Journal of Personality Disorders, 15(6), 475-486, 2001

© 2001 The Guilford Press

KAMINER AND
SADISTIC PERSONALITY
STEIN DISORDER

SADISTIC PERSONALITY DISORDER IN

PERPETRATORS OF HUMAN RIGHTS ABUSES:
A SOUTH AFRICAN CASE STUDY
Debra Kaminer, MPsych,
and Dan J. Stein, BSc (Med), MBFRCPC

Although state-sponsored human rights abuses have long been com-

monplace, the psychological profiles of perpetrators are not well delin-
eated. This article examines the utility of the diagnosis of sadistic
personality disorder (SPD) in explaining the commission of atrocities.
The history of, and controversies surrounding, SPD are briefly reviewed.
Using a case study from the amnesty trials of the Truth and Reconcilia-
tion Commission (TRC) in South Africa, the relevance of the SPD diagno-
sis for an infamous perpetrator of political violence is debated. Sources of
data include the perpetrator’s autobiography, transcripts from the am-
nesty trial, and Structured Clinical Interview for DSM-IV Axis II Person-
ality Disorders (SCID-II; First, Spitzer, Gibbon, & Williams, 1994) ratings
provided by four people who had contact with the perpetrator during his
trial. The authors provide arguments for and against the use of the SPD
diagnosis in this case and in similar contexts of perpetration. It is pro-
posed that neither psychological reductionism nor social reductionism
can adequately account for the motivations of political perpetrators, and
an integrative approach to the understanding of perpetrators is advo-
cated. Implications for diagnostic criteria are discussed.

There has arguably been a global rise in awareness of state-sponsored hu-

man rights abuses over the past decade, and certainly the details of political
crimes in contexts such as South Africa, Chile, Bosnia, and Rwanda have
increasingly been brought to public awareness through truth commissions
and international war crimes tribunals (Clark, 1992; Hayner, 1994; Inter-
national Criminal Tribunal for Former Yugoslavia, 1999). The accounts of
survivors of state-sponsored violence make painfully clear the brutal and
sadistic nature of these violations, which frequently include rape, torture,
murder, and other forms of psychological and physical cruelty (Agger &
Jensen, 1990; Cienfugos & Monelli, 1983; Truth and Reconciliation Com-

The authors were supported by the Medical Research Council (MRC) of South Africa.
From the Department of Psychology, University of Cape Town (Kaminer) and the Department of
Psychiatry, University of Stellenbosch, South Africa (Stein).
Address correspondence to Debra Kaminer, MPsych, Department of Psychology, University of
Cape Town, Rondebosch 7701, Cape Town, South Africa; E-mail: dkam@humanities.uct.ac.za.

475
476 KAMINER AND STEIN

mission of South Africa Report, 1998). We might well ask, therefore,

whether the people who perpetrate such acts are sadistic by nature.
Theories on the roots of evil (Baumeister, 1997; Kressel, 1996; Staub,
1989, 1998) have generally proposed that individual pathology accounts for
only a small percentage of human cruelty, and several authors have empha-
sized the role of social, political, historical, and ideological contexts in moti-
vating atrocities (Bauman, 1989; Foster, 2000a; Goldhagen, 1997). While
the individual characteristics of perpetrators are certainly insufficient to ex-
plain human cruelty on a mass scale, they cannot be ignored. Despite the
limitations of psychological reductionism, an understanding of individual
factors can inform the degree to which perpetrators, rather than broad po-
litical or ideological systems, should be held accountable for atrocities, and
may inform the prevention of such abuses in future (Stein, 2000). However,
the psychological profiles of those who commit severe human rights abuses
have not been well-delineated, owing in part to the lack of a suitable popula-
tion for systematic study: Perpetrators seldom present voluntarily for treat-
ment, and often live in hiding or anonymity once the political climate no
longer supports them (Post, 2000).
Although the existence of the sadistic personality disorder (SPD) as a clini-
cal entity has garnered much debate within psychiatry, the role of SPD in
the perpetration of political crimes has received little attention. Here, we
briefly review the development of the concept of SPD and some of the contro-
versies that have surrounded it. Thereafter, we debate the role of the SPD di-
agnosis in the context of politically motivated perpetration, illustrated by a
case study from the South African Truth and Reconciliation Commission
(TRC).

HISTORY OF SPD
For over a century, the theoretical literature has recognized the existence of
sadism, that is, taking pleasure in inflicting pain or humiliation on others.
The term was first coined by Krafft-Ebing (1898) and has since undergone
several theoretical developments within psychology (see review by Fiester &
Gay, 1991). There is general agreement that sadism refers to deriving satis-
faction or pleasure from inflicting pain or humiliation upon others, usually
(but not confined to) the sexual object. There is less agreement regarding the
etiology of sadism, with Freudian psychoanalysis emphasising its biologi-
cal, instinctual base (Freud, 1915, 1924) and later schools locating its ori-
gin within early object relations (Avery, 1977; Bieber, 1966; Fromm, 1973)
and disturbances in the development of the self (Kohut, 1971, 1972).
Although sexual sadism has long been considered an Axis I paraphilia
(American Psychiatric Association, 1987), there has been far less consen-
sus on whether repeated sadistic behavior which is not solely for the pur-
pose of sexual arousal, should constitute a personality disorder. With the
development of DSM-III-R (American Psychiatric Association, 1994), sa-
dism was conceptualized in the psychiatric nomenclature as a personality
disorder for the first time. It was proposed that sadistic personality disorder
be included in DSM-III-R to describe a longstanding pattern of cruel, de-
meaning, and aggressive behavior often seen in forensic settings but not ad-
SADISTIC PERSONALITY DISORDER 477

TABLE 1. Diagnostic Criteria for Sadistic Personality Disorder

A. A pervasive pattern of cruel, demeaning and aggressive behavior, beginning by early adulthood, as
indicated by the repeated occurrence of at least four of the following:
1. has used physical cruelty or violence for the purpose of establishing dominance in a relationship
(not merely to achieve some noninterpersonal goal, such as striking someone in order to rob him
or her)
2. humiliates or demeans people in the presence of others
3. has treated or disciplined someone under his or her control unusually harshly (e.g., a child, stu-
dent, prisoner, or patient)
4. is amused by, or takes pleasure in, the psychological or physical suffering of others (including ani-
mals)
5. has lied for the purpose of harming or inflicting pain on others (not merely to achieve some other
goal)
6. gets other people to do what he or she wants by frightening them (through intimidation or even ter-
ror)
7. restricts the autonomy of people with whom he or she has a close relationship (e.g., will not let
spouse leave the house unaccompanied or permit teenaged daughter to attend social functions)
8. is fascinated by violence, weapons, martial arts, injury, or torture
B. the behavior in A has not been directed toward only one person (e.g. spouse) and
C. has not been solely for the purpose of sexual arousal (as in sexual sadism)

equately described by other Axis II disorders. Eight criteria for the disorder
were developed (see Table 1), and the category was included in an appendix
of DSM-III-R entitled “Proposed Diagnostic Categories Needing Further
Study.” In the DSM definition, deriving pleasure from the suffering of others
is one possible criteria for sadism, but is not necessary for the diagnosis to
be made.
There was much controversy surrounding the inclusion of SPD as a diag-
nostic category, based primarily on its degree of overlap with other person-
ality disorders, the absence of data on its reliability and validity, and the
potential for misuse (Fiester & Gay, 1991). These issues have yet to be satis-
factorily clarified, as subsequent studies of SPD have been few, and findings
inconsistent. Reported prevalence rates in clinical and forensic settings
range widely from 2.5% to 33%, with a high rate of overlap with other per-
sonality disorders and with Axis I substance abuse and depressive disor-
ders (Berger, Berner, Bolterauer, Gutierrez & Berger, 1999; Freiman &
Widiger, 1989; Fuller, Blashfield, Miller, & Hester, 1992; Gay, 1989; Holt,
Meloy, & Strack, 1999; Reich, 1993; Spitzer, Feister, Gay, & Pfohl, 1991).
However, Fiester and Gay (1991) note that overlap or comorbidity does not
necessarily indicate the absence of a separate disorder, and it has been re-
ported in both an empirical study (Berger et al., 1999) and a survey of foren-
sic psychiatrists (Spitzer et al., 1991) that a substantial percentage of
forensic patients with SPD do not meet criteria for any other personality dis-
order.
Although one study (Freiman & Widiger, 1989) established that SPD has
high inter-rater reliability, this has yet to be replicated; and while there is
evidence supporting the face validity of most of the SPD criteria (Freiman &
Widiger, 1989; Spitzer et al., 1991; Blashfield & Breen, 1989) there are no
data on external validity. Spitzer and colleague’s 1991 survey of forensic
psychiatrists reported substantial concern about the misuse of SPD in miti-
478 KAMINER AND STEIN

gating responsibility for violent crime, although actual instances of this had
been rare (Spitzer et al., 1991). However, there have been no subsequent
studies of the use of SPD as a legal defense. Thus, the post-DSM-III-R litera-
ture has yet to resolve conclusively the main controversies surrounding
SPD, and SPD was not included in DSM-IV.
Here we examine an issue that has received little attention in the SPD de-
bate. Is (non-sexual) sadism always an individually located personality dis-
order or is it sometimes located in broader social, political, and cultural
processes? In particular, within a context of state-sponsored violence and
intimidation, where do we lay the blame for the intentional infliction of suf-
fering? And at what level do we treat the problem and work toward its future
prevention?

SPD IN PERPETRATORS OF STATE-SPONSORED VIOLENCE: A CASE

STUDY
Issues of culpability are particularly pertinent in post-apartheid South Af-
rica, where the degree of guilt of individual police and security force mem-
bers for the severe ill-treatment, torture, and murder of anti-apartheid
activists has become the focus of several amnesty trials at the Truth and
Reconciliation Commission (Stein, Swartz, & Walaza, 2000). Here, we dis-
cuss one highly publicized case of a policeman, Eugene de Kock, who was
instrumental in the planning and implementation of numerous “opera-
tions” including the kidnapping, assault, poisoning, torture, and murder of
activists.

CASE HISTORY

Court testimony (unpublished transcripts) and autobiographical accounts

(de Kock, 1998) suggest that de Kock was the product of a strict, rigid up-
bringing. His father was a prosecutor and magistrate, his mother a house-
wife. De Kock (1998) describes his father as an emotionally distant,
authoritarian man who abused alcohol, and whom he feared. His parents’
marriage was marked by conflict and his mother left the home when he was
a child, an experience he describes as the most frightening of his life. His
childhood was characterized by a form of emotional poverty:
...very little was discussed at home. The only talking point was whether I
had done my homework, whether it was correct, and whether I had done my
bit in the garden or elsewhere. Certainly there were never any pats on the
back or any praise. Only my father’s words: “You must work hard or you’ll
become a porter on the railways.” (de Kock, 1998, p. 50).

While his lawyer suggested during the amnesty trial that de Kock had been
emotionally desensitized by this upbringing, de Kock himself says:
“I do not believe my childhood was especially bizarre. To be sure, my father
was the proverbial hard man and he drank too much. So what? Many sons
have had hard men and drinkers for fathers” (de Kock, 1998, p. 45).
SADISTIC PERSONALITY DISORDER 479

He describes his mother as politically moderate, but his father was a strong
supporter of the Nationalist Party (the political party that developed and im-
plemented the policy of apartheid). Although politics were seldom dis-
cussed, “my brother and I were brought up by [my father] to be strongly
anti-communist” (de Kock, 1998, p. 49).
De Kock joined the South African police force in 1968 with the specific aim
of fighting “terrorism.” He soon applied for a course in counterinsurgency
and was involved in operations in neighboring Rhodesia (now Zimbabwe)
and South West Africa (now Namibia), which entailed the ambush and kill-
ing of anti-government “terrorists” in these regions. In 1983, several promo-
tions later, he joined the police counterinsurgency unit at a small South
African farm called Vlakplaas, where anti-terrorist operations continued
with the help of substantial government funding. These operations included
the abduction and interrogation of anti-apartheid activists: “We could never
have gained any information about the enemy — including potential acts of
terror — without harsh interrogation techniques. Interrogation methods
were generally a means to an end. And we believed the end justified the
means” (de Kock, 1998, p.103). De Kock was also involved in the bombing of
several buildings, and planned the murder of an activist by letter bomb.
During his time at Vlakplaas, he led numerous local and cross-border oper-
ations in which “terrorists,” their families, and companions were murdered,
often by de Kock himself. For example, on one occasion, “we killed the four
Chand family members, the watchman, and the family dog” (de Kock, 1998,
p. 193). (He later discovered that the family members included two deaf chil-
dren). He was also involved in the harsh punishment of disloyal informants:
“We beat him very badly and for a long time. He was a broken man by the
time we finished . . . .” (de Kock, 1998, p. 166). De Kock later shot the same
informant “twice in the heart with a .38 special revolver” and arranged for
his body to be “utterly blown up” by explosives (p. 167).
Testimony offered in mitigation during de Kock’s amnesty trial argued
that he suffered from the “emotional blunting” associated with
posttraumatic stress disorder (PTSD), as a result of repeated combat experi-
ences (unpublished transcripts). The state contested this and de Kock was
sentenced to two life sentences plus 212 years in prison, to run concur-
rently.

SADISTIC PERSONALITY OR SADISTIC SYSTEM?

De Kock has been dubbed “Prime Evil” by the South African media due to
his long list of political crimes. Yet, according to his trial testimony (unpub-
lished transcripts) and his autobiography, each act was perpetrated on the
orders of his superiors (including, he claims, the state president) and, fur-
thermore, he was frequently rewarded for his actions (he received the Police
Star for Outstanding Service several times and had been promoted to the
rank of colonel by the time of his discharge).
So who is to blame and who is to be punished? Where is the line between
the sadism of an individual and that of an entire political system? Similar is-
sues were debated at the trials of Nazi war criminals half a century ago
(Arendt, 1964) and more currently in the genocidal contexts of Rwanda and
480 KAMINER AND STEIN

Bosnia (Deklava & Post, 1997). The question for clinicians and researchers
is whether one should diagnose SPD for someone like de Kock if he meets
the criteria for the diagnosis, or whether the nature of the socio-political
context mitigates against such psychological reductionism? This question
is crucial to the development of strategies aimed at the prevention of future
human rights abuses, as well as to the rehabilitation of perpetrators (an im-
portant, albeit morally contentious, social and clinical issue).
According to his testimony and that of other witnesses during his amnesty
trial (unpublished transcripts), and also according to his autobiography, de
Kock meets enough SPD criteria to warrant a diagnosis (four out of eight cri-
teria are required for the diagnosis of SPD to be met). He has used physical
cruelty or violence for the purpose of dominating others, he has humiliated
and demeaned people in the presence of others, he has treated or disci-
plined someone under his control unusually harshly, he has gotten others
to do what he wanted by frightening them, and he is fascinated by weapons
and military tactics. There is no evidence from his autobiography or reports
of the expert witnesses who evaluated him at trial (unpublished transcripts)
that any of these behaviors have been for the purpose of sexual arousal, and
thus, they cannot be better accounted for by an Axis 1 diagnosis of sexual
sadism.
As an additional source of data, several people who had close contact with
de Kock during his trial were asked to rate his behavior according to the
Structured Clinical Interview for DSM-IV Axis II Personality Disorders
(SCID-II; First, Spitzer, Gibbon, & Williams, 1994), a structured diagnostic
interview of DSM-IV Axis II disorders. The raters included: the journalist to
whom de Kock related his autobiography; a psychologist and a criminologist
who both evaluated de Kock and testified at his trial as expert witnesses;
and the daughter of a slain anti-apartheid activist about whose assassina-
tion de Kock claimed to have knowledge, who visited him in jail on several
occasions and who reported extensively on the TRC proceedings in her pro-
fessional role as a journalist. These data have limited empirical value: they
were not formal clinical interviews, two of the raters had no clinical or foren-
sic background, and it is possible that de Kock’s situation at the time —
awaiting trial in a maximum security prison — would have made him reluc-
tant to reveal very much about himself, particularly anything that may be
incriminating. However, the ratings provide supplemental data on de Kock’s
behavior from four independent perspectives and from a variety of types of
interactions, and are used here primarily to contribute to the theoretical de-
bate.
The highest SPD rating was given by the biographer, who endorsed seven
criteria but did not endorse the criteria for taking pleasure in the suffering of
others. His ratings yielded additional diagnoses of borderline, narcissistic,
and obsessive compulsive personality disorders. The criminologist en-
dorsed five SPD criteria, but noted that each of these behaviors was specific
to de Kock’s previous work context. She did not endorse the following crite-
ria: takes pleasure in the suffering of others, has lied for the purposes of
harming or inflicting pain on others, restricts the autonomy of people with
whom he has a close relationship. She also rated de Kock as having a schiz-
oid and an antisocial personality disorder. Although these two raters also
SADISTIC PERSONALITY DISORDER 481

endorsed sufficient criteria for current behavior to give de Kock a diagnosis

of antisocial personality disorder, there is no evidence of a childhood or ado-
lescent history of conduct problems, which would be necessary to complete
this diagnosis. The overlap of SPD with other personality disorders reflects
findings in the SPD literature reviewed above and the high degree of overlap
in personality disorders in general (Oldham et al., 1992).
The other two raters did not endorse sufficient SPD criteria to warrant a
diagnosis. The psychologist noted that de Kock was fascinated by weapons
and battle tactics with regard to his counterinsurgency work, but did not
endorse any other SPD item, and did not diagnose any other personality dis-
order. The journalist did not endorse any SPD item, noting that some of the
behaviors had been present in de Kock’s previous work context but were not
currently present according to her observations. Her scores did not yield
any other Axis II diagnosis.

DISCUSSION
Based on information from his autobiography and trial, together with the
observations of four independent raters, do we diagnose de Kock as having
SPD? An argument can be made both for and against doing so.

THE CASE FOR SPD

Let us argue in favor of making the diagnosis for a moment. De Kock him-
self, several witnesses at his trial, and two raters all acknowledge sufficient
behaviors by de Kock to warrant a diagnosis of SPD. These behaviors, ac-
cording to DSM-III-R, specifically distinguish de Kock from “normal” people.
Thus, de Kock was not just an ordinary person in an abnormal situation.
Certainly, the socio-political context of the time encouraged his actions. But
even if his crimes were politically motivated and not purely for his own psy-
chological gratification, surely he must have a personality structure that
can accommodate the repeated commission of acts of cruelty. How else do
we explain his willingness to perpetrate these acts continually over a period
of many years (and it is clear from his autobiography that he acted willingly,
with conviction and commitment, not out of fear or simple obedience to au-
thority)? His boast that he was one of the most successful and feared of the
apartheid regime’s so-called counterinsurgency forces is not an idle one,
and his satisfaction in the details of his work appears to have been more sig-
nificant to him than the importance of fighting for apartheid. Furthermore,
the inflexibility of his methods and approach (which sometimes resulted in
the wrong person being killed, and in general acted only to further
strengthen the struggle against apartheid) appear to suggest dysfunction.
Although his autobiography expresses some disapproval of cruelty inflicted
by his colleagues, at no point do his own actions appear to be ego-dystonic
— his many violent acts are described in a pragmatic, matter-of-fact tone
devoid of emotional conflict or ambivalence (Foster, 2000b) — and some-
times boastfully proud. The weight of evidence could lead us to conclude
that de Kock had a longstanding, inherently sadistic personality structure
that simply found its perfect niche in the apartheid state.
482 KAMINER AND STEIN

If we allow that de Kock has a sadistic personality disorder, it has several

implications. It implies that his actions (and those of others like him) are the
outcome of some inherent pathology with biological and/or early environ-
mental roots. This, in turn, might suggest that his treatment or rehabilita-
tion (and that of others like him) should be based on a model of individual
pathology, and thus aim toward personality restructuring (although we
take the point that a diagnosis of antisocial personality disorder, for exam-
ple, does not often imply a call for treatment). It might also be taken to imply
that the prevention of many human rights abuses lies in the prevention or
early treatment of SPD and similar disorders.

THE CASE AGAINST SPD

Let us look at the argument against labeling de Kock with sadistic personal-
ity disorder. First, two raters commented that de Kock’s so-called SPD be-
haviors were specific to his previous work context and were not apparent in
his current general personality style. Similarly, many of the behaviors en-
dorsed by the two raters who did diagnose SPD could be viewed as an inher-
ent part of de Kock’s job description (that of “hired gun”), rather than
self-motivated behaviors. There is no evidence of sadism in de Kock’s behav-
ior toward his wife and children. Does the perpetration of sadistic acts (in
which, both these raters agree, de Kock took no pleasure) necessarily imply
an inherently sadistic character? Second, strong ideological justifications
(defending the state against “terrorists” and “communists”) may have
superceded any ego-dystonic feelings about his work (as many Nazi war
criminals also claimed in their defense). Third, it could be argued that de
Kock was indeed a normal person in abnormal circumstances. In the ideo-
logical atmosphere of the day, many white South Africans may have consid-
ered it normal and appropriate for “terrorists” and “communists” to be
eliminated by the state. Finally, if we label de Kock with SPD, we may have to
do the same for many others who commit similar crimes in contexts of
state-sponsored violence. This could yield a huge general prevalence of SPD
in countries such as South Africa, Bosnia, Rwanda, and Chile, which seems
unlikely given the low reported prevalence rates for other personality disor-
ders (APA, 1994).
What are the implications if we choose not to diagnose de Kock with a sa-
distic pathology, even though he meets the criteria on paper? First, it may
be taken to imply that atrocities are perpetrated by dysfunctional systems,
not dysfunctional individuals. Second, it might suggest that treatment and
rehabilitation lie in “de-programming” perpetrators of undesirable ideolo-
gies and prejudices, rather than personality restructuring. Third, it implies
that the future prevention of such atrocities lies in socio-cultural interven-
tions, namely the prevention of particular kinds of state structures and ide-
ologies.

TOWARD AN INTEGRATIVE MODEL

Ultimately, perhaps each of these arguments ends in a theoretical cul-de-

sac. If we conclude that de Kock is a normal man corrupted by an evil social
SADISTIC PERSONALITY DISORDER 483

system, then we all have the potential to become “Prime Evil” under the right
circumstances. But this thesis does not adequately explain what leads
some people to actively take up the “dirty work” of state-sponsored violence
while others do not, nor what made the much-decorated de Kock particu-
larly lethal in his job.
On the other hand, if we conclude that individual psychopathology is a
necessary prerequisite for the perpetration of state-sponsored violence,
what are the broader social mechanisms that trigger particular pre-existing
psychological disturbances in some people? How do social influences and
individual pathology intersect to cause the perpetration of acts of political
violence?
As we have argued above, these are not merely theoretical debates — they
have implications for clinical intervention, legal culpability, and prevention.
We posit that neither psychological redunctionism nor social reductionism
are adequate to explain and address the actions of political perpetrators.
Rather, a fuller understanding of the interplay between individual pathol-
ogy and broader contextual (social, cultural, political, historical, ideologi-
cal) factors is required.
It is likely that the interaction between individual pathology and contex-
tual influences as determinants of the perpetration of human rights abuses
is complex and bi-directional. Pre-existing sadistic personality characteris-
tics may lead sadistic individuals toward particular environments (e.g. po-
lice services or the military), which provide gratification for their needs, or
may make one person more comfortable with perpetrating sadistic acts in
an environment of state oppression than a colleague would be. A particular
combination of factors in the socio-political context (e.g. nationalist ideology
together with an authoritarian culture; ethnic prejudice together with a
threatened loss of resources) may activate in some individuals a pre-exist-
ing tendency toward sadism that would otherwise have remained perma-
nently dormant.
As both individual and contextual factors play a critical role in the perpe-
tration of human rights abuses, it may perhaps be most accurate to say that
the etiology of such forms of sadism is located at the interface between the
individual and his or her social context. It is this interface that requires
careful exploration and understanding. Since the acts, motivations, and
socio-political contexts of perpetrators are increasingly being documented
by truth commissions and war crime tribunals, there is growing scope for
the refinement of more integrated theoretical models of perpetration, in
which SPD and other psychopathologies may constitute one element. Such
an integrative approach may hold the key to the prevention of future
state-sponsored atrocities.

IMPLICATIONS FOR DIAGNOSTIC CRITERIA

The case of de Kock, and perpetrators like him, suggests that the utility of
the current diagnostic criteria for SPD may be limited insofar as they fail to
account for the role of the social context in the commission of atrocities. If
perpetrators of human rights abuses display behavioral criteria for SPD,
but this behavior is restricted to the performance of politically or ideologi-
484 KAMINER AND STEIN

cally motivated acts (either as functionaries of an oppressive state or as ci-

vilians in a context of political conflict) and is not evident in other areas of
their personality functioning, does this preclude a diagnosis of SPD?
One possibility for revision of the diagnostic criteria is to add an exclusion
criterion for cases where the person’s behavior is better explained by con-
textual factors than individual ones. While this would go a long way toward
addressing the conundrum presented by political perpetrators, this revi-
sion raises problems of its own. To what extent, for instance, can one mean-
ingfully separate contextual and individual factors? An integrative model
suggests that it may be difficult, even artificial, to do so when attempting to
understand the motivations of perpetrators of human rights abuses.
In thinking about revisions to the diagnostic criteria, we return to the orig-
inal conceptualization of sadism, which placed the criterion of sadistic plea-
sure at its center. Might it not be the presence of sadistic pleasure that
distinguishes SPD from sadistic behavior that is contextually motivated?
Thus, one could distinguish perpetrators who actually derive pleasure from
torturing others as part of their job from those whose sadistic acts are car-
ried out with some (or much) distaste but are driven by fervent political or
ideological commitment, by sheer obedience to authority, or other factors.
We would therefore venture the possibility of redefining SPD by making cri-
terion A4 (“is amused by, or takes pleasure in, the psychological or physical
suffering of others”) a compulsory criterion for the diagnosis, rather than
one possible criterion. (Analogously, some authors have suggested making
lack of remorse more crucial to the diagnosis of antisocial personality disor-
der to ensure that this disorder is not given, for example, to those who are
forced to commit crimes to obtain their livelihood). Deriving pleasure or
gratification from the suffering of others would distinguish persons whose
acts are driven by an intrinsic sadistic urge from those who are motivated by
other individual or contextual forces. Intrinsic gratification from inflicting
suffering would thus always be present in the person with SPD no matter
what other individual or contextual influences may contribute to their be-
havior; while individuals who commit sadistic acts in a variety of social con-
texts, but derive no pleasure from such activity, would be excluded from the
diagnosis. The question of determining whether a perpetrator’s pleasure in
his or her job was simply gratification in “a job well done” or whether it went
beyond this, would entail some clinical judgment.
This suggestion for revising the diagnostic criteria for SPD is purely ex-
ploratory and begs both theoretical debate and empirical validation. We
hope that this article will provide a stimulus for the revisitation of the SPD
diagnosis. And what of Eugene de Kock? Although we are unclear as to
whether he meets our proposed criteria for SPD, we believe that a range of
personality disorder traits (e.g., narcissistic and paranoid) are likely to have
contributed to his success (and ultimate failure) as “Prime Evil.” Prevention
at both the individual level (for example, identifying children with aggressive
and/or sadistic traits) and the social level (for example, strengthening dem-
ocratic state structures) is necessary to minimize the number of future
“Prime Evils” in South Africa.
SADISTIC PERSONALITY DISORDER
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