Which diagnosis best fits duration, episodicity, and exclusions?
A
Sexual sadism disorder
Over ≥6 months, recurrent and intense sexual arousal from physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviours
Over ≥6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviours
AA. Over ≥6 months, recurrent and intense sexual arousal from physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviours B. Individual has acted on these sexual urges with a non-consenting person, or the urges/fantasies cause clinically significant distress or impairment
BA. Over ≥6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviours B. Fantasies, urges, or behaviours cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Common specifiers
AIn a controlled environment; In remission
BWith asphyxiophilia; In a controlled environment; In remission
Differential flags
AConsensual BDSM (mutual consent; no distress - not a disorder); Antisocial PD with instrumental violence (not sexually arousing per se); Sexual masochism disorder (role reversal)
BConsensual BDSM practices without distress (cultural/lifestyle; not a disorder); PTSD with re-enactment of trauma (trauma-driven; different context); Self-injurious behaviour in BPD (emotional regulation; not sexually arousing)