Why was sadistic personality disorder removed from medical diagnostics?


The only explanation I’ve heard (and even this much is entirely unsubstantiated; I don’t know if anyone with credentials ever publicly made this claim) is that, by classifying it as a disorder, we risk giving criminals leniency for their acts by giving them an insanity defense, when the diagnosis does not in any way, shape, or form, mitigate the sadist’s culpability.

But that doesn’t make any sense. NPD and ASPD are also disorders which cause their patients to hurt people, they don’t mitigate legal culpability, and they’re still in the DSM!

In: 10

I don’t have an exact answer for you, but I do know a bit about the DSM and how it’s updated. Mental health diagnoses are usually pretty difficult to pin down because there’s a lot of overlap of signs and symptoms between diagnoses. For instance, OCD and anxiety are very similar in their presentation of persistent panic over what most would classify as safe. They’re still different things, of course, but this kind of overlap is seen all over the manual.

It could simply be that, like a lot of other diagnoses from previous manuals, they were too abstract to really qualify as a diagnosis (Stockholm syndrome comes to mind, though it was never a formal condition), or perhaps they fit together better with a different diagnosis like with ASD and Asperger’s. Technically, the latter isn’t a formal diagnosis anymore because it’s essentially autism, just a different level of it.

This is by no means a comprehensive look into this and if anyone else has better info, I’d love to learn too. But this is what I can think of at the moment. I hope this helps!

Sadistic personality disorder was a term used to describe people who liked to hurt others physically or emotionally on purpose. It was included in a manual called DSM III-TR that doctors used to diagnose mental problems. However, it was removed from the next version of the manual called DSM IV. One reason for this was that some people thought it was not a real mental problem, but just a way of being mean or evil. Another reason was that there was not enough evidence or research to support its existence as a separate disorder. Some experts disagreed with this decision and wanted it to be added back in future manuals.

Imagine you have a toy box with different kinds of toys. Some toys are soft and cuddly, some are hard and shiny, some make noises and some don’t. You like to play with all of them, but sometimes you get bored and want to try something new. So you decide to mix and match different parts of the toys, like putting a teddy bear’s head on a robot’s body, or making a car fly with a helicopter’s blades. You think this is fun and creative, but your parents don’t like it. They say you are ruining your toys and being cruel to them. They tell you to stop doing that and play with them properly.

Now imagine there is another kid who also has a toy box with different kinds of toys. But this kid doesn’t like to play with them at all. He only likes to break them apart, rip their stuffing out, burn their plastic parts, or smash them with a hammer. He doesn’t do this because he is bored or curious, but because he enjoys seeing the toys suffer and making them useless. He laughs when he hears them squeak or crackle. He doesn’t care if his parents scold him or take away his toys. He just wants to hurt them as much as possible.

The first kid is like someone who has sadistic personality disorder according to the old manual. The second kid is like someone who is just sadistic without having any disorder according to the new manual. The difference is that the first kid has some other reasons for doing what he does besides being mean, while the second kid has no other reasons at all.