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Article CommentaryAnalysis and Commentary

Sexual Sadism: Avoiding Its Misuse in Sexually Violent Predator Evaluations

Allen Frances and Richard Wollert
Journal of the American Academy of Psychiatry and the Law Online September 2012, 40 (3) 409-416;
Allen Frances
Dr. Frances is Professor Emeritus, Duke University, Durham, NC. Dr. Wollert is Research Professor of Psychology, Department of Psychology, Washington State University Vancouver, Vancouver, WA.
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Richard Wollert
Dr. Frances is Professor Emeritus, Duke University, Durham, NC. Dr. Wollert is Research Professor of Psychology, Department of Psychology, Washington State University Vancouver, Vancouver, WA.
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Abstract

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Task Force has recently rejected the proposal to include coercive paraphilia as an official diagnosis, reaffirming that rape is a crime and not a mental disorder. We hope this will discourage what has been the inappropriate practice of giving rapists the made-up diagnosis of paraphilia, NOS, nonconsent, to facilitate their psychiatric commitment under sexually violent predator (SVP) statutes. Losing the paraphilia, NOS, option has tempted some SVP evaluators to overdiagnose sexual sadism, which is an official DSM mental disorder. To prevent this improper application and to clarify those rare instances in which this diagnosis might apply, we present a brief review of the research on sexual sadism; an annotation of its definitions that have been included in the DSM since the Third Edition, published in 1980, and in the International Classification of Diseases, Tenth Edition (ICD-10); and a two-step process for making a diagnostic decision. Rape and sexual sadism have in common violence, cruelty, and a callous indifference on the part of the perpetrator to the suffering of the victim, but they differ markedly in motivation. Rapists use violence to enforce the victim's cooperation, to express aggression, or both. In contrast, in sexual sadism, the violence, domination, and infliction of pain and humiliation are a preferred or necessary precondition for sexual arousal. Only a small proportion of rapists qualify for the diagnosis of sexual sadism.

Footnotes

  • Disclosures of financial or other potential conflicts of interest: Dr. Frances was Chair of the DSM-IV Task Force.

  • © 2012 American Academy of Psychiatry and the Law
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Journal of the American Academy of Psychiatry and the Law Online: 40 (3)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 40, Issue 3
1 Sep 2012
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Sexual Sadism: Avoiding Its Misuse in Sexually Violent Predator Evaluations
Allen Frances, Richard Wollert
Journal of the American Academy of Psychiatry and the Law Online Sep 2012, 40 (3) 409-416;

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Sexual Sadism: Avoiding Its Misuse in Sexually Violent Predator Evaluations
Allen Frances, Richard Wollert
Journal of the American Academy of Psychiatry and the Law Online Sep 2012, 40 (3) 409-416;
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