Pesticide-specific case fatality and clinical outcomes among poisoning cases in Tanzania: a retrospective cross-sectional study.

Psychopathy is a personality disorder characterized by a cluster of affective, interpersonal, lifestyle, and antisocial traits. The precursors of these traits can be identified in a subgroup of young people exhibiting severe antisocial behavior []. Recent meta-analytic evidence estimates the prevalence of psychopathy in the general adult population at 4.5%; however, this estimate varies by assessment method. When evaluated with the Psychopathy Checklist-Revised (PCL-R), the prevalence decreases to approximately 1.2%, suggesting that severe clinical psychopathy is substantially less common than broader self-reported psychopathic traits []. It is a significant risk factor strongly associated with homicides, particularly severe forms such as sexual, sadistic, serial, and multiple-perpetrator homicides []. Furthermore, individuals with psychopathic traits tend to die at younger ages than the general population, and their deaths are often more violent []. Numerous studies have examined the relationship between psychopathy and sexual offending, with a focus on violence, aggression, and coercion as antisocial risk factors [,]. On the other hand, sadism is defined as the tendency to derive pleasure from the suffering of others []. Within this construct, sexual sadism is defined as a sexual preference disorder characterized by obtaining sexual arousal or gratification through inflicting suffering, pain, or humiliation on another person []. It is not limited to violent criminals but can also occur in nonclinical and noncriminal populations []. Sexual sadism is primarily identified among sexual offenders, especially sexual homicide offenders. Prevalence rates are as high as 75% among this group, compared to 4-42% among general sex offenders and 2.3-12% among non-forensic clinical samples []. Individuals with sadistic traits derive pleasure not only from observing others’ pain, but also from actively inflicting it. They are motivated by both the enjoyment of the aggressive act and the suffering caused []. Both constructs share conceptual space with the Dark Tetrad of personality traits (narcissism, Machiavellianism, psychopathy, and sadism) [,], but their specific relationship remains the subject of empirical debate. Some authors argue that sadism is a functionally independent component that increases the violent potential of psychopathy [,], while others claim that they are overlapping phenotypes with shared neurobiological bases, such as deficits in processing fear or others’ pain, as well as deficits in amygdala activation in response to distress signals [-].