Category Archives: Culture Bound Syndromes
In a previous blog on five ‘weird addictions’ I briefly mentioned pagophagia, a craving and compulsion for chewing ice. Pagophagia is a type of pica (which I also covered in a previous blog). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Although the incidence of pagophagia appears to have increased over the last 30 years in westernized cultures, Dr. B. Parry-Jones (in a 1992 issue of Psychological Medicine) carried out some historical research and pointed out that both Hippocrates and Aristotle wrote about the dangers of excessive intake of iced water. Parry-Jones also noted that references to disordered eating of ice and snow were also recorded in medical textbooks from the sixteenth century. However, the first contemporary reference to pagophagia appears to have been a 1969 paper by Dr. Charles Coltman in the Journal of the American Medical Association entitled ‘Pagophagia and iron lack’.
Pagophagia is closely associated with iron deficiency anemia but can also be caused by other factors (biochemical, developmental, psychological, and/or cultural disorders). If pagophagia is due to iron deficiency (such as case studies of those with sickle cell anemia), it may sometimes be accompanied by fatigue (e.g., being tired even when performing normally easy tasks). Dr. Youssef Osman and his colleagues published a number of case reports of pagophagia in a 2005 issue of the journal Pediatric Haematology and Oncology including the case of a child with sickle cell anemia and rectal polyps (that caused a lot of bleeding and made the anemia worse):
“An 8-year-old Omani boy, a known case of sickle cell anemia…presented with history of craving for ice. The child was noticed over the last 4 months to like drinking very cold water and to open the deep freezer and scratch the ice and eat it. The parents tried to stop him from doing so, but they failed…The child was started on oral iron therapy…and his craving for ice was completely stopped. Meanwhile, the rectal polyp was removed surgically”.
Other potential health side effects include constant headaches (a ‘brain freeze’ similar to ‘ice cream headache’) and teeth damage although this is thought to be relatively rare. However, a recent paper by Dr. Yasir Khan and Dr. Glen Tisman in the Journal of Medical Case Reports highlighted the case of a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water.
Khan and Tisman also suggested that some people who are deficient in iron experience tongue pain and glossal inflammation (glossitis). Others claim that chewing ice may help those with stomatitis (i.e., inflammation of the mucous lining inside the mouth). A recent 2009 case study published by Dr. Tsuyoshi Hata and his colleagues in the Kawasaki Medical Journal, reported the case of a 37-year old Japanese women who ate copious amounts of ice to relieve the pain of temporomandibular joint disorder (i.e., chronic pain in the joint that connects the jaw to the skull). Khan and Tisman also claim that the classical symptoms of pagophagia have changed in the last 40 years since Dr. Coltman’s initial paper in the Journal of the American Medical Association.
“This may probably be the result of advances in technology and changes in culture. When initially described [by Coltman], pagophagia was defined as the excessive ingestion of ice cubes from ice trays and the ingestion of ice scraped from the wall of the freezer. With the advent of ice cube makers and auto defrosters, the presentation of pagophagia has changed in a subtle manner as described in…our patients. Now we observe a subtler ingestion and/or sucking of ice cubes from large super-sized McDonald’s-like cups and from the use of popular bottled water containers that have been frozen”.
There have been few epidemiological studies examining the prevalence of pagophagia. Such estimates vary widely within particular populations but (according to Dr. Youssef Osman and his colleagues) have been shown to be more common in low socioeconomic and underdeveloped areas. Pagophagia is thought to be relatively harmless in itself or to one’s health, although there are some claims in the literature that pagophagia can be addictive. However, empirical reviews suggest that pagophagia (and pica more generally) is part of the obsessive-compulsive disorder spectrum of diseases. As a consequence, some case studies even suggest that ice chewing compromises their ability to maintain jobs or personal relationships.
Treatment for pagophagia can often be overcome with iron therapy and Vitamin C supplements (to supplement iron deficiency if that is the cause). For instance, Dr. Mark Marinella in a 2008 issue of the Mayo Clinic Proceedings successfully treated a 33-year old woman with pagophagia following complications with gastric bypass surgery:
“The patient received red blood cells, iron sucrose, and levofloxacin. On further questioning, the patient denied taking vitamin, mineral, or iron supplements since surgery and reported prolonged, heavy menstrual cycles. She consumed large amounts of ice daily for several months. The patient’s husband frequently observed her in the middle of the night with her head in the freezer eating the frost off the icemaker. The patient admitted to awakening several times nightly for months with an uncontrollable compulsion to eat the frost on the icemaker. This craving resolved after transfusion and iron administration”
However, if the condition is psychologically or culturally based, iron and vitamin supplements are unlikely to work, and other psychological treatments (such as cognitive-behavioural therapy) are likely to be employed.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Coltman, C.A. (1969). Pagophagia and iron lack. Journal of the American Medical Association, 207, 513-516.
de Los Angeles, L., de Tournemire, R. & Alvin, P. (2005). Pagophagia: pica caused by iron deficiency in an adolescent. Archives of Pediatrics, 12, 215-217.
Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemadej, U.J., Cole, O.J., Westney, O.E., Jones, S. Laryea, H. & Westney, L.S. (1994). Pica in an urban environment. Journal of Nutrition (Supplement), 124, 954-962.
Hata, T., Mandai, T., Ishida, K., Ito, S., Deguchi, H. & Hosoda, M. (2009). A rapid recovery from pagophagia following treatment for iron deficiency anemia and TMJ disorder accompanied by masked depression. Kawasaki Medical Journal, 35, 329-332.
Khan, Y. & Tisman, G. (2010). Pica in iron deficiency: A case series. Journal of Medical Case Reports, 4, 86. Located: http://www.jmedicalcasereports.com/content/4/1/86
Kirchner, J.T (2001). Management of pica: A medical enigma. American Family Physician, 63, 1177-1178.
Marinella, M. (2008). Nocturnal pagophagia complicating gastric bypass. Mayo Clinic Proceedings, 83, 961
Osman, Y.M., Wali, Y.A. & Osman, O.M. (2005). craving for ice and iron-deficiency anemia: a case series. Pediatric Hematology and Oncology, 22, 127-131.
Parry-Jones, B. (1992). Pagophagia, or compulsive ice consumption: A historical perspective. Psychological Medicine, 22, 561-571.
Back in 1996, I published a paper on behavioural addictions in the Journal of Workplace Learning. One of my introductory paragraphs in that paper noted:
“There is now a growing movement (e.g. Miller, 1980; Orford, 1985) which views a number of behaviours as potentially addictive, including many behaviours which do not involve the ingestion of a drug. These include behaviours diverse as gambling (Griffiths, 1995), overeating (Orford, 1985), sex (Carnes, 1983), exercise (Glasser, 1976), computer game playing (Griffiths, 1993a), pair bonding (Peele and Brodsky, 1975), wealth acquisition (Slater, 1980) and even Rubik’s Cube (Alexander, 1981)! Such diversity has led to new all encompassing definitions of what constitutes addictive behaviour”.
The reason I mention this is that I was recently asked to comment on a story about ‘wealth addiction’ and I vaguely remembered that I had mentioned (in passing) Philip Slater’s 1980 book (also entitled Wealth Addiction). Slater’s book was written from a sociological standpoint and was both controversial and provocative. Slater claimed on the book cover that: ““Money is America’s most powerful drug. Here’s how it weakens us and how we can free ourselves”. I also came across an interesting 2012 article by journalist Scott Burns (on ‘wealth addiction revisited’) who noted that:
“One of the hallmarks of wealth addiction is very simple: more possessions but less use. We become so interested in possessing the thing that we lose the experience it provides. This can be as vast as owning homes all around the world, as some of the very rich do, as simple as Bernie Madoff’s shoe collection, or as obsessive as a collection of rare watches. Whatever it is, the wealth addict confuses possession with experience”.
Slater argued that our increasing reliance on money and all of the things that it can buy has the potential to become an obsession that can destroy individual lives. According to short article by Dr. Paul Hokemeyer, wealth addiction has three key characteristics:
- Tolerance: More and more money is needed to attain a baseline level of satisfaction.
- Withdrawal: The thought of losing money or not making it fills a person with fear, anxiety and stress.
- Negative consequences: In their pursuit of money, the person forgoes emotional fulfillment, intimate relationships and peace of mind.
These are actually three of the six criteria that I personally believe comprise genuine addictive behaviour (although I use the word ‘conflict’ rather than ‘negative consequences’; the other three criteria are salience, mood modification and relapse – see my previous blog on behavioural addiction for further details).
The reason why wealth addiction has made a re-appearance over the last month is because of an article published in the New York Times by Sam Polk, a former hedge fund trader that worked on Wall Street (and who since the article has been published has been compared to Jordan Belfort, the person that Leonardo DiCaprio portrayed in the true story film The Wolf of Wall Street).
Polk’s article is an interesting read (whether you think wealth addiction exists or not) and I thought I would pick out some of the text and relate it to my own views about what constitutes addictive behaviour.
- Extract 1: “In my last year on Wall Street my bonus was $3.6 million – and I was angry because it wasn’t big enough. I was 30 years old, had no children to raise, no debts to pay, no philanthropic goal in mind. I wanted more money for exactly the same reason an alcoholic needs another drink: I was addicted”
Here, Polk refers to his work bonuses becoming bigger and bigger and that they were never enough. To me, this sounds like some kind of tolerance effect with more and more money needed to achieve the desired (presumably mood modifying effect). Polk also claims – after the fact – that he had become addicted.
- Extract 2: “I was also a daily drinker and pot smoker and a regular user of cocaine, Ritalin and ecstasy. I had a propensity for self-destruction that had resulted in my getting suspended from Columbia for burglary, arrested twice and fired from an Internet company for fist fighting”.
Polk openly discusses his previous use of potentially addictive substances and made the comparisons himself between his self-confessed behavioural (wealth) addiction and his previous self-destructive chemical abuse. Some readers may jump to the conclusion that Polk had (or has) an ‘addictive personality’ but this is not something that I personally believe in. To me, Polk is displaying ‘reciprocity’ (swapping one potential addiction with another) rather than being a function of an underlying personality trait. Giving up one addiction often leaves a large void and sometimes the only way to fill it is by engaging in other behaviours that provide similar feelings and sensations.
- Extract 3: “My counselor didn’t share my elation [at earning more and more money]. She said I might be using money the same way I’d used drugs and alcohol – to make myself feel powerful — and that maybe it would benefit me to stop focusing on accumulating more and instead focus on healing my inner wound”.
Here, Polk’s therapist appears to hit the nail on the head in relation to what money represented for Polk. I would describe the feeling that Polk gained from both drugs and money was omnipotence (something that I have also written about in relation to my research on gambling).
- Extract 4: “I was terrified of running out of money and of forgoing future bonuses. More than anything, I was afraid that five or 10 years down the road, I’d feel like an idiot for walking away from my one chance to be really important. What made it harder was that people thought I was crazy for thinking about leaving. In 2010, in a final paroxysm of my withering addiction, I demanded $8 million instead of $3.6 million. My bosses said they’d raise my bonus if I agreed to stay several more years. Instead, I walked away”.
Polk’s language here is very much rooted in what addicts say about their drug or behaviour of choice (“terrified” of being without the thing they love doing). The weighing up of the costs clearly led to a decision for Polk to quit his “withering addiction” and there are obviously signs both here (and the rest of the article if you read it) that leaving behind the wealth left him with some feelings of regret.
- Extract 7: “The first year was really hard. I went through what I can only describe as withdrawal — waking up at nights panicked about running out of money, scouring the headlines to see which of my old co-workers had gotten promoted. Over time it got easier — I started to realize that I had enough money, and if I needed to make more, I could. But my wealth addiction still hasn’t gone completely away. Sometimes I still buy lottery tickets”.
Here, Polk uses addictive terminology (i.e., withdrawal) to describe giving up the activity that led to him gaining wealth. Again, the fear of running out of money appears psychologically similar to the fear that other more traditional addicts have about running out of their drug of choice. It could also be argued that he has given up one form of gambling (financial trading) with partially doing another (buying lottery tickets).
- Extract 8: “I was lucky. My experience with drugs and alcohol allowed me to recognize my pursuit of wealth as an addiction. The years of work I did with my counselor helped me heal the parts of myself that felt damaged and inadequate, so that I had enough of a core sense of self to walk away”
Polk uses his experiences in giving up drugs with the help of his therapist as a way of helping him give up wealth acquisition. Knowing you have managed to give up one addiction shows that you have the mental strength to give up another.
Obviously I have never met Polk and I can only go on how he described his experiences during his time on Wall Street, However, the insights shared do seem to suggest that some of the wealth acquisition behaviour had addictive elements and that there was at least some evidence that Polk – at least on some occasions – experienced salience, tolerance, withdrawal, conflict and mood modification. Whether he was genuinely addicted to money in the same way as drug addicts are addicted to psychoactive substances is debatable. However, theoretically, I can see how someone might be become addicted to wealth. There are also interesting questions as to whether wealth acquisition may be an underlying motivation for those addicted to work.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Alexander, R. (1981). A cube popular in all circles. New York Times, 21 July, p. C6.
Burns, S. (2012). Beyond envy: Wealth addiction revisited. Dallas News, December 15: Located at: http://www.dallasnews.com/business/columnists/scott-burns/20121215-beyond-envy-wealth-addiction-revisited.ece?nclick_check=1
Carnes, P. (1983). Out of the Shadows: Understanding Sexual Addiction. CompCare, New York, NY.
Glasser, W. (1976). Positive Addictions. Harper & Row, New York, NY.
Griffiths, M.D. (1993). Are computer games bad for children? The Psychologist: Bulletin of the British Psychological Society, 6, 401-407.
Griffiths, M.D. (1995). Adolescent Gambling, Routledge: London.
Orford, J. (1985). Excessive Appetites: A Psychological View of the Addictions. Wiley: Chichester.
Peele, S. and Brodsky, A. (1975). Love and Addiction. Taplinger: New York, NY.
Polk, S. (2013). For the love of money. New York Times, January 29. Located at: http://www.nytimes.com/2014/01/19/opinion/sunday/for-the-love-of-money.html?_r=1
Slater, P. (1980). Wealth Addiction. E.P. Dutton: New York, NY.
While researching a previous blog on Stendhal Syndrome, I came across various references to a number of “city syndromes”. According to an interesting book chapter by Nadia Halim, city syndromes are “acute, (usually) short-lived disorders that have in common a similar set of symptoms and pattern of onset and recovery”. Each of the city syndromes that have been identified in the psychological literature is associated with a specific tourist destination (e.g., Jerusalem, Paris, Florence) and identified by medical practitioners (usually psychiatrists) when sufferers access mental health services. In essence, the condition is a type of ‘culture shock’ where an individual becomes psychologically disorientated when they experience new environments that feel alien to them.
One such city syndromes is ‘Paris Syndrome’, a psychological condition that appears to affect Japanese tourists only, suggesting that it is some kind of culture bound syndrome. According to an article in the BBC News, Paris Syndrome was first identified in 1986 by Professor Hiroaki Ota (a Japanese psychiatrist who was working in France at the time). The condition is said to cause mental breakdown when visiting the city. The incidence of the disorder is very small as reports estimate that only 10-20 people a year suffer out of millions of tourists. However, the only ‘cure’ is for the affected individuals to return back to Japan.
As far as I am aware, there are only a couple of academic papers that have been published on Paris Syndrome. The first one was a case study published in a 1998 issue of the Journal of the Nissei Hospital by Dr. Katada Tamami. This was a report of a male manic-depressive who shortly after visiting Paris presented with symptoms of insomnia, fluctuation of mood, aggression, irritation and increase in sex drive. Tamami noted that being separated from his family, and living alone in Paris, the man had an identity crisis as in Paris he was no longer a father or professor. His fantasy and idealization of Paris played a large part in his abnormal behaviour.
The second paper was by a group of French psychiatrists in a 2004 issue in the French psychiatry journal Nervure. The authors reported that between 1988 and 2003, a total of 63 Japanese patients had been hospitalized because of the condition (with a slight bias towards females in their 30s). Although the number of affected patients was relatively low, the Japanese Embassy arranged for a Japanese psychiatrist to work in the authors’ hospital (i.e., St. Anne’s Hospital). In fact, the Japanese Embassy has a 24-hour telephone hotline for Japanese tourists suffering from severe culture shock. The paper claimed that for affected individuals, the city of Paris held a “quasi-magical” attraction and that it was characteristically “symbolic of all the aspects of European culture that are admired in Japan”. A Wikipedia article on Paris Syndrome claims that: “the susceptibility of Japanese people may be linked to the popularity of Paris in Japanese culture”. The same article also noted that:
“Mario Renoux, the president of the Franco-Japanese Medical Association, states in Liberation’s article ‘Des Japonais entre mal du pays et mal de Paris” (December 13, 2004) that Japanese magazines are primarily responsible for creating this syndrome. Renoux indicates that Japanese media, magazines in particular, often depict Paris as a place where most people on the street look like fashion models and most women dress in high-fashion brands”.
The symptoms of Paris Syndrome are typically transient and include anxiety attacks, violent and aggressive outbursts, feelings of persecution, acute psychotic delusions (of paranoia, megalomania, erotomania and/or mysticism), dissociative and/or disoriented feelings, depersonalization, derealization, psychomotor abnormalities (e.g., dizziness, sweating, tachycardia), and – in some cases – thoughts of suicide. Interviews with the affected individuals revealed that the Japanese arrive in the city with highly romanticized expectations and that many had spent years dreaming of coming to Paris before doing it in actuality.
The authors of the paper published in Nervure identified two fundamentally different types of the syndrome based on previous psychiatric problems and when the symptoms occurred:
- Type 1 [Classic]: These individuals typically have a problematic psychiatric history and may travel to Paris for idiosyncratic “strange” or delusional reasons. However, the onset of the symptoms is immediate upon arrival in Paris (and may even begin in the airport).
- Type 2 [Delayed Expression]: These individuals do not usually have a personal and/or familial psychiatric history. The reasons for visiting Paris are typically for ‘normal’ travelling reasons but the onset of the symptoms is much later than the ‘classic’ type (i.e., three months or longer after arriving in Paris).
As an example of the first type of sufferer, the paper described the case of a 39-year-old Japanese woman with a history of schizophrenia that was hospitalized following a psychotic breakdown on her immediate arrival in Paris. She had come to Paris following an advertizing campaign that had the tagline: “France is waiting for you”. She took it to mean it was her personal destiny to go there and claimed she was going to become the queen of one of the Scandinavian countries (“Sweden, Finland or Denmark”). As an example of the second type of sufferer, the paper described the case of a 30-year-old Japanese man with no previous psychiatric history who came to France for educational reasons. The onset of the symptoms was five months after arriving in France and started when he moved into a Paris hotel (after initially studying in Reims). He was hospitalized after experiencing severe anxiety, insomnia, anorexia, and auditory hallucinations (i.e., voices threatening to kill him and his family).
One of the factors that appear to be common among sufferers is that they appear to be highly unprepared for the reality of day-to-day life in the city (e.g., the marked cultural differences, the great difference in language, the difference in public manners and behaviours, etc.). It is these differences that appear to act as a trigger for the onset of the behaviour. The most salient trigger for Paris Syndrome is thought to be the language barrier. Another factor appears to be intense exhaustion caused by trying to cram in as much as possible in the short time available for sightseeing alongside the effects of jetlag. Such factors are said to contribute to the psychological destabilization of some Japanese visitors. Another French physician (Youcef Mahmoudia) working at the hospital Hotel-Dieu de Paris claimed that Paris Syndrome was “a manifestation of psychopathology related to the voyage, rather than a syndrome of the traveller” and hypothesized that it was the excitement resulting from visiting Paris that caused the psychosomatic symptoms (e.g., increased heart rates, dizziness, etc.).
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Angelique, C. (2006). Paris syndrome hits Japanese. The Guardian, October 25. Located: http://www.guardian.co.uk/world/2006/oct/25/japan.france
Fastovsky N, Teitelbaum A, Zislin J, et al (2000). The Jerusalem syndrome. Psychiatric Services, 5, 1052.
Halim, N. (2009). Mad tourists: The “vectors” and meanings of city-syndromes. In K. White (Ed.), Configuring Madness. Oxford: Inter-Disciplinary Press.
Monden, C. (2005). Development of psychopathology in international tourists. In van Tilburg, M. & Vingerhoets, A. (Eds.), Psychological Aspects of Geographical Moves: Homesickness and Acculturation Stress (pp. 213-226). Amsterdam: Amsterdam Academic Archive.
Tamami, K. (1998). Reflexions on a case of Paris syndrome. Journal of the Nissei Hospital, 26, 127-132.
Viala, A., Ota, H., Vacheron, M.N., Martin, P., & Caroli, F. (2004). Les Japonais en voyage pathologique à Paris: Un modèle original de prise en charge transculturelle. Nervure (supplement), 17(5), 31-34.
Wikipedia (2012). Paris Syndrome. Located at: http://en.wikipedia.org/wiki/Paris_syndrome
Wyatt, C. (December 20, 2006). Paris Syndrome strikes Japanese. BBC News, December 20/ Located at: http://news.bbc.co.uk/1/hi/6197921.stm
In previous blogs I have looked at pica and some of the pica sub-variants including pagophagia (the eating of ice) and coprophagia (the eating of faeces). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Today’s blog takes a look at geophagia (the eating of earth, soil and/or clay). In a literature review published in the Journal of the Royal Society of Medicine by Dr Alexander Woywodt and Dr. Akos Kiss that geophagia has been regarded as a psychiatric disease, a culturally sanctioned practice and/or a sequel to poverty and famine. Geophagia is also a culturally sanctioned practice in some parts of the world. Woywodt and Kiss also stated that:
“[Geophagia] is not uncommon in southern parts of the United States5 as well as urban Africa. Fine red clay is often preferred. In particular, geophagia is observed during pregnancy or as a feature of iron-deficiency anaemia. Where poverty and famine are implicated, earth may serve as an appetite suppressant and filler; similarly, geophagia has been observed in anorexia nervosa. However, geophagia is often observed in the absence of hunger, and environmental and cultural contexts of the habit have been emphasized. Finally, geophagia is encountered in people with learning disability, particularly in the context of long-term institutionalization”.
The relationship between anaemia and pica (including geophagia) has been well documented. However, Woywodt and Kiss assert that it is still unclear whether anaemia prompts geophagia to compensate for iron deficiency or whether geophagia is the cause of anaemia. Prevalence rates of pica have range anywhere between 0.02% and 74% depending on the study and population studied although there are few reliable prevalence estimates of geophagia. One study of pregnant Tanzanian women found a prevalence rate of 26.5% (but this is – of course – a totally unrepresentative sample).
A recent review on pica led by Dr Sera Young (University of California, USA) noted that geophagia is the most common type of pica described in the psychological and medical literature although it did also report that geophagics frequently eat other non-food stuffs (particularly if the desired soil is unavailable or socially unacceptable). For many people, pica is not dangerous but for geophagia there may be complications including parasitic infections (from eating soil). Although eating soil and clay may be regarded as unappetizing (and perhaps bizarre) by most people, some authors have argued that eating soil can be nutritionally beneficial (which if that was the case, it wouldn’t technically be a form of pica).
While not being considered a social norm in Western society, eating soil or clay is said to be quite common among primitive or economically depressed peoples a way of augmenting a scanty and/or mineral-deficient diet. Having said that, the geophagia is most often confined to people suffering from chronic mental illness. Clay (as opposed to soil) consumption has been reported in India, Haiti, various parts of Africa (Cameroon, Gabon, Guinea), and even rural areas of the USA. Like soil consumption, clay consumption has also been associated with pregnant women and some women claim they eat it to eliminate nausea. The Wikipedia entry on geophagia noted:
“In Haiti, the poorest economy in the Western Hemisphere, geophagy is widespread. The clay mud is worked into what looks like pancakes or cookies, called ‘bon bons de terres’…The cookies have little or no nutritional value and are associated with various health problems”.
A study led by Dr. L.T. Glickman and colleagues, and published in a 1999 issue of the International Journal of Epidemiology, provided some data on geophagia by carrying out a study examining intestinal parasitism among children from three rural villages in Guinea (Africa). More specifically they examined the faecal stools of 266 randomly selected children (aged 1-18 years). The researchers found that 53% of children were infected by at least one type of soil-transmitted parasite. They also surveyed parents and reported that geophagia was reported by parents to occur in 57% of children aged 1-5 years, 53% of children aged 6-10 years, and 43%, of children aged 11-18 years. It was concluded that geophagia is an important risk factor for orally acquired parasitic infections in African children.
A small study carried out by Turkish researchers and published in a 1978 issue of Acta Haematologica carried out oral iron and zinc tolerance tests on 12 patients from Turkey and Iran aged between 8 and 21 years with iron deficiency anemia and geophagia. The research team reported decreased iron and zinc absorption in patients compared to control patients. They concluded that iron and zinc malabsorption may be an additional feature of the syndrome characterized by geophagia among those from Turkey and Iran. Finally, in their literature review on geophagia, Dr Woywodt and Dr Kiss concluded that:
“The causation is certainly multifactorial; and clearly the practice of earth-eating has existed since the first medical texts were written. The descriptions do not allow simple categorization as a psychiatric disease. Finally, geophagia is not confined to a particular cultural environment and is observed in the absence of hunger”
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Arcasoy, A., Cavdar, A.O. & Babacan, E. (1978). Decreased iron and zinc absorption in Turkish children with iron deficiency and geophagia. Acta Haematologica, 60, 76-84.
Ashworth, M., Hirdes, J.P. & Martin, L. (2008). The social and recreational characteristics of adults with intellectual disability and pica living in institutions. Research in Developmental Disabilities, 30, 512-520.
Danford, D.E. & Huber, A.M. (1982). Pica among mentally retarded adults. American Journal of Mental Deficiency, 87, 141-146.
Glickman, L.T., Camara, A.O., Glickman, N.W. & McCabe, G.P. (1999). Nematode intestinal parasites of children in rural Guinea, Africa: Prevalence and relationship to geophagia. International Journal of Epidemiology, 28, 169-174.
Kettaneh, A., Eclache, V., Fain, O., Sontag, C., Uzan, M. Carbillon, Stirnemann, J. & Thomas, M. (2005). Pica and food craving in patients with iron-deficiency anemia: A case-control study in France. American Journal of Medicine, 118, 185-188
Lacey, E. (1990). Broadening the perspective of pica: Literature review. Public Health Reports, 105, 29-35.
López, L.B., Ortega Soler, C.R. & de Portela, M.L. (2004). Pica during pregnancy: A frequently underestimated problem. Archivos latinoamericanos de nutricion, 54, 17-24.
Nyaruhucha, C.N. (2009). Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 11(1), 29–34.
Rose, E.A., Porcerelli, J.H, & Anne Neale, A.V. (2000). Pica: Common but commonly missed. Journal of the American Board of Family Practice, 13, 353-358.
Stein, D.J., Bouwer, C. & van Heerden, B. (1996). Pica and the obsessive- compulsive spectrum disorders. South African Medical Journal, 86, 1586-1592.
Woywodt, A. & Kiss, A. (2002). Geophagia: the history of earth-eating. Journal of the Royal Society of Medicine, 95:143-146.
Young, S.L., Wilson, M.J., Miller, D., & Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS One, 3(9), e3147.
Wikipedia (2012). Geophagy. Located at: http://en.wikipedia.org/wiki/Geophagy
In previous blogs I have examined various culture bound syndromes (CBSs) such as koro and berserkers. CBSs comprise a combination of psychiatric and/or somatic symptoms viewed as a recognizable disease within specific cultures or societies and are often unknown outside of their own local regions. One of the more unusual CBSs is dhat syndrome, typically located in the Indian sub-continent (India, Sri Lanka, Bangladash). Dhat is one of the CBSs listed in the World Health Organization’s International Classification of Diseases.
The term ‘Dhat syndrome’ was first described by Dr. N.N. Wig in a 1960 issue of the (Indian) Journal of Clinical and Social Psychiatry, and then by Dr. J.S. Neki in the British Journal of Psychiatry (1973). A 1975 paper by Dr. H.K. Malhotra and Dr. N.N. Wig in the Archives of Sexual Behavior called dhat “the exotic neurosis of the Orient”. According to a short paper by Dr. Om Prakash in the Indian Journal of Psychiatry, dhat syndrome comprises various psychological, somatic and sexual symptoms attributed by the patient to the passing of whitish fluid, believed to be semen in urine (i.e., psychological distress and anxiety related to semen-loss). Prakash says that the word ‘dhat’ is derived from the Sanskrit word ‘dhatu’ (which has multiple meanings including ‘metal’, ‘elixir’ and ‘constituent part of the body’). He also noted that:
“This notion of seminal loss frightens the individual into developing a sense of doom if a single drop of semen is lost, thereby producing a series of somatic symptoms…fear of semen loss and resulting problems [in India] is so strong that cures are advertised by vaids and hakims everywhere – on walls, on television, in newspapers and on roadside hoardings”.
The anxiety surrounding the semen loss can also relate to the releasing of semen via nocturnal emissions (i.e., ‘wet dreams’) and masturbation. The symptoms include fatigue, listlessness, appetite loss, lack of physical strength, poor concentration, forgetfulness, guilt, and (in some cases) sexual dysfunction. Given the syndrome relates to psychological anxiety surrounding semen loss, the disorder is (necessarily) found among men, but interestingly, the dhat syndrome has also been applied to women who experience similar symptoms relating to white vaginal discharge). According to an online article on CBSs, it claims that:
“The anxiety related to semen loss can be traced back thousands of years to Ayurvedic texts, where the loss of a single drop of semen, the most precious body fluid, could destabilize the entire body”
A 2004 literature review on dhat syndrome by Dr. A. Sumathipala and colleagues in the British Journal of Psychiatry speculated that the disorder was a “hypochondriacal preoccupation”. This may have some validity as a 1990 paper by Dr. R.K. Chadha and Dr. N. Ahuja (also in the British Journal of Psychiatry) reported a study of 52 dhat patients. Three-quarters of their sample were reported as having hypochondriacal symptoms.
Another study in the British Journal of Psychiatry a year later by Dr. M.S. Bhatia and Dr. S.C. Malik reported that 93 (out of 144) consecutive patients attending a sexual dysfunction clinic had dhat syndrome. A number of papers published on the dhat syndrome in the 1980s and 1990s all report that depressive, anxiety and/or somatoform disorders are prevalent in the majority of dhat sufferers. A small 1989 Sri Lankan study by Dr. P. De Silva and Dr. S. Dissanayake in the Sexual and Marital Therapy journal on 38 men with sexual dysfunction, reported that ‘semen loss’ was seen by most of the men as the main reason for their sexual dysfunction. The same study reported that 40% of the sample had hypochondriasis. Similar findings have been reported among Bangladeshi men. (It should also be noted that there are various reports of similar syndromes in other countries. For instance, Prakash’s paper also mentions ‘shen-k’uei’ in Taiwan and China which from the symptoms listed appear almost identical to dhat)
Based on papers published in the British Journal of Psychiatry and Indian Journal of Psychiatry (mainly from the 1980s and 1990s), Prakash presents a profile of those affected with dhat and claims that most are young males, recently married, from rural areas, low to average socioeconomic status (farmers, labourers, farmers), and from families with conservative attitudes towards sex. He also claims (seemingly based on a 2001 book chapter by by Dr. A. Avasthi and Dr. R. Nehra) that there are three types of dhat patients:
- Dhat alone (where their symptoms are attributed to semen loss, and with presenting symptoms that are hypochondriacal, depressive or anxiety-related in nature)
- Dhat with comorbid depression and anxiety (where dhat is seen as a symptom accompanying another disorder)
- Dhat with sexual dysfunction
The duration of the symptoms can be relatively short-lived (e.g., 3-12 months) but some papers report people suffering for up to 20 years. Prakash lists the most common co-morbid disorders and sexual dysfunctions associated with dhat. This included depressive neurosis (40%-42%), anxiety neurosis (21%-38%), somatoform and hypochondriasis (32%-40%), erectile dysfunction (22%-62%), and premature ejaculation (22%-44%). Prakash also reports that the majority (i.e., two-thirds) of dhat sufferers recover (66%), with the remainder either improved (22%) or unchanged (12%). Finally, the most recently published paper on dhat syndrome by Dr. Neena Sanjiv Sawant and Dr. Anand Nath in a 2012 issue of the Sri Lankan Journal of Psychiatry noted that dhat beliefs are often based on misconception and myths:
“These myths and misconceptions which are deeply rooted in Indian culture are passed from generation to generation. Due to the lack of proper information and lack of open communication between parents and children, the only source of knowledge for many remain their peers, who are equally ignorant about the subject, and this leads to widespread misconceptions. Many people consult unqualified practitioners who reinforce their ignorance”
Avasthi, A. & Nehra, R. (2001). Sexual disorders: A review of Indian Research. In: Murthy, R.S. (Ed.), Mental Health in India (1995-2000) (pp.42-53). Bangalore: People’s Action for Mental Health.
Behere, P.B., Natraj, G.S. (1984). Dhat syndrome: The phenomenology of a culture-bound sex neurosis of the orient. Indian Journal of Psychiatry, 26, 76-78.
Bhatia, M.S. & Malik, S.C. (1991). Dhat Syndrome – A useful diagnosis entity in Indian Culture. British Journal of Psychiatry, 159, 69-75.
Chadda, R.K. & Ahuja, N. (1990). Dhat syndrome: A sex neurosis of the Indian subcontinent. British Journal of Psychiatry, 156, 577-579.
De Silva, P. & Dissanayake, S.A.W. (1989) The loss of semen syndrome in Sri Lanka. A clinical study. Sexual and Marital Therapy, 4, 195-204.
Malhotra, H.K. & Wig, N.N. (1975). A culture bound sex neurosis in the Orient. Archives of Sexual Behaviour, 4, 519-528.
Neki, J.S. (1973). Psychiatry in South East Asia. British Journal of Psychiatry, 123, 257-269.
Prakash, O. (2007). Lessons for postgraduate trainees about Dhat syndrome. Indian Journal of Psychiatry, 49, 208–210.
Sawant, N.S. & Nath, A. (2012). Cultural misconceptions and associated depression in Dhat syndrome. Sri Lankan Journal of Psychiatry, 3, 17-20.
Sumathipala, A. Siribaddana, S.H. & Bhugra, D. (2004). Culture-bound syndromes: The story of dhat syndrome. British Journal of Psychiatry, 184, 200-209.
Wig, N.N. (1960). Problems of mental health in India. Journal of Clinical and Social Psychiatry (India), 17, 48-53.
In previous blogs I have examined various culture bound syndromes (i.e., a combination of psychiatric and/or somatic symptoms viewed as a recognizable disease within specific cultures or societies). Arguably, one of the most interesting culture bound syndromes is (the much disputed) ‘Windigo psychosis’ that was said to have been reported among Algonquian native tribes (which are among the biggest and most widespread of North American natives and who lived around the Great Lakes of Canada and America). The disorder allegedly comprised individuals who intensely craved human flesh and who believed they would turn into cannibals.
The windigo was a cannibalistic spirit forest creature that appeared in Algonquian legends, and was known by lots of other names and variants (including – among 37 others identified by John Columbo in his 1982 book Windigo – wendigo, weendigo, windiga, waindigo, windago, wihtikow, and witiko). For instance, the Ojibwa tribe (a Native American people originally located north of Lake Huron before moving westward in the 17th and 18th centuries into Michigan, Wisconsin, Minnesota, western Ontario, and Manitoba) believed the windigo was a ferocious ogre that took children away if they did not behave themselves. More generally, it was believed that the windigo could possess and infect human beings and transform them into cannibalistic creatures. Such cannibalistic practices were said to have begun in times of extreme winter famine when families were isolated and confined to their cabins because of heavy snowfall. Legend also has it that the infected sufferer would have their heart turned to ice.
However, windigo is a disorder that has been continually challenged across many decades as a myth (for instance, Dr. R.H. Prince in a 1992 issue of Transcultural Psychiatric Research Review; Dr. R.C. Simons and Dr. C. Hughes in a 1993 book chapter on culture bound syndrome; Dr. P.M. Yap in a 1967 issue of the Australia New Zealand Journal of Psychiatry). Whether the condition genuinely existed or not, no-one disputes that the number of cases reported over the last hundred years are minimal.
According to John Columbo, the first derivation of the word ‘windigo’ (i.e., the word ‘onaouientagos’ meaning both ‘cannibal’ and ‘evil spirit’) first appeared in print as long ago as 1722 in an account by Bacqueville de la Potherie, a French traveler. Windigo psychosis was said to occur when an individual became highly anxious that they were transforming into a windigo and believed that other humans that they lived among them were edible. Symptoms of the psychosis were said to include nausea, vomiting, poor appetite and anti-social behaviour. In extreme cases, the psychosis was said to produce suicidal tendencies (as a way of preventing possession by the windigo) and/or homicidal tendencies (to eat the human flesh of others). A book (The Lost Valley and Other Stories) written by Algernon Blackwood in 1910 featured a horror story (called ‘The Wendigo’), and was widely believed to be based on the Algonquian windigo legends.
In the 1982 book Windigo: An Anthology of Facts and Fantastic Fiction edited by John Columbo, he noted that:
“Windigo has been described as the phantom of hunger which stalks the forests of the north in search of lone Indians, halfbreeds, or white men to consume. It may take the form of a cannibalistic Indian who breathes flames. Or it may assume the guise of a supernatural spirit with a heart of ice that flies through the night skies in search of a victim to satisfy its craving for human flesh. Like the vampire, it feasts on flesh and blood. Like the werewolf, it shape-changes at will”.
In an online article about ‘culture specific diseases’, Denis O’Neil claims that modern medical diagnoses might label windigo as a form of paranoia because “of the irrational perceptions of being persecuted”. Here, O’Neil argues that it is the windigo monsters who are the persecutors (i.e., the windigo monsters are trying to turn people into monsters like themselves). O’Neil also argues that in contemporary North American culture “the perceived persecutors of paranoids are more likely to be other people or, perhaps, extra terrestrial visitors”.
Writing in a 2006 issue of the journal Transcultural Psychiatry, Dr. Wen-Shing Tseng said that it’s important to re-examine the sources of knowledge for each culture-related specific syndrome (including windigo which she also examined). She acknowledged that literature relating to windigo dated back to the 17th century, she made a lot of reference to the work of J.E. Saindon and the Reverend J.M. Cooper who both worked among an Algonquian community in the 1930s. She argued that the reports of both Saindon and Cooper “were based on second-hand information provided by non-clinical observers”. She then noted that the pioneering cultural psychiatrists of the 1950s and 1960s dealt with these early accounts “as though they were well-defined clinical entities with the diagnostic term witiko psychosis”.
In a paper by Dr. Lou Marano in a 1982 issue of Current Anthropology, it was noted that aspects of the Windigo belief complex may have had components in some individual’s psychological dysfunction. However, he concluded that after (i) five years’ field experience among Northern Algonquians, (ii) extensive archival research, and (iii) a critical examination of the literature:
“There probably never were any windigo psychotics in an etic/behavioral sense. When the windigo phenomenon is considered from the point of view of group sociodynamics rather than from that of individual psychodynamics, the crucial question is not what causes a person to become a cannibalistic maniac, but under what circumstances a Northern Algonquian is likely to be accused of having become a cannibalistic maniac and thus run the risk of being executed as such”.
In essence, Marano’s conclusion was that windigo psychosis was simply an artifact of research that was conducted without sufficient knowledge of the indigenous experience.
Colombo, J.R. (1982). Windigo: An Anthology of Facts and Fantastic Fiction. Lincoln: University of Nebraska Press.
Marano, Lou (1982). Windigo psychosis: The anatomy of an emic-etic Confusion. Current Anthropology, 23, 385-412.
O’Neil, D. (2010). Culture specific diseases. October 7. Located at: http://anthro.palomar.edu/medical/med_4.htm
Prince, R. H. (1992). Koro and the Fox Spirit on Hainan Island (China). Transcultural Psychiatric Research Review, 29(2), 119-132.
Simons, R. C., & Hughes, C. (1993). The culture bound syndrome. In A. Gaw (Ed.). Culture, Ethnicity and Mental Illness (pp. 75–99). Washington, DC: APA.
Tseng, W-S. (2006). From peculiar psychiatric disorders through culture-bound syndromes to culture-related specific syndromes. Transcultural Psychiatry, 43; 554-576.
Wikipedia (2012). Wendigo. Located at: http://en.wikipedia.org/wiki/Wendigo
Yap P. M. (1967). Classification of the culture-bound reactive syndromes. Australia New Zealand Journal of Psychiatry, 1, 172-179.
Yap, P. M. (1969). The culture bound syndromes. In W. Cahil., & T. Y. Lin. (Eds.). Mental Health Research in Asia and the Pacific (pp. 33-53). Honolulu: East West Centre Press.
In a previous blogs I have examined both Celebrity Worship Syndrome and whether fame can be addictive. Another behaviour allied to both of these is celebriphilia. There has been no scientific research on celebriphilia and I have only come across a few passing references to it in academic texts. In his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr Anil Aggrawal describes it as a sexual paraphilia where a “pathological desire to have sex with a celebrity”. The online Medical Dictionary is slightly different and defines celebriphilia as “an intense desire to have a romantic relationship with a celebrity” (and is therefore slightly different is the focus on this second definition is romance rather than sex, although there is an implicit assumption that having romantic relationship would involve sex). Finally, the only other definition that I have come across is in the online Nation Master encyclopedia that was a bit more padded out and claimed that:
“Celebriphilia is the sexual fetishism and obsession with sex with a celebrity or famous person. Celebriphiliacs may stalk these celebrities and either observe them for sexual pleasure voyeuristically or try and approach them and have sex with them. Some may simply masturbate to images of them”
Despite this more in-depth definition, it actually complicates matters as it brings in other behaviours such as voyeurism and stalking that are separate entities in and of themselves. As far as I can tell, the first reference to ‘celebriphilia’ appeared in an article written by journalists Benjamin Svetkey and Allison Hope Weiner for Entertainment Weekly. Their article was about Bonnie Lee Bakley, the wife of American actor Robert Blake (star of shows like Baretta and films such as In Cold Blood), who was shot in 2001 (May 4) while sitting outside a Los Angeles restaurant in Blake’s car. (Blake was eventually charged with his wife’s murder but was found not guilty. The murder remains officially unsolved although Bakley’s grown-up children from previous relationships took out a civil suit on Blake and was later found guilty of wrongful death).
The focus of the article by Svetkey and Weiner was Bakley’s celebriphilia and her ‘celebrity obsession’ (more specifically, her long-term history of pursuing relationships with celebrities). Bakley’s close friends all stated that her aim in life was to marry someone famous and all of her actions were geared around achieving this goal. Bakley was quoted as saying “being around celebrities makes you feel better than other people”. Her pursuing of celebrities began in 1990 when she became obsessed with wanting to marry rock ‘n’ roll singer Jerry Lee Lewis. She even moved to Memphis where Lewis was living, met him, and befriended Lewis’ sister as a way of getting closer to him. Bakley may have had a brief sexual relationship with Lewis, and in 1993 she gave birth to a daughter and claimed Lewis was the father (and even went as far as to name the baby Jeri Lee). Paternity tests later proved that Lewis was not the father of Bakley’s daughter. Following a move from Memphis to California, she continued her celebrity obsession by pursuing many different celebrities including actor Gary Busey, singer-songwriter and guitarist Chuck Berry, singer Frankie Valli, actor Robert De Niro, singer-songwriter Lou Christie, publisher Larry Flynt, entertainer Dean Martin, and musician Prince, before having a relationship with Marlon Brando’s son, Christian (following his release from prison in 1996).
It was in 1999, that Bakley met American actor Robert Blake while still dating Brando. She became pregnant again (telling both Blake and Brando that they were the father of the baby). She believed Brando was the father of the daughter she gave birth to (naming the child Christian Shannon Brando). However, later paternity tests showed it was Blake who was the father (and the baby was then re-named Rose). In November 2000, Bakley and Blake married (and Blake became Bakley’s tenth [!!!] husband). When I first read about Bakley’s attempts to have a relationship with someone famous, the first words that sprang to mind was ‘groupie’ and ‘stalker’. However, the article by Svetkey and Weiner specifically stated that:
“People who attempt to make themselves ”feel better” by romantically pursuing the famous [are] not groupies: Groupies are merely overzealous, oversexed fans. They’re not stalkers, either. Bakley’s relationship with Blake wasn’t imaginary…nor is she known to have ever threatened him with physical harm. And although her past was hardly squeaky-clean…she wasn’t simply a grifter. What Bakley pursued with meticulous and methodical precision wasn’t so much cash as cachet, the reflected glory of being with a star. Any star would do — even one like Blake, who hasn’t shone for the better part of a decade. Unlike stalkers and groupies, people like Bakley generally don’t develop crushes on the stars they pursue — it’s fame itself that flames their desires, regardless of whom it’s attached to. Sometimes they don’t even seem to like those they’re chasing. While Bakley was attempting a relationship with Blake, for instance, she was also apparently involved with Marlon Brando’s son Christian”.
Most of the famous people that she pursued most actively (i.e., Blake, Brando, Lewis) had careers that were on the wane. She chose people that wanted validation that they were still famous. Both Bakley and the ‘stars’ she chased appeared to be yearning validation, attention and wanting to be perceived as special. An American psychotherapist – Donald Fleming – was interviewed for the article by Svetkey and Weiner. He speculated about celebriphiles:
”Often these people have serious identity problems. They lack a centered sense of self. They’re usually people that have not developed any particular skills or abilities in life. They never developed out of their grandiose childhood wishes and fantasies to be important. The only way they can feel important or special or unique is through famous people being part of their life…People who follow stars often have the obsessive-compulsive trait. They can fool almost anybody. They become so acute at reading how to meet another person’s needs that they can pick up on their vulnerabilities and play them like a violin”.
Dr. David Giles who wrote one of the best books on the psychology of fame – Illusions of Immortality: A Psychology of Fame and Celebrity – explains the relationships that people have with celebrities as a parasocial interaction:
”One of the things about fame is how incredibly new it is to human experience. It started with mass communication, which is only about 100 years old. And the speed with which it’s developed – radio and then TV – has been astonishing. In an evolutionary sense, we may not have caught up with the phenomenon of fame as a species”.
Celebrity (and therefore celebriphilia) is as Dr. Giles would argue a completely modern, man-made phenomenon. In typical journalese, Svetkey and Weiner wrote that celebrity has “been injected into the cultural bloodstream like an untested drug – with a similar rush of disorienting results”. They also speculate about other people that display celebriphilia:
“Courtney Love may have once suffered a touch of it. (‘Become friends with Michael Stipe’, Kurt Cobain’s widow supposedly jotted in a journal years ago, mapping her road to fame)…And certainly Whitney Walton – known around Hollywood as the mysterious ‘Miranda’ – has something like it. She became infamous for charming her way into telephone friendships with Billy Joel, Warren Beatty, Quincy Jones, Richard Gere, and…other celebrities [including] Robert De Niro”.
As noted above, there has been no empirical research on celebriphilia unless you include the small amount of research on ‘celebrity stalking’ (although very few academics who have written on the topic use the word ‘celebriphilia’). However, there are a few exceptions. For instance, Dr. Brian Spitzberg and Dr. Michelle Cadiz wrote a paper on the media construction of stalking stereotypes and described one of the types as ‘stalking as celebriphilia’ in a 2002 issue of the Journal of Criminal Justice and Popular Culture (although the authors didn’t actually define what celebriphilia was in this context). In a 2006 book (Constructing Crime: Perspectives on Making News and Social Problems) edited by Dr. Victor Kappeler and Dr. Gary Potter, the authors briefly noted (in what seems a follow on from the paper by Spitzberg and Cadiz) that “media reports eventually moved away from a dominant image of stalkers as exclusively experiencing ‘celebriphilia’”.
Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.
Giles, D. (2000). Illusions of Immortality: A Psychology of Fame and Celebrity. London: Palgrave Macmillan.
Kappeler, V.E. & Gary W. Potter, G.W. (2006). Constructing Crime: Perspectives on Making News and Social Problems. Prospect Heights, IL: Waveland Press.
King, G. (2011). Who murdered Bonny Lee Bakley? (part 7: Bony the celebriphiliac). Crime Library, Located at: http://www.trutv.com/library/crime/notorious_murders/family/bakley/7.html
Medical Dictionary (2012). Celebriphilia. Located at: http://medical-dictionary.thefreedictionary.com/Celebriphilia
Nation Master (2012). Celebriphilia. Located at: http://www.nationmaster.com/encyclopedia/Celebriphilia
Spitsberg, B.H. & Cadiz, M. (2002). The media construction of stalking stereotypes. Journal of Criminal Justice and Popular Culture, 9(3), 128-149.
Svetkey, B. & Weiner, A.H. (2001). Dangerous game. Entertainment Weekly, June 22. Located at: http://www.ew.com/ew/article/0,,256019,00.html
Wiktionary (2012). Citations: Celebriphilia. Located at: http://en.wiktionary.org/wiki/Citations:celebriphilia