The diagnosis proposal appeared in the appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R),[1] however it was never put to use in clinical settings and later versions of the DSM (DSM-IV, DSM-IV-TR, and DSM-5) had it removed.

[2] According to the DSM-III-R, the diagnostic criteria were defined by a pervasive pattern of sadistic and cruel behavior that began in early adulthood.

[12][13] Millon writes that "Physically abusive, sadistic personalities are most often male, and it was felt that any such diagnosis might have the paradoxical effect of legally excusing cruel behavior.

"[14] Researchers were also concerned about the stigmatizing nature of the disorder, and that it put patients at higher risk of abuse from prison guards.

[15][16] Theorists like Theodore Millon wanted to generate further study on SPD, and so proposed it to the DSM-IV Personality Disorder Work Group, who rejected it.