Sexual sadism disorder is comorbid with other paraphilic disorders (with no clear prevalence of any one). Most of the research data comes from incarcerated males who have perpetrated sadistic crimes so it may not be representative of most men who have the disorder. There is little information on females with the disorder. There seems to be an impairment in emotional recognition and processing (as well as increased aggression levels) in individuals who have this illness. Less than 10 percent of convicted sex offenders have sexual sadism disorder; however, the incidence is as high as 75 percent in those who have committed a sexually motivated homicide. Treatment is primarily through drug therapy, such as female hormones and anti-androgen drugs. These will reduce the sexual impulses and improve the resultant behavior. There is a high rate of recidivism among people who get sexually aroused when exposed to violent content. These types of patients need ongoing monitoring if they are not incarcerated in order to avoid acting on their sexual fantasies of harming others.
PEDOPHILIC DISORDER (302.2) This is a diagnosis given to individuals who are at least sixteen years of age or older who are sexually aroused by prepubescent children. Any expression of the patient’s fantasies is a criminal offense in most parts of the world. There may be a difference between individuals who have desires that are ego-dystonic and individuals who indulge in their fantasies by possessing child pornography and who associate with other pedophiles. This is a highly treatment-resistant disorder with a great deal of recidivism (as high as 50 percent). This may not be accurate as some do not come to the attention of law enforcement, while others are incarcerated. This is an extremely damaging disorder for the victims, many of whom have lifelong sexual problems and PTSD. Some believe it is a psychological/sexual preference, while others hold a more moral approach, indicating that this represents criminal behavior. The differentiating factor is whether or not the individual acts on their fantasies. A “predatory pedophile” acts on their sexual desires. Others believe that pedophilia is a repressed sexual orientation that is amenable to treatment. 288
