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.
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)m
Ggets 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.
Iis fascinated by violence, weapons, martial arts, injury, or
torture
DSM-IV Code:
Not Specified
Associated
Features:
Patient
repeatedly enters into relationship with violent, sexually
abusive husband.
Depressed
Mood.
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. This disorder is fairly
uncommon and there is little information about occurrence by
gender or about family pattern.
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.
