Sadistic Personality Disorder or SPD in DSM-III
Hallmarks of this Mental Illness Are Cruelty and Infliction of Psychological Abuse
Jun 11, 2009
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is the reference book used by mental health professionals to make diagnoses for billing purposes.
The handbook, first published in 1952, has been revised five times. The latest work is the DSM-IV TR, fourth edition, revised text, published in 2000. Some of the original disorders have been eliminated because they’re no longer considered as such, while others have been added. Various psychological disorders have been put under a single umbrella.
Some psychiatrists regard the removal of Sadistic Personality Disorder (SPD) from the DSM as a serious mistake and are petitioning for its reinstatement in future editions.
Cluster B Personality Disorders Hallmarks
Individuals with personality disorders of this sort consistently disregard and violate the rights of other people. Behaviors might be aggressive and/or destructive and could include breaking laws, rules and/or deceit. These disorders can overlap with other psychiatric disorders. The hallmarks of Cluster B disorders are:
- Histrionic Personality Disorder (HPD) - Attention seeking, inappropriate emotions.
- Borderline Personality Disorder (BPD) - Instability in interpersonal relationships, self-image and behavior, impulsiveness.
- Narcissistic Personality Disorder (NPD) - Grandiosity, in fantasy and/or behavior, needs admiration, lacks empathy.
- Antisocial (formerly sociopath and psychopath) Personality Disorder (APD) - Lacks conscience, disregards and violates the rights of and exploits others.
DSM-III Criteria for Sadistic Personality Disorder
The hallmark of this disorder was persistent cruel and demeaning behavior exhibited towards others; the behavior directed toward more than one individual. At least four of the following repeatedly occurring behaviors were needed for a diagnosis:
- Uses physical cruelty to establish dominance in relationships;
- Humiliates or demeans people in front of others;
- Treats or disciplines someone under his or her control very harshly;
- Enjoys the psychological or physical suffering of others, including animals;
- Lies to harm or cause pain to others;
- Intimidates or terrorizes others to do what SPD wants;
- Limits independence of people with whom there is a close relationship, and;
- Intrigued by violence, weapons and/or torture.
Why Should SPD Be Restored to the DSM?
While Sadistic Personality Disorder is uncommon, it’s exclusion from the DSM-IV has had negative results for those suffering from the condition, along with those close to them and, primarily, their targets. Not all of those who are close to the SPD are targets and targets can change. Targets, due to the SPD’s psychological abuse, might develop mood and anxiety disorders, including post traumatic stress disorder, that require therapy.
This brief case history illustrates an argument as to why SPD should be reinstated to future editions of the DSM. Pseudonyms are used. Lucille met six of the seven criteria for the SPD diagnosis. Her first targets were her father-in-law who adored her and her toddler daughter. Later, targets would include her husband, sister, mother, granddaughter and female friends.
Some of the targets talked to Lucille’s daughter, Shawn, about her cruelty and asked why this was occurring. Shawn was a therapist whose career began in 1998. She used the DSM-IV as a diagnostic tool. It wasn’t until several years later, while doing research, that Shawn learned of SPD. She realized her mother had the disorder.
Looking back, Shawn was able to see how the family enabled Lucille out of ignorance. It was “her way.” Lucille frequently employed pity parties and guilt trips. She also would say, “If there’s anything I hate, it’s a liar.” Usually this was followed by, “:I want to tell you something,” at some point in the conversation, “but you must keep it a secret.” Then, she’d lie.
It was known that Lucille was cruel and manipulative. It was evident to all that she intimidated and humiliated people. People talked about how she gloated when she recounted what she did to others and feared they might receive the same treatment if they displeased her.
Would Things Have Been Different had the SPD Been in the DSM?
Would there have been effective treatments developed for the SPD? It’s a known fact that there is no cure for Antisocial Personality Disorder. People with Cluster B Personality Disorders are difficult to treat. They don’t feel distress with their dysfunctional behavior because they get what they want. They justify their actions. Most refuse to seek therapy, so it’s unlikely that there would have been such treatment.
Could the targets have received more effective therapy if SPD was recognized? Most likely. Client-centered therapy is tailored to the individual’s needs. Usually, a variety of therapeutic techniques are employed. There should be slight differences in the way a target of an Narcissistic Personality Disorder is treated and how a Histrionic Personality Disorder patient would be treated.
Many believe that the only way to be sure that reinstatement of the SPD in the DSM is warranted is to include it in the next edition and continue research to discover whether or not this is beneficial.
Sources:
- DSM-IV TR on BehaveNet.com.
- Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, American Psychiatric Association, (1987).
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