696 Paraphilic Disorders
Diagnostic Features
The diagnostic criteria for sexual sadism disord er are intended to apply both to individuals
who freely admit to having such paraphilic interests and to those who deny any sexual interest
in the physical or psychological suffering of another individual despite substantial objective
evidence to the contrary. Indivi duals who openly acknowledge in tense sexual interest in the
physical or psychological suffering of others are referred to as “admitting individuals.” If these
individuals also report psychosocial difficulties because of their sexual  attractions or prefer-
ences for the physical or psychological suffering of another individual, they may be diagnosed
with sexual sadism disorder. In contrast, if admitting individuals declare no distress, exempli-
fied by anxiety, obsessions, gu ilt, or shame, about these para philic impulses, and are not ham-
pered by them in pursuing other goals, and thei r self-reported, psychiat ric, or legal histories
indicate that they do not act on them, then they  could be ascertained as having sadistic sexual
interest but they would not meet criteria for sexual sadism disorder.
Examples of individuals who deny any interest in the physical or psychological suffering
of another individual include in dividuals known to have inflicted pain or suffering on mul-
tiple victims on separate occasions but who de ny any urges or fantasies about such sexual
behavior and who may further claim that known episodes of sexual assault were either un-
intentional or nonsexual. Others may admit past  episodes of sexual behavior involving the
infliction of pain or suffering on a nonconsenting individual but do not report any significant
or sustained sexual interest in the physical or  psychological suffering of another individual.
Since these individuals deny having urges or fantasies involving sexual arousal to pain and
suffering, it follows that they would also deny feeling subjectively distressed or socially im-