Category Archives: Psychology

Campaign killer? Gambling with people’s reputations (revisited)

On Twitter last week, Adrian Parkinson of the Campaign for Fairer Gambling (and the associated Stop The FOBTs campaign) posted a number of tweets about me (and my research). In the tweets, Parkinson said that (a) I am a “supposed academic”, (b) I am the “industry ‘funded’ defender of FOBTs” (fixed odds betting terminals), (c) I am “doing more dirty work” for the Association of British Bookmakers, and (d) I do “what the industry tells [me] to do”.

Parkinson Libel Tweets 2014

All of these assertions are untrue and potentially libellous. According to legal dictionaries, the official definition of libel is “to publish in print (including pictures), writing or broadcast through radio, television or film, an untruth about another which will do harm to that person or his/her reputation, by tending to bring the target into ridicule, hatred, scorn or contempt of others”. Based on this defintion, Parkinson’s tweets are potentially libellous and are definitely an attack on my professional integrity. This cannot go unchallenged so here are the facts of the matter in relation to the claims made.

  • “Supposed academic”: Obviously the assertion by Parkinson that I am a “supposed academic” is both false and deliberately malicious. An academic by most dictionary definitions is a teacher or scholar in a university or other institute of higher education”. As a professor employed at an English university, there is nothing “supposed” about my occupation or status. To add to this, I would point out that on the basis of my academic research and reputation I became of one of the UK’s youngest ever professors (aged 34 years). So far in my career, I have been awarded 14 national and/or international awards and prizes for my gambling research and research dissemination including three Fellowship awards (British Psychological Society, Royal Society of Arts, and the Academy of Social Sciences) and two Lifetime Achievement awards. I am also one of the most highly cited psychologists in the world (currently 17,500 citations on Google Scholar that you can check here).
  • “Industry funded’ defender of FOBTs”: Parkinson claimed that I am “funded defender” of FOBTs and the gambling industry. In my career to date, I have published approximately 460 academic peer reviewed journal papers (which most academics would describe as ‘prolific’ – and not bad for a “supposed academic”) and another 1000+ academic articles (in professional/practitioner journals, gambling trade press, newspapers, magazines, etc.). Of these 1500 or so papers and articles, none were funded by a research grant from the gaming industry. Two of the papers I have published – both concerning social responsibility in gambling initiatives – did arise out of gaming industry consultancy (one study was about gamblers’ attitudes toward the social responsibility tool PlayScan funded by Svenska Spel, and the other was the development of a new social responsibility tool for the gaming industry to use to protect vulnerable player funded by the Nova Scotia Gaming Corporation). Also, none of my published academic papers has ever been specifically about FOBTS. I have published a handful academic journal papers that have mentioned FOBTs in passing but all of those were papers based on data collected in the British Gambling Prevalence Surveys (of which I was one of the co-authors) and were funded by the Gambling Commission not the gambling industry. In 2008, I also wrote a report for the Department of Culture, Media and Sport (again funded by the Gambling Commission) on high stake-high prize machines that included references to FOBTs. However, the only article I have ever published specifically on FOBTs was one of my previous blogs (which looked at FOBTS in relation to the BGPS findings). In short, the assertion that I am an “industry ‘funded’ defender of FOBTs” simply has no basis in truth whatsoever.
  • “Dirty work” for the Association of British Association of Bookmakers: Parkinson claimed I carry out “dirty work” for the ABB. In my academic career I have been a consultant in the area of responsible gambling for approximately 15 years and have written in the region of 150 consultancy reports. Of these reports, three have been for the Association of British Bookmakers. The first report (in June 2013) was evaluation and input into the new code of conduct concerning responsible gambling and player protection (and which I wrote about in a previous blog). I was invited to carry out this piece of work by Neil Goulden (Chairman of the UK’s Responsible Gambling Trust) specifically because of my reputation of being both totally independent and as someone that has been critical of the gambling industry on previous occasions in relation to social responsibility and player protection. More recently (July 2014), I was commissioned to carry out two further pieces of consultancy for the ABB. The first was a review of problem gambling in Great Britain and the second was a preliminary evaluation of the responsible gambling initiatives relating to the introduction of the ABB’s new Code of Conduct (both of which are being published today). All three pieces of consultancy that I have carried out for the ABB concerned player protection and responsible gambling. Far from being “dirty work” they are the very areas areas that are at the heart of almost all the research that I carry out into problem gambling.
  • “Doing what the industry tells me to do”: Of all the potentially libellous claims made about me by Parkinson, this is the one that is the most ludicrous. The main reason I was asked for my expertise in the first place by the ABB was because I have never been afraid to criticize the gaming industry when they have done something I believe to be wrong and/or socially irresponsible. Anyone who actually knows me and has followed my research career over the last three decades will tell you that the one common denominator is my absolute independence in anything that I do. For the best part of 15 years I was vilified and criticized by some members of the gaming industry because of my belief that vulnerable and susceptible people should be protected from the potential harms of gambling. When ‘social responsibility’ and ‘responsible gambling’ became important issues in gaining operating licenses, gaming companies soon started approaching me to help them develop their codes of conduct and player protection programs. In short, I have spent years telling the gambling industry what I think they should do to minimize problem gambling (not the other way around).

There are of course bigger issues here concerning research funding, and this is an issue on which I have published my own views (see ‘Further reading’ below). Parkinson’s incorrect and misguided comments about me appear to be based on the view that academics shouldn’t have any association whatsoever with the gambling industry. Unfortunately, this (in my opinion) is a blinkered view that will not help those that need it (i.e., vulnerable populations). Almost all of the ‘big name’ researchers in the gambling studies field have carried out research and/or consultancy funded by the gambling industry. When this happens it may call into question academic ‘independence’. However, industry funded research appears to be an increasing economic reality in many countries across the world. In the UK, the governmental philosophy of research funding relating to gambling is now ‘polluter pays’ (i.e., the UK government has said it will not fund research on gambling and that the industry will have to pay for such work itself). Although my own research is not industry funded, the current funding model is pushing researchers in the gambling field down such a route.

One researcher that I have published with (now retired from day-to-day university life) refuses to carry out research or consultancy if it is sponsored or funded by the gambling industry (even indirectly via the Responsible Gambling Trust because the money is accrued from voluntary donations by the gambling industry). Furthermore, he will not attend conferences that have gaming industry sponsorship and declines invitations to speak if they are held on gaming premises. Although laudable and highly principled, researchers who now want to pursue a research career in the gambling studies field will are likely to find that taking such principled actions will become a barrier to career enhancement.

Having been in the gambling studies field for nearly 30 years now, I feel very proud that over the last decade, some sectors of the gaming industry have now started to take the issue of social responsibility in gambling seriously. All the personal vitriol that I received for years from certain individuals working in the gaming industry appears (in retrospect) to have been worth it. My own view is that if those in the gambling industry are really serious about social responsibility, they need to sometimes work in partnership with researchers in the gambling studies field if the end goal is the same (i.e., protection of vulnerable individuals and minimization of problem gambling).

From my research, I have gotten to know people that have had gambling problems and that would like to ban slot machines (including FOBTs). This is highly unlikely to reduce gambling problems. We know that banning alcohol does not cure alcoholism. Similarly, banning gambling products will not solve the issue of problem gambling. It would only drive the activity underground. Most people that gamble (including myself) do not have a problem. The underlying principle of social responsibility is to maximize fun for those that enjoy gambling and minimize harm for those that may be vulnerable. Mr. Parkinson and his campaign have every right to express their views but what they say should have a basis in fact (rather than prejudice) and they definitely shouldn’t resort to questioning my reputation or research in the absence of the full facts.

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

Further reading

Adams P. J., Raeburn J., De Silva K. (2009). A question of balance: prioritizing public health responses to harm from gambling. Addiction, 104: 688–91.

Griffiths, M.D. (2009). Minimising harm from gambling: What is the gambling industry’s role? Addiction, 104, 696-697.

Griffiths, M.D. (2008). Impact of high stake, high prize gaming machines on problem gaming. Birmingham: Gambling Commission.

Griffiths, M.D. (2009). Gambling research and the search for a sustainable funding infrastructure. Gambling Research, 21(1), 28-32.

Griffiths, M.D., Wood, R.T.A. & Parke, J. (2009). Social responsibility tools in online gambling: A survey of attitudes and behaviour among Internet gamblers. CyberPsychology and Behavior, 12, 413-421.

Morrison, P. (2009). A new national framework for Australian gambling research: A discussion paper on the potential challenges and processes involved. Gambling Research, 21(1), 8-24.

Wood, R.T.A., Shorter, G.W. & Griffiths, M.D. (2014). Rating the suitability of responsible gambling features for specific game types: A resource for optimizing responsible gambling strategy. International Journal of Mental Health and Addiction, 12, 94–112.

Blog-nitive psychology: 500 articles and counting

It’s hard for me to believe that this is the 500th article that I have published on my personal blog. It’s also the shortest. I apologise that it is not about any particular topic but a brief look back at what my readers access when they come across my site. (Regular readers might recall I did the same thing back in October 2012 in an article I wrote called ‘Google surf: What does the search for sex online say about someone?’). As of August 26 (2014), my blog had 1,788,932 visitors and is something I am very proud of (as I am now averaging around 3,500 visitors a day). As I write this blog, my most looked at page is my blog’s home page (256,262 visitors) but as that changes every few days this doesn’t really tell me anything about people like to access on my site.

Below is a list of all the blogs that I have written that have had over 10,000 visitors (and just happens to be 25 articles exactly).

The first thing that struck me about my most read about articles is that they all concern sexual fetishes and paraphilias (in fact the top 30 all concern sexual fetishes and paraphilias – the 31st most read article is one on coprophagia [7,250 views] with my article on excessive nose picking being the 33rd most read [6,745 views]). This obviously reflects either (a) what people want to read about, and/or (b) reflect issues that people have in their own lives.

I’ve had at least five emails from readers who have written me saying (words to the effect of) “Why can’t you write what you are supposed to write about (i.e., gambling)?” to which I reply that although I am a Professor of Gambling Studies, I widely research in other areas of addictive behaviour. I simply write about the extremes of human behaviour and things that I find of interest. (In fact, only one article on gambling that I have written is in the top 100 most read articles and that was on gambling personality [3,050 views]). If other people find them of interest, that’s even better. However, I am sometimes guided by my readers, and a small but significant minority of the blogs I have written have actually been suggested by emails I have received (my blogs on extreme couponing, IVF addiction, loom bandsornithophilia, condom snorting, and haircut fetishes come to mind).

Given this is my 500th article in my personal blog, it won’t come as any surprise to know that I take my blogging seriously (in fact I have written academic articles on the benefits of blogging and using blogs to collect research data [see ‘Further reading’ below] and also written an article on ‘addictive blogging’!). Additionally (if you didn’t already know), I also have a regular blog column on the Psychology Today website (‘In Excess’), as well as regular blogging for The Independent newspaper, The Conversation, GamaSutra, and Rehabs.com. If there was a 12-step ‘Blogaholics Anonymous’ I might even be the first member.

“My name is Mark and I am a compulsive blogger”

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

Further reading

Griffiths, M.D. (2012). Blog eat blog: Can blogging be addictive? April 23. Located at: http://drmarkgriffiths.wordpress.com/2012/04/20/blog-eat-blog-can-blogging-be-addictive/

Griffiths, M.D. (2012). Stats entertainment: A review of my 2012 blogs. December 31. Located at: http://drmarkgriffiths.wordpress.com/2012/12/31/stats-entertainment-a-review-of-my-2012-blogs/

Griffiths, M.D. (2013). How writing blogs can help your academic career. Psy-PAG Quarterly, 87, 39-40.

Griffiths, M.D. (2013). Stats entertainment (Part 2): A 2013 review of my personal blog. December 31. Located at: http://drmarkgriffiths.wordpress.com/2013/12/31/stats-entertainment-part-2-a-2013-review-of-my-personal-blog/

Griffiths, M.D. (2014). Top tips on…Writing blogs. Psy-PAG Quarterly, 90, 13-14.

Griffiths, M.D. (2014). Blogging the limelight: A personal account of the benefit of excessive blogging. May 8. Located at: http://drmarkgriffiths.wordpress.com/2014/05/08/blogging-the-limelight-a-personal-account-of-the-benefits-of-excessive-blogging/

Griffiths, M.D., Lewis, A., Ortiz de Gortari, A.B. & Kuss, D.J. (2014). Online forums and blogs: A new and innovative methodology for data collection. Studia Psychologica, in press.

Arcade fire: A brief look at pinball addiction

“I guess what started my pinball addiction was how it has become the perfect distraction. I like to drink beer. And go out. And recreate. Pinball is often found in bars here in the San Francisco Bay Area, so grabbing a beer and dropping a few quarters and playing a game with a friend is a great way to kick it. That’s kind of how it started, as something I might do here and there, but it’s grown into a full blown addiction as I’ve discovered more about pinball. It’s a hobby, a sport, and a pastime, but for me, it’s all consuming” (Gene X, December 18, 2013).

PinballJunky.com is a periodic hobby-blog operated by one guy with over 20 years of unbridled collector’s obsession over anything having to do with the Art, Science, History and Culture of Pinball. Armed with an arsenal of over 30 Pins, our Moderator has built, rebuilt, repaired, restored, demolished and labored with an OCD level of passion over 100’s of pinball machines from the 70’s, 80’s and 90’s era. While he has experimented with various EM pins over the years, The Junky is particularly passionate about the SS games of the 90s and present” (from the Pinball Junky website).

As far as I am aware, only one academic paper has ever been published on pinball addiction, and that was a case study that I published in 1992 issue of Psychological Reports. My paper featured the case of a young man (aged 25 years) that I interviewed as part of another study on slot machine gambling (that I published in a 1994 issue of the British Journal of Psychology about the role of cognitive bias and skill in slot machine gambling). During the post-experimental interview, I asked all my participants to complete a questionnaire that included the (1987 revised third edition) Diagnostic and Statistical Manual of Mental Disorders criteria for pathological gambling. None of the nine items was endorsed but after completing my questionnaire, my participant spontaneously added that if he’d been asked the same questions about his pinball playing and videogame playing he would have answered ‘yes’ to a majority of the questions. On the spur of the moment I changed the word ‘gamble’ in the DSM-III-R criteria to the word ‘play’ and asked him to take that part of the survey again. In short, I asked him if he endorsed any of the following

  • Frequent preoccupation with playing or obtaining money to play
  • Often plays with larger amounts of money or over a longer period than intended
  • Need to play more to achieve the desired excitement
  • Restlessness or irritability if unable to play
  • Repeatedly returns to win back losses
  • Repeated efforts to cut down or stop playing
  • Often plays when expected to fulfill social, educational or occupational obligations.
  • Has given up some important social, occupational or recreational activity in order to play
  • Continues to play despite inability to pay mounting debts, or despite other significant social, occupational, or legal problems that the individual knows to be exacerbated by playing

If a person answers ‘yes’ to four of the above questions, the person was deemed to be an amusement machine ‘addict’. This time, my participant answered ‘yes’ to six out the nine questions, that I interpreted as showing signs of pinball pathology. It was at this point he was interviewed further.

The participant began playing pinball machines (and arcade videogame machines) at school when he was around 14 or 15 years of age. This he did with many of his male peers at the start of the ‘videogame explosion’ (as he put it) in around 1979 to 1980. He became “very good” at pinball playing and felt particularly good when lots of people, both male and female, were watching him and he was playing well. This implied he played mainly for social reasons. However, he also enjoyed playing on his own and, at the time of my study, he predominantly played alone. While playing, he reported that he experienced a ‘high’ – a continuous high (as opposed to an immediate high or ‘rush’ reported by some addicted slot machine gamblers (that I had reported throughout my published studies on adolescent slot machine players in 1990 and 1991) which was especially notable when he “started off with a good ball”, got free replay”, or experienced something intrinsically motivating to him (e.g., someone watching him play).

Back in 1983, Dr. Sidney Kaplan and Dr. Shirley Kaplan reported in the Journal of Popular Culture, that male pinball players may be attracted by the machine’s sexual graphics. However, my participant reported that he was more attracted by the features within the game and liked the idea that he could master a game, something that attracted him to videogames as well. He went on to say that both pinball machines and videogame machines were very similar because they both (i) score through points, (ii) have no financial reward – unlike a fruit machine, (iii) give the players pleasure from gaining a high score, i.e., an intrinsic reward, (iv) have the chance to gain free replays, and (v) require skill to play well. The reasons he didn’t play slot machines were because (i) its financial rewards were too infrequent, (ii) they are mostly chance-oriented, (iii) there are no points to score, and (iv) there is no free replay feature (except of course if the player won and decided to play again).

At the time I published the paper, it had been argued at various gambling conferences that I attended that “videogames are not as bad as slot machines because the better the player gets, the less money the player spends”. At face value this was correct as some adolescents could make 10 pence last over an hour on a videogame. However, the participant explained to me that he (and others) used to spend “hundreds of pounds” learning to play videogames and pinball machines, and then, when they were proficient at them, they would get bored with the game and spend their money learning how to play a new game on another machine. For this participant, pinball machines were different from videogame playing. Although he had played many different pinball machines, he had a personal favourite which he always returned to because it was the one on which he had his first “major success” (i.e., a very high score).

Back in 1992 I argued that it would be beneficial to adapt the criteria for pathological gambling for use in the monitoring of gaming machine addictions. By using such checklists (which can be administered quickly and easily), I argued it would be possible to record objective measures of incidence of probable amusement-machine addicts (including pinball addiction) and possibly show whether these types of addictions are implicated or act as precursors to more established addictions (e.g., pathological gambling). In 2013, criteria for Internet Gaming Disorder were included in Section 3 of the latest DSM-5 (using many of the criteria outlined above). However, given the complete lack of any other academic paper on pinball addiction, it doesn’t look as though pinball addiction will be appearing in any psychiatric diagnostic manual anytime soon. However, this case and other papers that I wrote on slot machine and video game addiction at the time led to my 1995 paper on technological addictions (that has now become one of my most highly cited papers).

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

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd Edition -Revised). Washington D.C. : Author

Griffiths, M.D. (1990). Addiction to fruit machines: A preliminary study among males. Journal of Gambling Studies, 6, 113-126.

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

Griffiths, M.D. (1991). Amusement machine playing in childhood and adolescence: A comparative analysis of video games and fruit machines. Journal of Adolescence, 14, 53-73.

Griffiths, M.D. (1991). The psychobiology of the near miss in fruit machine gambling. Journal of Psychology, 125, 347-357.

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

Griffiths, M.D. (1992). Pinball wizard: A case study of a pinball addict. Psychological Reports, 71, 160-162.

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

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

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

Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Kaplan, S. J. (1983). The image of amusement arcades and differences in male and female video game playing. Journal of Popular Culture, 17(1), 93-98.

Kaplan, S., & Kaplan, S. (1981). A research note: Video games, sex, and sex differences. Social Science, 208-212

Kaplan, S., & Kaplan, S. (1983). Video games, sex and sex differences. The Journal of Popular Culture, 17(2), 61-66.

Trance-sexuality: A brief look at sex and stage hypnosis

Regular readers of my blog may remember that my first academically published papers were on hypnosis (as I recounted in a previous blog I did on hypnofetishism). Consequently, I’ve always had a passing interest in stage hypnotism although some of those that I’ve seen sail close to the wind in terms of their ethics. In fact the following online query raised some of the sort of questions I have often asked myself when watching such shows:

“My in-laws recently attended an ‘adults only’ hypnotist show in Las Vegas. The hypnotist selected audience members to be hypnotized. I’m sure you all know the drill here. The selected individuals did all sorts of sexual (or inferred sexual acts) from masturbating a teddy bear to having an orgasm when another sneezes…Is it ethical? Is it a form of abuse if these people were not in full control of their capacities? I would think in this day of lawsuit happy lawyers a participant could easily sue a hypnotist for ‘suggesting’ this type of behavior”

Over the last few years there have been a number of high profile stories about ‘X-rated’ stage hypnotists. For instance, in 2012, Colin Adamson’s “raunchy hypnosis show” was banned for being “too rude” by the University of Kent’s student union after the hypnotist got his participants to simulate sex acts and lap dances on stage. Some of those on stage were made to believe they were having orgasms while others simulated masturbation. One of the women that was hypnotized into believing she had been touched indecently by someone watching the show and was left ”too upset to speak”. Sadaeva president of the University of Kent Feminist Society was “disgusted” and was quoted as saying: “[Adamson] shows a lack of empathy towards rape victims and all women, and a lack of basic human decency – he has no place at a student union”.

One infamous case of problems with someone that participated in stage hypnotism was recounted by Dr. Michael Heap in a 2000 issue of the journal Contemporary Hypnosis (as well as on his own website). Heap was an expert witness for the defendant in a case he calls ‘Norman versus Byrnes’ (Mr. Byrnes was the defendant, the stage hypnotist; Mr. Norman, the plaintiff was the person on stage under hypnosis). Dr. Heap began by briefly reviewing the main issues:

“Mr. Norman’s story is that on Wednesday June 30th 1993, he took part in Mr. Byrnes’s stage hypnosis show at a hotel.  At some point in the show Mr. Byrnes offered to help Mr. Norman give up smoking.  Amongst other things, he gave him a post-hypnotic suggestion that from now on cigarettes would taste foul.  Towards the end of the performance Mr. Byrnes suggested to his volunteers that as they were sitting in their chairs they would feel more and more sexy.  He then hit his microphone repeatedly calling out ’10 times more sexy’, ’20 times more sexy’…..and so on.  Mr. Norman seemed to become carried away; he stood up and made thrusting movements at the chair.  Mr. Byrnes then suggested to the participants that when they went to bed that night they would feel even 50 times more sexy than they did then. Mr. and Mrs. Norman both confirmed that when they went to bed that night, as soon as Mr. Norman laid down on the mattress he started shaking violently and bouncing up and down.  Mr. Norman claimed that he was having sexual intercourse with the mattress and that indeed he did find the mattress sexually attractive.  Thus he continued simulating intercourse with the mattress and the other contents of his bed, with the exception of his wife”.

Mr. Norman had sex with his hotel bedroom furniture for about four hours (1am to 5am). When Mr. Norman stopped at one point to smoke a cigarette he became violently sick. On resuming his furniture sex, Mrs. Norman managed to stop the activity by blowing cigarette smoke into her husband’s face. Over the following days, Mr. Norman’s sexual urges diminished during the day but the uncontrollable urge to have sex with the furniture and other domestic appliances came back each night in the hotel room. Mr. Norman and his wife reported that the objects that became sexually attractive included all the bed’s contents, the hotel ceiling, a variety of ornaments in the hotel room, the room’s armchair, the hotel bath, and a tumble dryer. Dr. Heap then reported:

“On Monday, five days after her husband’s stage hypnosis experience, Mrs. Norman went to see a lawyer; on Wednesday Mr. Norman went to see his doctor.  He was prescribed antidepressants and several days later his doctor ‘performed hypnotherapy on him to remove the post-hypnotic suggestion’ and this appeared to be successful.  However, about three weeks later he was referred to a psychiatrist, Dr. Thomas, with ‘depression and delusions’ and violent behaviour. Dr. Thomas saw Mr. Norman on October 18th…Dr. Thomas ascribed Mr. Norman’s problems to Mr. Byrnes’s failure to take him ‘out of the hypnotic trance’…Things appeared to go quiet, and Mr. Norman did not receive any medication or treatment for these problems until four months later…Mr. Norman continued to present with a bewildering array of mental symptoms variously diagnosed as dissociative state, hypomania, hysteria, Ganser’s syndrome, major depression, post-traumatic stress disorder, paranoid psychosis and schizo-affective disorder”.

Mr. Norman’s legal team then secured the services of a consultant psychiatrist Dr. James, who was former official of the British Society of Medical and Dental Hypnosis. Dr. James then made a number of allegations of negligence against Byrnes (e.g., Byrnes didn’t establish what the exact counter-suggestion should have been to dispel the post-hypnotic suggestion). Dr. Heap then claimed:

“When I consider these serious allegations against Mr. Byrnes, I cannot help hearing in my mind the music ‘The Sorcerer’s Apprentice’.  Dr. James casts Mr. Byrnes in the role of an inept would-be wizard whose task, under the stern eye of a properly qualified master wizard, is to discover the best counter-spell or incantation that would lift the evil curse with which he had previously inadvertently bewitched Mr. Norman…This case came to trial in September 1997.  I sat in Court every day…but on the fifth day, long before the defence had opened its case, the trial collapsed.  Mr. Norman’s financial backer withdrew, his legal aid having already been rescinded.  The reason for the latter was as follows: had Mr. Norman won his case, the compensation that he would have received would have been claimed back by the state to offset the considerable welfare and sickness benefits he had received while indisposed.  Thus he would have been financially no better off and legal aid is not granted when such is the case”.

Dr. Heap was under the view that Mr. Norman was “clearly malingering in his claims to have been afflicted with his unusual sexual compulsions”. Heap claimed that there were grounds for considering Norman’s symptoms as a factitious disorder (like Munchausen’s Syndrome).

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

Further reading

Heap, M. (2000). A legal case of a man complaining of an extraordinary sexual disorder following stage hypnosis. Contemporary Hypnosis, 17(3), 143-149.

Heap, M. (2001). Some stories about hypnosis. The Skeptical Intelligencer, 3(4), 29-35

Heap, M. (2014). Some stories about hypnosis. Located at: http://www.mheap.com/hypnosis.html

Play to win: A brief look at competitive video gaming

To date, competitive gaming has not been widely researched or recognized in the scientific and professional literature on video games. As the name suggests, competitive gaming comprises players who regularly compete in tournaments organized and run by the gaming community, often for large monetary gains. Secondary benefits include the recognition and admiration of other gaming community members. Such tournaments are now often run by companies that host the events at large convention centers in major cities (e.g., New York City, Los Angeles, Seoul, etc.).

Despite three decades of worldwide growth in competitive gaming, little empirical investigation has catalogued these activities. Although empirical studies are lacking, studies have noted that competitive games now use Internet radio coverage with play-by-play commentaries, large-screen televised projections of game footage, sizeable live audiences, and cash prizes in the hundreds of thousands of dollars. For elite competitive gamers (i.e., professional gamers), the activity is a full-time job. Many games played competitively appear to demand high levels of sophistication in strategizing, planning, multi-tasking, and timing to master.

Academic studies have shown that certain competitive games, if used properly, can also promote prosocial behaviour and skill development. Furthermore, professional success in competitive gaming seemingly requires persistent practice and sophisticated skill sets. It is likely that these positive effects are more substantial than the effects of games played on a casual level. Numerous studies have demonstrated the benefits of gaming more generally in lieu of the positive effects of competitive gaming, particularly in relation to improved spatial cognitive benefits. Studies have also suggested that video games can provide an enriched medium for strategic problem solving. Other studies support the differences between novice and advanced levels of play in video games. For instance, research has demonstrated measurable differences between novice and expert game players, the latter group often demonstrating enhanced short-term memory, executive control/self-monitoring, pattern recognition, visual-spatial abilities (e.g., object rotation), and task-switching efficiency, along with more efficient problem-solving skills.      

Competitive gaming has the potential to change the dynamics and motivations of gaming. For instance, if a player can make a financial living and career from playing a video game, it becomes an occupation rather than a hobby. This raises interesting questions about the role of context in excessive gaming and potential addiction. Although there is ongoing scientific debate on the nature and extent of adverse consequences associated with excessive digital technology use, I have noted (in a 2010 issue of the International Journal of Mental Health and Addiction) that long hours of video game use alone do not indicate video game addiction (i.e., heavy use on its own is not a sufficient criterion for addiction). Therefore, in order to evaluate problematic video game use, researchers must consider possible negative consequences players are experiencing in their lives. When video game players are capable of financially supporting themselves from their play, this matter becomes more complex. For example, how would one categorize a professional video game player who was making over $100,000 per year playing video games, but was also experiencing social difficulties as a result of excessive video game use? This point is not meant to imply that a successful professional gamer is incapable of suffering pathological effects from game use, but rather to raise the distinct possibility that professional gamers will view their use as non-problematic due to the success they experience.

When it comes to competitive gaming, many players will play excessively and spend hours and hours every single day either practicing or competing. For many competitive gamers, their whole life is dominated by the activity and may impact on their relationships and family life. However, this does not necessarily mean they are addicted to playing the games because the excessive game playing is clearly a by-product of the activity being their job. However, it could perhaps be argued that they are addicted to their work (and in this case, their work comprises video game playing).

Workaholics have been conceptualized in different ways. For instance, in a 2011 review I published in The Psychologist, I noted that workaholics are typically viewed as one (or a combination) of the following. They are (i) viewed as hyper-performers, (ii) work as a way of stopping themselves thinking about their emotional and personal lives, and (iii) are over concerned with their work and neglect other areas of their lives. Some of these may indeed be applied to competitive gamers (particularly the reference to ‘hyper-performers’ and the fact that other areas of their lives may be neglected in pursuit of their ultimate goal). Some authors note that there is a behavioural component and a psychological component to workaholism. The behavioural component comprises working excessively hard (i.e., a high number of hours per day and/or week), whereas the psychological (dispositional) component comprises being obsessed with work (i.e., working compulsively and being unable to detach from work). Again, these behavioural and psychological components could potentially be applied to competitive gamers.

I have also noted that there are those who differentiate between positive and negative forms of workaholism. For instance, some (like myself) view workaholism as both a negative and complex process that eventually affects the person’s ability to function properly. In contrast, others highlight the workaholics who are totally achievement oriented and have perfectionist and compulsive-dependent traits. Here, the competitive gamer might be viewed as a more positive form of workaholism. Research appears to indicate there are a number of central characteristics of workaholics. In short, they typically: (i) spend a great deal of time in work activities, (ii) are preoccupied with work even when they are not working, (iii) work beyond what is reasonably expected from them to meet their job requirements, and (iv) spend more time working because of an inner compulsion, rather than because of any external factors. Again, some or all of these characteristics could be applied to competitive gamers.

Furthermore, competitive gaming is not the sole means by which proficient gamers can financially support themselves. Researchers (such as Dr. Edward Castranova) studying the economics of synthetic worlds (e.g., digital gaming environments) have observed that gamers also procure income by marketing virtual objects in Massively Multiplayer Online Role-Playing Games (MMORPGs). These digital objects often include avatars, or characters controlled by players that interact with gaming environments and other players. Each avatar has unique physical attributes and skills that a player may select, purchase, and/or develop over many hours of game play (e.g., the gradual enhancement strength, speed, weapon-wielding abilities, etc.).

As noted above, competitive gamers are likely to play for extended periods of time and sacrifice other areas of their lives if they have the potential to make a living from gaming. This single-minded dedication may become a problem for some players because the goal of becoming a professional gamer is often unrealistic. There are currently no precise figures relating to the number of competitive game players, but anecdotal evidence suggests that few professional gamers generate sufficient income to support themselves financially. Although viability may change in the future, at present, the great majority of competitive gamers have little chance of becoming successful and financially independent professionals. For this reason (i.e., the motivation to become a professional), competitive gamers may be more susceptible to excessive use than the average video game player. Additionally, even successful professional gamers are likely to play for extended periods of time, as playing less than eight hours each day could mean that they are not practicing enough compared to other professional players. Those who work with (and treat) problematic video game players should keep this factor in mind (especially given that excessive video game use may increase as competitive gaming receives more bona fide recognition as a possible career choice). 

Competitive gaming, as with video game playing more generally, has psychosocial advantages and disadvantages and is thus an important area to consider when evaluating gaming as a whole. It may be critical to include questions about competitive gaming (and context more generally) in measures evaluating the degree, extent, and “addictive” potential of video game use. Furthermore, it would appear essential for psychologists to inquire about competitive gaming in a clinical interview during which a client reports playing video games. If clients turn out to be competitive gamers, this will likely distinguish them in many ways from a person who simply plays video games excessively for fun and/or escape.

Various approaches and strategies could be used to stimulate research into competitive gaming. For example, studies could compare the abilities of professional or high-level competitive gamers with everyday or far less experienced gamers to better understand (a) similarities and contrasts in capacities, and (b) whether skills transfer to other domains. Another possibility is to utilize case studies of highly successful professional gamers. Such in-depth studies can generate descriptive information that can help in formulating hypotheses about potential differences between these individuals and non-competitive gamers and lead to better informed and more rigorous empirical investigations. How and why are some competitive gamers able to succeed while so many other players try and fail? Are some of these characteristics and skills (e.g., persistence and speed of mental processing) similar to those seen in professional athletes or others who are extremely successful in their occupations?

Competitive gaming may offer numerous benefits that could be more pronounced than the positive effects found when games are played casually. It may also be problematic, as competitive gamers might be more likely to sacrifice other areas of their lives if they believe they can become professional players. Most importantly, those researchers in the gaming studies field might keep in mind that competitive and professional gamers are a distinct population and may differ considerably (both psychologically and/or behaviorally) from casual gamers.

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

Additional input: Kyle Faust and Joseph Meyer

Further reading

Andrews, G., & Murphy, K. (2006). Does video game playing improve executive functioning? In M. A. Vanchevsky (Ed.), Frontiers in: Cognitive psychology (pp. 145–161). Hauppauge, NY: Nova Science Publishers.

Boot, W. R., Kramer, A. F., Simons, D. J., Fabiani, M., & Gratton, G. (2008). The effects of video game playing on attention, memory, and executive control. Acta Psychologica, 129, 387–398.

Castronova, E. (2005). Synthetic worlds: The business and culture of online games. Chicago, IL: The University of Chicago Press.

Castronova, E., Williams, D., Shen, C., Ratan, R., Xiong, L., Huang, Y., & Keegan, B. (2009). As real as real? Macroeconomic behavior in a large-scale virtual world. New Media and Society, 11, 685–707.

Cheshire, T. (2011, July 4). Career gamers: Inside the world of modern professional gaming. Wired. Retrieved from http://www.wired.co.uk/magazine/archive/2011/07/features/career-gamers?page=all

Faust, K., Meyer, J. & Griffiths, M.D. (2013). Competitive gaming: The potential benefits of scientific study. International Journal of Cyber Behavior, Psychology and Learning, 3(1), 67-76.

Goodale, G. (2003, August 8). Are video games a sport? They may not break a sweat, but these competitors say they are tomorrow’s athletes. The Christian Science Monitor. Retrieved from http://www.csmonitor.com/2003/0808/p13s01-alsp.html

Griffiths, M. D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119–125.

Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

Hong, J-C, & Liu, M-C. (2003). A study on thinking strategy between experts and novices of computer games. Computers in Human Behavior, 19, 245–258.

Hutchins, B. (2008). Signs of meta-change in second modernity: The growth of e-sport and the World Cyber Games. New Media Society, 10, 851–869.

King, D., Delfabbro, P., & Griffiths, M. (2009). The psychological study of video game players: Methodological challenges and practical advice. International Journal of Mental Health Addiction, 7, 555-562.

Lee, Y-H, & Lin, H. (2011). ‘Gaming is my work’: Identity work in internet-hobbyist game workers. Work Employment Society, 25, 451–467.

Reeves, S., Brown, B., & Laurier, E. (2009). Experts at play: Understanding skilled expertise. Games and Culture, 4, 205–227.

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

Bog standard: A brief look at toilet tissue eating

In previous blogs I have looked at pica (i.e., the eating of non-nutritive items or substances) and subtypes of pica such as geophagia (eating of soil, mud, clay, etc.), pagophagia (eating of ice), acuphagia (eating of metal), and coprophagia (eating of faeces). It wasn’t until I started to research on specific sub-types of pica, that I discovered how many different types of non-food substances had been identified in the academic and clinical literature. For instance, Dr. V.J. Louw and colleagues provided a long list in a 2007 issue of the South African Medical Journal including cravings for the heads of burnt matches (cautopyreiophagia), cigarettes and cigarette ashes, paper, starch (amylophagia), crayons, cardboard, stones (lithophagia), mothballs, hair (trichophagia), egg shells, foam rubber, aspirin, coins, vinyl gloves, popcorn (arabositophagia), and baking powder. Most of these are generally thought to be harmless but as Louw and colleagues note, a wide range of medical problems have been documented:

“These include abdominal problems (sometimes necessitating surgery), hypokalaemia, hyperkalaemia, dental injury, napthalene poisoning (in pica for toilet air-freshener blocks), phosphorus poisoning (in pica for burnt matches), peritoneal mesothelioma (geophagia of asbestos-rich soil), mercury poisoning (in paper pica), lead poisoning (in dried paint pica and geophagia), and a pre-eclampsia-like syndrome (baking powder pica)”.

In the clinical literature, the eating of paper has been occasionally documented (although anecdotal evidence suggests this is fairly common and I remember doing it myself as a child). A recent review paper on pica by Dr. Silvestre Frenk and colleagues in the Mexican journal Boletín Médico del Hospital Infantil de México highlighted dozens of pica-subtypes and created many new names for various pica sub-types. They proposed that people who eat paper display ‘papirophagia’ (in fact if you type ‘papirphagia’ into Google, you only get one hit – the paper by Silvestre and colleagues – although this blog may make it two!). Eating paper is not thought to be particularly harmful although I did find a case of mercury poisoning because of ‘paper pica’ (as the authors – Dr. F. Olynk and Dr. D. Sharpe – called it) in a 1982 issue of the New England Journal of Medicine.

One sub-type of papirophagia is the eating of toilet paper. As far as I am aware, there is only one case study in the literature and this was published back in 1981, Dr. J. Chisholm Jr. and Dr. H. Martín in the Journal of the National Medical Association. They described the case of a 37-year old black woman with an “unusually bizarre craving” for toilet tissue paper. The authors reported that:

“[The] woman was referred for evaluation of disturbed smell and loss of taste for over one year. These were associated with chronic fatigue and listlessness. During this same period of time, she rather embarrassedly admitted to an overwhelming desire to eat toilet tissue. Frequently, she would awaken at night and dash to her bathroom to eat toilet tissue. No other type(s) of pica were admitted. In addition, she gave a long history of menorrhagia and frequently passed vaginal blood clots during her menses. Her libido was normal and there was no history of poor wound healing, skin or mucous membrane lesions, or intestinal symptoms. Her dietary history suggested a high carbohydrate diet, and due to a mild exogenous obesity she intermittently resorted to a vegan-like diet that included beans and various seeds”

A variety of medical tests were carried out and she was diagnosed with combined iron and zinc deficiency. She was treated with iron and zinc tablets and within a week, both her taste and smell had returned, and her energy levels greatly improved. Zinc deficiencies can lead to a wide variety of clinical disorders including loss of small and taste, anorexia, dwarfism (i.e., growth retardation), impaired wound healing, and geophagia. The woman’s (sometimes) vegan diet may have been to blame for her zinc deficiency as the authors noted that:

Although vegetables contain zinc, vegans should be made aware that zinc from plant sources is not readily absorbed because naturally occurring phytates, particularly high in beans and seeds, reduce zinc gastrointestinal absorption. Carbohydrates are very poor sources of zinc. Chronic iron deficiency secondary to chronic menorrhagia accounts well for the anemia, fatigue, and unusual pica for toilet tissue noted in this patient”.

Paper pica has occasionally been mentioned in other academic papers although details have typically been limited. For instance, a 1995 paper in the journal Birth by Dr. N.R. Cooksey on three cases of pica in pregnancy reported that one of the women chewed non-perfumed blue toilet paper during the first trimester of her pregnancy (and was forced by her mother to stop). There was also a 2003 paper published by Dr. Dumaguing in the Journal of Geriatric Psychiatry and Neurology examining pica in mentally ill geriatrics. One of the cases mentioned was a 76-year old patient that not only ingested their medication (an emollient cream for arthritis) but was also recorded eating toilet paper, napkins, Styrofoam cups, crayons, and other patients’ medications.

A more recent 2008 paper by Dr. Sera Young and her colleagues in the journal PLoS ONE, critically reviewed procedures and guidelines for interviews and sample collection in relation to pica substances. In describing the protocols involved, they referred to paper pica in the questions that should be asked:

“What is the local name, brand name, or type of pica substance desired or consumed? This will help others to know if this substance has already been studied and assist interested researchers in obtaining subsequent samples at a later date. Furthermore, different manufactured products may contain different materials, e.g. Crayola chalkboard chalk contains slightly different ingredients from other brands. Similarly, the consequences of toilet tissue paper consumption are different from those of eating pages of a novel; information would be lost if the substance was simply described as paper. For these reasons, the substance consumed should be described in as much detail and as accurately as possible”.

Personally (and based on anecdotal evidence), I think that papirophagia is not overly rare (especially among children – although I admit this may be more out of curiosity that craving) but the clinical literature suggests that it is a fairly rare disorder found amongst distinct sub-groups (pregnant women, the mentally ill). Given the fact that for most people eating paper would not cause any problems, this would provide the main reason why so few cases end up seeking medical, clinical, and/or psychological help.

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

Further reading

Chisholm Jr, J. C., & Martín, H. I. (1981). Hypozincemia, ageusia, dysosmia, and toilet tissue pica. Journal of the National Medical Association, 73(2), 163-164.

Cooksey, N.R. (1995). Pica and olfactory craving of pregnancy: How deep are the secrets? Birth, 22, 129-137.

Dumaguing, N.I., Singh, I., Sethi, M., & Devanand, D.P. (2003). Pica in the geriatric mentally ill: unrelenting and potentially fatal. Journal of Geriatric Psychiatry and Neurology, 16, 189-191.

Frenk, S., Faure, M.A., Nieto, S. & Olivares, Z. (2013). Pica. Boletín Médico del Hospital Infantil de México, 70(1), 55-61

Louw, V.J., Du Preez, P., Malan, A., Van Deventer, L., Van Wyk, D., & Joubert, G. (2007). Pica and food craving in adults with iron deficiency in Bloemfontein, South Africa. South African Medical Journal, 97, 1069-1071.

Olynyk, F., & Sharpe, D. H. (1982). Mercury poisoning in paper pica. The New England Journal of Medicine, 306, 1056 -1057.

Young, S.L., Wilson, M.J., Miller, D., Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS ONE, 3(9), e3147. doi:10.1371/journal.pone.0003147

Urine for a treat: A brief overview of catheterophilia

In a previous blog, I examined medical fetishism (i.e., those individuals that derive sexual pleasure and arousal from medical procedures and/or something medically related). Maddy’s Mansion features a small article on medical fetishism and is a little more wide ranging in scope:

“Medical fetishism refers to a collection of sexual fetishes for objects, practices, environments, and situations of a medical or clinical nature. This may include the sexual attraction to medical practitioners, medical uniforms, surgery, anaesthesia or intimate examinations such as rectal examination, gynecological examination, urological examination, andrological examination, rectal temperature taking, catheterization, diapering, enemas, injections, the insertion of suppositories, menstrual cups and prostatic massage; or medical devices such as orthopedic casts and orthopedic braces. Also, the field of dentistry and objects such as dental braces, retainers or headgear, and medical gags. Within BDSM [bondage, domination, submission, sadomasochism] culture, a medical scene is a term used to describe the form of role-play in which specific or general medical fetishes are pandered to in an individual or acted out between partners”.

As is obvious from the description above, one very specific sub-type of medical fetishism is catheterophilia. Both Dr. Anil Aggrawal (in his book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices) and Dr. Brenda Love (in her Encyclopedia of Unusual Sex Practices) define catheterophilia as sexual arousal from use of catheters. The Right Diagnosis website goes a little further and reports that catheterophilia can include one or more of the following: (i) sexual interest in using a catheter, (ii) abnormal amount of time spent thinking about using a catheter, (iii) recurring intense sexual fantasies involving using a catheter, (iv) recurring intense sexual urges involving using a catheter, and (v) sexual preference for using a catheter.

Not only is catheterophilia a sub-type of medical fetishism but is also a sub-type of urethralism (that I also covered in a previous blog). Catheterophilia may also share some overlaps with other sexual paraphilias such as paraphilic infantilism (i.e., deriving sexual pleasure and arousal from pretending to be an adult baby). Dr. G. Pranzarone in his Dictionary of Sexology (and relying heavily on Professor John Money’s seminal 1986 book Lovemaps) defines urethralism as:

“The condition or activity of achieving sexuoerotic arousal through stimulation of the urinary urethra by means of insertions of rubber cathethers, rods, objects, fluids, ballbearings, and even long flexible cathether-like electrodes (“sparklers”). This activity may be part of a paraphilic rubber catheter fetish, a sadomasochistic repertory, sexuoerotic experimentation and variety, or activity the result of anatomic ignorance as urethral intercourse has been described wherein a case of infertility was due to the insertion of the husband’s penis into the wife’s urethra rather than the vagina”.

Pranzarone also provides a little information on catheterophilia, and notes that it is a sexual paraphilia of the “fetishistic and talismanic type in which the sexual arousal and facilitation or attainment of orgasm are responsive to and contingent on having a catheter inserted up into the urethra”. Catheterization is nothing new and according to Dr. Brenda Love has been practiced for at least 4000 years. She also provided a lengthy entry in her sexual encyclopedia although most of it is devoted to describing different types of catheters. However, her perspective on catheter use is related more to sexual masochism and sexual sadism. More specifically, she claims that:

“Catheters are used in sex play as a symbol of total control over a partner. This type of sex play is similar to the catheterization found in health care facilities. The sterilized catheter is inserted up through the urethra and into the bladder which allows the flow of urine to be controlled by the dominant partner. The stimulation seems to trigger the brain’s pleasure center that ordinarily responds to urination or ejaculation…the urethra is often sore and burns for half an hour afterward”

Apart from definitions of catheterophilia, and short summaries that the condition exists, there has been little in the way of academic or clinical research. I couldn’t even find a single case study. A Finnish study led by Dr Laurence Alison reported in a 2001 issue of the Archives of Sexual Behavior reported that enduring the insertion of a catheter was one of the activities engaged in by sadomasochists, particularly those involved in ‘hyper-masculine pain administration’. Other associated activities by this group of practitioners included rimming, dildo use, cock binding, being urinated upon, being given an enema, fisting, and being defecated upon. Gay men were more likely than heterosexuals to engage in these types of activity.

In 2002, the same team, this time led by Dr. Kenneth Sandnabba examined the sexual behaviour of sadomasochists in the journal Sexual and Relationship Therapy. The paper summarized the results from five empirical studies of a sample of 184 Finnish sadomasochists (22 women and 162 men). More specifically, the examined the frequency with which the respondents engaged in different sexual practices, behaviours and role-plays during the preceding 12 months and reported that 9.2% had used catheters as part of the sexual activities.

In a previous blog on fetishism, I wrote at length about a study led by Dr G. Scorolli (University of Bologna, Italy) on the relative prevalence of different fetishes using online fetish forum data. It was estimated (very conservatively in the authors’ opinion), that their sample size comprised at least 5000 fetishists (but was likely to be a lot more). Their results showed that there were 28 fetishists (less than 1% of all fetishists) with a sexual interest in catheters.

When I published my previous blog on urethralism, one reader wrote to me with an example of urethral stimulation via catheter use. Obviously, I have no idea to the extent of such practices and how typical this experience is, but I thought I would share it with you nonetheless:

“I have read a patient’s experiences of catheter insertions. He said his first one was excruciating and subsequent insertions became less and less bothersome. Nurses state that some men [say] the Foley catheter does not bother them at all. From common sense I see that there is callousing happening from urethra trauma (especially the first insertion. [This is a] compelling reason why patients should always have a condom catheter, and the Foley catheter used only when necessary. I am most concerned with the permanent nerve damage the very nerves that are also needed for optimum orgasmic intensity”.

The Right Diagnosis website claims that treatment for catheterophilia is generally not sought unless the condition becomes problematic for the person in some way and they feel compelled to address their condition. The site also claims that the majority of catheterophiles learn to accept their fetish and manage to achieve gratification in an appropriate manner.

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

Further reading

Alison, L., Santtila, P., Sandnabba, N. K., & Nordling, N. (2001). Sadomasochistically oriented behavior: Diversity in practice and meaning. Archives of Sexual Behavior, 30, 1–12.

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Love, B. (2001). Encyclopedia of Unusual Sex Practices. London: Greenwich Editions.

Maddy’s Mansion (2010). Catheterophilia. October 4. Located at: http://maddysmansion.blogspot.co.uk/2010/10/catheterophilia.html?zx=b5754ebdc388557b

Money, J. (1986). Lovemaps: Clinical Concepts of Sexual/Erotic Health and Pathology, Paraphilia, and Gender Transposition of Childhood, Adolescence, and Maturity. New York: Irvington Publishers.

Pranzarone, G.F. (2000). The Dictionary of Sexology. Located at: http://ebookee.org/Dictionary-of-Sexology-EN_997360.html

Right Diagnosis (2012). Catheterophilia. February 1. Located at: http://www.rightdiagnosis.com/c/catheterophilia/intro.htm

Sandnabba, N.K., Santtila, P., Alison, L., & Nordling, N. (2002). Demographics, sexual behaviour, family background and abuse experiences of practitioners of sadomasochistic sex: A review of recent research. Sexual and Relationship Therapy, 17, 39–55.

Scorolli, C., Ghirlanda, S., Enquist, M., Zattoni, S. & Jannini, E.A. (2007). Relative prevalence of different fetishes. International Journal of Impotence Research, 19, 432-437.

Winning runs? Another look at exercise addiction

Research appears to indicate that at times of psychological and/or emotional hardship, some habitual exercisers engage in such activity as a form of escape. The reliance on exercise as a means of coping with adversity has the potential become obsessive as well as compulsive. Associated with increased tolerance, over-exercising may lead to physical injuries, and (in extreme cases) irreversible health consequences, and mortality. Over-exercising to the point where a person loses control over the exercise routine has been termed ‘exercise addiction’ or ‘exercise dependence’. Due to the multidisciplinary nature of the literature regarding problematic exercise, different screening instruments have been formulated to assess the problem. In a 2013 issue of the journal Psychology of Sport and Exercise, I and a team of Hungarian researchers published the first ever national study of exercise addiction, and compared two different screening instruments (i.e., the Exercise Addiction Inventory [EAI] and the Exercise Dependence Scale [EDS]).

We made the assumption that these two instruments attempt to assess the same phenomenon. We also published a comprehensive review examining the literature on problematic exercise in a 2012 issue of Substance Use and Misuse and came to the conclusion that the most appropriate term to use is ‘exercise addiction’ because it incorporates both ‘dependence’ and ‘compulsion’. However, most researchers in the field use the terms ‘exercise addiction’, ‘exercise dependence’ and ‘compulsive exercise’ to mean the same thing.

These six core components of addictive behaviour that I outlined in my very first blog served the theoretical foundation for the Exercise Addiction Inventory (EAI). The EAI is a short, psychometrically validated questionnaire that comprises only six statements, each corresponding to one of the symptoms in the ‘components’ model of addiction. However, the cut-off points for exercise addiction were never tested psychometrically. The Exercise Dependence Scale (EDS) was based on the Diagnostic and Statistical Manual of Mental Disorder-IV criteria for substance dependence. The higher the score, the higher is the risk for addiction.

The EAI and the EDS are perhaps the most recent and most widely used screening tools in the research area of exercise addiction, primarily because of their superior psychometric properties in contrast to other instruments, and secondarily because of their theoretical underpinning. However, until our recently published study, these two tools had never been used in a nationally representative study. We assessed exercise addiction within the framework of the National Survey on Addiction Problems in Hungary (NSAPH).

The final sample comprised 2,170 people, stratified according to geographical location, degree of urbanization, and age. Those in this sample who engaged in regular exercise at least on a weekly basis (17.5%) were invited to complete the EAI and the EDS and comprised 474 participants (270 males and 204 females). In line with our assumptions, there was a high correlation between the two exercise addiction/dependence measures. On the basis of results we obtained, we reported that 0.3-0.5% of population is involved in addictive exercise (and equates to 1.9% to 3.2% of weekly regular exercisers).

As mentioned above, our study is the first national study ever to assess the prevalence of exercise addiction in a representative national sample and therefore there are no studies to compare our national findings of the study to. Our study provides primary benchmark data that subsequent national studies will need to be compared to. It is also the first ever study to compare the psychometric properties of (arguably) the two most widely used screening instruments that assess exercise dependence/addiction.

Based on the results of our study, it appears that both of the tools we examined (i.e., EAI and EDS) can reliably be applied in the future for both scientific research in the exercise addiction field, and as a screening instrument in non-research settings. For instance, the short, 6-item EAI could be used as a screening instrument in empirical surveys as a way of combating questionnaire fatigue. It could also be used as a ‘quick and easy’ tool that can be used by health practitioners (such as GPs with their patients) in screening for exercise addiction. The EDS also appears to be suitable for acquiring a more detailed and greater empirical insight to the problem in future studies.

However, there were also a number of limitations to our study. Owing to the sampling method, it was financially impractical to use observational data on physical activity and/or face-to-face clinical interviewing, and therefore we had to base our analysis solely on the basis of self-reports. Self-report data is also prone to the weaknesses of survey methodologies more generally including factors such as recall bias and social desirability. Another limitation was the cross-sectional nature of the dataset, therefore the causality inferences are limited, although further research may identify trends in exercise behaviours and provide models to determine the changes in exercise addiction. Another important question is the generalizability of these results to other countries. However, this question cannot be answered in a reliable way. Though the prevalence of regular exercise is lower in Hungary than in most of the other countries of the European Union, this result, in and of itself, does not necessarily mean that prevalence of excessive exercise is lower as well. It is also possible that though the prevalence of regular exercise is lower than in other countries, prevalence of exercise addiction among the exercisers is higher.

Our results indicate that while optimal regular exercising is a key component of preserving and improving physical and mental health, in case of a small proportion of the population, excessive exercise can generate significant problems. Both the EDS and EAI are adequate screening solutions to assessing exercise dependence/addiction within target populations. While the seven-factor EDS might give a more complex picture on the problem, the short, 6-item EAI has the added advantage of providing anyone who uses the instrument with an estimation of problems with exercise very quickly. Nevertheless, clinical validation of these assessment tools needs to be further targeted and scrutinized by future research.

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

Further reading

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

Allegre, B., Therme, P., & Griffiths, M. D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of ‘ultra-marathoners’. International Journal of Mental Health and Addiction, 5, 233-243.

Berczik, K., Szabó, A., Griffiths, M. D., Kurimay, T., Kun, B., Urbán, R., & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychomaetric examination of the Exercise Dependence Scale-Revised. Measurement in Phisical Education and Exercise Science, 8, 183-201.

Griffiths, M. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, e30-31.

Hausenblas H. A., & Downs, S. D. (2002a) Exercise dependence: a systematic review. Psychology of Sport Exercise, 3, 89-123.

Hausenblas, H. A., & Downs, S. D. (2002). How much is too much? The development and validation of the exercise dependence scale. Psychology and Health, 17, 387-404.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

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

Szabo, A. (2000). Physical activity as a source of psychological dysfunction. In S. J. Biddle, K. R. Fox & S. H. Boutcher (Eds.), Physical Activity and Psychological Well-Being (pp. 130-153). London: Routledge.

Szabo, A., & Griffiths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

Terry, A., Szabo, A., & Griffiths, M. (2004). The exercise addiction inventory: a new brief screening tool. Addiction Research and Theory, 12, 489-499.

Inter-bet gambling: The psychology of online sports betting

Until the early 2000s, there appeared to be a commonly held perception that consumers viewed the Internet as an information gathering tool rather than a place to spend money. The explosive growth in online gambling and betting shows this is no longer true. For me, one of the interesting questions is how gaming companies use the psychology of people who like to gamble on sports events to get them to access sports betting sites (especially if it is done in a socially responsible way that enhances the punter’s experience rather than exploits them).

Trust and reliability: Let’s look at sports betting from an individual level. A sports fan has logged on to the Internet and is in the process of deciding which online sports betting website to make a beeline for. What kinds of things influence their decision? A recommendation from one of their friends? Advice from a gambling portal? An advert they saw in a magazine? From a psychological perspective, research on how and why people access particular commercial websites indicates that one of the most important factors is trust. If people know and trust the name, they are more likely to use that service. Reliability is also a related key factor. Research shows that many people (including sports bettors) still have concerns about Internet security and may not be happy about putting their personal details online. But if there is a reliable offline branch nearby, it gives them an added sense of security (i.e., a psychological safety net). For some people, trust and security issues will continue to be important inhibitors of online gambling. Punters need assurance and compelling value propositions from trusted gaming operators and operators to overcome these concerns.

Personalization: One of the growth areas in e-commerce has been personalization and most online commercial organisations now have a personalization strategy as part of its business plan. However, this practice is a double-edged sword that can prove to be a large logistical problem for companies who use such a strategy. Tracking every move for marketing purposes is one thing. Using these data for personalization purposes can sometimes prove troublesome. The amount of data is potentially enormous. Producing personalized pages for everyone is also logistically difficult and may even turn potential punters away. The key is knowing what to ask the punter. Those in the gaming industry have to think intelligently and creatively about what to ask their customers in a way that the information gained can be used effectively. Attracting customers and providing recommendations relies on the those in the gaming industry putting punters first. Integration can also be a factor here. The industry has to think of creative ways to make the website experience more personal.

Imprinting: One of the most important marketing strategies that companies engage in is “imprinting” new customers. Online punters quickly adopt predictable Internet usage patterns and evidence suggests that they don’t switch online allegiances easily. Smart gaming operators will work at becoming a starting point for the novice gambler and capitalize on this opportunity for capturing player loyalty. The emerging post-teenage market is a key consideration although from a social responsibility perspective thought needs to be given so that teenagers are not exploited. There is a whole Internet generation of people coming through who have a positive outlook on online commercial activities. They may be happier to enter credit card details online and/or meet others online. This has the potential to lead to major clientele changes as the profiles of these people may be radically different from previous punters. The problem is that the young don’t tend to have much disposable income and are less likely to own credit cards. Therefore, another market segment that operators need to target to are the over-50s who are starting to use the Internet for shopping and entertainment use. Early retirees have both time and money. This is why gaming operators need to strategically target the ‘grey pound.’

Contextual commerce: So what can operators do next? Contextual commerce may be one avenue that gaming operators will need to go down. In most retail outlets, shoppers notice what other people are buying and this may influence the purchaser’s choice. Companies are now using software that allows customers to do this online including interacting with other like-minded people. Seeing what everyone else is betting on may influence the decision process. There is also the potential to bring in techniques used on home television shopping channels. Presenters tell viewers how much of a product has been sold with viewers to instil a sense of urgency into the buying process, along with an element of peer review. This could be applied by gaming operators if people are gambling as part of a sports betting community.

Getting the balance right on the chance-skill dimension: All forms of gambling lie on a chance-skill dimension. Neither games of pure skill nor games of pure chance are particularly attractive to sports gamblers. Games of chance (like lotteries) offer no significant edge to sports gamblers and are unlikely to be gambled upon. While games of skill provide a significant edge for the gambler, serious gamblers need more than an edge – they often need an opponent who can be exploited (which helps explain the popularity of online poker). Serious gamblers gravitate towards types of gambling that provide an appropriate mix of chance and skill. This is one of the reasons why sports betting – and in particular activities like horse race betting – is so popular for gamblers. The edge available in horse race gambling can be sufficient to fully support professional gamblers as they bring their wide range of knowledge to the activity. There is the complex interplay of factors that contributes to the final outcome of the race.

Inter-gambler competition and the exercise of skill: Over the last few years I have often been asked by the media about the increasing popularity of online sports betting, particularly in relation to betting exchanges. Psychologists claim that male gamblers are attracted to sports betting because they love competitiveness. Sports bettors clearly feel that gambling via betting exchanges provides value for money and an opportunity to exercise their skill. Another important factor that I feel is really important in the rise of sports betting is not just the inherent competiveness but also the inter-gambler competition. Obviously there is an overlap between competitiveness and skill but they are certainly not the same and operators need to show how the sites they recommend feed into the psychological needs and desires of the sports bettor.

I’m sure many people’s view of psychology is that it is little more than common sense (and to be honest, some of it is). However, I hope that some of what I had to offer in the rest of this blog was more than just common sense.

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

Further reading

Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.

Griffiths, M.D. (2005). Online betting exchanges: A brief overview. Youth Gambling International, 5(2), 1-2.

Griffiths, M.D. (2007). Brand psychology: Social acceptability and familiarity that breeds trust and loyalty. Casino and Gaming International, 3(3), 69-72.

Griffiths, M.D. (2009). Social responsibility in gambling: The implications of real-time behavioural tracking. Casino and Gaming International, 5(3), 99-104.

Griffiths, M.D. & Whitty, M.W. (2010). Online behavioural tracking in Internet gambling research: Ethical and methodological issues. International Journal of Internet Research Ethics, 3, 104-117.

McCormack. A. & Griffiths, M.D. (2012). What differentiates professional poker players from recreational poker players? A qualitative interview study. International Journal of Mental Health and Addiction, 10, 243-257.

Parke, A., Griffiths, M.D. & Irwing, P. (2004). Personality traits in pathological gambling: Sensation seeking, deferment of gratification and competitiveness as risk factors, Addiction Research and Theory, 12, 201-212.

Recher, J. & Griffiths, M.D. (2012). An exploratory qualitative study of online poker professional players. Social Psychological Review, 14(2), 13-25.

Wood, R.T.A. & Griffiths. M.D. (2008). Why Swedish people play online poker and factors that can increase or decrease trust in poker websites: A qualitative investigation. Journal of Gambling Issues, 21, 80-97.

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