Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SADISM”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMed1987

The untreatable family.

The untreatable family is defined as one in which it is unsafe to permit an abused child to live. Despite the fact that many families turn out to be resistive to treatment, they have received very little attention. In the field of physical abuse, 16-60% of parents reabuse their children following the initial incident. Sexual reabuse is estimated to occur in 16% of cases. Treatment of abusive families also aims to alter family functioning. From studies in physical abuse we find 20-87% of families are unchanged or worse at the end of treatment. In sexual abuse the equivalent figures are 16-38%. Parental factors associated with a poor outcome include parental history of severe childhood abuse, persistent denial of abusive behavior, refusal to accept help, severe personality disorder, mental handicap complicated by personality disorder, parental psychosis with delusions involving the child, and alcohol/drug abuse. Parents lack empathy for their child and fail to see the child's needs as separate from their own. Severe forms of abuse (fractures, burns, scalds, premeditated infliction of pain, vaginal intercourse or sexual sadism) are more likely to prove untreatable. Munchausen by proxy, nonaccidental poisoning, and severe forms of nonorganic failure to thrive are similarly resistant. An early recognition of untreatability may help to reduce burnout by diverting precious resources from the untreatable to the families for whom there is relatively more hope.

Child↗
PubMed2005

Homicide by ligature strangulation in Finland: offence and offender characteristics.

In Finland, homicide by ligature strangulation is a rare event. The purpose of this study was to investigate recent homicide cases by ligature strangulation and to analyse offence and offender characteristics. All forensic psychiatric evaluation statements of offenders accused of ligature strangulation homicides during the 7-year period 1996--2002 (n=19) were reviewed retrospectively. Thirty-five percent of the victims were females. In four cases, the victim was the offender's intimate partner; in one case, it was the stepson; in one case, a father and in the rest of the cases (n=13), an acquaintance. None of the cases involved planning, sadism or sexual elements. In 89% of the cases, the offender was either intoxicated or on drugs at the time of the offence and in 94% of the cases, the victim was found at the scene of the killing. Of the offenders, 63% had crime history, and approximately half of the offenders had experienced parental alcohol abuse, domestic violence or previous trauma. Most of the offenders were unemployed at the time of the offence. In all, 89% were diagnosed as having personality disorder and two were schizophrenic.

Adolescent↗
PubMed1998

Factors associated with sexual behavior problems in young sexually abused children.

OBJECTIVE: To identify variables associated with the presence of sexual behavior problems in young sexually abused children. METHOD: Data were gathered from the clinical records of 100 sexually abused boys and girls ages 3-7 years enrolled in two treatment programs. Information was coded systematically on approximately 350 areas related to the child and family's history and functioning, the sexual abuse experience, and treatment outcome. The children were grouped and compared according to their presenting sexual behavior into three categories: (1) developmentally "expected"; (2) "sexualized/self-focused"; and (3) problematic "interpersonal" sexual behavior. RESULTS: Bivariate and multivariate analyses highlighted five variables which were predictive of sexual behavior problems among sexually abused children. Sexual arousal of the child during his/her sexual abuse, the perpetrator's use of sadism, and a history of physical and emotional abuse differentiated between those children with and without "interpersonal" sexual behavior problems. Who the child blamed for his/her sexual abuse further contributed to the distinction between children whose sexual behavior was exclusively "self-focused" (sexualized) versus "interpersonal." CONCLUSIONS: The five major predictor variables, as well as other variables identified in this study, have potential utility in assessing child risk for negative outcomes and determining referral priorities for sexual abuse treatment. Given that sexual arousal and who the child blames for the abuse are prominent variables associated with sexual problems and self-blame, clinicians will need to ensure that sexually abused children and their caregivers are given specific opportunities to deal with these areas in the supportive context of treatment. Children with sexual behavior problems differ not only in the type and level of sexual behavior they exhibit but in most other areas as well, suggesting a need for differential assessment and individualized treatment approaches.

Analysis of Variance↗
PubMed1998

Preferential rape in the theory of courtship disorder.

The theory of courtship disorder suggests voyeurism, exhibitionism, frotteurism, and preferential rape (a paraphilic preference for coercive sex) are expressions of a common underlying disturbance. Previous research has demonstrated that voyeurism, exhibitionism, and frotteurism are relatively likely to co-occur; however, their associations with rape are weaker. One explanation is that rapists are more heterogeneous and may not always be motivated by a paraphilic interest in coercive sex. Paraphilic interests can be identified using phallometric testing, but the sensitivity of the test is attenuated by voluntary control over erectile responding. Another approach is to look for a behavioral marker associated with paraphilic rape-proneness. Freund (1990) has argued that exhibitionism may be the "hub" of courtship disorder because exposing one's genitals to a stranger is rare in control subjects. We predicted that rapists who also engaged in exhibitionistic activity would be more likely than other rapists to also engage in other expressions of courtship disorder, i.e., voyeurism and frotteurism. To rule out the possibility that rapists who report exhibitionistic activity only differ in their willingness to report anomalous sexual behavior, we also predicted no difference between the groups in their self-reported involvement in other paraphilic activities such as sadism or masochism, or paraphilic target preferences such as fetishism or transvestism. Finally, we predicted no difference between groups in their willingness to admit to attempting or committing rape. The results supported our predictions, and lend credence to the notion of preferential rape as an expression of courtship disorder. Moreover, these results suggest that the presence of another paraphilia, particularly exhibitionism, may be useful as a behavioral marker for paraphilic rape-proneness.

Adult↗
PubMed2002

The analysis of a pre-adolescent girl with primal scene fantasies.

This paper presents the analysis of Daphne, a ten-year-old girl whose prominent primal scene fantasies organized the analytic process in a rather unusual way, creating challenging technical problems and offering the analyst the opportunity to learn more about the formation of primal scene fantasies and their potential impact on psychic development and function. The data are consistent with the view that primal scene fantasies become organized in response to the cognitive requirements of development--to answer the enigmas of sexual difference, genital sensations, procreation, and parental rejection; that these fantasies arise from phase-specific libidinal and aggressive struggles such as voyeurism, exhibitionism, sadism, and homoerotic fantasy; and that they influence superego development. Daphne, however, appeared to have used the primal scene fantasy in a rather extraordinary way to organize and integrate the vicissitudes of development and especially to master conflict. Moreover, the analytic work demonstrates the technical difficulty of distinguishing between primal scene fantasy and primal scene exposure. Another technical issue was raised by the remarkable discrepancy between this little girl's relatively high functioning behavior and demeanor both in school and at home, and the outpouring of sexual material that emerged and flooded our sessions. Why was there such a discrepancy? How should I manage the sexualized nature of the material? Several colleagues, reflecting on the overstimulated quality of the analytic productions, questioned whether I "should have done something" to stop it. In the hours, I certainly felt perplexed by the discontinuity between her presentation and her fantasies. Thus, I ask the reader to follow me in the process of uncovering the particular way in which the analytic data revealed themselves.

Child↗
PubMedDate not supplied

Treatment of paraphilia with luteinizing hormone-releasing hormone agonists.

Up to now there have been no published results of therapy of paraphilia (for example, pedophilia or sadism) and sexual aggressive impulsiveness with luteinizing hormone-releasing hormone (LHRH) agonists in the German-speaking countries. After a short introduction about physiologic features and the present state of investigations in treatment of paraphilia with LHRH agonists we describe 11 patients who were treated with the LHRH agonist Leuprolide Acetate over a period of 12 months. The patients showed no tendency toward sexually aggressive behavior and reported an evident reduction of penile erection, ejaculation, masturbation, sexually deviant impulsiveness, and fantasies. One patient died from suicide. In combination with other treatments, LHRH Agonists seem to be a very promising alternative to cyproterone acetate and its possible carcinogene effects.

Adult↗
PubMed1989

Gender differences in sexual behaviors and fantasies in a college population.

This study presents male and female responses of 193 university students to questions about sexual experiences and fantasies. There are few significant gender differences in experiences, but many in fantasies. Males fantasized about sex more and exhibited greater interest in partner variation and in the spectrum from domination to sadism. While male sexuality is often described as aggressive/sadistic and female sexuality as passive/masochistic, most men and women in our population do not report fantasies supporting such stereotypes.

Adult↗
PubMed2006

The paraphilia-related disorders: an investigation of the relevance of the concept in sexual murderers.

Paraphilic disorders (PAs) and sexual preoccupation are known risk factors for recidivism in sexual offenders. Nonparaphilic sexual excessive behaviors-so-called paraphilia-related disorders (PRDs), like paraphilias, are also characterized by sexual preoccupation and volitional impairment and can be diagnosed in paraphilic men. The prevalence and clinical significance of PRDs in sexual homicide perpetrators, however, is unknown. We investigated the relationship between PAs and PRDs retrospectively in a sample of 161 sexual murderers. Four groups were compared: men without a PA or a PRD diagnosis, men with at least one PRD but no PA, men with at least one PA but no PRD, and finally, those with a combination of both (PA+PRD). The PA+PRD group had the most lifetime cumulative sexual impulsivity disorders, more developmental problems, the highest persistent frequency of sexual activity, the highest number of previous sexual offences, more sexual sadism, and compulsive masturbation. Men of the PRD subsample had suffered more from childhood sexual abuse, showed more promiscuity, psychopathy, and alcohol problems. The use of the PRD concept in this special offender group should be further investigated with prospectively designed studies.

Alcoholism↗
PubMed1988

Technical expertise as an ethical form: towards an ethics of distance.

The present article proceeds from the observation that the therapeutic relationship is basically unequal. This inequality essentially concerns the respective situation of the patient and his or her doctor vis-à-vis medical knowledge. A strict professionalism guarantees that this inequality remains factual and without essential value. Yet, if both partners unreflectively allow affectivity excessively to intrude into their relationship, their behaviour may then be inspired by subconscious, rather than rational, motives. In that case, the unverifiable allegations of philanthropy or paternalism may be used to rationalise a kind of 'medical sadism' which attempts to justify the will to humiliate the patient by means of the constraints inherent in medical care. The concept of ethical form is introduced as a non-verbal criterion of ethical reliability. It is mainly a way of training the will through the application of rationally justified rules of behaviour. In this context, it is suggested that an effort to remain constantly within the limits of professionalism represents a method of training for the achievement of some degree of ethical credibility in the therapeutic relationship. In the long term, such abstinence could constitute a sort of catharsis, and thereby help to reveal the non-rational motives in medical behaviour. Contrary to the belief prevailing in modern society, the established limits of medical knowledge are not so broad. The application of these limits would probably be the best method of preventing emotions from interfering undesirably in the therapeutic relationship.

Dehumanization↗
PubMed1990

The transference neurosis in Freud's writings.

This paper reviews the evolution of the concept of transference neurosis in Freud's writings. It suggests that the language in which the concept of the transference neurosis is originally expressed by Freud includes an idea of the analyst as aggressively pursuing the analytic cure by waging a solitary battle against the patient's disease. With the representation of the death drive and the larger role accorded to sadism as its external manifestation in Freud's revised drive theory of 1920, the patient becomes the ally; resistance, in the sense of the conservative forces, not disease, in the sense of libidinal conflict, becomes the enemy. It is thus difficult to speak of a transference neurosis in the circumscribed way Freud originally meant it, and he ceased to use the term after 1926 rather than redefine it to fit his broader perspective. In this broader perspective, relative resolution of conflict replaced radical liberation of the patient from disease. That Freud did not redefine the term does not imply that he discarded it, or that we necessarily should. This paper suggests that Freud implied a functional distinction between transference as transforming agent and transference neurosis as result of that transformation. That distinction defines psychoanalytic cure in terms of the understanding of a symbolic transformation which is, through the transference neurosis, reexperienced as part of the psychoanalytic process.

Countertransference↗
PubMed1999

Evil is more than banal: situationism and the concept of evil.

Social psychology as a discipline has given relatively little attention to the problem of evil in society, and those discussions in this field that do exist typically regard evil actions as only varieties of aggression without any characteristics that distinguish them from other forms of intentional mistreatment of others. Because of the field's situationistic perspective emphasizing the individual's susceptibility to the power of the immediate situation, social psychoiogists generally view the fairly high levels of obedience to authority displayed in Milgram's (1963, 1974) classic experiment as the paradigmatic example of evil behavior. For them, much evil is, in Arendt's (1963) well-known phrase, only "banal," and Milgram's findings are often viewed as illustrating the "central dynamic" involved in the slaughter of millions of Jews and other "undesirables" in the Holocaust. This article holds that Milgram's (1974) obedience research does not represent significant features of the Holocaust, especially the sadism that occurred not infrequently, and disregards the vital difference between those who initiated the murderous policy and the others who followed their orders. Building on Darley's (1992) earlier conjectures about the features that ordinary people might consider in judging whether any given action is evil, I suggest that many persons have a prototypic conception of evil and speculate about the dimensions that could be involved in this prototype.

Journal Article↗
PubMed2003

The observing ego as voyeur.

A resistance to self-observation and self-reflection is discussed in which there is a perversion of the observing ego. The observing ego has been unconsciously recruited in the service of enacting an unconscious fantasy: the fantasy of being an excited observer of a primal scene who is punished for making forbidden observations. This voyeuristic observing ego is pathologically enmeshed in a love triangle with the patient's seductive superego (i.e. identification with the desired but unfaithful parent) and with the patient's punitive superego (i.e. identification with the rivalrous parent). This unconscious scenario is played out in the clinical situation as the patient unreflectively cycles through phases of denial (i.e. self-seduction) and moral masochism (i.e. self-betrayal). A case study illustrates how humor may be employed to free the observing ego from being enthralled by a perverse superego. Humor may unconsciously enable a rebellious attitude toward the omnipotent sadism of a perversely oppressive superego and thus enable the observing ego to break free from its pathological enmeshment.

Denial, Psychological↗
PubMed1985

Virginia Woolf: manic-depressive psychosis and genius. An illustration of separation-individuation theory.

Virginia Stephen was a member of one of England's great literary families, many of whom were also mentally ill. An exquisitely endowed infant, she was beautifully matched with her mother during the symbiotic state of development, and later called this period "the base upon which life stands." Difficulties presumably began as early as the differentiation subphase of separation. Mrs. Stephen appeared to be a narcissistic woman, who required constant affirmation, and thus was unable to respond to the needs of a developing child. Virginia probably was rescued from engulfment by a powerful biologically determined practicing period of separation-individuation. This great organismic surge, in all likelihood, is as characteristic of toddlers who are incipient manics as of children of future genius. Because of the strong regressive pull, it is probable that Virginia experienced a particularly high-powered glee in evading the field of her mother. This "economic condition," according to Freud, is a given that is felt by the manic as he overthrows the imprisoning restraints of the superego. Deflated by events beyond her control, such as the sadism of her siblings, Virginia probably attempted to return to her mother. But it appears that Mrs. Stephen was not available. Hence Virginia was forced to split off her anger and turn it against herself, keeping her aggression unavailable for neutralization. As a result she was unable to proceed to an age-adequate level of development. The raw rage lay smoldering within until many years later, when it burst forth to power her manic attacks. This failure of rapprochement presumably deflated Virginia, and resulted in a basic mood of depression already apparent in the nursery. Virginia also experienced a second basic mood, elation, which appears to have been characteristic of her even in well periods, and resembles the description of the typical manic victim given by Beck.

Bipolar Disorder↗
PubMed2001

Child serial murder-psychodynamics: closely watched shadows.

There is a malignant transformation in object relations resulting in an identification with an omnipotent and cruel object resulting in an identity transformation. If the tension, desperation, and dissociation increase, serial murder becomes spree murder. The presence of pathological narcissism and psychopathic tendencies are of diagnostic significance in understanding the murderer's personality functioning and motivation to kill. Meloy (1988) considered the degree of sadism and aggression combined with narcissistic qualities to reflect the "malignancy" of the psychopathic disturbance where gratification (of aggression) occurs in the service of narcissistic functioning--that is, cruelty toward others in the form of a triumphant victory over a rejecting object. Meloy also believes that dissociation is ubiquitious in the psychopath. The initial murder of the serial murderer may reflect a "new identity." The pathological object-relations of narcissism and the malignant narcissism are important diagnostic indicators in the personality functioning of serial killers and the occurrence of these phenomena is a significant factor in the formation of the personalities of serial killers, their inner motivations, and their pattern of commission.

Adult↗
PubMed2003

Pharmacotherapy of paraphilias with long-acting agonists of luteinizing hormone-releasing hormone: a systematic review.

BACKGROUND: In addition to psychotherapy, pharmacotherapy is an important treatment option for paraphilias, especially in sexual offenders. Cyproterone acetate (CPA) and medroxyprogesterone acetate (MPA) are commonly used but can have serious side effects. Selective serotonin reuptake inhibitors (SSRIs) may also be effective in less severe cases. Recent research shows that luteinizing hormone-releasing hormone (LHRH) agonists may offer a new treatment option for treatment of paraphilic patients. METHOD: MEDLINE was searched for clinical trials, case-control studies, case reports, and other clinically and theoretically important literature published between 1980 and November 2002 on the treatment of paraphilia with LHRH agonists. Keywords included LHRH agonists, GnRH- agonists, antiandrogens, paraphilia, pedophilia, and sex offenders. RESULTS: We found 4 case reports, 1 case- control study, 7 open uncontrolled studies, and 1 study comparing patients receiving CPA with those receiving LHRH agonist treatment in forensic hospitals. In total, the studies reported on a sample of 118 treated patients with different forms of paraphilias (sadism, pedophilia, exhibitionism, voyeurism). Nearly all of the studies used self-reports to measure the effects of medication. Duration of follow-up was between 6 months and 7 years and revealed that there were no relapses if patients remained under treatment. Patients previously treated with other agents like CPA, MPA, or SSRIs reported better effects when taking LHRH agonists. CONCLUSION: Although there is a need for further research, LHRH agonists offer a treatment option for patients with severe paraphilia. We propose a differentiated pharmacologic treatment regarding side effects, symptomatology, and severity.

Algorithms↗
PubMed1976

Theoretical and clinical approaches to the treatment of adolescent drug addiction.

Psychologists, social workers, addiction specialists, and occupational therapists often find themselves faced with clients who not only are addicted but also have personal, family, and social problems. These combined problems make the drug-abusing client an extremely difficult one to work with. Occupational therapists have a particular challenge in that they must not only understand and analyze their clients' occupational behavior but also their needs as addicts. This paper describes an approach to adolescent addiction that presents a clinical and theoretical consideration that could be helpful to professionals who work with addicted or drug-abusing clients. In the approach a fusion must be made between the client and the therapist or treatment program. The fusion is temporary but long enough to provide opportunities for clients to work through their feelings of anger, aggression, and sadism, as well as their ego and superego problems. To understand all aspects of their use of drugs, an easily memorized two-dimensional scheme is drawn by the client and therapist together and is used to formulate a treatment plan. Separation from the therapist or program is an essential part of treatment. At this time the client is given the kind of emotional support required to establish new relationships.

Adolescent↗
PubMed2004

Treatment of paraphilia in young adults with leuprolide acetate: a preliminary case report series.

Some juveniles who engage in sexual offenses may have a paraphilia, a psychiatric disorder characterized by a pervasive pattern of deviant and impairing sexual fantasies, thoughts, and/or behaviors. Though there is no known cure for these conditions, paraphilias can be effectively managed using a multimodal treatment approach. This may include the use of psychotherapeutic and pharmacological treatment interventions, including antiandrogen medications. One such agent, leuprolide acetate (leuprolide), a luteinizing hormone-releasing-hormone agonist, has been shown to be effective in reducing paraphilic symptoms in adult patients. To date, however, there is no published data on its use and effectiveness in adolescent and young adult paraphilic patients. This study consists of a case report series of six young adult patients treated with leuprolide. All subjects had been diagnosed with at least one paraphilia (i.e., Pedophilia, Sexual Sadism, Frotteurism, and Paraphilia Not Otherwise Specified). All subjects had been refractory to treatment in a residential program for adolescent sex offenders prior to initiation of leuprolide. All six subjects reported a reduction in sexually deviant symptoms following treatment with leuprolide. Clinicians rated four as much improved and two as moderately improved. The treatment was well tolerated in all six subjects. This preliminary case series supports the conclusion that leuprolide deserves further examination as a potentially safe and effective component in the treatment of young adult patients with paraphilia.

Adult↗
PubMed1990

[Smerdjakoff--the epileptic decline of existence].

Since long the main interest of psychiatric clinical research has been the determination of character-changes in Janz' typus of the sleep-epileptic, who shows a specific inclination to what is low down, and therefrom calls him and ties him up. Smerdjakoff is this epileptic-prototype. He is linked to what is low down. His height is only pseudo-height. His crisis consists mainly in the threat of being dragged away from the height he claims, i.e. when he deteriorates to mediocracy. Then sadism in its typical aggression shows up--which converts the epileptic in one of the most dangerous psychotic persons.

Adult↗