Self-Defeating and Sadistic Personality Disorders: Needed Additions to the Diagnostic Nomenclature

Journal of Personality Disorders, 1(2), 161-167, 1987

'&1987 The Guilford Press

I strongly support the inclusion of self-defeating personality disorder and

sadistic personality disorder in our diagnostic nomenclature because I be lieve that these are valid clinical entities that need to be diagnosed before appropriate treatment can be undertaken. Failure to diagnose these con

ditions will lead to inadequate and imprecise treatment at best, or at worst,

no treatment at all.

DESCRIPTIVE BASES OF THESE DISORDERS

Forms of Masochistic Behavior. Figures 1 through 3 present a continuum

of behaviors on a purely descriptive basis from the normal at one end of the spectrum to the pathological at the other. For masochistic behavior

masochism being defined as the coexistence of pleasure and pain there

is a normal state of altruism in which the individual accepts pain and sacrifice, possibly even death, by placing a value system or another human

being above and beyond himself or herself. Sexual masochism is at the

opposite extreme. In this condition the achievement of sexual excitement

is predicated on the individual's having suffering, pain, and humiliation inflicted by a sexual partner. Between these two extremes is the self-de feating personality disorder, in which a basic impairment of self-esteem

results in the individual feeling that he or she does not have anything of

value to offer the world. In contrast to sexual masochism, the pervasive pattern of self-defeating behavior does not bring sexual pleasure.

Forms ofAggressive Behavior. Normal sublimated aggression constitutes

the necessary assertiveness essential for love, work, play, and creativity.

Sexual sadism is the pathological extreme in which the achievement of Requests for reprints should be sent to Richard C. Simons, University of Colorado Health

Sciences Center, Department of Psychiatry-C249, 4200 East 9th Avenue, Denver, Colorado

80262.

The author wishes to acknowledge the contribution to this paper of Dr. Herbert S Gaskill.

who first proposed to him an official diagnosis of sadistic personality disorder at a meeting of

the Denver Psychoanalytic Society on March 26. 1984.

161

SELF-DEFEATING AND SADISTIC PERSONALITY

DISORDERS: Needed Additions to the

Diagnostic Nomenclature

Richard C. Simons, MD

University of Colorado Health Sciences Center

162 SIMONS

Forms of Masochistic Behavior

I I

Normal Pathological

I 1 Altruism Self-Defeating Sexual

Personality Masochism

Disorder

Forms of Aggressive Behavior

i...