Category Archives: Obsessive-Compulsive Disorder
In a number of previous blogs I have made reference to the fact that I am a music obsessive. One of the consequences of my insatiable desire for music is that I often find myself unconsciously singing (either along with the music itself or just spontaneously as the mood takes me). Although I do not believe I have a compulsion to break into song, I was surprised to find that there are a number of case studies in the psychological literature on compulsive singing and other music related compulsions such as compulsive humming and whistling (although these all appear to be consequences of other underlying conditions). As noted in a previous blog, compulsive behaviour typically involves a repetitive and irresistible urge to perform a particular action (or set of actions) where the person feels they have no control to inhibit or stop the habitual behaviour. Compulsivity is part of obsessive-compulsive disorder (OCD), but may occasionally occur as stand-alone symptom following the onset of various physiological disorders.
One of the earliest papers I came across on the phenomenon was by Dr. Daniel Jacome in a 1984 issue of the Journal of Neurology, Neurosurgery and Psychiatry. Dr. Jacome described the case of a “musically naive patient with dominant fronto-temporal and anterior parietal infarct developed transcortical mixed aphasia. From early convalescence, he exhibited elated mood with hyperprosody and repetitive, spontaneous whistling and whistling in response to questions”. In addition to the whistling, Jacome also reported that the individual spontaneously sang without any error in melody, lyrics, pitch, and rhythm. The man also developed the desire to spend long periods of time listening to music.
Compulsive whistling was also reported in a 2012 issue of BMC Psychiatry by Dr. Rosaura Polak and her colleagues. Their paper reported the case of a 65-year-old man who started whistling compulsively following a heart attack. The heart attack had caused some brain damage due to a lack of oxygen to the brain. Prior to the cardiac arrest, the man had never displayed any obsessive-compulsive symptoms or psychiatric complaints. He was treated with clomipramine (a seretonin reuptake inhibitor) and this decreased time spent compulsively whistling. The authors concluded that:
“This case shows that the whistling can be explained in the context of compulsivity with its repetitive character. It illustrates that the compulsive behavior can be present as an independent symptom of cortico-striatal dysfunction, and may not always belong to frontal syndrome, punding or OCD. Finally, this case illustrates that pharmacological treatment with clomipramine is effective and suggests that similar cases of compulsivity may benefit from this treatment”
A paper published in a 2000 issue of the Journal of the Korean Neurological Association examining 25 patients with fronto-temporal dementia (20 women and five men with an average age of 56 years) noted that compulsive behaviour is one of the commonest early manifestations of the condition. The researchers analyzed their symptoms and compulsive behaviours and 22 of the patients (88%) showed various compulsive behaviours including “reading signboards, stereotypy of speech, ordering, hoarding, washing, checking, counting, singing, and wandering a fixed route”. However, no real detail was provided in relation to the compulsive singing. Other papers – such as one in a 2002 issue of European Psychiatry by Dr. F. Muratori and colleagues – have reported compulsive singing in people that have Kleine-Levin syndrome (i.e., recurrent primary hypersomnia where individualscan lapse into a deep sleep at any time without warning, sometimes lasting as long as 16 hours).
One of the most interesting and detailed papers on compulsive singing is a 2007 paper by Dr. Christophe Bonvin and colleagues in the Annals of Neurology. They reported two case studies of individuals with advanced Parkinson’s disease who exhibited “a peculiar and stereotyped behavior characterized by an irrepressible need to sing compulsively when under high-dose dopamine replacement therapy”. They argued that the compulsive singing behaviour shared many features with punding (i.e., repetitive behaviour that is a side effect of some drugs). Here is a brief summary of the two cases:
Patient 1: “A 70-year-old female university professor and amateur piano player while being treated with 1,268 L-dopa equivalent units (LEU)…exhibited a repetitive, compulsive behavior characterized by singing endlessly…It started with an irrepressible urge to hum the rhythm and then the main melody of Francesca di Foix, a jocular opera written in 1831 by Gaetano Donizetti. She had heard this rarely produced piece in Milan years ago, and although she did not particularly like it, she had an obsessive need to repeat this song again and again for hours. Even though it was disruptive, preventing sleep and social interactions, singing was reported as pleasant and associated with a feeling of calmness and relief. If interrupted, she became irritated…All symptoms improved minimally after quetiapine (25mg twice daily) had been introduced”.
Patient 2: “A 71-year-old male painter…[that] grew up in a family of musicians and used to spend time listening to classical music and singing willingly…While being treated with 634 LEU, he started to hum repeatedly the same melody, initially once a week, then several times daily, mostly in the evening…Although he asserted singing exclusively Mozart’s 7th Serenade (‘Haffner’ KV 250), his wife reported also about 10 different poorly elaborated songs. This stereotyped behavior was reported as irrepressible and gave him a sensation of relief and ‘peace of mind’. On demand, he could stop singing for short periods but felt somewhat frustrated, demonstrating some aggressive behavior toward his spouse. There were no concomitant auditory or visual hallucinations. This phenomenon exacerbated dramatically when LD/benserazide was increased to 1,000/250mg daily (1134 LEU)…[This resulted in] the patient losing control over the compulsion and singing almost unendingly all day…Eventually, compulsive singing improved, but did not disappear, when LD/benserazide was reduced to the minimal daily doses (500/125mg)”.
The authors noted that in both of these patients developed a peculiar, stereotyped, and compulsive behaviour characterized by an urge to sing repeatedly the same song. They also concluded that in both cases:
“[The] compulsive singing developed as an isolated, elaborate, and selective feature, unrelated to mania or psychosis…Although the singing behavior was fully recognized by both patients as inadequate and socially disruptive, they were unable to stop singing for more than a few seconds to minutes, partly because the singing-induced sensation of pleasure felt was overwhelming. To the best of our knowledge, this phenomenon has not been consistently identified in [Parkinson’s disease] thus far…Moreover, PET and functional magnetic resonance imaging studies conducted in humans have correlated pleasure and reward from music listening with a significant activation of the ventral tegmental area and accumbens nucleus, as well as of the hypothalamus, insula, and orbitofrontal cortex. These findings suggest that music listening may recruit similar neural circuitry of reward and emotions as other pleasure inducing stimuli like food and sex, and this may also be the case for singing”.
In 2010, Dr. Hiroshi Kataoka and Dr. Satoshi Ueno described the case of an 82-year old woman (also with Parkinson disease) who started to sing compulsively (in the absence of any other types of pathologic behaviour) following treatment with pergolide. In the journal Cognitive and Behavioral Neurology, the authors reported that she would hum the same melody and sing songs repeatedly. When she stopped taking her ergolide medication, the compulsive singing and humming considerably subsided. Drs. Kataoka and Ueno suggested that a dopamine agonist in the patient’s medication may have contributed to her compulsive singing. The same phenomenon was also reported in three Parkinson’s patients treated with dopamine agonists by a Dr. C. Borrue-Fernandez at a Spanish conference on treating Parkinson’s disease in 2011.
It would appear from the few papers that have been published on compulsive singing that it almost always occurs alongside or as a consequence of other primary medical conditions and that some excessive or sensitized dopaminergic stimulation is a necessary prerequisite for such musical stereotypies to occur.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Bonvin, C., Horvath, J., Christe, B., Landis, T., & Burkhard, P. R. (2007). Compulsive singing: another aspect of punding in Parkinson’s disease. Annals of Neurology, 62, 525-528.
Borrue-Fernandez, C. (2011). Compulsive singing as an Impulse Control Disorder in dopamine agonist treated patients: Review of three cases. The 15th Congress of the European Federation of Neurological Societies.
Jacome, D. E. (1984). Aphasia with elation, hypermusia, musicophilia and compulsive whistling. Journal of Neurology, Neurosurgery and Psychiatry, 47, 308-310.
Kataoka, H., & Ueno, S. (2010). Compulsive singing associated with a dopamine agonist in Parkinson disease. Cognitive and Behavioral Neurology, 23(2), 140-141.
Muratori, F., Bertini, N., & Masi, G. (2002). Efficacy of lithium treatment in Kleine–Levin syndrome. European Psychiatry, 17, 232–3.
Polak, A. R., van der Paardt, J. W., Figee, M., Vulink, N., de Koning, P., Olff, M., & Denys, D. (2012). Compulsive carnival song whistling following cardiac arrest: a case study. BMC Psychiatry, 12(1), 75.
Yoon, S. J., Jeong, J. H., Kang, S. J., & Na, D. L. (2000). Compulsive behaviors and presenting symptoms of frontotemporal dementia. Journal of the Korean Neurological Association, 18, 681-686
One of the recurring questions I am often asked to comment on by the media is whether celebrities are more prone to addiction than other groups of people. One of the problems in trying to answer what looks like an easy question is that the definition of ‘celebrity’ is different to different people. Most people would argue that celebrities are famous people, but are all famous people celebrities? Are well-known sportspeople and politicians ‘celebrities’? Are high profile criminals celebrities? While all of us would say that Hollywood A-Listers such as Tom Cruise, Johnny Depp, Angelina Jolie, Brad Pitt and Julia Roberts are ‘celebrities’, many of the people that end up on ‘celebrity’ reality shows are far from what I would call a celebrity. Being the girlfriend or relative of someone famous does not necessarily famous.
Another problem in trying to answer this question is what kinds of addiction are the media actually referring to? Implicitly, the question might be referring to alcohol and/or illicit drug addictions but why should other addictions such as nicotine addiction or addiction to prescription drugs not be included? In addition to this, I have often been asked to comment on celebrities that are addicted to sex or gambling. However, if we include behavioural addictions in this definition of addiction, then why not include addictions to shopping, eating, or exercise? If we take this to an extreme, how many celebrities are addicted to work?
Now that I’ve aired these problematic definitional issues (without necessarily trying to answer them), I will return to the question of whether celebrities are more prone to addiction. To me, when I think about what a celebrity is, I think of someone who is widely known by most people, is usually in the world of entertainment (actor, singer, musician, television presenter), and may have more financial income than most other people I know. When I think about these types of people, I’ve always said to the media that it doesn’t surprise me when such people develop addictions. Given these situations, I would argue that high profile celebrities may have greater access to some kinds of addictive substances.
Given that there is a general relationship between accessibility and addiction, it shouldn’t be a surprise if a higher proportion of celebrities succumbs to addictive behaviours compared with a member of the general public. The ‘availability hypothesis’ may also hold true for various behavioural addictions that celebrities have admitted having – most notably addictions to gambling and/or sex. It could perhaps be argued that high profile celebrities are richer than most of us (and could therefore afford to gamble more than you or I) or they have greater access to sexual partners because they are seen as more desirable (because of their perceived wealth and/or notoriety).
Firstly, when I think about celebrities that have ‘gone off the rails’ and admitted to having addiction problems (Charlie Sheen, Robert Downey Jr, Alec Baldwin) and those that have died from their addiction (Whitney Houston, Jim Morrison, Amy Winehouse) I would argue that these types of high profile celebrity have the financial means to afford a drug habit like cocaine or heroin. For many in the entertainment business such as being the lead singer in a famous rock band, taking drugs may also be viewed as one of the defining behaviours of the stereotypical ‘rock ‘n’ roll’ lifestyle. In short, it’s almost expected. In an interview with an online magazine The Fix, Dr. Scott Teitelbaum, an American psychiatrist based at the University of Florida:
“Some people who become famous and get put on a pedestal begin to think of themselves differently and lose their sense of humility. And this is something you can see with addicts, too. Famous or not, people in the midst of their addiction will behave in a narcissistic, selfish way: they’ll be anti-social and have a disregard for rules and regulations. But that is part of who they as an addict – not necessarily who they would be as a sober person. Then there are some people who are narcissists outside of their disease, who don’t need a drug or alcohol addiction to make them feel like the rules don’t apply to them – and yes, I have seen in this in many athletes and actors. Of course, you also have non-famous people who struggle with both…People with addiction and people with narcissism share a similar emptiness inside. Those who are famous might fill it with achievement or with drugs and alcohol. That’s certainly not the case for everyone. But when you see people who are both famous and narcisstic – people who struggle with staying right-sized or they don’t have a real sense of who they are without the fame – you know that they’re in trouble… People with addiction and people with narcissism both seek outside sources for inside happiness. And ultimately neither the fame nor the drugs nor the drinking will work”.
The same article also pointed out that there is an increase in the number of people who (usually through reality television) are becoming (in)famous but have no discernable talent whatsoever. In my own writings on the psychology of fame, I have made the point that (historically) fame was a by-product of a particular role (e.g., country president, news anchorman) or talent (e.g., captain of the national sports team, a great actor). While the Andy Warhol maxim that everyone will be famous for 15 minutes will never be truly fulfilled, the large increase in the number of media outlets and number of reality television shows suggests that more people than ever are getting their 15 minutes of fame. In short, the intersection between fame and addiction is on the increase. US psychiatrist Dr. Dale Archer was also interviewed for The Fix article and was quoted as saying:
“Fame and addiction are definitely related. Those who are prone to addiction get a much higher high from things – whether it’s food, shopping, gambling or fame – which means it [the behavior or situation] will trigger cravings. When we get an addictive rush, we are getting a dopamine spike. If you talk to anyone who performs at all, they will talk about the ‘high’ of performing. And many people who experience that high report that when they’re not performing, they don’t feel as well. All of which is a good setup for addiction. People also get high from all the trappings that come with fame. The special treatment, the publicity, the ego. Fame has the potential to be incredibly addicting”.
I argued some of these same points in a previous blog on whether fame can be addictive in and of itself. Another related factor I am asked about is the effect of having fame from an early age and whether this can be a pre-cursor or risk factor for later addiction. Dr. Archer was also asked about this and claimed:
“The younger you are when you get famous, the greater the likelihood that you’re going to suffer consequences down the road. If you grow up as a child star, you realize that you can get away with things other people can’t. There is a loss of self and a loss of emotional growth and a loss of thinking that you need to work in relationship with other people”.
I’m broadly in agreement with this although my guess is that this only applies to a minority of child stars rather than being a general truism. However, trying to carry out scientific research examining early childhood experiences of fame amongst people that are now adult is difficult (to say the least). There also seems to be a lot of children and teenagers who’s only desire when young is “to be famous” when they are older. As most who have this aim will ultimately fail, there is always the concern that to cope with this failure, they will turn to addictive substances and/or behaviours.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Griffiths, M.D. & Joinson, A. (1998). Max-imum impact: The psychology of fame. Psychology Post, 6, 8-9.
Halpern, J. (2007). Fame Junkies. New York: Houghton Mifflin Harcourt
McGuinness, K. (2012). Are Celebrities More Prone to Addiction? The Fix, January, 18. Located at: http://www.thefix.com/content/fame-and-drug-addiction-celebrity-addicts100001
Rockwell, D. & Giles, D.C. (2009). Being a celebrity: A phenomenology of fame. Journal of Phenomenological Psychology, 40, 178-210.
“I was reminded of a scene in the second series of The Thick Of It, where Peter Mannion, an old-school Tory MP, is told by his Steve Hilton-style spin doctor that he needs to start embracing the internet. ‘Have you ever tried Googling your own name?’ he asks. ‘It’s like opening the door to a room where everyone tells you how shit you are.’ I think this nicely encapsulates the relative merits of Googling yourself: namely, that there are none” (from an article by journalist Bryony Gordon, Daily Telegraph, February 29, 2012).
Last year, the actor Dominic West let it be known to the mass media that he regularly Googles himself and was reported as saying: “I like to have chats about myself with people – mainly putting forward the case for the defence. I use my own name but nobody ever believes me”. I have never worked out why it is such a social faux pas to Google yourself and why it is so derided. I’m quite happy to admit that I regularly Google myself, and that I probably do it more than most other people. In my defence, I am regularly interviewed by the print media and I like to check on what gets reported (particularly as it’s not unknown for me to get misquoted or for my words to be taken out of context. In an article published in the Online Journalism Review, Patrick Dent writes in defence of egosurfing:
“If you are a Web professional – whether an online instructor or journalist, Web developer or marketer – you should be aware of your presence on the Web. And perhaps more importantly, the existence of Web namesakes. And if you are active in the job market, being aware of your nom-de-plume’s cyberexistence is crucial. You should be aware of any nefarious deeds or ill impressions Internet namesakes may be performing… This all goes to illustrate that searching for your name on the Internet is more than the self-serving, vanity endeavor that the label ‘ego-surfing’ implies. Beyond being an interesting exercise, and yes in some cases stroking your ego, it is a prudent – if not downright necessary – activity in today’s Web-aware professional world”.
As an academic, being cited by others is something that is seen positively. As of this morning, I had 14,564 citations on Google Scholar (which for the non-academics reading this means that my papers, articles and books have been cited 14,564 times in other papers, articles, and books). Googling myself is just another variation of seeing how I’ve been cited and I do not think there is anything wrong with it. I suppose I just like knowing about the digital footprint I am leaving online. According to the entry on Wikipedia:
“Egosurfing (also referred to as Googling yourself and less frequently called vanity searching, egosearching, egogoogling, autogoogling, self-googling, master-googling, google-bating) is the practice of searching for one’s own given name, surname, full name, pseudonym, or screen name on a popular search engine in order to review the results. Similarly, an egosurfer is one who surfs the Internet for his or her own name to see what information appears. It has become increasingly popular with the rise of internet search engines, as well as free blogging and web-hosting services”.
So, there you have it. According to Wikipedia’s definition I am officially an egosurfer. The same article also claims that the word ‘egosurfing’ was first coined in 1995 by Sean Carton (who’s written many books about online technology) and then featured in a March 1995 issue of Wired magazine (although the Wired definition of egosurfing is more encompassing and says it is “scanning the Net, databases, print media, or research papers looking for mentions of your own name”).
According to a short 1999 article in the British Medical Journal by Professor James Drife, looking yourself up online is “arguably the naffest way of coping with boredom”. Professor Drife’s whole article was a simple account of what he had found by Googling his own name. By doing so, he claimed to have expanded his horizons, and “strengthened [his] belief that the world is not quite ready to do without paper. Nevertheless, universities could be making plans to judge academics on their internet hits and the response rate”. (Something that I believe is already happening and is one of the reason I like to egosurf). Exactly the same thing was carried out by JoAnne Lehman, one of the editors of Feminist Collections: A Quarterly of Women’s Studies Resources and published in 2004. She also listed all the things she had discovered egosurfing and concluded:
“If there’s a point to my telling of this story here – beyond the desire to promote a woman writer’s work – perhaps it’s about the satisfaction of connecting with kindred spirits, and how those connections can be made in surprising ways. Oh, and maybe that Internet surfing, even the ego kind, isn’t necessarily a waste of time”.
Writing about ego-surfing appears to be a popular way of writing an article not just in academic journals but also in non-academic publications such as the national press. Bryony Gordon (the journalist I cited at the beginning of this blog) wrote that:
“Now, I am not Dominic West (Hollywood star; 5,030,000 Google results in just 0.18 seconds). I am Bryony Gordon (newspaper journalist; 431,000 Google results in a glacial 0.21 seconds). But I don’t think it matters whether you are a world famous actor or Joe Bloggs; the fact remains that Googling yourself is a dangerous and egoistical exercise that will never end well. The best case scenario for Joe Bloggs is that he finds nothing, thus making him feel like a nobody; the worst that he finds a group of his mates bitching about him on a social networking site. Ditto, on a good day the likes of Dominic West will come away from a self-Googling session with an even bigger sense of self-importance, on a bad one with a miserable neediness that their agents and lackeys will have to pull them out of. As Reese Witherspoon says, ‘it’s an affirmation of every horrible feeling you have about yourself’”.
Articles in Tech Crunch (by Duncan Riley), and Tech News World (by Katherine Noyes) reported that 47% of Americans had Googled themselves based on a study carried out by the Pew Internet and American Life Project (up from the previous study in 2002). Using a telephone survey, the study sampled 2,373 adults (of which 1,623 were internet users). Only a very small minority (3%) Googled themselves regularly (and there was nothing on excessive self-Googling). The main reasons given for egosurfing were (i) for entertainment purposes, (ii) as a means of online reputation management (which is probably the category that I would fall under), and (iii) self-promotion and maintenance of a positive online reputation (e.g., locating online inaccuracies and ‘data spills’ and correcting them).
This is certainly an area worthy of further empirical investigation – even if it’s just to examine stereotypes around the kind of person who ego-surfs.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Dent, P. (2000). ‘Ego-Surfing’ derides valid, prudent activity. Online Journalism Review. Located at: http://www.ojr.org/ojr/ethics/1017964102.php
Drife, J.O. (1999). Egosurfing. British Medical Journal, 318, 203.
Gordon, B. (2012). Google and be damned. Daily Telegraph, February 29. Located at: http://www.telegraph.co.uk/technology/google/9111193/Google-and-be-damned.html
Lehman, J. (2004). From the editors. Feminist Collections: A Quarterly of Women’s Studies Resources, 26, ii.
Nicolai, T. Kirchhoff, L., Bruns, A., Wilson, J. & Barry Saunders, B. (2008). Google Yourself! Measuring the performance of personalized information resources. Proceedings Association of Internet Researchers 2008: Internet Research 9.0: Rethinking Community, Rethinking Place, Copenhagen, Denmark. Located at: http://en.scientificcommons.org/31968134
Noyes, K. (2007). Pew study: Self-Googling on the rise. Tech News World, December 17. Located at: http://www.technewsworld.com/story/Pew-Study-Self-Googling-on-the-Rise-60810.html
Riley, D. (2007). Do you use Google for vanity searching? You’re not alone. Tech Crunch, December 16. Located at: http://www.pewinternet.org/Media-Mentions/2007/Do-You-Use-Google-For-Vanity-Searching-Youre-Not-Alone.aspx
Wikipedia (2012). Egosurfing. Located at: http://en.wikipedia.org/wiki/Egosurfing
Regular readers of my blog will be aware that I have taken a passing interest in body tattoos both in relation to those who are sexually aroused by them (see my previous blog on stigmatophilia) and the representation of tattoos in films. I also have to admit that I’ve been watching the UK Channel 4 television series My Tattoo Addiction (mainly because it had the word ‘addiction’ in the title). Although I aim to look at the issue of ‘tattoo addiction’ in more academic terms in a future blog (so apologies for those of you wanting something empirically-based), but I just wanted to quickly examine whether any of the people featured across the television series could be classed in any way as ‘addicted’ to having tattoos.
Most of the time, the programme simply followed various British people where a story involving a tattoo made good (in this case ‘car crash’) television but had nothing to do with ‘addiction’. For instance, one story involved a trans-gendered individual who had his wife’s name tattooed on his arm but then changed gender so she had it changed into another different tattoo representing a symbolic transformation from man to woman. Another moving case story was of a woman who had a double mastectomy following breast cancer and then had nipples tattooed onto her reconstructed breasts following cosmetic surgery. A regular segment followed the events in one of the many tattoo parlours in Magaluf (in the Spanish island of Majorca) where almost all the people filmed were on ‘18-30’ type holidays. All of these appeared to be completely inebriated and having tattoos they would ultimately regret. Most of the cases featured young men and women having the names of people they had met that night and/or bizarre designs (such as the ‘burger nipple’) tattooed on their buttocks (at least that’s the take home message I took from it).
A number of the cases followed described themselves as having an “obsessive personality” and at least two of the cases were arguably obsessed with fictional literary characters that resulted in lots of tattoos (but I’ll come back to them in a minute). One of the men filmed for the documentary was 34-year old Mark from Buckinghamshire, and described by the programme as a “full blown tattoo addict”. He started off having a sole tattoo done when he was 22 years of age “then two, then three…and now it’s crept up on to [his] head”. Mark’s tattoos included one of the glamour model Jordan (i.e., Katie Price) with the words ‘Rape Me’ written across her chest, another of Audrey Hepburn with a sadomasochistic ball gag in her mouth, and another of a prudish Victorian lady reading a pornographic book about anal sex. When asked the reason for getting such extreme tattoos, Mark simply said he liked “the individuality, the outlet, and the shock factor” of his tattoos. Shocking, arguably. Addicted to tattoos? Not by my criteria.
Arguably one of the most sensational segments of the series was the controversial body art styled by tattooist Woody (who had gained much “notoriety for his challenging artwork”) including a tattoo of Adolf Hitler holding a large piece of paper with the words ‘Gas Bill’ on it. Woody claimed he liked his tattoos to “make statements”. The whole of his chest and stomach was taken up with a single tattoo that simply said “Pure F**king Hate” and his back was taken up with a single tattoo that reads “100% C**T” (without the asterisks – I just thought I’d add those for my readers with a sensitive disposition).
Of all the people featured in the series, two most caught my interest (psychologically), Jay – a 29-year old bodybuilder from Kent, and Kathy – a 52-year old woman from Reading. Jay was first described as having a “secret in his attic”. Since he was a boy, he has been an avid collector of super-hero action figures. His whole attic was full of unopened super-hero action figures (thousands of them it looked to me). His collection obsession was argued by Jay to be no different to someone who collects stamps – “just on a bigger scale”. The programme claimed that his “obsession [was] growing and manifesting itself in a new way” because he was getting his back tattooed with eleven large female super-heroes (the programme showed him having his sixth one done in a marathon 10-hour session). The programme narrator then went on to say that although Jay had only just started getting tattooed, he was already giving as much dedication to his tattoos as he was to his collecting.
Jay claimed that whenever he did anything in life he always ‘gave it his all’ and that his reasons for getting super-hero tattoos ran deeper than most. He has dedicated his whole life “to the pursuit of physical excellence” and in his early twenties competed in the World’s Strongest Man competition. Unfortunately, he had to give it up after a serious heart failure but now devoted to bodybuilding despite being on heart medication for the rest of his life. It appeared to me that Jay was constantly replacing one highly salient activity with another (much like ‘reciprocity’ found in addicts that give up one addiction only to replace it with another).
He was told by a friend to fill his life with “something positive otherwise you’ll self-destruct”. It was during this period that Jay’s interest in super-heroes took on greater significance. It helped him come to terms that he would never reach his dream of becoming the world’s strongest man. I also noticed that around his house there were many items of super-hero memorabilia and accessories along with loads of super-hero DVDs. Jay questioned himself as to whether he has an obsessive or compulsive behaviour. His response was something that I would wholeheartedly agree with given my views on the differences between healthy and addictive behaviour: “As long as the obsession doesn’t ruin my life, why is it such a bad thing? With what I’ve done it’s given me the life I’ve got…it’s the will to do what I do, the best I can”.
Kathy began her story by recounting that in 2010 she had “stumbled across the book that would change her life forever [about a] young and unassuming girl that doesn’t fit in, and comes to the attention of [a] family…it’s just a love story”. The narrator claimed the book “spoke to Kathy in a way she had never experienced before”. The book in question was Twilight (the young adult vampire-romance novel by Stephanie Meyer). She went and got The Twilight Saga DVDs and became “totally hooked”. The books and DVDs weren’t enough and she started getting Twilight characters tattooed on her body to the point where her whole back is now covered in them, along with her arms, legs, and upper chest. Kathy’s husband Colin was “very tolerant” of Kathy’s tattoos and his only stipulation was that he didn’t want her to have any tattoos on her face. The interviewer asked Kathy if she had an “obsession with Twilight” to which she simply replied that she did. While being filmed at a local tattoo convention, Kathy says that:
Every two weeks after pay day she got another tattoo. At the time of the programme she had undergone 91 hours of tattooing and was just about to have another tattoo put on some remaining space on one of her legs. Most of her tattoos were of (or related to) the character Edward Cullen (played by Robert Pattinson). Kathy’s husband Colin was “very tolerant” of Kathy’s tattoos and his only stipulation was that he didn’t want her to have any tattoos on her face. The interviewer asked Kathy if she had an “obsession with Twilight” to which she simply replied that she did. While being filmed at a local tattoo convention, Kathy says that:
“Tattooing is addictive. This is my form of getting my fix. It’s not a bad thing. Obviously there’s a certain amount of pain [but] it’s what I get a buzz off now”.
Although a late starter in the tattoo world, Kathy said she couldn’t now imagine a life without tattoos and that without them her life would be “very boring” and that she wouldn’t be the person she now is. However, she admitted the tattoos had caused family conflicts. She hadn’t spoken with her brother in five years because he was too embarrassed by her tattoos, and her father refuses to be seen with her in public. Her sisters were more supportive and noticed that the tattoos had brought Kathy “out of her shell”. The tattoos had apparently turned Kathy from a “wallflower” into someone quite extrovert.
I was interested in how she came to tattoing so late in her life. Kathy revealed that became very depressed after the death of her 63-year old mother in 1999 and it was then that her weight started to balloon through overeating, and she developed a very low self-esteem. She refused to have photographs taken and was “ashamed” of what she looked like. After becoming “hooked” on the first Twilight book, she said it gave her life focus. She had now read it so many times she’s had to buy new copies as well read copies had become dog-eared.
She then bought the music soundtracks and then started exercising to the music. She would even exercise in front of the DVDs for two or three hours at a go. It was then she started losing weight and began getting tattoos. She said that the tattoos gave her focus and was a permanent reminder of how she had got her life “back on track” and kept her “feeling young”. The constant new tattoos were “costing [her] a small fortune – just over eight and a half thousand pounds so far”. She then went on to say that in terms of what she has planned in the future, the total cost of the tattooing will be between £17,000 and £25,000. She says it’s keeping her “permanently broke” but despite the cost she’s “not stopping”.
Based on the information in the documentary, both Jay and Kathy appeared to display elements of addictive and obsessive behaviour. However, I would argue that the addictive elements are more to do with something external to the tattoos (i.e., super-heroes and bodybuilding for Jay, and the Twilight story for Kathy) rather than the tattoos themselves (even though Kathy said that the act of getting tattoos was a buzz and addictive). There appeared to be some conflicts in both of their lives (health, financial, and/or family conflicts) although none that suggested that either were truly addicted to anything (tattoos or otherwise). For both of them, the behaviour they engaged appeared to make them feel better about themselves rather than being something negatively detrimental. As I have said time and time again, the difference between a healthy enthusiasm and an addiction is that healthy enthusiasms add to life and addictions take away from them.
Duggal, H.S. & Fisher, B. (2002). Repetitive tattooing in borderline personality and obsessive-compulsive disorder. Indian Journal of Psychiatry, 44, 190–192.
Irwin, K. (2003). Saints and sinners: elite tattoo collectors and tattooists as positive and negative deviants. Sociological Spectrum, 23, 27-57.
Raspa, R.F. & Cusack, J. (1990) Psychiatric implications of tattoos. American Family Physician, 41,1481-1486.
Wohlrab, S., Stahl, J. & Kappeler, P.M. (2007). Modifying the body: Motivations for getting tattooed and pierced. Body Image, 4, 87-95.
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
Back in the early 2000s, I (and one of my colleagues, Dr. Michael Larkin) carried out some research at the Promis addiction clinic down in Kent. We were researching people’s phenomenological experiences of addiction, and our interviews with the addicts receiving treatment were really helpful in the writing of what I personally thought were some really interesting papers (see ‘Further reading’ below). However, what interested me even more were the conversations I had with the clinic’s Director, Dr, Robert Lefever who told me of his interest and research into ‘compulsive helping’. Dr. Lefever has written a number of articles online about compulsive helping. In one of them he began by stating:
“Of all the addictive behaviours those surrounding relationships like sex and love addiction, relationship addiction or compulsive helping can be the most difficult to understand. This is further hindered by the confusing terminology used to describe it. Just as addiction means as many different things to as many people so do terms like co-dependency. We have tried to help clarify the situation by using different terms for different behaviours. Where people are addicted to someone they have a relationship with we call it relationship addiction, where people are addicted to helping others with their problems we call it compulsive helping”.
Dr. Lefever says that by giving these behaviours descriptive titles (like ‘compulsive helping’ and ‘relationship addiction’) help the affected person to identify the specific behaviour that they are actually addicted to. He also argues that such labels help the affected person relaise that the person responsible for the addictive behaviour is the individual and not someone or something else. However, Dr. Lefever is the first to admit that “the concept of compulsive helping can be particularly difficult to get one’s head around”.
Obviously not all helping is harmful but Lefever distinguishes between ‘caring’ (which he views as healthy) and caretaking (which he views as unhealthy). Compulsive helping occurs when the ‘caretaker’ (rather than a carer) continually takes on the responsibilities of someone else (very often a person who they love), and in essence runs that person’s life for them. Compulsive helpers often help other people that have an addiction (such as an alcoholic or a gambling addict) but Lefever claims that compulsive helpers can also end up compulsively helping people that doesn’t have problems themselves. (However, those without a problem are far more likely to notice compulsive helping behaviour in other people if they feel it is significantly and continually interfering in their day-to-day life and business). More specifically:
“Caring is lovely and healthy. I would never wish to change that characteristic in anyone. Caretaking however, is over-caring for someone, taking on the other person’s responsibilities for themselves and not allowing the other person to have the consequences of his or her behaviour…Helping is loving. Compulsive helping is destructive of both self and the other person. It is destructive of my own life and destructive of the person whom I am trying to compulsively help. That is not what I would call a loving action”.
Another short article on ‘compulsive helping’ by Rochelle Craig on her Piece By Piece Recovery website has a slightly different take and notes that:
“Compulsive Helping is when the individual finds it impossible to say no each and every time they are asked. A compulsive helper will always help regardless of what the situation is whether it is convenient for them or not. This can result in the compulsive helper building up resentment against the other person or persons and feeling like a doormat. When this happens the compulsive helper begins to resent being asked”
Like Dr. Lefever, Rochelle Craig believes that compulsive helpers take on too much responsibility, and therefore take away responsibility away from other people. Craig is adamant that people should examine their motivation for their helping behaviour to assess the extent to which it is helpful. If the act of helping others is a continual source of gaining self-worth, it may be indicative of compulsive helping. Other signs of compulsive helping is carrying on helping even if it is putting one’s own health, job, and/or other relationships at risk, Craig asserts that:
“It is important to remember that we are talking about addictive behaviour, we are talking about extremes, and we are talking about situations where the compulsive helper is so absorbed with helping others that they lose their own identity. Recovery is about self-discovery, self-improvement and building on self-esteem without relying on constantly helping others. It is about self-care first and everyone else second! Recovery is about recognising the difference between compulsive helping and genuine acts of kindness and most importantly it is learning to say no!”
In another (different) article on compulsive helping, Dr. Lefever refers to ‘compulsive helping’ as ‘co-dependency’ and claims that compulsive helping “is the most perverse, widespread and destructive of all addictive or compulsive behaviours” and the ‘need to be needed’. In fact Dr. Lefever claims that:
“Behind any addict of any kind will be a compulsive helper, or a bunch of them, taking responsibility for them. The compulsive helpers try to solve problems and ferret out information on causes and treatments. They give incessant advice and generally get in the way of addicts having any chance of learning or doing things for themselves – which, ultimately, are the only things that are going to help. Those of us who are afflicted by it go out of our way to give uninvited help. We want to feel useful and constructively helpful. These are admirable characteristics. But they can be very destructive when they are applied without thought to the consequences…When people have too much done for them, they fail to develop their own skills. They become part of the dependency culture”.
Dr. Lefever and psychologists at the University of Kent have published a number of empirical studies on addiction including compulsive helping. In a study led by Professor Geoffrey Stephenson and published in a 1995 issue of the journal Addiction Research, the researchers evaluated addiction in 16 behavioural areas on 471 patients (using 191 male addicts and 281 female admitted to Lefever’s Promis Recovery Centre). The addicted patients’ questionnaires were subjected to a factor analysis and results showed there to be two fundamentally different types of addiction labeled as ‘nurturance’ and ‘hedonism’. ‘Nurturance’ included caffeine, work, exploitative relationships (submissive), shopping, exercise, food bingeing, food starving and compulsive helping. ‘Hedonism’ included alcohol, nicotine, recreational drugs, gambling, exploitative relationships (dominant), sex, and prescription drugs.
A follow-up study published in 2004 by Stephenson and Lefever in the journal Addictive Behaviors, confirmed these earlier results but also suggested that ‘hedonism’ could further be divided into a ‘drug use’ factor and an ‘interpersonal dominance’ factor. The nurturance addictions comprised of both ‘self-regarding’ and ‘other-regarding’ factors. A more recent study in a 2010 issue of Addictive Behaviors by Dr. Vance MacLaren and Dr. Lisa Best confirmed the results among a student population (n=938). Despite this empirical research, it should be remembered that all of the data on compulsive helping has been done using the instrument that Lefever and his colleagues developed. There’s certainly a need for research to be carried out with instruments that weren’t developed and/or carried out by the people who have a vested interest in the ‘compulsive helping’ construct.
Craig, R. (2012). Compulsive helping. Located at: http://www.piecebypiecerecovery.co.uk/index.php?pageid=8
Griffiths, M.D. & Larkin, M. (2004). Conceptualizing addiction: The case for a ‘complex systems’ account. Addiction Research and Theory, 12, 99-102.
Haylett, S., Stephenson, G.M. & Haylett, S. (2004). Covariation in addictive behaviours: A study of addictive orientations using the Shorter PROMIS Questionnaire. Addictive Behaviors, 29, 61-71.
Larkin, M. & Griffiths, M.D. (2002). Experiences of addiction and recovery: The case for subjective accounts. Addiction Research and Theory, 10, 281-311.
Larkin, M. & Griffiths, M.D. (2004). Dangerous sports and recreational drug-use: Rationalising and contextualising risk. Journal of Community and Applied Social Psychology, 14, 215-232.
Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.
Lefever, R. (2012). Compulsive helping. Located at: http://promis.co.uk/addiction-info/addiction/compulsive-behaviours/
Lefever, R. (2012). Compulsive helping. Located at: http://www.doctor-robert.com/compulsive-helping/
Maclaren, V.V. & Best, L.A. (2010). Multiple addictive behaviors in young adults: Student norms for the Shorter PROMIS Questionnaire. Addictive Behaviors, 35, 252-255.
Stephenson, G.M., Maggi, P., Lefever, R.M.H. & Morojele, N.K. (1995). Excessive Behaviours: An Archival Study of Behavioural Tendencies reported by 471 patients admitted to an addiction treatment centre. Addiction Research, 3, 245-265.
In previous blogs on vampirism as a sexual paraphilia and tampon fetishes, I briefly mentioned zoophagia. In his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr Anil Aggrawal defines zoophagia as eating live animals for erotic arousal. The online Wiktionary provides the same definition but also adds that it is another name for Renfield’s Syndrome (which I also covered in my blog on vampirism as a sexual paraphilia). Renfield’s Syndrome (as yet) does not appear in the Diagnostic and Statistical Manual of Mental Disorders but has been described as consisting of three stages (of which only one stage comprises zoophagia). More specifically:
- Stage 1 – Autovampirism (autohemophagia): In the first stage, RS sufferers drink their own blood and often bite or cut themselves to do so (although some pay just pick at their own scabs).
- Stage 2 – Zoophagia: In the second stage, RS sufferers eat live animals and/or drink their blood. The sources animal blood may come from butchers and abbatoirs if they have no direct access.
- Stage 3 – True vampirism: In the final stage, RS sufferers drink blood from other human beings. The sources of blood may be stolen from blood banks or hospitals or may be direct from other people. In the most extreme cases, RS sufferers may commit violent crimes including murder to feed their craving.
What is clear from the description of zoophagia as part of Renfield’s Syndrome is that sexual pleasure and sexual arousal do not appear to be part of the motivation to engage in the behaviour. Of all the sexual paraphlias I have ever written about, zoophagia is one of the few that I find it hard to imagine what the etiology of the behaviour involves. How does anybody end up developing sexual pleasure from eating animals while they are still alive?
There is very little written about zoophagia from an academic perspective. Most references to the behaviour are found in the forensic crime literature in relation to sexual homicides or as a behaviour associated with specific events such as satanic rituals (although this is more to do with haematophagy – the drinking of animal blood – than zoopahgia). As Dr. Eric Hickey notes in his 2010 book Serial Murderers and Their Victims, in most countries, drinking blood is not a crime. Zoophagia is arguably a sub-type of haematophilia (i.e., a sexual paraphilia in which individuals derive sexual pleasure and arousal from the tasting or drinking blood). Dr. Hickey also noted the relationship between zoophagia and haematophilia:
“[Haematophilia] is usually done in the presence of others. Most persons engaging in this form of paraphilia also have participated in or have co-occurring paraphilia often harmful to others. In addition, a ‘true hematolagniac’ is a fantasy-driven psychopath and to be considered very dangerous. According to Noll (1992), such desires are founded in severe childhood abuse. The child may engage in auto-vampirism in tasting his own blood and during puberty. These acts are eventually sexualized and reinforced through masturbation. A progressive paraphilic stage during adolescence is the sexual arousal of eating animals and drinking their blood (zoophagia) while masturbating. The compulsive, fantasy driven, sexual nature of this paraphilia creates a very dangerous adult”.
One of the most infamous serial killers that engaged in zoophagic activity was the German Peter Kurten (1883-1931), a mass murderer nicknamed the ‘Vampire of Dusseldorf’ (a case study also written about by Dr. Louis Schlesinger in his 2004 book Sexual Murder). Citing the work of criminologist Herschel Prins published in a 1985 issue of the British Journal of Psychiatry, Dr. Hickey recalled that:
“Kurten was raised in a very physically and sexually abusive home where he witnessed his alcoholic father raping his mother and sisters. He also engaged in sexually abusing his sisters…At age 11 he was taught by the local dog catcher how to torture dogs and sheep while masturbating. He developed multiple paraphilia including vampirism, hematolagnia, necrophilia, erotophonophilia, and zoophagia and was known to drink directly from the severed jugular of his victims. He raped, tortured, and killed at least nine known victims although he was believed to have murdered several others. He used hammers, knives, and scissors to kill both young girls and women and admitted that he was sexually aroused by the blood and violence. Some victims incurred many more stab wounds than others, and when asked about this variation he explained that with some victims his orgasm was achieved more quickly…Before his beheading he asked if he would be able to hear the blood gushing from his neck stump because “that would be the pleasure to end all pleasures”.
Most of the literature on the drinking of blood for sexual pleasure concerns humans and is found in the studies on clinical vampirism (that I reviewed in a previous blog). From the few case studies I have read where zoophagia was mentioned in passing, all of the people written about engage in other sexually paraphilic behaviours (similar to that of Kurten outlined above). There may also be links between zoophagia and sexual cannibalism (which I also covered in a previous blog). For instance, some zoophagic activity might be viewed as omophagic activity in which the act is a form of symbolic ritual where the person consuming the blood and/or flesh of a live animal believes they are incorporating the ‘life force’ of the animal in question. For instance, an entry in Murderpedia claims:
“Some killers have adopted a form of omophagia, which is called zoophagia, as a means of possessing their victims. Zoophagia is the consumption of life forms, as seen in the character of Renfield in Dracula, who progresses from spiders to flies to birds to cats. The idea is to ingest increasingly sophisticated life forms as a way to improve one’s own”
An online article on vampires and the fetish scene by the Occult and Violent Ritual Crime Research Center notes that some of the behaviours that vampires engage in are similar to behaviours engaged in by fetishists. In a section on ‘blood rituals and blood play’, the article notes that throughout history and across cultures, people have attributed sacred and magical qualities to blood, and that blood rituals include drinking and/or pouring blood on the body. It also noted that:
“In some cultures it was believed that drinking the blood of a victim would endow you with the victim’s strength. Similarly by drinking the blood of an animal you would acquire its qualities…The use of blood is commonly referred to as blood sports, blood play, blood lust and blood fetishism”.
Any information that we currently have on zoophagia comes from clinical and/or forensic case studies. It would appear that zoophagia is incredibly rare, usually occurs among males, often coincides with other sexually paraphilic behaviour, and is most likely to occur among those with psychopathic and/or serial killing tendencies (unless the behaviour is part of a satanic and/or other ritualistic event).
Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.
Benezech, M., Bourgeois, M., Boukhabza, D. & Yesavage, J. (1981). Cannibalism and vampirism in paranoid schizophrenia. Journal of Clinical Psychiatry, 42(7), 290.
Gubb, K., Segal, J., Khota1, A, Dicks, A. (2006). Clinical Vampirism: a review and illustrative case report. South African Psychiatry Review, 9, 163-168.
Halevy, A., Levi, Y., Ahnaker, A. & Orda, R. (1989). Auto-vampirism: An unusual cause of anaemia. Journal of the Royal Society of Medicine, 82, 630-631.
Jaffe, P., & DiCataldo, F. (1994). Clinical vampirism: Blending myth and reality. Bulletin of the American Academy of Psychiatry and the Law, 22, 533-544.
Noll, R. (1992). Vampires, Werewolves and Demons: Twentieth Century Reports in the Psychiatric Literature. New York: Brunner/Mazel.
Occult and Violent Ritual Crime Research Center (2012). Renfield’s Syndrome. Located at: http://www.athenaresearchgroup.org/renfieldsyndrome.htm
Perlmutter, D. (2004). Investigating Religious Terrorism and Ritualistic Crimes. Boca Raton, Florida: CRC Press LLC.
Prins, H. (1985). Vampirism: A clinical condition. British Journal of Psychiatry, 146, 666-668.
Wilson N. (2000) A psychoanalytic contribution to psychic vampirism: a case vignette. American Journal of Psychoanalysis, 60, 177-86.
I recently published a potentially controversial paper in the journal Frontiers in Psychiatry arguing that loss of control may not always be a natural consequence of addiction. Research into addiction has a long history although there has always been much debate as to what the key components of addiction are. Irrespective of the theory and model of addiction, most theorizing on addiction tends to assume (implicitly or explicitly) that ‘loss of control’ is central (if not fundamental) to addiction. My paper challenges such notions by arguing that there are a minority of individuals who appear to be addicted to a behaviour (i.e., work) but do not necessarily appear to display any loss of control.
Research into many different types of addiction has shown that addicts are not a homogeneous group, and this may also have implications surrounding control and loss of control. Many years ago, in my 1995 book Adolescent Gambling, I argued that in relation to problem gambling there appear to be at least two sub-types of addiction – primary addictions and secondary addictions. I defined primary addictions as those in which a person is addicted to the activity itself, and that individuals love engaging in the activity whether it is gambling, sex or playing video games. Here, the behaviour is primarily engaged in to get aroused, excited, and/or to get a ‘buzz’ or ‘high’. I defined secondary addictions as those in which the person engages in the behaviour as a way of dealing with other underlying problems (i.e., the addiction is symptomatic of other underlying problems). Here the behaviour is primarily engaged in to escape, to numb, to de-stress, and/or to relax.
Therapeutically, I argued that it is easier to treat secondary addictions. My argument was that if the underlying problem is addressed (e.g., depression), the addictive behaviour should diminish and/or disappear. Primary addicts appear to be more resistant to treatment because they genuinely love the behaviour (even though it may be causing major problems in their life). Furthermore, the very existence of primary addictions challenges the idea that loss of control is fundamental to definitions and concepts of addiction. Clearly, people with primary addictions have almost no desire to stop or cut down their behaviour of choice because it is something they believe is life affirming and central to the identity of who they are. But does lack of a desire to stop the behaviour they love prevent ‘loss of control’ from occurring? Arguably it does, particularly when examining the research on workaholism.
I have popularized the ‘addiction components model’, particularly in relation to behavioural addiction (i.e., non-chemical addictions that do not involve the ingestion of a psychoactive substance). The addiction components model operationally defines addictive activity as any behaviour that features what I believe are the six core components of addiction (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict and relapse, and which I outlined in my very first blog on this site)
One of the observations that can be made by examining these six criteria is that ‘loss of control’ is not one of the necessary components for an individual to be defined as addicted to an activity. Although I acknowledge that ‘loss of control’ can occur in many (if not most) addicts, loss of control is subsumed within the ‘conflict’ component rather than a core component in and of itself. The main reason for this is because I believe that there are some addictions – particularly behavioural addictions such as workaholism – where the person may be addicted without necessarily losing control. However, such a claim depends on how ‘loss of control’ is defined and the highlights the ambiguity in our standard understanding of addiction (i.e., the ambiguity of control as ability/means versus control as goal/end).
When theorists define and conceptualise ‘loss of control’ as applied to addictive behaviour, it typically refers to (i) the loss of the ability to regulate and control the behaviour, (ii) the loss of ability to choose between a range of behavioural options, and/or (iii) the lack of resistance to prevent engagement in the behaviour. In some behaviours such as workaholism and anorexia, the person arguably tries to achieve control in some way (i.e., over their work in the case of a workaholic, or over food in the case of an anorexic). However, this in itself is not a counter-example to the idea that addiction is a ‘loss of control’ if workaholics and anorexics have lost the ability to control other aspects of their day-to-day lives in their pursuit of control over work or food (i.e., there is a difference between control as the goal/end of behaviour, and control as an ability/means.
There is an abundance of research indicating that one of the key indicators of workaholism (alongside such behaviours as high performance standards, long working hours, working outside of work hours, and personal identification with the job) is that of control of work activities. In a recent paper I wrote with my colleague Dr. Maria Karanika-Murray in the Journal of Behavioral Addictions, we also noted that the need for control is high among workaholics, and as a consequence they have difficulty in disengaging from work leading to many other negative detrimental effects on their life such as relationship breakdowns. Even some of the instruments developed to assess workaholism utilize questions concerning the need to be in control.
There are also other studies that suggest some workaholics do not experience a ‘loss of control’ in the traditional sense that is used elsewhere in the addiction literature. For instance, in a 2004 issue of the Journal of Organizational Change Management, Dr. Peter Mudrack reported that two particular aspects of obsessive-compulsive personality (i.e., being stubborn and highly responsible) were predictive of workaholism. A very recent paper by Dr. Ayesha Tabassum and Dr. Tasnuva Rahman in the International Journal of Research Studies in Psychology noted that perfectionist workaholics experience an overbearing need for control and are very scrupulous and detail-oriented about their work. Unusually among addictions, workaholics usually have no desire to reduce or regulate their work behaviour (i.e., there is no ambivalence or conflicting desire for them). In this instance, there is no evidence of ‘loss of control’ as traditionally understood, because if they had ambivalent or conflicting desires, they would change their behaviour (i.e., reduce the amount of time they spend working). Although not an exhaustive list of studies, those mentioned here appear to indicate that some workaholics appear to be more in control than not in control.
When the addiction is primary, the goal/end of the behaviour is desired and/or endorsed without ambivalence by the addict. In these situations (as in some cases of workaholism), there is no evidence for loss of control, because no (failed) attempts are made by the addict to alter their behaviour. However, this could arguably still be compatible with the claim that there is loss of control in the sense of ability and/or means, because, if the workaholic tried to work less (or work in a less controlling way) because they started to recognize ill effects the addictive behaviour was having on their personal life, then they may fail to do so. Therefore, the lack of evidence is indicative rather than conclusive.
However, one of the reasons that workaholism raises interesting theoretical and conceptual issues concerning the loss of control is that it is an example of an addiction where the goal/end is itself a form of control (i.e., control over their productivity/outputs, control over others, control over time-keeping, etc.). Unlike many other addictions, such behaviour is not impulsive and/or chaotic but carefully planned and executed. So this raises the question, in what sense is workaholism a loss of control, understood in the typical way, as ability/means to the behaviour’s goal/end? In some cases of workaholism, there is no evidence that the workaholic lacks control over this goal/end, as they do not try to change their behaviour (and thus cannot fail to do so).
It could be argued – and this is admittedly speculative – that ‘loss of control’ as is traditionally understood appears to have a greater association with secondary addiction (i.e., where an individual’s addiction is symptomatic of other underlying problems) than primary (or ‘happy’ or ‘positive’) addiction (i.e., where an individual feels totally rewarded by the activity despite the negative consequences). Such a speculation has good face validity but needs empirical testing. However, a complicating factor is the fact that my studies on adolescent gambling addicts have demonstrated that some individuals start out as primary addicts but became secondary addicts over time. Again, this suggests that control (and loss of it) may be something that changes its nature over time.
In essence, workaholics appear to make poor choices and/or decisions that have wide-reaching detrimental consequences in their lives. However, at present we lack evidence that (should they decide otherwise) they would be unable to work in a more healthy way. Furthermore, and equally as important, the nature of workaholic behaviour is not impulsive and chaotic, but carefully planned and executed. This is particularly striking among some workaholics, because as I have noted, it is an addiction that for some individuals they continue to work happily despite objectively negative consequences (e.g., relationship breakdowns, neglect of parental duties, etc.). What the empirical research on workaholism suggests is that it is an example of an addiction in which the problem is better characterized as loss of prudence rather than loss of control, as traditionally understood.
Andreassen, C.S., Griffiths, M.D., Hetland, J. & Pallesen, S. (2012). Development of a Work Addiction Scale. Scandinavian Journal of Psychology, 53, 265-272.
Andreassen, C. S., Torsheim, T., Brunborg, G. S., & Pallesen, S. (2012) Development of a Facebook addiction scale. Psychological Reports, 110, 501-517.
Griffiths, M.D. (1995). Adolescent Gambling. London: Routledge.
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.
Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.
Mudrack, P.E. (2004). Job involvement, obsessive-compulsive personality traits, and workaholic behavioral tendencies. Journal of Organizational Change Management, 17, 490-508.
Mudrack, P.E. & Naughton, T.J. (2001) The assessment of workaholism as behavioral tendencies: Scale development and preliminary empirical testing. International Journal of Stress Management, 8, 93-111.
Tabassum, A. & Rahman, T. (2012). Gaining the insight of workaholism, its nature and its outcome: A literature review. International Journal of Research Studies in Psychology, 2, 81-92.
In a previous blog on bibliomania (i.e., an obsessive-compulsive disorder associated with the collecting and hoarding of books), I briefly mentioned that collecting more generally could perhaps be addictive for some people. Writing in a 2006 issue of the International Journal of Psychoanalysis, Dr. Peter Subkowski wrote that the urge to collect is a ubiquitous phenomenon that has anthropological, sociobiological, and individual psychodynamic roots. Dr. Russell Belk writing in a 1991 issue of the Journal of Social Behavior and Personality described collectors of mass-produced objects as falling into one of two main types: the taxonomic collector who attempts to own an example of every type of a series of items produced, and the aesthetic collector who simply gathers items because they are pleasing in some way.
So what are the motivations for collecting? In a 1991 issue of the Journal of Social Behavior and Personality, Dr. Ruth Formanek suggested five common motivations for collecting. These were: (i) extension of the self (e.g., acquiring knowledge, or in controlling one’s collection); (ii) social (finding, relating to, and sharing with, like-minded others); (iii) preserving history and creating a sense of continuity; (iv) financial investment; and (v), an addiction or compulsion. Formanek claimed that the commonality to all motivations to collect was a passion for the particular things collected. One of the prime researchers in the ‘collecting’ field is Dr. Russell Belk who has written many papers and chapters on the topic. In a 1991 book chapter, Dr. Belk (along with Melanie Wallendorf, John F. Sherry, Jr., and Morris B. Holbrook) noted that:
“In examining literary and social science treatments of collecting…some regard it as a passion, others as a disease. It is frequently described as a pleasurable activity that can have some unpleasant consequences. In its pleasurable aspect, collecting embodies the characteristics of flow…It is an optimal experience that is psychologically integrating and socially beneficial. In its darker aspect, collecting is an activity over which many consumers fear losing control. Whether likened to idolatry or illness, collectors acknowledge the very real possibility that collecting can become addictive. Danet and Katriel (1990) suggest that the seemingly self-deprecating admission of addiction to one’s collection can be a way of disclaiming responsibility for uninhibited collecting. At the same time they recognize that ‘serious’ collectors relish their ability to freely express passion in their collecting activity. What apparently is being negotiated in the area between passion and addiction is the definition of whether the collector controls or is controlled by the activity of collecting”.
The chapter also claimed that the tendency to pursue an altered state of consciousness produced by any ritual activity “whether behaviorally via collecting, or pharmacologically via chemical use” is cross-culturally universal. Obviously they acknowledged that most collectors are not addicts but claimed there was “compelling evidence of its pervasiveness in the observations of others” based in self-report surveys, and the labels by which collectors in their research studies described themselves (e.g., “magazineaholic”, “getting a Mickey Mouse fix”, “print Junkie”). Brenda Danet and Tamara Katriel claimed some of their collectors’ said it was “a disease”. They also reported that Sigmund Freud amassed a large collection of 2,300 Roman, Greek, Egyptian, Assyrian, and Chinese antiquities that eventually numbered approximately 2300 and described his collecting passion as “an addiction second in intensity only to his nicotine addiction“. Based on their interviews with collectors, the chapter then went on to claim:
“Although almost any behavior can become addictive, the pattern of behavior characteristic of collectors makes it especially prone to addiction. Most collectors interviewed mentioned the search for additions to a collection as the central activity of their collecting behavior. Rather than spend time examining or organizing items that are already in the collection, collectors prefer to search or shop for additions to the collection. Search behavior may be compulsively and ritualistically enacted. Acquiring rather than possessing provides the temporary fix for the addict. A sense of longing and desire — a feeling that something is missing in life — is temporarily met by adding to the collection. But this is a temporary fix, a staving off of withdrawal, followed by a feeling of emptiness and anxiety that is addressed by searching for more. Shopping and searching are the ritualized means by which the collector obtains a sense of competence and mastery in life. These activities are the bittersweet consequences of experiencing longing in the arena of the marketplace”.
They also noted that searching and shopping for collection items highlight the ritualized aspects (i.e., it is patterned and repetitive). They provided the example of a Barbie doll collector that spent considerable time at doll shows that had specific rules that guided his doll buying (e.g., having the dealer completely undress then redress the doll to allow him to see if any part of the body is damaged). They also reported that items for their collection found in the search were often seen as having irresistible power over the person. One collector of antique bronzes was quoted as saying “I just had to have it. It had to be mine”. Searching for such items are “not the only addictive focus for collectors”. Belk and colleagues reported that:
“Compulsive attention to and control over the objects in the collection provides an additional source of feelings of control and mastery –important feelings to an addict. For example, one interpretation of the propensity of collectors to will their collections to museums is that, by doing so, they retain a certain sense of control of the collection by insuring that it will not fall into the hands of another collector. Collecting activity allows a collector to avoid other aspects of life. It is a form of withdrawal from other aspects of life that is nevertheless often positively sanctioned…On the whole, collecting, particularly for the addict, involves the individual in a repetitive, predictable pattern of behavior which can provide a form of solace for someone who is troubled by living in an unpredictable world”.
In a 1995 paper in the Journal of Economic Psychology, Dr. Belk carried out in-depth interviews with 200 collectors. He claimed that for most, collecting was a highly beneficial activity. However, he also noted there were extreme cases where collecting was found to be addictive and dysfunctional for the affected individuals and their families. He also wrote that:
“Collectors often refer to themselves, only half in jest, as suffering from a mania, a madness, an addiction, a compulsion, or an obsession. Because collecting is generally a socially approved activity, no one is likely to treat such a confession as stigmatizing in the way that it would be for an alcoholic, a heroin addict, a compulsive gambler, or someone truly believed to be mentally ill…But like much humor there is an uneasy fear behind these self-admissions, for some collectors really are out of control”.
The most vivid example that Belk encountered was a dealer and collector of Disney cartoon character replicas who was a recovering poly-drug abuser who himself described his collecting behaviour as an addiction. Over many years, he accumulated a large collection of Mickey Mouse memorabilia to obtained his “Mickey fix”. Consequently he was often unable to pay his house rent or pay his bills. Belk claimed that he thrill of collecting and displaying his objects eventually threatened his psychological wellbeing and in the collector’s words had to go “cold turkey” and cease collecting.
Finally, in an online article about addictive collecting, Hale Dwoskin, CEO and director of training of Sedona Training Associates provided a list of symptoms of a collecting addiction:
- You look for/buy/trade collectibles for hours on end, and the time you spend doing this is increasing
- You think about collectibles constantly, even when you’re not collecting
- You have missed important meetings/events because of collecting
- It’s difficult for you to not buy more collectibles, even for just a few days
- You try to sneak more collectibles into your home
- You have tried, unsuccessfully, to stop collecting
- Your family or friends have asked you to cut back on collecting
- Your personal interests have changed because of your collecting
- You have lost a personal or professional relationship because of collecting
As an ‘avid’ collector myself (of records, CDs and music in general) I can certainly see how collecting can become an expensive habit that goes beyond disposable income. Although I think that it is theoretically possible to be addicted to collecting, the number of genuine ‘collecting addicts’ is likely to be very low.
Belk, R. W. (1982). Acquiring, possessing, and collecting: fundamental processes in consumer behavior. Marketing Theory: Philosophy of Science Perspectives, 185-190.
Belk, R. W. (1992). Attachment to possessions. In: Place attachment (pp. 37-62). New York: Springer.
Belk, R. W. (1994). Collectors and collecting. Interpreting objects and collections, 317-326.
Belk, R. W. (1995). Collecting as luxury consumption: Effects on individuals and households. Journal of Economic Psychology, 16(3), 477-490.
Belk, R.W., Wallendorf, M., Sherry, J.F., & Holbrook, M.B. (1991). Collecting in a consumer culture. In: Highways and buyways: Naturalistic research from the consumer behavior odyssey, pp.178-215.
Danet, B. & Katriel, T. (1989). No two alike: The aesthetics of collecting. Play and Culture, 2, 253-277.
Formanek, R. (1991). Why they collect: Collectors reveal their motivations. Journal of Social Behavior and Personality, 6(6), 275-286.
MacLeod, K. (2007). Romps with Ransom’s King: Fans, Collectors, Academics, and the MP Shiel Archives. ESC: English Studies in Canada, 30(1), 117-136
Subkowski, P. (2006). On the psychodynamics of collecting. International Journal of Psychoanalysis, 87, 383-401.
In a previous blog, I examined Body Dysmorphic Disorder (BDD). At its simplest level, BDD is a distressing, handicapping, and/or impairing preoccupation with an imagined or slight defect in body appearance that the sufferer perceives to be ugly, unattractive, and/or deformed. BDD sufferers can think about their perceived defect for hours and hours every day. The International Classification of Diseases (ICD-10) criteria for BDD is:
- Persistent belief in the presence of at least one serious physical illness underlying the presenting symptom(s), even though repeated investigations and examinations have identified no adequate physical explanation, or a persistent preoccupation with a presumed deformity or disfigurement.
- Persistent refusal to accept the advice and reassurance of several different doctors that there is no physical illness or abnormality underlying the symptoms.
One particular body part that has been the focus of some research in the BDD field is that of genitalia. Many men worry about the size of their penis and think it is too small. This is perfectly normal and the worry or concern is highly unlikely to be a symptom of BDD. In a 2004 issue of the Postgraduate Medical Journal, British psychiatrist Dr David Veale reported that although there are broad similarities between the genders in BDD, there are some differences. For instance, men with BDD show a greater preoccupation with their genitals, and women with BDD are more likely to have a co-morbid eating disorder. Dr. David Sarwer (writing in a 2006 issue of Plastic and Reconstructive Surgery) asserted that the rate of body dysmorphic disorder should be examined among patients re-questing atypical procedures and cites the example of those individuals requesting genital surgery.
Back in 2008, Channel 4 in the UK had a television series called Penis Envy. The first episode (The Perfect Penis) featured a US psychology student who paid $4000 to have his penis lengthened by cutting the ligament in his pubis. Such actions might be indicative of BDD but the programme didn’t explore this facet. Following such operations, men then have to spend the following weeks suspending a weight from their penis for at least eight hours a day. For all the financial and physical burdens faced, the average increase in length is only 0.5-3cm (with official statistics being closer to 0.5cm than 3cm). Other methods of increasing genital size include the injection of silicon into the penis (although this is dangerous and can result in a silicon embolism).
Dr. Stephen Snyder (Associate Clinical Professor of Psychiatry, Mount Sinai School of Medicine, New York, US) was interviewed about (so-called) ‘Penile Dysmorphic Disorder’ (PDD) in an online Psychology Today article. He was quoted as saying:
“I don’t know of any statistics on [PDD]. Anxiety or insecurity about penis size is extremely common in men. It would be difficult to determine how frequently the more serious condition of penis-focused BDD occurs. People with BDD tend to avoid mental health specialists…It’s much more likely I think that a man with penile BDD will purchase penis enlargement equipment or consult a surgeon than consult someone like me…Some people seem to have an innate tendency for obsessive thinking. Why some of these people develop BDD, and others OCD or Anorexia Nervosa is unknown…A man who begins to obsess about the size of his penis may begin to compulsively and repeatedly measure his erections, and to avoid dating because he’s convinced he’ll be humiliated. Then the whole thing can spiral out of control, until ultimately he’s online studying penis enlargement techniques”.
A 2006 study led by Dr. J. Lever and published by Psychology of Men and Masculinity reported that in an online survey of over 52,000 participants, most male participants rated their penis as average (66%) and only 22% as large and 12% as small. Among the female participants, around 85% of women were satisfied with their partners’ penile size, while only 55% of men were satisfied, with 45% wanting to be larger (and 0.2% to be smaller).
Just recently, Dr. Warren Holman highlighted the case of ‘Sam’, a 17-year-old white male from a middle-class Jewish family living in Midwest USA with penile dysmorphic disorder (in a 2012 issue of Social Work in Mental Health). As Dr. Holman reported:
“Sam had stopped attending school several weeks earlier, and on many days would not even leave his home. He said he wanted to remain at home and away from school because, ‘My penis is shrinking and people can tell.’ Sam reported he had had his anxiety about his penis for about a year, but until recently had been able to reason himself out of it…Sam was well related, and his mental status was unremarkable except for his belief about his penis”.
Dr. Holman believed that Sam’s conviction that his penis was shrinking (and people could tell) suggested three possible diagnoses (i.e., social phobia; BDD and/or delusional disorder of the somatic type; or schizophrenia). Holman eventually reached the conclusion that Sam’s beliefs were due to BDD although did say that it “may be in a prodromal phase of schizophrenia”. Sam was treated via a form of psychodynamic counselling (which much to the disappointment of Holman ultimately failed perhaps because of initial misdiagnosis).
In 2007, British urologists Dr. Kevan Wylie and Dr. Ian Eardley published a review on penile size in BJU International. They summarized all of the studies on penile size that have examined flaccid penis length, stretched penis length, erect penis length, flaccid penis girth and erect penis girth. They reported that:
“Stretched penile length in these studies was typically 12–13 cm, with an erect length of 14–16 cm. For girth, there was again remarkable consistency of results, with a mean girth of 9–10 cm for the flaccid penis and 12–13 cm for the erect penis…Concern over the size of the penis, when such concern becomes excessive, might present as the ‘small penis syndrome’ [SPS], an obsessive rumination with compulsive checking rituals, body dysmorphic disorder, or as part of a psychosis”.
However, they did also assert that more research was required on the effects of race and age on penile length. Wylie and Eardley speculate that SPS (or ‘locker room syndrome’ as they also call it) originates in childhood following the sight of their father’s, elder sibling’s and/or older friend’s penis. This appears to have support from a 2005 study (also published in BJU International). Dr. N. Mondaini and Dr. P. Gontero surveyed men who thought they had a small penis at an andrology clinic and reported that nearly two-thirds said their SPS had begun in childhood (63%) with the rest saying it began in adolescence (37%).
Wylie and Eardley also examined the treatment options of men with SPS and also examined the evidence of commercial penis extending techniques. They concluded that:
“It is recommended that the initial approach to a man who has SPS is a thorough urological, psychosexual, psychological and psychiatric assessment that might involve more than one clinician…Conservative approaches to therapy, based on education and self-awareness, as well as short-term structured psychotherapy [cognitive-behavioural therapy] are often successful, and should be the initial interventions in all men. Of the physical treatments available, there is poorly documented evidence to support the use of penile extenders. More information is need on the outcomes with these devices. Similarly, there is emerging evidence about the place of surgery and there are now several reports suggesting that dividing the suspensory ligament can increase flaccid penile length”.
Goodman, M.P. (2009). Female Cosmetic Genital Surgery. Obstetrics and Gynecology, 113, 154-159.
Holman, W.D. (2012). “My Penis Is Shrinking and People Can Tell”: A Confusing Case of Apparent Body Dysmorphic Disorder. Social Work in Mental Health, 9, 319-335.
Morrison, T.G., Bearden, A., Ellis, S.R. & Harriman, R. (2005). Correlates of genital perceptions among Canadian post- secondary students. Electronic Journal of Human Sexuality, 8. Located at: http://www.ejhs.org/volume8/GenitalPerceptions.htm
Lever, J., Fredereicjk, D.A. & Peplau, L.A. (2006). Does size matter? Men’s and women’s views on penis size across the lifespan. Psychology of Men and Masculinity, 3,129-143.
Mondaini, N. & Gontero, P. (2005). Idiopathic short penis: myth or reality? BJU International, 95, 8–9.
Sarwer, D.B. (2006). Body Dysmorphic Disorder and cosmetic surgery. Plastic and Reconstructive Surgery, December, 168e-180e.
Snyder, S. (2011). When size obsession gets out of hand. Psychology Today, June 11. Located at: http://www.psychologytoday.com/blog/sexualitytoday/201106/when-size-obsession-gets-out-hand
Sondheimer, A. (1988). Clomipramine treatment of delusional disorder-somatic type. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 188-192.
Veale, D. (2004). Body dysmorphic disorder. Postgraduate Medical Journal, 80, 67-71.
Wylie, K.R. & Eardley, I. (2007). Penile size and the ‘small penis syndrome’. BJU International, 99, 1449–1455.