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Sadistic Personality Disorder and Comorbid Mental Illness in Adolescent Psychiatric Inpatients

Dr. Myers is Professor and Chief, Division of Child and Adolescent Psychiatry, and Director, Forensic Psychiatry Program at the University of South Florida, Tampa, FL. Dr. Husted is a fourth-year resident in the Department of Psychiatry, University of Florida, Gainesville, FL. Dr. Burket is Associate Professor, Department of Psychiatric Medicine, Division of Child and Family Psychiatry, University of Virginia, Charlottesville, VA. This research was supported in part by an unrestricted grant to Drs. Burket and Myers from the Upjohn Company. Address correspondence to: Wade C. Myers, MD, Professor, Department of Psychiatry and Behavioral Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 102, Tampa, FL 33612. E-mail: wmyers{at}hsc.usf.edu

Sadistic personality disorder (SPD) is a controversial diagnosis proposed in the DSM-III-R, but not included in the DSM-IV. Few studies have focused on this disorder in adolescents. This article describes the results of a study that sought to determine the presence of sadistic personality characteristics in psychiatrically hospitalized adolescents and of comorbid Axis I or personality disorder patterns in those youth with SPD or SPD traits. Fifty-six adolescents were assessed for sadistic and other personality disorders with the Structured Interview for DSM-III-R Personality Disorders-Revised (SIDP-R). Axis I disorders were assessed using the Diagnostic Interview for Children and Adolescents, Adolescent Version (DICA-R-A) and portions of the Schedule for Affective Disorders and Schizophrenia for School Age Children, Epidemiologic (K-SADS-E). The youth were divided into those with SPD and SPD traits, the Sadistic Group (n = 18), and the Nonsadistic Group (n = 38). A significant proportion of the adolescents in this study met full DSM criteria for SPD (14%). The Sadistic Group (32%) had significantly more Axis I and personality pathology than did the Nonsadistic Group. However, all but one in the Sadistic Group met criteria for other personality disorders, confounding the interpretation of these findings and consistent with adult literature studies. Subjects with sadistic personality characteristics were identified in this adolescent inpatient sample, and they had more extensive Axis I and II psychopathology than the comparison group. The validity of this disorder in younger populations requires further study. Future studies should also explore the impact that the mandatory use of the pleasure/gratification criterion has on the validity of the SPD diagnosis and whether the requisite presence of this criterion decreases the overlap currently noted between SPD and other Axis II diagnoses.