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!
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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!
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