Cheesy does it: An unusual case of sitophilia

In a previous blog I looked at sitophilia, a sexual paraphilia in which individuals have an erotic attraction to (and derive sexual arousal from) food. One of the strangest sitophile stories I have read concerns the case of the ‘Swiss Cheese Pervert’.  In the run up to Christmas 2013, a chubby man estimated to be in his 40s was driving around the Mayfair district of Philadelphia (USA) and exposing his genitals to a number of women while seated in his Sedan. However, this was no ordinary case of exhibitionism. As the Fortean Times reported:

“He would then dangle a large slice of Swiss cheese over his penis and offers to pay the women to perform sexual acts on him using the snack. At least two other women received messages on [the] OKCupid [online dating website] they believe were from the same man, describing how being unpopular with women drove him to have sex with cheese. He offered to pay $50 for a woman to pleasure him with a slice. The city’s police suspect 41-year-old Chris Pagano, since he was arrested in 2006 and 2009 for allegedly propositioning women with Swiss cheese on the streets of Norristown, Philadelphia. Pagano claimed that the latest incidents had nothing to do with him – but the picture he used on Facebook was the same as the one on the OKCupid profile message sent to a woman asking her to indulge his cheese craving”.

Pagano’s previous arrests were well documented in the local Philadelphia press and one journalist (Victor Fiorello) has written a number of stories about Pagano’s sexual exploits. In one of his stories he obtained the court documents in relation to the 2006 and 2009 arrests and one extract (with the woman’s name removed to protect her identity) read that:

“[The woman] told police that at approximately 0030 hours she was walking home from a store the male approached her from behind and asked her a question. The male removed a large block of cheese from his pocket and told [the woman] that he would pay her $20 to rub the Swiss cheese on his penis. [The woman] became alarmed and fled on foot toward her residence. The male offered [the woman] more money as she fled the area. [The woman] described the male as white, balding, and weighing over 300 pounds”

Following the late 2013 reports in the local press, one woman (Gabby Chest) telephoned the police saying that she had got an email on the OKCupid website from a “really strange guy” fitting the description of Pagano and who in his message wrote that he was “looking for someone to perform masturbation on him with cheese”. In the online message to Ms. Chest, the man admitted that he had great difficulty in initiating relationships with women because of his weight problem. This (he claimed) led to his cheese fetish and helped him to deal with his sexual urges. The whole message was reprinted on the PhillyMag website and I have reprinted it verbatim as I think it provides a good insight into the behaviour:

“Hello, my name is Chris. I am sure you are seeking a relationship, and I am sort of seeking the same, well sort of. You see I am currently content with my life. I enjoy meeting new people and making friends, but I also enjoy looking for women who are just looking for fun, opportunities, and or sex. I am kind of hoping you may be one of those women, who are open to certain activities of a suggestive nature. I realize talking and or requesting anything sexual with a someone you don’t know can be a turn off for most, but would you be interested in getting to know me, and perhaps being involved in a sexual encounter together? I know it’s a bit much to take in, since you really don’t know me. Still I am open to get to know you at first before anything would happen. I want to be up-front with you and tell you what exactly I am looking for. This way you have an idea of what I am into. You see it’s not sex in the traditional sense, it’s more a fetish. Don’t get me wrong I do enjoy traditional sex, but I grown to prefer this more. This fetish is a Sitophilia type fetish. I will give you a short explanation that lead me to discover why I like this type of fetish.

You see, when I was young and even now I seemed to be judged on my looks and not on my personality. So finding women and starting relationships was harder for me then most. Couple that with a strong sex drive, and you get the picture. So I developed this fetish to help me deal with my sexual urges. I found that women tend to like dairy products, and settled on cheese to represent the girl. Thus I started having sex with cheese. I like to use Swiss cheese and would wrap slices of the cheese around penis, then masturbate. Now tho [sic], after finding several girls to do it for me, I prefer having girls do it for me, instead of myself. Still I suppose I was lucky in finding those women, and our relationships did not last long, since our relationship based more on my fetish and me helping them out money wise. When they became comfortable again, we stayed friends, but they seemed to move on with their lives or I moved on because of the drama that sometimes followed some of them. The other problem I encounter is that women tend to be more freaked out over my fetish, then they would be over other questionable activities that are far more disgusting then mine. I don’t understand why using cheese in the way I use it is so disturbing to women, the ones who have done my fetish for me say it’s quite vanilla compared to so things they have encountered, and say I am quite harmless given my kind personality. So my request is, is there any way you would be willing to strike up an arraignment with me to do my fetish for me, if of course you would be open to this sort of activity? 

Lastly if I have offended you, I am sorry as it was not my intention to do so. I just hope my fetish with cheese does not disturb you in any way, sorry if it has. Also when I mention arrangement, please don’t think it just has to be money either, I know you are not a prostitute, in fact I don’t want women like that at all. It can be anything you feel is a fair trade. Please if you could please let me know if you might be interested or not, and what you think of my request, I would appreciate it, thanks”.

In another online message, it is alleged that he said: “I am lucky I never became a rapist”. This latter admission suggesting that his cheese infatuation was a less palatable alternative to his cheese infatuation. In an email on the OKCupid website, he wrote to another woman and added:

“I tried many different kinds of cheese, like American, Provolone, chez whiz, jack, and cheddar, but settled on Swiss as the best…because of its eye patterns, texture, and the way it feels against my penis. When I was younger I had far more stamina for cheese sex. I was able to wrap and wear a good 1½ pounds of Swiss cheese against my penis, and wear it for hours at a time before I would climax…One last note, I do not like cheese, except for mozzarella, and that is the one cheese I have never used on myself. So no I do not eat the cheese after I am done using it for pleasure, it is discarded. I am always asked that question”.

I found the online message sent to Ms. Chest of great psychological interest. Pagano obviously knew that his preferred sexual behaviour was sitophilia and that he himself conceptualized his own behaviour as fetishistic. He also provided what I believe to be a plausible explanation as to how cheese became a symbolic female substitute for sex. Using cheese in his early masturbatory experiences would almost certainly created an associative pairing between sex and cheese (to the point where cheese on its own may have caused a classically conditioned response resulting in sexual arousal). Pagano’s own realistic assessment of his sexual attractiveness appears to have led to sexual displacement in which cheese represented an outlet for his sexual urges and desires. He was fully aware that his desires would seem strange to most people and that he was prepared to pay for the activity if that helped women participate. From the newspaper reports I read, it would appear that the criminal exhibitionism (i.e., flashing his genitalia at women he approached in his car) was peripheral to his real desire of soliciting women to engage in ‘cheesy’ sex.

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

Further reading

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

Daily Mail (2014). ‘Swiss Cheese Pervert’ terrorizes Philadelphia asking women to perform sexual acts on him using a slice of fromage. Daily Mail. January 13. Located at: http://www.dailymail.co.uk/news/article-2538687/Swiss-Cheese-Pervert-terrorizing-Philadelphia.html

Fiorello, V. (2014). Is this guy the Swiss Cheese Pervert? PhillyMag, January 11. Located at: www.phillymag.com/news/2014/01/11/norristowns-swiss-cheese-pervert/

Fiorello, V. (2014). Here are mugshots of alleged Swiss Cheese Pervert Chris Pagano. PhillyMag, January 11. Located at: http://www.phillymag.com/news/2014/01/13/mugshots-swiss-cheese-pervert-chris-pagano/

Fortean Times (2014). Please cheese me…Fortean Times, March 1, p.10

Sell division: Responsible marketing and advertising by the gambling industry

Over the last few years there has been a great deal of speculation over the role of advertising as a possible stimulus to increased gambling, and as a contributor to problem gambling (including underage gambling). Various lobby groups (e.g., anti-gambling coalitions, religious groups, etc.) claim advertising has played a role in the widespread cultural acceptance of gambling. These groups also claim casino advertising tends to use glamorous images and beautiful people to sell gambling, while other advertisements for lottery tickets and slot machines depict ordinary people winning loads of money or millions from a single coin in the slot.

Around the world, various lobby groups claim that advertisements used by the gambling industry often border on misrepresentations and distortion. There are further claims that adverts are seductive, appealing to people’s greed and desperation for money. Real examples include: ‘Winning is easy’, ‘Win a truckload of cash’, ‘Win a million, the fewer numbers you choose, the easier it is to win’, ‘It’s easy to win’ and ‘$600,000 giveaway simply by inserting card into the poker machine’. Lobby groups further claim that in amongst the thousands of words and images of encouragement, there is rarely anything about the odds of winning – let alone the odds of losing. It has also been claimed that many gambling adverts feature get-rich-quick slogans that sometimes denigrate the values of hard work, initiative, responsibility, perseverance, optimism, investing for the future, and even education.

Those promoting gambling products typically respond in a number of ways. The most popular arguments used to defend such marketing and advertising is that: (i) the gaming industry is in the business of selling fantasies and dreams, (ii) consumers knows the claims are excessive, (iii) big claims are made to catch people’s attention, (iv) people don’t really believe these advertisements, and (v) business advertising is not there to emphasise ‘negative’ aspects of products.   While some of these industry responses have some merit, a much fairer balance is needed.

Statements such as ‘winning is easy’ are most likely (in a legal sense) be considered to be ‘puffery’. Puffery involves making exaggerated statements of opinion (not fact) to attract attention. Various jurisdictions deem it is not misleading or deceptive to engage in puffery. Whether a statement is puffery will depend on the circumstances. A claim is less likely to be puffery if its accuracy can be assessed. The use of a claim such as ‘winning is easy’ is likely to be considered puffery because it is subjective and cannot be assessed for accuracy. However, a statement like ‘five chances to win a million’ may not be puffery as it likely to be measurable.

Most of us who work in the field of responsible gambling agree that all relevant governmental gambling regulatory agencies should ban aggressive advertising strategies, especially those that target people in impoverished individuals or youth. It is also worth pointing out that there are many examples of good practice. Responsible marketing and advertising needs to think about the content and tone of gambling advertising, including the use of minors in ads, and the inclusion of game information. There has to be a strong commitment to socially responsible behaviour that applies across all product sectors, including sensitive areas like gambling. Socially responsible advertising should form one of the elements of protection afforded to ordinary customers and be reflected in the codes of practice. Children and problem gamblers deserve additional shielding from exposure to gambling products and premises, and their advertising. Many codes that regulate gambling marketing and advertising across the world now typically include special provisions on the protection of such groups.

Gambling advertising also plays an important role in ‘normalizing’ gambling. Content analyses of gambling adverts have reported that gambling is portrayed as a normal, enjoyable form of entertainment involving fun and excitement. Furthermore, they are often centred on friends and social events. The likelihood of large financial gain is often central theme, with gambling also viewed as a way to escape day-to-day pressures (one gaming company’s advertising even had the strapline “Bet to forget”). Research has found that there is a large public awareness of gambling advertising, and that problem gamblers often mention advertising as a trigger to gambling.

An example of good practice is that of Canadian gaming operator Loto-Quebec. They did a thorough review of its advertising code and some of the key aspects in terms of responsible marketing and advertising of gambling included:

  • A marketing policy that (i) prohibits any advertising that is overly aggressive, (ii) rejects concepts liable to incite the interest of children, and (iii) prohibits the use of spokespeople who are popular among youth, and (iv) prohibits placement of advertisements within media programs viewed mainly by minors.
  • The odds of winning are highlighted. This is being done in response to the suggestions expressed so frequently by various groups interested in knowing their chances of winning.
  • Television commercials for new products devote 20% of their airtime to promoting the gambling help line and to presenting warnings about problem gambling.
  • A policy that prohibits the targeting of any particular group or community for the purposes of promoting its products. For example, one of their instant lotteries used a Chinese theme to stimulate interest. However, the Chinese community did not agree with making references to its customs in order to promote the game. Out of respect for this community, the game was immediately suspended.

As various national and international advertising regulation bodies have advocated, socially responsible advertising should form one of the elements of protection afforded to ordinary customers and be reflected in the codes of practice. Personally, I believe that gambling advertising should focus on buying entertainment rather than winning money. Gambling problems often occur when an individual’s primary reason to gamble is to win money.

Many countries have strict codes for gambling advertisements, and good codes (like those in the UK) recommend that gambling advertisements must not: (i) exploit cultural beliefs or traditions about gambling or luck, (ii) condone or encourage criminal or anti-social behaviour, (iii) condone or feature gambling in a working environment (with the exception for licensed gambling premises), (iv) exploit the susceptibilities, aspirations, credulity, inexperience or lack of knowledge of under-18s or other vulnerable persons, (v) be likely to be of particular appeal to under-18s, especially by reflecting or being associated with youth culture, and (vi) feature anyone who is, or seems to be, under 25 years old gambling or playing a significant role.

Quite clearly it is appropriate and necessary for the gaming industry to advertise, market, and promote its facilities and products. However, I believe that all advertising and marketing should be carried out in a socially responsible manner as it is good for long-term repeat business.

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

Further reading

Adams, P. (2004). Minimising the impact of gambling in the subtle degradation of democratic systems, Journal of Gambling Issues, 11. Available at: http://www.camh.net/egambling/issue11/jgi_11_adams.html.

Binde, P. (2007). Selling dreams – causing nightmares? On gambling advertising and problem gambling. Journal of Gambling Issues, 20, 167-191.

Griffiths, M.D. (2005). Does advertising of gambling increase gambling addiction? International Journal of Mental Health and Addiction, 3(2), 15-25.

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. (2010). Online ads and the promotion of responsible gambling. World Online Gambling Law Report, 9(6), 14.

Griffiths, M.D. & Wood, R.T.A. (2008). Responsible gaming and best practice: How can academics help? Casino and Gaming International, 4(1), 107-112.

Hanss, D., Mentzoni, R.A., Griffiths, M.D., & Pallesen, S. (2015). The impact of gambling advertising: Problem gamblers report stronger impacts on involvement, knowledge, and awareness than recreational gamblers. Psychology of Addictive Behaviors, in press.

Korn, D, Hurson, T. & Reynolds, J. (2004). Commercial Gambling Advertising: Possible Impact on Youth Knowledge, Attitudes, Beliefs and Behavioural Intentions. Report submitted to the Ontario Gambling Research Centre.

Extremes of dreams (so it seems): The psychology of ‘Vanilla Sky’

Regular readers of my blog will know that when it comes to certain films and television shows (and their accompanying DVD box sets) I can be somewhat obsessive and fanatical (for instance see, my blog on my love of all things concerning Hannibal Lecter). I’m one of those individuals that will watch some films again and again looking for further insight and deeper meanings (such as Memento, The Usual Suspects, Donnie Darko, Inception, Shutter Island, Seven, and The Shining). One of the films I have watched many times is Cameron Crowe’s psychological thriller Vanilla Sky (starring Tom Cruise, Kurt Russell, Cameron Diaz and Penélope Cruz), a remake of the Spanish film Abre los Ojos (Open Your Eyes).

One of the reason I like the film is that it prominently features the concept of lucid dreaming. I’d never heard of lucid dreaming until 1988. I was doing my PhD at the University of Exeter at the time and one of my best friends (Robert Rooksby) was doing his PhD on lucid dreaming. As the Wikipedia entry on lucid dreaming notes:

“A lucid dream is any dream in which one is aware that one is dreaming. In relation to this phenomenon, Greek philosopher Aristotle observed: ‘often when one is asleep, there is something in consciousness which declares that what then presents itself is but a dream’…The person most widely acknowledged as having coined the term is Dutch psychiatrist and writer Frederik (Willem) van Eeden…In a lucid dream, the dreamer has greater chances to exert some degree of control over their participation within the dream or be able to manipulate their imaginary experiences in the dream environment…Lucid dreams can be realistic and vivid. It is shown that there are higher amounts of beta-1 frequency band (13–19 Hz) brain wave activity experienced by lucid dreamers, hence there is an increased amount of activity in the parietal lobes making lucid dreaming a conscious process”.

Much like the films of David Lynch (one of my favourite film directors), Vanilla Sky is a film forces you to think about what is going on and is one of those films that you can come to your own conclusions as to what it all means. As a psychologist, I love films that play with the mind and Vanilla Sky is one of those films, particularly as psychology in the form of dreams, subjective reality, and the unconscious lie at the heart of the film. The director Cameron Crowe added many obscure clues and hidden references throughout the film to help viewers further explain the film and to add more layers.  There are dozens of dedicated websites that have compiled lists of theories, messages and/or hidden clues. In the film’s production notes, Crowe later admitted: “We constructed the movie, visually and story-wise, to reveal more and more the closer you look at it. As deep as you want to go with it, my desire was for the movie to meet you there”. That alone is enough of a hook to get me watching repeatedly.

Another aspect of the film that I love is the perfect use of music. Almost every lyric of every song used throughout the movie interweaves seamlessly between the actors, the in-scene narrative, and the developing story line. The songs are expertly chosen. This is no surprise given that Crowe was formerly a music journalist and a contributing editor at Rolling Stone magazine. Like me, Crowe is a huge fan of The Beatles, and referred to the “clues” in Vanilla Sky as his own version of the ‘Paul McCartney is Dead’ rumour that swept the world in 1969 (i.e., the notorious Beatles hoax when fans worldwide became convinced through song lyrics, sonic tricks, and album art that Paul McCartney had died and was replaced by a look-alike). As Crowe commented: “Divorcing it from whether Paul was really dead or not, that was a really great parlour game: searching for clues, the excitement of different layers, some of them chilling, some of them really funny. It was a great model for us [on Vanilla Sky]”. One of the homages to The Beatles in the film concerns their song Revolution 9. The film contains countless references to the number (or time) 9:09 (on Aames’ wristwatch, a child’s shirt, the prison chalkboard, and multiple references to cats who, has myth has it, have nine lives).

I’m assuming that anyone that has read this far has seen the film (but if you haven’t – spoiler alert – some of what I’m about to write will likely reduce the enjoyment of watching the film for the first time). The thrust of the plot is as follows:

“From a prison cell where he has been charged for murder, David Aames (Tom Cruise, in a prosthetic mask, tells his life story to court psychologist Dr. Curtis McCabe (Kurt Russell). In flashback, David [who is acrophobic with an irrational fear of heights] is shown to be the wealthy owner of a large publishing firm in New York City which he inherited from his father, leaving its regular duties to his father’s trusted associates. As David enjoys the bachelor lifestyle, he is introduced to Sofia Serrano (Penélope Cruz) by his best friend and author Brian Shelby [who is writing a book on Aames] at a party. David and Sofia spend a night together talking, and fall in love. When David’s former lover, Julianna “Julie” Gianni (Cameron Diaz) hears of Sofia, she attempts to kill herself and David in a car crash. Julie dies but David survives, his face grotesquely disfigured, leading him to wear a mask to hide the injuries. With no hope to use plastic surgery to repair the damage, David cannot come to grips with the idea of wearing the mask for the rest of his life. One night on a night out with Sofia…David gets hopelessly drunk, and [is left by Sophia] to wallow in the street outside” (Wikipedia entry on Vanilla Sky)

It is generally accepted that everything from this point in the film is a dream (although others say the whole film is a dream). Rather than live out the rest of his life in a disfigured state, Aames has his body cryogenically frozen by a company called Life Extension after attempting suicide. He lives the rest of his life as a lucid dream from the moment he was found on the pavement after his drunken night out (“under the ‘vanilla sky’ from a Monet painting”). However, during cryogenic sleep, the lucid dream goes horribly wrong and starts to incorporate elements from his subconscious. After 150 years in suspended sleep, the company that placed Aames into cryogenic suspension calls in ‘Tech Support’ and Aames is offered a choice to either be reinserted into a corrected lucid dream, or to wake up by taking a leap of faith – literally – from the top of a high roof (that forces him to challenge his fear of heights).

Conquering his final fear, David jumps off the building, his life flashing before his eyes, and whites out immediately before hitting the ground. A female voice commands him to ‘open your eyes’ (a recurring theme in the movie), and the film ends with David opening his eyes” (Wikipedia entry on Vanilla Sky).

Many different websites examining the film claim there are five interpretations of the film’s ending (and this is supported by Crowe himself). The five interpretations (taken verbatim from the Wikipedia entry on the film) are:

  • “Tech support is telling the truth: 150 years have passed since Aames killed himself and subsequent events form a lucid dream.
  • The entire film is a dream, evidenced by the sticker on Aames’ car that reads “2/30/01″ (February 30 does not occur in the Gregorian Calendar).
  • The events following the crash form a dream that occurs while Aames is in a coma.
  • The entire film is the plot of the book that Brian [Shelby, his best friend] is writing.
  • The entire film after the crash is a hallucination caused by the drugs that were administered during Aames’ reconstructive surgery”.

(I’m most persuaded by the first interpretation). What I also love about the film is that Crowe added lots of little details that take a few viewings of the film before they are usually spotted. All of these help in both trying to interpret the film, as well as becoming a game where repeated watching becomes more rewarding. For instance:

  • In the first scene in which Julianna appears, the tune ringing on her cell phone is Row Row Row Your Boat that features the lyric “life is but a dream”.
  • At his birthday party, Aames is asked how it’s going to which he responds “Livin’ the dream, baby…livin’ the dream”.
  • At the same party, Aames’ best friend Brian Shelby comes into the second apartment wears a t-shirt with the words “fantasy” in sparkly sequins.
  • In one of the prison scenes, the word ‘DREAM’ is spelt out backwards on a chalkboard.
  • In the prison cell, the book, Memories, Dreams, and Reflections (by Carl Jung) is on the table while Aames is talking to his psychiatrist Dr. McCabe. The book concerns Jung’s personal dreams and how they helped uncover his “shadow” and removed his persona (his ‘mask’). In fact one critique of the film by Carlo Cavagna described the whole film as “overtly Jungian”. More specifically, he asserted that Vanilla Sky is fundamentally about the relationship between the ego and the unconscious, and practically a primer on the most fundamental concepts found in any Jungian glossary…For Jung, the unconscious includes desires repressed by our education and socialization, but there is more ‘psychic material that lies below the threshold of consciousness’. The unconscious is the foundation on which the conscious mind is based”.
  • On Aames’ prison uniform the name tag says “Frozen Guy”.
  • His patient number on his Life Extension cryogenic tank says “PL515NT 4R51MS” (which if the numbers are replaced with their corresponding letters of the alphabet, it almost spells “Pleasant Dreams”).
  • As Aames is getting his prison photograph taken, the slate spells ‘When did the dream become a nightmare?’ (in simple code).
  • Sofia calls Aames a “pleasure delayer” twice in the film (but says it so subtly that it’s hard to hear properly).
  • When Aames and Sophia are lying in bed after making love, Sophia asks “Is this is a dream?” and Aames replied “absolutely”.
  • At one point in the film, Dr. McCabe tells Aames that he’d had a nightmare the day before.  Aames replies that “It’s all a nightmare”.

I said earlier in the article that I thought the songs were perfectly chosen. Many fans of the film have noted that the lyrics repeatedly appear to match the emotion of the scene where it is played. As the Uncool website notes:

“For example, the song that plays over David leaving Sophia’s in the morning is Jeff Buckley’s, ‘Last Goodbye’…that morning was there last one true goodbye. Yes, they see each other after this, but after the car wreck when both of their lives are forever changed. ‘Last Goodbye’ also contains the lyrics: ‘Kiss me, please kiss me, but kiss me out of desire, babe not consolation’ which follows David’s plight rather well (as the next time he sees her is after the accident and he wants her affections but not sympathy for his disfigurement)…Bruce Springsteen’s ‘The River’ album (featured in the closing montage) also has some lyrical significance. One of the best lines from the song ‘The River’ is: “Is a dream a lie if it don’t come true, or is it something worse?” Also, two R.E.M. songs are featured. Don’t forget what R.E.M. stands for. Rapid eye movement. As in a state of sleep. It’s when you dream”.

It doesn’t take a psychologist to work out that I simply love the level of detail that went into making the film. I am not a great fan of psychodynamic (psychoanalytic) interpretation, but in Vanilla Sky, the mask that Aames wore became his ‘persona’ and the term was used by Carl Jung to describe the face that we as individuals present to society and (in some cases) to ourselves. Carlo Cavagna argues that:

“[Aames] attraction to [Sophie] is irresistible because she is his anima, his archetypal dream lover, the personification of the feminine nature in his own unconscious. Jung posited that all men carry an ideal image of woman in their heads and unconsciously project that image onto “the person of the beloved…David’s disfigured face, which he sometimes hides with his mask, represents his shadow. For Jung, the shadow is the inferior part of the personality, the sum of all personal and collective psychic elements that, because of their incompatibility with the chosen conscious attitude, are denied expression in life and therefore coalesce into a relatively autonomous “splinter personality” in the unconscious. Despite the negative connotations of the word ‘shadow’, Jung meant it to encompass all those qualities that are suppressed, both positive and negative. ‘The shadow personifies everything that the subject refuses to acknowledge about himself and yet is always thrusting itself upon him directly or indirectly’… [Aames] reality is subjective, and his shadow is breaking through into consciousness. This is the source of the film’s main conflict. In discussing dream therapy and the difficulty of processing and assimilating the unconscious, Jung wrote that several negative outcomes are possible – eccentricity, infantilism, paranoia, schizophrenia, or regression (the restoration of the persona). The revelation and assimilation of David’s unconscious is essentially the story of Vanilla Sky”.

Although there are many critics who hated the film, I love it on many different levels (including the underlying psychology).

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

Further reading

Cavagna, C. (2001, December). Vanilla Sky. Located at: http://www.aboutfilm.com/movies/v/vanillasky.htm

Jung, C.G. (1961). Memories, Dreams, Reflections. New York: Vantage.

Kummer, R. (2010). “What is happiness to you?” Vanilla Sky (2001) Film Analysis. Located at: http://rkummer.hubpages.com/hub/What-is-happiness-to-you-Vanilla-Sky-2001-Film-Analysis

Rooksby, R. and Terwee, Sybe J.S. (1990). Freud, van Eeden and lucid dreaming. Lucidity Letter, 9(2), 18–28. Located at: http://www.sawka.com/spiritwatch/freudvan.htm

Turner, R. (2014). Vanilla Sky movie review: Beyond lucid dreams. Located at: http://www.world-of-lucid-dreaming.com/vanilla-sky-review.html

The Uncool (2015). Vanilla Sky secrets. Located at: http://www.theuncool.com/films/vanilla-sky/vanilla-sky-secrets

Wikipedia (2015). Vanilla Sky. Located at: https://en.wikipedia.org/?title=Vanilla_Sky

Cell growth: A brief look at mobile sports betting

It is often claimed by marketeers that remote gambling makes commercial sense (i.e., the combining of gambling and remote technologies such as the internet and mobile phones into one convenient package). Mobile phone betting and gambling not only provides convenience and flexibility, but perhaps more importantly from a gaming operator’s perspective, provides gambling on the move, whenever and wherever. Since it is somewhat unnatural to always be near a computer, it could be argued that mobile phones are an ideal medium for betting and gambling. Whenever gamblers have a few minutes to spare (at the airport, commuting to work, waiting in a queue, etc.), they can occupy themselves by gambling.

Conventional wisdom says that two things have the power to drive any new consumer technology – pornography and gambling. These activities helped satellite and cable television, video, and the Internet and provide adult entertainment in a convenient and guilt-free environment. Betting via mobile phone is no different. Along with pornography, gambling should have little trouble reaching profitability – especially if this is combined with sports events. Sports interest is huge. There are thousands of communities (including those online). The most successful of those communities will look to ‘mobilize’ and then ‘monetize’.

The mobile phone industry has grown rapidly in the last decade. Market research highlights that mobile phone revenues from mobile gambling and gaming is increasingly rapidly. Although mobile gaming revenues are increasing, it is estimated that less than 2% of mobile industry revenue is generated by gaming and gambling. It is generally thought that lottery gambling will make most money for mobile gambling operators because governments are generally less censorious about lotteries than other forms of gambling. They are also easy to play and relatively low cost compared to other types of gambling.

To some extent, the majority of gamblers are risk-takers to begin with. Therefore, they may be less cautious with new forms of technology. For every day gamblers, mobile phones are ideal for bet placing, and gamblers will be able to check on their bets, and place new ones. Furthermore, it is anonymous, and can provide immediate gratification, anytime, anywhere. Anonymity and secrecy may be potential benefits of mobile gambling as for a lot of people there is still stigma attached to gambling in places like betting shops and casinos. Mobile sports betting is also well suited to personal (i.e., one-to-one) gambling, where users bet against each other rather than bookies. Online betting exchanges demonstrate that people bet on anything and everything to do with sport (with each other).

Although mobile phone technology has improved exponentially over the last decade, it is unlikely that mobile phone graphics and technology will ever truly compete with Internet web browsers (although I am happy to be proved wrong). Intuitively, mobile phone gambling is best suited for sports and event betting. With mobile phone betting, all that is required is real-time access to data about the event to be bet on (e.g., a horse race, a football match), and the ability to make a bet in a timely fashion.

These basic requirements are, of course, easily be provided by the current generation of mobile phones, and the appropriate software. The placing of the bet is not the driving motivation in event wagering. Since being the spectator is what sports fans are really interested in, the sports gambler does not need fulfillment from the process of gambling. People betting on sports will use mobile phones because they are easy, convenient and take no time to boot up. Once they have their sports book registered as a bookmark on their phone, they can access it and place a bet within a very short space of time.

As I have noted in previous blogs, 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 bettors. Games of chance (like lotteries) offer no significant edge to sports bettors and are unlikely to be gambled upon. Serious punters 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. However, in the mobile sports betting market, it is likely to be football that will make the big money for sports betting agencies.

Consider the following scenario. A betting service that knows where you are and/or what you are doing has the capacity to suggest something context-related to the mobile user to bet on. For instance, if the mobile phone user bought a ticket for a soccer match using an electronic service, this service may share this information with a betting company. If in that match the referee gives a penalty for one team, a person’s mobile could ring and give the user an opportunity (on screen) to bet whether or not the penalty will be scored. On this type of service, the mobile phone user will only have to decide if they want to bet, and if they do, the amount of money. Two clicks and the bet will be placed. Context, timeliness, simplicity, and above all user involvement look like enough to convince also people that never entered a bet-shop.

Many football clubs are turning themselves into powerful media companies. They have their own digital TV channel and signed up a host of big-name technology partners. Such companies will get the chance to develop co-branded mobile services with the club. This offers users access to content similar to their website (receiving real-time scores and team news via SMS). While watching matches, users will be able to view statistics, player biographies, and order merchandise. Such mobility will facilitate an increase in ‘personalized’ gambling where bettors gamble against each other, rather than the house.

Gambling will (if it is not already) become part of the match day experience. A typical scenario might involve a £10 bet with a friend on a weekend football match. The gambler can text their friend via SMS and log on to the betting service to make their gamble. If the friend accepts, the gambler has got the chance to win (or lose). Football clubs will get a share of the profits from the service. Clubs are keen to get fans using branded mobile devices where they can simply hit a ‘bet’ button and place a wager with the club’s mobile phone partner.

As with all new forms of technological gambling, ease of use is paramount to success. Mobile phones have become more user-friendly. Pricing structures are also important. Internet access and mobile phone use that is paid for by the minute produces very different customer behavior to those that have one off payment fees (e.g., unlimited use and access for a monthly rental fee). The latter payment structure facilitates leisure use, as punters would not be worried that for every extra minute they are online, they are increasing the size of their phone bills. For me, mobile sports betting is where the future of mobile gambling is likely to be.

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

Further reading

Griffiths, M.D. (2004). Mobile phone gambling: preparing for take off. World Online Gambling Law Report, 8(3), 6-7.

Griffiths, M.D. (2005). The psychosocial impact of mobile phone gambling. World Online Gambling Law Report, 4 (10), 14-15.

Griffiths, M.D. (2010). The psychology of sports betting: What should affiliates know? i-Gaming Business Affiliate, August/September, 46-47.

Griffiths, M.D. (2011). Mobile sportsbetting: A view from the social sciences. i-Gaming Business, 69, 64-65.

Griffiths, M.D. (2011). Technological trends remote gambling: A psychological perspective. i-Gaming Business, 71, 39-40.

Griffiths, M.D. (2013). Adolescent mobile phone addiction: A cause for concern? Education and Health, 31, 76-78.

Griffiths, M.D. (2007). Mobile phone gambling. In D. Taniar (Ed.), Encyclopedia of Mobile Computing and Commerce (pp.553-556). Pennsylvania: Information Science Reference.

Gas roots: A beginner’s guide to anaesthesiophilia

“I love the idea of being wheeled in my bed along the hospital corridors before bursting through the swing doors of the Anaesthetic Room. The lady anaethetist then smiles and tells me that she has decided to put me to sleep with the Gas. ‘NO! Not the Gas!’ The lady then insists by saying that it is her treat and that she has been looking forward to this moment! She smiles as she lowers the black rubbery mask and whispers, ‘Now just relax. IT’S TIME! Breathe in the Gas nice and deep. I look forward to seeing you struggle to keep your eyes open; but very soon you will succumb to the lovely Gas and you will have to close your eyes! Sleep well!’ She leans closer to me and laughs as I take deep breaths of the lovely Gas!!” (Participant at Sleep Peeps website).

In a previous blog, I examined medical fetishism that refers to an umbrella group of related sexual fetishes in which individuals derive sexual pleasure and arousal from medical and/or clinical practices and procedures (e.g., undergoing a rectal examination or urethral swab, having temperature taken), objects (e.g., stethoscope, hypodermic needle), situations (e.g., waiting to see a nurse), and environments (e.g., being in a hospital waiting room). One form of medical fetishism is anaesthesia fetishism in which individuals derive sexual pleasure and arousal from either administering and/or receiving some kind of anaesthetic such as chloroform, ether, butane, etc. As an entry in Wikipedia notes:

This may include the sexual attraction to the equipment, processes, substances, effects, environments or situations. Sexual arousal from the desire to administer anesthesia, or the sexual desire for oneself to be anaesthetized are two forms in which an individual may exist as an arbiter of the fetish. Older-style anesthesia masks of black rubber, still in occasional use today, are one of the more common elements fetishized, and have earned the nickname Black Beauty by many fetishists…The Internet has enabled people with this relatively rare paraphilia to discuss the subject and exchange anesthesia-related multimedia”.

Back in 1999, I had my first ever article published on sexually paraphilic behaviour in the magazine Bizarre. It was an article on autoerotic deaths and it featured the cases of ten people who had died in strange sexual circumstances. One of the cases I featured was originally published in a 1988 issue of the American Journal of Forensic Medicine and Pathology (by Dr. J.J. McLennan and colleagues). The case involved a single 59-year old white US male antiques dealer. The man was found dead in his locked apartment. He was seated in front of a dental anaesthetic machine with the anaesthetic face-mask over his face. He was sucking on a rubber teat similar (but much bigger) than a baby’s feeding bottle. There were other anaesthetic machines around the apartment as well as a lot of sexual literature (magazines, photographs, paintings, manuscripts all concerned with his elaborate fetish some of which included photographs of himself in these situations). He was wearing a rubber type apron, three woolen cardigans, a woman’s blouse and two pairs of women’s trousers and a pair of women’s bloomers. This appeared to be a genuine case of anaesthesiophilia. (A similar case was also reported in 1988 the same journal by Dr. S. Leadbeatter. Here, the method of induction of cerebral hypoxia was inhalation of nitrous oxide [i.e., ‘laughing gas’] from a dental anesthetic machine).

In the same article I featured the case of a single 32-year old white US male computer programmer that was published in a 1983 issue of Medicine, Science and the Law (by Dr. S.M. Cordner). Here, the man was found dead in bed with cassette recorder next to him and covered in dry semen stains. He was wearing headphones which playing “snorting” horse sounds. There was also a can of aerosol propellant. At the end of the bed was a large painting of a male strapped to the hind legs of a horse who was being anally penetrating by the horse. The horse was ridden by a leather-clad woman. He was also wearing some kind if homemade masturbatory device. His death was recorded as cardio-respiratory failure consistent with aerosol propellant abuse (death by misadventure).

Although this case wasn’t technically anaesthesiophilia, it did involve self-administration of a chemical agent to modify the sensations of masturbation. However, in a 2009 book chapter on ‘adult sexual offences’ by Dr. Deborah Rogers (in the book Clinical Forensic Medicine), she seems to suggest that the case I have just described would be classed as anaesthesiophilia as she defines such a paraphilia as it involves the person using a volatile substance (e.g., chloroform, ether, butane) as a source of sexual arousal. She also points out the commonalities between anaesthesiophilia, hypoxyphilia (sexual arousal and pleasure from oxygen deprivation), and electrophilia (sexual arousal and pleasure from electricity and electric stimuli). More specifically she notes:

“Some sexual variations involve inherently life-threatening practices. These include autoerotic asphyxia (using strangulation, hanging, gagging, plastic bag asphyxia, inverted suspension), electrophilia and anaesthesiophilia. When accidental deaths do occur in these circumstances associated paraphernalia may be present at the scene, such as evidence of transvestism, bondage, pornographic material or mirrors. Family members or friends who discover the body in these situations may, in an attempt to preserve the reputation of the deceased, remove certain articles. In doing so they may create a scene erroneously considered a suicide or homicide. When the truth is divulged sympathetic explanations are necessary for reassurance that these deaths are usually accidental”.

Many of the same points were made by Dr. Stephen Hucker writing in a 2011 issue of the Archives of Sexual Behavior. Hucker compared electrophilia and hypoxyphilia and electrophilia with anaesthesiophilia. He also stated that all these behaviours have potential “to result in a well-recognized mode of accidental death” and come “under the general rubric of sexual masochism.

Using Dr. Rogers’ wider definition of anaesthesiophilia indicates that the practice – while rare – is well known in the forensic literature where a number of autoerotic deaths have been reported as arising from the sexual use of volatile substances. One of the first such deaths reported in the literature dates back to a 1933 German report (by Dr. F. Schwarz). He recounted the case of a man who had used a complex system of valves, tubes, and balloons to get sexually aroused from nitrous oxide (stolen from his dad’s medical practice).

Another lethal German case from 1997 was reported by Dr. M. Rothschild and Dr. V. Schneider. Again, the source of sexual arousal was nitrous oxide (this time dispensed from cream dispenser cartridges via a homemade system of anesthetic tubes, plastic bags, and an anesthetic face mask. A paper by Dr. D. Breitmeier and colleagues in a 2002 issue of the Journal of Legal Medicine reported an autoerotic death of a man due to a bizarre combination of asphyxia by suffocation and intoxication with (the drug) ketamine that was self-administered by an intravenous catheter.

Dr. R.W. Byard and his colleagues also reported an unusual autoerotic death in a 2000 issue of the Journal of Clinical Forensic Medicine. They reported the case of a 38-year-old man who was “found dead in bed dressed in female clothing with a mouth gag, handcuffs and bindings around the genitals and limbs”. A gas mask respirator was also covering the mouth and nose and death was attributed to a combination of chloroform toxicity and upper-airway obstruction. Another autoerotic death involving chloroform was reported by Dr. Peter Singer and Dr. Graham Jones in a 2006 issue of the Journal of Analytical Toxicology.

“He was found lying on the floor of his apartment, prone on a piece of foam and a towel. His eyes were bound with a towel, his lower face and nose were almost entirely covered with duct tape surrounding a rubber hose in his mouth. The other end of the hose was loosely sitting inside an open bottle which was in a box beside him. He was bound-up by an intricate system of ropes, handles, and rods, ending with a noose around his neck”

Clearly, much of what we know about anaesthesiophilia appears to be based on case reports where the use of an anaesthetizing agent during the sexual act has gone horribly wrong. Most of the deaths occurred because the person appears to have been on their own and was presumably a masturbatory act. Engaging in the act where more than one person is present significantly reduces the chances of anything unwanted happening for the anaesthesiophile.

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

Further reading

Breitmeier D., Passie, T., Mansouri, F., Albrecht, K, Kleemann, W.J. (2002) Autoerotic accident associated with self-applied ketamine. Journal of Legal Medicine, 116, 113-116.

Bungardt, N. & L. Pötsch, (2003). [Report on a methemoglobinemia associated death]. Archiv fur Kriminologie, 212, 176-183.

Byard, R.W., Kostakis, C., Pigou, P.E. & Gilbert, J.D. (2000). Volatile substance use in sexual asphyxia. Journal of Clinical Forensic Medicine, 7, 26-28.

Cordner, S.M. (1983). An unusual case of sudden death associated with masturbation. Medicine, Science and Law, 23, 54-56.

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

Hucker, S. (2011). Hypoxyphilia. Archives of Sexual Behavior, 40, 1323-1326.

Leadbeatter, S., (1988). Dental anesthetic death: An unusual autoerotic episode. American Journal of Forensic Medicine and Pathology, 9, 60-63.

McLennan, J.J., Sekula-Perlman, A., Lippstone, M.B. & Callery, R.T. (1998). Propane-associated autoerotic fatalities. American Journal of Forensic Medicine and Pathology, 19, 381-386.

Musshoff, F., Padosch, S.A., Kroener, L.A, et al., (2006). Accidental autoerotic death by volatile substance abuse or nonsexually motivated accidents? American Journal of Forensic Medicine and Pathology, 27, 188-192.

Rogers, D.J. (2009). Adult sexual offences. In McLay, W.D.S. (Ed.). Clinical Forensic Medicine (3rd Edition, pp. 137-154). Cambridge: Cambridge University Press.

Rothschild, M.A. & Schneider, V. (1997). Uber zwei autoerotische Unf T Lachgasnarkose und Thoraxkompression. Archiv fur Kriminologie, 200, 65-72.

Schwarz, F. (1933). T Lachgasvergiftung bei Selbstnarkose. Archiv fur Kriminologie, 93, 215-217.

Singer, P.P. & Jones, G.R. (2006). An unusual autoerotic fatality associated with chloroform inhalation. Journal of Analytical Toxicology, 30, 216-218.

Stemberga, V., Bralić, M., Bosnar, A. & Coklo M. (2007). Propane-associated autoerotic asphyxiation: accident or suicide? Collegium Antropologicum, 31, 625-627.

Thibault R, Spencer JD, Bishop JW, Hibler NS (1984) An unusual autoerotic death: asphyxia with an abdominal ligature. Journal of Forensic Science, 29, 679-684.

Wikipedia (2012). Medical fetishism. Located at: http://en.wikipedia.org/wiki/Medical_fetishism

Whirled piece: Dancing as an addiction

In previous blogs I have examined various (admittedly extreme) aspects of dancing including people that are sexually aroused by dancing (choreophilia), dancing as a form of frottuerism, people that are addicted to dancing (in this case, the Argentine tango), and people who have developed medical complaints as a result of dancing (‘breaker’s neck’ caused by break dancing). However, over the last few months I have been a co-author on two dance-related research papers with my research colleagues in Hungary (led by Aniko Maraz). The first one (published in the journal PLoS ONE) was about the development and psychometric validation of the ‘Dancing Motives Inventory’ (DMI). The second one (also published in PLoS ONE) was a study of dance addiction (and which I will describe in more detail below).

I’m sure many of you reading this will think that dancing is a somewhat trivial area to be carrying out scientific research. However, research has shown that dancing can have substantial benefits for physical and mental health such as decreased depression and anxiety, and increased physical and psychological wellbeing. After we developed the DMI, we realised that very little known about the psychological underpinnings of excessive dancing, and whether in extreme cases, dancing could be classed as an addictive behaviour. Given the lack of empirical research in dance addiction, we conceptualized dance addiction to be akin to exercise addiction. For example, a study published in the journal Perceptual and Motor Skills led by Dr. Edgar Pierce reported that dancers scored higher on the Exercise Addiction Scale compared to endurance and non-endurance athletes. Added to this, both exercise and dancing require stamina and physical fitness, and for this reason, dance is often classified as a form of exercise.

Over the last 20 years I have published many papers on exercise addiction (see ‘Further reading’ below) so there is no reason why dance addiction couldn’t theoretically exist (in fact, it could be argued that dance addiction – if it exists – is a sub-type of exercise addiction). There are also a handful of studies that have examined excessive dancing and whether it can be addictive to a small minority. A study by Edgar Pierce and Myra Daleng (again in Perceptual and Motor Skills) conducted a study with 10 elite ballet dancers and found that dancers rated thinner bodies as ideal and significantly more desirable than their actual body image despite being in the ‘ideal’ BMI range. The study also found that dancers often continue to dance despite discomfort, “because of the embedded subculture in dance that embraces injury, pain, and tolerance”. In a more recent study in the Journal of Behavioral Addictions (and which I reported at length in a previous blog), Dr. Remi Targhetta and colleagues assessed addiction to the Argentine tango. They found that almost half of their participants (45%) met the DSM-IV criteria of abuse, although a substantially lower prevalence rate (7%) was found when using more conservative criteria.

In our recently published study, we proposed that excessive social dancing would be associated with detriments to mental health. More specifically, we aimed to (i) identify subgroups of dancers regarding addiction tendencies, (ii) explore which factors account for the elevated risk of dance addiction, and (iii) explore the motivations underlying excessive dancing.

Our sample included 447 salsa and ballroom dancers (32% male and 68% female, with an average age of 33 years) who danced recreationally at least once a week. To assess ‘dance addiction’ we created the ‘Dance Addiction Inventory’ modified from the Exercise Addiction Inventory (that I co-developed back in 2004) in which we simply replaced the word ‘exercise’ with the word ‘dance’. We also assessed the dancers’ general mental health, borderline personality disorder, eating disorder symptoms, and dance motives.

As far as we are aware, our study is the first to explore the psychopathology and motivation behind dance addiction. Based on my criteria of addiction, five distinct types of dancers were identified. Only two of these types danced excessively. About one-quarter of our sample reported high values on all criteria of addiction but they reported no conflict with the social environment. However, 11% of dancers (and what we termed the ‘high risk’ group) scored high on all addiction symptoms and experienced conflict in their life as a consequence of their excessive dancing.

Our study also found that dance addiction was associated with mild psychopathology, especially with elevated number of eating disorder symptoms and (to a lesser extent) borderline personality traits (something which has also been found in research examining exercise addiction). Perhaps unsurprisingly, escapism (and to a lesser extent mood enhancement) was an especially strong indicator of dance addiction. I say ‘unsurprisingly’ because escapism has already been much reported in other types of behavioural addiction such as gambling and video gaming (including a lot of my own research). Here, escapism as a motivational factor refers to dancing in order to avoid feeling empty or as a mechanism to deal with everyday problems. Based on our findings, we believe that to a minority of individuals appear to be addicted to dancing and that it may be being used be a maladaptive coping mechanism.

Based on what we know in the exercise addiction literature, we proposed that future studies should also assess whether eating disorder is primary or secondary to dance addiction (i.e., whether the purpose of excessive dancing is weight-control and/or the motivation to perform leads to disturbances in eating patterns). I should also point out that although we found that distress was correlated with dance addiction, the association disappeared when other measures were added to the regression model. This may indicate that distress is not directly associated with problematic dancing and that it may arise from other problematic factors such as having an eating disorder.

Given the lack of research in the field, other studies are needed to confirm or refute the findings of our study. Given that dancing is a social activity, social conflicts may not arise when the person has only fellow dancers as partners or friends – therefore, the risky behaviour may remain somewhat hidden. Another question that could be examined is whether there is any difference between amateur and professional dancers in terms of addiction tendency (although among professional dancers there may be a debate about whether their behaviour is dancing addiction or ‘workaholism’). Also, we don’t know whether our findings can be extended to other dance genres (as we only surveyed ballroom and salsa dancers)

I would just like to end by saying that dancing is very clearly a healthy activity for the majority of individuals. However, our study does seem to suggest that excessive dancing may have problematic and/or harmful effects for a small minority. Although we couldn’t establish causality, dance addiction appears to have the potential to be associated with mild psychopathology.

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

Additional input: Aniko Maraz, Róbert Urbán and Zsolt Demetrovics.

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

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

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

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, 30-31.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.

Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PloS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

Pierce, E.F. & Daleng, M.L. (1998) Distortion of body image among elite female dancers. Perceptual and Motor Skills, 87, 769-770.

Pierce, E.F., Daleng, M.L. & McGowan, R.W. (1993) Scores on exercise dependence among dancers. Perceptual and Motor Skills, 76, 531-535.

Ramirez, B., Masella, P.A., Fiscina, B., Lala, V.R., & Edwards, M. D. (1984). Breaker’s neck. Journal of the American Medical Association, 252(24), 3366-3367.

Targhetta, R., Nalpas, B. & Perney, P. (2013). Argentine tango: Another behavioral addiction? Journal of Behavioral Addictions, 2, 179-186.

Meditate to medicate: Mindfulness as a treatment for behavioural addiction

Please note: A version of the following article was first published on addiction.com and was co-written with my research colleagues Edo Shonin and William Van Gordon

Mindfulness is a form of meditation that derives from Buddhist practice and is one of the fastest growing areas of psychological research. We have defined mindfulness as the process of engaging a full, direct, and active awareness of experienced phenomena that is spiritual in aspect and that is maintained from one moment to the next. As part of the practice of mindfulness, a ‘meditative anchor’, such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present moment sensory and cognitive-affective experience.

Throughout the last two decades, Buddhist principles have increasingly been employed in the treatment of a wide range of psychological disorders including mood and anxiety disorders, substance use disorders, bipolar disorder, and schizophrenia-spectrum disorders. The emerging role of Buddhism in clinical settings appears to mirror a growth in research examining the potential effects of Buddhist meditation on brain neurophysiology. Such research forms part of a wider dialogue concerned with the evidence-based applications of specific forms of spiritual practice for improved psychological health.

Within mental health and addiction treatment settings, mindfulness-based interventions (MBIs) are generally delivered in a secular eight-week format and often comprise the following: (i) weekly sessions of 90-180 minutes duration, (ii) a taught psycho-education component, (iii) guided mindfulness exercises, (iv) a CD of guided meditation to facilitate daily self-practice, and (v) varying degrees of one-to-one discussion-based therapy with the program instructor. Examples of MBIs used in behavioural addiction treatment studies include Mindfulness-Based Cognitive Therapy, Mindfulness-Enhanced Cognitive Behaviour Therapy, Mindfulness-Based Relapse Prevention, Mindfulness-Based Stress Reduction, and Meditation Awareness Training.

Studies investigating the role of mindfulness in the treatment of behavioural addictions have – to date – primarily focused on problem and/or pathological gambling. These studies have shown that levels of dispositional mindfulness in problem gamblers are inversely associated with gambling severity, thought suppression, and psychological distress. Recent clinical case studies have demonstrated that weekly mindfulness therapy sessions can lead to clinically significant change in problem gambling individuals. Published case studies include: (i) a male in his sixties addicted to offline roulette playing, (ii) a 61-year old female (with comorbid anxiety and depression) addicted to slot machine gambling (treated with a modified version of Mindfulness-Based Cognitive Therapy), and (iii) a 32-year old female (with co-occurring schizophrenia) addicted to online slot-machine playing (treated with a modified version of Meditation Awareness Training). Also, a recent study showed that problem gamblers that received Mindfulness-Enhanced Cognitive Behaviour Therapy demonstrated significant improvements compared to a control group in levels of gambling severity, gambling urges, and emotional distress.

Outside of gambling addiction, case studies have investigated the applications of mindfulness for treating addiction to work (i.e., workaholism) and sex. In the case of the workaholic, a director of a blue-chip technology company in his late thirties was successfully treated for his workaholism utilizing Meditation Awareness Training. Significant pre-post improvements were also observed for sleep quality, psychological distress, work duration, work involvement during non-work hours, and employer-rated job performance. However, as with any case study, the single-participant nature of the study significantly restricts the generalizability of such findings.

Key treatment mechanisms that have been identified and/or proposed in this respect (several of which overlap with mechanisms identified as part of the mindfulness-based treatment of chemical addictions) include:

  • A perceptual shift in the mode of responding and relating to sensory and cognitive-affective stimuli that permits individuals to objectify their cognitive processes and to apprehend them as passing phenomena.
  • Reductions in relapse and withdrawal symptoms via substituting maladaptive addictive behaviours with a ‘positive addiction’ to mindfulness/meditation (particularly the ‘blissful’ and/or tranquil states associated with certain meditative practices).
  • Transferring the locus of control for stress from external conditions to internal metacognitive and attentional resources.
  • The modulation of dysphoric mood states and addiction-related shameful and self-disparaging schemas via the cultivation of compassion and self-compassion.
  • Reductions in salience and myopic focus on reward (i.e., by undermining the intrinsic value and ‘authenticity’ that individuals assign to the object of addiction) due to a better understanding of the ‘impermanent’ nature of existence (e.g., all that is won must ultimately be lost, an attractive body will age and wither, a senior/lucrative occupational role must one day be relinquished, etc.).
  • Growth in spiritual awareness that broadens perspective and induces a re-evaluation of life priorities.
  • ‘Urge surfing’ (the meditative process of adopting an observatory, non-judgemental, and non-reactive attentional-set towards mental urges) that aids in the regulation of habitual compulsive responses.
  • Reduced autonomic and psychological arousal via conscious-breathing-induced increases in prefrontal functioning and vagal nerve output (breath awareness is a central feature of mindfulness practice).
  • Increased capacity to defer gratitude due to improvements in levels of patience.
  • A greater ability to label and therefore modulate mental urges and faulty thinking patterns.

Although preliminary findings indicate that there are applications for MBIs in the treatment of behavioural addictions, further empirical and clinical research utilizing larger-sample controlled study designs is clearly needed. Despite this, both the classical Buddhist meditation literature and recent scientific findings appear to agree that when correctly practised and administered, mindfulness meditation is a safe, non-invasive, and cost-effective tool for treating behavioural addictions and for improving psychological health more generally.

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

Further reading

Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, in press.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 194, doi: 10.3389/fpsyg.2013.00194.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Mindfulness as a treatment for behavioural addiction. Journal of Addiction Research and Therapy, 5: e122. doi: 10.4172/2155-6105.1000e122.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Current trends in mindfulness and mental health. International Journal of Mental Health and Addiction, 12, 113-115.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2014). Practical tips for using mindfulness in general practice. British Journal of General Practice, 624 368-369.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Mindfulness in psychology: A breath of fresh air? The Psychologist: Bulletin of the British Psychological Society, 28, 28-31.

Shonin, E., Van Gordon W., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.

Ball control: A beginner’s guide to Tamakeri

“My boyfriend keeps asking me to kick him in his balls as hard as I can, and he says he’s ‘into it’. I love my boyfriend and I will do anything that makes him happy. He would do the same for me too, but is this normal?”

I came across this opening quote will doing some research on sexual masochism for a previous blog. I thought nothing of it at the time (except thinking it was a fairly painful way to get your sexual kicks – no pun untended). However, I have since come across a few online articles all noting that this specific type of masochistic practice is known as Tamakeri in Japanese culture. The first time I came across it was in a 2010 online article called Ten Fetishes and Paraphilias (all of which – bar one – I have examined in previous blogs). The (unnamed) author of the article wrote that:

“The name [Tamakeri] translates from the Japanese as ‘Ball kicking’, and that tells you all you need to know, really. It’s a paraphilia, and also a genre of pornography involving women abusing men by their testicles, marketed to masochistic men excited by the prospect”.

A number of online sites confirm that Tamakeri is the practice of men receiving kicks in the testicles for sexual pleasure (such as the Kicked In The Groin website), and also appears in Japanese films (such as the horror film Horny House of Horror). The practice os also referred to in two more books I have. Dr. Anil Aggrawal in his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices described Tamakeri as “arousal when a female kicks a man in the testicles; a variant of masochism, prevalent in Japan”. In the 2007 book on The Miscellany of Sex, Francesca Twinn  also describes Tamakeri as “another Japanese contribution to sexual culture: the desire to watch a woman kick a man in the testicles, which has a healthy porn industry to cater to it”.

However, some of the information surrounding the practice is of dubious provenance. A number of different sites (such as the Uncyclopedia entry on Tamakeri) claim that the practice is best defined by “Prof. Erika Nagai” in her book “Pleasures of Castration (ISBN-666-13-1337-455-0)”. However, I have failed to locate the book on any database and the only academic writing I have found with that title was a book chapter (‘The Pleasures of Castration: the Postoperative Status of Hijras, Jankhas, and Academics’) by Professor Lawrence Cohen published in the 1995 book Sexual Nature, Sexual Culture (edited by Paul Abramson and Steven Pinkerton). There is indeed a woman called Erika Nagai who does appear to have engaged in the practice of Tamakeri but as a performer (such as her videos at the Female Dom website) rather than author (unless she has written in her capacity as an ‘adult film actress’). One online encyclopedia reported that:

“[Erika Nagai] is very known for her works under the japanese AV company SOD (Soft on Demand); where most of them feature her as an aggressive karate martial artist performer, catfighting versus fellow colleagues Ayukawa and Miyama Chiharu or using her abilities and brute force against male performers”

The following (crude and non-academic) passage on the practice of Tamakeri allegedly comes from Nagai’s book but may well be pure fiction given I have no proof that the book exists:

“Tamakeri comes from [Japan]…and is considered a rare treat by much of Japanese society. The fun pastime usually involves one clothed female and one nude male, with the female trying to inflict painful pleasure on her male counterpart by squashing his testicles. This can be simply done by kicking his bare nutsack (as forcefully as possible) while giggling (loudly, if possible). She must be sure to strike both of his babymakers, so that his balls are mashed equally flat…Some couples try to employ objects like a hammer, baseball bat or an anvil and – after some real experience – even a 16th century style piano. Beginners are advised to stick to their feet, knees and fists until the male target has his nuts thoroughly toughened up. It is preferable that the testicles be clean shaven, so that the impact against them can be seen more clearly, as well as the degree of swelling after they have been mashed a few times in succession”.

There is also a more interesting article on Tamakeri at the Japan For The Uninvited website. This confirms that the practice exists and that it is “a peculiarly Japanese form of BDSM” involving women kicking naked men in the testicles. The article claims that Tamakeri has come to the fore in Japanese pornography in recent years. It also notes that:

“Apparently, a clean, hearty ‘Slap!’ of impact is very important. Astonishingly, most of the ball kicking sessions are followed by sex, which means Tamakeri actors need the superhuman ability to stay hard while their member takes a bruising. It would be refreshing to think that Japanese women were driving demand for Tamakeri videos, revelling in the idea of dominating and humiliating their men. Sadly, the main customers for this kind of thing seem to be masochistic young men. Indeed, it has been much easier for pornographers to find willing kickees than kickers. The films are certainly masochistic from the man’s point-of-view, but not really submissive. The focus is still control over women, in this case ordering a girl to hurt them precisely where they choose. In this way, Tamakeri videos give men an unusual sense of power”.

The Wikipedia entry on Tamakeri claims that it is the sexual fetish of testicular abuse but also claims that it can involve more than just kicking men in their testicles for sexual pleasure. Other ways that give rise to male sexual pleasure include testicles being punched, twisted, grabbed and kneed. The article also makes a number of claims that do not seem to have any empirical support (just a single reference to a September 2002 newspaper article in the Mainichi Daily News entitled ‘New adult videos deal a blow to manhood’). For instance:

“Though the genre appeals primarily to men, it does have some female following in Japan and elsewhere. Female performers generally are young, out-of-work models or actresses who appear in these videos only occasionally. Male performers are often masochists who apply to work in the videos. A manga series in Shonen Jump depicted a story about a Japanese karate girl who has gift in fighting. One tamakeri scene shows her challenge a male Muay Thai champion to fight in a street fight. The girl beats the Thai fighter easily and humiliates him by removing his boxing shorts to squeeze his private parts until he passes out”.

As you guess from this (very) brief overview, I didn’t manage to locate a single academic paper on the topic of Tamakeri (not even a passing reference) so I can only conclude that although the practice exists, it would appear to be relatively rare.

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

Further reading

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

A-Proper-Blog (2010). Ten fetishes and paraphilias. November 19. Located at: http://a-proper-blog.blogspot.co.uk/2010/11/ten-fetishes-and-paraphilias.html

Twinn, F. (2007). The Miscellany of Sex: Tantalizing Travels Through Love, Lust and Libido. London: Arcturus.

Uncyclopedia (2012). Tamakeri. Located at: http://uncyclopedia.wikia.com/wiki/Tamakeri

Urban Dictionary (2012). Tamakeri. Located at: http://www.urbandictionary.com/define.php?term=Tamakeri

Wikipedia (2012). Tamakeri. Located at: http://en.wikipedia.org/wiki/Tamakeri

Disfigure it out: A brief look at post-mortem mutilation in murder cases

A body of an adult female of about 25 years old was found dead in a naked condition in a reserved forest area in South Delhi in June, 2006 by police. There was information to [the] police via public call as 2-3 people had killed one lady after [having] sex [with her] and [then running] away. Further enquiry, revealed that they all had consumed alcohol along with the lady. They also had sexual intercourse with her using condom…Following the quarrel they killed her by hitting her head with a heavy stone. After killing her, they also tried to destroy her identity by burning her face with wooden stick and twigs and her clothes. One of them also introduced a wine bottle inside [her] vagina. There were multiple postmortem injuries in particular pattern over left side lower part of chest, abdomen and inguinal regions including upper part of left thigh. All [the] accused were subsequently arrested by the police”.

This shocking account of a brutal murder was the opening paragraph in a paper by Dr. B.L. Chaudhary and his colleagues in a 2007 issue of the Journal of Indian Academy of Forensic Medicine (JIAFM). Although an increasingly common theme in television and film homicides, post-mortem mutilation of a dead person’s body by perpetrators is arguably much rarer than the incidence in fictionalized drama. The JIAFM paper noted that the majority of such cases typically involve body “dismemberment for the purpose of disposing or hiding a body or of preventing identification”.

A national study carried out in Sweden by Dr. Jovan Rajs and colleagues in the Journal of Forensic Sciences found that only 22 deaths over a 30-year period (1961-1990) had been criminally mutilated and/or dismembered. These were then classified into one of three types: (i) defensive, (ii) offensive (i.e., lust murder) and (iii) necromanic mutilation. They reported that the perpetrators of the defensive and aggressive post-mortem mutilation were typically “disorganized” (i.e., alcoholics, drug abusers, mentally disordered) whereas the lust murderers were typically “organized” with a long history of violent crimes. The JIAFM paper summarized the findings of Raus and colleagues:

“The characteristics of the mutilations were diverse. In cases of murder committed in association with sexual deviation, wounding is usually limited to the breasts and sexual organs. Corpse mutilation can also be of a symbolic nature as in cases of mafia murders (revenge punishment) and then it is associated with torturing the victim and with the motive of destruction of identify of victim”.

In the case of the female victim reported by Chaudhary and colleagues, they reported that it was the victim’s head, face, and chest that were burned, destroyed, and mutilated post-mortem. They speculated that this was done to either (i) to prevent identification of the victim, (ii) to make it difficult to determine the cause of death, or (iii) as an act of depersonalization as it is often seen “when the murder is disorganized and has a close relation to his victim or offensive mutilation as general act of frustration”. Why the men had inserted a foreign object into the woman’s vagina was less clear. The authors speculated that it may have been because of (i) frustration of a non-performing sexual partner because of heavy intoxication, (ii) an extortion demand by victim, (iii) blackmail by the victim, or (iv) psychopathic tendencies of the perpetrators can carried out for sadistic pleasure. However, they also added that:

“In this case as there was alleged history of consensual sexual activity which could be or could not be as body had injuries so it could be non-consensual activity also. Apparently there was no smell in the [gastric] contents but samples were sent for alcohol screening/concentration estimation. In [the medical] literature, various materials and objects like chilly powder, corrosives, metal or wooden sticks are introduced into genitalia as a part of punishment for unfaithfulness or infidelity. Males suffering from depression due to erectile dysfunctions, premature ejaculation and impotency may indulge in extreme frustration cases. In this psychological profiling of the accused can also be helpful in knowing for such abnormal instincts. At times, provocative words by female partner about their malehood could trigger such impulsive murder and mutilation”

Post-mortem mutilation while extreme can sometimes border on the almost unbelievable. For instance, Dr. J. Kunz and Dr. A. Gross published a paper in a 2001 issue of the American Journal of Forensic and Medical Pathology which as Ronseal would claim “does exactly what it says on the tin” as it was entitled Victim’s scalp on the killer’s head: An unusual case of criminal postmortem mutilation”. The paper reported that:

“After killing his father, the son decapitated his body and dissected the scalp free, forming a mask of the father’s head and neck. The young man wore the scalp-mask over his own head to imitate the father. The motive of the murder was revenge, and the postmortem mutilation was the realization of the perpetrator’s fantasies, symbolically representing a penalty for the reprehensible past life of his father”.

Another extreme case of postmortem mutilation following murder was reported by Dr. Tomasz Konopka and his colleagues in a 2006 issue of the Journal of Forensic Medicine and Pathology. In this instance, a Polish man cut up the corpse and dismembered the body into 850 fragments. He “employed various tools to divide the body into fragments and subsequently boiled the pieces to reduce their volume”. This reduced the body volume by 30kg. The murderer then placed all the body fragments into two large pots in a space under his stairwell and then plastered over the wall to hide the body. Another paper by Dr. Konopka and colleagues in a 2007 issue of Legal Medicine examined 23 cases of dismembered bodies in the 1968-2005 period at the Cracow Department of Forensic Medicine. Of these, 17 were cases of defensive mutilation, three were offensive mutilation and two were dismemberment (decapitation, and direct cause of death). One case remained unclassified where the murderer dissected free skin from the whole torso. They concluded that:

“Apart from rare cases of necrophilia, the victim of dismemberment is always a victim of homicide. Homicides ending with corpse dismemberment are most commonly committed by a person close to, or at least acquainted with the victim and they are performed at the site of homicide, generally in the place inhabited by the victim, the perpetrator or shared by both. Such instances are generally not planned by the perpetrator and rarely serial in character”.

Finally, I came across an interesting 2009 paper by a Finnish team led by Dr. Häkkänen-Nyholm in the Journal of Forensic Sciences. The authors noted that research relating to mutilation of bodies by murderers was “sparse”. They estimated the rate of mutilation of the victim’s body in Finnish homicides. To do this they examined all crime and forensic reports of homicide offenders from 1995–2004 (n = 676). Only 13 murders (2.2%) involved postmortem mutilation. They concluded that:

“Educational and mental health problems in childhood, inpatient mental health contacts, self-destructiveness, and schizophrenia were significantly more frequent in offenders guilty of mutilation. Mutilation bore no significant association with psychopathy or substance abuse. The higher than usual prevalence of developmental difficulties and mental disorder of this subsample of offenders needs to be recognized”.

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

Further reading

Chaudhary, B.L., Murty, O.P. & Singh, D. (2007). Foreign objects in genitalia: Homicide with destruction of identity – A case report. Journal of Indian Academy of Forensic Medicine, 29(4), 135-137.

Häkkänen-Nyholm, H., Weizmann‐Henelius, G., Salenius, S., Lindberg, N., & Repo-Tiihonen, E. (2009). Homicides with mutilation of the victim’s body. Journal of Forensic Sciences, 54(4), 933-937.

Hladík, J., Štefan, J., Srch, M., & Pilin, A. (2000). A rare case of evisceration. International Journal of Legal Medicine, 113(2), 107-109.

Konopka, T., Bolechala, F., & Strona, M. (2006). An unusual case of corpse dismemberment. The American Journal of Forensic Medicine and Pathology, 27(2), 163-165.

Konopka, T., Strona, M., Bolechała, F., & Kunz, J. (2007). Corpse dismemberment in the material collected by the Department of Forensic Medicine, Cracow, Poland. Legal Medicine, 9(1), 1-13.

Kunz, J. & Gross, A. (2001). Victim’s scalp on the killer’s head: An unusual case of criminal postmortem mutilation. American Journal of Forensic and Medical Pathology, 22(3), 327-31.

Rajs, J., Lundstrom, M., Broberg, M., Lidberg, L., & Lindquist, O. (1998). Criminal mutilation of the human body in Sweden: A thirty year medico-legal and forensic psychiatric study. Journal of Forensic Sciences, 43(3), 563-80.

Simonsen, J. (1989). A sadistic homicide. The American Journal of Forensic Medicine and Pathology, 10(2), 159-163.

Türk, E. E., Püschel, K., & Tsokos, M. (2004). Features characteristic of homicide in cases of complete decapitation. The American Journal of Forensic Medicine and Pathology, 25(1), 83-86.

Net losses: Another look at problematic online gaming

I have examined problematic and/or addictive video gaming in a number of my previous blogs. Despite the increasing amount of empirical research into problematic online gaming, the phenomenon still sadly lacks a consensual definition. Some researchers (including myself, and others such as John Charlton and Ian Danforth) consider video games as the starting point for examining the characteristics of this specific pathology, while other researchers consider the internet as the main platform that unites different addictive internet activities including online games (such as my friends and colleagues Tony Van Rooij and Kimberley Young). There are also recent studies that have made an effort to integrate both approaches (such as some work I carried out with Zsolt Demetrovics and his team of Hungarian researchers in the journal PLoS ONE).

I have noted in a number of my papers on addiction (particularly in a paper I had published in a 2005 issue of the Journal of Substance Use) that although each addiction has several particular and idiosyncratic characteristics, they have more commonalities than differences that may reflect a common etiology of addictive behaviour. Using the ‘components’ model of addiction, within a biopsychosocial framework, I consider online game addiction a specific type of video game addiction that can be categorized as a nonfinancial type of pathological gambling. I developed the components of video game addiction theory by modifying Iain Brown’s earlier addiction criteria. These are:

(1) Salience: This is when video gaming becomes the most important activity in the person’s life and dominates his/her thinking (i.e., preoccupations and cognitive distortions), feelings (i.e., cravings) and behaviour (i.e., deterioration of socialized behaviour);

(2) Mood modification: This is the subjective experience that people report as a consequence of engaging in video game play (i.e. they experience an arousing ‘buzz’ or a ‘high’ or, paradoxically, a tranquillizing and/or distressing feel of ‘escape’ or ‘numbing’).

(3) Tolerance: This is the process whereby increasing amounts of video game play are required to achieve the former effects, meaning that for persons engaged in video game playing, they gradually build up the amount of the time they spend online engaged in the behaviour.

(4) Withdrawal symptoms: These are the unpleasant feeling states or physical effects that occur when video gaming is discontinued or suddenly reduced, for example, the shakes, moodiness, irritability, etc.

(5) Conflict: This refers to the conflicts between the video game player and those around them (i.e., interpersonal conflict), conflicts with other activities (e.g., job, schoolwork, social life, hobbies and interests) or from within the individual themselves (i.e., intrapsychic conflict and/or subjective feelings of loss of control) which are concerned with spending too much time engaged in video game play.

(6) Relapse: This is the tendency for repeated reversions to earlier patterns of video game play to recur and for even the most extreme patterns typical at the height of excessive video game play to be quickly restored after periods of abstinence or control.

John Charlton and Ian Danforth analyzed these six criteria and found that tolerance, mood modification and cognitive salience were indicators of high engagement, while the other components – withdrawal symptoms, conflict, relapse and behavioural salience – played a central role in the development of addiction.

Researchers such as Guy Porter and Vladan Starcevic don’t differentiate between problematic video game use and problematic online game use. They conceptualized problematic video game use as excessive use of one or more video games resulting in a preoccupation with and a loss of control over playing video games, and various negative psychosocial and/or physical consequences. Their criteria for problematic video game use didn’t include other features usually associated with dependence or addiction, such as tolerance and physical symptoms of withdrawal, because in their opinion there is no clear evidence that problem video game use is associated with these phenomena.

Arguably the most well known representative of the internet-based approach is Kimberley Young who developed her theoretical framework for problematic online gaming based on her internet addiction criteria which were based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – (Fourth Edition, DSM-IV) criteria for pathological gambling. Her theory states that online game addicts gradually lose control over their game play, that is, they are unable to decrease the amount of time spent playing while immersing themselves increasingly in this particular recreational activity, and eventually develop problems in their real life. The idea that internet/online video game addiction can be assessed by the combination of an internet addiction score and the amount of time spent gaming are also reflective of the internet-based approach.

Integrative approaches try to take into consideration both aforementioned approaches. For instance, a 2010 paper by M.G. Kim and J. Kim in Computers in Human Behavior claimed that neither the first nor the second approach can adequately capture the unique features of online games such as Massively Multiplayer Online Role-Playing Games (MMORPGs), therefore it’s absolutely necessary to create an integrated approach. They argued that “internet users are no more addicted to the internet than alcoholics are addicted to bottles” which means that the internet is just one channel through which people may access whatever content they want (e.g., gambling, shopping, chatting, sex, etc.) and therefore users of the internet may be addicted to the particular content or services that the Internet provides, rather than the channel itself. On the other hand, online games differ from traditional stand-alone games, such as offline video games, in important aspects such as the social dimension or the role-playing dimension that allow interaction with other real players.

Their multidimensional Problematic Online Game Use (POGU) model reflects this integrated approach fairly well. It was theoretically developed on the basis of several studies and theories (such as those by Iain Brown, John Charlton, Ian Danforth, Kimberley Young and myself), and resulted in five underlying dimensions: euphoria, health problems, conflict, failure of self-control, and preference of virtual relationship. A 2012 study I carried out with Zsolt Demetrovics and his team also support the integrative approach and stresses the need to include all types of online games in addiction models in order to make comparisons between genres and gamer populations possible (such as those who play online Real-Time Strategy (RTS) games and online First Person Shooter (FPS) games in addition to the widely researched MMORPG players). According to this model, six dimensions cover the phenomenon of problematic online gaming – preoccupation, overuse, immersion, social isolation, interpersonal conflicts, and withdrawal. Personally, I believe that online game addiction can be defined as one type of behavioural addiction. In fact ‘internet gaming disorder’ has just been included in the appendices of the new DSM-5 in order to encourage research to determine whether this particular condition should be added to the manual as a disorder in the future.

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

Additional input: Orsolya Pápay, Katalin Nagygyörgy and Zsolt Demetrovics

Further reading

Charlton, J. P., & Danforth, I.D.W. (2007). Distinguishing addiction and high engagement in the context of online game playing. Computers in Human Behavior, 23(3), 1531-1548.

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. doi:10.1371/journal.pone.0036417.

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

Han, D. H., Hwang, J. W., & Renshaw, P. F. (2010). Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. Experimental and Clinical Psychopharmacology, 18, 297-304.

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., 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.

Peters, C. S., & Malesky, L. A. (2008). Problematic usage among highly-engaged players of massively multiplayer online role playing games. Cyberpsychology & Behavior, 11(4), 480-483.

Pontes, H. & Griffiths, M.D. (2014). The assessment of internet gaming disorder in clinical research. Clinical Research and Regulatory Affairs, 31(2-4), 35-48.

Pontes, H., Király, O. Demetrovics, Z. & Griffiths, M.D. (2014). The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: The development of the IGD-20 Test. PLoS ONE, 9(10): e110137. doi:10.1371/journal.pone.0110137.

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143.

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.

Van Rooij, A. J., Schoenmakers, T. M., Vermulst, A. A., Van den Eijnden, R. J., & Van de Mheen, D. (2011). Online video game addiction: identification of addicted adolescent gamers. Addiction, 106(1), 205-212.

Young, K. S. (1998a). Caught in the Net: How to recognize the signs of Internet addiction and a winning strategy for recovery. New York: Wiley.

Young, K. S. (1999). Internet addiction: Symptoms, evaluation, and treatment. In L. Vande Creek & T. Jackson (Eds.), Innovations in clinical practice: A source book (pp. 17, 19–31). Sarasota, FL: Professional Resource Press.

Follow

Get every new post delivered to your Inbox.

Join 1,937 other followers