The Sadistic Patient - A Case Study

Theoretical description of the sadistic personality. Read sample therapy notes from a man diagnosed with Sadistic Personality Disorder.


The Sadistic personality disorder was included in the DSM III-TR but removed from the DSM IV and from its text revision, the DSM IV-TR. This was criticized by some scholars, notably Theodore Millon.

Notes of first therapy session with Jared, male, 43, diagnosed with Sadistic Personality Disorder

"A little discipline never hurt nobody." - repeats Jared, clearly amused. Beating a three year old and letting her freeze to near death on your doorstep in subzero temperatures, is this his idea of discipline? "It's one way or getting the message across" - Jared laughs heartily and then composes himself: "Listen, Doc, I am as merciful and compassionate as they come, believe you me. But what I can't stand is cry-babies, weaklings, and whining bitches. Besides, it's fun to see how a little ice does wonders to their sirens."

Why did he force the mother to dump her by now limp and profusely bleeding infant daughter outside the door? If she were a proper caretaker none of this would have happened. He wanted to show her wretched family who is the only boss in the household. "They were getting on my nerves, her mother and sister. They needed some re-education, like in them Chinese camps."- he chuckles. They all claim to be terrified of him and intimidated by his capricious and violent behavior. "I sure hope so!" - he smirks.

The kid says that you pinched her repeatedly and that's why she cried. "I was just kidding with her." Pinching hurts. "Sure does!" - he roars and slaps my shoulder across the desk - "I like you, Doc!" The slap hurt, too. Could he please refrain from doing it in the future? "Whatever turns you own, ma'shrink" - he accepts my interdict jovially.

The mother says that about a year ago you beat the same child and caused her grave injuries because she wouldn't cry when you pinched her and kicked her around. You kept yelling "cry, you bitch, cry." Then you mauled her because she wouldn't cry and now you spanked her because she did cry. "She has to make up her mind and stick to it. I respect that. But she can't change her behavior every time I pinch her. That's why I disciplined her. I want her to have a spine." It seems to me that he is the one who keeps changing the rules. his face darken and he leans forward, whispering hoarsely:

"I like you, Doc, and all - but don't cross the line here or you may get a taste of the same medicine yourself." Is this a threat? He merely glowers at me malevolently. Doesn't he like me any more? "(Expletive deleted) off."

This article appears in my book, "Malignant Self Love - Narcissism Revisited"


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APA Reference
Vaknin, S. (2009, October 1). The Sadistic Patient - A Case Study, HealthyPlace. Retrieved on 2024, July 13 from

Last Updated: July 5, 2018

Medically reviewed by Harry Croft, MD

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