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PubMed1985

Coping with a transvestitic mate: clinical implications.

The transvestite's mate often seeks psychiatric consultation following discovery of her partner's cross-dressing. The clinical management of such situations is complex and mandates investigation of how such women have coped with the knowledge that their partner wears women's clothes for sexual arousal. This report reviews the coping styles of 20 women married or living with transvestitic men. Depression, hostility, sadism and alcohol abuse were methods utilized to cope with their perverse mate. Therapeutic strategies are discussed to help such women during the initial stages of a consultation so that they may develop sufficient insight and information to intelligently manage the dilemma in which they find themselves.

Adult↗
PubMed2006

On sexual violence.

PURPOSE OF REVIEW: Sexual violence is a multidimensional concept that is not completely understood even within forensic psychiatry. Violent sexual behaviour such as sexually sadistic homicides would be included within the definition, but it is commonly defined more broadly as any deviant sexual behaviour. In this review, the broadest definition of sexual violence is used in order to facilitate the most comprehensive review of scientific articles in the field. RECENT FINDINGS: This review covers sexual violence from the extreme of sexually motivated homicides to sexual violence in Internet crimes. The review can be divided into four subject areas. The first relates to extreme sexual violence such as sexually motivated homicide, the second area refers to Internet sexual offending, the third relates to studies on the characteristics of the perpetrators of sexual offending behaviour and the fourth relates to risk evaluation and the prevalence of sexual violence. SUMMARY: Significant advances have been made in relation to sexual sadism. Deviant sexual behaviour using the Internet is being studied. Significant research advances continue in understanding clinical characteristics of various types of sexual offenders. Other important areas of research relate to meta-analytical studies of sexual offenders.

Homicide↗
PubMed1984

The multiple meanings of masochism in psychoanalytic discourse.

The term masochism was originally used in a narrow, specifically sexual sense (referring to perversions ), but has come to encompass for many analysts an exceedingly broad and variably determined range of clinical phenomena that bear no consistent relation to sexual excitement. In addition, these expanding clinical perspectives have long been entangled with Freud's shifting metapsychological constructions designed to ground masochism in instinctual theory. As a result, the term is used with little consistency and at varied levels of abstraction: loosely descriptive, dynamic, theoretical. It is not always explicit which meaning is intended or what inferences, if any, are meant to be drawn from the term. When used in its broadest sense, masochism may falsely suggest dynamic similarity between diverse phenomena, and is often ambiguous with respect to the presence or absence of underlying erotic or perverse excitement. In the clinical situation, the categorization of material as masochistic may evoke an associated set of genetic, dynamic, or theoretical ideas which may alter the perception, ordering, and interpretation of clinical data. Particularly conducive to this subtle steering process are the enduring influence of the early concept of feminine masochism and the related concept of sadistic and masochistic paired opposite component sexual instincts--a theoretical, physicalistic , linear concept incompatible with the clinical model of overdetermination and multiple function. This paper includes a review of the terminological and conceptual history of masochism, briefly touches on the parallel history of sadism , and offers some provisional definitional solutions.

Anxiety, Castration↗
PubMed2003

A study of the psychosexual characteristics of sex killers: can we identify them before it is too late?

Thirty-three sex killers were compared to 80 sexual aggressives, 23 sadists, and 611 general sex offenders on sexual history and preferences, substance abuse crime, violence, mental illness, personality, neurological and endocrine abnormalities. Compared to other groups, sex killers started their criminal careers earlier, more often had been to reform school, were members of criminal gangs, set fires, and were cruel to animals. They tended so show more sadism, fetishism, and voyeurism. They more often collected pornography, but they did not use it in their offenses. They more often abused drugs and some suffered from drug induced psychoses. Their most common diagnosis was antisocial personality disorder, but only 15.2% met criteria for psychopathy. Sex killers showed most signs of neuropsychological impairment, grades failure, and learning disabilities. Results suggest that greater emphasis be placed on studying adolescent sex offenders and conduct disordered children which may help identify potential sex killers.

Adolescent↗
PubMed2006

Is the appendix a useful appendage? An empirical examination of depressive, passive-aggressive (negativistic), sadistic, and self-defeating personality disorders.

Decisions about whether to include depressive, passive-aggressive, sadistic, and self-defeating disorders in Axis II have been made difficult by a relative dearth of data. We report the results of a study identifying potential defining features of these diagnoses and assessing their distinctiveness from other Axis II personality disorders (PDs). A national sample of experienced psychiatrists and psychologists used the SWAP-200 to describe a patient with a current axis II disorder or an appendix or deleted PD from DSM-II-R. We examined clinicians' descriptions of patients to identify their most characteristic features, and then applied an empirical clustering procedure, Q-factor analysis, to see whether versions of these disorders would emerge empirically. As currently conceptualized, only passive-aggressive PD was distinct from other PDs. When the data were subjected to Q-factor analysis, the first and largest grouping was a dysphoric (depressive) PD. A hostile-negativistic subcategory emerged that resembled passive-aggressive PD, along with a revised dependent diagnosis that included many self-defeating/masochistic features. The results suggest that a depressive or dysphoric personality may represent an internalizing spectrum of personality pathology, and that a hostile-negativistic PD may be distinct from the disorders in the text of DSM-IV. Sadistic and self-defeating PD do not appear to represent distinct disorders, although they include personality traits (sadism and revictimization) associated with distinct developmental histories.

Depression↗
PubMed1999

Serial murder of six victims by an African-American male.

A case of a 22-year-old African-American male who sexually assaulted and murdered six African-American females who were strangers to him is reported. Formal study of the subject eight years after the homicides revealed a mildly mentally retarded individual who had, at various times, diagnosable anxiety and depressive disorders. His diagnosed paraphilia was sexual sadism. He also met criteria for both Antisocial and Schizoid Personality Disorder, which are discussed in the context of the comorbidity of psychopathy and schizotypy among some serial murderers. Traumagenic events from his childhood and adolescence included an absent father, sexual and physical abuse, the witnessing of adult sex, and the viewing of violent pornography.

Adult↗
PubMedDate not supplied

[Malignant narcissism and sexual homicide--exemplified by the Jack Unterweger case].

With the syndrome of malignant narcissism, which is characterised by narcissistic personality disorder, anti-social behaviour, sadism and a marked tendency to paranoid reactions, Kernberg (1985, 1996) describes an independent form of pathological narcissism. According to Stone (1996) this is found in many mass-murderers and serial killers. On the basis of the example of Jack Unterweger the connection between malignant narcissism and sexual offence is discussed as to psychodynamic development, personality structure and psychopathology. Unterweger, who was convicted to lifelong imprisonment in 1976 for sadistic sexual murder, became a wellknown writer in prison and was released prematurely in 1990 as the Austria case of successful rehabilitation. As stated in the sentence passed against him he killed 11 prostitutes in Europe and the USA within the next 18 months, but never pleaded guilty. Psychiatric examination revealed numerous elements of malignant narcissism and the constellation of his development and life was typical of serial offenders.

Antisocial Personality Disorder↗
PubMed1991

Child molesters who abduct.

This study examined the differences between 97 abducting and 60 nonabducting child molesters on selected typological and antisocial/criminal variables. Although the results supported one a priori hypothesis, they disconfirmed two others and yielded an unpredicted but theoretically interesting abductor covariate. Our hypothesis that child abductors would more likely be classified as "low" in their contact with children (i.e., have little or no contact with children outside of their offenses) than the nonabductors was supported. In contrast, our hypotheses that the abductors were more likely to be characterized by a history of antisocial and criminal behavior as well as a greater degree of aggression were not supported. Abductors were found to be lower in social competence than the child molesters who never abducted their victims. The results were discussed in terms of abduction as in victim control strategy that is more likely employed by offenders with poor social and interpersonal skills. The complex interrelation among social competence, weapons, and sadism for abductors and nonabductors was explored.

Child↗
PubMed1986

Detective magazines: pornography for the sexual sadist?

The origins of detective magazines can be traced to 17th and 18th century crime pamphlets and to 19th century periodicals that Lombroso called "really criminal newspapers." Content analysis of current detective magazines shows that their covers juxtapose erotic images with images of violence, bondage, and domination; that their articles provide lurid descriptions of murder, rape, and torture; and that they publish advertisements for weapons, burglary and car theft tools, false identification, and sexual aids. Six case histories of sexual sadists illustrate the use of these magazines as a source of fantasy material. We postulate that detective magazines may contribute to the development of sexual sadism, facilitate sadistic fantasies, and serve as training manuals and equipment catalogs for criminals. We recommend that detective magazines be considered during policy debates about media violence and pornography.

Adult↗
PubMed1994

Destructive hostility: the Jeffrey Dahmer case. A psychiatric and forensic study of a serial killer.

We were involved as forensic experts in the case of the serial killer Jeffrey Dahmer. We discuss the scene and victim autopsy findings, with a brief consideration of the basic emotion of hostility. These findings support the thesis that at the basis of this serial killer's behavior were primary unconscious feelings of hate that he had channeled into a sadistic programmed destruction of 17 young men. The interview of the serial killer, the photographic scene documentation, and the autopsy findings stress the ambivalent homosexuality of the killer, his sexual sadism, his obsessive fetishism, and his possible cannibalism and necrophilia.

Adolescent↗
PubMed1977

[Status of vampirism and autovampirism].

Any interpretation of the perversion called vampirism ought to take into consideration the myths in which the relations between living and dead people (vampires, incubi, succubi, etc...) are represented, myths through which the persons alive project onto the dead ones to ambivalent, sexual and agressive, wishes they had toward the dead when they were still alive. Clinically the word vampirism should be used to name all sexual or agressive acts, whether blood-sucking happens or not, committed on a dead or dying person. In one third of the cases the act has both a sexual and an agressive components (mutilation of the dead body); in the other two thirds the act seems to have only a sexual component (sexual pleasure in the presence of or in contact with the dead body). The origin and the meaning of this exceptional perversion are discussed. Auto-vampirism, even more exceptional than vampirism, differs from the latter by the fact that blood succion is the essential symptom and by the fact that it is not on the side of sadism but on the side of masochism. In the light of two case-histories, one of which never published before, and on the basis of the Freudian theory of masochism, an interpretation of the data is propounded.

Adult↗
PubMed1995

A clinical investigation of malingering and psychopathy in hospitalized insanity acquittees.

This study compares Psychopathy Checklist-Revised (PCL-R) scores, DSM-III-R diagnoses, and select behavioral indices between hospitalized insanity acquittees (N = 18) and hospitalized insanity acquittees who successfully malingered (N = 18). The malingerers were significantly more likely to have a history of murder or rape, carry a diagnosis of antisocial personality disorder or sexual sadism, and produce greater PCL-R factor 1, factor 2, and total scores than insanity acquittees who did not malinger. The malingerers were also significantly more likely to be verbally or physically assaultive, require specialized treatment plans to control their aggression, have sexual relations with female staff, deal drugs, and be considered an escape risk within the forensic hospital. These findings are discussed within the context of insanity statutes and the relevance of malingering, psychopathy, and treatability to future policy concerning the disposition of insanity acquittees.

Adult↗
PubMed1994

Role of genetic factors in human sexual behavior based on studies of Tourette syndrome and ADHD probands and their relatives.

Most significant variations in the expression of human sexuality are considered to be the result of learned behavior or psychological problems. Tourette syndrome (TS) is a common, hereditary tic and disinhibition disorder sometimes associated with compulsive use of obscene words (coprolalia) and previously reported to be occasionally associated with exhibitionism. To further explore the relationship between the Gts genes and sexual behavior, questions concerning a wide range of such behaviors were administered to 1,040 subjects, 14 years of age or older, consisting of 358 TS probands, 101 non-proband relatives with TS, 359 non-TS first degree relatives, 79 attention deficit hyperactivity disorder (ADHD) probands, 70 unaffected relatives of the ADHD probands, and 73 controls. The behaviors included magnitude of sex drive, sex orientation, exhibitionism, transvestitism, transsexualism, sadism, masochism, pedophilia, fetishism, aversion to being touched, and aversion to sex. While most of these behaviors occurred in a distinct minority of TS subjects, there was a significant positive correlation between each behavior examined and the degree of genetic loading for the Gts gene(s). The nature of these behaviors and their association with TS suggests many are variants of obsessive-compulsive disorder. Studies in animals indicate that changes in serotonin and dopamine play a significant role in the sexual behavior and many lines of evidence are consistent with the hypothesis that TS is due to genetic changes in serotonin and dopamine metabolism. These studies suggest that genetic factors play a much greater role in a wide range of forms of sexual expression than previously thought.

Adolescent↗
PubMed2004

Serial murder by children and adolescents.

Six cases of serial murder by children and adolescents spanning the past 150 years are presented. The available literature pertaining to this area is reviewed. Each of these six offenders committed sexually homicidal behavior as demonstrated by their expression of erotic interest or engagement in overt sexual behavior at the crime scenes. From a DSM-IV-TR perspective they all exhibited signs of sexual sadism, and their crime characteristics reflected behavior of a more predatory than affective nature. Hands on methods of killing were preferred, i.e., cutting, stabbing, or strangulation. These crimes are extremely rare. Case reports in this area are encouraged to advance our knowledge of these youths.

Adolescent↗
PubMed2002

Risk assessment as collective clinical judgement.

INTRODUCTION: Risk assessment occupies an increasingly important position in psychiatry. This paper contends that collective judgement is the optimal method of assessing risk. THE MEANING OF RISK: Risk has a dual meaning: emotional and judgemental. RISKS FACED BY STAFF: Assaults, threats and survival anxiety. THE EFFECTS OF DANGER ON THE GROUP: Staff wariness and resistance, attribution of blame. THE AMBIGUOUS TASK: For a group to function well it must have a clear task. Custodial roles can lead to ambiguity. THE EMOTIONS OF LARGER GROUPS: Externally directed hostility, internal homogenization of views. SOCIAL DEFENCES: Rituals can develop in forensic institutions, as well as militarism. ANTI-THERAPEUTIC CULTURE: Sadism may develop where a marked power differential develops. THE ROLE OF THE LEADER: Danger intensifies the feelings about leaders, perhaps idealization, perhaps disaffection. Leaders and others need to agree on risk assessment or fragmentation will occur. THE MODIFICATION OF RISK: The assessment of risk may modify it. Mutual hostility must be reduced. Dialogue and understanding are needed. A CLIMATE FOR RISK ASSESSMENT: The environment should be less authoritarian and more democratic, so that patients can join a group and internalize its values. Reflective space is also required. CONCLUSIONS: Risk assessment is best described in terms of human endeavour, not in the language of scientific measurement.

Adult↗
PubMed2006

Excessive violence and psychotic symptomatology among homicide offenders with schizophrenia.

BACKGROUND: It is not currently known how psychotic symptoms are associated with the nature of violence among homicide offenders with schizophrenia, or, more specifically, whether different psychotic symptoms are differentially linked with excessive violence. AIM: To identify factors associated with the use of excessive violence among homicide offenders with schizophrenia. METHODS: Forensic psychiatric examination statements and Criminal Index File data of 125 consecutive Finnish homicide offenders with a diagnosis of schizophrenia were analysed. RESULTS: Nearly one-third of the cases in this sample involved extreme violence, including features such as sadism, mutilation, sexual components or multiple stabbings. Excessive violence was a feature of acts when the offender was not the sole perpetrator or when there was a previous homicidal history. Positive psychotic symptoms, including delusions, were not associated with the use of excessive violence. CONCLUSIONS: These results highlight the importance of variables other than clinical state when examining qualitative aspects of homicidal acts, such as the degree and nature of violence, by offenders with schizophrenia. Further study is needed with a more specific focus on the qualities of the violence among different subgroups of offenders, but inclusive of those with psychosis.

Adolescent↗
PubMed2000

At one with death: destructive narcissism.

In this paper, narcissism is considered to be the relation of self with an idealized internal object, and Narcissus's romance with his reflection is taken to be a two-party affair. Destructiveness, an inborn capability, is distinguished from destructive narcissism, a two-party situation between the self and a sadistic internal figure built on the idealization of power. Too often, only half the narcissistic pair is analyzed. The internal object becomes the persecutor of self, while the sadism of self, projected onto the persecutor, goes unanalyzed. This paper takes up a clinical solution: how the analysis can seize the destructive internal object and resolve it down to its nucleus, the self.

Adult↗
PubMed2005

"On my way here, I passed a man with a scab": understanding a case of severe obsessive-compulsive disorder.

The author describes the psychoanalysis of "John" to illustrate her view of the psychodynamic organization of obsessive-compulsive disorder. She begins with Freud's recognition of the patient's sadism and of the patient's terror of the oedipal situation, which led to the regression to the anal-erotic level of psychic organization. The author then calls upon ideas from contemporary British object relations theory to describe the damage to the objects and to the sense of self in the individual's inner world that occurs as a further defense when overwhelming danger is experienced. This integrated conceptualization is clearly illustrated in John's clinical material.

Adult↗