Category Archives: Psychiatry

Pop psychology: A peek inside the mind of Iggy Pop

I have just come back from a two-week holiday in Portugal and managed to catch up with reading a lot of non-academic books. Two of the books I took with me were Paul Trynka’s biography of Iggy Pop (Open Up and Bleed [2007]) and Brett Callwood’s biography of The Stooges, the band in which Iggy Pop first made his name (The Stooges: A Journey Through the Michigan Underworld [2008]). Just before I left to go on holiday I also read Dave Thompson’s book Your Pretty Face is Going to Hell: The Dangerous Glitter of David Bowie, Iggy Pop, and Lou Reed (2009). This engrossing reading has been accompanied by me listening to The Stooges almost non-stop for the last month – not just their five studio albums (The Stooges [1969], Fun House [1979], Raw Power [1973], The Weirdness [2007], and Ready To Die [2013]) but loads of official and non-official bootlegs from the 1970-1974 period. In short, it’s my latest music obsession.

Although I say it myself, I have been a bit of an Iggy Pop aficionado for many years. It was through my musical appreciation of both David Bowie and Lou Reed that I found myself enthralled by the music of Iggy Pop. Back in my early 20s, I bought three Iggy Pop albums purely because they were produced by David Bowie (The Idiot [1977], Lust For Life [1977], and Blah Blah Blah [1986]). Thankfully, the albums were great and over time I acquired every studio LP that Iggy has released as a solo artist (and a lot more aside – I hate to think how much money I have spent on the three artists and their respective bands over the years). Unusually, I didn’t get into The Stooges until around 2007 after reading an in-depth article about them in Mojo magazine. Since then I’ve added them to my list of musical obsessions where I have to own every last note they have ever recorded (official and unofficial). When it comes to music I am all-or-nothing. Maybe I’m not that far removed from my musical heroes in that sense. I’m sure my partner would disagree. She says I’m no different to a trainspotter who ticks off lists of numbers.

One thing that connects Pop, Reed and Bowie (in addition to the fact they are all talented egotistical songwriters and performers who got to know each other well in the early 1970s) is their addictions to various drugs (heroin in the case of Pop and Reed, and cocaine in the case of Bowie – although they’ve all had other addictions such as Iggy’s dependence on Quaaludes). This is perhaps not altogether unexpected. As I noted in one of my previous blogs on whether celebrities are more prone to addiction than the general public, I wrote:

“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”.

Nowhere is this more exemplified than by Iggy Pop. Not only would Iggy take almost every known drug to excess, it seemed to carry over into every part of his lifestyle. For instance, reading about Iggy’s sexual exploits, there appears to be a lot of evidence that he may have also been addicted to sex (although that’s speculation on my part with the only evidence I have is all the alleged stories in the various biographies of him). Another thing that amazes me about Iggy Pop was that he decided to give up taking drugs in the autumn of 1983 and pretty much stuck to it (again mirroring Lou Reed who also decided to clean up his act and go cold turkey on willpower alone). Spontaneous remission after very heavy drug addictions is rare but Iggy appears to have done it. Maybe Iggy gave up his negative addictions for a more positive addiction – in his case playing live. David Bowie went as far as to say that playing live was an obsessive for Iggy. As noted in Paul Trynka’s biography:

“[His touring] was simultaneously impressive and inexplicable. David Bowie used the word’ obsessive’ about Iggy’s compulsion to tour – but there was an internal logic. Jim knew he’d made his best music in the first ten years of his career, and he also believed he’d blown it…but he knew his own excesses or simple lack of psychic stamina were a key reason why the Stooges crashed and burned. Now he had to still prove his stamina, to make up for those weaknesses of three decades ago”.

Iggy Pop is (of course) a stage name. Iggy was born James Newell Osterberg (April 21, 1947). The ‘Iggy’ moniker came from one of the early bands he drummed in (The Iguanas). I mention this because another facet of Iggy Pop’s life that I find psychologically interesting is the many references to ‘Iggy Pop’ being a character created by Jim Osterberg (in much the same way that Bowie created the persona ‘Ziggy Stardust’ – ironically a character that many say is at least partly modeled on Iggy Pop!). Many people that have got to know Jim Osterberg describe him as intelligent, witty, talkative, well read, and excellent social company. Many people that have been in the company of Iggy Pop describe him as sex-crazed, hedonistic, outrageous, a party animal, and a junkie (at least from the late 1960s to the early to mid-1990s). It’s almost as if a real living character was created in which Jim Osterberg could live out an alternative life that he could never do as the person he had become growing up. Iggy Pop became a persona that Jim Osterberg could escape into. When things went horribly wrong (and they often did), it was Iggy’s doing not Osterberg’s. It’s almost as if Osterberg had a kind of multiple personality disorder (now called ‘dissociative identity disorder’ [DID]). One definition notes:

“[Dissociative identity disorder] is a mental disorder on the dissociative spectrum characterized by at least two distinct and relatively enduring identities or dissociated personality states that alternately control a person’s behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness…Diagnosis is often difficult as there is considerable comorbidity with other mental disorders”.

I don’t for one minute believe ‘Jim/Iggy’ suffers from DID but a case could possibly made based on the definition above. Some of the things he did on stage in the name of ‘entertainment’ included gross acts of self-mutilation such as stubbing cigarettes out on his naked body, flagellating himself, cutting his chest open with knives and broken glass bottles. He was a sexual exhibitionist and appeared to love showing his penis to the watching audience. On one infamous occasion, he even dry-humped a large teddy bear live on a British children’s television show. (Maybe Iggy is a secret plushophile? Check out the clip on here on YouTube).

In 1975, Iggy was admitted to the Los Angeles Neuropsychiatric Institute (NPI) and underwent treatment (including psychoanalysis) under the care of American psychiatrist Dr. Murray Zucker. After he had completely detoxed all the drugs in his body, Iggy was diagnosed with hypomania (a mental affliction also affecting another of my musical heroes, Adam Ant). This condition was described by Iggy’s biographer Paul Trynka:

“Bipolar disorder [is] characterised by episodes of euphoric or overexcited and irrational behaviour, succeeded by depression. Hypomanics are often described as euphoric, charismatic, energetic, prone to grandiosity, hypersexual, and unrealistic in their ambitions – all of which sounded like a checklist of Iggy’s character traits”.

Dr. Zucker later told Paul Trynka that hypomania tends to get worse with age and it hadn’t with Iggy and therefore the diagnosis of a bipolar disorder may have been wrong. Dr. Zucker now wonders whether “the talent, intensity, perceptiveness, and behavioural extremes” of Iggy were who he truly was “and not a disease…that Jim’s behaviour was simply him enjoying the range of his brain, playing with it, exploring different personae, until it got to the point of not knowing what was up and what was down’. In short, Dr. Zucker (who maintained professional contact with Iggy during the 1980s) claimed Iggy was perhaps “someone who went to the brink of madness just to see what it was like”. Dr. Zucker also claimed that Iggy (like many in the entertainment industry) was a narcissist (“excessive for the average individual” but “unsurprising in a singer…this unending emotional neediness for attention, that’s never enough”). In fact, Iggy went on to write the song ‘I Need More‘ (and was also the title of his autobiography) which pretty much sums him up many of his pychological motivations (at least when he was younger).

It’s clear that Iggy has been drug-free and fit for many years now although many would say that all of his best musical work came about when he was jumping from one addiction to another – particularly during the decade from 1968 to 1978. This raises the question as to whether musicians and songwriters are more creative under the influences of psychoactive substances (but I will leave that for another blog – I’ve just begun some research on creativity and substance abuse with some of my Hungarian research colleagues). I’ll leave the last word with Dr. Zucker (who unlike me) had Iggy as a patient:

“I always got the feeling [Iggy] enjoyed his brain so much he would play with it to the point of himself not knowing what was up and what was down. At times, he seemed to have complete control of turning this on and that on, playing with different personas, out-Bowie-ing David Bowie, as a display of the range of his brain. But then at other times you get the feeling he wasn’t in control – he was just bouncing around with it. It wasn’t just lack of discipline, it wasn’t necessarily bipolar, it was God knows what”.

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

Further reading

Ambrose, J. (2008). Gimme Danger: The Story of Iggy Pop. London: Omnibus Press.

Callwood, B. (2008). The Stooges: A Journey Through the Michigan Underworld. London: Independent Music Press.

Pop, I. & Wehrer, A, (1982). I Need More. New York: Karz-Cohl Publishing.

Thompson, D. (2009). Your Pretty Face is Going to Hell: The Dangerous Glitter of David Bowie, Iggy Pop, and Lou Reed. London: Backbeat Books.

Trynka, P. (2007). Open Up and Bleed. London: Sphere.

Wikipedia (2014). Iggy Pop. Located at: http://en.wikipedia.org/wiki/Iggy_Pop

No lady luck: A case study of adolescent female slot machine addiction

Based on research into adolescent slot machine playing, all British research has found that most adolescent slot machine players are male and that very few female adolescent slot machine addicts have ever been identified in the literature. The main findings relating to adolescent female slot machine players were published in papers by Dr. Sue Fisher and myself (mostly in the 1990s). In 1993, Dr. Fisher reported the existence of teenage females with no playing skills and little interest in acquiring them, and who gamble on slot machines primarily to gain access to the arcade venue where they can socialize with their friends (calling them ‘Rent-a-Spacers’). Their preferred role is one of ‘spectator’. In an earlier published (1991) study in the Journal of Applied and Community Psychology, I observed that arcades were a meeting place for adolescent social groups in which playing activity was predominantly male-oriented with girls looking on in ‘cheerleader’ roles. In 2003, I published a rare case study of an adolescent female slot machine addict (who I called ‘Jo’) and thought I would share some of the things I found from that study in today’s blog

During a nine-month period, I interviewed Jo three times formally and also maintained regular contact with her on an informal basis. She was confirmed as a probable pathological gambler using the American Psychiatric Association’s DSM-IV criteria for pathological gambling.

Jo was brought up as an only child in a seaside town in the South West of England. She described her parents as “comfortable, middle class and loving”. However, she also made reference to the fact that there were reasonably strict rules in the house. Her father was an insurance salesman and her mother was a schoolteacher. She went to a mixed school, and up to the age of 13 years she had good school reports and was in the top 10% of her class academically. She was also very good at sports (and was an active member of the school athletics club) and described herself as “physically stronger” than most of her peers. Jo claims she did not really relate to the other girls in her school and often got into playground fights with them. During her early adolescence she made a few good friends although these were mostly boys of her own age or a little older. She herself described her adolescent years as a “tomboy”. Educationally, she left school when she was 16 years old and got an office job working as an administrative assistant.

Jo started playing slot machines at a young age because they were so abundant in the town where she lived. She described them as “being part of the wallpaper”. To some extent, her parents encouraged her gambling. Like a lot of “seaside parents”, they often took Jo to the amusement arcades as a child for “a weekend treat”. Like many families, they did not see anything wrong with going to the seaside arcade because they felt it was “harmless fun and didn’t cost much.” However, these early experiences coupled with exposure to slot machines in her peer group were instrumental factors in Jo’s acquisition of slot machine playing. Living in a seaside town, access to the machines was widespread, and the main place for “hanging out” was at the local arcades. There were four or five of them because the town was a popular tourist attraction. Arcades provided a meeting point for her friends. She was part of a gang in which hanging around the arcades was one of the few activities that the group could engage in.

At 13 years old, she mainly used to just watch her male friends play on the slot machines and video games. However, within a year, she was playing on slot machines as much as her peers. The arcade was where Jo “felt safe and protected”. She liked it that everyone who worked there knew who she was. In the arcade she was a ‘somebody’ rather than a ‘nobody’. In essence, the arcade provided a medium where Jo’s self-esteem was raised.

Jo gave a number of insights into her motivations for slot machine playing. Skill did not appear to be a motivating factor for continued play. She played to win money (to further her playing rather than fuel any winning fantasies) and did not see the machines as particularly skilful. Although most of Jo’s (male) friends claimed that slot machine playing was very skillful if you were good at it, Jo always believed that slot machines were not like video games and that “winning big” had a lot of luck to it. Knowing her way round a slot machine while helpful, didn’t make her feel as though she was especially skilful except when complete novices would play. Also, being female, the older age women who played on the simple machines would talk to her (unlike the adolescent males who would be shunned by this clientele). This made her feel wanted and needed. However, between the ages of 14 and 15 years, Jo’s slot machine playing became all encompassing. As she explains:

“There was a period in my life between the ages of 15 and 17 where the machines became the most important thing in my life. I didn’t worry about money. I just believed I would win it back or that money would come from somewhere because it always had. I was forever chasing my losses. I would always tell myself that after a bad loss, the arcade was only ‘borrowing’ my money and that they would have to ‘pay it back’ next time I was in there. Of course, that rarely happened but once I was playing again, money worries and losses went out of the window. Gambling became my primary means of escape. On the positive side, at least it helped me to give up smoking and drinking. I simply couldn’t afford to buy nicotine or alcohol – or anything else for that matter. I never believed that gambling would make me rich – I just thought it would help me clear my debts.”

Jo didn’t acknowledge that she had a problem – even when she started to go down to the arcade on her own and using all her disposable income to fund her slot machine playing. However, in retrospect, she realized a problem was developing.

“I used to spend every penny I had on the (slot) machines. It was a good job I wasn’t into clothes like the other girls at school. I couldn’t have afforded to buy anything as I lost everything I had in the long run. I used to wear the same pair of jeans for months. I don’t even think I washed them”.

When Jo was 15 years old, a telephone call from the school headmaster alerted Jo’s mother that her daughter might be having some problems in her life. The headmaster phoned to say that Jo’s attendance had been very poor during the previous three months and that she had stopped attending athletics practice. When confronted, Jo admitted that she had not been attending school but said that all the girls in her class hated her. To some extent this was true (she didn’t get on with any of the girls at her school) but was not the reason she was truanting. Instead of going to school she had been spending her time in the local arcades. For a few weeks she tried to stop her gambling. Now that her parents knew there were problems, she thought this would be the ideal time to give up. However, after 17 days without gambling, her boyfriend split up with her and she relapsed by gambling again. This then carried on for almost two years.

Jo’s parents were very understanding and looked for alternatives to help their daughter. They considered moving classes within the school and moving schools completely. Jo simply said she would try to integrate more. At no stage did Jo’s parents ever suspect that her erratic behaviour was linked to anything other than the problems of adolescent mixing. Jo managed to successfully hide her problem for a further two years before everything came out into the open.

As an only child it was difficult for Jo’s parents to know whether their experience was normal. They hardly saw Jo. At the age of 16 years, Jo upset her parents not only by leaving school but also by leaving home. They knew there was little that they could do. When Jo left home, she assumed that all her problems would disappear. However, she got into more and more trouble and was unable to make ends meet. She lived from hand to mouth. She began to steal from friends, from work and from anyone she met. On two occasions she met males she had never met before that moment, went back to their houses, and then stole their money and/or valuables.

Over this period of nearly two years Jo became more and more withdrawn, lost her friends and ended up resorting to stealing from her place of work. Eventually she was sacked (for taking the petty cash) although her employers were unaware that her problem was gambling (or that she even had a problem). They assumed she wanted more money to supplement her very modest wages. Although she lost her job, the company did not instigate criminal charges.

The first major turning point was being sacked from her first job for theft of the petty cash. She had nowhere else to go but back home. Her parents were a tremendous support although were surprised that slot machines were the heart of the problem. Jo claimed her mother didn’t believe her at first. They wondered how someone could get addicted to a machine. Jo claimed it would have been easier for her mother to accept if she had a drug or alcohol problem rather than a gambling problem.

The cessation of her gambling began when Jo (with her parents’ help) got another job in a remote village in Cornwall (in South West England). There was no arcade, no slot machines in the local pub, and no slot machine within a four-mile radius. She did not drive a car and it was too far to walk to the nearest town. In essence, the lack of access to a slot machine forced her to stop playing. She still got the cravings but there was nothing she could do. She also claimed to have a number of serious self-reported withdrawal symptoms. At work she was short-tempered, irritable with colleagues, and constantly moody. Physically, she had trouble sleeping, and occasionally had stomach cramps, and felt nauseous through lack of play.

Jo eventually joined a local Gamblers Anonymous (GA) that her parents drove her to every week. She only attended a handful of times and stopped attending because she was the only female in the group, the only slot machine player, and also the youngest. Despite the opportunity to share her experiences with eleven or twelve people in a similar position to herself, she felt psychologically isolated. Being able to talk about the problem with people she could trust (i.e., her parents) was a great help. In addition, with her desire to stop and with no access to slot machines, Jo managed to curtail her gambling. She claims she “wasted four years of her adolescence” due to slot machine playing – and she doesn’t want to waste any more of her life. However, there is no certainty that Jo is ‘cured’ – Jo feels a number of triggers could set her off again (like rejection of someone close to her). Talking to people has been Jo’s “salvation” as she calls it. She had always thought that slot machine playing couldn’t be a problem and therefore found it hard that people would accept the “addiction” she had. Other people’s acceptance that she suffered something akin to alcoholism or drug addiction has helped her recovery.

From my own personal research experience, Jo’ account is fairly typical of slot machine addicts. This is an individual who began playing slot machines socially, steadily gambled more and more over time, spent every last penny on gambling and resorted to the cycle of using their own money, borrowing money, and then finally stealing money, just to fund their gambling habit. Criminal proceedings could have occurred but fortunately (for Jo), she was punished by losing her job. The one major difference between this and all other accounts is that Jo happens to be female.

The major limitation of a study such as this is that it relied totally on retrospective self-report. Not only do I have to take Jo’s account as true but it is also subject to the fallibility of human memory. There is also the major limitation that the findings here are based on one person only and there is little that can be said about generalizability.

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

Further reading

Fisher, S. E. (1992). Measuring pathological gambling in children: The case of fruit machines in the U.K. Journal of Gambling Studies, 8, 263-285.

Fisher, S. (1993). The pull of the fruit machine: A sociological typology of young players. Sociological Review, 41, 446-474.

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

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

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2003). Fruit machine addiction in females: A case study. Journal of Gambling Issues, 8. Located at: http://jgi.camh.net/doi/full/10.4309/jgi.2003.8.6

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

Griffiths, M.D. (2011).A typology of UK slot machine gamblers: A longitudinal observational and interview study. International Journal of Mental Health and Addiction, 9, 606-626.

Deerly beloved: Animal tissue as a masturbatory aid

A couple of weeks ago I bought a secondhand copy of The Fortean Times Book of Weird Sex by Steve Moore (mainly because it cost me only one pence at an online book store). One of the stories (on pp.96-97) concerned a bizarre story of an autoerotic death involving an adolescent boy. I checked out the reference list at the back off the book to see where the story had originated and the source was listed as an Associated Press story from Knoxville (Maryland, USA). It didn’t take me too long to track down the press release on the internet. The report said:

“A 16-year old boy in Knoxville was found dead in his bedroom in what police describe as a gruesome, horrifying death. Firefighters were called to the scene Monday morning by a neighbor who smelled something burning. When the firemen found the remains of the teenager they called the police in to investigate. At first investigators believed that they were dealing with a ritualistic murder. Posters of heavy metal rock and roll groups covered his bedroom walls, groups which are often connected with satanic worship and rituals. According to a firefighter who was on the scene, the boy was found nude, with the remains of a cow’s heart attached to his genitals. Wires had been attached to the heart and plugged into a wall socket. The boy died from electrocution, then the electricity literally cooked his remains. Investigating Officer Hardaway dismissed the ritual murder theory when detectives found several underground pornographic magazines under the boy’s mattress. One of the magazines, called ‘Ovid Now’, describes a sexual ‘toy’ that can be made from the fresh heart of a cow, a simple electrical circuit, and some batteries. This deviancy is apparently gaining limited popularity in the rural South. Practitioners get the dead heart to beat, and then use the beating organ for sexual perversions. ‘This is one of the most gruesome things I have ever seen. I can’t believe that there are people who actually enjoy this sort of thing’ Hardaway commented. The boy’s parents are currently on vacation in Florida, where they were contacted and informed about the tragedy. They were unavailable for comment”.

As I have already written a previous blog on electrophilia and published an article on the ten strangest autoerotic deaths (in the magazine Bizarre) I thought it would make the basis for a good blog. However, after a bit more investigation I discovered the story to be a fake. The Snopes.com website (also know as the Urban Legends Reference Pages) investigated the story and showed it to be completely false. The author of the article (Barbara Mikkelson) wrote:

“The [cow heart masturbation story] isn’t a bona fide Associated Press article. No such death has been recorded, let alone been reported on by the Associated Press. What we have here is a work of fiction, an inventive leg-pull. Pranksters are everywhere, both on-line and off-line. In this case, someone took his best shot at presenting a gruesomely salacious story as a news item by dressing it up to mimic the style he assumed wire service copy adhered to, resulting in a laughable Associated Press pastiche”.

The same article also reported another fictitious tale of masturbatory death by animal (in this case a lobster). Here, the story was that a women had masturbated using a live lobster and that the lobster had defecated into her vagina, implanting brine shrimp eggs that then hatched inside her. Additionally, there are a few fictional cases in literature, the most infamous being the use of an animal liver as a masturbatory aid in Philip Roth’s 1969 novel Portnoy’s Complaint. The novel is basically the monologue of (as Wikipedia describes) “a lust-ridden, mother-addicted young Jewish bachelor who confesses to his psychoanalyst in intimate, shameful detail, and coarse, abusive language”. In my previous blog on sitophilia (sexual arousal from food), I did note that processed animal tissue has been used as a masturbatory aid (the most notable being botulinonia that involves the sexual use of sausages).

However, there is one case report in the scientific literature that is definitely true. It was published in a 1990 issue of the American Journal of Forensic Medicine and Pathology by Dr. Barry Randall, Dr. Richard Vance, and Dr. Timothy McAlmont and was simply titled ‘Xenolingual eroticism’. The paper described the case of a 29-year old female that presented at an abortion clinic saying that she had missed her periods and that she had a possible pregnancy that required termination. She was given a D&C (dilatation and curettage) and a muscular “pale grey tissue mass” measuring seven centimetres in length and 3 centimetres in diameter was found inside her vaginal passage. The object removed from her vagina turned out to be a deer tongue that the woman has been using as a masturbatory aid. At the time their case study was published, Dr. Randall and colleagues reviewed all the relevant literature on masturbatory practices in the Index Medicus database and found 42 papers (of which 27 detailed autoerotic deaths and 14 describing the psychology of autoeroticism). They then noted that:

“Only one reference reviewed various nonlethal autoerotic practices. Over a 42-year period, Aliabadi et al. recorded 18 patients, only three of whom were women, who presented with foreign body insertion for erotic purposes. All three women had inserted foreign bodies into the urinary tract. Acts of autoeroticism involving vaginal masturbation with foreign objects are perhaps more common. None to our knowledge have been reported because these do not result in death or injury, and typically would not come to medical attention. The literature discloses examples of foreign bodies extracted from the male and female lower urinary tract because objects of small diameter may be retracted by natural muscular impulses into the proximal urethra and/or bladder. Indeed, according to Kinsey and others >90% of foreign bodies found in the female bladder or urethra are there as a result of masturbation. Also, large objects retrieved from the vagina are found mostly in married women aged 17-30 [years]. However, these objects, most commonly bananas, cucumbers, and other large vegetables, rarely come to surgical attention. The medical literature reveals only seven references to bestiality. None of them deals with the issue of using nonviable animal tissue for autoerotic purposes. This report is presented so that xenoerotic objects may be placed on the list of possible masturbatory tools that may come to the attention of medical personnel”.

As far as I am aware, the case study by Dr. Randall and colleagues is the only academic paper on the use of animal tissue as a masturbatory aid. I did actually cite this study in a previous blog in relation to Dr. Anil Aggrawal’s 2011 typology of zoophiles in the Journal of Forensic and Legal Medicine. The case cited by Randall and colleagues could be classed as a fetishistic zoophile. According to Dr. Aggrawal, these individuals keep various animal parts (especially fur) that they then use as an erotic stimulus as a crucial part of their sexual activity. Obviously the use of a deer tongue is rare but appears to fit the definition of a fetishistic zoophile.

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

Further reading

Aggrawal, A. (2011). A new classification of zoophilia. Journal of Forensic and Legal Medicine, 18, 73-78.

Aliabadi, H., Cass, A.S., Gleich, P., & Johnson, C.F. (1985). Self-Inflicted foreign bodies involving lower urinary tract and male genitals. Urology, 26, 12-16.

Brown, S. (1995). The Fortean Times Book of Weird Sex. London: John Brown Publishing.

Griffiths, M.D. (1999). Dying for it: Autoerotic deaths. Bizarre, 24, 62-65.

Mikkelson, B. (2006). Cowboy heart. Snopes.com, May 13. Located at: http://www.snopes.com/risque/kinky/cowheart.asp

Randall, M. B., Vance, R. P., & McCalmont, T. H. (1990). Xenolingual autoeroticism. The American Journal of Forensic Medicine and Pathology, 11, 89-92.

Snopes (2000). Lobster love. Snopes.com, January 26. Located at: http://www.snopes.com/risque/juvenile/lobster.asp

Snopes (2006). Deerly beloved. Snopes.com, February 26. Located at: http://www.snopes.com/risque/animals/deertongue.asp

List watch: A brief look at glazomania

“Real happiness consists in not what we actually accomplish, but what we think we accomplish” (Charles Green Shaw, American abstract artist)

Ever since I can remember I have always been someone that compiled lists. Back in my youth it was lists of my favourite pop groups, film stars, sports stars, etc. I still make loads of lists but these days they are more likely to be long ‘to do’ lists (in fact, I’ve even written articles on getting the most out of ‘to do’ lists and being organized – see ‘Further reading’ below) or writing articles in the form of lists (in fact, I used to write what I called ‘psychol-lists’ for the British Psychological Society’s in-house magazine The Psychologist). When I make lists I feel more productive, and they are often the spurs to get things done (as long as I actually do the things on the list).

Obviously, list making can be an important activity in the organizational skills of many working individuals. Based on my own observations, most people make lists so they (i) don’t forget things, (ii) don’t procrastinate, (iii) feel in control and focused in what they are doing, (iv) can relieve stress, and (v) can cross things off the list and feel a sense of accomplishment. However, for a minority of people, making lists appears to be obsessive and a mental health issue. In short, there may be a fine line between being organized and being neurotic. From my own personal experience, I know that writing lists can be related to perfectionism. But life isn’t perfect and not completing activities on ‘to do’ lists can raise stress and worry levels. Ironically, the only way some people can deal with this is to make even more lists of things to do.

Obsessive list making is sometimes referred to as glazomania (check out the ‘Manias’ page at The Scorpio Tales website). Online dictionaries tend to define glazomania as either a passion for list makingor an unusual fascination with making lists”. However, the term ‘glazomania’ doesn’t appear to be used much academically. I did come across one recent paper in Distinktion: Scandinavian Journal of Social Theory, by Dr. Urs Staeheli that mentioned it:

“Recently, quite a number of coffee-table books have been published that collect different sorts of everyday lists. Some authors even speak of a ‘glazomania‘ (Cagen 2007) – that is, an uncontrolled urge to produce lists and a fascination with list-making”

However, there was no other information provided. I managed to track down the 2007 reference to Sasha Cagen’s book (To-Do List: From Buying Milk to Finding a Soul Mate, What Our Lists Reveal About Us). The book includes creative list-making exercises with the aim of helping individuals to “get in touch with their passion for life, inside and out of work, and refocus them on what brings them alive”. Cagen now makes a living on writing and giving workshops on the benefits of list making (one of her major clients being Google)

Although the term ‘glazomania’ is seldom used academically or clinically, obsessive list making is often mentioned as one of the symptoms of obsessive-compulsive disorder. As one online admission I came across noted:

“I have OCD, and recently my OCD flares up in the form of compulsive list making. This behavior totally affects my ability to be productive because I am constantly afraid of forgetting something and of spending time doing the wrong thing. Does anyone have any tips on how to break the cycle?”

The Wikipedia entry on obsessive-compulsive personality disorder notes that the main symptoms are “preoccupation with remembering and paying attention to minute details and facts, following rules and regulations, compulsion to make lists and schedules, as well as rigidity/inflexibility of beliefs or showing perfectionism that interferes with task-completion. Symptoms may cause extreme distress and interfere with a person’s occupational and social functioning” (my emphasis)

Psychologically, an argument could be made that obsessive list makers are simply trying to create an illusion of control in otherwise chaotic lives. The reason whyindividuals with OCD make lists compulsively is that they often afraid (in some cases, to the point of being phobic) that they will forget something important (even though research shows they do not have memory problems). These (arguably unnecessary) lists provide a reminder to carry out daily activities (i.e. brushing teeth, making breakfast, etc.). As with other OCD-type behaviours, the action of making a list helps the individual to feel psychologically better (albeit temporarily). The etiological roots may lie in the fact that the sufferer may at some point in their past history have been reprimanded severely, or repeatedly, by others for innocently forgetting things that were important. The OCD Types website adds:

“They never learn that they do not need the list to remember things. People with OCD may also make lists to remember things that may be contaminated to later wash or avoid, which also contributes to the OCD process. List-making can be in writing or verbalized aloud”.

In 2010, the BBC reported an exhibition at the Archives of American Art in Washington featuring lists made by eminent artists (everything from “scribbled on scraps of paper” to the “elaborately illustrated” including lists by Pablo Picasso, Alfred Konrad, Oscar Bluemner, Eerp Saarinen and Harry Bertoia). Bluemner even kept lists of lists. The curator of the exhibition (Liza Kirwin) told the BBC that:

“In trying to give order to his life, [Bluemner] obscures the clarity of the inventory of his work. He’s completely obsessed with this type of record keeping…This very mundane and ubiquitous form of documentation can tell you a great deal about somebody’s personal biography, where they’ve been and where they’re going. People can relate to this form of documentation because so many people are list keepers and organise their lives this way”.

In the same article, the BBC interviewed the US psychoanalyst Dr. Michael Maccoby who claimed that there are various types of list makers. However, there was little detail and the only quote in relation to types of list makers claimed: “The extreme is the obsessive who has to make lists of everything. These are people who have an unconscious fear that everything is going to be out of control if they don’t make a list”. As far as I am aware, there is no published empirical research on personality types and list making although there is some psychological literature showing that list making – as part of time management practices – appears to have some beneficial effects on both student grade point averages and workplace productivity.

Finally, a few months ago, an online article by Dr. Carrie Barron at the Psychology Today website provided a brief summary of why making lists is psychologically good for people. I’m not sure about the empirical basis of her claims but they seem to have reasonable face validity. I’ll leave you with her reasons (her verbatim list of “six great benefits”!). In summary, Barron believes that lists:

  • “Provide a positive psychological process whereby questions and confusions can be worked through.
  • Foster a capacity to select and prioritize. This is useful for an information-overload situation.
  • Separate minutia from what matters, which is good for identity as well as achievement.
  • Help determine the steps needed. That which resonates informs direction and plan.
  • Combat avoidance. Taking abstract to concrete sets the stage for commitment and action. Especially if you add self-imposed deadlines.
  • Organize and contain a sense of inner chaos, which can make your load feel more manageable”.

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

 

Further reading

 

Barron, C. (2014). How making lists can quell anxiety and breed creativity. Psychology Today, March 9. Located at: http://www.psychologytoday.com/blog/the-creativity-cure/201403/how-making-lists-can-quell-anxiety-and-breed-creativity

 

Cagen, S. (2007). To-Do List: From Buying Milk to Finding a Soul Mate, What Our Lists Reveal About Us. Chicago: Touchstone.

 

Griffiths, M.D. (1995). Psycholo-lists. The Psychologist: Bulletin of the British Psychological Society, 8, 240.

 

Griffiths, M.D. (1996). More psycholo-lists. The Psychologist: Bulletin of the British Psychological Society, 9, 384.

 

Griffiths, M.D. (2006). Tips on…To do lists. British Medical Journal Careers, 332, 215.

 

Griffiths, M.D. (2008). Tips on…’To do’ lists. Psy-PAG Quarterly, 68, 27-28.

 

O’Brien, J. (2010). The art of list-making. BBC News, March 3. Located at: http://news.bbc.co.uk/1/hi/8537856.stm

 

OCD Types (2014). About obsessive-compulsive disorder. Located at: http://www.ocdtypes.com/unusual-compulsions.php

 

Staeheli, U. (2012). Listing the global: Dis/connectivity beyond representation? Distinktion: Scandinavian Journal of Social Theory, 13(3), 233-246.

 

Wikipedia (2014). Obsessive-compulsive personality disorder. Located at: http://en.wikipedia.org/wiki/Obsessive–compulsive_personality_disorder

 

Term warfare: ‘Problem gambling’ and ‘gambling addiction’ are not the same

Throughout my career, I have constantly pointed out that I met very few people that are genuinely addicted to playing weekly or bi-weekly Lotto games. When stating this, some people counter my assertion that they know people who spend far too much money on buying Lotto tickets and that it is areal problem in their life. However, this is a classic instance of confusing ‘problem gambling’ with ‘gambling addiction’. These two terms are not inter-changeable. When I give lectures on gambling addiction I always point out that “all gambling addicts are problem gamblers but not all problem gamblers are gambling addicts”.

Nowhere is this more relevant than in the print and broadcast media. For instance, I have been one of the co-authors on the last two British Gambling Prevalence Surveys (published in 2007 and 2011). In these surveys we assessed the rate of problem gambling using two different problem gambling screens. Neither of these screens assesses ‘gambling addiction’ and problem gambling is operationally defined according to the number of criteria endorsed on each screen. For instance, in both studies we used the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to estimate the prevalence of problem gambling. Anyone that endorsed three or more items (out of ten) was classed as a problem gambler. Anyone that endorsed five or more items was classed as a pathological gambler. Pathological gambling is more akin to gambling addiction but we found only a tiny percentage of our national participants could be classed as such. What we did report was that 0.9% of our sample were problem gamblers (i.e., they scored three or more on the DSM-IV criteria).

What we didn’t say (and never have said) was that 0.9% of British adults (approximately 500,000 people) are addicted to gambling. However, many stories in the British media when they talk about problem gambling will claim ‘half a million adults in Great Britain are gambling addicts’ (or words to that effect). I am not trying to downplay the issue of gambling addiction. I know only too well the pain and suffering it can bring to individuals and their families. Also, just because I may not define a problem gambler as being genuinely addicted (by my own criteria as outlined in a previous blog), that doesn’t mean that their problem gambling might not be impacting in major negatively detrimental ways on their life (e.g., relationship problems, financial problems, work problems, etc.).

However, returning to the issue of being ‘addicted’ to Lotto games I have always stated in many of my published papers on both addiction and (more specifically) gambling addiction, that addictions rely on constant rewards. A person cannot be genuinely addicted unless they are receiving constant rewards (i.e., their behaviour being reinforced). Playing a Lotto game in which the result of the gamble is only given once or twice a week is not something that can provide constant rewards. A person can only be rewarded (i.e., reinforced) once or twice a week. Basically, Lotto games are discontinuous and have a very low event frequency (once or twice a week). Continuous gambling activities (like the playing of a slot machine) have very high event frequencies (e.g., a typical pub slot machine in the UK has an event frequency of 10-12 times a minute). Gambling activities with high event frequencies tend to have higher associations with problem gambling, and are more likely to be associated with genuine gambling addictions.

That doesn’t mean people can’t spend too much money buying lottery tickets. Buying ticket after ticket can indeed lead people to have a gambling problem with Lotto. However, I know of no addiction criterion that relates to the amount of money spent engaging in an activity. Obviously the lack of money can lead to some signs of problematic and/or addictive behaviour (such as committing criminal activity in order to get money the person hasn’t got to gamble) but this is a consequence of the behaviour not a criterion in itself. In most of the behavioural addictions that I carry out research into (exercise addiction, sex addiction, video game addiction, etc.), there is little money spent but some of these behaviours for a small minority of people are genuinely addictions.

One of the reasons I felt the need to write this article was a press release I saw the other day from the Salvation Army in New Zealand. The story basically said that for some people, playing Lotto was an addictive activity. Here are some of the things the press release said:

“The Salvation Army Problem Gambling service is seeing an increase in the number of clients for whom Lotto products has become a problem for them and their families. ‘When it becomes an addiction, gambling creates havoc in people’s lives’, says Commissioner Alistair Herring, National Director of Addiction Services. ‘The gambling of some of our clients has led to criminal offending, domestic violence, loss of the family home, and – most commonly – children going without food and other basic needs. Regrettably, some people are unable to buy a simple product like a Lotto ticket without it leading to harm for themselves and others. A Lotto ticket can seem harmless but once their purchase becomes an addiction the results can be devastating’…In the past year, The Salvation Army problem gambling programme assisted over 1400 clients most of whom used Lotto. Fifty-seven clients said Lotto was the most significant aspect of their gambling problem. ‘This sort of sales promotion without fully understanding the damage the product can have on an individual and their family is irresponsible. New Zealand is moving toward food labelling that identifies additives dangerous to health. Yet Lotto tickets are sold without any warning that they can lead to health dangers through addiction’. One of the results of Lotteries Commission activity is that Countdown supermarkets recently started selling Lotto tickets at the checkout”.

Many of you reading this may think I am being a little pedantic but while I don’t doubt that buying too many Lotto tickets can be problematic if the person buying them simply can’t afford it, the resulting behaviour is ‘problem gambling’ not ‘gambling addiction’. In relation to my own criteria for addiction, the only way someone could be addicted to Lotto was if they were actually addicted to the buying of the tickets rather than the outcome of the gamble itself. This is not as bizarre as it sounds as some research that I carried out in the late 1990s and early 2000s with Dr. Richard Wood appeared to show that a small proportion of adolescents (aged 11 to 15 years) were addicted to playing both Lotto and scratchcard lottery games.

While it is theoretically possible for kids to be hooked on lottery scratchcards (as you can play again and again and again if you have the time, money, and opportunity), we found it strange that adolescents should have ‘addiction’ problems with Lotto. However, in follow-up qualitative focus groups, some adolescents reported that they actually got a buzz from the buying of Lotto tickets and scratchcards because it was an illegal activity for them (i.e., only those aged 16 years or older can play lottery games in the UK so the buying of tickets below this age is a criminal offence). Basically, there was a small minority of kids that were getting a buzz or high from the illegality of buying a lottery ticket rather than the gambling itself.

Along with Michael Auer, I published a paper in the journal Frontiers in Psychology where we argued game type was actually irrelevant in the development of gambling problems. We provided two examples that demonstrate that it is the structural characteristics rather than the game type that is critical in the acquisition, development and maintenance of problem and pathological gambling for those who are vulnerable and/or susceptible. A ‘safe’ slot machine could be designed in which no-one would ever develop a gambling problem. The simplest way to do this would be to ensure that whoever was playing the machine could not press the ‘play button’ or pull the lever more than once a week. An enforced structural characteristic of an event frequency of once a week would almost guarantee that players could not develop a gambling problem. Alternatively, a risky form of lottery game could be designed where instead of the draw taking place weekly, bi-weekly or daily, it would be designed to take place once every few minutes. Such an example is not hypothetical and resembles lottery games that already exist in the form of rapid-draw lottery games like keno.

Although many people (including those that work in the print media) may still use the terms ‘problem gambling’ and ‘gambling addiction’ interchangeably, hopefully I have demonstrated in this article that there is a need to think of these terms as being on a continuum in which ‘gambling addiction’ is at the extreme end of the scale and that ‘problem gambling’ (while still of major concern) doesn’t necessarily lead to problems in every area of a person’s life.

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

Further reading

Griffiths, M.D. & Auer, M. (2013). The irrelevancy of game-type in the acquisition, development and maintenance of problem gambling. Frontiers in Psychology, 3, 621. doi: 10.3389/fpsyg.2012.00621.

Griffiths, M.D. & Wood, R.T.A. (2001). The psychology of lottery gambling. International Gambling Studies, 1, 27-44.

Leino, T., Torsheim, T., Blaszczynski, A., Griffiths, M.D., Mentzoni, R., Pallesen, S. & Molde, H. (2014). The relationship between structural characteristics and gambling behavior: A population based study. Journal of Gambling Studies, in press.

McCormack, A. & Griffiths, M.D. (2013). A scoping study of the structural and situational characteristics of internet gambling. International Journal of Cyber Behavior, Psychology and Learning, 3(1), 29-49.

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

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

Salvation Army (2014). Buying Lotto…Winning a gambling addiction. July 2. Located at: http://www.scoop.co.nz/stories/CU1407/S00032/buying-lotto-winning-a-gambling-addiction.htm

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

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

Wood, R.T.A. & Griffiths, M.D. (1998). The acquisition, development and maintenance of lottery and scratchcard gambling in adolescence. Journal of Adolescence, 21, 265-273.

Wood, R.T.A. & Griffiths, M.D. (2002). Adolescent perceptions of the National Lottery and scratchcards: A qualitative study using group interviews. Journal of Adolescence, 25/6, 655 – 668.

Wood, R.T.A. & Griffiths, M.D. (2004). Adolescent lottery and scratchcard players: Do their attitudes influence their gambling behaviour? Journal of Adolescence, 27, 467-475.

Metal defectives: A brief look at metal eating and acuphagia

In a previous blog I briefly examined pica (an eating behaviour in which individuals eat non-nutritive items or substances such as coal, hair and wood). One thing I was surprised to find out was how many different sub-types of pica there are. For instance, a 2005 review of pica by Dr. L.N. Stiegler in an autism journal listed (in alphabetical order) acuphagia (eating sharp objects), amylophagia (laundry starch), coprophagia (faeces), cautopyreiophagia (burnt matches), foliophagia (leaves, grass), geophagia (sand, clay, dirt), lignophagia (wood, bark, twigs), lithophagia (stones, pebbles), pagophagia (ice, freezer frost), plumbophagia (lead items), tobaccophagia (cigarettes, butts), and trichophagia (hair). Today’s blog examines acuphagia and metal eating (which doesn’t appear to have specific sub-name). Here are a few interesting media stories that caught my eye:

  • Case 1: “Serbian pensioner Branko Crnogorac was rushed to hospital after he attempted to eat a bicycle within three days as part of a bet made by friends.The stuntman, who has already consumed 25,000 light bulbs, 12,000 forks and thousands of vinyl records in a glittering 60-year career, was in a severe condition when doctors attended to him. ‘I almost died,’ said Mr Crnogorac. ’Doctors at the same time found two kilograms of assorted ironware in my stomach, including two gold rings. ‘So after 20 years of eating everything, I’ve realised my digestive system is not as strong as it used to be, so I’ve decided to retire.’ Crnogorac’s obsessive object eating began after a friend recommended he eat sand to calm down an acidic stomach ache. From then on Mr Crnogorac resolved to eat any object in sight. Mr Crnogorac has also managed to eat 2,000 spoons and 2,600 plates”.
  • Case 2: “Doctors in a coastal town in northwestern Peru have rescued the innards of a 38-year-old man by removing 17 metal objects – among them nails, a watch clasp and a knife – that he ate. Luis Zarate was taken to the regional hospital of Trujillo earlier this week by his family after complaining of sharp stomach pains. Doctors took X-rays of his chest that showed his insides littered with screws. ‘There were 17 strange objects found at the level of his stomach and colon’, said Dr. Julio Acevedo, one of the surgeons who operated on Zarate. The black-and-white scans showed Zarate’s skeleton interlaced with things like bolts, barbed-wire and pens. ‘The objects had caused the stomach to expand’ said Acevedo. Doctors said Zarate was mentally ill but it was not clear why he ate the metal”.
  • Case 3: A 40-year-old Ethiopian man is recovering in hospital after surgeons in Addis Ababa removed 222 metallic objects from his stomach.Gazehegn Debebe was admitted to Tibebu General Hospital last week after complaining of continuous vomiting.After intensive investigation, doctors opened his stomach to find an assortment of 15 cm nails, door keys, hair pins, coins and even watch batteries.Doctors at the hospital say it’s incredible that Gazahegn’s stomach could contain all these objects…‘He must have been eating these objects for at least two years, as the wall of his stomach had thickened to accommodate all the inedible objects’ said Dr Samuel.Some of the nails found were 15 cm in length…It is unclear why Gazehegn was eating nails and other objects, but his family say he has a history of mental illness”.
  • Case 4: “47-year old Englishman Allison Johnson [was an] alcoholic burglar with a compulsion to eat silverware, Johnson has had 30 operations to remove strange things from his stomach. In 1992, he had eight forks and the metal sections of a mop head lodged in his body. He has been repeatedly jailed and then released, each time going immediately to a restaurant and ordering lavishly. Unable to pay, he would then tell the owner to call the police, and eat cutlery until they arrived. Johnson’s lawyer said of his client, ‘He finds it hard to eat and obviously has difficulty going to the lavatory”.

After reading these news stories, it got me wondering what academic research had been carried out on people that voluntarily eat metal objects (irrespective of whether the person is mentally ill).One of the earliest papers that I came across was a case study by Dr. K.M. Hambridge and Dr. A. Silverman published in a 1973 issue of the Archives of Disease in Childhood. They described the case of a 2-year-old girl had a 6-month history of pica, that resulted in ‘metal-eating’. She had a poor appetite generally and was diagnosed with a zinc deficiency. When she was one-and-a-half-years old she began to eat small metallic objects (such as keys, the metal trim on carpets, and bits of aluminium foil). She was treated with a dietary zinc supplement and within 3 days, her pica disappeared completely. Papers and other anecdotal evidence from parents demonstrates children eating metallic objects is well documented, although acuphagia in children appears to be very rare (and is potentially fatal). In a 2003 book chapter in the book Child Psychopathology, Dr. L.G. Klinger and colleagues reported that acuphagia has been documented in autistic children, and that this may be possibly due to sensory disturbances.

Acuphagia and metal eating appears to be rarer in adult populations although a number of case studies from around the world have been published over the last decade. For instance, a 2007 paper by Dr. D. Halliday and Dr. F. Iroegbu reported the case of a 22-year old adult Nigerian male (Mr. C.O.) that turned up at hospital complaining of “persistent vomiting after meals, cough, weakness, inability to walk and swelling of the legs and face”. The initial diagnosis was ‘kwashiorkor’ (protein calorie malnutrition) but following an X-ray, the doctors discovered there were metallic objects in his upper abdomen. Following a surgical procedure, a total of 497 metallic objects weighing 1.84 kilograms were found in his stomach (and what was most remarkable was that his stomach was completely in tact). This included 303 two-inch nails, 145 coins, 25 office pins, six razor blades, and 18 sowing needles.Mr. C.O. was referred for psychiatric consultation but denied he had swallowed all the metallic objects (and no-one close to him had ever seen him ingest any metallic objects). Halliday and Iroegbu concluded that in their part of the world, magical arts (i.e., juju) is widely practiced and believed, and that this was the most likely explanation for his illness, triggered by a number of other factors including poverty, isolation, neglect and loneliness.

In 2008, another case was reported in the Indian Journal of Surgery by Dr. P. Kariholu and his colleagues. However, they debated whether their case was acuphagia and/or hyalophagia (the eating of glass materials – a subtype not actually listed in Stiegler’s classification above). In this particular case, a young 20-year old woman presented for treatment with an impacted mass of 18 bangles broken into 55 glass bangle pieces (each measuring 2cm to 7cm) in the stomach as well as few in her small and large bowel. The bangles were successfully removed via surgery.

A short 2007 article in The Medicine Forum by Dr. Saurabh Bansal described the case of a 29-year old male with a history of acuphagia who needed treatment after “accidentally” swallowing a pen. The patient underwent an esophagogastroduodenoscopy (EGD) to remove the pen, and left the hospital six hours after the EGD. Ten days later, the same man returned to the hospital with hematemesis (i.e., vomiting blood). This time he had swallowed a knife and after emergency treatment was sent to the psychiatric facility. Unfortunately no information was provided in relation to the man’s psychiatric assessment.

Most recently, a 2010 paper by Dr. B.T. te Wildt and colleagues in a psychiatric journal reported a case of acuphagia as a disorder of impulse control. They reported the case of a 41-year-old man with intellectual disabilities who required medical treatment after having swallowing around 20 sharp objects. He had also swallowed a glove. The patient claimed that the swallowing of the objects was done to alleviate tension and stress. The authors also wrote that the man’s “aberrant behavior also seemed to serve as a means to exert pressure on psychosocial workers. Other deviations included the pushing of sharp objects under the skin and multiple paraphiliae. As a child, the patient suffered from early psychological and physical traumatization. Both parents were allegedly physically abusive alcoholics”.

Although very few cases of acuphagia have been reported in the medical literature (particularly in adults), most of these suggest that those displaying the symptoms have psychological and/or psychiatric disorders that may be accompanied by some form of learning disability (except – of course – if the behaviour is part of an ‘entertainment’ act).

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

Further reading

Bansal, S. (2007). Acuphagia. The Medicine Forum, 9, Article 23. Available at: http://jdc.jefferson.edu/tmf/vol9/iss1/23

Halliday, D., & Iroegbu, F. (2007). Case report ‘Acuphagia’ – An adult Nigerian who ingested 497 sharp metallic objects. Editorial Advisory Board, 4(2), 54-59.

Hambidge, K.M., & Silverman, A. (1973). Pica with rapid improvement after dietary zinc supplementation. Archives of Disease in Childhood, 48, 567-568.

Kariholu, P. L., Jakareddy, R., Hemanth Kumar, M., Paramesh, K. N., & Pavankumar, N. P. (2008). Pica – A case of acuphagia or hyalophagia?. Indian Journal of Surgery, 70(3), 144-146.

Klinger, L.G., Dawson, G., & Renner, P. (2003). Autistic disorder. In: E.J. Mash & R.A. Barkley (Eds.), Child Psychopathology, 2nd Edition (pp. 409-454). New York: Guilford Press.

Stiegler, L.N. (2005). Understanding pica behavior: A review for clinical and education professionals. Focus on Autism and Other Developmental Disabilities, 20(1), 27-38.

te Wildt, B. T., Tettenborn, C., Schneider, U., Ohlmeier, M. D., Zedler, M., Zakhalev, R. & Krueger, M. (2010). Swallowing foreign bodies as an example of impulse control disorder in a patient with intellectual disabilities: a case report. Psychiatry (Edgmont), 7(9), 34

Velvet gold mind: Psychopathy, addiction, ECT, and the psychology of Lou Reed

Regular readers of my blog will have no doubt picked up that one of my all time favourite bands is the Velvet Underground (VU) – often referred to as “The Psychopath’s Rolling Stones“. I bought my first VU album on vinyl back in 1980 as a 14-year old adolescent (a 12-track compilation that I still have simply called ‘The Velvet Underground’). When I bought it I had heard very few VU songs on the radio and one of the main reasons I bought it was because a number of my musical heroes at the time (Ian McCulloch the lead singer of the Echo and the Bunnymen being the one I seem to remember) kept listing VU songs in their ‘Top 10 Tracks’ in Smash Hits magazine.

Over time I have steadily accumulated a massive collection of VU and VU-related albums (mainly solo LPs of VU band members, most notably Lou Reed, John Cale, and Nico, as well as dozens and dozens of bootleg LPs). As much as I love the recorded solo outputs of Cale and Nico, it is Lou Reed that I have always found the most psychologically fascinating on both a musical and personal level (even though Cale was admittedly the better musician) – and because of his autobiographical lyrics (many of which were collated in his 1992 book Between Thought and Expression). Reed (along with a few other musicians such as John Lennon, Morrissey, David Bowie, Adam Ant, and Gary Numan) is someone I would love to have interviewed, as he was a psychological paradox and appeared to have so many different facets to his personality. During is early career, Reed was a self-confessed drug addict and wrote songs about both heroin (‘I’m Waiting For The Man‘ and admitting in his song ‘Heroin‘ that it was “my wife and it’s my life”) and amphetamines (‘White Light, White Heat‘). I would also argue that in later life he replaced these negative addictions with what Bill Glasser defined as a ‘positive addiction‘ in the form of t’ai chi ch’uan (i.e., tai chi).

In the 1960s and early 1970s, Reed’s lyrics covered topics that shocked many people. His song lyrics recounted life’s misfits and those that lived on the fringes (particularly of the life he had himself experienced in New York and as part of pop artist Andy Warhol’s entourage). His world was one of drug addiction, transvestite drag queens, bisexuality, and sado-masochism. Like many of the best and most literary writers, he wrote about what he knew and had experienced. As Reed himself pointed out many times, the subject matter of his songs were no different from his literary heroes such as Edgar Allen Poe, Hubert Selby Jr., William Burroughs, and Delmore Schwartz. Sex and drugs were common themes in novels and poetry. Reed wondered why listeners and rock critics alike were so horrified by the content of his songs when the same content could be found in books from the 1950s and early 1960s.

Reed was a much feared interviewee by music journalists and often poured vitriol on many rock critics (Lester Bangs and Robert Christgau being the most high profile). Just listen to his 1978 live LP Take No Prisoners that is remembered more for the acerbic monologues in between the songs than for the music. Although I would have loved to interview him, his experiences with psychologists and psychiatrists arguably left him emotionally scarred for life (or at the very least a deep mistrust of therapists). His affluent parents sent him for weekly sessions of electroconvulsive therapy (ECT) as a young teenager to “cure” him of his homosexual desires and urges. It had such a negative impression on him that he documented the experiences on his song ‘Kill Your Sons’ (from his 1974 LP Sally Can’t Dance). As he was quoted as saying in Legs McNeil and Gillian McCain’s 1996 book Please Kill Me:

“They put the thing down your throat so you don’t swallow your tongue, and they put electrodes on your head. That’s what was recommended in Rockland State Hospital to discourage homosexual feelings. The effect is that you lose your memory and become a vegetable”

Up until the ECT session, Reed appeared to have lead a relatively trouble-free childhood (although there were admittedly some juvenile delinquent activities). The ECT sessions may have been the catalyst that far from ‘curing’ him of his sexual urges confused the issue even more. Reed was more explicit in the lyrics to ‘Kill Your Sons’ about the whole experience of ECT and what he thought about it:

“All your two-bit psychiatrists are giving you electro shock/They say, they let you live at home, with mom and dad/Instead of mental hospital/But every time you tried to read a book/You couldn’t get to page 17/’Cause you forgot, where you were/So you couldn’t even read/Don’t you know, they’re gonna kill your sons”.

I have read almost every biography that has ever been published on Reed and there appears to be an almost unconscious pathological need to subvert the traditional rock cycle treadmill of fame and success. There is no doubt that Reed wanted to be respected and remembered for his literary writing – but many of his decisions and actions were self-defeating. In my own field of gambling, the psychologist Edmund Bergler speculated that addicted gamblers have an ‘unconscious desire to lose’ – a form of psychic masochism. If Reed was on Bergler’s couch, he may have come to the same conclusion about Reed.

There are so many points in Reed’s life where he appeared to deliberately sabotage his own career and commit what others have described ‘artistic suicide’. For instance, after David Bowie had befriended him in the early 1970s and produced his first hit LP (Transformer) and biggest hit (‘Walk On The Wild Side’), he fell out with Bowie and recorded what a number of rock critics have described as “the most depressing album of all time” (the 1973 LP Berlin). He then seemed to get his career back on course with his one and only top 10 US album (1974 LP Sally Can’t Dance) only to follow it up with the album consisting of four tracks of guitar feedback each 16 minutes in length (1975 album Metal Machine Music). James Wolcott writing for the Village Voice went as far as to say that  Metal Machine Music “crowned Reed’s reputation as a master of psychopathic insolence”. Although both “career killing” LPs have since been hailed as masterpieces in their own way, both releases provide an argument that Reed was a masochist on some level even if the original pain didn’t become pleasure until 30 years later.

The arguably self-inflicted pain didn’t end with his musical output. Almost every important person he looked up to in his life between 1964 and the early 1990s were cast aside and verbally and/or physically abused by Reed at some point. This included his managers (e.g., Andy Warhol, Steve Sesnick, Dennis Katz), his admirers and benefactors (e.g., David Bowie), his record company senior executives (e.g., Clive Davis), his lovers (e.g., Shelly Albin, Nico, Bettye Kronstad, Sylvia Morales, “Rachel” [Tommy] Humphries), and his musical collaborators (e.g., John Cale, Doug Yule, Robert Quine).

Some people have claimed Reed was almost psychopathic in some of his actions. The criminal psychologist Professor Robert Hare developed the Revised Hare Psychopathy Checklist (PCL-R), a psychological assessment that determines whether someone is a psychopath.

At heart, Hare’s test is simple: a list of 20 criteria, each given a score of 0 (if it doesn’t apply to the person), 1 (if it partially applies) or 2 (if it fully applies). The list in full is: glibness and superficial charm, grandiose sense of self-worth, pathological lying, cunning/manipulative, lack of remorse, emotional shallowness, callousness and lack of empathy, unwillingness to accept responsibility for actions, a tendency to boredom, a parasitic lifestyle, a lack of realistic long-term goals, impulsivity, irresponsibility, lack of behavioural control, behavioural problems in early life, juvenile delinquency, criminal versatility, a history of ‘revocation of conditional release’ (i.e., broken parole), multiple marriages, and promiscuous sexual behaviour. A pure, prototypical psychopath would score 40. A score of 30 or more qualifies for a diagnosis of psychopathy”

Personally, I think there are psychopathic traits in almost any person with a successful career, and Reed (from the many biographies I have read) would certainly endorse some of the indicators in the list above. However, as he (i) became older, (ii) became teetotal and drug-free, (iii) studied Buddhist philosophy (including meditation and tai chi), and (iv) settled down and married performance artist and musician Laurie Anderson, he arguably became happier and produced some of the best music of his career.

The trio of ‘concept’ albums including his ‘warts ‘n’ all’ tribute to his home city (New York, 1989), his moving tribute to Andy Warhol (Songs for Drella, 1990, with John Cale), and his lyrical musings on illness, death and dying (1992, Magic and Loss) were all critically lauded (and among my own personal favourites). Songs for Drella (the VU’s nickname for Andy Warhol – a contraction of the names Cinderella and Dracula) is not just one of Reed’s best albums but it’s one of the best LP’s ever. The fact that the songs were heartfelt and full of remorse for the way Reed had treated Warhol in the latter years of his life, suggest that the characterization of Reed as a psychopath is unfair.

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

Further reading

Bockris, V. (1994). Lou Reed: The Biography. London: Hutchinson.

Bockris, V. & Malanga, G. (1995). Up-tight – The Velvet Underground Story.London:Omnibus Press.

Doggett, P. (1991). Lou reed – Growing Up in Public. London: 
Omnibus Press.

Glasser, W. (1976), Positive Addictions. New York, NY: Harper & Row.

Henry, T. (1989), Break All Rules! Punk Rock and the Making of a Style, Ann Arbour MI: UMI Research Press.

Hare, R. D., & Vertommen, H. (2003). The Hare Psychopathy Checklist-Revised. Multi-Health Systems, Incorporated.

Heylin, C. (2005). All Yesterday’s Parties – The Velvet Underground In Print 1966-1971. Cambridge, MA: Da Capo Press.

Hogan, P. (2007). The Rough Guide To The Velvet Underground. London: Penguin.

Jovanovich, R. (2010). The Velvet Underground – Peeled. Aurum Press.

Kostek, M.C. (1992). The Velvet Underground Handbook
. London: 
Black Spring Press.

McNeil, Legs; McCain, G. (1996). Please Kill Me: The Uncensored Oral History of Punk. London: Grove Press.

Muggleton, D. & Weinzierl, R. (2003). The Post-subcultures Reader. Oxford: Berg.

Reed, L. (1992). Between Thought and Expression. 
London: Penguin Books.

Wall, M. (2013). Lou Reed: The Life. Croydon: Orion Books.

Men of steal: A brief look at the psychology of shoplifting

In previous blogs I have examined activities like shopping as an addiction. One similar such behaviour is shoplifting. I have to admit that from a personal perspective I came from a family where at least two of my siblings were regular shoplifters and were both regularly caught by shop staff members and reported to the police. As a teenager, my brother was a habitual shoplifter. His behaviour was economically motivated at the start (i.e., we came from a very poor and impoverished family and he stole things because he couldn’t afford to buy things that his friends had) but was later carried out to help feed his addiction to slot machines (i.e., he would steal shop items, sell them, and use the money to gamble). This latter behaviour is common among adolescent gamblers and I have written about this in both of my published books on adolescent slot machine addiction as well as in a number of my published papers.

Last week, one of my regular blog readers, forensic psychologist Dr. John C. Brady, sent me a copy of his latest book Why Rich Women Shoplift – When They Have It All. It’s an engrossing and fascinating read (I sat an read it all in one sitting) and there are many references throughout to seeing some forms of shoplifting as an addiction. I will return to this topic in a future blog (along with a look at the related behaviour of kleptomania) but I thought I would use today’s blog to talk about something very specific in Dr. Brady’s book.

One of the many interesting things I read was Brady’s classification of 16 different types of shoplifters with seven underlying psychological dimensions. The classification included those that are (i) impulse driven (The Externalizer; The Compulsive; The Atypical Shoplifter), (ii) psychologically motivated (The Kleptomaniac; The Thrill Seeker; The Trophy Shoplifter; The Binge-Spree Shoplifter; The Equalizer; The Situational Shoplifter), (iii) economically influenced (The Professional; The Impoverished [Economically Disadvantaged] Shoplifter), (iv) age determined (The Provisional/Delinquent Shoplifter), (v) alcohol and substance connected (The Drug or Alcohol Addict), (vi) mentally/medically impaired (The Alzheimer’s Sufferer/Amnesiac; The Chemically/Alcohol Driven Shoplifter), and (vii) no identifiable psychosocial drivers (The Inadvertent/Amateur Shoplifter). Brady acknowledges that the typology is purely descriptive, not exhaustive and was not developed to be mutually exclusive. Here is a brief description of the 16 types:

  • The Externalizer: These are people who feel that they are not in control of their lives (“controlled by outside forces that serve as negative psychological drivers, lowering their moral threshold”) and have an external locus of control. Brady argues that shoplifting simply channels to express anger or help legitimize their personal aggression. All of Brady’s rich women that shoplift fit this particular profile.
  • The Compulsive: From the descriptor, it is self-evident that this type of shoplifts as a compulsive behaviour and may also engage in other types of addictive behaviour such as gambling addiction and shopping/buying addiction. According to Brady they are generous individuals but do not care about themselves. When they are caught shoplifting they are full of remorse (and only feel good during or just after the shoplifting incident) but simply cannot resist the urge to shoplift.
  • The Atypical Shoplifter: This type of shoplifter is based on the work of Dr. Will Cupchik and described in his 2011 book Why Honest People Shoplift or Commit Other Acts of Theft: Assessment and Treatment of ‘Atypical Theft Offenders. Brady describes such people as not shoplifting for any kind of personal economic gains. Such people claim they had no idea why they engaged in shoplifting except to say that it wasn’t economically motivated.
  • The Kleptomaniac: Like atypical shoplifters, kleptomaniacs also steal and shoplift for no apparent reason (and do so impulsively). Many people may have the impression that most shoplifters are kleptomaniacs but as Brady is keen to point out, only 5% of shoplifters are kleptomaniacs. Brady claims this category is the most controversial although the classification in the Diagnostic and Statistical Manual of Mental Disorders (correctly) classes kleptomania as an impulse-control disorder and the behaviour is not carried out as an expression of anger or vengeance. (Dr. Brady spends a whole chapter in his book explaining why the DSM classification of kleptomania is poor).
  • The Thrill Seeker: Brady describes this group of people (typically adolescents) as a “higher risk shoplifter” who shoplift for the intrinsic excitement of carrying out an illegal behaviour. They may also shoplift as part of a dare simultaneously with other shoplifters. Brady claims that shoplifting for thrill seekers gives them a sense of autonomy (and that the goal is “psychological overcompensation” for individuals that may have a history of failure in the lives).
  • The Trophy Shoplifter: Brady claims there have been an increasing number of cases of trophy shoplifters reported in the media. Citing Terence Shulman (who also wrote the Foreword for Brady’s book), Brady quotes from Cluttered Lives, Empty Souls – Compulsive Stealing, Spending and Hoarding (Shulman’s 2011 book) and says trophy shoppers “tend to need to have the best of everything: they seek out that perfect object, be it fashion, art, car, etc. – the more special, unique, or rare, the better”. To me, this behaviour appears to be a by-product of being an ardent collector, and Brady does go on to say there is a “direct connection” between a collector and a trophy shoplifter.
  • The Binge-Spree Shoplifter: According to Brady, binge-spree shoplifters are typically adolescents (but may carry on as an adult) where the person shoplifts in a short bout of thefts arising from a combination of weak impulses and doing it to impress their peers (i.e., or as Brady terms it “subcultural recognition”). Like binge drinking and binge gambling, the behaviour occurs in short specific bouts followed by appreciable periods of abstinence.
  • The Equalizer: This category of shoplifter arose from some of Brady’s own case studies. Some of the shoplifters he interviewed felt that over the course of their lives, many things (both real and perceived) had been taken from them and that shoplifting was “retaliatory justification” for such past events. Brady also described such individuals as going through their lives with “a good-size chip on their shoulders” and who are agitated, edgy and resistant to treatment.
  • The Situational Shoplifter: Brady describes the situational shoplifter as an opportunist that steals on the spur of the moment after seeing an item that has some kind of appeal to them. The process itself was described by Brady as “almost unconscious”. In many ways, the motivation is similar to the compulsive shoplifter but the activity is much more likely to be done on a very occasional basis.
  • The Professional: Professional shoplifters are very simply those that steal (often expensive “high-end”) items for profit. A number of television shows in the UK have profiled such people and as Brady points out, this type of shoplifter shows no remorse if caught and will often try to resist arrest.
  • The Impoverished [Economically Disadvantaged] Shoplifter: Like the professional shoplifter, the motivation to steal is economically motivated but is done out of necessity rather than for profit and/or greed. Items stolen may be basic necessities (food, toiletries, nappies, etc.) and when caught such people may show remorse (however, according to Brady they are hostile towards the “system” that has led to them being economically disadvantaged).
  • The Provisional/Delinquent Shoplifter: This type of shoplifter is usually an adolescent delinquent that shoplifts as part of a wider group of antisocial behaviours in their “troubled teens”. There appears to be some crossover with thrill seeking shoplifters and binge-spree shoplifters as there are elements of both hedonism and peer pressure associated with the criminal act. The good news is that many teens appear to mature out of such behaviour.
  • The Drug or Alcohol Addict: This type of shoplifter engages in shoplifting behaviour to support their addictive habit (and as such – and as Brady acknowledges – could technically be in the ‘economically influenced’ category of shoplifters. Brady claims they often take high risks and will try to steal as many items as quickly as possible and then run out of the shop. According to Brady, pre-planning is almost non-existent.
  • The Alzheimer’s Sufferer/Amnesiac: This group of shoplifters includes those with severe memory problems and who simply walk out of shops without paying simply because they forgot and/or didn’t realize they hadn’t paid. Brady claims that this group of shoplifters is arguably the fastest growing group as we live in a society where the average age of dying is increasing all the time.
  • The Chemically/Alcohol Driven Shoplifter: Brady claims that this group of shoplifters is distinct from drug and alcohol addicts because the shoplifting is not economically motivated and occurs because they are in an altered state of awareness (due to the psychoactive effects of the substances ingested). As Brady notes, their “mental state typically involves such symptoms as confusion, psychomotor agitation, memory lapse, disorientation, nervousness, and perceptual disturbance” (especially those high on cocaine or meth). From a public safety perspective, the police claim that it is these individuals that pose the biggest threat.
  • The Inadvertent/Amateur Shoplifter: This final category refers to those without any kind of psychological or physiological disorder who simply “forget to pay” for an item. People may not even realize for some considerable time after that they didn’t pay for the item(s) and it is then up to the person’s conscience as to whether they return the “stolen” items.

I think this typology is intuitive and covers almost all the types of shoplifter that I can think of. I say ‘almost’ as my own brother’s late teenage shoplifting behaviour would not be included in any of the 16 types listed here. However, the ‘drug/alcohol addict’ category could be widened to ‘chemical or behavioural addict’ and then he would be able to be included.

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

Further reading

Brady, J.C. (2013). Why Rich Women Shoplift – When They Have It All. San Jose, CA: Western Psych Press.

Cupchick, W. (1997). Why Honest People Shoplift or Commit Other Acts of Theft: Assessment and Treatment of ‘Atypical Theft Offenders. Toronto: Tagami Communication.

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

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

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

Griffiths, M.D. (in press). Gambling and crime. In W.G. Jennings (Ed.), The Encyclopedia of Crime and Punishment. London: Sage.

Griffiths, M.D. & Sparrow, P. (1996). Funding fruit machine addiction: The hidden crime. Probation Journal, 43, 211-213.

Shulman, T.D. (2011). Cluttered Lives, Empty Souls – Compulsive Stealing, Spending and Hoarding. West Conshohocken, PA: Infinity Publishing.

Yeoman, T. & Griffiths, M.D. (1996). Adolescent machine gambling and crime. Journal of Adolescence, 19, 99-104.

That’ll do icily: A brief look at pagophagia

In a previous blog on five ‘weird addictions’ I briefly mentioned pagophagia, a craving and compulsion for chewing ice. Pagophagia is a type of pica (which I also covered in a previous blog). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Although the incidence of pagophagia appears to have increased over the last 30 years in westernized cultures, Dr. B. Parry-Jones (in a 1992 issue of Psychological Medicine) carried out some historical research and pointed out that both Hippocrates and Aristotle wrote about the dangers of excessive intake of iced water. Parry-Jones also noted that references to disordered eating of ice and snow were also recorded in medical textbooks from the sixteenth century. However, the first contemporary reference to pagophagia appears to have been a 1969 paper by Dr. Charles Coltman in the Journal of the American Medical Association entitled ‘Pagophagia and iron lack’.

Pagophagia is closely associated with iron deficiency anemia but can also be caused by other factors (biochemical, developmental, psychological, and/or cultural disorders). If pagophagia is due to iron deficiency (such as case studies of those with sickle cell anemia), it may sometimes be accompanied by fatigue (e.g., being tired even when performing normally easy tasks). Dr. Youssef Osman and his colleagues published a number of case reports of pagophagia in a 2005 issue of the journal Pediatric Haematology and Oncology including the case of a child with sickle cell anemia and rectal polyps (that caused a lot of bleeding and made the anemia worse):

“An 8-year-old Omani boy, a known case of sickle cell anemia…presented with history of craving for ice. The child was noticed over the last 4 months to like drinking very cold water and to open the deep freezer and scratch the ice and eat it. The parents tried to stop him from doing so, but they failed…The child was started on oral iron therapy…and his craving for ice was completely stopped. Meanwhile, the rectal polyp was removed surgically”.

Other potential health side effects include constant headaches (a ‘brain freeze’ similar to ‘ice cream headache’) and teeth damage although this is thought to be relatively rare. However, a recent paper by Dr. Yasir Khan and Dr. Glen Tisman in the Journal of Medical Case Reports highlighted the case of a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water.

Khan and Tisman also suggested that some people who are deficient in iron experience tongue pain and glossal inflammation (glossitis). Others claim that chewing ice may help those with stomatitis (i.e., inflammation of the mucous lining inside the mouth). A recent 2009 case study published by Dr. Tsuyoshi Hata and his colleagues in the Kawasaki Medical Journal, reported the case of a 37-year old Japanese women who ate copious amounts of ice to relieve the pain of temporomandibular joint disorder (i.e., chronic pain in the joint that connects the jaw to the skull). Khan and Tisman also claim that the classical symptoms of pagophagia have changed in the last 40 years since Dr. Coltman’s initial paper in the Journal of the American Medical Association.

“This may probably be the result of advances in technology and changes in culture. When initially described [by Coltman], pagophagia was defined as the excessive ingestion of ice cubes from ice trays and the ingestion of ice scraped from the wall of the freezer. With the advent of ice cube makers and auto defrosters, the presentation of pagophagia has changed in a subtle manner as described in…our patients. Now we observe a subtler ingestion and/or sucking of ice cubes from large super-sized McDonalds-like cups and from the use of popular bottled water containers that have been frozen”.

There have been few epidemiological studies examining the prevalence of pagophagia. Such estimates vary widely within particular populations but (according to Dr. Youssef Osman and his colleagues) have been shown to be more common in low socioeconomic and underdeveloped areas. Pagophagia is thought to be relatively harmless in itself or to one’s health, although there are some claims in the literature that pagophagia can be addictive. However, empirical reviews suggest that pagophagia (and pica more generally) is part of the obsessive-compulsive disorder spectrum of diseases. As a consequence, some case studies even suggest that ice chewing compromises their ability to maintain jobs or personal relationships.

Treatment for pagophagia can often be overcome with iron therapy and Vitamin C supplements (to supplement iron deficiency if that is the cause). For instance, Dr. Mark Marinella in a 2008 issue of the Mayo Clinic Proceedings successfully treated a 33-year old woman with pagophagia following complications with gastric bypass surgery:

“The patient received red blood cells, iron sucrose, and levofloxacin. On further questioning, the patient denied taking vitamin, mineral, or iron supplements since surgery and reported prolonged, heavy menstrual cycles. She consumed large amounts of ice daily for several months. The patient’s husband frequently observed her in the middle of the night with her head in the freezer eating the frost off the icemaker. The patient admitted to awakening several times nightly for months with an uncontrollable compulsion to eat the frost on the icemaker. This craving resolved after transfusion and iron administration”

However, if the condition is psychologically or culturally based, iron and vitamin supplements are unlikely to work, and other psychological treatments (such as cognitive-behavioural therapy) are likely to be employed.

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

Further reading

Coltman, C.A. (1969). Pagophagia and iron lack. Journal of the American Medical Association, 207, 513-516.

de Los Angeles, L., de Tournemire, R. & Alvin, P. (2005). Pagophagia: pica caused by iron deficiency in an adolescent. Archives of Pediatrics, 12, 215-217.

Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemadej, U.J., Cole, O.J., Westney, O.E., Jones, S. Laryea, H. & Westney, L.S. (1994). Pica in an urban environment. Journal of Nutrition (Supplement), 124, 954-962.

Hata, T., Mandai, T., Ishida, K., Ito, S., Deguchi, H. & Hosoda, M. (2009). A rapid recovery from pagophagia following treatment for iron deficiency anemia and TMJ disorder accompanied by masked depression. Kawasaki Medical Journal, 35, 329-332.

Khan, Y. & Tisman, G. (2010). Pica in iron deficiency: A case series. Journal of Medical Case Reports, 4, 86. Located: http://www.jmedicalcasereports.com/content/4/1/86

Kirchner, J.T (2001). Management of pica: A medical enigma. American Family Physician, 63, 1177-1178.

Marinella, M. (2008). Nocturnal pagophagia complicating gastric bypass. Mayo Clinic Proceedings, 83, 961

Osman, Y.M., Wali, Y.A. & Osman, O.M. (2005). craving for ice and iron-deficiency anemia: a case series. Pediatric Hematology and Oncology, 22, 127-131.

Parry-Jones, B. (1992). Pagophagia, or compulsive ice consumption: A historical perspective. Psychological Medicine, 22, 561-571.

I drink, therefore I am: A brief look at alcohol dependence in Great Britain

Alcohol dependence is often viewed as a cluster of behavioural, cognitive, and physiological phenomena that in most affected people includes a strong desire to consume alcohol, and have difficulties in controlling their drinking. According to a 2013 report by Alcoholics Anonymous, alcoholism kills more people in the UK than any other drug apart from nicotine. Based on Government statistics, they claim one adult in every 13 is alcohol-dependent (although this is much higher than data collected from the most methodologically robust studies – see below). The General Household Survey (GHS) and the General Lifestyle Survey (GLF) have been measuring drinking behaviour for over 30 years. In relation to alcohol use, the latest 2013 Office for National Statistics (ONS) report notes that:

“The Department of Health estimates that the harmful use of alcohol costs the National Health Service around £2.7bn a year and 7% of all hospital admissions are alcohol related. Drinking can lead to over 40 medical conditions, including cancer, stroke, hypertension, liver disease and heart disease. Reducing the harm caused by alcohol is therefore a priority for the Government and the devolved administrations. Excessive consumption of alcohol is a major preventable cause of premature mortality with alcohol-related deaths accounting for almost 1.5% of all deaths in England and Wales in 2011”.

The ONS notes that obtaining reliable data on drinking behaviour is difficult. Compared to national alcohol sales, surveys carried out by social scientists consistently record lower levels of how much alcohol they consume because participants may consciously and/or unconsciously be underestimating alcohol consumption (e.g., alcohol use in the home may be based on the number of glasses of wine drunk with the amount poured into the glass being much greater than a standard unit of alcohol). In the most recent 2013 report (based on data collected in 2011), participants were asked two questions about their alcohol consumption. These were (i) maximum amount of alcohol drunk on any one day in the previous seven days, and (ii) average weekly alcohol consumption. The survey also obtained three measures of maximum daily alcohol consumption.

  • Exceeding the recommended daily alcohol limit. This measure assessed the proportion of men and women exceeding the recommended units of alcohol on their heaviest drinking day (i.e. 4 units for men, 3 units for women).
  • Engaging in binge drinking (i.e., intoxication). This measure assessed the proportion of men and women who exceeded the number of daily units considered as intoxicating (i.e., 8 units for men, 6 units for women).
  • Engaging in heavy drinking. This measure assessed the proportion of men and women who drank more than three times the recommended daily units of alcohol (i.e., more than 12 units for men and more than 9 units for women).

The results indicated that:

  • Over half of all adults (59%) reported that they had consumed alcohol in the week prior to the survey.
  • Men (66%) were more likely than women (54%) to have had an alcoholic drink in the week before the survey
  • More men (16%) drank on at least five out of seven days than women (9%) in the week prior to the survey.
  • Almost one in ten men (9%) drank alcohol every day in the week prior to the survey compared to only one in twenty women (5%).
  • More men (34%) exceeded the daily recommended units of alcohol than women (28%).
  • More men (18%) were binge alcohol drinkers than women (12%)
  • More men (9%) were heavy drinkers than women (6%)
  • Heavy drinking was most prevalent in those aged 16 to 44 years
  • Drinking alcohol was also associated with smoking nicotine with smokers being more likely to be binge drinkers and heavy drinkers.

Another major report on alcohol use in England was recently published by the Lifestyle Statistics, Health and Social Care Information Centre (in 2013). Their analyses were mainly obtained from the Health and Social Care Information Centre (HSCIC), Hospital Episodes Statistics (HES), and prescribing data. They reported that:

  • 61% of men and 72% of women had either drunk no alcohol in the last week, or had drunk within the recommended levels on the day they drank the most alcohol.
  • 64% of men drank no more than 21 units weekly, and 63% of women drank no more than 14 units weekly.
  • 12% of school pupils had drunk alcohol in the last week. This continues a decline from 26% in 2001, and is at a similar level to 2010, when 13% of pupils reported drinking in the last week.
  • In 2011/12, there were 200,900 admissions to English hospitals where the primary diagnosis was attributable to alcohol consumption (a 1% increase on the previous year).
  • In 2011/12, there were an estimated 1,220,300 admissions to English hospitals related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis (an increase of 4% on the previous year).
  • In 2012, there were 178,247 prescription items prescribed for the treatment of alcohol dependence in primary care settings or NHS hospitals and dispensed in the community (an increase of 6% on the previous year).

Arguably the most robust data on alcohol dependence in the UK comes from the 2009 Adult Psychiatric Morbidity Survey (APMS) carried out by the National Centre for Social Research and University of Leicester. Alcohol problems (including alcohol dependence) were measured using the AUDIT (Alcohol Use Disorders Identification Test) and the SADQ-C (Severity of Alcohol Dependence Questionnaire, community version). An AUDIT score of eight or more indicated hazardous drinking, and 16 or more indicated harmful drinking. SADQ-C scores of 4-19 indicated mild dependence; 20-34, moderate dependence; 35 or more, severe dependence.

Using the AUDIT, the prevalence of hazardous drinking was 24.2% (33.2% males, 15.7% females). A total of 3.8% of adults (5.8% males, 1.9% females) drank alcohol at harmful levels, i.e., around 1 in 25 adults. Among males, the highest prevalence of both hazardous and harmful drinking was in 25-34 year olds, whereas in females it was in 16 -24 year olds. Using the SADQ-C, the prevalence of alcohol dependence was 5.9% (8.7% males, 3.3% females), i.e., around 1 in 16 adults. For males, the highest levels of dependence were identified in those between the ages of 25-34 years (16.8%), whereas for females it was between the ages of 16-24 years (9.8%). Most of the recorded dependence levels were mild (5.4%), with relatively few adults showing symptoms of moderate or severe dependence (0.4% and 0.1% respectively). Compared to the previous APMS survey in 2000, the prevalence of alcohol dependence was lower for males in 2007, whereas it remained at a similar level for females.

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

Further reading

Lifestyle Statistics, Health and Social Care Information Centre (2013). Statistics on Alcohol: England, 2013. Located at: https://catalogue.ic.nhs.uk/publications/public-health/alcohol/alco-eng-2013/alc-eng-2013-rep.pdf

National Centre for Social Research/University of Leicester (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. London: NHS Information Centre

Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.

Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

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