Sadism, sadomasochism, sex, and violence

Blunted startle reactivity in everyday sadism and psychopathy

Two studies examined the amplitude of the startle response as a function of the Dark Tetrad of personality (narcissism, Machiavellianism, psychopathy, and sadism). We measured electromyographic activity of the orbicularis oculi muscle evoked by a startle stimulus while participants viewed images on a computer screen. Both studies revealed a negative correlation between general startle reactivity (averaged across positive, negative, and neutral images) and sadistic tendencies. In Study 2, all four dark traits were negative correlates of general startle reactivity. Study 2 also examined the personality correlates of aversive startle potentiation (ASP; indexed by greater reactivity while viewing negatively-valenced images than positive or neutral images). ASP correlated negatively with a variety of personality measures of psychopathy and sadism, their facets, and related personality tendencies (callousness, risk-taking, and restricted affect). These findings suggest that ordinary people with high levels of callousness and antagonism display physiological evidence of non-reactivity (i.e., blunted acoustic startle in general), whereas psychopathy and sadism are preferentially associated with reduced ASP.

The Moderating Effects of “Dark” Personality Traits and Message Vividness on the Persuasiveness of Terrorist Narrative Propaganda

Terrorism researchers have long discussed the role of psychology in the radicalization process. This work has included research on the respective roles of individual psychological traits and responses to terrorist propaganda. Unfortunately, much of this work has looked at psychological traits and responses to propaganda individually and has not considered how these factors may interact. This study redresses this gap in the literature. In this experiment (N = 268), participants were measured in terms of their narcissism, Machiavellianism, subclinical psychopathy, and everyday sadism—collectively called the Dark Tetrad. Participants were then exposed to a vivid or nonvivid terrorist narrative (or a control message). Results indicate that Machiavellianism interacts with both narrative exposure and narrative vividness to amplify the persuasive effect of terrorist narratives. Neither narcissism, subclinical psychopathy, nor everyday sadism had such an effect. These results highlight the importance of considering the psychological traits of audiences when evaluating proclivity for radicalization via persuasion by terrorist narratives.

Sexual Sadism: Its Role in the Crime-Commission Process of Sexual Homicide of Children

This study investigates the role of sexual sadism in the crime-commission process of sexual homicide (SH) involving child victims. A comparison between sadistic and nonsadistic cases involving child victims is conducted by examining the crime context, crime characteristics, methods of killing, body recovery characteristics, and forensic awareness strategies used by offenders. The sample comes from the Sexual Homicide International Database (SHIelD) including 135 cases of solved SHs involving child victims-35 cases with sexual sadism and 101 cases without sexual sadism. The Sexual Homicide Crime Scene Rating Scale for Sexual Sadism (SADSEX-SH) scale is used to identify sexual sadism from crime scene actions. Bivariate and multivariate analysis are performed to examine the differences between the two groups. Findings indicate that sadistic SH of children are characterized by an important level of structured premeditation, the commission of more diversified sexual acts, the use of specific method of killing, and the partial use of forensic awareness strategies. Practical implications in terms of criminal investigations are discussed.

The Biology of BDSM: A Systematic Review

INTRODUCTION

BDSM is an abbreviation used to reference the concepts of bondage and discipline, dominance and submission, sadism and masochism, enacted by power exchanges between consensual partners. In recent years, attention has shifted from the idea of BDSM as a pathological and tabooed niche practice towards viewing BDSM as a healthy form of intimacy.

AIM

This systematic review brings together all existing literature on the biology of BDSM and places it in a broader biological context.

METHODS

A systematic search was conducted on PubMed, Web of Science and PsycARTICLES, of which 10 articles are included and discussed in this systematic review.

RESULTS

There is evidence for cortisol changes in submissives as a result of a BDSM interaction, suggesting involvement of the physiological stress system. Endocannabinoid changes implicate the pleasure and reward system. In dominants, this biologically measured pleasure seemed to be dependent on power play rather than pain play. Testosterone and oxytocin are also implicated in BDSM, though their role is less evident. Research into brain region activity patterns related to BDSM interest suggests a role for the parietal operculum and ventral striatum in the context of the pleasure and reward system, the primary and secondary somatosensory cortex in the context of pain perception, empathy-related circuits such as the anterior insula, anterior midcingulate cortex and sensorimotor cortex and the left frontal cortex in the context of social and sexual interactions. Pain thresholds are shown to be higher in submissive individuals and a BDSM interaction may cause pain thresholds to rise in submissives as well.

CONCLUSION

BDSM interactions are complex and influenced by several psychological, social and biological processes. Though research is limited, there is emerging evidence for an interaction between several biological systems involved in these types of interests and activities. This means there is an important role for future research to replicate and supplement current results.

The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders

Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.

An Updated Sexual Homicide Crime Scene Rating Scale for Sexual Sadism (SADSEX-SH)

The Sexual Homicide Crime Scene Rating Scale for Sexual Sadism (SADSEX-SH) is a rating scale which dimensionally measures the degree of offender sexual sadism in suspected sexual homicide cases. Scoring is accomplished using crime scene and related investigative information. Preliminary norms for the SADSEX-SH prototype indicate that it correctly classified offenders with and without sexual sadism. This study further assessed SADSEX-SH sensitivity, specificity, and inter-rater reliability by comparing a larger sample of male sexual homicide offenders with (n = 20) and without (n = 20) sexual sadism. Two items generally undetectable at crime scenes were removed from the originally proposed 10-item scale, resulting in a final 8-item version. SADSEX-SH total scores for the two groups significantly differed (7.7 ± 3.5, range = 2-14 vs. 2.6 ± 2.0, range = 0-7, t = 5.58, p < .001). Inter-rater reliability was excellent (intraclass correlation coefficients [ICCs] = 0.6-1.0). Using a revised cutoff score of 6, sensitivity was 70.0% and specificity was 90%. This revised scale may prove useful for investigators, clinicians, and institutional professionals in helping to identify and address sexual sadism in sexual homicide offenders.

Bondage-Discipline, Dominance-Submission and Sadomasochism (BDSM) From an Integrative Biopsychosocial Perspective: A Systematic Review

INTRODUCTION

BDSM (bondage and discipline, dominance and submission, and sadism and masochism) increasingly receives attention from the scientific community. Where earlier research efforts mainly focused on epidemiologic characteristics, psychological and biologic factors driving BDSM preferences have recently gained interest as well.

AIM

To bring together all the existing scientific literature on BDSM from a biopsychosocial perspective.

METHODS

Based on the PRISMA guidelines, the current systematic review brings together all the existing literature on BDSM from a biopsychosocial perspective.

MAIN OUTCOME MEASURE

Prevalence rates of BDSM interests were investigated in the literature, as well as the associations between BDSM interests on one hand and personality traits, adverse childhood experiences, education levels, sexual orientations and biological markers on the other.

RESULTS

Biologic factors such as gender identity, sex hormone levels, and the neurologic constitution of the brain's pain and reward systems influence BDSM orientation. With regard to psychological factors, both personality traits (eg, higher levels of openness or extraversion) and the presence of a personality disorder have been associated with a heightened interest in BDSM, although only limited supporting evidence is available. Additionally, sensation-seeking levels and impulsivity seem to contribute, because they presumably guide one's drive to explore new or more-intense kinks. Whereas attachment styles impact couple dynamics, they also influence willingness to explore limits in a BDSM context. Lastly, education levels impact relational and sexual dynamics.

STRENGTHS AND LIMITATIONS

The limitations of the current review reflect those of the topical scientific literature. Although the number of studies focused on all aspects of BDSM is exponentially growing, most of these are only descriptive, and very few focus on underlying driving processes.

CONCLUSION

From this biopsychosocial perspective, we offer a dimensional approach while integrating the factors driving the onset and evolution of BDSM interests. De Neef N, Coppens V, Huys W, et al. Bondage-Discipline, Dominance-Submission and Sadomasochism (BDSM) From an Integrative Biopsychosocial Perspective: A Systematic Review. Sex Med 2019;7:129-144.

Empathy in female submissive BDSM practitioners

The practice of bondage/discipline, dominance/submission, sadism/masochism (BDSM) sometimes is associated with giving and receiving pain. It remains unresolved how BDSM practitioners perceive the pain of other people. This study investigated whether and how the BDSM experience affects human empathy. Experiment 1 measured trait empathy and subjective empathic responses in BDSM practitioners and control respondents. The results revealed lower trait empathy scores and subjective pain intensity ratings in the female submissive group (Subs) compared to controls. Experiment 2 measured participants' neural responses to others' suffering by recording event-related potentials (ERPs) from female Subs and controls while viewing painful and neutral expressions. We found that the differential amplitudes between painful and neutral expressions in the frontal N1 (92-112ms), frontal P2 (132-172ms) and central late LPP (700-1000ms) were reduced in the submissive group versus the control group. These findings suggest that being in the submissive role during BDSM practice weakens female individuals' empathic responses to others' suffering at both the behavioral and neural levels.

Embodiment and Humiliation Moderation of Neural Responses to Others' Suffering in Female Submissive BDSM Practitioners

Giving and receiving pain are common in the practice of BDSM (bondage-discipline, dominance-submission, and sadism-masochism). Playing a submissive role during BDSM practice weakens both the behavioral and neural empathic responses of female individuals to others' suffering, suggesting that long-term BDSM experience affects BDSM practitioners' empathic ability. This study further investigates whether physical restriction during BDSM practice also modulates individuals' neural responses to others' suffering. We measured neural responses to others' suffering by recording event-related potentials (ERPs) in female submissives while they viewed painful and neutral expressions in sexual sadistic/general social contexts under ball gag Blocking and Relaxed conditions. The neural responses recorded during 92-112 ms (N1), 132-172 ms (P2), 200-340 ms (N2), early late positive potential (LPP, 400-600 ms), and late LPP (700-1,000 ms) were included in the analyses. Compared to the relaxed condition, when a ball gag was used to prevent facial muscle movement and facial mimicry, the N1, early LPP, and late LPP responses neural responses to others' suffering were inhibited. The moderation effect of ball gag blocking on the N1 and early LPP amplitudes was positively correlated with the subjective feelings of facial muscle stillness, and the blocking moderation effect on the late LPP amplitudes was positively correlated with subjective feelings of humiliation. This study is the first neuropsychological investigation of the transient BDSM-related physical restriction effects on BDSM practitioners. These findings suggest that physical restriction (via a ball gag) during BDSM practices increases the wearer's facial muscle stillness and sense of humiliation. This physical restriction inhibits both early automatic responses and late controlled processes in response to the suffering of others.

Convergent Validity of Three Measures of Sexual Sadism: Value of a Dimensional Measure

Sexual sadism can be described as the sexual pleasure produced by acts of cruelty and bodily punishment. The most common method for evaluating sexual sadism is clinical evaluation, that is, evaluation based on the diagnostic criteria of nosological instruments such as the Diagnostic and Statistical Manual of Mental Disorders ( DSM) or the International Classification of Diseases (ICD). It is also possible to evaluate sadistic sexual preferences by phallometry, which provides a physiological measure of sexual excitation by deviant and nondeviant scenarios. The most recently developed evaluation method is the Severe Sexual Sadism Scale (SESAS), a dimensional instrument that has been empirically validated. Despite the availability of all these measurement techniques, very little research has been conducted on their degree of convergence. Consequently, the aim of the current study was to assess the relationship between these three measures of sexual sadism. Our analyses were conducted on a sample of rapists ( N = 72), assessed in a maximum-security penitentiary. There was no significant relation between phallometric scores and other measures of sexual sadism. There was, however, an important correlation between SESAS scores and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) sexual sadism diagnosis. Our results are consistent with other phallometric studies, which reported no difference in the penile responses of individuals diagnosed as sadists and those not diagnosed as sadists. Results and implications for future research are discussed.

Sadistic Offender or Sexual Sadism? Taxometric Evidence for a Dimensional Structure of Sexual Sadism

Severe sexual sadism is a disorder of sexual preferences that focuses on humiliation and domination of the victim, sometimes causing grievous injury or death. Because offenders with high levels of sadism represent a risk to both reoffend and cause considerable harm should they reoffend, a diagnosis of sexual sadism has serious implications. The actual diagnosis of sexual sadism is fraught with problems (i.e., low reliability and validity) and exhibits poor consistency across assessments and studies (Levenson, 2004; Marshall, Kennedy, & Yates, 2002a). Various authors have proposed that sadism should be reconceptualized and have suggested that a dimensional approach may be more effective than a classificatory one for diagnosing sexual sadism (e.g., Marshall & Kennedy, 2003; Nietschke, Osterheider, & Mokros, 2009b). The dimension versus taxon question also impacts debates about the etiology and treatment of sadism. We assessed the taxonicity of sexual sadism by conducting a taxometric analysis of the scores of 474 sex offenders from penitentiary settings on the MTC Sexual Sadism Scale, using Meehl's taxometric methods (Meehl & Yonce, 1994; Waller & Meehl, 1998). Findings indicated that sexual sadism presents a clear underlying dimensional structure. These results are consistent with earlier research supporting a dimensional assessment of sexual sadism and indicate that the diagnosis of sexual sadism should be reconceptualized. The theoretical and clinical implications of these findings are discussed.

Discriminating Coercive from Sadomasochistic Sexuality

Sadomasochistic (SM) sexual interest is reported by a wide range of individuals. Within the sex offender literature, the presence of SM interest is often viewed as a herald of criminal sexual behavior; however, research indicates that SM interests are not predictive of coercive sexual behavior. In the current study, we measured a range of sexual fantasies and behaviors, and then applied cluster analyses to determine (1) if individuals endorsed elevated SM interests also endorsed coercive fantasies and, (2) to explore cluster membership correlates using measures of sensation seeking, externalizing and antisocial behaviors, attitudes toward rape, and empathic capacity. A total of 550 participants were recruited through a variety of on-line discussion areas. A four cluster solution best fit the data with distinct clusters observed for those endorsing SM behaviors and those reporting coercive sexual behavior. Additional analyses revealed greater endorsement of victim blaming attitudes and lower empathic concern among members of the coercive sexual behavior cluster. Elevated sensation seeking and externalizing behaviors were reported by members of clusters marked by SM and coercive sexual behavior. Results provide further support for the differentiation between SM and coercive sexual behaviors as representative of individuals with divergent attitudes, traits, and behaviors.

Behavioral Confirmation of Everyday Sadism

Past research on socially aversive personalities has focused on subclinical psychopathy, subclinical narcissism, and Machiavellianism—the “Dark Triad” of personality. In the research reported here, we evaluated whether an everyday form of sadism should be added to that list. Acts of apparent cruelty were captured using two laboratory procedures, and we showed that such behavior could be predicted with two measures of sadistic personality. Study 1 featured a bug-killing paradigm. As expected, sadists volunteered to kill bugs at greater rates than did nonsadists. Study 2 examined willingness to harm an innocent victim. When aggression was easy, sadism and Dark Triad measures predicted unprovoked aggression. However, only sadists were willing to work for the opportunity to hurt an innocent person. In both studies, sadism emerged as an independent predictor of behavior reflecting an appetite for cruelty. Together, these findings support the construct validity of everyday sadism and its incorporation into a new “Dark Tetrad” of personality.

Problems with paraphilias in the DSM-5

This paper critiques changes in the diagnositic criteria for the paraphilias as set out in the DSM-5. In addition to general areas of concern, five specific problem areas are identified. This includes: definitions by exclusion; culturally based criteria; ignoring etiology; minimizing consent issues; and lack of field trials. A suggestion to improve the diagnostic criteria is offered.

The DSM diagnostic criteria for sexual sadism

I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Sadism for the Sexual and Gender Identity Disorders Workgroup for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Sadism, the assessment of Sexual Sadism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Sadism using the DSM in non-forensic populations. I conclude that the diagnosis of Sexual Sadism should be retained, that minimal modifications of the wording of this diagnosis are warranted, and that there is a need for the development of dimensional and structured diagnostic instruments.