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Domestic abuse
9%
4/43
Dependent personality disorder
0%
0/43
Avoidant personality disorder
Sexual masochism
74%
32/43
Sexual sadism
16%
7/43
Select Answer to see Preferred Response
This patient has stated that she is sexually aroused from acts of injury or humiliation suggesting a diagnosis of sexual masochism. Sexual masochism is a sexual disorder in which patient’s derive pleasure or arousal from humiliating, abusive, or demeaning acts. These acts can include hitting, choking, and even burning. The diagnosis is made according to the Diagnostic and Statistical Manual (DSM) criteria, which include arousal from these acts, social or occupational dysfunction due to these acts or urges, and the presence of symptoms for at least 6 months. It is important to thoroughly screen for domestic abuse in patient’s that present with any signs of abuse, and to ensure that abuse never begins in these patients. Incorrect Answers: Answer 1: Domestic abuse should be high on the differential for this patient. There is no information that suggests that this patient is being domestically abused other than the patient’s physical exam findings and young age. Otherwise, the patient seems to be independent, goal-oriented, and self-sufficient (has a job to pay for school). It is important to believe your patients when they tell you something, in particular in this case since sexual masochism could very easily explain this patient’s presentation. Nonetheless, this patient should be carefully monitored and screened again for domestic abuse in the future. Answer 2: Dependent personality disorder presents with excessive neediness or clinginess. These patient’s rely heavily on others (spouse, family members) to make decisions and structure their lives. They often avoid arguments and are very agreeable. This patient seems to be independent given her career goals, position in school, and current job, and does not demonstrate these traits. Answer 3: Avoidant personality disorder presents with excess shyness and avoidance of social situations. These patients often fear embarrassment when engaging with others, and may isolate themselves though they desire social contact. Answer 5: Sexual sadism is when individuals experience sexual arousal or pleasure from humiliating or demeaning others rather than when individuals are humiliated or demeaned as this patient is. Bullet Summary: Sexual masochism occurs when patients receive sexual arousal or pleasure from being humiliated, demeaned, or abused.
4.7
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