Skip to main content

Coercive Sexual Sadism: a Systematic Qualitative Review


Purpose of Review

Coercive sexual sadism can be distinguished from consensual BDSM (bondage discipline/dominance submission/sadism masochism) role-play and from everyday sadism, a personality trait. The purpose of this paper is to provide a systematic qualitative review of the pertinent literature on coercive sexual sadism from the last three years.

Recent Findings

Clinical assessment of sexual sadism can be made more objective through behavioral checklists based on crime scene actions. The latent structure of sexual sadism is likely dimensional, placing the disorder at the upper end of a continuum of sexually aggressive behavior. Sexual sadism does not seem to increase the risk of violent offense recidivism (including sexual contact offenses) above and beyond the risk implied by established risk factors of delinquency.


Coercive sexual sadism denotes a disposition for sexually aggressive behavior. Whether this disposition is put into practice is likely due to other trait and state variables. Treatment studies are completely lacking in the recent literature.

This is a preview of subscription content, access via your institution.

Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington: Author; 2013.

    Book  Google Scholar 

  2. World Health Organization. ICD-11 for mortality and morbidity statistics. 2019. Accessed 10 July 2019.

  3. von Krafft-Ebing R. Psychopathia sexualis, with especial reference to the antipathic sexual instinct: a medico-forensic study. 12th ed. New York: Rebman; 1906.

    Google Scholar 

  4. • De Neef N, Coppens V, Huys W, Morrens M. Bondage-Discipline, Dominance-Submission and Sadomasochism (BDSM) from an integrative biopsychosocial perspective: a systematic review. J Sex Med. 2019;7:129–44. A systematic review of consensual variants of sadism (BDSM) from a biopsychological perspective. Complementary to the present article.

    Article  Google Scholar 

  5. Paulhus DL, Dutton DG. Everyday sadism. In: Zeigler-Hill V, Marcus DK, editors. The dark side of personality: science and practice in social, personality, and clinical psychology. Washington: American Psychological Association; 2016. p. 109–20.

    Chapter  Google Scholar 

  6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington: Author; 1987.

    Google Scholar 

  7. • Darjee R. Sexual sadism and psychopathy in sexual homicide offenders: an exploration of their associates in a clinical sample. Int J Offender Ther Comp Criminol. 2019;63:1738–65.

    Article  PubMed  Google Scholar 

  8. • Eher R, Rettenberger M, Turner D. The prevalence of mental disorders in incarcerated contact sexual offenders. Acta Psychiatr Scand. 2019;139:572–81.

    CAS  Article  PubMed  Google Scholar 

  9. •• Gonçalves LC, Rossegger A, Gerth J, Singh JP, Endrass J. Sexual sadism among sex offenders in Switzerland. Sex Abuse. 2018. With this empirical study the authors tested the association between sexual sadism and offense recidivism.

  10. • Oswald P, Ducro C, Alvarez L, Pham T. Évaluation du sadisme sexuel sévère dans un population médico-légale: Validation francophone de la Sexual Sadism Scale (SESAS) [Evaluation of Severe Sexual Sadism in a Forensic Population: French Validation of the Sexual Sadism Scale (SESAS)]. Ann Méd-Psychol. 2018.

    Article  Google Scholar 

  11. • Reale K, Beauregard E, Martineau M. Is investigative awareness a distinctive feature of sexual sadism? J Interpers Viol. 2017.

  12. • Reale K, Beauregard E, Martineau M. Sadism in sexual homicide offenders: Identifying distinct groups. J Criminal Psychol. 2017;7:120–33.

    Article  Google Scholar 

  13. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009.

  14. • Sea J, Beauregard E. The hebephiliac: pedophile or teleiophiliac? Int J Offender Ther Comp Criminol. 2018;62:2507–26.

    Article  Google Scholar 

  15. • Sea J, Kim K, Youngs D. Behavioural profiles and offender characteristics across 111 Korean sexual assaults. J Invest Psychol Off. 2016;13:3–21.

    Google Scholar 

  16. • Stupperich A, Strack M. Among a German sample of forensic patients, previous animal abuse mediates between psychopathy and sadistic actions. J Forensic Sci. 2016;61:699–705.

    Article  Google Scholar 

  17. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: Author; 2000.

    Google Scholar 

  18. •• Baur E, Forsman M, Santtila P, Johansson A, Sandnabba K, et al. Paraphilic sexual interests and sexually coercive behavior: a population-based twin study. Arch Sex Behav. 2016;45:1163–72. With this empirical study, the authors tested the associations of paraphilic interests (including sadism) with sexually coercive behavior in a large population-based sample.

    Article  PubMed  Google Scholar 

  19. • Harrati S, Coulanges M, Derivois D, Vavassori D. Qualitative study on the traumatic experiences of female sex offenders. J Loss Trauma. 2018;23:271–86.

    Article  Google Scholar 

  20. Mokros A, Schilling F, Weiss K, Nitschke J, Eher R. Sadism in sexual offenders: evidence for dimensionality. Psychol Assess. 2014;26:138–47.

    Article  PubMed  Google Scholar 

  21. • Yoon D, Mauzaite A, Mokros A. Sexual Sadism Scale. In: Milhausen RR, Sakaluk JK, Fisher TD, Davis CM, Yarber WL, editors. Handbook of sexuality-related measures. 4th ed. New York: Routledge; 2019. p. 525-527. Within this chapter, the authors provide a summary of the Sexual Sadism Scale (SeSaS): development, psychometric properties, item descriptions, and scoring.

  22. • Stefanska EB, Nitschke J, Carter AJ, Mokros A. Sadism among sexual homicide offenders: validation of the Sexual Sadism Scale. Psychol Assess. 2019;31:132–7.

    Article  PubMed  Google Scholar 

  23. • Longpré N, Guay JP, Knight RA. MTC Sadism Scale: toward a dimensional assessment of severe sexual sadism with behavioral markers. Assessment. 2019;26:70–84.

    Article  PubMed  Google Scholar 

  24. • Longpré N, Guay JP, Knight RA. MTC Sadism Scale. In: Milhausen RR, Sakaluk JK, Fisher TD, Davis CM, Yarber WL, editors. Handbook of sexuality-related measures. 4th ed. New York: Routledge; 2019. p. 518-520. Within this chapter, the authors provide a summary of the MTC Sadism Scale: development, psychometric properties, item descriptions, and scoring.

  25. •• Longpré N, Guay JP, Knight RA, Benbouriche M. Sadistic offender or sexual sadism? Taxometric evidence for a dimensional structure of sexual sadism. Arch Sex Behav. 2018;47:403–16. A study on the latent structure of sexual sadism, providing evidence for a dimensional view.

    Article  PubMed  Google Scholar 

  26. • Longpré N, Proulx J, Brouillette-Alarie S. Convergent validity of three measures of sexual sadism: value of a dimensional measure. Sex Abuse. 2018;30:192–208.

    Article  PubMed  Google Scholar 

  27. • Schaaf S, Jeglic EL, Calkins C, Raymaekers L, Leguizamo A. Examining ethno-racial related differences in child molester typology: an MTC:CM3 approach. J Interpers Viol. 2019;34:1683–702.

    Article  Google Scholar 

  28. • Healey J, Beauregard E, Beech A, Vettor S. Is the sexual murderer a unique type of offender? A typology of violent sexual offenders using crime scene behaviors. Sex Abuse. 2016;28:512–33.

    Article  Google Scholar 

  29. • Chan HC, Beauregard E. Non-homicidal and homicidal sexual offenders: prevalence of maladaptive personality traits and paraphilic behaviors. J Interpers Violence. 2016;31:2259–90.

    Article  Google Scholar 

  30. • Healey J, Beauregard E. Impulsivity as an etiological factor in sexual homicide. J Crim Justice. 2017;48:30–6.

    Article  Google Scholar 

  31. • Higgs T, Carter AJ, Stefanska EB, Glorney E. (2017). Toward identification of the sexual killer: a comparison of sexual killers engaging in post-mortem sexual interference and non-homicide sexual aggressors. Sex Abuse. 2017;29:479–99.

    Article  Google Scholar 

  32. • Higgs T, Stefanska E, Carter AJ, Browne KD. The developmental and criminal histories of subgroups of sexual murderers engaging, or not engaging, in post mortem sexual interference, compared to rapists. J Crim Justice. 2017;53:92–101.

    Article  Google Scholar 

  33. • Stefanska EB, Higgs T, Carter AJ, Beech AR. When is a murder a sexual murder? Understanding the sexual element in the classification of sexual killings. J Crim Justice. 2017;50:53–61.

    Article  Google Scholar 

  34. • DeLisi M, Drury A, Elbert M, Tahja K, Caropreso D, Heinrichs T. Sexual sadism and criminal versatility: does sexual sadism spillover into nonsexual crimes? J Aggress Confl Peace Res. 2017;9:2–12.

    Article  Google Scholar 

  35. • DeLisi M, Drury AJ, Caropreso D, Heinrichs T, Tahja KN, Elbert MJ. Antisocial Personality Disorder with or without antecedent conduct disorder: the differences are psychiatric and paraphilic. Crim Justice Behav. 2018;45:902–17.

    Article  Google Scholar 

  36. • Eher R, Schilling F, Hansmann B, Pumberger T, Nitschke J, et al. Sexual sadism and violent reoffending. Sex Abuse. 2016;28:46–72.

    Article  PubMed  Google Scholar 

  37. Marshall WL, Kennedy P, Yates P, Serran GA. Diagnosing sexual sadism in sexual offenders; Reliability across diagnosticians. Int J Offender Ther Comp Criminol. 2002;46:668–76.

    CAS  Article  PubMed  Google Scholar 

  38. • Proulx J, Beauregard E, Carter AJ, Mokros A, Darjee R, James J, editors. Routledge international handbook of sexual homicide studies. 1st ed. Abingdon: Routledge; 2018. An edited book on sexual homicide that includes a five-chapter section on sexual sadism

    Google Scholar 

  39. • Harenski CL, Thornton DM, Harenski KA, Decety J, Kiehl KA. Increased frontotemporal activation during pain observation in sexual sadism. Arch Gen Psychiatry. 2012;69:283–92. A functional magnetic resonance imaging (fMRI) study of 8 sexual sadists viewing pictures of individuals in pain. Stronger amygdala activation compared with 7 non-sadistic individuals.

    Article  Google Scholar 

  40. Laws DR, Meyer J, Holmen ML. Reduction of sadistic sexual arousal by olfactory aversion: a case study. Behav Res Ther. 1978;16:281–5.

    CAS  Article  PubMed  Google Scholar 

  41. Marks I, Gelder M, Bancroft J. Sexual deviants two years after electric aversion. Brit J Psychiatry. 1970;117:173–85.

    CAS  Article  Google Scholar 

  42. Mees HL. Sadistic fantasies modified by aversive conditioning and substitution: a case study. Behav Res Therapy. 1966;4:317–20.

    CAS  Article  Google Scholar 

  43. Davison GC. Elimination of a sadistic fantasy by a client-controlled counterconditioning technique: a case study. J Abnormal Psychol. 1968;73:84–90.

    CAS  Article  Google Scholar 

  44. Hayes SC, Brownell KD, Barlow DH. The use of self-administered covert sensitization in the treatment of exhibitionism and sadism. Behav Ther. 1978;9:283–9.

    Article  Google Scholar 

  45. Kraus C, Strohm K, Hill A, Habermann N, Berner W, Briken P. Selektive Serotoninwiederaufnahmehemmer (SSRI) in der Behandlung von Paraphilien [Selective serotonin reuptake inhibitors (SSRI) in the treatment of paraphilia: a retrospective study]. Fortschr Neurol Psychiat. 2007;75:351–6.

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Andreas Mokros.

Ethics declarations

Conflict of Interest

Julien Wessels and Miriam Hofmann each declare no potential conflicts of interest.

Andreas Mokros is one of the co-authors of the Sexual Sadism Scale (SeSaS; Mokros et al., 2014, Psychol Assessment; doi:10.1037/a0034861). Furthermore, he is a co-editor of the Routledge International Handbook of Sexual Homicide Studies (Proulx et al., 2018) that is highlighted in the “References” section as recommended reading. Joachim Nitschke is one of the co-authors of the Sexual Sadism Scale (SeSaS; Mokros et al., 2014, Psychol Assessment; doi:10.1037/a0034861).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Sexual Disorders

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mokros, A., Wessels, J., Hofmann, M. et al. Coercive Sexual Sadism: a Systematic Qualitative Review. Curr Psychiatry Rep 21, 135 (2019).

Download citation

  • Published:

  • DOI:


  • Sadism
  • Aggression
  • Sexual
  • Offense recidivism
  • Treatment
  • SeSaS