Experts Explain Sadistic Personality Disorder

Do you know someone who engages in sadistic behavior, and you’re worried they might have a personality disorder? Read on to learn more.

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Do you know someone who seems to get a thrill out of hurting other people, and doesn’t think there’s anything wrong with it? Maybe they go out of their way to humiliate others or even physically harm people — and they enjoy it. 

In psychological terms, someone who derives pleasure from another person’s pain or humiliation is known as a sadist. Patterns like these can sometimes reflect traits related to sadistic personality disorder. While the condition is an outdated diagnosis, the language can still help explain why some people appear to take pleasure in others’ suffering. Read on to learn more about sadistic personality disorder, its symptoms, causes, diagnosis, treatment, and more.

What is sadistic personality disorder?

Sadistic personality disorder is a now obsolete diagnosis marked by pervasive sadism — getting pleasure out of hurting others. “This includes patterns of enjoyment causing physical and or psychological harm to others using cruelty and aggression,” says Nicole Lonano, MS, a Group Facilitator at Charlie Health. 

This personality disorder is ego-syntonic, meaning the behavior aligns with how the individual views themselves and their values, which also means they don’t see anything wrong with it and won’t feel guilt. 

A sadistic person does not feel distressed by their own actions, even when others are clearly harmed. For these reasons, sadists would likely not seek out treatment because they don’t think they have a problem. 

“These people really engage in behaviors that are outside of the norm of what is acceptable in society,” says Kathleen Douglass, LCPC, a Charlie Health Primary Therapist. “They can be very controlling and demeaning, as well as violent. They lack empathy, and oftentimes a moral compass [that aligns with what most of us consider right], and show a disregard for the rights and well-being of others.”

Taken together, these behaviors form a longstanding pattern of cruelty, intimidation, and dominance that affects many aspects of a person’s life.

Signs of sadistic personality disorder

Symptoms of sadistic personality disorder include:

• Using physical violence or cruelty to assert dominance in relationships
• Humiliating or demeaning someone in front of other people
• Treating or disciplining someone disproportionately harshly
• Getting amusement or pleasure from people or animals who are suffering (psychologically or physically)
• Lying to someone to hurt them
• Getting people to do what they want through intimidation or fright
• Being controlling of someone they have a close relationship with
• Having a fascination with violence, torture, and injuries

According to the DSM-III-R, for someone to be diagnosed with sadistic personality disorder, they would have to exhibit repeated occurrences of at least four of these symptoms, with onset in early adulthood. Sadistic behavior must be present across multiple relationships, not only toward a single person (such as a spouse or child).

Sadistic personality disorder vs. sexual sadism disorder

These two disorders both share the quality of sadism. However, sexual sadism disorder is categorized as a paraphilic disorder where someone’s sexual arousal depends on inflicting (or fantasizing about inflicting) psychological or physical suffering on someone else. 

Sexual sadism disorder is still present in the most current version of the DSM (the DSM-5-TR). The diagnosis requires that this pattern lasts at least six months and causes the individual distress and impairs their overall functioning, or involves nonconsenting partners.

In contrast, sadistic personality disorder is related to a broader pattern of sadism across many areas of life, not just limited to sexual behavior. Plus, the motivation is general pleasure or control rather than sexual excitement.

Sadistic personality disorder vs. everyday sadism

It’s possible to engage in some sadistic behavior or display a sadistic personality trait without having a disorder. This is referred to as “everyday sadism.” The American Psychological Association defines everyday sadism as “largely acceptable forms of subclinical sadism that are prevalent in modern culture.”

Everyday sadism can show up in subtle ways — like enjoying violent media, trolling online, or finding humor in videos of people getting hurt — but it doesn’t involve the pervasive, aggressive, and controlling behaviors seen in sadistic personality disorder. This also doesn’t mean that someone necessarily is a sadist.

However, someone who consistently enjoys humiliating others, seeks out opportunities to hurt people, or feels powerful only when others are suffering may fall closer on the spectrum toward more pathological sadism.

What causes sadistic personality disorder?

Personality disorders, including sadistic personality disorder, are often caused by a variety of factors, including genetic and environmental factors, Lonano says.

For environmental factors, former editions of the DSM lists childhood abuse as a risk factor for developing sadistic personality disorder. This includes being a survivor of:

• Physical abuse
• Sexual abuse
• Psychological abuse

Additionally, growing up witnessing abuse in the family (such as having a parent who physically, sexually, or emotionally abuses their spouse) is another risk factor.

Diagnosing sadistic personality disorder

Are you curious if you or someone you know has sadistic personality disorder or a related personality disorder? There are a few things to keep in mind. 

Is there a sadistic personality disorder test?

There is no single reliable and accurate sadistic personality disorder test. While there are many “tests” you can find online, none of these are official diagnostic tools. When it comes to diagnosing any personality disorder, a mental health professional is the only person who can complete a thorough, proper assessment and provide an accurate diagnosis.

Sadistic personality disorder DSM-5 updates

Sadistic personality disorder is no longer included in the DSM (Diagnostic and Statistical Manual of Mental Disorders). The diagnosis was first added to the DSM-III-R, published in 1987. It was included in the appendix as a condition for further study rather than a fully accepted diagnosis. It was excluded from the next version of the DSM — the DSM-IV — in 1994.

“This disorder was removed from the DSM-5 related to concerns of misuse in the legal system and lack of evidence to distinguish it as a unique disorder from others like antisocial personality disorder or narcissistic personality disorder,” Lonano says. 

Another related diagnosis, specifically in children under 18, is conduct disorder, Douglass says. This is categorized as a disruptive behavior disorder, not a personality disorder. However, it involves persistent aggressive and defiant behaviors, some of which may overlap with sadistic traits. 

Today, if someone exhibits multiple signs of sadistic personality disorder, it’s possible that their symptoms would fall under the categories of antisocial personality disorder (ASPD) or narcissistic personality disorder (NPD) in the DSM-5, and the individual would be diagnosed with that, or conduct disorder in youth. 

“However, it is important to indicate here that not every person with these diagnoses will exhibit sadistic tendencies — it is just one possible symptom of the disorder,” Douglass says. 

Understanding similar diagnoses

Antisocial personality disorder (ASPD) and narcissistic personality disorder (NPD) are two current-day DSM-5 diagnoses most commonly associated with sadistic traits in adults.

1. Antisocial personality disorder 

Antisocial personality disorder is marked by violating and disregarding the rights of other people. This disorder is also linked to psychopathy and sociopathy.

Symptoms include:

• Breaking laws and disregarding social norms 
• Lying to people for pleasure or personal gain
• Acting impulsively
• Aggressiveness and getting into physical fights 
• Disregarding their own safety and the safety of others
• Acting irresponsibly, likely to struggle to hold a job
• Lacking remorse for hurting people or breaking the law

Some individuals with ASPD may exhibit sadistic behaviors, but not all do.

2. Narcissistic personality disorder

Narcissistic personality disorder is characterized by grandiosity, an excessive need for admiration, and a lack of empathy. Symptoms include:

• Having an inflated sense of self, exaggerating accomplishments and talents
• Often fantasizing about things like success, power, and beauty
• Believing that they’re special and can only be understood by other special people or institutions
• Needing excessive admiration from others
• Feeling entitled to special treatment
• Taking advantage of other people for personal gain
• Lacking empathy for others
• Thinking people are jealous of them
• Acting arrogant
  

In some cases, a narcissist may engage in sadistic acts, but this isn’t a core feature of NPD and likely isn’t present in most individuals with the personality disorder.

3. Conduct disorder

Conduct disorder is a child and adolescent disruptive behavioral disorder characterized by aggression and disobedience. Conduct disorder is not diagnosed in adults beyond the age of 18; instead, they would likely be diagnosed with antisocial personality disorder if they continue to display disruptive behaviors alongside meeting additional symptom criteria for ASPD.  

Symptoms include:

• Aggression toward humans and/or animals
• Destroying property
• Lying, deceiving, and stealing
• Violating rules 

Again, some kids or teens with conduct disorder might engage in sadistic behavior, but this isn’t always the case. 

How to treat sadistic personality disorder

There is no “cure” for sadistic personality disorder, or any personality disorder, for that matter. However, treatment is available for the symptoms and behaviors that often accompany sadistic traits.

Motivation for change is a big barrier to care. Since someone demonstrating sadistic behavioral patterns likely doesn’t see anything wrong with their behavior, and their behavior doesn’t cause them any distress, it’s unlikely they seek out therapy. Sadists may refuse treatment or only seek help when it’s mandated (such as through the criminal justice system, if they’ve been accused of a crime).

“These disorders are even more challenging to treat because they lack awareness that what they are doing is wrong,” Douglass says. “If a person can identify how they behave and acknowledge that they have a problem with sadism, then it may be possible to work on some of the symptoms of these disorders.” 

Douglass adds that in therapy, sadists can work on impulse control, distress tolerance, and obsessive or intrusive thoughts — as long as they’re willing to put in the work. 

Treatment options

For treating personality disorders like antisocial personality disorder and narcissistic personality disorder, some therapy modalities that can help include:

• Dialectical behavior therapy: DBT is a skills-based therapy that focuses on improving emotional regulation, distress tolerance, and interpersonal skills, Lonano says. DBT skills can help reduce impulsive, aggressive behaviors and unhealthy coping strategies, supporting more positive ones. 
• Cognitive behavioral therapy: CBT helps individuals identify and change unhealthy thought patterns and behaviors, says Lonano. This therapy might also help address distorted beliefs about power, control, and dominance that may reinforce sadistic behavior.
• Psychodynamic therapy: Psychodynamic therapy can help individuals explore their early life experiences and unconscious thought patterns that may contribute to their symptoms. This can help determine the root cause of the disorder.
• Group therapy: Lonano says group therapy provides a safe space to work on self-awareness, empathy, and social skills. In a supportive therapeutic group moderated by a professional, individuals can practice healthier interpersonal behaviors and gain insight from others.
• Trauma-informed therapy: Since many people with personality disorders may also have experienced trauma early in life, it’s important to unpack and process this trauma. Trauma-informed therapy will help improve overall well-being.

In a child or teen who has conduct disorder, treatment may include:

• Cognitive behavioral therapy: CBT can help a child with conduct disorder identify harmful thought patterns and learn healthier ways to respond to frustration or conflict.
• Anger management training: Kids with conduct disorder typically struggle with intense anger. Anger management helps them learn to cope with anger and control their reactions rather than resorting to harm. 
• Parent management training: Parent management training teaches caregivers strategies for setting limits, reinforcing positive behaviors, and reducing aggressive or oppositional behavior at home. 

How Charlie Health can help

If you or someone you love is struggling with their mental health, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for individuals dealing with serious and complex mental disorders, including personality disorders like NPD and ASPD. We can also help children ages 8 and up who have conduct disorder.

Our trauma-informed mental health professionals use a variety of evidence-based therapy modalities, such as CBT and DBT, in individual therapy, group sessions, and family therapy for well-rounded treatment. With treatment, managing personality disorder symptoms is possible. Fill out the form below or give us a call to start your healing journey today.