title: Increased frontotemporal activation during pain observation in sexual sadism: preliminary findings.
abstract: BACKGROUND
  Sexual sadism is a psychiatric disorder in which sexual pleasure is derived from inflicting pain, suffering, or humiliation on others. While the psychological and forensic aspects of sexual sadism have been well characterized, little is known about the neurocognitive circuitry associated with the disorder. Sexual sadists show increased peripheral sexual arousal when observing other individuals in pain. The neural mechanisms underlying this unusual response are not well understood. We predicted that sadists relative to nonsadists would show increased responses in brain regions associated with sexual arousal (amygdala, hypothalamus, and ventral striatum) and affective pain processing (anterior cingulate and anterior insula) during pain observation.
  
  
  OBJECTIVE
  To study the neural correlates of pain observation in sadists and nonsadists.
  
  
  METHODS
  Case-control cross-sectional study. Sadists and nonsadists viewed 50 social scenes, 25 that depicted a person in pain (eg, one person stabbing another person's hand with scissors) and 25 thematically matched no-pain pictures (eg, one person stabbing a table with scissors, with another person's hand nearby). Pain severity ratings (range, 0 [none] to 4 [severe]) were acquired following each picture presentation.
  
  
  METHODS
  Sand Ridge Secure Treatment Center, Mauston, Wisconsin.
  
  
  METHODS
  Fifteen violent sexual offenders, including 8 sadists and 7 nonsadists (defined using the Severe Sexual Sadism Scale) who were matched for age, IQ, and education.
  
  
  METHODS
  Hemodynamic response revealed by functional magnetic resonance imaging and pain severity ratings.
  
  
  RESULTS
  Sadists relative to nonsadists showed greater amygdala activation when viewing pain pictures. They also rated pain pictures higher on pain severity than nonsadists. Sadists but not nonsadists showed a positive correlation between pain severity ratings and activity in the anterior insula.
  
  
  CONCLUSIONS
  These results provide neurobehavioral evidence of unusually heightened sensitivity to the pain of others in sadists.
authors.affiliation: The Mind Research Network, Albuquerque, NM 87106, USA. charenski@mrn.org
authors.forename: Carla L
authors.initials: CL
authors.lastname: Harenski
authors.forename: David M
authors.initials: DM
authors.lastname: Thornton
authors.forename: Keith A
authors.initials: KA
authors.lastname: Harenski
authors.forename: Jean
authors.initials: J
authors.lastname: Decety
authors.forename: Kent A
authors.initials: KA
authors.lastname: Kiehl
mesh_terms: D000679:Amygdala / Q000503:physiopathology; D001479:Basal Ganglia / Q000503:physiopathology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005625:Frontal Lobe / Q000503:physiopathology*; D059907:Functional Neuroimaging; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D007031:Hypothalamus / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement; D010775:Photic Stimulation; D012448:Sadism / Q000503:physiopathology*; D013702:Temporal Lobe / Q000503:physiopathology*