Examples of individuals who deny any interest in the physical or psychological suffering of another individual include individuals known to have inﬂicted pain or suffering on mul— behavior and who may further claim that known episodes of sexual assault were either un- intentional or nonsexual. Others may admit past episodes of sexual behavior involving the inﬂiction of pain or suffering on a nonconsenting individual but do not report any significant or sustained sexual interest in the physical or psychological suffering of another individual.
Since these individuals deny having urges or fantasies involving sexual arousal to pain and suffering, it follows that they would also deny feeling subjectively distressed or socially im- paired by such impulses. Such individuals may be diagnosed with sexual sadism disorder despite their negative self—report. Their recurrent behavior constitutes clinical support for the presence of the paraphilia of sexual sadism (by satisfying Criterion A) and simultane— ously demonstrates that their paraphilically motivated behavior is causing clinically signif- icant distress, harm, or risk of harm to others (satisfying Criterion B).
"Recurrent” sexual sadism involving nonconsenting others (i.e., multiple victims, each on a separate occasion) may, as general rule, be interpreted as three or more victims on separate occasions. Fewer victims can be interpreted as satisfying this criterion, if there are multiple instances of inﬂiction of pain and suffering to the same victim, or if there is cor— roborating evidence of a strong or preferential interest in pain and suffering involving multiple victims. Note that multiple victims, as suggested earlier, are a sufficient but not a necessary condition for diagnosis, as the criteria may be met if the individual acknowl- edges intense sadistic sexual interest.
The Criterion A time frame, indicating that the signs or symptoms of sexual sadism must have persisted for at least 6 months, should also be understood as a general guide- line, not a strict threshold, to ensure that the sexual interest in inﬂicting pain and suffering on nonconsenting victims is not merely transient. However, the diagnosis may be met if there is a clearly sustained but shorter period of sadistic behaviors.
The extensive use of pornography involving the inﬂiction of pain and suffering is some- times an associated feature of sexual sadism disorder.
The population prevalence of sexual sadism disorder is unknown and is largely based on individuals in forensic settings. Depending on the criteria for sexual sadism, prevalence varies widely, from 2% to 30%. Among civilly committed sexual offenders in the United
States, less than 10% have sexual sadism. Among individuals who have committed sexu- ally motivated homicides, rates of sexual sadism disorder range from 37% to 75%.
Individuals with sexual sadism in forensic samples are almost exclusively male, but a rep- resentative sample of the population in Australia reported that 2.2% of men and 1.3% of women said they had been involved in bondage and discipline, "sadomasochism," or dom- inance and submission in the previous year. Information on the development and course of sexual sadism disorder is extremely limited. One study reported that females became aware of their sadomasochistic orientation as young adults, and another reported that the mean age at onset of sadism in a group of males was 19.4 years. Whereas sexual sadism per se is probably a lifelong characteristic, sexual sadism disorder may ﬂuctuate according to the individual’s subjective distress or his or her propensity to harm nonconsenting others.
Advancing age is likely to have the same reducing effect on this disorder as it has on other paraphilic or normophilic sexual behavior.