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 International Journal of Forensic Mental Health

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Correlates of Distinctive Categories of Sadism – Results of

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Four Case Reports

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Journal: International Journal of Forensic Mental Health

Manuscript ID: Draft

Manuscript Type: Original Article

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Keywords: sadism, categories, determinants

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Page 1 of 20 International Journal of Forensic Mental Health

Correlates of Distinctive Categories of Sadism 1

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3 Correlates of Distinctive Categories of Sadism – Results of Four Case Reports
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Abstract
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12 In this article the case reports of four sadists were analyzed. Sadism can be linked to
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narcissistic injury, shame, self-hate, envy, revenge, rejection, social exclusion, thrill seeking,
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17 unbearable loneliness, curiosity and scientific interests, social-emotional and moral

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19 underdevelopment, and need for transformation. More research into the psychosocial,
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22 neurobiological, cultural, political, and intrapsychic aspects of sadism is warranted for the
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24 development of more effective prevention and intervention programs for indivuduals at risk of
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26 sadistic development.
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31 Key-words: sadism, determinants, case reports, qualitative research
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 International Journal of Forensic Mental Health Page 2 of 20

Correlates of Distinctive Categories of Sadism 2

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3 Correlates of Distinctive Categories of Sadism – Results of Four Case Reports
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The term ‘sadism’ was coined by Krafft-Ebing (1886/1965) to depict the association
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10 between cruelty, violence, and lust. His description of the disorder was based upon the writings of
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12 the Marquis de Sade, as well as a number of famous and clinical case studies. Krafft-Ebing's basic
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assumption was that all forms of sex not directly related to procreation were perversions. He
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17 described sadism and masochism in terms of the theory of degeneration. Krafft-Ebing saw a basic
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19 and natural tendency in men towards sexual sadism and a natural tendency of women towards
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22 sexual masochism, a view that would be expanded by psychoanalysis.
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24 However, Krafft-Ebing's theories were adopted by Sigmund Freud and became an integral
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26 part of psychoanalysis, thereby ensuring their predominance. Freud made masochism and -- to a
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29 lesser degree -- sadism core parts of psychoanalysis. In “Three Essays on the Theory of Sexuality”
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31 he called the tendency to inflict and receive pain during sex "the most common and important of all
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perversions" (Freud,1905/1962). He also pointed out that both tendencies commonly occurred in the
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36 same individual. Freud changed his theories on the genesis of sadism and masochism repeatedly,
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38 first stating that masochism only arose as a form of sadism against the self. He later introduced such
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41 concepts as "primary" and "secondary" masochism and sub-forms such as "feminine" and "moral"
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43 masochism. He also saw guilt as an important factor and integrated sadism and masochism into his
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45 theory of psychosexual development. They were assumed to be a sign of incomplete or incorrect
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sexual development in the child. Current theorists and classification systems provide similar
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50 conceptions of the disorder, and generally describe sadism as the pairing of sexual arousal with the
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52 infliction of physical or emotional pain and dominance and control over a victim (Brittain, 1970;
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55 Dietz et al., 1990; Gratzer and Bradford, 1995; Gray et al., 2003; MacCulloch et al., 1983).
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57 Outside the area of psychoanalysis, views on sadomasochism began to change in the late
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20th century with the study of actual behavior of real-life sadomasochists. The first large-scale

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Page 3 of 20 International Journal of Forensic Mental Health

Correlates of Distinctive Categories of Sadism 3

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3 empirical study on sadomasochism was conducted by Andreas Spengler in 1977. Spengler, a
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5 German physician, used questionnaires to gain basic data (Spengler 1977). The results of this study
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contradicted most earlier work, especially that of the psychoanalysts, and Spengler (1979)
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10 concluded that previous research was "heavily burdened with prejudice and ignorance". It was
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12 revealed that far more people than previously assumed practice sadomasochism and
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sadomasochism. Much of the modern research is less concerned with what causes sadistic and
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17 masochistic urges than describing their mechanisms and characteristics.

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19 Sadism is a behavioral spectrum ranging from mild forms of culturally sanctioned ritual to
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22 the grotesque criminality of serial killers (Drukteinis, 1992; American Psychiatric Association,
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24 2004). 25% (n=19 of 76; see Delscluse & Pham, 2005) and 36,7% (n=61 of 166; see Hill et al.,
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26 2007) of two sample of violent forensic patients demonstrate sadistic behavior and fantasies.
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29 Sadistic fantasies and behaviors can include dominance, humiliation, bondage, biting, burning,
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31 whipping, penetration with foreign objects, strangulation, and mutilation of the body (Dietz et al.,
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1990, Hucker, 1997, MacCulloch et l., 1983; Warren and Hazelwood, 2002). The prevalence of
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36 sexual fantasies in normal populations varied from 0,5-33% (Decluse & Pham, 2005) and 2.1-
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38 39,4% (Gary et al., 2003). Sexual sadism is primarily a male phenomenon and little, if any, work
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41 has addressed the prevalence or specific symptom manifestations in women (Kirsch & Becker,
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43 2007).
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Definition
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52 Sadistic personality disorder (SPD) is a proposed diagnostic category in the DSM-III-R, but
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55 is not included in the DSM-IV. Individuals with a sadistic prototype personality maintain a
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57 combative self-image and an abrasive interpersonal style. They believe that they should be in
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control in interpersonal affairs, and they feel threatened in situations where they are not in charge.

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 International Journal of Forensic Mental Health Page 4 of 20

Correlates of Distinctive Categories of Sadism 4

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3 When they are in a position of status or authority, they may be inclined to abuse their position
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5 (Rasmussen, 2005). The DSM-IV definition of sadism includes the following criteria: "Over a
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period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
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10 involving acts (real, not simulated) in which the psychological or physical suffering (including
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12 humiliation) of the victim is sexually exciting to the person" (p. 530). This definition of sexual
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sadism indicates that the origins of sexual pleasure and sexual excitement are found in fantasies or
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17 acts in which physical or psychological torture causes the victim to suffer. However, according
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19 several authors, the essence of sadism is not the victim's suffering, but rather the absolute power
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22 exerted over them (Dietz, Hazelwood & Warren, 1990; Gratzer & Bradford, 1995; Johnson &
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24 Becker, 1997; MacCulloch, Snowden, Wood & Mills, 1983; Proulx et al., 2006 ).The DSM-IV
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26 defines sexual sadism as a paraphilia that involves “recurrent, intense sexually arousing fantasies,
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29 sexual urges, or behaviors involving (real) acts…in which the psychological or physical suffering of
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31 the victim…is sexually exciting to the person” (American Psychiatric Association, 2000, p. 574).
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36 Determinants of Sadism
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41 Sadism is linked to attachment dysfunctions (Bender et al., 2001; Blizard, 2001; Howell,
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43 1996); low self-esteem and threat of self-esteem (Brittain, 1970); the conviction of being unlovable
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45 and unacceptable (Rizzuto, 1999); painful experiences of rejection/neglect (Martens & Palermo,
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2005); envy and a desire to incorporate the envied object (Klein, 1975); revenge which can act as a
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50 defence against shame, loss, guilt, powerlessness, and mourning, by directing rage outward, away
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52 from painful object loss (Beattie, 2005); a dysbalanced shame-rage mechanism (Rosenberger,
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55 2005); narcissistic injury (Baumeister & Campbell, 1999; Brittain, 1970); intense need for absolute
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57 control as a consequence of fear of object loss (Martens & Palermo, 2005; Person, 1986);
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unbearable loneliness (Grubin, 1994; Martens & Palermo, 2005); vulnerability to primal anxiety,

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Page 5 of 20 International Journal of Forensic Mental Health

Correlates of Distinctive Categories of Sadism 5

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3 aroused by danger of annihilation, or nonexistence, which can be compensated for only by a total
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5 mastery over the object, such as sadism (Lafond, 1992); provoding structure of the dominant,
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sadistic partner to the submissive, masochistic partner in SM-relationships (Cohen, 1969); sensation
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10 seeking (Baumeister & Campbell, 1999); and prevalence of a martyr father or mother (Steiner,
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12 2004). Both the martyr mother and martyr father were non-significantly correlated with sexual
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sadism in males. The martyr mother is unhappy and depressed, and coveys these feelings to her
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17 children who often feel responsible for her unhappiness. Children who have a martyr mother run an
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19 significant increased risk for developing self-hate, negative self-cognitions, depression (in prior
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22 studies) (Steiner, 2004), lack of social coping with stress (Baumeister & Campbell, 1999), and
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24 neurobiological dysfunctions (Bradford, 2006) . Various studies have shown that sexual sadism is
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26 associated with brain damage, most commonly in the anterior temporal lobe region of the brain.
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29 How underlying cerebral damage is associated to criminal and sexually violent behaviour is still
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31 unclear (Bradford, 2006).
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36 Qualitative Study Into the Determinants of Sadism
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41 In this qualitative psychodynamic study I examined by means of in-depth interviews and
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43 analysis of the psychotherapeutic process and police files (see for details Crits-Christoph, 1998;
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45 Kächele, 1992; Stuhr & Wachholz, 2001) the distinctive correlates of sadistic behavior in four male
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psychopaths (age 20-46) who were treated in forensic psychiatric hospitals between 1966 and 1995.
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50 I also studied other additional case reports of sadists and other investigations, which were relevant
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52 and of additional value to this study.
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55 My interviews were targeted towards the meanings of central themes in the life world of the
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57 subjects. I made an attempt to cover both a factual and a meaning level. I also utilzed the police
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reports and psychotherapy reports. The topics of the interviews were the a) behaviors; b) opinions,

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 International Journal of Forensic Mental Health Page 6 of 20

Correlates of Distinctive Categories of Sadism 6

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3 moral awareness/capacities and (self-) knowledge; c) feelings and emotional capacities, social
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5 awareness/capacities; d) sensory; e) language use; f) aversive experiences and traumas; g)
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vulnerabilities; and h) background/demographics of the patients. I used the general interview guide
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10 approach, which is intended to ensure that the same general areas of information are collected from
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12 each interviewee. This provides more focus than the conversational (go with the flow) approach, but
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still allows a degree of freedom and adaptability in getting the information from the interviewee.
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19 Case Report 1
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24 Ed was 22 years of age when he was sentenced to forensic psychiatric treatment, because he
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26 molested and raped 7 children between 10 and 14 years of age. He reported that his pedophilic
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29 acting out was a response to humiliation by an adult person. His father-in-law (who was his
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31 employer too) was often dissatisfied with his work performances,, he did not like Ed. After severe
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criticism by his father-in-law he felt intense rageful tendency to rageful, sexual behavior. His
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36 offenses were driven by narcissistic injury, which was paired with intense shame and frustration
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38 (see Martens, 1997, 2005a,b), uncontrollable anger, and need to take revenge. Ed reported that he
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41 selected fragile, young girls for his ritual acts of revenge, because he was afraid of assertive older
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43 girls or women. He considered his victims as substitutes to those people who did hurt him. The
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45 sadistic act gave him optimal gratification when he felt that the suffering and the agony of his
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victims was unbearable. He started his sadistic ritual by humiliating the girls and saying things to
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50 them such as “you are my dirty and stupid little pig.” These acting outs resulted in a short living
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52 increase of self-esteem and improved mood for a couple of days. But, little by little the shame and
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55 self-hate returned. These negative emotions were associated with long-lasting experiences of
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57 rejection by his relatives and peers.
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During psychotherapy he became aware of his social-emotional and moral

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Page 7 of 20 International Journal of Forensic Mental Health

Correlates of Distinctive Categories of Sadism 7

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3 incapacities/limitations, which interfered with normal attachments and interactions with other
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5 people. He realized that he had never a chance to normal social-emotional and moral development
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as a consequence of his social exclusion which caused a lack of social-emotional and moral
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10 practice. He became aware that he hated himself and that he hated his wife, because she was the
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that he was unlovable. But, he felt also an intense need be considered by other persons as special
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22 Ed suffered since early childhood from a low self-esteem that was provoked by severe
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24 emotional neglect and rejection by his parents and other relatives. Emotional neglect was
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26 characterized by a lack of positive attention and role models, lack of prosocial stimulation and
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29 feedback, and lack of social support. Narcissistic injury provoked in him self-hate, shame and
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31 related anger, frustration and an obsessive drive to acting out and revenge. For this purpose he
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selected always shy, vulnerable, young girls who would easily cooperate with him. Furthermore, his
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36 frightful intimidation would break their last resistance. He enjoyed having complete control over
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38 them and he felt that he regained in this way some power over his life. During the therapeutic
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41 process he became increasingly able to feel remorse for what he did to the girls. He was capable to
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43 consider the impact that his sadistic, sexual acts had on the life of the victimized girls such as abuse
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45 of vulnerability, helplessness, the traumatic experience of being raped, and feelings of loss and
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mourning.
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57 Hank was severely physically, emotionally and sexually abused by his parents until he was
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22 years of age. Nobody noticed this because he and his family lived an isolated life on a fishing

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 International Journal of Forensic Mental Health Page 8 of 20

Correlates of Distinctive Categories of Sadism 8

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3 boat. Hank developed sadistic tendencies, which could not stopped or corrected because of a lack of
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5 available pro-social role models. He was not aware that these tendencies were deviant. His daughter
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reported the police that he severely abused his wife and her in a sadistic manner. After his arrest
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10 Hank told the police officers and research psychiatrist that he loved his wife and children. The
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12 emotional and mental world of Hank was so disturbed and immature that he had no idea how to
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15 behave in a social desirable way. His wife never tried to find help for her and the children’s
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17 problems. She was also physically, emotionally, and sexually abused since she was 7 years of age.
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20 Psychotherapeutic treatment and a structured therapeutic hospital community with many interactive
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22 learning moments stimulated Hank to develop his social-emotional and moral skills/capacities. At
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27 social-emotional interactions and he rejected his sadistic tendencies.
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31 The sadistic development of Hank was linked to serious abuse and neglect, lack of
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between the episodes of his sadistic acting out, could display normal responsible and caring
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41 behavior and even tenderness. He defended his family against attacks and threats from the outside
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43 world and he tried to solve their problems. He failed to help his children and wife who suffered
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46 from emotional instability and depression as result of the abusive situation, because he was not
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55 Case Report 3
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60 Victor was an accountant who displayed episodically excessive sensation seeking behavior,

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Page 9 of 20 International Journal of Forensic Mental Health

Correlates of Distinctive Categories of Sadism 9

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3 which occurred when he had drunk too much. When he was sober he demonsrated a very social,
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5 amusing and well adjusted attitude. But, Hank hated this attitude and hankered to become a
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complete different person. He craved for rigorous character transformation by means of sadistic
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10 acts. For that purpose he assaulted and humiliated complete strangers and brought them in
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12 compromizing situations. These strangers were carefully selected by him. Suitable victims
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demonstrated boring, inauthentic behavior like he did. As a consequence of a solistic, sadistic act
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19 these sadistic acts were probably an expression of resistance against his smooth, conformistic,
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22 opportunistic, and inauthentic character. He considered his sadistic acting outs as a) attempts to find
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24 a way out of this impasse, and b) expressions of counterbalance against undesirable societal/social
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26 requirements and expectations. He felt afterwards some compassion with his victims, but no shame.
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31 Victor’s sadistic attitude was determined by shame and frustration because of lack of self-
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realization, his poor self-image, low self-esteem, self-hate, intense desire to transfrom his old
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38 sadistic acting out.
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Fred was a divorced engineer of 55 year of age who was very fond of his privacy and a quiet
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50 living environment. For that reason he was the owner of a one of the 5 houses that were build in a
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52 forest. His neighbors were retired persons who lived there without their children. After a couple of
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55 years his next neighbors moved to a service flat and the house was bought by a family with three
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57 children. Right from the beginning the situation escalated because this family caused continuously
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inconvenience. They produced load noise and displayed egocentric behavior and lack of

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 International Journal of Forensic Mental Health Page 10 of 20

Correlates of Distinctive Categories of Sadism 10

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3 consideration with neighbors. Fred damaged in the first week three cars and two bikes which belong
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5 to the family. In the mid of the night he throw pieces of wood and stones on the roof of the
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newcomers’ house so that all family members waked up fearfully. Furthermore, he warned the
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10 family members that they should move away very quickly, because he would make their life to a
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hell. The police was unable to take action against Fred, because he denied everything and it could
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15 not be proofed that he caused this damage and frightening actions. As a consequence his
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17 provocative and assaultive behavior became worse. Fred parked his small airplane on the green of
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20 the family and he ignored the protest of the family. Only after intervention of the police three days
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22 later he agreed to replace the plain. He accused himself by telling the police that it was an
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24 emergency case. For a couple of days he hold the dog of the family as a hostage and gave him
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27 drugs, because he barked too much. After that Fred assaulted and injured the parents and her little
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29 daughter he was arrested and sentenced to forensic psychiatric treatment. He told his psychiatrist
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31 during his treatment sessions that he hated this family because they a) were arrogant and
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34 disregarded the needs and rights of their neighbors, b) played in a gaudiness way the happy family
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36 so that he was confronted with his inability to normal family commitments. This provoked in him
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an irresistible, impulsive tendencies to sadistic actions, which were targeted towards infliction of a
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41 maximum of emotional suffering to the family.
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46 Fred’s sadistic feelings were provoked by a combination of hate because of the new family
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50 limitations. Even when the family members demonstrated consideration and a respectful attitude his
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Sadism in a Boarding School
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Page 11 of 20 International Journal of Forensic Mental Health

Correlates of Distinctive Categories of Sadism 11

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3 Robert Musil (1906) provided in his autobiographic book an observation of group sadism in
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5 the setting of an aristocratic boarding school. It tells a story of a student who has stolen things from
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fellow students, which was against the strict code of honor. The thief in question was forced by his
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10 fellow students to become their slave as a kind of penalty. Subsequently, they carry out cruel and
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12 sadistic experiments in order to investigate if the thief possessed a soul, since they regarded him as
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moral lost. Serious curiosity was the major motive of these sadistic experiments.
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19 The boys demonstrated only in this context sadistic behavior. In fact, some of the boys who
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22 were involved in these sadistic experiments felt guilty about the sadistic acts, but they had not the
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24 courage to refuse further involvement. They were under the influence of their high gifted leader and
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26 were impressed by his smart arguments that should justify these sadistic experiments. The thief
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29 demonstrated even as response to the punishment such blameworthy attitude (lying, fraud, betrayal)
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31 that the students felt that it was their intellectual and even moral duty to investigate to core of his
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badness. When they found some indication of a soul in this deviant person they were intending to
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36 release him from his undesirable character traits by means of their special treatment, which should
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38 enable self-insight in the mechanism of the degenerated part of his personality.
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Lifton (1986) presented in his book “The Nazi Doctor” several case reports of doctors who
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50 demonstrated scientific curiosity that was paired with sadism. Dr. Eisele injected many patients in
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52 Buchenwald with apomorphine to observe them vomiting. He performed many unnecessary
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55 experiments and amputations and then murdered his patients (at least 300). Dr. Berning lead the
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57 “famine experiments” on Soviet prisoners. While the prisoners starved to death, he observed their
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bodely functions degrade; this included loss of libido, dizziness, headaches, edema and swelling of

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 International Journal of Forensic Mental Health Page 12 of 20

Correlates of Distinctive Categories of Sadism 12

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3 their lower abdomen. Dr. Finke did freezing experiments with human beings. Dr Gebhart inflicted
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5 wounds upon his women patients at Ravensbruck and then injected salfanilamide into the wounds.
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This was fatal to all women. These are a few of the cases that are described in the book of Lifton.
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10 But, it must be mentioned that not all Nazi doctors demonstrated sadistic tendencies, there were
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12 some exceptions.
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17 The Nazi doctors who showed sadistic behavior were well adjusted individuals and
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19 demonstrated no sadistic tendencies outside the work setting of the concentration camps. Once they
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22 came in the position that they got absolute control over human beings who were not protected by
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24 law or authorities (because they were regarded as inferior, worthless and harmful) they developed a
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26 sadistic attitude. These Nazi doctors believed that they had good arguments to dehumanize this
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29 category of prisoners and were convinced that their experiments were not unethical. They believed
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31 that the Jews deserved such fate.
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36 Sadism of Two Cannibalistic Serial Killers
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41 Martens & Palermo (2005) analysed the case reports of Jeffrey Dahmer and Dennis Nilsen
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43 who were sadistic, cannibalistic serial killer. When they had company Dahmer and Nilsen killed
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45 their visitors during moments of intense helplessness and fear of being left alone again. Dahmer
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and Nilsen talked to the dead bodies and watched TV with them. Nilsen wrote poems for the death
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50 victims. Dahmer preferred to keep some victims alive by injecting acid in their brains so that they
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52 would become zombies who would never leave him. But, these experiments failed.
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55 Martens & Palermo concluded that the sadistic killing of Nilsen and Dahmer was associated
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57 with unbearable loneliness; emotional suffering; an incapacity to normal social interaction, social
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understanding and empathy; moral incapacities as a consequence of severe neglect and rejection

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3 and social isolation; experience of social exclusion as a consequence of many painful rejections
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5 and neglect during upbringing which caused insecure attachment; an incapacity to form bonds; low
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self-esteem, shame, frustrations and self-hate, because they regarded themselves as losers and
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10 inferior; severe misfortune; and need for absolute control over another human being. Furthermore,
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12 they demonstrated severe destructive tendencies towards themselves, including severe substance
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abuse.
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17 Martens (2010) examimed the psychodynamic link between loneliness and sadism on basis
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19 of a case report of the sadistic and cannibalistic serial killer Jeffery Dahmer. Envy, shame/rage
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22 mechanism, a disturbed oral-sadistic development, castration fear and severe feelings of inferiority,
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24 the conviction of being unlovable and unacceptable, need to diminish tension, powerful and sadistic
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26 fantasies as a consequence of inadequate and frustrated parenting, and reality distortion appear to be
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29 involved in sadistic etiology.

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36 Ordinary People Who Torture
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41 Ordinary people can engage in incredibly destructive behavior if so ordered by legitimate
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43 authority (Milgram, 1974). In those studies of Milgram, participants acting as teachers frequently
On

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45 followed an experimenter's orders to punish a supposed learner (actually a confederate) with electric
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shock, all the way to administering lethal levels. Obedience to authority sustains every culture
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50 (Fiske et al., 2004). Social influence starts with small, apparently trivial actions, for example
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52 insulting epithets, followed by more serious actions such as humiliation and abuse, as novices
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55 overcome their hesitancy and learn by doing (Fiske et al., 2004). It is unclear if these ordinary
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57 individuals who torture on commend gradually enjoy these activities and will meet the criteria of
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sadism.

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5 Discussion
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8
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10 Sadism correlates with negative, ambivalent, and primitive emotions such as unhappiness,
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12 frustrations, shame, revenge, envy, deep narcissistic injury, feelings of inferiority and self-hate
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which were inverted to the outside world in order to avoid self-blame. Obviously, these emotions
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17 were never subject of proper and profound examination and analyzation. As a consequence of a lack
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19 of correction and insight theses emotions might become increasingly dangerous, uncontrollable and
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22 unpredictable. Because the sadistic acting out is rewarded by ecstasy and satisfaction, it has a
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24 craving and addicting effect. Sadistic personalities are inclined to link all current negative emotions
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26 and experiences, often without distinction and self-criticism, to negative experiences in the past,
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29 which should onconsciously legitimize sadistic acting out. However, most of them are not able to
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31 suppress all the time the awareness of being terrible wrong by harming other people who were not
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responsible for their aversive experiences in the past.
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36 Nevertheless, sadism can also function as an intrapsychic mechanism which strives to
iew

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38 establish a new mental and emotional balance. The intrapsychic process that facilitates acting out
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41 of primitive emotions in an obsessive manner might be transformed into activities which might lead
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43 to sublimation, self-insight, catharsis and maturation as a consequence of a fruitful learning process.
On

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45 Every sadists might have contemplative moments when they are aware of their incapacities,
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limitations and deviance. Some of the interviewed sadists reported that it is hard to live with
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50 obsessive sadistic tendencies, which are self-destructive too. Some sadists have significant signs of
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52 guilt which is related to special cases. I remember the case of a ruthless sadistic murderer who was
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55 confronted with a victim who asked him of it was allowed to pray before he would be killed. He did
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57 not allow it and afterward he felt serious remorse. This impressive experience made him in a
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special sense vulnerable for the rest of his life. Martens (1997, 1999, 2002), Black et al., (1995)

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3 and Robins (1966) studied the process of character transformation in remitted and matured
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5 psychopaths and revealed that following factors contributed to maturation and remission: a
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prosocial, positive and long-lasting relationship; spiritual experiences/activities; increase of
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10 responsibility (for instance as a consequence of becoming a father); positive work experiences;
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12 graduation from school; impressive experiences; disease; and reduction of substance abuse.
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17 Conclusions
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22 Sadism can be linked to destructive tendencies, social-emotional and moral incapacities,
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24 mental disorders (such as antisocial personality disorder, substance abuse, and psychosis; see the
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26 Zodiak murder who believed that he was chosen by God to select and kill particular persons and
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29 that all killed people would be his slaves in heaven), neurobiological dysfunctions, need of
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31 sublimation, self-investigation and even catharsis. It might correlate with conflicting destructive
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(violent tendencies) and constructive (need to change and grow) intrapsychic drives and needs.
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36 Many “non-deviant” persons will have experienced less or more serious and deviant sadistic
iew

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emotions (for instance enjoyment of other's mishaps and worse). However, it is unclear which
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41 categories and intensity of sadistic experiences can be considered as pathological. It is very
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43 important to define the criteria of unacceptable expressions of sadism in order to assess and prevent
On

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46 pathological development, for example in children at risk of deviant development. Studies and
47
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48 guidelines in this area are needed.

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50 A complex interplay between psychosocial, intrapsychic, cultural, ethnic, political and
51
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53 neurobiological correlates might be involved in pathological sadistic behavior, but not all correlates
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55 are necessarily involved in sadistic etiology in each individual case. It is unclear if genetic factors
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play a role in sadistic development, but several antisocial features which are linked to sadistic
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60 behavior such as hostility, violence, impulsivity and sensation seeking are neurobiological and/or

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 International Journal of Forensic Mental Health Page 16 of 20

Correlates of Distinctive Categories of Sadism 16

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3 genetic determined (see Martens, 2005c). Neurobiological, political, cultural and ethnic correlates
4
5 did not play a role in the sadistic development of the cases which were presented in this study. But,
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7
in another study of Martens (2003) it was evident that political and cultural influences/ motives
8
9
10 played a significant role the development of antisocial sadistic behavior of some categories of
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12 terrorists with antisocial personality disorders.
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More research is be needed into the psychosocial, intrapsychic, genetic, neurobiological,
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17 cultural, political, ethnic determinants of sadism and interaction between these correlates in order to
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19 construct more effective assessment, prevention and treatment programs.
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21
22
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24 References
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26
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38 Baumeister, R. F., & Campbell, W. K. (1999). The intrinsic appeal of evil: Sadism, sensational
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43 Beattie, H. J. (2005). Revenge. Journal of the American Psychoanalytic Association, 53(2), 513-
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5 Bradford. J. M. W. (2006). On sexual violence. Current opinion in psychiatry, 19, 527-532.
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45 Correspondence concerning this article should be addressed to Willem H. J. Martens MD, PhD, W.
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Kahn Institute of Theoretical Psychiatry and Neuroscience, Het Nateland 1, 3911XZ Rhenen.
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