The actual prevalence of the disorder is unknown; however, 12 percent of women and 25 percent of men report fantasies centered around masochism. About half of consenting adults enjoy being bitten or scratched as part of sexual play. The prevalence of this behavior is higher among women who are lesbians or bisexuals. Having distress around the behavior is a requirement for the diagnosis. The biggest risk is injury to the patient, particularly in cases of autoerotic asphyxia. This is the leading cause of death due to the disorder, often occurring during masturbation. The treatment can involve antiandrogen therapy to control hypersexuality and be more receptive to psychotherapy or to reduce the chances of injury or death related to the behavior. Drug therapy does not involve a long-term solution but does help psychotherapeutic goals. Journaling of fantasies is helpful to the therapeutic process. Psychoeducation and sexual education along with social skills training can help resolve the behavior.
SEXUAL SADISM DISORDER (302.84) In cases of sexual sadism disorder, the individual has an algolagnic disorder in which there is sexual arousal by inflicting physical and/or psychological suffering upon another person. There is intense sexual excitement by the fantasizing over or witnessing of physical or psychological harm to another, who may or may not be consenting. It must be present for six months to qualify as being a sexual paraphilic disorder, with the diagnosis made when there is distress, impairment of functioning, or an act upon a nonconsenting individual. Specifiers involve whether the patient is in a controlled environment (such as incarceration) or has been symptom-free for five years without distress. There is a scale called the SSSS (Severe Sexual Sadism Scale) that indicates the propensity toward the disorder. The patient can deny their fantasies and their behavior and will still meet the criteria for the disorder but the differential diagnosis involves sadism versus a nonsadistic sexual assault. Mild forms of pain between consenting adults does not qualify as sexual sadism disorder.
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