ABSTRACT
Sexual sadism is a paraphilia considered to be associated with a proneness to violence. In contrast to consensual sadomasochistic role play, forensically relevant forms of sadism include the humiliation, coercion, and possibly the injury, of involuntary victims. Consequently, the perpetrators tend to be regarded as high-risk offenders who are difficult (or maybe even impossible) to treat. The current chapter first provides an overview of past developments in treating sexual sadism within a forensic framework. Behaviour and cognitive behaviour therapy, psychodynamic treatment, and surgical and pharmacological interventions will be reviewed. Given the lack of studies with sufficiently large samples (let alone randomized controlled studies), mostly case descriptions and small-sample studies will be reviewed. Based on this overview, recommendations for an integrative treatment routine (combining psychotherapy and pharmacological treatment) will be delineated. Finally, case vignettes from our own practice will be presented in order to highlight the particular problems and pitfalls of treating sexual sadists in a correctional or forensic-psychiatric setting. In this regard, the co-occurrence of sexual preference disorders and of personality disorders will be discussed.
