Gender and Sexual Disorders 487
Any type of rape is a criminal act; sadistic rape—while criminal—is also a typeof sexual sadism, as defi ned in DSM-IV-TR. What distinguishes sadistic rape from
other forms of rape is that in the former the offender becomes sexually aroused by
gratuitous violence or the victim’s suffering or humiliation (Heil & Simons, 2008).
In contrast, nonsadistic rape occurs when the rapist uses force in order to get his
victim to “comply,” but not because such force is a critical element of his sexual
arousal pattern (Yates, Hucker, & Kingston, 2008).
For those diagnosed with sexual sadism, the sadistic sexual fantasies were of-ten present in childhood, and the sadistic behavior commonly began in early adult-
hood—as occurred with the man in Case 11.4. Sexual sadism is usually chronic,
and the severity of the sadistic behaviors increases over time (American Psychiatric
Association, 2000).
Sexual Masochism: Receiving the Pain
Whereas sexual sadism involves hurting others, sexual masochism is characterized
by recurrent sexual arousal in response to fantasies, urges, or behaviors related to
being hurt—specifi cally, being humiliated or made to suffer in other ways (see Table
11.3; American Psychiatric Association, 2000). Moreover, for a diagnosis of sexual
masochism, the sexual fantasies, urges, and behavior must cause signifi cant distress
or impair functioning.
Sexual masochism is diagnosed in both men and women and is, in fact, theonly paraphilia that occurs at measurable rates among women (Levitt, Moser, &
Jamison, 1994). One study found that about a quarter of women who engage in
sexually masochistic behavior reported a history of sexual abuse during childhood,
which suggests that the abuse made them more likely to be aroused by masochis-
tic acts (Nordling, Sandnabba, & Santtila, 2000). However, these women did not
necessarily have sexual masochism, because they did not report distress or impaired
functioning because of their sexual preferences.
Some people with sexual masochism infl ict the pain or humiliation on them-selves, whereas others rely on someone else to do this to them. Some people with
sexual masochism may also have sexual sadism, alternating the role they assume.
They may also have fetishism or transvestic fetishism, which we discuss next.
Paraphilias Involving Nonhuman Objects
Two paraphilic disorders—fetishism and transvestic fetishism—are characterized by
persistent sexual fantasies, urges, and behaviors that focus on nonhuman animals
or objects, such as clothing, which lead to signifi cant distress or impair functioning.
Sexual Masochism: Receiving the Pain
CASE 11.4 • FROM THE OUTSIDE: Sexual Sadism
A physician, raised alone by his widowed mother since age 2, has been preoccupied with
spanking’s erotic charge for him since age 6. Socially awkward during adolescence and his
20s, he married the fi rst woman he dated and gradually introduced her to his secret arousal
pattern of imagining himself spanking women. Although horrifi ed, she episodically agreed
to indulge him on an infrequent schedule to supplement their frequent ordinary sexual be-
havior. He ejaculated only when imagining spanking. Following her sixth episode of anxious,
sullen depression in 20 years of marriage, her psychologist instructed her to tell him “No
more.” He fell into despair, was diagnosed with a major depressive disorder, and wrote a long
letter to her about why he was entitled to spank her. He claimed to have had little idea that her
participation in this humiliation was negatively affecting her mental health (“She even had
orgasms sometimes after I spanked her!”). He became suicidal as a solution to the dilemma
of choosing between his or her happiness and becoming conscious that what he was asking
was abusive. He was shocked to discover that she had long considered suicide as a solution
to her marital trap of loving an otherwise good husband and father who had an unexplained
sick sexual need.
(Sadock & Sadock, 2007, pp. 709–710)Sexual masochism
A paraphilia in which the individual
repeatedly becomes sexually aroused by
fantasies, urges, or behaviors related to being
hurt—specifi cally, being humiliated or made
to suffer in other ways—and this arousal
pattern causes signifi cant distress or impairs
functioning.