Sadistic Personality Style

Style, Disorder, and the Space Between

Unlike most styles in the PDM-3, the sadistic style has no empirically derived prototype. It did not emerge empirically in research with the Shedler-Westen Assessment Procedure (SWAP), possibly because it is rare in the clinical samples studied. The manual therefore offers a “clinically derived description” (McWilliams & Shedler, 2026, pp. 666, 695).

At the healthy end, there is no sadistic personality in the full sense. There are sadistic strivings that are integrated, contained, and put to use: competitive drive, teasing that both people enjoy, firmness, and dominance that serves a legitimate purpose. The PDM-3 adds that many people whose sexual fantasies or activities involve dominance and pain are not sadistic generally and do not have a sadistic personality (p. 695).

At the neurotic level, sadistic feelings are present but conflicted. They come with guilt and are recognized as ego-alien, meaning foreign to how the person sees themself. McWilliams describes therapists who discover “fantasies of sadistic retaliation” toward patients who resist their help. She argues that admitting such feelings is what keeps them from being acted out (2011, pp. 279–280). Similarly, an older adult with no history of cruelty who lashes out humiliatingly under the strain of illness and dependency is usually showing brief episodes, not a character trait (Del Corno & Plotkin, 2026, p. 948).

At the borderline level, domination becomes an organizing motive. Contempt and hatred become central emotions, and attachment is impaired (pp. 695, 949).

At the psychotic level, reality testing itself is impaired (Gordon & Bornstein, 2025), so sadistic preoccupations are no longer held in check by a clear sense of what is real.

Signs that sadistic dynamics have become a personality disorder include:

• Calm instead of heat. The PDM-3 calls emotional detachment or guiltless enthusiasm in pursuing domination the hallmark of the style. That is different from striking out when provoked (p. 695).
• A pattern of choosing targets who are subordinate, weaker, or comparatively powerless (p. 695).
• Planning and preparation, rather than reaction (p. 695).
• Treating others as objects for amusement rather than as subjects with their own minds (p. 695).
• Secrecy and lying, including keeping the preoccupation itself hidden (p. 695).
• Pervasiveness, so that the same pattern shows up at home, at work, and with caregivers.
• Little insight. Older adults with sadistic personalities, for example, typically regard their behavior as normal and acceptable (p. 949).

The PDM-3 also cautions that only a fraction of people who abuse others are characterologically sadistic, and it notes that people with this style are seen mainly in forensic settings rather than in ordinary clinical practice (pp. 694–695).

No current official diagnosis exists. A provisional sadistic personality disorder appeared in an appendix of DSM-III-R in the late 1980s. Its core feature was a pervasive pattern of cruel, demeaning, and aggressive behavior, engaged in for amusement or for pleasure in others’ suffering. It was dropped from later editions as insufficiently distinct from antisocial and narcissistic personality disorders. Sexual sadism, by contrast, has remained a separate diagnosis (Lobbestael et al., 2023). Neither DSM-5 nor ICD-11, which has dropped named personality types altogether (Bach & First, 2018), includes a sadistic personality category. The PDM-3 keeps one, quoting Meloy: “burning the map does not eliminate the territory” (p. 694).

Inner World

The PDM-3 places deadness at the center of this style. An inner sterility is relieved by exerting control over another person’s experience (p. 694). Fromm’s formula, impotence turned into omnipotence, suggests that the feared state underneath is helplessness. The PDM-3’s older-adult chapter fills in the emotional picture. Hatred and contempt are central. A belief in one’s own superiority justifies humiliating others. Fear of being humiliated can lead to anticipatory defenses, such as devaluing others first and showing a conspicuous lack of empathy (pp. 948–949). The calm with which cruelty is carried out may itself have begun, the PDM-3 suggests, as a defense against overwhelming rage (p. 695).

Identification with the aggressor is a central dynamic in many accounts. McWilliams writes that under conditions of fear or abuse, people try to master their fright by taking on qualities of those who hurt them. She sums up the unconscious appeal as “I’m not the helpless victim; I’m the powerful perpetrator” and notes that the mechanism is especially evident in dispositions toward sadism (2011, p. 112). A survey of forensic psychiatrists found childhood abuse and parental loss common in the histories of people who met the old DSM-III-R criteria (Spitzer et al., 1991). These are findings about risk, not destiny. Most people who were mistreated do not become cruel, and McWilliams warns that generalizations about who turns trauma outward and who turns it inward have many exceptions (2011, p. 271).

Pathogenic beliefs are the unconscious convictions that shape behavior. Read from the descriptions above, they might include:

• There are only those who dominate and those who are dominated.
• Vulnerability invites attack, so it is safer to attack first.
• Other people’s feelings are not quite real, or are mine to play with.

Self-esteem is maintained through control and felt superiority, and threatened by dependency, limits, and any situation that reverses the power relationship. The PDM-3 describes illness and institutional care in later life as such situations, which often meet with great resentment (p. 949).

In the PDM-3 mental capacities, the style involves serious difficulty with the capacity for trust, empathy, and intimacy and with internal standards and ideals. In versions where the inner deadness is prominent, affect regulation is affected too.

Defenses

The PDM-3’s older-adult chapter names omnipotent control and emotional detachment as notable attitudes in this style (p. 949). Omnipotent control is related to the defense the site calls omnipotence. Identification with the aggressor, a form of identification, converts helplessness into power (McWilliams, 2011, p. 112). Devaluation of others both expresses contempt and protects against expected humiliation (Del Corno & Plotkin, 2026, p. 948). The dispassionate quality of the cruelty resembles an extreme isolation of affect, cut off from both the person’s own feelings and the other person’s pain. McWilliams lists sadism among the behaviors that, when unconsciously driven, fall under the heading of acting out (2011, p. 121). Where sadism is part of a dissociative picture, it may live in a split-off self-state rather than in the person as a whole (p. 155).

At the healthy end, the relevant defense is sublimation. McWilliams recounts Freud’s view that a periodontist might be sublimating sadism, turning an urge to inflict injury into skilled, socially valuable work (2011, p. 147). Self-assertion and humor can also carry aggressive pleasure in forms that respect the other person.

Lying deserves mention. The PDM-3 notes that people with this style are mendacious, take pleasure in deceiving others, and may enjoy tormenting interviewers by lying, withholding information, or dwelling on their preoccupations (p. 695).

Relationships

Relationships tend to be organized along lines of dominance and submission. The PDM-3, drawing on Shapiro, notes that targets are chosen for being subordinate, weaker, and comparatively powerless (p. 695). Partners, children, employees, patients, and caregivers can all be placed in that position. In families, the pattern may persist quietly for decades. The PDM-3 describes an older adult who was once the household’s decision maker continuing to exert authority while disregarding other family members, and directing contempt or constant reproach at the nurses and relatives who now provide care (p. 949). People around someone with this style often describe walking on eggshells, feeling intimidated, and doubting their own perceptions.

As for origins, the literature offers theories rather than settled answers:

• Identification with abusive figures, discussed above.
• An early attachment deficit that leaves others feeling like things rather than people (p. 695).
• Gendered patterns of identification and of response to trauma. Some psychoanalytic observers believe these make men more prone to disorders of too little attachment, including sadism, and abused boys more likely than abused girls to identify with the aggressor (McWilliams, 2011, pp. 202–203, 271).

Almost all cases described by forensic psychiatrists in the 1991 survey were men (Spitzer et al., 1991). McWilliams is careful to add that sadistic women are not rare (2011, p. 271).

In Therapy

Two terms help here. Transference is the set of expectations and feelings a person brings from earlier relationships into the therapy relationship. Countertransference is the therapist’s emotional response, which can carry important information.

With characterological sadism, the transference tends to cast the clinician as one more potential target. Lying, withholding, and taunting may become part of the interaction itself (McWilliams & Shedler, 2026, p. 695).

Clinicians report reactions that are often physical:

• Visceral disturbance, vague unease, and intimidation.
• “Creepiness” and the sense of being overwhelmed by negative feelings.
• What Meloy describes as goose bumps or hair standing on end, the ancient reactions of prey to a predator.

The PDM-3 treats such “countertransferential torment” as possible evidence of underlying sadism. It urges therapists to take these reactions seriously, assess more thoroughly, and plan treatment with possible dangerousness in mind (p. 695). McWilliams, writing about therapist safety in general, puts it bluntly: “Denial is not an adaptive defense in a therapist” (2004, p. 81).

The PDM-3 is frank about outcomes. Its authors know of no reports of successful therapy for characterological sadism. M. H. Stone, after carefully analyzing biographical accounts of murderers, considered the people with this style whom he examined beyond the reach of therapy. Treating others as objects to toy with may prevent a working alliance, and the pleasure involved may be so reinforcing that change efforts fail (pp. 695–696).

Understanding still matters. According to the PDM-3, an accurate grasp of sadistic personality helps clinicians:

• Make sound recommendations to courts.
• Limit opportunities for harm.
• Help the people affected.
• Allocate resources realistically.
• Avoid becoming targets themselves (p. 696).

In care settings for older adults, treatment often has to focus on containing the most extreme behavior and protecting those who might become targets (p. 949).

The picture is different when sadism is one theme within another personality rather than its organizing principle. That includes sadistic elements in masochistic, narcissistic, paranoid, or dissociative patterns, and the ordinary sadistic feelings of basically decent people. In those cases, the general psychodynamic attitude McWilliams describes applies: clinicians look to the “sadistic parts of themselves” for empathy (2004, p. 35), and patients are helped to own, understand, and contain feelings they would rather disavow.

Variations

• Everyday and clinical sadism. Research separates vicarious sadism, enjoying others’ pain that one did not cause, from direct sadism, causing it oneself. It also separates subclinical “everyday sadism,” reported by around 7% of some student samples, from the forensic and clinical forms (Lobbestael et al., 2023).
• Sexual and characterological sadism. These overlap but are not the same. The PDM-3 suggests that people with sadistic personality disorder are likely also sadistic sexually, but most people with sadistic sexual interests do not have a sadistic personality (p. 695).
• Sadism within psychopathy. Sadism and psychopathy are “highly related” but not identical (p. 694). Among the “Dark Triad” traits of narcissism, Machiavellianism, and psychopathy, psychopathy shows the strongest link with self-reported sadism (Lobbestael et al., 2023).
• Malignant narcissism. Kernberg’s term describes narcissism “suffused with sadistic aggression,” on a continuum with psychopathy (McWilliams & Shedler, 2026, p. 688).
• Sadomasochistic patterns. Freud noted that the active and passive forms tend to appear together in the same person (Freud, 1920, pp. 23–24). The PDM-3 observes that masochistic personalities often involve disavowed sadism. One example is the moral masochist whose self-sacrifice coexists with harsh intolerance of people who fall short (p. 671).
• Psychopathic and dissociative blends. McWilliams sees sadism more often as a strand within psychopathy or dissociation than as a stand-alone character (2011, p. 155).
• Life stage. In adolescence, the PDM-3 notes, young people with severe emerging antisocial personalities may take pleasure in sadism (p. 499). In old age, overt cruelty becomes less feasible, so sadistic traits may show up instead as humiliating attitudes, constant reproach, or pleasure in others’ unhappiness, and may be overlooked (pp. 948–949).

How Different Thinkers See It

Freud: a component drive, then a turn outward

In 1905 Freud treated sadism as an aggressive component of sexuality that had become “independent and exaggerated.” He reserved the term perversion for the extreme case in which gratification depends entirely on subjugating and mistreating the other. He also noted that sadism and masochism regularly occur together in one person (Freud, 1920, pp. 21–24). In “The Economic Problem of Masochism” (1924), as Ribas (2005) summarizes it, he reversed the order: masochism became primary, and sadism became masochism turned outward.

Fromm: malignant aggression

As Wang et al. (2026) summarize The Anatomy of Human Destructiveness (1973), Erich Fromm distinguished defensive, biologically adaptive aggression from “malignant” aggression, which he saw as rooted in character and social conditions. Sadistic aggression, in their reading of Fromm, is a form of malignant aggression driven by a desire for absolute control and domination over others. The PDM-3 adopts his phrase about impotence turned into omnipotence (p. 694). Fromm’s distinctive contribution was social. Because he rooted malignant aggression in both individual character and social conditions, he treated understanding sadism as a task for social and cultural critique as well as for individual treatment (Wang et al., 2026).

Kernberg: sadism in the narcissistic spectrum

Kernberg’s “malignant narcissism” places sadistic aggression inside a severe narcissistic structure. His colleagues have operationalized it as grandiose narcissism plus paranoid tendencies, psychopathic features, and a sadistic, aggressive interpersonal style. Higher scores predicted slower improvement in treatment for people with borderline personality disorder (Lenzenweger et al., 2018).

Meloy and Shapiro: predation and rigid control

Meloy’s writing on “wickedness” links psychopathy and sadism and describes the visceral, predator–prey countertransference these patients can evoke (Meloy, 1997; McWilliams & Shedler, 2026, pp. 694–695). Forensic scientists, the PDM-3 adds, distinguish affective from predatory violence (p. 695). Shapiro’s work on rigid character, as the PDM-3 summarizes it, emphasizes the choice of weaker targets (Shapiro, 1981; McWilliams & Shedler, 2026, p. 695).

Cleckley: whim versus malice

Cleckley drew an early line between psychopathic harm and deliberate cruelty. He described people with the typical psychopathic pattern as harming others through whim, pettiness, and an inability to grasp their hurt. By contrast, he described a fictional character with sustained, well-organized malice who understood exactly how her actions would hurt. He linked her to severe paranoid reactions with sadomasochistic elements rather than to a separate sadistic type (Cleckley, 1988, p. 322). The contrast anticipates the way the PDM-3 now separates the two styles.

DSM-III-R, Millon, and the empirical turn

The PDM-3 credits Millon with one of the few comprehensive clinical accounts of sadistic personality (Millon & Davis, 1996; McWilliams & Shedler, 2026, p. 694). The DSM-III-R appendix diagnosis prompted research. A survey of forensic psychiatrists, with 279 usable responses, found that about half had evaluated someone who met the criteria, and that most of those with experience of the disorder saw the diagnosis as useful. Most also worried that it could be misused in legal settings (Spitzer et al., 1991). Today, research has moved toward dimensional measures and the “Dark Tetrad,” which adds sadism to narcissism, Machiavellianism, and psychopathy (Lobbestael et al., 2023; Quinapanta-Castro et al., 2026).

A real disagreement remains. Researchers hold diverging views about whether sadism is a distinct trait or largely overlaps with psychopathy, and some find current measures of the two nearly redundant (Lobbestael et al., 2023; Quinapanta-Castro et al., 2026).

Examples

The therapist’s own sadism

McWilliams describes a common sequence when therapists work with self-defeating patients. First comes excessive generosity. When the patient only becomes more helpless, ego-alien irritation follows, and then fantasies of sadistic retaliation. She writes that therapists find such urges hard to admit, but “feelings that go unacknowledged are likely to be acted out.” The example shows sadistic feeling at a healthy, conflicted level, in people whose main motive is to help.

Nancy McWilliams, Psychoanalytic Diagnosis (2011), pp. 279–280

A sly smile

McWilliams notes that when people with a masochistic style recount how others have mistreated them, a trace of a sly smile sometimes crosses their aggrieved faces. It is easy to read this as sadistic pleasure in exposing their tormenters. She suggests a more careful reading: the suffering brings secondary gains, such as a moral victory over the people who hurt them or more connection with the listener. The example shows sadism as a disavowed strand inside another style rather than as the organizing theme of a personality.

Nancy McWilliams, Psychoanalytic Diagnosis (2011), pp. 277–278

Jenny in The Strange Woman (fiction)

Cleckley discusses the title character of Ben Ames Williams’s novel The Strange Woman, who works with “persistent purposiveness” and “sustained malice” to destroy the happiness of the people closest to her. Cleckley contrasts her deliberate, well-aimed cruelty with the whim-driven harm he saw in the psychopathic pattern. He calls her picture closer to a paranoid life scheme with sadomasochistic elements. The fictional case illustrates the planned, purposeful quality the PDM-3 treats as central to sadistic personality.

Hervey Cleckley, The Mask of Sanity (5th ed., 1988), p. 322

How It Differs From Look-Alikes

Psychopathic style

The two overlap heavily, and concern about that overlap may be why the diagnosis was dropped from the DSM (McWilliams & Shedler, 2026, p. 694). People with a psychopathic style seek power and the thrill of getting over on others, and the harm they cause is often a by-product. In the sadistic style, the other person’s suffering or humiliation is itself the point. Cleckley drew a similar contrast between the whim-driven harm he saw in the psychopathic pattern and a fictional character’s deliberate malice (1988, p. 322).

Reactive anger

Many people strike out when provoked or attacked. Forensic scientists distinguish this “affective” violence from “predatory” violence. The hallmark of the sadistic style is detachment or guiltless enthusiasm, not a burst of rage (McWilliams & Shedler, 2026, p. 695).

Consensual sexual dominance

Sexual fantasies or practices involving dominance do not make a personality sadistic. Most people with such interests are not sadistic in the rest of their lives (McWilliams & Shedler, 2026, p. 695).

Narcissistic style

Contempt and devaluation are common in the narcissistic style, but they mainly serve to protect self-esteem. Only at the malignant end does narcissism become “suffused with sadistic aggression” (McWilliams & Shedler, 2026, p. 688).

Masochistic style

People with a masochistic style may provoke mistreatment, and at lower levels they may defend against their own sadism by inducing others to enact it (p. 671). Their sadism tends to be disavowed rather than openly pursued.

Late-life irritability

Increased dependency and unfamiliar settings can trigger humiliating outbursts in older adults. Without a lifelong history, such episodes tend to be brief and do not define the person’s relationships (p. 948).

History

The word comes from the Marquis de Sade, and Krafft-Ebing gave sadism and masochism their clinical names (McWilliams, 2011, p. 267; Freud, 1920, pp. 21–22). Freud took the terms into psychoanalysis in 1905 and revised his view of their relationship in 1924. Fromm’s 1973 study treated sadism as a matter of character and society rather than mainly of sexuality.

The diagnostic history is short. In the late 1980s, sadistic personality disorder entered DSM-III-R as a proposed diagnosis in its appendix, to be considered for future editions (Lobbestael et al., 2023). Forensic psychiatrists surveyed soon afterward found it valid and useful but feared legal misuse (Spitzer et al., 1991). DSM-IV dropped it. The reasons were never fully spelled out, though they likely included overlap with antisocial and narcissistic disorders (Lobbestael et al., 2023; McWilliams & Shedler, 2026, p. 694). Neither DSM-5 nor ICD-11 restored it.

The PDM kept the style, while acknowledging the thin research base. Apart from studies of criminal sexual sadism, there has been little empirical research on sadistic personality (p. 694). McWilliams left it out of her book-length typology, considering people whose character is centrally sadistic rare in voluntary treatment, and pointed readers to the PDM (2011, pp. xiii, 155). More recently, social and personality psychology has studied sadism as a dimensional trait in the general population, through measures of everyday sadism and the Dark Tetrad. A recent review notes that research linking sadism to the ten DSM personality disorders is still scarce (Lobbestael et al., 2023).

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