$JJUHVVLRQDQG9LROHQW%HKDYLRU²

Contents lists available at ScienceDirect

Aggression and Violent Behavior

journal homepage: www.elsevier.com/locate/aggviobeh

A meta-analysis of the association between psychopathy and sadism in 7

forensic samples☆
⁎
Debra O'Connell , David K. Marcus
Department of Psychology, Washington State University, PO Box 644820, Johnson Tower 233, Pullman, WA 99164-4820, USA

A B S T R A C T

This meta-analysis examined the association between psychopathic personality traits as assessed by the Psychopathy Checklist-Revised (PCL-R; Hare, 1991), and
sadism. The PCL-R yields a total score as well as two factor scores. Factor 1 encompasses the interpersonal/affective components of psychopathy such as glibness, and
callousness. Factor 2 captures the antisocial behavior aspects of psychopathy including impulsivity, and poor planning abilities. The meta-analysis included 19
independent adult, male forensic samples from 16 articles that included a total of 5161 participants. The average r across all studies for PCL-R total score and sadism
was 0.24 (p < .001). Both PCL-R Factor 1 (r = 0.25, p < .01) and PCL-R Factor 2 (r = 0.26, p < .01), yielded similar correlations with sadism. Sadism mea-
surement method and type of sadism assessed did not significantly moderate the association between psychopathy and sadism. However, there was low power in the
moderator analyses. These results support previous research that found both the interpersonal/affective component of psychopathy and the antisocial behavior
component of psychopathy are associated with sadism.

Psychopathic personality traits include characteristics such as su-
perficial charm, irresponsibility, fearlessness, conning behavior/ma-
nipulation, and lack of empathy (Hare, 1970). Sadism is defined as
deriving enjoyment from the suffering of others (Baumeister &
Campbell, 1999). Although individuals who exhibit each of these per-
sonality traits often hurt others, the reasons for doing so seem to be
driven by different motivations. Psychopathic individuals will hurt
others in order to obtain something they want, and will not care that
they have caused harm to someone (Hare & Neumann, 2008). Sadistic
individuals will hurt others simply for the pleasure they experience
from doing so (Paulhus, 2014). Studies have consistently found an as-
sociation between psychopathic personality traits and sadism, with
offenders who are both psychopathic and sadistic being more violent
and likely to recidivate (Meloy, 2000; Porter, Woodworth, Earle,
Drugge, & Boer, 2003) compared to individuals who are either psy-
chopathic or sadistic. In fact, a diagnosis of psychopathy and/or sadism
is often used to justify longer sentences or deny parole (e.g., Levenson,
2004; Lloyd, Clark, & Forth, 2010). Still, the precise nature of how
psychopathy and sadism are related remains ambiguous, both in terms
of the magnitude of the association and in terms of what components
explain this shared variance.
Within forensic settings, the association between psychopathy and
sadism has only been studied in male samples, and researchers have
primarily utilized the Psychopathy Checklist-Revised (PCL-R; Hare,
1991) to measure psychopathy. The PCL-R yields a total score as well as
two correlated factors (Hare, 1991). Factor 1 encompasses the inter-
personal/affective components of psychopathy such as glibness,
shallow affect, and callousness. Factor 2 captures the antisocial beha-
vior aspects of psychopathy including impulsivity, parasitic lifestyle,
and poor planning abilities. Measurement method for sadism in the
literature has varied, and includes both self-report as well as clinician-
ratings of behavior, personality traits, or a combination of both. Pre-
vious literature reviews on psychopathy and sadism have focused on
forensic subsamples such as homicide offenders (e.g., James & Proulx,
2014; Kirsch & Becker, 2007). To date, no meta-analyses have been
conducted to examine the association between psychopathy and sadism
among offenders. By synthesizing the available findings across different
types of forensic samples (e.g., homicide offenders, sex offenders, sub-
stance abuse offenders) via meta-analysis, it will be possible to quantify
the strength of the overall association between psychopathy and

☆
This work was based on Debra O'Connell's preliminary exam project at Washington State University.
⁎
Corresponding author at: Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA.
E-mail addresses: debra.oconnell@wsu.edu (D. O'Connell), david.marcus@wsu.edu (D.K. Marcus).

https://doi.org/10.1016/j.avb.2019.02.013
Received 15 May 2018; Received in revised form 2 October 2018; Accepted 18 February 2019
$YDLODEOHRQOLQH)HEUXDU\
‹(OVHYLHU/WG$OOULJKWVUHVHUYHG
D. O'Connell and D.K. Marcus
sadism.
The current meta-analysis examined the overall association between
psychopathy and sadism as well as the associations between the inter-
personal/affective component of psychopathy and sadism and the an-
tisocial behavior component of psychopathy and sadism. Only studies
utilizing the PCL-R were included in the meta-analysis. An additional
advantage of limiting the meta-analysis to PCL-R studies is that, unlike
some other measures of psychopathy, none of the items on the PCL-R
address sadistic pleasure at another's pain.1
1. Psychopathy and sadism
Sadism as a construct has changed over time and debate continues
as to whether sadism is best conceptualized as a personality dysfunc-
tion, a type of antisocial behavior, or a combination of both (e.g.,
Krueger, 2010). Additionally, there has been debate over whether
sexual sadism is a separate construct from other forms of sadism (e.g.,
sadism as a personality disorder, and sadism as a personality trait;
Kirsch & Becker, 2007; Krueger, 2010). Because of continued debate
over the definition of sadism, a review of the association between
psychopathy and sadism will be organized by type of sadism assessed
and include a brief overview of each type of sadism.
1.1. Psychopathy and sexual sadism
The severity of sexually sadistic behavior can vary across a spectrum
of behavior from adults engaged in consensual acts of sadism and ma-
sochism to torture and homicide of non-consenting victims. Empirical
research on the association between psychopathy and sexual sadism has
exclusively examined male forensic samples, particularly sex offenders.
Across studies, PCL-R total scores are consistently and positively cor-
related with sexual sadism (Firestone, Bradford, Greenberg, Larose, &
Curry, 1998; Langevin, 2003; Porter et al., 2003). However, the asso-
ciations between sexual sadism and the two factors of the PCL-R have
been inconsistent. Porter et al. (2003) found an association between the
interpersonal/affective components of psychopathy (PCL-R, F1) and
sexual sadism, but not the antisocial behavior components of psycho-
pathy (PCL-R, F2) and sexual sadism. Similarly, homicidal offenders
had higher F1 scores and diagnoses of sexual sadism compared to non-
homicidal offenders (Firestone et al., 1998). In contrast, sexually sa-
distic sex offenders had significantly higher F2 scores compared to
other sex offenders, but sadistic sex offenders did not differ from other
sex offenders on F1 (Barbaree, Seto, Serin, Amos, & Preston, 1994).
Mokros, Osterheider, Hucker, and Nitschke (2011) examined the
association between psychopathy and sexual sadism using the hospital
records of 100 sex offenders, using the four facet scoring model of the
PCL-R. The four-facet model of the PCL-R separates F1 into Inter-
personal and Affective facets, and F2 into Lifestyle, and Antisocial fa-
cets. The Interpersonal Facet is characterized by such traits as manip-
ulation, and pathological lying, and the Affective Facet captures such
items as lack of remorse, callousness, and lack of empathy. The Lifestyle
Facet encompasses impulsivity, and irresponsibility, whereas the Anti-
social Facet primarily refers to criminal activity during childhood and
1
The original criteria for the meta-analysis included any measure of psy-
chopathy; however, all of the research conducted with non-forensic samples
(mostly college students) utilized self-report measures of psychopathy and
sadism. Therefore, including the non-forensic samples would have confounded
psychopathy measure, sample type, and method variance. Additionally, the
studies with non-forensic samples utilized the “dark triad,” and “dark tetrad”
models of psychopathy and everyday sadism that are conceptually different
from PCL-R defined psychopathy, and sadism measured in the forensic samples.
Finally, by limiting the meta-analysis to offender/forensic samples, we ensured
that the data were collected from individuals who had seriously harmed others.
Following a preliminary review of relevant studies, we decided to limit the
inclusion criteria to PCL-R studies of forensic samples.

$JJUHVVLRQDQG9LROHQW%HKDYLRU²
adulthood. Mokros et al. (2011) found that the PCL-R Affective and
Antisocial Facets were both correlated with sexual sadism, whereas the
PCL-R Interpersonal and Lifestyle Facets were not. These findings sug-
gest that some traits from both PCL-R Factor 1 and Factor 2 are asso-
ciated with sadism.
1.2. Psychopathy and sadistic personality
Sadistic Personality Disorder (SPD) first appeared in the appendix of
the DSM-III-R (American Psychiatric Association, 1987) as a personality
disorder to be considered for future editions of the DSM. To meet di-
agnostic criteria for SPD, an individual must have engaged in “a per-
vasive pattern of cruel, demeaning, and aggressive behavior, beginning
by early adulthood” (American Psychiatric Association, 1987, p. 371)
for the purpose of amusement or obtaining pleasure from the suffering
of others. Ultimately, SPD was not included in later editions of the DSM,
but these DSM criteria have been used in some studies that have ex-
amined the association between psychopathy and sadism (e.g.,
Delescluse & Pham, 2005).
Holt, Meloy, and Strack (1999) examined the association between
psychopathy and sadism in a sample of 41 offenders classified as either
violent, or sexually violent. Psychopathy was measured using the two-
factor model of the PCL-R. Sadism was measured with the sadism scale
of the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1987),
the sadism items from Personality Disorder Examination (PDE;
Loranger, 1988), and the diagnostic criteria for sexual sadism from the
DSM-IV (American Psychiatric Association, 2000) Holt et al. (1999)
found significant, positive correlations between the PCL-R total score,
F1, and F2 with both the MCMI-II sadism scale and the PDE. The cor-
relations ranged from r = 0.48–0.64. Additionally, individuals classi-
fied as “psychopaths,” based on the PCL-R recommended score of 30 or
higher, scored significantly higher on the MCMI-II sadism scale and the
sadism items on the PDE compared to non-psychopathic offenders. Of
note, the psychopathic sexually violent offenders did not differ sig-
nificantly from the psychopathic violent offenders in their MCMI-II
scores or their PDE scores. There were no significant correlations be-
tween DSM-IV sexual sadism criteria and psychopathy, although the
researchers noted that one limitation was the small number of partici-
pants meeting diagnostic criteria for DSM-IV sexual sadism in their
sample (n = 3).
In summary, a majority of the research on the association between
psychopathy and sadism in forensic settings has assessed sexual sadism.
Occasionally, sadism has been more broadly defined as a general en-
joyment of hurting others. Although there is clear evidence that there is
an association between PCL-R total scores and sadism (e.g., Firestone
et al., 1998; Holt et al., 1999; Langevin, 2003; Porter et al., 2003), the
findings have been less consistent regarding how each PCL-R factor is
related to sadism.
2. The present study
The present meta-analysis assessed the association between psy-
chopathic personality traits as measured by the Psychopathy Checklist-
Revised (PCL-R; Hare, 1991) and all types of sadism (i.e., sexual sadism,
personality models of sadism, and mixed violent/sexual sadism) in
forensic samples. The meta-analysis was limited to studies utilizing the
PCL-R because the literature search yielded only one study that did not
use the PCL-R in a forensic sample.
Consistent with previous research on psychopathy and sadism
(e.g.,Firestone et al., 1998; Holt et al., 1999; Langevin, 2003; Mokros
et al., 2011), it was hypothesized that PCL-R total scores, Factor 1 and
Factor 2 will all positively correlate with measures of sadism. Because
of shared method variance, we also expected that the association be-
tween psychopathy and sadism would be stronger when sadism was
measured by clinician-ratings compared to self-report. Additionally, we
examined whether type of sadism (i.e., sexual or other) moderated the
D. O'Connell and D.K. Marcus
association between psychopathy and sadism.
3. Method
3.1. Identification of studies
The first author conducted a search of PsycINFO using the term
“psychopathy” and variants (i.e., “psychopath,” and “psychopathic”)
combined with the term “sadism” and variants (i.e., “sadist,” and “sa-
distic”). These search terms initially yielded 694 results, and filters
were applied to only include empirical, peer-reviewed articles which
narrowed the results to 92. Additional searches were conducted in
PubMed and ISI Web of Science. After cross-referencing the PubMed
search results with the articles returned from the PsycInfo search,
PubMed yielded five additional articles (k = 97). All search results from
ISI Web of Science were accounted for in either the PsycINFO or
PubMed search. To be included in the meta-analysis, studies had to (a)
provide codable statistics in the form of a correlation coefficient or the
necessary information to calculate one; (b) measure psychopathy using
the PCL-R (Hare, 1991); (c) include a measure of sadism or a descrip-
tion of diagnostic criteria (e.g., DSM-III sadistic personality disorder
diagnosis); and (d) have researchers who have direct contact with
subjects or access to criminal or psychological records.2
Sixteen of the 97 articles met the inclusion criteria and provided
data for 19 independent samples. The 76 excluded references were
excluded because they (a) did not include details about how psycho-
pathy and sadism were measured (13); (b) were commentaries, theory
papers, or review articles which did not report new data (44); (c)
measured Antisocial Personality Disorder, but not psychopathy (6); (d)
had a sample overlapping with another study (k = 3); (d) used a psy-
chopathy measure other than the PCL-R (5); or (e) did not provide
usable data to calculate a correlation coefficient (10). See Fig. 1 for a
flowchart of study selection.
In cases where usable data were not provided, but all other inclu-
sion criteria were met, the author listed to receive correspondence was
contacted for further information. Out of 12 authors emailed to request
data, two authors provided the location of usable data that had been
overlooked during coding, one author provided a reference to a recently
published article, four reported that they no longer had the data files,
and there was no response from the remaining six. The reference sec-
tions of the included articles were then used to locate additional re-
ferences to potentially include in the meta-analysis, which did not yield
any additional usable additional samples/studies. Thus, the meta-ana-
lysis included 19 independent samples from 16 studies that included
5161 participants. All studies included in the meta-analysis are listed in
Table 1.
3.2. Procedure
The studies were coded for region, sample size, percentage
Caucasian, IQ, age group, type of sadism (sexual, mixed sexual/violent,
and mixed sexual/personality), sadism measure used, and sadism
measure method (clinician rating, self-report). All included studies used
exclusively male samples. When reported, separate effect sizes were
calculated for the association between PCL-R F1 and sadism, and PCL-R
F2 and sadism. Any articles that did not report Pearson's product-mo-
ment correlation coefficients, but provided the requisite data to calcu-
late an effect size were converted using an online effect-size calculator
(Wilson, 2001). To correct for bias, Pearson's rs were then converted
with Fisher's Zr transformation (Lipsey & Wilson, 2001, p.107), mean
2
Despite applying filters to the search terms to only yield empirical, peer-
reviewed articles, there were many articles returned that involved clinical
opinions of celebrities, people in documentary films, fictional characters, and
unclear specifications of level of contact with the subjects.

$JJUHVVLRQDQG9LROHQW%HKDYLRU²
effect sizes were calculated, and then the Z-values were converted back
to r for reporting. The effect sizes were weighted by sample size, and the
inverse variance weight used was the sample size minus three (Lipsey &
Wilson, 2001, p. 64).
When multiple measures of sadism were included in a study, the
effect sizes from each measure were averaged. However, if a study used
both a dichotomous (e.g., DSM-III Sadistic Personality Disorder diag-
nosis) and a continuous measure (e.g., Sadistic Attitudes and Behavior
Scale) of sadism, the effect size from the continuous measure was in-
cluded in the meta-analysis to maximize variance and power.
All analyses were conducted using a maximum-likelihood random
effects model with Lipsey and Wilson's (2001) statistical program for
SPSS. A Q test of homogeneity was used to determine whether there
was significant heterogeneity among the effect sizes. I2 was calculated
to determine the percentage of variance attributable to heterogeneity
across studies (Higgins, Thompson, Deeks, & Altman, 2003). I2 values
range from 0 to 100. Values of 25%, 50%, and 75% have been proposed
as anchor points for low, moderate, and high I2 values (Higgins et al.,
2003). The regression test for funnel plot asymmetry (Egger, Smith,
Schneider, & Minder, 1997), the trim and fill procedure (Duval &
Tweedie, 2000), and the leave-one-out analysis were conducted using
the metafor package in R (Viechtbauer, 2010) to examine possible
publication bias or outlier effects. The meta-analytic analogue to the
analysis of variance (ANOVA) was used to test for the categorical
moderators (Hedges, 1982; Lipsey & Wilson, 2001).
4. Results
4.1. Primary analyses
The mean effect size for PCL-R total score and sadism was r = 0.24,
which was statistically significant (k = 19; 95% CI = 0.16–0.34;
Z = 5.34, p < .001). There was considerable heterogeneity among the
studies Q (18) = 109.40, p < .001, I2 = 84.5, indicating that these
studies do not all derive from the same population. The funnel plot
indicated that most of the effect sizes fell within the expected dis-
tribution (Fig. 2), and the regression test for funnel plot asymmetry
using the standard error of the observed values as a predictor variable
was not significant (z = 1.70, p = .08). Additionally, the trim and fill
procedure did not impute any additional studies to the funnel plot. The
leave-one-out procedure indicated that no single study was skewing the
mean effect size, with rs ranging from 0.22 to 0.27, and all p va-
lues < .001.
Eight studies reported the associations between the PCL-R factor
scores and sadism. The mean effect size for the association between
PCL-R F1 and sadism was r = 0.25, which was statistically significant
(95% CI = 0.09–0.44; Z = 3.01, p < .01). There was moderate het-
erogeneity among the studies Q(7) = 15.44, p = .03, I2 = 54.7, in-
dicating that these studies do not all derive from the same population.
The funnel plot generated from the data indicated that all but one study
fell within the expected distribution (Fig. 3). The regression test for
funnel plot asymmetry with standard error selected as the predictor was
not significant (z = 0.32, p = .74). The trim and fill procedure did not
suggest imputing any additional studies. The leave-one-out analysis
indicated even when the study with the largest effect size was elimi-
nated, the average effect remained significant at p < .01, with rs
ranging from 0.16 to 0.29, and all p values ≤ .01.
The mean effect size for the association between PCL-R Factor 2 and
sadism was r = 0.26, which was statistically significant (95%
CI = 0.08–0.46; Z = 2.82, p < .01). There was a moderate amount of
heterogeneity among the studies Q(7) = 18.52, p < .01, I2 = 62.2,
indicating that these studies do not all derive from the same population.
Examination of the funnel plot indicated that all but two studies fell
within the expected distribution (Fig. 4). The regression test for funnel
plot asymmetry was not significant (z = 0.65, p = .51). Additionally,
the trim and fill analysis indicated there were no missing studies in the
D. O'Connell and D.K. Marcus
Records identified through searches of
PsycInfo, PubMed, and ISI Web of
Science of the terms “psychopathy” and
variants combined with the term
“sadism” and variants.
(699)
Records screened after limiting the results
to empirical, peer-reviewed articles.
(97)
Articles included in the meta-
analysis
(16; k = 19)**
Fig. 1. Flow chart of study selection. *In response to an email to clarify whether the sample of one study overlapped with another, the author provided a reference to
a recently published article that met the inclusion criteria. **3 studies provided data on two independent samples each, and were coded as two separate studies
thereby adding 3 more samples to the analyses.
funnel plot. Finally, re-running the analyses leaving out one study at a
time indicated that even when the study with the largest effect size was
eliminated, the average effect remained significant at p < .05 with rs
ranging from 0.20 to 0.31, and all p values < .05.
4.2. Moderation analyses
Measurement method used to assess sadism (i.e., self-report vs.
clinician-rating), and type of sadism were tested as potential mod-
erators of the relationship between PCL-R total scores and sadism. The
minimum number of studies in each category for a variable to be in-
cluded as a moderator was k = 3, which precluded moderator analyses
for PCL-R factor scores (i.e., of the studies that reported associations
with PCL-R factor scores, only two used self-report measures of sadism,
and only one study examined a form of sadism other than sexual
sadism).
A random effects model analogous to the ANOVA (Hedges, 1982)
was conducted to test whether sadism measurement method moderated
the association between psychopathy and sadism. More specifically, we
investigated whether the variation among the effect sizes for psycho-
pathy total score and sadism was attributed to differences in how
sadism was measured (e.g., self-report vs. clinician-rating). The
$JJUHVVLRQDQG9LROHQW%HKDYLRU²
Records identified through other
sources*
(1)
Full-text articles excluded, with reasons
- no usable data (10)
- no direct contact with those assessed or used
inadequate records (e.g., analyzing book
characters, using documentary films; 44)
- no specification of the diagnostic criteria (13)
- measured Antisocial Personality Disorder,
but not psychopathy (6)
-overlapping sample with another study (3)
-used a measure other than the PCL-R (5)
association between PCL-R scores and self-reported sadism did not
differ significantly from the association between PCL-R scores and
clinician-ratings of sadism, QB(1) = 2.54, p = .11; QW(17) = 19.54,
p = .29. The average effect size for the three studies of PCL-R total
scores and self-report measures of sadism was 0.38 (95%
CI = 0.19–0.62; Z = 3.71, p < .001), and the average effect size for
the 16 studies of PCL-R total score and clinician-ratings of sadism was
0.21 (95% CI = 0.12–0.31; Z = 4.47, p < .001).
Fifteen of the 19 samples assessing the association between PCL-R
total scores and sadism measured sexual sadism (k = 15). The other
four samples assessed mixed violent and sexual sadism (k = 2), and
personality/character sadism (k = 2). There were no significant dif-
ferences between the studies that specifically assessed sexual sadism
and the other four studies, QB(1) = 1.79, p = .18; QW(17) = 18.45,
p = .36. The average effect size for the 15 samples that assessed the
association between psychopathy total scores and sexual sadism was
0.22 (95% CI = 0.12–0.32; Z = 4.24, p < .001). The average effect
size for the four studies that assessed the association between psycho-
pathy total scores and other types of sadism was 0.36 (95%
CI = 0.17–0.58; Z = 3.57, p = .001).

D. O'Connell and D.K. Marcus $JJUHVVLRQDQG9LROHQW%HKDYLRU²

Table 1
Studies included in the meta-analysis.
Reference N Type of sadism Sadism measure method Effect (r)-Ptotal Effect (r)-PF1 Effect (r)-PF2

Barbaree et al. (1994) 23 S CR 0.35 0.20 0.38

Briken, Habermann, Kafka, Berner, and Hill (2006)a 56 S CR 0.59
Briken et al. (2006)b 29 S CR 0.41
Delescluse and Pham (2005) 76 M CR 0.04 0.09 −0.03
Eher et al. (2015) 992 S CR 0.15
Harenski, Thornton, Harenski, Decety, and Kiehl (2012) 15 S CR 0.12 0.07 0.19
Hill, Habermann, Berner, and Briken (2007) 166 S CR 0.20
Holt et al. (1999) 41 M CR 0.64 0.64 0.57
Langevin and Curnoe (2015)a 2414 S CR 0.00
Langevin and Curnoe (2015)b 62 S CR −0.04
Looman, Dickie, and Maillet (2008) 18 S CR 0.23 0.34 0.25
Mokros et al. (2011) 99 S CR 0.28
Nitschke, Istrefi, Osterheider, and Mokros (2012) 35 S CR 0.16
Porter et al. (2003) 38 S SR 0.35 0.34 0.20
Richards and Jackson (2011) 78 S CR 0.06 0.06 0.07
Robertson and Knight (2014)a 314 S SR 0.35
Robertson and Knight (2014)b 599 S CR 0.16
Shine and Hobson (1997) 46 P SR 0.47 0.28 0.50
Stupperich and Strack (2016) 60 P CR 0.30

Note. Type of Sadism: S = sexual, M = mixed group of more than one type, P = Personality. Sadism Measure Method: CR = clinician-rating, SR = self-report. Effect
(r) Ptotal = Pearson's product-moment correlation coefficients for the association between sadism and psychopathy total score. Effect (r) PF1 = Pearson's product-
moment correlation coefficients for the association between sadism and the interpersonal/affective component of psychopathy. Effect (r) PF2 = Pearson's product-
moment correlation coefficients for the association between sadism and the impulsivity/antisocial behavior component of psychopathy. Superscripts a and b denote
when two different samples were included in the same article.

Fig. 2. Funnel plot of effect sizes for the association between PCL-R total score Fig. 3. Funnel plot of effect sizes for the association between PCL-R Factor 1
and sadism. and sadism.

5. Discussion
Although several studies have indicated that psychopathy and
sadism are separate, but related constructs (e.g., James & Proulx, 2014;
Kirsch & Becker, 2007; Porter, Campbell, Woodworth, & Birt, 2001) no
prior meta-analyses have examined the strength of this association. The
primary aims of the meta-analysis were to (a) assess the association in
forensic samples between psychopathy as measured by the PCL-R and
various forms of sadism, and (b) determine how each factor of the PCL-
R is associated with sadism.
The hypothesis that PCL-R total score, as well as Factor 1 and Factor
2 would be associated with sadism was supported. These findings are
consistent with previous research on the association between psycho-
pathy and sadism. Additionally, the finding that both PCL-R Factor 1
and Factor 2 are associated with sadism supports the model proposed
by Porter et al. (2001) that both interpersonal/affective components of
psychopathy and the antisocial behavior component contribute to the
association between psychopathy and sadism. The medium effect sizes
found for the association between PCL-R total scores and sadism as well
as the PCL-R factor scores and sadism indicate that psychopathy and
sadism are related, but distinct constructs. Consequently, it may be
fruitful in future research to examine whether psychopathy and sadism
each make independent contributions to the prediction of antisocial or
aggressive behavior, or to the prediction of criminal recidivism. Re-
searchers should also examine potential interactions between sadism
and psychopathy (e.g., is sadism especially predictive of antisocial be-
havior at high levels of psychopathy?).
Although the method of measuring sadism did not moderate the
association between psychopathy and sadism, only three studies used
self-report measures, which limited the power of this analysis. Although
not significantly different, the associations between the PCL-R and self-
reported sadism (0.38) were nearly twice as large as the association
between the PCL-R and clinician-rated sadism, which was contrary to
our hypothesis. Most of the clinician-rated studies diagnosed sadism


D. O'Connell and D.K. Marcus
Fig. 4. Funnel plot of effect sizes for the association between PCL-R Factor 2
and sadism.
based on coding case files for characteristics of criminal acts to indicate
sadistic behavior (e.g., evidence of torture, recording crimes, indicators
of planning for the crime, etc.), or had been classified by previous
clinicians as meeting diagnostic criteria for DSM Sexual Sadism based
on offense characteristics (e.g., Briken et al., 2006; Eher et al., 2015;
Mokros et al., 2011; Nitschke et al., 2012). When sadism was assessed
via a clinical interview (e.g., Richards & Jackson, 2011), offenders were
only asked about behaviors that were later classified by the researchers
as sadistic. In contrast, self-report measures of sadism may also assess
sadistic thoughts or fantasies in addition to behaviors. For example,
Robertson and Knight (2014) used the self-report Multidimensional
Inventory of Development, Sex, and Aggression (MIDSA; Knight &
Cerce, 1999) in one of the samples in their study. The MIDSA is a
computerized inventory that assesses for both sexually sadistic beha-
viors and fantasies. Interestingly, Robertson and Knight (2014) found
that the association between PCL-R total scores and MIDSA scores in the
first sample was roughly twice as large as the association between PCL-
R total scores and clinician-ratings of sexually sadistic behaviors in their
second sample. It is possible that offenders feel more comfortable dis-
closing sadistic thoughts, fantasies, and behaviors in a self-report
format, particularly if the participants are told that their answers will
be confidential or anonymous. Still, because this moderator analysis
was not significant, these speculations should be treated tentatively
until there are additional studies that assess sadism using self-report
measures in forensic samples.
The moderator analysis for type of sadism assessed was not sig-
nificant; however, a large majority of the samples (15 out of 18) only
assessed sexual sadism, limiting the power of this analysis. Of the four
studies that did not exclusively assess sexual sadism, the effect sizes
ranged from almost no association (Delescluse & Pham, 2005) to a
medium effect size (Hill et al., 2007; Stupperich & Strack, 2016) to a
large effect size (Holt et al., 1999). However, the Delescluse and Pham
(2005) study, which yielded the smallest effect, also required that in
order for participants to be classified as sadistic, they had to meet all
eight DSM-II-R criteria for Sadistic Personality Disorder, which is an
unrealistically stringent standard that may have attenuated a possible
association between psychopathy and sadism. Additionally, both stu-
dies that assessed multiple forms of sadism included sexual sadism
(Delescluse & Pham, 2005; Holt et al., 1999). Therefore, it remains
unclear whether different types of sadism vary in how they are related
to psychopathy.
The meta-analysis had several strengths. It was the first meta-ana-
lysis to examine the association between psychopathy and sadism, as

$JJUHVVLRQDQG9LROHQW%HKDYLRU²
well as the association between subcomponents of psychopathy and
sadism. The present study was, however, limited in several ways. First,
the small amount of empirical research available on PCL-R psychopathy
and sadism in forensic populations limited the meta-analysis to 19
samples. Additionally, the association between PCL-R psychopathy and
sadism has exclusively been studied in male, forensic samples, and most
studies have limited their definitions of sadism to clinician-rated
sexually sadistic behaviors. Further complicating the study of the as-
sociation between components of psychopathy and sadism has been the
low reporting rate of factor scores for the PCL-R. These factors resulted
in the moderator analyses being underpowered, and precluded con-
ducting moderator analyses with PCL-R factor scores and sadism.
Future research on the association between psychopathy and sadism in
offender samples should be conducted with women, and include
broader conceptualizations of sadism and as well as different models of
psychopathy (e.g., the triarchic model; Patrick, Fowles, & Krueger,
2009) to further elucidate which components of psychopathy are as-
sociated with sadism.
In summary, both the interpersonal/affective component of psy-
chopathy (PCL-R Factor 1) and the antisocial behavior component of
psychopathy (PCL-R Factor 2) are similarly associated with sadism in
forensic samples. Thus, sadism among forensic populations may involve
both a lack of empathy for others and willingness to exploit others for
one's pleasure or gain (Factor 1), as well as a pattern of impulsive rule-
breaking behaviors (Factor 2). Although the moderator analyses were
null, they were likely underpowered due to the lack of published studies
measuring non-sexual forms of sadism or self-reported sadism. The re-
sults of the present study hint that the overall association between
psychopathy and sadism may be stronger when sadism is measured via
self-report, or when sadism is assessed more broadly than a specific
focus on sexual sadism (i.e., when a broad spectrum of sadistic
thoughts, fantasies, and behaviors are assessed).
Declarations of interest
None.
References3
American Psychiatric Association (1987). Diagnostic and statistical manual of disorders (3rd
ed.). Washington, DC: American Psychiatric Pub.
American Psychiatric Association (2000). Diagnostic and statistical manual of disorders (4th
ed. – text revision). Washington, DC: American Psychiatric Pub.
*Barbaree, H. E., Seto, M. C., Serin, R. C., Amos, N. L., & Preston, D. L. (1994).
Comparisons between sexual and nonsexual rapist subtypes sexual arousal to rape,
offense precursors, and offense characteristics. Criminal Justice and Behavior, 21,
95–114.
Baumeister, R. F., & Campbell, W. K. (1999). The intrinsic appeal of evil: Sadism, sen-
sational thrills, and threatened egotism. Personality and Social Psychology Review, 3,
210–221.
*Briken, P., Habermann, N., Kafka, M. P., Berner, W., & Hill, A. (2006). The paraphilia-
related disorders: An investigation of the relevance of the concept in sexual mur-
derers. Journal of Forensic Sciences, 51, 683–688.
*Delescluse, C., & Pham, T. H. (2005). Évaluation du trouble de la personnalité sadique en
relation avec la psychopathie auprès de patients internés en hôpital psychiatrique
sécuritaire. L'Encéphale, 31, 683–691.
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot–based method of
testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463.
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis de-
tected by a simple, graphical test. British Medical Journal, 315, 629–634.
*Eher, R., Schilling, F., Hansmann, B., Pumberger, T., Nitschke, J., Habermeyer, E., &
Mokros, A. (2015). Sadism and violent reoffending in sexual offenders. Sexual Abuse:
A Journal of Research and Treatment, 28, 46–72.
Firestone, P., Bradford, J. M., Greenberg, D. M., Larose, M. R., & Curry, S. (1998).
Homicidal and nonhomicidal child molesters: Psychological, phallometric, and
criminal features. Sexual Abuse: A Journal of Research and Treatment, 10(4), 305–323.
Hare, R. D. (1970). Psychopathy: Theory and research. New York: Wiley.
Hare, R. D. (1991). The Hare psychopathy checklist – Revised. Toronto, ON, Canada: Multi-
Health Systems.
3
References marked with an asterisk indicate references included in the
meta-analysis.
D. O'Connell and D.K. Marcus
Hare, R. D., & Neumann, C. S. (2008). Psychopathy as a clinical and empirical construct.
Annual Review of Clinical Psychology, 4, 217–246.
*Harenski, C. L., Thornton, D. M., Harenski, K. A., Decety, J., & Kiehl, K. A. (2012).
Increased frontotemporal activation during pain observation in sexual sadism:
Preliminary findings. Archives of General Psychiatry, 69, 283–292.
Hedges, L. V. (1982). Fitting categorical models to effect sizes from a series of experi-
ments. Journal of Educational Statistics, 7, 119–137.
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring incon-
sistency in meta-analyses. British Medical Journal, 327, 557–560.
*Hill, A., Habermann, N., Berner, W., & Briken, P. (2007). Psychiatric disorders in single
and multiple sexual murderers. Psychopathology, 40, 22–28.
*Holt, S. E., Meloy, J. R., & Strack, S. (1999). Sadism and psychopathy in violent and
sexually violent offenders. The Journal of the American Academy of Psychiatry and the
Law, 27, 23–32.
James, J., & Proulx, J. (2014). A psychological and developmental profile of sexual
murderers: A systematic review. Aggression and Violent Behavior, 19, 592–607.
Kirsch, L. G., & Becker, J. V. (2007). Emotional deficits in psychopathy and sexual sadism:
Implications for violent and sadistic behavior. Clinical Psychology Review, 27,
904–922.
Knight, R. A., & Cerce, D. D. (1999). Validation and revision of the multidimensional
assessment of sex and aggression. Psychologica Belgica, 39, 135–161.
Krueger, R. B. (2010). The DSM diagnostic criteria for sexual sadism. Archives of Sexual
Behavior, 39(2), 325–345.
Langevin, R. (2003). A study of the psychosexual characteristics of sex killers: Can we
identify them before it is too late? International Journal of Offender Therapy and
Comparative Criminology, 47, 366–382.
*Langevin, R., & Curnoe, S. (2015). Are dangerous offenders different from other offen-
ders? A clinical profile. International Journal of Offender Therapy and Comparative
Criminology, 58, 780–801.
Levenson, J. S. (2004). Reliability of sexually violent predator civil commitment criteria.
Law and Human Behavior, 28, 357–369.
Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Vol. 49. Thousand Oaks, CA:
Sage Publications.
Lloyd, C. D., Clark, H. J., & Forth, A. E. (2010). Psychopathy, expert testimony, and
indeterminate sentences: Exploring the relationship between Psychopathy Checklist-
Revised testimony and trial outcome in Canada. Legal and Criminological Psychology,
15, 323–339.
*Looman, J., Dickie, I., & Maillet, G. (2008). Sexual arousal among rapist subtypes.

$JJUHVVLRQDQG9LROHQW%HKDYLRU²
Journal of Sexual Aggression, 14, 267–279.
Loranger, A. (1988). Personality Disorder Examination (PDE). Yonkers, NY: DV
Communications.
Meloy, J. R. (2000). The nature and dynamics of sexual homicide: An integrative review.
Aggression and Violent Behavior, 5, 1–22.
Millon, T. (1987). Millon clinical multiaxial inventory-II manual. Minneapolis, MN: National
Computer Systems.
*Mokros, A., Osterheider, M., Hucker, S. J., & Nitschke, J. (2011). Psychopathy and
sexual sadism. Law and Human Behavior, 35, 188–199.
*Nitschke, J., Istrefi, S., Osterheider, M., & Mokros, A. (2012). Empathy in sexually sa-
distic offenders: An experimental comparison with non-sadistic sexual offenders.
International Journal of Law and Psychiatry, 35, 165–167.
Patrick, C. J., Fowles, D. C., & Krueger, R. F. (2009). Triarchic conceptualization of
psychopathy: Developmental origins of disinhibition, boldness, and meanness.
Development and Psychopathology, 21, 913–938.
Paulhus, D. L. (2014). Toward a taxonomy of dark personalities. Current Directions in
Psychological Science, 23, 421–426.
Porter, S., Campbell, M. A., Woodworth, M., & Birt, A. R. (2001). A new psychological
conceptualization of the sexual psychopath. Advances in Psychology Research, 7,
21–36.
*Porter, S., Woodworth, M., Earle, J., Drugge, J., & Boer, D. (2003). Characteristics of
sexual homicides committed by psychopathic and nonpsychopathic offenders. Law
and Human Behavior, 27, 459–470.
*Richards, H., & Jackson, R. L. (2011). Behavioral discriminators of sexual sadism and
paraphilia nonconsent in a sample of civilly committed sexual offenders. International
Journal of Offender Therapy and Comparative Criminology, 55, 207–227.
*Robertson, C. A., & Knight, R. A. (2014). Relating sexual sadism and psychopathy to one
another, non-sexual violence, and sexual crime behaviors. Aggressive Behavior, 40,
12–23.
*Shine, J., & Hobson, J. (1997). Construct validity of the Hare Psychopathy Checklist,
revised, on a UK prison population. Journal of Forensic Psychiatry, 8, 546–561.
Stupperich, A., & Strack, M. (2016). Among a German sample of forensic patients, pre-
vious animal abuse mediates between psychopathy and sadistic actions. Journal of
Forensic Sciences, 61, 699–705.
Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package.
Journal of Statistical Software, 36, 1–48.
Wilson, D. B. (2001). Practical meta-analysis effect size calculator.