suffering, it follows that they would also deny feeling subjectively distressed or socially im-
paired by such impulses. Such individuals may be diagnosed with sexual sadism disorder
despite their negative self-report. Their recurrent behavior constitutes clinical support for
the presence of the paraphilia of sexual sadi sm (by satisfying Criterion A) and simultane-
ously demonstrates that their paraphilically motivated behavior is causing clinically signif-
icant distress, harm, or risk of harm  to others (satisfying Criterion B).
“Recurrent” sexual sadism invo lving nonconsenting others (i .e., multiple victims, each
on a separate occasion) may, as general rule , be interpreted as three or more victims on
separate occasions. Fewer victims can be interpre ted as satisfying this criterion, if there are
multiple instances of infliction of pain and su ffering to the same victim, or if there is cor-
roborating evidence of a strong  or preferential interest in  pain and suffering involving
multiple victims. Note that multiple victims, as suggested earlier, are a sufficient but not
a necessary condition for diagnosis, as the crit eria may be met if the individual acknowl-
edges intense sadistic sexual interest. 
The Criterion A time frame, indicating that  the signs or symptoms of sexual sadism
must have persisted for at least 6 months, should also be understood as a general guide-
line, not a strict threshold, to ensure that the sexual interest in inflicting pain and suffering
on nonconsenting victims is not merely tran sient. However, the diagnosis may be met if
there is a clearly sustaine d but shorter period of sadistic behaviors. 
Associated Features Supporting Diagnosis
The extensive use of pornography involving the inflic tion of pain and suffering is some-
times an associated  feature of sexual  sadism disorder.