I love view: Can Google Glass be addictive?

Last week, The Guardian (and news media all over the world) reported the story of a man being treated for internet addiction disorder brought on by his excessive use of Google Glass. According to The Guardian’s report:

“The man had been using the technology for around 18 hours a day – removing it only to sleep and wash – and complained of feeling irritable and argumentative without the device. In the two months since he bought the device, he had also begun experiencing his dreams as if viewed through the device’s small grey window…[The patient] had checked into the Sarp [Substance Addiction Recovery Program] in September 2013 for alcoholism treatment. The facility requires patients to steer clear of addictive behaviours for 35 days – no alcohol, drugs, or cigarettes – but it also takes away all electronic devices. Doctors noticed the patient repeatedly tapped his right temple with his index finger. He said the movement was an involuntary mimic of the motion regularly used to switch on the heads-up display on his Google Glass”.

The story was based on a case study that has just been published in the journal Addictive Behaviors by Dr. Kathryn Yung and her colleagues from the Department of Mental Health, Naval Medical Center in San Diego (United States). The authors claim that the paper (i) reported the first ever case of internet addiction disorder involving the problematic use of Google Glass, (ii) showed that excessive and problematic uses of Google Glass can be associated with involuntary movements to the temple area and short-term memory problems, and (iii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass. For those reading this who have not yet come across what Google Glass is, the authors provided a brief description: 

Google Glass™ was named as one of the best inventions of the year by Time Magazine in 2012. The device is a wearable mobile computing device with Bluetooth connectivity to internet-ready devices. Google Glass™ has an optical head-mounted display, resembling eyeglasses; it displays information in a Smartphone-like, but hands-free format that is controlled via voice commands and touch”.

The man that came in for treatment was a 31-year old enlisted service member who had served seven months in Afghanistan. Although he did not suffer any kind of post-traumatic stress disorder (PTSD) he was reported by the authors as having a mood disorder, most consistent with a substance-induced hypomania overlaying a depressive disorder, anxiety disorder with characteristics of social phobia, obsessive–compulsive disorder, and severe alcohol and tobacco use disorders”. His referral to the substance use program was because he had resumed problematic alcohol drinking following a previous eight-week intensive outpatient treatment. It was only after re-entering the program that staff noticed other behaviours that were nothing to do with his alcohol problem. More specifically, they reported that:

“The patient had been wearing the Google Glass™ device each day for up to 18 h for two months prior to admission, removing the device during sleep and bathing. He was given permission by his superiors to use the device at work, as the device allowed him to function at a high level by accessing detailed and complicated information quickly. The patient shared that the Google Glass™ increased his confidence with social situations, as the device frequently became an initial topic of discussion. All electronic devices and mobile computing devices are customarily removed from patients during substance rehabilitation treatment. The patient noted significant frustration and irritability related to not being able to use the device during treatment. He stated, ‘The withdrawal from this is much worse than the withdrawal I went through from alcohol’, He noted that when he dreamed during his residential treatment, he envisioned the dream through the device. He would experience the dream through a small gray window, which was consistent with what he saw when wearing the device while awake. He reported that if he had been prevented from wearing the device while at work, he would become extremely irritable and argumentative. When asked questions by the examiner, the patient was noted on exam to reach his right hand up to his temple area and tap it with his forefinger. He explained that this felt almost involuntary, in that it was the familiar motion he would make in order to turn on the device in order to access information and answer questions. He found that he almost ‘craved’ using the device, especially when trying to recall information”.

Even though my primary area of research interest in behavioural addictions, the thing that caught my attention in the description above was the observation that his dreams were experienced in the way he viewed things through Google Glass while he was awake. On first reading this I thought this sounding very much like some research I have been doing with my colleague Angelica Ortiz de Gortari on Game Transfer Phenomena (GTP) in which gamers transfer aspects of their game playing into real life situations. Our work is an extension of the so-called Tetris Effect where Tetris players see falling blocks before their eyes even when they are not playing the game. It appears the authors of this case study has also made the same connection as they reported:

The patient’s experiences of viewing his dreams through the device appear to be best explained solely by his heavy use of the device and may be consistent with what is referred to as the ‘Tetris Effect’. When individuals play the game Tetris for long periods of time, they report seeing invasive imagery of the game in their sleep (Stickgold, Malia, Maguire, Roddenberry, & O’Connor, 2000). Interestingly, Stickgold et al. noted that patients with amnesia due to traumatic brain injury, who had trouble with short-term memory recall, reported invasive imagery of the game during sleep even though they did not recall playing the game (Stickgold et al., 2000). Technology-assisted learning devices and video gaming appear to be powerful methods to aid in the acquisition of new information. Further studies in the field of traumatic brain injury utilizing gaming and technology-assisted learning are needed”.

At the end of the 35-day inpatient stay, the outcome was reported as being good. The patient reported he felt less irritable, and he was making far fewer compulsive movements to his temple. However, no further follow-up was reported by Yung and her colleagues. There are, of course, wider questions about whether addiction to the internet even exists although the article in The Guardian did provide a link to a comprehensive and systematic review of internet addiction that I co-authored with Dr. Kuss and others in the journal Current Pharmaceutical Design. As regular readers of my blog will be aware, I believe that there is a fundamental difference between addictions on the internet and addictions to the internet. The vast majority of people appear to have addictions on the internet (such as gambling addiction, gaming addiction, sex addiction, shopping addiction, etc.) where the internet facilitates other addictive behaviours. However, there is growing evidence of internet-only addictive behaviour (with social networking addiction being the most common).

In relation to this case study, there have been some that have said that the study doesn’t have face validity because the battery life of Google Glass is so small that it is impossible to spend up to 18 hours a day wearing it. (For instance, check out an interesting article written by Taylor Hatmaker published by the Daily Dot). I ought to add that one of the study’s co-authors, Dr. Andrew Doan did say to various news outlets that:

“A wearable device is constantly there – so the neurological reward associated with using it is constantly accessible. There’s nothing inherently bad about Google Glass. It’s just that there is very little time between these rushes. So for an individual who’s looking to escape, for an individual who has underlying mental dysregulation, for people with a predisposition for addiction, technology provides a very convenient way to access these rushes. And the danger with wearable technology is that you’re allowed to be almost constantly in the closet, while appearing like you’re present in the moment”.

Based on the two-page paper that was published, I don’t think there was enough evidence presented to say whether the man in question was addicted to the internet via Google Glass. There were certainly elements associated with addiction but that doesn’t mean somebody is genuinely addicted. Furthermore, most addictive behaviours have to have been present for at least six months before being diagnosed as a genuine addiction. In this case, the man had only been using Google Glass for two months before entering the treatment program.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Ghorayshi, A. (2014). Google glass user treated for internet addiction caused by device. The Guardian, October 14. Located at: http://www.theguardian.com/science/2014/oct/14/google-glass-user-treated-addiction-withdrawal-symptoms

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

Griffiths, M.D. (2010). Internet abuse and internet addiction in the workplace. Journal of Worplace Learning, 7, 463-472.

Hatmaker, T. (2014). There is no such thing as Google Glass addiction. The Daily Dot, October 15. Located at: https://www.dailydot.com/technology/google-glass-internet-addiction/

Kuss, D.J., Griffiths, M.D. & Binder, J. (2013). Internet addiction in students: Prevalence and risk factors. Computers in Human Behavior, 29, 959-966.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Kuss, D.J., Shorter, G.W., van Rooij, A.J., Griffiths, M.D., & Schoenmakers, T.M. (2014). Assessing Internet addiction using the parsimonious Internet addiction components model – A preliminary study. International Journal of Mental Health and Addiction, 12, 351-366.

Kuss, D.J., van Rooij, A.J., Shorter, G.W., Griffiths, M.D. & van de Mheen, D. (2013). Internet addiction in adolescents: Prevalence and risk factors. Computers in Human Behavior, 29, 1987-1996.

Ortiz de Gotari, A., Aronnson, K. & Griffiths, M.D. (2011). Game Transfer Phenomena in video game playing: A qualitative interview study. International Journal of Cyber Behavior, Psychology and Learning, 1(3), 15-33.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. Gackenbach (Ed.), Video Game Play and Consciousness (pp.223-250). Hauppauge, NY: Nova Science.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30, 95-105.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning, 4(1), 59-75.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12, 432-452.

Stickgold, R., Malia, A., Maguire, D., Roddenberry, D., & O’Connor, M. (2000). Replaying the game: Hypnagogic images in normals and amnesics. Science, 290, 350–353.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2014). Internet Addiction Disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program. Addictive Behaviors, http://dx.doi.org/10.1016/j.addbeh.2014.09.024.

Joystick junkies: A brief overview of online gaming addiction

Over the last 15 years, research into various online addictions have greatly increased. Prior to the 2013 publication of the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there had been some debate as to whether ‘internet addiction’ should be introduced into the text as a separate disorder. Alongside this, there has also been debate as to whether those researching in the online addiction field should be researching generalized internet use and/or the potentially addictive activities that can be engaged on the internet (e.g., gambling, video gaming, sex, shopping, etc.).

It should also be noted that given the lack of consensus as to whether video game addiction exists and/or whether the term ‘addiction’ is the most appropriate to use, some researchers have instead used terminology such as ‘excessive’ or ‘problematic’ to denote the harmful use of video games. Terminology for what appears to be for the same disorder and/or its consequences include problem video game playing, problematic online game use, video game addiction, online gaming addiction, internet gaming addiction, and compulsive Internet use.

Following these debates, the Substance Use Disorder Work Group (SUDWG) recommended that the DSM-5 include a sub-type of problematic internet use (i.e., internet gaming disorder [IGD]) in Section 3 (‘Emerging Measures and Models’) as an area that needed future research before being included in future editions of the DSM. According to Dr. Nancy Petry and Dr. Charles O’Brien, IGD will not be included as a separate mental disorder until the (i) defining features of IGD have been identified, (ii) reliability and validity of specific IGD criteria have been obtained cross-culturally, (iii) prevalence rates have been determined in representative epidemiological samples across the world, and (iv) etiology and associated biological features have been evaluated.

Although there is now a rapidly growing literature on pathological video gaming, one of the key reasons that IGD was not included in the main text of the DSM-5 was that the SUDWG concluded that no standard diagnostic criteria were used to assess gaming addiction across these many studies. In 2013, some of my colleagues and I published a paper in Clinical Psychology Review examining all instruments assessing problematic, pathological and/or addictive gaming. We reported that 18 different screening instruments had been developed, and that these had been used in 63 quantitative studies comprising 58,415 participants. The prevalence rates for problematic gaming were highly variable depending on age (e.g., children, adolescents, young adults, older adults) and sample (e.g., college students, internet users, gamers, etc.). Most studies’ prevalence rates of problematic gaming ranged between 1% and 10% but higher figures have been reported (particularly amongst self-selected samples of video gamers). In our review, we also identified both strengths and weaknesses of these instruments.

The main strengths of the instrumentation included the: (i) the brevity and ease of scoring, (ii) excellent psychometric properties such as convergent validity and internal consistency, and (iii) robust data that will aid the development of standardized norms for adolescent populations. However, the main weaknesses identified in the instrumentation included: (i) core addiction indicators being inconsistent across studies, (iii) a general lack of any temporal dimension, (iii) inconsistent cut-off scores relating to clinical status, (iv) poor and/or inadequate inter-rater reliability and predictive validity, and (v) inconsistent and/or dimensionality.

It has also been noted by many researchers (including me) that the criteria for IGD assessment tools are theoretically based on a variety of different potentially problematic activities including substance use disorders, pathological gambling, and/or other behavioural addiction criteria. There are also issues surrounding the settings in which diagnostic screens are used as those used in clinical practice settings may require a different emphasis that those used in epidemiological, experimental, and neurobiological research settings.

Video gaming that is problematic, pathological and/or addictive lacks a widely accepted definition. Some researchers in the field consider video games as the starting point for examining the characteristics of this specific disorder, while others consider the internet as the main platform that unites different addictive internet activities, including online games. My colleagues and I have begun to make an effort to integrate both approaches, i.e., classifying online gaming addiction as a sub-type of video game addiction but acknowledging that some situational and structural characteristics of the internet may facilitate addictive tendencies (e.g., accessibility, anonymity, affordability, disinhibition, etc.).

Throughout my career I have argued that although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), and likely reflects a common etiology of addictive behaviour. When I started research internet addiction in the mid-1990s, I came to the view that there is a fundamental difference between addiction to the internet, and addictions on the internet. However many online games (such as Massively Multiplayer Online Role Playing Games) differ from traditional stand-alone video games as there are social and/or role-playing dimension that allow interaction with other gamers.

Irrespective of approach or model, the components and dimensions that comprise online gaming addiction outlined above are very similar to the IGD criteria in Section 3 of the DSM-5. For instance, my six addiction components directly map onto the nine proposed criteria for IGD (of which five or more need to be endorsed and resulting in clinically significant impairment). More specifically: (1) preoccupation with internet games [salience]; (2) withdrawal symptoms when internet gaming is taken away [withdrawal]; (3) the need to spend increasing amounts of time engaged in internet gaming [tolerance], (4) unsuccessful attempts to control participation in internet gaming [relapse/loss of control]; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, internet gaming [conflict]; (6) continued excessive use of internet games despite knowledge of psychosocial problems [conflict]; (7) deception of family members, therapists, or others regarding the amount of internet gaming [conflict]; (8) use of the internet gaming to escape or relieve a negative mood [mood modification];  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in internet games [conflict].

The fact that IGD was included in Section 3 of the DSM-5 appears to have been well received by researchers and clinicians in the gaming addiction field (and by those individuals that have sought treatment for such disorders and had their experiences psychiatrically validated and feel less stigmatized). However, for IGD to be included in the section on ‘Substance-Related and Addictive Disorders’ along with ‘Gambling Disorder’, the gaming addiction field must unite and start using the same assessment measures so that comparisons can be made across different demographic groups and different cultures.

For epidemiological purposes, my research colleagues and I have asserted that the most appropriate measures in assessing problematic online use (including internet gaming) should meet six requirements. Such an instrument should have: (i) brevity (to make surveys as short as possible and help overcome question fatigue); (ii) comprehensiveness (to examine all core aspects of problematic gaming as possible); (iii) reliability and validity across age groups (e.g., adolescents vs. adults); (iv) reliability and validity across data collection methods (e.g., online, face-to-face interview, paper-and-pencil); (v) cross-cultural reliability and validity; and (vi) clinical validation. We aso reached the conclusion that an ideal assessment instrument should serve as the basis for defining adequate cut-off scores in terms of both specificity and sensitivity.

The good news is that research in the gaming addiction field does appear to be reaching an emerging consensus. There have also been over 20 studies using neuroimaging techniques (such as functional magnetic resonance imaging) indicating that generalized internet addiction and online gaming addiction share neurobiological similarities with more traditional addictions. However, it is critical that a unified approach to assessment of IGD is urgently needed as this is the only way that there will be a strong empirical and scientific basis for IGD to be included in the next DSM.

Note: A version of this article was first published on Rehabs.com

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders – Text Revision (Fifth Edition). Washington, D.C.: Author.

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M. D., Pápay, O., . . . Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5), e36417.

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

Griffiths, M. D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191-197.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, under review.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

Kim, M. G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.

King, D. L., Delfabbro, P. H., Griffiths, M. D., & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

King, D. L., Delfabbro, P. H., & Griffiths, M. D. (2012). Cognitive-behavioral approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

King, D.L., Haagsma, M.C., Delfabbro, P.H., Gradisar, M.S., Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Koronczai, B., Urban, R., Kokonyei, G., Paksi, B., Papp, K., Kun, B., . . . Demetrovics, Z. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.

Kuss, D.J. & Griffiths, M.D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2, 347-374.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2013).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, in press.

Pápay, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment. New York: Elsevier.

Petry, N.M., & O’Brien, C.P. (2013). Internet gaming disorder and the DSM-5. Addiction, 108, 1186–1187.

Porter, G., Starcevic, V., Berle, D., & Fenech, P. (2010). Recognizing problem video game use. The Australian and New Zealand Journal of Psychiatry, 44, 120-128.

Young, K. S. (1998). Internet addiction: The emergence of a new clinical disorder. Cyberpsychology and Behavior, 1, 237-244.

Palm minimization: An unusual case of Alien Hand Syndrome

In a previous blog I briefly overviewed Alien Hand Syndrome. Since writing that blog I came across an interesting case of alien hand syndrome published in a 2000 issue of the American Journal of Physical Medicine and Rehabilitation by Dr. B. Hai and Dr. I. Odderson. They reported an unusual case in which their patient had a right hemispheric stroke and subsequently experienced what the authors described as embarrassing manifestations of Alien Hand Syndrome in the form of involuntary masturbation. The case involved a 73-year old man who was brought into a hospital emergency ward by his wife because of a sudden loss of movement in the left-hand side of his body (including a slight droop on the left-hand side of his face), slurred speech and poor balance. Furthermore, he could stand if helped but was unable to walk unaided. The man had obviously had a stroke but four days later he started to experience involuntary movements of his left arm and claimed his left hand “has a mind of his own”. The paper reported that:

“He developed a tonic grasp reflex with inability to release. He also had a tendency to reach and grasp onto objects with the left hand, such as the telephone cord or the remote control for the television, and was unable to release despite verbal commands. He would persistently grab his comb or fix the collar of his shirt. He also demonstrated difficulty performing bimanual activities, such as eating

Most worryingly, the man’s wife expressed extreme concern when her husband’s left hand would expose his genitals and start to masturbate in public. The involuntary masturbation happened on numerous occasions when talking with the nurses and doctors in the hospital, and only ever occurred with his left hand (even though the man was right-handed). The man denied that he had any history of “excessive self-stimulation, sexual dysfunction, or exhibitionism. While in hospital, the man was dismayed and frustrated that he was unable to stop his left hand stimulating his genitals in front of other people. The authors reported that:

“A clinical impression of [Alien Hand Syndrome] was made, and magnetic resonance imaging of the brain showed an acute infarct [dead tissue] in the medial right frontal lobe [of his brain] in the anterior cerebral artery distribution involving the right anterior cingulate gyrus and the corpus callosum. After [three weeks] of acute inpatient rehabilitation, the patient was able to walk with a standard walker and negotiate stairs with rails with contact guard assist. He also began to use his left hand for bimanual activities. He was subsequently discharged to home with his family”.

After a month of treatment, the man was able to walk again unassisted but his left hand was still not under his own control (and telling the medical staff that his hand “still has a mind of his own and won’t turn things loose”). However, the good news was that the involuntary masturbation in public subsided and eventually ceased. The authors of the paper claim this is a very rare case because their patient displayed “an unusual and disturbing manifestation of uncontrolled involuntary genital fondling with the nondominant, apraxic hand and with mirroring hand movements during eating”. The authors also noted that the involuntary movements of the man’s left hand never occurred while they were carrying out medical tests and suggested that their findings indicate “the possibility of the presence of a dexterous ‘alien’ mode of control that can be distinguished from a more clumsy and slow ‘voluntary’ mode of control”. Although there is no known treatment for AHS, as I noted in my previous blog on the topic, the symptoms can be minimized and managed to some extent by keeping the affected hand occupied and involved in a task (e.g., by giving it an object to hold in its grasp). This would seem to explain why the man never masturbated while undergoing medical tests (i.e., his hands were being occupied). The authors also noted that:

“So far, at least two types of [Alien Hand Syndrome] have been described. The callosal type, as seen in our patient (lesion involving the corpus callosum with or without frontal damage), is characterized by frequent intermanual conflict and apraxia of the affected limb. The frontal type (lesion involving the left mediofrontal and callosal) is associated with dominant hand grasp reflex, compulsive movements (such as groping), restraining actions, and compulsive manipulation of tool [Feinberg, Schindler & Flanagan, 1992]”.

As I noted in my previous blog on AHS, research indicates that AHS sufferers often personify the alien hand and may believe the hand is ‘possessed’ by some other spirit or alien life form. Their hands may even appear to act in opposition to each other (such as when AHS sufferers who are also cigarette smokers put a cigarette in their mouth to set it alight, only for the alien hand to pull it out and throw the cigarette away). Such behaviour is an example of ‘intermanual conflict’ and has been given the name ‘diagnostic ideomotor apraxia’.

A number of published papers have reported that involuntary masturbation can be associated with other conditions. For instance, it has been associated with temporal lobe epilepsy. Dr. M. Cherian reported the case of excessive masturbation in a young girl in a 1997 issue of the European Journal of Pediatrics. However, until the publication of this case of AHS, it had not ever been associated with having a stroke. Dr. Hai and Dr. Odderson conclude:

Although [Alien Hand Syndrome] is a rare phenomenon, this condition should be considered in patients who present with a feeling of alienation of one or both upper limbs accompanied by complex purposeful involuntary movement. It must be differentiated from limb neglect and anosognosia, which present with dissociation from the limb as perceived object (i.e., where the limb is not perceived as a part of the “self”), but without involuntary movement and without dissociation from control over purposeful complex action of the affected limb (i.e., where the actions of the limb are perceived as self-generated). Further studies are required to elucidate a definite anatomical explanation that can lead to accurate diagnosis, specific treatment, and rehabilitation of these patients”

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK 

Further reading

Biran, I. & Chatterjee, A. (2004). Alien Hand Syndrome. Archives of Neurology, 61, 292-294.

Cherian, M.P. (1997). Excessive masturbation in a young girl: A rare presentation of temporal lobe epilepsy. European Journal of Pediatrics, 156, 249.

Doody, R.S. & Jankovic, J. (1992). The alien hand and related signs. Journal of Neurology, Neurosurgery and Psychiatry, 55, 806-810.

Feinberg, T.E., Schindler, R.J. & Flanagan, N.G. (1992). Two alien hand syndromes. Neurology, 42, 19-24.

Hai, B.G.O., & Odderson, I.R. (2000). Involuntary masturbation as a manifestation of stroke-related alien hand syndrome. American Journal of Physical Medicine & Rehabilitation, 79, 395-398.

Jacome, D.E. & Risko, M.S. (1983). Absence status manifested by compulsive masturbation. Archives of Neurology, 40, 523-524.

Scepkowski, L.A. & Cronin-Golomb, A. (2003). The alien hand: Cases, categorizations, and anatomical correlates. Behavioral and Cognitive Neuroscience Reviews, 2, 261-277.

The weighting game: Gambling with the nation’s health (revisited)

A couple of weeks ago I wrote a blog on why problem gambling should be considered a health issue. Earlier this week, I came across an interesting study carried out by jackpot.co.uk who surveyed 2,131 online gamblers (58% males and 42% female) about their health. After the self-reported data had been collected, the gamblers were classed into one of nine categories based on the casino game type that the gambler played most often (i.e., slot machines, video poker, blackjack, roulette, dice/craps, baccarat, poker, pai gow, and ‘other’). The data were then tabulated so that all the health variables (including obesity) corresponded to the gambler’s preferred casino game.

I was interested in the findings not only because I am a Professor of Gambling Studies, but also because I was a member of the Department of Health’s Expert Working Group on Sedentary Behaviour, Screen Time and Obesity’ (a reference to our final report to the British government can be found in the ‘Further Reading’ section below). The study took an objective measurement of physical condition by asking each gambler their height (centimetres) and their weight (kilograms) to calculate each person’s Body Mass Index (BMI) by dividing the gamblers’ weight by height (metres) and dividing by height again (for example, someone who weighs 80kg and is 180cm tall, the BMI is 24.1 as this is 80/1.80)/1.80). The survey then asked s few general health and lifestyle questions (similar to ones that we have used in the last few British Gambling Prevalence Surveys:

  • Do you normally drink more than the recommended limit for weekly alcohol consumption (21 units of alcohol for men and 14 for women)? (Yes/No)
  • Do you smoke regularly? (Yes/No)
  • Do you normally engage in at least 30 minutes of physical activity, 5 times per week? (Yes/No)

Overall, the survey found that British casino gamblers as a group were no less healthy than the rest of the British population, with an average Body Mass index (BMI) of 27 (which is the same as the UK national average). However, the survey also reported that the average BMIs, health, and lifestyle choices (such as smoking cigarettes, engaging in exercise, and drinking alcohol varied considerably depending on the casino games that the respondents played. Here are some of the main findings:

  • Slots players were the least healthy. They took less exercise and had an average BMI of 31, pushing them into the category of obese (which is linked to increased chance of developing illnesses such as Type 2 diabetes and reduced life expectancy)
  • Roulette, blackjack, video poker and craps/dice players were not far behind slots players, each having BMI levels higher than the national average.
  • Those that played poker, baccarat and Pai Gow had an average BMI of 25 or under (well within the normal range recommended by the World Health Organisation.
  • Whilst drinking levels might be reasonably high among poker players, they were very exercise conscious, with 58% engaging in physical activity for at least 30 minutes, five times a week. For slots players the figure was 27% meeting this government recommended target.
  • Overall slots players drink the most, with 24.1% drinking over the recommended weekly limit. Poker players are not far behind on 23%. Female slots players were the biggest drinking subgroup, closely followed by male poker players.
  • Slots players also smoked more, with 24% being regular smokers (compared to the UK national average of 20%). Blackjack and roulette players smoked slightly more than average, on 21% and 22% respectively, while poker players smoked slightly less than average, on 19.5%.

None of these results is overly surprising as there are many studies (including my own) showing comorbidity between gambling and other potentially addictive behaviours. However, very few academic studies have ever looked at these health variables by game type. Although this was not an academic study, the results will likely be of interest to those in the gambling studies field.

The survey also examined the most common platform on which the gamblers played casino games. The most common was the desktop computer (65%), followed by mobiles and tablets (20%) and land-based casinos (14%). This is not surprising given the survey was completed by online gamblers. Interestingly, desktop use was linked to higher levels of obesity, drinking and smoking. This is something that I would expect given that online gambling is the most sedentary of these activities.

There are (of course) some limitations with the data collected particularly as it comprised a self-selected sample of online gamblers that played via jackpot.co.uk websites. We have no idea as to whether the sample is representative of all online gamblers but as I noted above, it is no surprise that online gamblers preferred playing casino games online compared to offline (i.e., land-based casinos). The data were also self-report and are therefore open to any number of individual biases including recall biases and social desirability biases. Also, we have no geographical breakdown of the sample as the internet (by definition) is global. However, the sample size is good in comparison to many published studies on gambling and the sample included individuals that were actually gamblers (as opposed to university undergraduates or members of the general public). According to Sam Marsden (editor of jackpot.co.uk and author of the report):

“There’s an undeniable link connecting passive games like slots and video poker to unhealthy, sedentary lifestyles. On the other hand, games that require concentration, strategy and some physical stamina like poker and blackjack seem to fare much better in the health stakes. It seems it’s less a case of ‘you are what you eat’ and more ‘you are what you play’.”  

Although such a conclusion could be argued to be PR spin on the findings, the results suggest that more rigorous studies could be carried out in the area including secondary analyses of the robust datasets that already exist including the British Gambling Prevalence Surveys, the English Health Surveys, and the Scottish health Surveys.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Biddle, S., Cavill, N., Ekelund, U., Gorely, T., Griffiths, M.D., Jago, R., et al. (2010). Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health/Department For Children, Schools and Families (126pp).

Griffiths, M.D. (2001). Gambling – An emerging area of concern for health psychologists. Journal of Health Psychology, 6, 477-479.

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association (ISBN 1-905545-11-8).

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Marsden, S. (2014). Booze, bets, and BMI. Jackpot.co.uk, October 6. Located at: http://www.jackpot.co.uk/online-casino-articles/booze-bets-bmi

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

Wardle, H., Griffiths, M.D., Orford, J., Moody, A. & Volberg, R. (2012). Gambling in Britain: A time of change? Health implications from the British Gambling Prevalence Survey 2010. International Journal of Mental Health and Addiction, 10, 273-277.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M. D., Constantine, R., & Pigott, S. (2007). The British Gambling Prevalence Survey 2007. London: National Centre for Social Research.

Method factors: The cognitive psychology of gambling (revisited)

One of the proudest moments of my academic career was when my 1994 study on the role of cognitive bias in slot machine gambling published in the British Journal of Psychology was introduced as a compulsory study that all ‘A’ Level students on the OCR syllabus have to learn about here in the UK. Today’s blog looks at that 1994 study in context.

I began a PhD on the psychology of slot machines back in 1987 and spent the first three or four months reading everything I could about how psychological research methods had been used to study this relatively new area of research. As a PhD student, the paper that really inspired me was a pioneering study by George Anderson and Iain Brown (also published in the British Journal of Psychology in 1984). Up until the mid-1980s almost all of the experimental work on the psychology of gambling had been done in laboratory settings and the question of ecological validity was something that I had great concerns about. I didn’t want to study gamblers in a psychology laboratory, I wanted to examine them in the gambling environments themselves. Anderson and Brown studied the role of arousal in gambling and used heart rate measures as an indicator of arousal. They found that regular gamblers’ heart rates increased significantly by around 23 beats per minute (compared to baseline resting levels) when they were gambling in a casino but when doing the same activity in a laboratory setting there was no significant increase in heart rate. To me, this perhaps explained why previous studies on arousal during laboratory gambling had failed to find significant heart rate increases above baseline levels.

Anderson and Brown claimed that Skinnerian reinforcement theory couldn’t account for the phenomenology of addictive gambling (especially relapse after abstinence). As a result of their ecologically valid experimental study, Anderson and Brown postulated a theoretical model centred upon individual differences in cortical and autonomic arousal in combination with irregular reinforcement schedules. They argued for a neo-Pavlovian model in which arousal played a central role in the addiction process. According to Anderson and Brown this model accounts for reinstatement after abstinence and allows for the maintenance of the behaviour by internal mood/state/arousal cues in addition to external situation cues. I found this theoretical perspective too restrictive and believed that gambling addiction was a more complex process and was the consequence of a combination of a person’s biological/genetic predisposition, their psychological make-up (personality, attitudes, beliefs, expectations, etc.), and the environment they were brought up in. This is what most people would now recognize as a biopsychosocial perspective that runs through much of my subsequent writing and research. Added to this, I passionately believed there were other important factors at play including the situational factors of where the activity took place such as the design of the gambling environment, and the structural features of the activity itself such as the speed of play and ambient factors like lights, colour, noise and music.

My 1994 study found that regular gamblers produced significantly more irrational verbalisations that non-regular gamblers. (The ethics committee wouldn’t let me use non-gamblers as they didn’t want participants to be introduced to gambling via a university research study!). One of the most observations in my study was that regular gamblers personified the machine and often treated the machine as if it was a person. They attributed thought processes to it and would talk to it as if it could actually hear them. Another of the more interesting observations concerned ‘the psychology of the near miss’ (or more accurately. ‘the near win’). I noticed that when I used the ‘thinking aloud method’ as a way of gaining direct cognitive access to what gamblers were thinking as they played a slot machine, regular gamblers often explained away their losses and changed clear losing situations into near winning ones. On a cognitive level gamblers weren’t constantly losing, they were constantly nearly winning, and this, I argued, was both psychologically and physiologically rewarding for them. (I also did a study where I measured gamblers’ heart rates in an amusement arcade where, like Anderson and Brown I found regular gamblers had significantly increased heart rates when compared to baseline resting levels).

Anyone reading my 1994 paper will instantly spot what appears to be a major limitation of the study – the fact that there was no inter-rater reliability in the coding of the verbalisations that I transcribed. Could this be (as some have argued) the Achilles Heel of the study? I have argued that in the context of this study having a second rater might have added a confounding variable in itself. Another rater wouldn’t have had the time with the data that I had and wouldn’t have been there at the time of the experiment. In short, ‘not being there’ would have been a great disadvantage to a second coder as they would not have understood the context in which various verbalizations were made. I transcribed each tape straight after each trial so that I could remember the context of everything that was said by each player. I would also add that this was one study that was done in conjunction with lots of others simultaneously (the details of which are provided below).

The work of Dr. Paul Delfabbro in Australia built on my idea of analysing gamblers within session and postulated that gambling is maintained by winning and losing sequences within the operant conditioning paradigm (i.e., that the only rewards and reinforcers in gambling are purely monetary). I then argued in response to that paper (in a 1999 issue of the British Journal of Psychology) that Delfabbro’s contribution was too narrow in its focus in that they had taken no account of the ‘near miss’ in relation to operant conditioning theory and that there may be other reinforcers that play a role in the maintenance process (such as physiological rewards, psychological rewards, and social rewards). I also argued that gambling was biopsychosocial behaviour and should therefore be explained by a biopsychosocial account.

My 1994 study showed that gamblers could be studied in real-life contexts and that useful data could be collected. It also showed the complexity of gambling and that gamblers could turn apparently objective outcomes (i.e., losing) into ones that were highly subjective (i.e., near winning ones). I also showed that this had implications for treatment and that maybe these cognitive biases could be used by psychologists as a way of ‘re-educating’ gamblers through some kind of ‘cognitive correction’ technique. I should also point out that this one experimental study was one small part of a much bigger jigsaw. What I mean by this is that my 1994 shouldn’t be seen in isolation but read along with my simultaneous observational studies of arcade gamblers, my other experimental studies, my semi-structured interview studies, surveys, and my case studies. All of these studies as a whole were featured in my first book (Adolescent Gambling, published in1995).

My work into the role of cognitive bias in gambling and gambling addiction also led to me studying behavioural addictions more generally. Since I finished my PhD I have branched out and carried out research into videogame addiction, Internet addiction, sex addiction, work addiction, and exercise addiction. Many psychologists don’t view excessive behaviour as an addiction, but for me gambling is the ‘breakthrough’ addiction. I have argued that when gambling is taken to excess it can be comparable to other more recognised addictions like alcoholism. If you accept that gambling can be a genuine addiction, there is no theoretical reason why other behaviours when taken to excess cannot be considered potentially addictive if ‘gambling addiction’ exists.

A key difference between excessive use and addiction is the detrimental effects (or lack of) that arise as a result of that behaviour. When people are addicted to a behaviour that becomes the single most important thing in their life, they compromise everything else in their life to do it. A person’s job/work, personal relationships and hobbies are severely compromised. The basic difference between an excessive healthy enthusiasm and an addiction is that healthy enthusiasms add to life – addictions take away from it. This is very much a (non-psychological) lay view, but there is a lot of truth in it.

I am the first to admit that my 1994 study when taken in isolation is hardly up there with the ‘classic’ studies of Freud, Watson, Skinner or Milgram. However, as part of two decades of other research into gambling and other potentially excessive behaviours I would like to think I have had an influence in my field. Only time will tell.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory,14, 631-646.

Anderson, G. and Brown, R.I.F. (1984). Real and laboratory gambling, sensation seeking and arousal. British Journal of Psychology, 75, 401-410.

Delfabbro, P. & Winefield, A.H. (1999). Poker machine gambling: An analysis of within-session characteristics. British Journal of Psychology, 90, 425-439.

Griffiths, M.D. (1990). The acquisition, development and maintenance of fruit machine gambling. Journal of Gambling Studies, 6, 193-204.

Griffiths, M.D. (1991a). The observational study of adolescent gambling in UK amusement arcades. Journal of Community and Applied Social Psychology, 1, 309-320.

Griffiths, M.D. (1991b). Fruit machine addiction: Two brief case studies. British Journal of Addiction, 85, 465.

Griffiths, M.D. (1993a). Fruit machine gambling: The importance of structural characteristics. Journal of Gambling Studies, 9, 101-120.

Griffiths, M.D. (1993b). Tolerance in gambling: An objective measure using the psychophysiological analysis of male fruit machine gamblers. Addictive Behaviors, 18, 365-372.

Griffiths, M.D. (1993c). Pathological gambling: Possible treatment using an audio playback technique. Journal of Gambling Studies, 9, 295-297.

Griffiths, M.D. (1993d). Factors in problem adolescent fruit machine gambling: Results of a small postal survey. Journal of Gambling Studies, 9, 31-45.

Griffiths, M.D. (1993e). Fruit machine addiction in adolescence: A case study. Journal of Gambling Studies, 9, 387-399.

Griffiths, M.D. (1994). The role of cognitive bias and skill in fruit machine gambling. British Journal of Psychology, 85, 351-369.

Griffiths, M.D. (1995a). The role of subjective mood states in the maintenence of gambling behaviour, Journal of Gambling Studies, 11, 123-135.

Griffiths, M.D. (1995b). Adolescent gambling. London: Routledge.

Griffiths, M.D. (1999). The psychology of the near miss (revisited): A comment on Delfabbro and Winefield. British Journal of Psychology, 90, 441-445.

Griffiths, M.D. (2005). A “components” model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2008). Diagnosis and management of video game addiction. New Directions in Addiction Treatment and Prevention, 12, 27-41.

Griffiths, M.D. & Delfabbro, P. (2001). The biopsychosocial approach to gambling: Contextual factors in research and clinical interventions. Journal of Gambling Issues, 5, 1-33.

Griffiths, M.D. & Parke, J. (2003). The environmental psychology of gambling. In G. Reith (Ed.), Gambling: Who wins? Who Loses? pp. 277-292. New York: Prometheus Books.

Parke, J. & Griffiths, M.D. (2006). The psychology of the fruit machine: The role of structural characteristics (revisited). International Journal of Mental Health and Addiction, 4, 151-179.

Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.211-243. New York: Elsevier.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

Ginger rogerers: A very brief look at figging‬

While researching various other blogs (most notably one on urtication and sexual arousal from stinging nettles), I came across the sexual practice of figging. For the uninitiated, figging in the broadest sense refers the act of inserting something (typically ginger) into the body (typically a bodily orifice such as the anus, vagina and/or urethra) that subsequently causes a stinging and/or burning sensation for sexual pleasure and arousal. Figging would appear to be a relatively rare sexual activity, as it doesn’t appear in either Dr. Anil Aggrawal’s Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices or Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices. Furthermore, there is not a single reference to figging in any academic article or book that I am aware of. According to an online article at the London Fetish Scene website:

“The word [figging] is likely to be a derivative of ‘feague’, the practice during Victorian times of putting a piece of peeled ginger into a horse’s anus to make it appear more sprightly and hold its tail up (for shows and selling). Mostly, figging is still used to mean putting a peeled, shaped piece of ginger root into an anus, but in a BDSM context the anus would be that of a [submissive]. Sometimes ‘figging’ is used to refer to a pervertable other than ginger (for example nettles) and also to cover the insertion into the vagina, athough it may be incorrect to consider these as figging…The ginger root is skinned and may also be carved into the shape of a butt plug. Inserting ginger into a healthy anus for even quite lengthy periods should cause no physical damage…Apart from, or together with, figging, ginger pieces or juice from crushed ginger can be inserted in the vagina or applied to the clitoris or male genitals. Care should be taken here, especially with juice, as the genitals are much more sensitive…Victorian texts on the proper treatment of recalcitrant wives included the instructions for figging as it was considered that a spanking should be received on relaxed buttocks and this was seen as one way to train them to receive the spanking properly. It may be from this practice that the phrase who gives a fig?’ originated”.

(By the way, I had never come across the word ‘pervertible’ but in another article on the London Fetish Scene website, pervertibles are defined as “ordinary non-sexual objects, especially everyday household objects, that can be used sexually, particularly in BDSM play”). The (very short) Wikipedia entry on figging also makes reference to the practice of inserting ginger into the anuses of horses (although they describe this practice as ‘gingering’ rather than figging).

As with other types of pain, sexual masochists can find the painful sensations of figging an erotic experience. In sadomasochistic sexual activity, the dominant partner may use figging as a punishment on their submissive partner. The London Fetish Scene article claims:

“If the sub is made to tighten his/her buttocks with a fig inside the anus, the sensation becomes more intense: thus they will usually try to relax those muscles. This provides a good target for caning or spanking, which will often cause the sub to clench his/her backside, which will immediately increase the feeling of heat and pain, thus causing them to want to un-clench”.

There is also the very similar practice called ‘rhapanidosis’ which refers to the insertion of horseradish into bodily orifices (usually the anus), and was allegedly a punishment given to adulterous wives in ancient Athens. According to Wikipedia:

“There is some doubt as to whether the punishment was ever enforced or whether the references to it in comic plays (such as the debate between Right and Wrong in The Clouds of Aritophanes) should be understood as signifying public humiliation in general. In order to be allowed to apply rhaphanidosis to an adulteror, one must catch the man in the act of adultery with one’s own wife, in one’s own house. Rhaphanidosis was not the only penalty available; sodomy by mulletfish was common as well, or the man could simply be killed on the spot. Following this, the adulterous wife would have to be divorced”.

In my research for this blog I came across more than a few websites that espouse the joys of figging. The Figging (Anal Discipline) website has a surprisingly diverse set of articles (such as one on ‘Why figging enhances sex’) and there are a number of websites that provide a ‘how to’ guide for figging. For instance, one detailed guide on the Live Journal by a BDSM practitioner provides the ‘theory and practice of ginger figging’ and asserts:

“Figging is a fairly rare practice that seems to have declined in popularity recently, which I think is a shame because it’s so easy and the effects are so interesting. It’s a lot of fun, and I encourage people to experiment with it”.

There’s also an interesting first person account by Elizabeth Black on the Sex is Social website who describes in detail the first time she tried it (and liked it). Other first hand accounts didn’t (such as those on A Kinkster’s Guide concluding “Stick to sex toys – don’t try this!”). Although there are many academic articles on sadomasochism and sadomasochistic practices, not one of them mentions figging. Therefore, we know absolutely nothing about the prevalence of the practice (but as I said earlier, it is likely to be very rare).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Black, E. (2010). The fine art of figging Sex is Social, January 2. Located at: http://www.edenfantasys.com/sexis/sex/figging-0102101/

Figging: Anal Discipline (2005). Why figging enhances sex. November 19. Located at: http://www.figging.com/2005/11/19/why-figging-enhances-sex/

Live Journal (2007). BDSM: Theory and practice of figging. Located at: http://tacit.livejournal.com/225189.html

Wikipedia (2013). Figging. Located at: http://en.wikipedia.org/wiki/Figging

Wikipedia (2013). Rhaphanidosis. Located at: http://en.wikipedia.org/wiki/Rhaphanidosis

Wipi (2013). Figging. Located at: http://www.londonfetishscene.com/wipi/index.php/Figging

Wipi (2013). Pervertible. Located at: http://www.londonfetishscene.com/wipi/index.php/Pervertable

Blocked-in syndrome: Another look at Game Transfer Phenomena

Back in the early 1990s, I used to play the video game Tetris on my handheld Nintendo Game Boy. Although I say so myself, I was a really good player and I used to play for hours every day. When I went to bed I would see falling blocks as I closed my eyes. I often experienced the same thing when waking up. What I didn’t realise was that many other gamers experienced this too and that it had a name – ‘The Tetris Effect’. According to Wikipedia,the Tetris effect occurs when people devote so much time and attention to an activity that it begins to pattern their thoughts, mental images, and dreams.”

In the late 1980s I started researching into the area of video game addiction. One of the papers I cited a lot in my early research concerning the side effects of excessive playing was a 1993 case study published in the Irish Journal of Psychological Medicine by Dr. Sean Spence. Dr. Spence reported the case of a female video game player who was diagnosed as suffering from persecutory delusions, exhibiting violent behaviour, and experiencing constant imaginary auditory hallucinations triggered by the music of the Super Mario Brothers video game. This case study and the Tetris effect are both examples of what I and my research colleague Angelica Ortiz de Gortari call ‘game transfer phenomena’ (GTP).

These phenomena tend to occur when video game players become so immersed in their gaming that when they stop playing, they sometimes transfer some of their virtual gaming experiences to the real world. These phenomena can occur both visually and aurally as well is in the form of unconscious bodily movements.

We have been researching GTP for a number of years and our first published study in 2011 made worldwide news. Some of the press coverage was both sensationalist (“Gamers can’t tell real world from fantasy, say researchers) and misleading (“How video games blur real life boundaries and prompt thoughts of violent solutions to players’ problems) and angered some of the gaming community. Our first published study in the International Journal of Cyber Behavior, Psychology and Learning was an exploratory study in which 42 gamers were interviewed. Although the sample was small, we reported that all our participants had, at some point, experienced some type of involuntary sensations, thoughts, actions and/or reflexes in relation to videogames when not playing them. For instance, one gamer reported witnessing a mathematics equation appearing in a bubble above his teacher’s head while another reported health bars hovering over football players from a rival team. However, this didn’t stop some of the press coverage being derogatory (Unscientific survey of 42 gamers concludes video games interfere with perceptions of reality).

Since then we have published three more studies from a self-selected dataset of over 1,600 gamers’ experiences (all of who had experienced some form of GTP) in various academic journals (International Journal of Human Computer Interaction; International Journal of Mental Health and Addiction; International Journal of Cyber Behavior, Psychology and Learning). Our findings have shown that some gamers (i) are unable to stop thinking about the game, (ii) expect that something from the game will happen in real life, (iii) display confusion between video game events and real life events, (iv) have impulses to perform something as in the video game, (v) have verbal outbursts, and (vi) experience voluntary and involuntary behaviours.

While some gamers qualify their experiences as funny, amusing, or even normal, others said they got surprised, felt worried, embarrassed and their experiences were a reason to quit playing. Based on our research so far, Game Transfer Phenomena appear to be commonplace among excessive gamers but the good news is that most of these phenomena are short-lasting, temporary, and appear to resolve of their own accord.

Despite instances of GTP elsewhere in the psychological and medical literature, we argue that there are important reasons for not using the ‘Tetris effect’ concept when studying game transfer effects. Among the most important are that: (i) the Tetris effect definition is very broad and does not emphasize the importance of the association between real life stimulus and video game elements as a trigger of some of the transfer experiences, (ii) it does not make a clear distinction between sensorial modalities in the game transfer experiences or talk about players’ experiences across sensorial modalities (e.g., hearing a sound and visualizing a video game element), and (iii) the name itself is inspired by a one specific stereotypical puzzle game (i.e., Tetris). This simple name indicates that it is repetition that triggers the transfer effects but there are other factors involved in game transfer experiences. Furthermore, modern video games use more than abstract shapes and offer more flexible scenarios compared to Tetris and similar games.

Our latest study that surveyed over 2,500 gamers is currently being analysed but preliminary results indicate that game transfer phenomena appear to be common among players – especially those that play heavily. It could be that some gamers are more susceptible than others to experience GTP. Although for many gamers the effects of these experiences appear to be short lived, our research also shows that some gamers experience them recurrently. More research is needed to understand the cognitive and psychological implications of GTP. Our studies to date show there is a need to investigate neural adaptations and after-effects induced by video game playing as a way of encouraging healthy and safe video game playing.

Note: This blog is an extended version of an article first published in The Conversation

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK 

Further reading

Gackenbach, J.I (2008). Video game play and consciouness development: A transpersonal perspective. Journal of Transpersonal Psychology, 40(1), 60-87.

Griffiths, M. D., Kuss, D.J., & Ortiz de Gortari, A. (2013). Videogames as therapy: A review of the medical and psychological literature. In I. M. Miranda & M. M. Cruz-Cunha (Eds.), Handbook of research on ICTs for healthcare and social services: Developments and applications (pp.43-68). Pennsylvania: IGI Global.

Ortiz de Gotari, A., Aronnson, K. & Griffiths, M.D. (2011). Game Transfer Phenomena in video game playing: A qualitative interview study. International Journal of Cyber Behavior, Psychology and Learning, 1(3), 15-33.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. Gackenbach (Ed.), Video Game Play and Consciousness (pp.223-250). Nova Science

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30, 95-105.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning, 4(1), 59-75.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12, 432-452.

Parfitt, B. (2011). Metro “can’t tell real world from fantasy”. MCV. September 21. Located at: http://www.mcvuk.com/news/read/metro-can-t-tell-real-world-from-fantasy/085065

Purchase, R. (2011). Prof clarifies Game Transfer Phenomena. Eurogamer.net. September 21. Located at: http://www.eurogamer.net/articles/2011-09-21-game-transfer-phenomena-authors-defence

Spence, S.A. (1993). Nintendo hallucinations: A new phenomenological entity. Irish Journal of Psychological Medicine, 10, 98-99.

The Tetris Effect. Located at: http://en.wikipedia.org/wiki/Tetris_effect

The national wealth service: Problem gambling is a health issue

Over the last decade, the United Kingdom has undergone major changes of gambling legislation (most notably, the 2005 Gambling Act that came into force on September 1, 2007). The Gambling Act has provided the British public with increased opportunities and access to gambling like they have never seen before. Gambling legislation was revolutionized and many of the tight restrictions on gambling dating back to the 1968 Gaming Act were relaxed (particularly in relation to the advertising of gambling). The deregulation of gambling has also been coupled with the many new media in which people can gamble (internet gambling, mobile phone gambling, interactive television gambling, gambling via social networking sites). Given the expected explosion in gambling opportunities, is this something that the health and medical professions should be concerned about?

Gambling has not been traditionally viewed as a public health matter although research into the health, social and economic impacts of gambling has grown considerably since the 1990s. In August 1995, the British Medical Journal published an editorial called ‘Gambling with the nation’s health?’ which argued that gambling was a health issue because it widened the inequalities of income and that there was an association between inequality of income in industrialized countries and lower life expectancy. However, there are many other more specific reasons why gambling should be viewed as an issue for the medical profession.

According to the last British Gambling Prevalence Survey (BGPS) published in 2011, just under 1% of the British population have a severe gambling problem although the rate is approximately twice as high in adolescents, particularly as a result of problematic slot machine gambling. Disordered gambling is characterized by unrealistic optimism on the gambler’s part. All bets are made in an effort to recoup their losses. The result is that instead of “cutting their losses”, gamblers get deeper into debt pre-occupying themselves with gambling, determined that a big win will repay their loans and solve all their problems.

It is clear that the social and health costs of problem gambling can be large on both an individual and societal level. Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, family neglect, and bankruptcy. I have also reported in a number of my papers (including a 2007 report I wrote for the British Medical Association) that there can also be adverse health consequences for both the gambler and their partner including depression, insomnia, intestinal disorders, migraines, and other stress-related disorders. In the UK, preliminary analysis of the calls to the national gambling helpline also indicated that a significant minority of the callers reported health-related consequences as a result of their problem gambling. These include depression, anxiety, stomach problems, other stress-related disorders and suicidal ideation.

There are also other issues relating to problem gambling that may have medical consequences. One US study published in the Journal of Emergency Medicine by Dr. Robert Muellman and his colleagues found that intimate partner violence (IPV) was predicted by pathological gambling in the perpetrator. In a sample of 286 women admitted to the emergency department at a University Hospital in Nebraska, findings revealed that a woman whose partner was a problem gambler was 10.5 times more likely to be a victim of IPV than partners of a non-problem gambler.

Health-related problems due to problem gambling can also result from withdrawal effects. In a study published in the American Journal of the Addictions, Dr. Richard Rosenthal and Dr. Henry Lesieur found that at least 65% of pathological gamblers reported at least one physical side-effect during withdrawal including insomnia, headaches, upset stomach, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty and/or chills. Their results were also compared to the withdrawal effects from a substance-dependent control group. They concluded that pathological gamblers experienced more physical withdrawal effects when attempting to stop than the substance-dependent group. I also found similar things in a small study that I published in the Social Psychological Review (with Michael Smeaton).

Pathological gambling is very much the ‘hidden’ addiction. Unlike (say) alcoholism, there is no slurred speech and no stumbling into work. Furthermore, overt signs of problems often don’t occur until late in the pathological gambler’s career. If problem gambling is an addiction that can destroy families and have medical consequences, it becomes clear that medical professionals should be aware of the effects of gambling in just the same way that they are with other potentially addictive activities like drinking (alcohol) and smoking (nicotine).

However, gambling addiction is an activity that is not (at present) being treated via the British National Health Service (NHS). This was shown in a paper that I published with Dr. Jane Rigbye in a paper we published in a 2011 issue of the International Journal of Mental Health and Addiction. We sent a total of 327 letters were sent to all Primary Care Trusts, Foundation Trusts and Mental Health Trusts in the UK requesting information about problem gambling service provision and past year treatment of gambling problems within their Trust under the Freedom of Information Act. Our findings showed that 97% of the NHS Trusts did not provide any service (specialist or otherwise) for treating those with gambling problems (i.e., only nine Trusts provided evidence of how they deal with problem gambling). Only one Trust offered dedicated specialist help for problem gambling. Our study showed there was some evidence that problem gamblers may get treatment via the NHS if that person has other co-morbid disorders as the primary referral problem.

Problem gambling is very much a health issue that needs to be taken seriously by all within the health and medical professions. General practitioners routinely ask patients about smoking and drinking but gambling is something that is not generally discussed. Problem gambling may be perceived as a somewhat ‘grey area’ in the field of health and it is therefore very easy to deny that those in the medical profession should be playing a role. If the main aim of practitioners is to ensure the health of their patients, then it is quite clear that an awareness of gambling and the issues surrounding it should be an important part of basic knowledge.

As briefly outlined above, opportunities to gamble and access to gambling have increased because of deregulation and technology. What has been demonstrated from research evidence in other countries is that – in general – where accessibility of gambling is increased there is an increase not only in the number of regular gamblers but also an increase in the number of problem gamblers – although this may not be proportional. This obviously means that not everyone is susceptible to developing gambling addictions but it does mean that at a societal (rather than individual) level, in general, the more gambling opportunities, the more problems. Other countries such as Australia, Canada and New Zealand have seen increases in problem gambling as a result of gambling liberalization. In the UK, the last BGPS showed that problem gambling in Great Britain had increased by 50% compared to the previous BGPS published in 2007. (However, the latest data from the combined Health Survey for England and the Scottish Health Survey in 2014 reported that problem gambling had fallen to about 0.5%).

Gambling is without doubt a health and issue and there is an urgent need to enhance awareness within the medical and health professions about gambling-related problems and to develop effective strategies to prevent and treat problem gambling. The rapid expansion of gambling represents a significant public health concern and health/medical practitioners also need to research into the impact of gambling on vulnerable, at-risk, and special populations. It is inevitable that a small minority of people will become casualties of gambling in the UK, and therefore help should be provided for the problem gamblers. Since gambling is here to stay and is effectively state-sponsored, the Government should consider giving priority funding (out of taxes raised from gambling revenue) to organizations and practitioners who provide advice, counselling and treatment for people with severe gambling problems.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association.

Griffiths, M.D. (2011). Adolescent gambling. In B. Bradford Brown & Mitch Prinstein (Eds.), Encyclopedia of Adolescence (Volume 3) (pp.11-20). San Diego: Academic Press.

Griffiths, M.D., Scarfe, A. & Bellringer, P. (1999). The UK National telephone Helpline – Results on the first year of operation. Journal of Gambling Studies, 15, 83-90.

McKee, M. & Sassi, F. (1995). Gambling with the nation’s health. British Medical Journal, 311, 521-522.

Muelleman, R. L., DenOtter, T., Wadman, M. C., Tran, T. P., & Anderson, J. (2002). Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence. Journal of Emergency Medicine, 23, 307-312.

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

Rosenthal, R. & Lesieur, H (1992). Self-reported withdrawal symptoms and pathological gambling. American Journal of the Addictions, 1, 150-154.

Setness, P.A. (1997). Pathological gambling: When do social issues become medical issues? Postgraduate Medicine, 102, 13-18.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Pet projects: A brief look at domestic animals with social media accounts

Earlier today, I was interviewed by BBC radio about people that have set up social media accounts for their pets. In all honesty I am not a pet person but I am also well aware of the many psychological studies showing that pets hold a special place in the lives of many families and that many people treat pets as if they are one of the family. Professor John Archer has written many papers on the psychology of pet ownership and in a 1997 review paper (‘Why do people love their pets?”) in the journal Evolution and Human Behavior noted:

“People form strong attachments with their pets…[The owning of pets] enable pets to elicit caregiving from humans…in some circumstances…pet owners derive more satisfaction from their pet relationship than those with humans, because they supply a type of unconditional relationship that is usually absent from those with other human beings”.

In August 2014, the Daily Telegraph published the results of a survey they had done and reported that almost one in four dogs and cats now has their own social feed or webpage. In fact, their survey of 2,000 pet owners claimed that 9% of dogs had their own Twitter account and 13% of cats had their own Facebook page. It was also reported that 2% of dogs even had their own blog. The article then went on to list pets that had high numbers of followers and admirers. This included ‘Boo the Dog’ (the ‘world’s cutest dog’ according to pop star Ke$ha with 15 million Facebook ‘Likes’), ‘Grumpy Cat’ (‘famous for his unimpressed face’ with 6 million Facebook ‘Likes’), Graham The Kitten (singer Ed Sheeran’s cat with 99,500 followers), ‘Maggie May’ (tennis player Andy Murray’s dog with 27,000 followers), and ‘Meredith Swift’ (singer Taylor Swift’s cat with 10,000 followers).

As there is no academic research on pets with social media account I went looking online for information and came across an article on the Social Times website entitled ‘Your dog may be more popular than you – 20% have over 50 Facebook friends’. The article began:

“How many pets are online?  How many pet owners are tweeting and Facebooking for their cats and dogs? How many pets have a YouTube page? A new infographic from eBay Classifieds reveals that Fido and Fluffy are hitting the social web a lot more often than you may think! The ‘Social Savvy Critters’ infographic reveals that 14% of dog owners maintain a Facebook page for their pet, 6% tweet for their dogs on Twitter, and a whopping 27% have their own YouTube page! In addition to providing stats about how many pets are online, the infographic also offers up some advice for pet owners looking to get their furry friends online. They provide 8 Twitter tips for dogs, tips on creating a blog from your pet’s perspective, and a list of pet-related social networks”.

The data were collected for a survey carried out by DoggyLoot.com. I have no details on how the data were collected or how many dog owners participated in the survey but in the absence of empirical research it’s the best I could find. The same survey also reported that among the 14% that had set up Facebook accounts for their dogs, 42% of the dogs (I’m not making this up, honestly) had 1-25 Facebook friends, and 20% had 50-100 Facebook friends. The article also made reference to a number of online communities where pets online can get together including petzume.com and petizens.com.

During my research for the radio interview I was surprised to find that Facebook founder had set up a Facebook account for his Hungarian sheepdog (‘Beast’) posting messages such as “I just took a dump and made Mark Zuckerberg pick it up. It was glorious”. The Guardian newspaper did a profile piece on Zuckerberg and his dog after the online social media account had been set up that turned into an article about pets being online. The (2012) article noted that: 

“Pets on social networking sites are huge – high-profile Beast is liked by more than 42,000 people so far – and more and more of us are creating online lives for our companion animals, despite Facebook rules that state you must be over 13 to use the site (at just two months, even in dog years, Beast is only 16 months old) and, more importantly, you cannot create a profile for anyone other than yourself”.

The Guardian reporter (Bim Adewumni) asked the obvious question of who befriends a dog on Facebook or follows a cat on Twitter? And (more importantly) why? To answer the questions, Adewumni interviewed people that had set up online accounts. She wrote:

“Yasmin Eshref set up a page for her cat Georgie Coalie, as a joke to cheer up a friend. ‘But then lots of friends started adding her and sending messages to her’ says Eshref. Georgie passed away last year, but lives on in Facebook. ‘I suppose I kept it up for sentimental reasons, like not wanting to throw away the possessions of a dead person. I know it sounds a bit naff, but it’s just hard to let go’ she says. One friend tells me she has befriended a dog belonging to a friend on Facebook. ‘He even posts updates. I love him’. But another follows a puppy she is less than enamoured with: ‘Truly, I think it is slightly ridiculous. I did it to avoid offending my friends. The dog is cute, but I’m not that into him’. Animals on social networking sites have enormous numbers of fans. Sockamillion, a grey-and-white cat belonging to computer administrator and historian Jason Scott, tweets under the alias Sockington and has more than 1.4 million followers on Twitter. His list of followers reveals hundreds of tweeting cats and dogs. There are also spoof accounts for Bo, the family dog of the Obamas, and, of course, Larry, the newly acquired Downing Street cat. Fictional animals are doing just as well. Scooby Doo, Gromit and even Aleksandr Orlov, the meerkat from the car insurance advertisements, have Facebook pages”.

As there is no research on why people set up social media accounts for their pets (or why people follow them on Twitter or ‘Like’ them on Facebook) we can only speculate about possible motivations for such actions. If pets are considered an equal member of some families or act as surrogate children for childless couples, it’s perhaps unsurprising if some set up online social media accounts in their name. As noted in the Guardian article, some may set the accounts up as a joke or for sentimental reasons. Others may find it harmless fun or do it simply because they can. As I have noted in much of my cyber-psychological research, many activities carried out online are usually done for similar reasons including amusement, boredom, and revenge.

Others may do things online to explore facets of their personality that they can’t do offline or as a way of feeling better about themselves. Is someone that writes online from the perspective of their pet psychologically any different from gamers who swap their gender or species within an online video game? Unlike some online activities connected with social media (online trolling, social media addiction, etc.), there appears to be little harm in posing as your pet. Given the unlikelihood of any problematic behaviour, I can’t see how such behaviour will ever become an area for serious scientific study.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Adewunmi, B. (2011). Why has Mark Zuckerberg set up a Facebook page for his dog? The Guardian, March 9. http://www.theguardian.com/global/2011/mar/09/mark-zuckerberg-dog-facebook-page

Archer, J. (1997). Why do people love their pets? Evolution and Human Behavior, 18(4), 237-259.

Bryant, C. (2012). 7 ways to make your dog a social media superstar. Dogster, December 18. Located at: http://www.dogster.com/lifestyle/make-your-dog-social-media-superstar-7-tips

eBay Classifieds Blogs (2012). Social savvy critters. January 16. Located at: http://blog.ebayclassifieds.com/2012/01/16/social-savvy-critters/

Fuster, H., Oberst, U., Griffiths, M.D., Carbonell, X., Chamarro, A. & Talarn, A. (2012). Psychological motivation in online role-playing games: A study of Spanish World of Warcraft players. Anales de Psicologia, 28, 274-280.

Hussain, Z. & Griffiths, M.D. (2008). Gender swapping and socialising in cyberspace: An exploratory study. CyberPsychology and Behavior, 11, 47-53.

Kealey, H. (2014). The most popular pets on social media. The Daily Telegraph, August 26. Located at: http://www.telegraph.co.uk/lifestyle/pets/11056619/The-most-popular-pets-on-social-media.html

Lewis, A. & Griffiths, M.D. (2011). Confronting gender representation: A qualitative study of the experiences and motivations of female casual-gamers. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 28, 245-272.

McCormack. A. & Griffiths, M.D. (2012). Motivating and inhibiting factors in online gambling behaviour: A grounded theory study. International Journal of Mental Health and Addiction, 10, 39-53.

O’Neill, M. (2012). Your dog may be more popular than you – 20% have over 50 Facebook friends. Social Times, January 18Located at: http://socialtimes.com/social-media-pets-infographic_b88001

Thacker, S. & Griffiths, M.D. (2012). An exploratory study of trolling in online video gaming. International Journal of Cyber Behavior, Psychology and Learning, 2(4), 17-33.

Belch rare bit: A very brief look at burping fetishes

Over the last couple of years I’ve covered some pretty idiosyncratic fetishes in my blog. Today’s topic is up there with the strangest (and perhaps one of the least commonplace) – burping fetishism. My assertion that it is one of the least commonplace comes from the fact there is (perhaps unsurprisingly) absolutely nothing in the academic or clinical literature on burping fetishism. Furthermore, I was only able locate one online forum that appeared to be solely dedicated to the sexual side of burping – check out the Burp Fetish Forums website. (I ought to also mention that on YouTube there are dedicated collections of people burping on camera. Although these collected clips may be sexually arousing to a burp fetishist, I guess most people who watch them do so because they find them amusing).

However, it was while I was writing a previous blog on sneeze fetishes (in itself a strange and rare fetish) that I came across a few people also admitting that they were also sexually aroused by the thought and/or sight of someone burping and belching. (I’m not sure if there is really any difference between burping and belching although from what I’ve read in a fetishistic sense is that belching appears to be very loud burping whereas burping does not necessarily have to be loud).

Anecdotally, the ‘loudness’ aspect appears to be an important element to burp fetishists. In this sense, it is the noise made rather than the action itself that appears to be what is sexualized and/or interpreted by the fetishist as sexually pleasurable and arousing. In sexual behaviour more generally, hearing quite clearly influences sexual arousal and response. However, this is typically in the form of music that facilitates peoples’ mood in readiness for sex, and/or the sounds that people make while engaging in sexual activity (e.g., ‘talking dirty’ and/or moaning and groaning while making love). One 2002 book chapter I read on sexual response (in a book on human sexuality by Dr. Tina Miracle, Dr. Andrew Miracle and Roy Baumeister) reported some interesting studies on the role of sound in sexual arousal. More specifically it reported that:

“In one study, male college students were shown 60-second erotic videos both with and without the accompanying audio. There was a significant positive correlation between male sexual arousal and sound, as measured by penile plethysmograph and self-report (Gaither & Plaud, 1997). Another study found that a male partner’s silence during lovemaking inhibited the female partner’s sexual response (DeMartino, 1990). However, silence might be preferable to some other sounds, such as your partner burping during an embrace or the ringing of the phone. Many people find the sound of the words ‘I love you’ to be the most arousing of all”.

Interestingly, this extract makes a point of noting that burping during sex would be one of the worst sounds to hear in a sexual situation. However, judging by the extracts I collated below, this is not the case with everyone. I managed to find a small but sizable number of online admissions relating to burp fetishes. Obviously I cannot guarantee the veracity of the content but in the context of the pages that I found them on, they appear to be genuine and heartfelt:

  • Extract 1: “I’m a girl and I have a major fetish for guys that can burp loud. [I don’t know why] but I enjoy it a lot. It’s so sexy. I can also burp really loud so I wish I could find a guy with it so it’s mutual, but no luck so far. I can burp pretty good, and I also have a fetish for burping girls. The girl has to be attractive (not super ultra hot, but that would be nice), and I find it extremely erotic if they can out belch me. I don’t know why I was born with this ‘kink’, or why others are born with it”
  • Extract 2: “I for one love it when I hear a girl burp. In particular, I suppose it has to be a girl who I find attractive in the first place. If I don’t find her attractive then it’s only just as impressive as hearing another male burp. Don’t give up. Your burpin’ lovin’ man is out there somewhere. Fortunately, our mating call is loud and clear so you will eventually find him smiling back at you when you let one roar someday”.
  • Extract 3: Ever since I [can] remember, I’ve been turned on by other women burping! I cant go a day without watching a burping / farting / stuffing video”.
  • Extract 4: I’m a new guy here with some of what I would consider to be general turn ons (muscles, worship, lifting, etc.), but it’s my fetish for burping that I’m curious about. First off, I was wondering if there were other people in this forum who shared a similar fetish for belching and hearing other guys burp…I know in my case, the feeling of air trapped in the stomach tends to feed into another fetish of mine, inflation…YouTube provides a good library of belching guy videos, and I found one other site that deals with the fetish aspect (which I can’t list yet because of the post count limit), but the focus there is primarily for the heterosexual, burping girl enthusiast crowd”.
  • Extract 5: “Has anyone ever successfully gotten a boyfriend/girlfriend that can do/has features of their fetish? I would have no idea how to find a guy who can burp. It’s not something that usually comes up at the first date. But this goes for any fetish. Is it too much to ask to have a boyfriend to fulfill your fetish, and if not, how would you go about dropping the bomb to your boyfriend [or] girlfriend?”
  • Extract 6: “I really get turned on when I hear a men belch or burp. It’s burly and just wrong on so many levels, but it’s real and I love the thought of how much a person can consume to make them do that…Isn’t that so weird?”

There are also various online forums where burp fetishes are discussed (such as the Amber Cutie website). Although these online admissions surrounding the sexiness of burping are short, (if true) they lead to some immediate conclusions. Firstly, the online confessions came from both men and women. Secondly, the online confessions were made both heterosexuals and homosexuals. Thirdly, there appear to be psychological and/or behavioural overlaps with other sexual fetishes including inflation fetishes, feederism (i.e., stuffing) fetishes, and farting fetishes. All of these are arguably connected with the consumption of foodstuffs so perhaps the overlaps are not that surprising. The only other fetishes that I have come across where there is some overlap is sneeze fetishists that also have a burp fetish, and paraphilic infantilism (i.e., adult babies) where being burped by mother/matron figures is sometimes sexually arousing. However, all of these identified overlaps are anecdotal and not based on any scientific or clinical research.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Miracle, T.S., Miracle, A. & Baumeister, R. (2002). Human Sexuality: Meeting Your Basic Needs. Upper Saddle River, NJ: Prentice-Hall/Pearson.

Plaud, J.L., Gaither, G.A., Hegstad, H.J., Rowan, L., & Devitt, M.K. (1999). Volunteer bias in human psychophysiological sexual arousal research: To whom do our research results apply? Journal of Sex Research, 36, 171-179.

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