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Controversies exist about the diagnostic validity of sexual sadism and its relation to sadistic personality disorder in sex offenders. The aim of this study was to investigate which diagnostic, developmental, and criminal characteristics differentiate sexual sadistic from non-sadistic sexual homicide perpetrators. Psychiatric court reports on 166 men who had committed a sexual homicide were evaluated regarding psychiatric, sexual and criminal history. Sixty-one offenders (36.7%) with sexual sadism (SeSd) were compared with 105 (63.3%) offenders without this diagnosis (NSeSd). Besides the sexual sadistic symptoms, there were seven factors that discriminated best between the two groups (sexual masochism, sadistic personality disorder, isolation in childhood, multiple sexual homicide, previous rape, previous tendencies for similar behavior, and long duration of the homicidal act). Sexual sadism is connected with circumscribed other characteristics and has to be considered in risk assessment and treatment of sex offenders.
The importance of sexual sadism as a cause of serious sex offenses has been widely discussed in forensic psychiatry and could be corroborated empirically (Berger, Berner, Bolterauer, Gutierrez, & Berger, 1999; Berner, Berger, & Hill, 2003; Briken, Nika, & Berner, 1999). However, in a study on 51 sex offenders Marshall, Kennedy, and Yates (2002) concluded that the diagnosis of sexual sadism is unreliable and practically useless. The sexually sadistic perpetrators in their sample, when compared with the non-sadistic offenders, showed almost no differences.
The relation of sexual sadism to sadistic personality disorder (PD)-a persistent pattern of general, nonsexual arousal and pleasure in humiliating, punishing, and harming other persons-is an important and controversial issue as well. Sadistic PD is regarded as an important factor particularly in forensic populations (Spitzer, Fiester, Gay, & Pfohl, 1991; Stone, 2001). Loranger, Sartorius, Andreoli, Berger, Buchheim, Channabasavanna et al. (1994) found that in a general clinical sample only 0.5% were diagnosed with sadistic PD and 1.3% with its masochistic counterpart, self-defeating PD. In forensic samples sadistic PD is much more prevalent. In a group of 70 sex offenders, treated in a specialized prison in Austria, high prevalence rates were found for sadistic PD (27.2%) as well as for sexual sadism (40.0%) with a great overlap: 46.4% of the offenders with sexual sadism had a comorbid sadistic PD, and 68.4% of those with sadistic PD were diagnosed with sexual sadism (Berger...