 2024, from https://counselingnow.com/sadistic-personality-disorder/
• Schwartz, A., LCSW, Ph.D. (2013, May 17). Sadistic Personality Disorder: The Cleveland Tragedy. MentalHelp.net. Retrieved January 18, 2024, from https://www.mentalhelp.net/blogs/sadistic-personality-disorder-the-cleveland-tragedy/