Category Archives: Psychiatry

Coming to a head-ache: A brief look at coital cephalalgia

“Not tonight dear, I’ve got a headache” is a staple (and somewhat stereotypical) phrase typically used by women in various television sitcoms to politely turn down their husband’s sexual advances. However, there is a small minority of individuals where sexual activity can actually trigger headaches (known in the clinical and medical literature as ‘coital cephalalgia’ and ‘benign coital headache’) often occurring at the brink of orgasm. (Here, the term ‘benign’ defines a primary headache syndrome not caused by any intracranial disorder). Often characterized by sufferers as a “severe pain behind the eyes” it can be short-term or long-lasting (up to days in extreme cases), and can affect both sexes across the age spectrum. According to the National Headache Foundation, around 1 in 5 women and 1 in 20 men experience “exertional headaches” (i.e., headaches caused by increased blood pressure in the brain that typically occurs during exercise). Such exercise can in a minority of cases include sexual activity.

One of the earliest recorded cases of coital cephalalgia – at least one of the earliest I found when I did an online literature search – was published in a 1974 issue of the Irish Journal of Medical Science by Dr. Edward Martin. He published six case studies of a benign syndrome of recurrent headache during sexual intercourse”. For instance, one of his cases was a 42-year old male engineer that claimed he suffered migraine headaches during sex (lasting from 10 to 60 minutes). It first occurred just two weeks after marrying his wife and then carried on at regular intervals. The headache always occurred “abruptly at the onset of orgasm”. After about a year, the headaches subsided to the point where they were only occasional. (Other articles I have read say that the first paper published on this topic was by Dr. J.W. Lance who wrote a paper entitled ‘Headaches related to sexual activity’ in the Journal of Neurology, Neurosurgery, and Psychiatry. However, that paper was published two years after the one by Dr. Martin). Another early paper published by Dr. M. Porter and Dr. J. Jankovic, in a 1981 issue of the Archives of Neurology reported eight cases of benign coital cephalalgia (BCC), “an acute headache that is time related to sexual intercourse” (and a variant of migraine). The authors reported that all eight sufferers were successfully treated with propranolol hydrochloride.

In a 1988 issue of Cephalalgia, Dr. J.M. Martinez and his colleagues reported three cases of benign coital cephalalgia (all of who had a history of migraine). Comparing their own cases with those that had previously been published, they concluded that such sex-related headaches may have resulted from heart problems (“ischaemic disturbances”) triggered by “haemodynamic changes occurring in orgasm”. There is also some evidence that the condition may have a partly genetic basis as a 1986 paper By Dr. D.R. Johns in the Archives of Neurology reported four cases of benign sexual headache (BSH) in four sisters from the same family. He reported the most severely affected of the sisters was successfully treated with propranolol hydrochloride (as reported above), and that BSH was a variant of migraine.

In a 2005 review paper by Polish medic Dr. I. Domitrz, I. (published in the journal Ginekologia Polska) on primary headaches associated with sexual activity], it was noted that BCH was rare and that:

“The pathogenesis of this type of headache remains unknown. Clinical manifestation is typical and connected with three phases of sexual activity. Coital cephalalgia is divided into two subtypes: preorgasmic and orgasmic headache. Some authors specify the third type–postural type. Preorgasmic headache starts as a dull bilateral ache and increases with sexual excitement. Orgasmic headache has sudden, intense character and occurs at orgasm. Postural headache has been reported to develop after coitus”.

In a 1992 issue of the journal Cephalalgia, Danish doctors Dr. J.R. Østergaard and Dr. M. Kraft studied the natural history of patients with a diagnosis of benign coital headache (BCH) that presented themselves for treatment in their clinic over a 13-year period (1978-1991). Of the 32 patients that had been treated for BCH, 26 of them participated in their follow-up study. They reported that 13 patients (50% of their sample) had recurrent attacks of coital headaches separated by intervals of up to 10 years. Of these 13, eleven of them “suffered a concomitant primary headache whereas this was present in only one of those patients without recurrent attacks of coital headache”. Apart from one patient who suffered blurred vision, the headaches were not too severe as there were no reports of vomiting, visual disturbances, sensory/motor disturbances, or unconsciousness. The paper concluded that BCH can clearly be “distinguished from headaches due to cerebral aneurysm or arteriovenous malformation rupture. The presence of a concomitant primary headache syndrome is a risk-factor for recurrence of coital headache”.

Arguably the most well known researcher in the field of sexual headaches is the German Dr. Achim Frese who has published a whole series of papers with his team on the topic. In a 2005 review paper in the journal Practical Neurology, Frese and his colleague Dr. Stefan Evers noted that:

“The frequency of headache associated with sexual activity is unknown. In the only population-based epidemiological study, the lifetime prevalence was about 1% with a wide confi dence interval, similar to the frequency of benign cough headache and benign exertional headache (Rasmussen & Olesen 1992). Very likely, the frequency is underestimated because patients often feel too embarrassed to report intimate details about their sexual activities. We estimate that patients with headache associated with sexual activity account for about 1% of all headache patients who are referred to our supraregional headache clinics”.

In 2003, Frese and colleagues examined the demographic and clinical features of headaches associated with sexual activity (HSA) in the journal Neurology. Between Over a five-year period (1996-2001), they interviewed 51 patients with the diagnosis of HAS. The average age of onset was just under 40 years of age and there were approximately three times more males with HSA. They also reported that 11 of their participants had HSA type 1 (i.e., dull subtype), which gradually increased with increasing sexual excitement. The remaining 40 participants had HSA type 2 (i.e., explosive subtype). There were no participants with HSA type 3 (i.e., postural subtype). HSA wasn’t dependent on any specific sexual habits and most often occurred during sexual activity with their usual partner (94%) and during masturbation (35%). There were no differences between HSA types 1 and 2 in relation to demographic factors, clinical features, or comorbidity, except for a higher probability of stopping the attack by breaking off sexual activity in HSA type 1.

In 2007, Frese and his colleagues published a paper in the journal Cephalagia looking at the prognosis and treatment of HSA. In this study they followed up 60 HSA cases in an eight-year period (1996-2004). Of the 45 cases that had experienced just single attacks prior to baseline examination, the vast majority (n=37) had no further attacks. The most effective treatment was the use of beta-blockers. They also reported that:

“Seven patients suffered from at least one further bout with an average duration of 2.1 months. One patient developed a chronic course of the disease after an episodic start. Of the 15 patients with chronic disease at the first examination, seven were in remission and five had ongoing attacks at follow-up…Episodic HSA occurs in approximately three-quarters and chronic HSA in approximately one-quarter of patients. Even in chronic HAS, the prognosis is favourable, with remission rates of 69% during an observation period of 3 years”.

In an earlier 2003 paper (also in the journal Cephalgia), Frese and colleagues examined the cognitive processes of people with type 2 HSA (i.e., the explosive subtype) by measuring event-related potentials (ERPs). They measured visual ERPs in 24 individuals with HSA outside the headache period. These individuals were then compared to a control group (age- and sex-matched). They found that those with HSA type 2 have a loss of cognitive habituation as measured by ERP and that their ERP patterns were very similar to that in observed migraine sufferers.

Earlier this year, Frese and colleagues published an observational study in the journal Cephalagia examining whether having sex could actually alleviate headaches (including migraines). From their previous research, they noted that headaches associated with sexual activity were well-known but that some case reports in the literature suggest that sexual activity during a headache might relieve the pain (in at least some patients). The research team sent a questionnaire to 800 migraine patients and 200 patients with other kinds of headache (called ‘cluster’ headaches). The paper reported that:

“In migraine, 34% of the patients had experience with sexual activity during an attack; out of these patients, 60% reported an improvement of their migraine attack (70% of them reported moderate to complete relief) and 33% reported worsening. In cluster headache, 31% of the patients had experience with sexual activity during an attack; out of these patients, 37% reported an improvement of their cluster headache attack (91% of them reported moderate to complete relief) and 50% reported worsening. Some patients, in particular male migraine patients, even used sexual activity as a therapeutic tool. The majority of patients with migraine or cluster headache do not have sexual activity during headache attacks. Our data suggest, however, that sexual activity can lead to partial or complete relief of headache in some migraine and a few cluster headache patients”

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

Further reading

Chakravarty, A. (2006). Primary headaches associated with sexual activity—some observations in Indian patients. Cephalalgia, 26, 202-207

Domitrz, I. (2005). Primary headache associated with sexual activity]. Ginekologia polska, 76, 995-999

Frese, A., Eikermann, A., Frese, K., Schwaag, S., Husstedt, I. W., & Evers, S. (2003). Headache associated with sexual activity Demography, clinical features, and comorbidity. Neurology, 61, 796-800.

Frese, A., & Evers, S. (2005). Primary headache syndromes associated with sexual activity. Practical Neurology, 5, 350-355.

Frese, A., Frese, K., Ringelstein, E. B., Husstedt, I. W., & Evers, S. (2003). Cognitive processing in headache associated with sexual activity. Cephalalgia, 23, 545-551

Frese, A., Gantenbein, A., Marziniak, M., Husstedt, I. W., Goadsby, P. J., & Evers, S. (2006). Triptans in orgasmic headache. Cephalalgia, 26, 1458-1461

Frese, A., Rahmann, A., Gregor, N., Biehl, K., Husstedt, I. W., & Evers, S. (2007). Headache associated with sexual activity: prognosis and treatment options. Cephalalgia, 27, 1265-1270

 

Hambach, A., Evers, S., Summ, O., Husstedt, I. W., & Frese, A. (2013). The impact of sexual activity on idiopathic headaches: An observational study. Cephalalgia, 33, 384-389

Johns, D. R. (1986). Benign sexual headache within a family. Archives of Neurology, 43, 1158-1160.

Lance, J.W. (1976). Headaches related to sexual activity. Journal of Neurology, Neurosurgery and Psychiatry. 39, 1226-30.

Martin, E. A. (1974). Headache during sexual intercourse (coital cephalalgia). Irish Journal of Medical Science, 143, 342-345.

Martinez, J. M., Roig, C., & Arboix, A. (1988). Complicated coital cephalalgia: three cases with benign evolution. Cephalalgia, 8, 265-268

Ostergaard, J. R., & Kraft, M. (1992). Benign coital headache. Cephalalgia, 12, 353-355

Pascual, J., Iglesias, F., Oterino, A., Vazquez-Barquero, A., & Berciano, J. (1996). Cough, exertional, and sexual headaches An analysis of 72 benign and symptomatic cases. Neurology, 46, 1520-1524

Porter, M. & Jankovic, J. (1981). Benign coital cephalalgia: differential diagnosis and treatment. Archives of Neurology, 38(11), 710-712.

Rasmussen, B.K. & Olesen, J. (1992) Symptomatic and nonsymptomatic headaches in a general population. Neurology, 42, 1225–31.

Silbert, P. L., Edis, R. H., Stewart-Wynne, E. G., & Gubbay, S. S. (1991). Benign vascular sexual headache and exertional headache: interrelationships and long-term prognosis. Journal of Neurology, Neurosurgery and Psychiatry, 54, 417-421

Joystick junkies: A brief overview of online gaming addiction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Palm minimization: An unusual case of Alien Hand Syndrome

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

The national wealth service: Problem gambling is a health issue

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

Token gestures: A brief look at ‘sexual trophy collecting’

Back in 2002, I had a little piece published on excessive collecting behaviour in the Guardian newspaper (‘Addicted to hoarding’). In it I wrote:

“I have always been interested in why we have what seems like an innate ability to collect. I would almost go as far as to say that we are ‘natural born hoarders’. Furthermore, there has been surprisingly little research in this area and Freud’s theories on the topic are unfortunately almost empirically untestable. I would also add that for some people, collecting is at the pathological end of the behavioural continuum. There are some that are (for want of a better word) ‘addicted’ to collecting and there are some with obsessive-compulsive disorders who simply cannot throw away anything”.

Since then I’ve published a few articles on the psychology of collecting in this blog and is probably one of the reasons that I have had a few approaches over the last couple months from journalists asking me about the psychology behind various forms of collecting. (In fact, I’ve also been approached to write an academic chapter on the phenomenon too). Two of the most recent media requests included journalists writing articles on why people collect retro video games (which I hope to write about in a future blog) and another on why people collect ‘sexual trophies’.

I have to admit that I am no expert on sexual trophies so I did a little reading on the topic. According to one definition I came across, a sexual trophy is “any item or piece of clothing gained from a sexual encounter as proof of a successful sexual conquest”. To tie in with the release of US comedy I Just Want My Pants Back, MTV conducted a [non-academic] survey and reported that one in three young British people (aged between 18 and 34 years) admitted to owning some sort of sex trophy with one in six of them (16%) claiming they had two or more sex-based trophies (a group that MTV termed ‘Sexual Magpies’).

However, when it comes to the collecting ‘sexual trophies’, I would argue that most academic research that I have come across on the topic relates to more criminal sexual deviance rather than day-to-day sexual encounters. For instance, in the 2010 book Serial Murderers and Their Victims, Dr. Eric Hickey described the case of man – who was a voyeur – from Georgia (US) that used to break into houses and steal women’s underwear. On his eventual arrest they found over 400 pairs of knickers that he had stolen. More disturbing are cases such as this excerpt from a story in the Daily Telegraph. This is arguably more typical of what I perceive to be sexual trophy hunters:

“A company manager and ‘pillar of the community’ has been exposed after 20 years as a serial sex attacker known as the Shoe Rapist. James Lloyd, 49, a long-standing Freemason who took the footwear of his victims as trophies, was finally caught through advances in DNA techniques. Police later found more than 100 pairs of stiletto shoes hidden behind a trap door at the printing works where he was employed… As well as taking their shoes, he often stole jewellery from the women, mainly in their teens and early 20s, between 1983 and 1986” (Daily Telegraph, July 18, 2006).

However, Dr. Hickey’s book describes even worse acts of sexual trophy collecting. He noted that many serial killers are “known for their habits of collecting trophies or souvenirs. Others have collected lingerie, shoes, hats, and other apparel”. A sizeable section of the book concentrates on the types of serial killers that are popular in the media (such as those that commit ‘lust murders‘) and are the subject of many Hollywood films such as the series of films with (my favourite fictional psychopath) Hannibal Lecter. As Hickey notes:

“These are the rapists who enjoy killing and, often, indulging in acts of sadism and perversion. These are the men who have engaged in necrophilia, cannibalism, and the drinking of victims’ blood. Some like to bite their victims; others enjoy trophy collecting – shoes, underwear, and body parts, such as hair clippings, feet, heads, fingers, breasts, and sexual organs…[and] evoke our disgust, horror, and fascination”.

One of the cases discussed is 1950s US serial killer Harvey Glatman (known in the media as ‘The Lonely Hearts Killer’) who used to take photographs of the women he murdered. Citing the work of Dr. Robert Keppel (another expert in serial murder cases and author of Serial Murder: Future Implications for Police Investigations), Dr. Hickey wrote:

“His photos were more than souvenirs, because in Glatman’s mind, they actually carried the power of his need for bondage and control. They showed the women in various poses: sitting up or lying down, hands always bound behind their backs, innocent looks on their faces, but with eyes wide with terror because they had guessed what was to come”.

Other murderers described by Dr. Hickey included a man that liked to surgically remove (and keep) the eyeballs from his sexual victims (most probably 1990s’ serial killer Charles Allbright) and another that skinned his victims and made lampshades, eating utensils, and clothing. In his overview of necrophilic homicide (i.e., those individuals that kill others in order to engage in sexual activity), Hickey also mentions that such necrosadistic murderers often engage in other paraphilias related to necrophilia “including partialism or the desire to collect specific body parts that the offenders finds sexually arousing. This may include feet, hands, hair, and heads, among others”. Hickey also noted that:

“Another important characteristic of these lust killers was the ‘perversion factor’. This subgroup was often prone to carry out bizarre sexual acts. These acts most commonly included necrophilia and trophy collection. Jerry Brudos severed the breasts of some of his victims and made epoxy molds. Brudos, like others, also photographed his victims in various poses, dressed and disrobed. The photos served as trophies and a stimulus to act out again”.

Later in the book, Dr. Hickey examines the case of Jerry Brudos in more detail (please be warned that some of the things written here may offend those of a sensitive nature):

“At an early age, Jerry Brudos developed a particular interest in women’s shoes, especially black, spike-heeled shoes. As he matured, his shoe fetish increasingly provided sexual arousal. At 17, he used a knife to assault a girl and force her to disrobe while he took pictures of her. For his crime he was incarcerated in a mental hospital for 9 months. His therapy uncovered his sexual fantasy for revenge against women, fantasies that included placing kidnapped girls into freezers so he could later arrange their stiff bodies in sexually explicit poses. He was evaluated as possessing a personality disorder but was not considered to be psychotic…He continued to collect women’s undergarments and shoes. Prior to his first murder, he had already assaulted four women and raped one of them. At age 28, Jerry was ready to start killing…He took [his first victim] to his garage, where he smashed her skull with a two-by-four. Before disposing of the body in a nearby river, he severed her left foot and placed it in his freezer. He often would amuse himself by dressing the foot in a spiked-heel shoe. His fantasy for greater sexual pleasure led him…to strangle [another victim] with a postal strap. After killing her, he had sexual intercourse with the corpse, then cut off the right breast and made an epoxy mold of the organ. Before dumping her body in the river, he took pictures of the corpse. Unable to satisfy his sexual fantasies and still in the grasp of violent urges, he found his third victim…After sexually assaulting her, he strangled her in his garage, amputated both breasts, again took pictures, and tossed her body into the river”.

Arguably the most infamous ‘sexual trophy collector’ was 1980s US serial killer Jeffrey Dahmer, the so-called ‘Milwaukee Cannibal’. In Dr. Hickey’s account he noted that:

“Restraining Dahmer, the officers looked around the apartment and counted at least 11 skulls (7 of them carefully boiled and cleaned) and a collection of bones, decomposed hands, and genitals. Three of the cleaned skulls had been spray-painted black and silver. These were to be part of the shrine fantasized by Dahmer. A complete skeleton suspended from a shower spigot and three skulls with holes drilled into them were found throughout the apartment…Chemicals, including muriatic acid, ethyl alcohol, chloroform, and formaldehyde, were also discovered, along with several Polaroid photographs of recently dismembered young men. A complete human head sat in the refrigerator”.

Another infamous case from the early 1970s (that I admit I had never heard of until I read Dr. Hickey’s book) was Ed Kemper, a cannibalistic killer who also collected human trophies and keepsakes of his victims. Citing the book Hunting Humans by Dr. Elliot Leyton, it was reported that:

“At the age of 23, Ed started killing again, a task that would last nearly a year and entail eight more victims. He shot, stabbed, and strangled them. All were strangers to him, and all were hitchhikers. He cannibalized at least two of his victims, slicing off parts of their legs and cooking the flesh in a macaroni casserole. He decapitated all of his victims and dissected most of them, saving body parts for sexual pleasure, sometimes storing heads in the refrigerator. Ed collected ‘keepsakes’ including teeth, skin, and hair from the victims. After killing a victim, he often engaged in sex with the corpse, even after it had been decapitated. In his confession Kemper stated five different reasons for his crimes. His themes centered on sexual urges, wanting to possess his victims, trophy hunting, a hatred for his mother, and revenge against an unjust society (Leyton, 1986)”.

The most obvious question related to these depraved acts is why such people do it in the first place. Writing in the Encyclopedia of Murder and Violent Crime, Nicole Mott provides an answer:

“A trophy is in essence a souvenir. In the context of violent behavior or murder, keeping a part of the victim as a trophy represents power over that individual. When the offender keeps this kind of souvenir, it serves as a way to preserve the memory of the victim and the experience of his or her death. The most common trophies for violent offenders are body parts but also include photographs of the crime scene and jewelry or clothing from the victim. Offenders use the trophies as memorabilia, but also to reenact their fantasies. They often masturbate or use the trophies as props in sexual acts. Their exaggerated fear of rejection is quelled in front of inanimate trophies. Ritualistic trophy taking, as is found with serial offenders, acts as a signature. A signature is similar to a modus operandi (a similar act ritualistically performed in virtually all crimes of one offender), yet it is an act that is not necessary to complete the crime”

In one of my previous blogs on the psychology of collecting more generally, I referred to a paper by Dr. Ruth Formanek in the Journal of Social Behavior and Personality. She suggested five common motivations for collecting: (i) extension of the self (e.g., acquiring knowledge, or in controlling one’s collection); (ii) social (finding, relating to, and sharing with, like-minded others); (iii) preserving history and creating a sense of continuity; (iv) financial investment; and (v), an addiction or compulsion. She also claimed that the commonality to all motivations to collect was a passion for the particular things collected. Personally, I think that the acquisition of sexual trophies – even in the most deranged individuals – can be placed within this motivational typology in that such individuals clearly have a passion for what they do and I would argue that the behaviour is an extension of the self that to some individuals may be a compulsion or addiction.

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

Further reading

Branagh, N. (2012). Third of UK owns sex trophy. March 26. Located at: http://www.studentbeans.com/mag/en/sex-relationships/third-of-uk-owns-sex-trophy

Du Clos, B. (1993). Fair Game. New York: St. Martin’s Paperbacks.

Griffiths, M.D. (2002). Addicted to hoarding. The Guardian (Review Section), August 10, p.19.

Formanek, R. (1991). Why they collect: Collectors reveal their motivations. Journal of Social Behavior and Personality, 6(6), 275-286.

Hickey, E. W. (Ed.). (2003). Encyclopedia of Murder and Violent Crime. London: Sage Publications

Hickey, E. W. (2010). Serial Murderers and Their Victims (Fifth Edition). Pacific Grove, CA: Brooks/Cole.

Keppel, R. D. (1989). Serial Murder: Future Implications for Police Investigations. Cincinnati, OH: Anderson.

Leyton, E. (1986a). Hunting Humans. Toronto: McClelland and Stewart.

Leyton, E. (1986b). Compulsive Killers: The Story of Modern Multiple Murder. New York: New York University Press.

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.

Follow

Get every new post delivered to your Inbox.

Join 1,601 other followers