Pedophilic Disorder 697
Development and Course
Individuals with sexual sadism in forensic samples are almost exclusively male, but a rep-
resentative sample of the population in Aust ralia reported that 2.2% of men and 1.3% of
women said they had been involved in bondage and discipline, “sadomasochism,” or dom-
inance and submission in the previous year . Information on the development and course
of sexual sadism disorder is extremely lim ited. One study reported that females became
aware of their sadomasochistic interest as young adults, and another reported that the
mean age at onset of sadism in a group of males was 19.4 years. Whereas sexual sadism per
se is probably a lifelong characteristic, sexu al sadism disorder may fluctuate according to
the individual’s subjective distress or his or her propensity to harm nonconsenting others.
Advancing age is likely to have the same reducing effect on this disorder as it has on other
paraphilic or normophilic sexual behavior.
Differential Diagnosis
Many of the conditions that could be diffe rential diagnoses for sexual sadism disorder
(e.g., antisocial pers onality disorder, sexual masochism disorder, hypersexuality, sub-
stance use disorders) sometime s occur also as comorb id diagnoses. Therefore, it is neces-
sary to carefully evaluate the evidence for sexual sadism disorder, keeping the possibility
of other paraphilias or mental disorders as pa rt of the differential diagnosis. The majority
of individuals who are active in community networks that pr actice sadistic and masoch-
istic behaviors do not express any dissatisfaction  with their sexual interests, and their be-
havior would not meet DSM-5 criteria for sexual  sadism disorder. Sadi stic interest, but not
the disorder, may be considered in the differential diagnosis.