Sadistic personality disorder is an obsolete term for a proposed personality disorder defined by a pervasive pattern of sadistic and cruel behavior. People who fitted this diagnosis were thought to have a desire to control others and to have accomplished this through use of physical or emotional violence. The diagnosis proposal appeared in the appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), however it was never put to use in clinical settings and later versions of the DSM (DSM-IV, DSM-IV-TR, and DSM-5) had it removed. Among other reasons, psychiatrists believed it would be used to legally excuse sadistic behavior.

Comorbidity with other personality disorders

Sadistic personality disorder was thought to have been frequently comorbid with other personality disorders, primarily other types of psychopathological disorders. In contrast, sadism has also been found in patients who do not display any or other forms of psychopathic disorders. Conduct disorder in childhood, and Alcohol use disorder were thought to have been frequently comorbid with Sadistic personality disorder. Researchers had difficulty distinguishing sadistic personality disorder from the other personality disorders due to high levels of comorbidity, hence another reason why it was eventually removed.

Diagnostic criteria

According to the DSM-III-R, the diagnostic criteria were defined by a pervasive pattern of sadistic and cruel behavior that began in early adulthood. It was defined by four of the following. This behavior couldn’t have been better explained by sexual sadism disorder and it had to have been directed towards more than one person.

Differential diagnosis

Millon's subtypes

Theodore Millon claimed there were four subtypes of sadism, which he termed enforcing sadism, explosive sadism, spineless sadism, and tyrannical sadism.

History

Sadistic personality disorder was developed as forensic psychiatrists had noticed many patients with sadistic behavior. It was introduced to the DSM in 1987 and it was placed in the DSM-III-R as a way to facilitate further systematic clinical study and research. It was removed from the DSM for numerous reasons, including the fact it could be used to legally excuse sadistic acts. Sadistic personality disorder also shared a high rate of comorbidity with other disorders, implying that it was not a distinct disorder on its own. Millon writes that "Physically abusive, sadistic personalities are most often male, and it was felt that any such diagnosis might have the paradoxical effect of legally excusing cruel behavior." Researchers were also concerned about the stigmatizing nature of the disorder, and that it put patients at higher risk of abuse from prison guards. Theorists like Theodore Millon wanted to generate further study on SPD, and so proposed it to the DSM-IV Personality Disorder Work Group, who rejected it.

Sub-clinical sadism in personality psychology

There is renewed interest in studying sadism as a personality trait. Sadism joins with subclinical psychopathy, narcissism, and Machiavellianism to form the so-called "dark tetrad’ of personality.