Monthly Archives: February 2012

“I can’t believe it’s not clutter”: An overview of compulsive hoarding

Like many people, I save and collect various items (in my case, records and CDs). Collecting is a natural human activity and some evolutionary psychologists have argued that it may have had an evolutionary advantage in our past history (e.g., there may have been periods of severe deprivation where hoarding was adaptive and enhanced the probability of reproductive success and human survival). However, for a small minority, collecting and hoarding can become excessive and pathological as demonstrated a few months ago (December 2011), when Channel 4 broadcast a television programme on compulsive hoarders as part of the Cutting Edge series of documentaries

Compulsive hoarding – also known as pathological collecting in some scientific circles – is a behaviour typically characterized by the excessive acquisition and keeping of seemingly worthless objects that have little or no material value. According to a recent review led by Dr Albert Pertusa (Institute of Psychiatry, London), a widely accepted definition of compulsive hoarding is “the excessive collection and failure to discard objects of apparently little value, leading to clutter, distress, and disability” (p.371). The difficulty in discarding or letting go of the accumulated possessions is the critical criterion of pathological hoarding. It is also worth noting that some leading figures in the hoarding field don’t like the term ‘compulsive hoarding’ for many of the same reasons that those in the gambling studies field don’t like the term ‘compulsive gambling’.

There has been a substantial increase in research into the disorder in recent years. Interestingly, it appears to be inversely related to income (as it is far more common among the economically deprived). Based on empirical research, the prevalence of compulsive hoarding is thought to be around 2-5% among adult populations although there are certain socio-demographic groups where the prevalence is known to be higher (e.g., there is a higher prevalence among men and the elderly).

As with most behaviours that involve a compulsive element, there are associated physical health risks with compulsive hoarding. There are also reports that the behaviour can lead to detriments in other areas of the affected person’s life including impaired psychological functioning, financial difficulties, and the compromising of relationships with family and friends.

Given that excessive hoarding impacts on the physical living space of the individual and can take over in every room in an affected person’s home (such as people who never throw away a single newspaper or magazine), it can lead to a negatively detrimental effect on life’s essential activities such as personal hygiene and house sanitation – both of which may lead to increased health risks. Other activities such as sleeping and cooking food can also be seriously affected. Mobility in the person’s day-to-day living space may be affected and some hoarded items (such as newspapers and household waste) may lead to increased fire risks. It has also been noted that at a societal level, compulsive hoarding is a burden on public health in terms of poor physical health, occupational impairment, and the utilization of social services.

Although the collecting behaviour may be pathological, there is still a lot of scientific debate as to whether it is a stand alone disorder or symptomatic of other conditions, most notably obsessive-compulsive disorder [OCD] – particularly as approximately 20%-40% of people with OCD patients are known to have various hoarding compulsions and obsessions. Some researchers also suggest that other psychological traits such as perfectionism and indecisiveness may underpin some hoarding behaviour. Other co-morbidities are known to exist including alcoholism, in addition to paranoid, avoidant, and schizotypal traits. Compulsive hoarding also appears to be similar to impulse control disorders, particularly that of compulsive buying as many hoarders’ homes are full of bought items that are often unopened and still in their original packaging. Approximately three-quarters of hoarders also engage in excessive buying, and over half also accumulate items and possessions for free. Research has indicated that the condition of hoarders’ homes have been described as “merely cluttered” to “squalid”.

In fact, Dr Pertusa and his colleagues claim that the majority of hoarding studies are actually based on the assumption that the behaviour is a form of OCD. However, there is accumulating evidence that hoarding may be a separate entity to OCD. As is also pointed out by Pertusa and colleagues, there is no reference to hoarding behaviour in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV) criteria for OCD. Furthermore, in relation to obsessive-compulsive personality disorder, hoarding is mentioned in only one of the eight diagnostic criteria.

A recent meta-analytic study led by Dr Michael Bloch (Yale School of Medicine, USA) examined 21 worldwide studies with over 5000 OCD individuals and concluded that hoarding is an independent factor in both in children and adults. The study also reported that unlike typical OCD sufferers, compulsive hoarders don’t experience intrusive thoughts about possessions urging them to perform ritualized behaviour. It has also been observed that around a third of compulsive hoarders don’t show any other OCD symptoms. Dr Bloch and colleagues conclude that compulsive hoarding is a more passive behaviour where intense distress is only triggered when the hoarders face the prospect of having to get rid of their accumulated possessions.

Although there are many published studies where compulsive hoarders are treated pharmacologically with serotonin reuptake inhibitors (that show very mixed results in relation to their effectiveness), the most effective treatment appears to be cognitive behavioural therapy (CBT). This typically involves hoarders learning (through cognitive restructuring and response prevention) how to deal with situations that cause intense anxiety. Research also suggests that some types of CBT are better than others. CBT approaches that focus on the hoarder’s motivation, acquisition of new items, and removal of items from the hoarder’s home appear to show the best outcome. Treatment studies also suggest that pathological hoarding may be best classified as a discrete disorder with its own diagnostic criteria rather than as a form of OCD.

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

Further reading

Abramowitz, J. S., Wheaton, M. G., & Storch, E. A. (2008). The status of hoarding as a symptom of obsessive–compulsive disorder. Behaviour Research and Therapy, 46, 1026-1033.

Bloch, M.H., Landeros-Weisenberger, A., Rosario, M.C., Pittenger, C., & Leckman, J.F. (2008). Meta-analysis of the symptom structure of obsessive–compulsive disorder. American Journal of Psychiatry, 165, 1532-1542.

Frost, R. & Gross, R. (1993). The hoarding of possessions. Behaviour Research and Therapy, 31, 367-382.

Frost, R.O., Tolin, D.F., Steketee, G., Fitch, K.E., & Selbo-Bruns, A. (2009). Excessive acquisition in hoarding. Journal of Anxiety Disorders, 23, 632-639.

Mataix-Cols, D., Nakatani, E., Micali, N. & Heyman, I. (2008). Structure of obsessive– compulsive symptoms in pediatric OCD. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 773-778.

Muroff, J., Steketee, G., Rasmussen, J., Gibson, A., Bratiotis, C. & Sorrentino, C. (2009). Group cognitive and behavioral treatment for compulsive hoarding: A preliminary trial. Depression and Anxiety, 26, 634-640.

Pertusa, A., Frost, R.O., Fullana, M.A., Samuels, J., Steketee, G., Tolin, D., Saxena, S., Leckman, J.F., Mataix-Cols, D. (2010). Refining the diagnostic boundaries of compulsive hoarding: A critical review. Clinical Psychology Review, 30, 371-386.

Pertusa, A., Fullana, M. A., Singh, S., Alonso, P., Menchon, J. M., & Mataix-Cols, D. (2008). Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both. American Journal of Psychiatry, 165, 1289-1298.

Saxena, S. (2008). Neurobiology and treatment of compulsive hoarding. CNS Spectrums, 13 (Suppl 14), 29-36.

Tolin, D.F., Frost, R.O. & Steketee, G. (2007). An open trial of cognitive-behavioral therapy for compulsive hoarding. Behaviour Research and Therapy, 45, 1461-1470.

Tolin, D.F., Frost, R.O., Steketee, G., & Fitch, K.E. (2008). Family burden of compulsive hoarding: Results of an internet survey. Behaviour Research and Therapy, 46, 334-344.

Dressed to thrill? A brief overview of transvestic fetishism

There is arguably more debate about whether transvestism can be classed as a disorder and/or sexually deviant than any other paraphilia. Transvestism has traditionally been defined as the cross-dressing in clothes worn by the opposite sex for sexual pleasure. However, there are a number of groups of people who may dress themselves in the clothes of the opposite sex but may experience absolutely no sexual arousal whatsoever. Therefore, those who study paraphilic behaviour are more likely to use the term ‘transvestic fetishism’ to describe the small group of people (typically male but there are some documented female cases in the literature) who derive their sexual pleasure from cross-dressing. Therefore, transvestite groups (where the word simply refers to cross-dressing) may comprise:

  • Transvestic fetishists who cross-dress for sexual pleasure and that in some cases may involve sexual arousal from a very specific piece of clothing
  • Female impersonators who cross-dress to entertain
  • Effeminate homosexuals (who may occasionally cross-dress for fun)
  • Transexuals who cross-dress because they fell they have been biologically assigned to the wrong sex and typically suffer from a gender identity disorder. It has also been speculated that some transsexuals may be psychologically similar to paraphilias such as apotemnophilia (i.e., the desire to be an amputee)

These different groups show that unlike all other paraphilias (e.g., necrophilia, zoophilia, hypoxyphilia), the motivations for cross-dressing may not necessarily be sexually motivated, and therefore are unlikely to be viewed as either deviant or disordered.

In the World Health Organization’s International Classification of Diseases (ICD-10), transvestic fetishism is defined as “the wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex”. Similarly, the latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines it as “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing”. Interestingly, Dr Kirk Newring (Nebraska Department of Correctional Services, USA) and his colleagues think is possible that future books on sexual deviance will not include transvestic fetishism as a sexual deviance, but rather as a sexual variance.

There have been a couple of relatively large-scale studies of transvestism including that of Dr Richard Docter and Dr Virginia Prince (California State University, USA) who surveyed 1,032 transvestites, and Dr Niklas Långström (Centre for Violence Prevention, Karolinska Institutet, Stockholm, Sweden) and Dr Kenneth Zucker (Centre for Addiction and Mental Health, Toronto, Ontario, Canada) who examined tranvestism in a Swedish community survey of 2,540 adults. This, and other research, has suggested there appear to be at least two distinct sub-groups of transvestic fetishists (‘periodic transvestites’ and ‘marginal transvestites’).

  • Periodic transvestites: These transvestites are said to have psychological satisfaction with both their male gender and sexual identity, and with the activity of cross-dressing activity. Furthermore, they have no desire to pursue any other form of feminization.
  • Marginal transvestites: These transvestites experience psychological dissatisfaction with their male gender and sexual identity. The sexual arousal experienced from cross-dressing is typically lower than that of periodic transvestites. They may also engage in other feminization activities including hormone treatment, bodily hair removal, and (in extreme cases) surgical reconstruction. Some marginal transvestites may therefore include transsexuals who cross-dress not only for sexual pleasure but also for gender synchrony.

As with many other paraphilic behaviours, there is a relative lack of data and much of it comes from clinical case studies. Based on the published papers, the data suggest that the majority of transvestic fetishists report cross-dressing in secret before the onset of adolescence. As children, cross-dressing may provide excitement and pleasure but the activity is unlikely to be particularly sexualized (e.g., clothes that belong to females in the house may trigger and/or facilitate highly pleasurable sensory experiences [such as perfumed fragrances] accompanied by feelings of familiarity and comfort. During adolescence, case study evidence suggests that the act of cross-dressing becomes increasingly paired with sexual urges and arousal (e.g., erections, ejaculation) and in some cases it may lead to thoughts of being female in public or in private.

However, some sexologists have speculated that the transvestic behaviour develops via classical conditioning after an accidental exposure to female clothing or a female undressing. Similarly, it has also been suggested transvestic behaviour may be negatively reinforced when it is used as a means coping during times of emotional distress (for instance, a number of studies have reported high rates of parental separation during transvestic men’s childhood). The etiology of transvestism appears to be similar to other paraphilic behaviours (i.e. early conditioning experiences) although there are case studies of parental punishment by humiliation of wearing girls’ clothes leading to transvestism. According to Dr Kenneth Zucker and colleagues such separation may explain the need for transitional objects that many children eventually develop.

Smaller scale studies carried out in the 1970s to the 1990s reported that transvestites were more likely to be heterosexual and married. In 2005, Långström and Zucker’s study of 2,450 Swedes appeared to confirm these earlier findings. The archetypal transvestite was reported as being in his mid-30s, in a steady relationship and having at least one child. Perhaps surprisingly, there were no major socio-demographic differences between transvestic males and non-transvestic males. In Långström and Zucker’s study, nearly 3% of males (n=36) and 0.4% of females (n=5) reported sexual arousal from cross-dressing at least once. The transvestic behaviour occurred more in heterosexual males (85.7%, n=35). This finding was similar to findings of Docter and Prince’s large-scale study of 1,032 transvestites where up to 89% transvestic males identified themselves as heterosexual. Findings from small-scale studies indicate that most men do not tell their wives prior to marriage and when the wives do find out, they tend to tolerate it rather than support it.

Långström and Zucker also examined the co-occurrence of other paraphilic behaviours. The transvestic men were more likely than non-transvestic men to report sexual sadism and/or masochism, exhibitionism, and voyeurism. In a 1981 study of 222 transvestic males, Buhrich and Beaumont reported high rates of bondage fantasies while dressed in women’s clothing. However, over time and into middle age, sexual desires may diminish but the cross-dressing may remain (and therefore would no longer be classed as transvestic fetishism). Most transvestites do not seek professional help (as they do not experience any distress associated with their behaviour) and even with therapy it is unlikely the behaviour will be altered if the person wants to carry on cross-dressing.

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

Further reading

Buhrich, N. (1978). Motivation for cross-dressing in heterosexual transvestism. Acta Psychiatrica Scandinavica, 57, 145–152.

Buhrich, N., & Beaumont, T. (1981). Comparison of transvestism in Australia and America. Archives of Sexual Behavior, 26, 589–605.

Docter, R. F., & Prince, V. (1997). Transvestism: A survey of 1032 cross-dressers. Archives of Sexual Behavior, 26, 589-605.

Långström, N., & Zucker, K. J. (2005). Transvestic fetishism in the general population: Prevalence and correlates. Journal of Sex and Marital Therapy, 31, 87-95.

Moser, V. & Kleinplatz, P.J. (2002). Transvestic fetishism: Psychopathology or iatrogenic effect? New Jersey Psychologist, 52(2), 16-17.

Newring, K.A.B. Wheeler, J. & Draper  (2008). Transvestic fetishism. Assessment and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (Second Edition) (pp.285-305). New York: Guildford Press.

Stoller, R. J. (1971). The term, “transvestism.” Archives of General Psychiatry, 24, 230–237.

Sullivan, C.B.L., Bradley, S.J., & Zucker, K.J. (1995). Gender identity disorder (transsexualism) and transvestic fetishism. In V. B. Van Hasselt & M. Hersen (Eds.), Handbook of adolescent psychopathology: A guide to diagnosis and treatment (pp. 525–558). New York: Lexington Books.

Wheeler, J. Newring, K.A.B. &  Draper, C.  (2008). Transvestic fetishism. Psychopathology and Theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (Second Edition) (pp.272-284). New York: Guildford Press.

Zucker, K.J., & Blanchard, R. (1997). Transvestic fetishism: Psychopathology and theory. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (First Edition) (pp. 253-279). New York: Guilford Press.

Identity cards: The psychology of online personas in poker

In my role as research consultant for an online poker company, I was involved in a survey of 2000 people on poker names. The results revealed that around 45% of men and women are using (or would use) alternative names when playing online poker to give them some kind of advantage. I found these results somewhat predictable as (a) many people use alternative names in online activities, and (b) most people will adopt strategies if they feel it has a material advantage for them. As online poker grows, more people will use bluff tactics (such as changing their gender online) that they couldn’t do in an offline gambling environment.

There are many parallels between playing online poker and other online gaming activities such as online computer gaming. However, online role-playing computer gamers by definition, take on different online social personas. In online activities, online social personas are created purely by what is typed on screen. These are known as ‘text-based virtual realities’ and the name that a person chooses to play under is just one strategy that people can adopt when playing against opponents if they believe it offers them an advantage.

The survey found that 11% males and 25% females would use a name that suggested they were members of the opposite sex in order to give themselves an advantage. In most online arenas, females are more likely to change their gender or use masculine versions of their real name (e.g., ‘Chris’ instead of ‘Christine’ or names like ‘Charlie’). There are good reasons for this. In male-dominated chat rooms, it is not uncommon for females to receive lots of unwanted male attention the moment they log on. Many females adopt male personas as a way of avoiding the unwanted attention. In online game playing arenas, females often adopt male personas as they usually feel less psychological intimidation and/or alienation by doing so. Our own research has also shown that females have more positive attitudes toward online gambling because the Internet is a gender-neutral environment unlike the more male-dominated offline environments like betting shops and casinos.

Online poker permits players to create a false identity. For others it allows players to retain anonymity. As a player you can pretend to be a young attractive novice female player when in fact you are actually a very experienced recognised professional. On a psychological level, the key to a ‘hustle’ or manipulating other players in poker is by projecting a character and hiding your identity. Essentially it is about representing a façade, whether it is for one hand or the whole of the game. While playing poker online, a player can adopt any ‘character’ they wish to suit any game in which they engage in. For instance, if you are playing with novices it may be profitable to portray an experienced professional in order to intimidate players into submission.

Using the Internet relay chat (IRC) band provided, it is easier for online poker players to develop their persona(s). The tone and pitch of what a player “says” is not revealed in the text on the screen. At a fundamental level all players are acting with their most unemotional ‘poker face’. In these situations, players can exude confidence as they go all in on a psychological bluff, when in reality they may have shaking hands and be sweating like a pig. The key to winning on a psychological level is by inducing emotional reactions from other players, so with knowledge of the opponent, it is possible to ‘tailor’ interactions to induce the desired response.

Image has become all-important in the commercial arena and for some online poker players it is no different. One of the most important things about poker names is that they may help players define their self-image and who they are – at least on some psychological level. For some people, this ‘personal branding’ may be more important than their social identities within a playing community. What you gamble on and what name players choose can be an extension of this. At the very least, names are important in initial impression formation. However, whether they have any longer lasting effect remains speculative and questionable.

Some people do clearly think about the name that they use and the image it projects. For instance, one well-known player who has worked with our research unit used to go under the online name ‘Dostoyevsky’. Dostoyevsky, of course, was the famous Russian novelist who wrote the semi-autobiographical book ‘The Gambler’ based on his own experiences. The use of the online name suggests an air of intellectuality and knowingness. Whether it actually makes a difference to the playing behaviour of Dostoyevsky’s opponents is highly questionable.

Having said that, our own research at Nottingham Trent University suggests the names that people choose has a minimal effect online. It appears to be given more credence by amateur players. Experienced players say that because of the micro-limits and mass of novice players, the bluff of name change and/or image makes negligible difference to their playing behaviour.

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

Further reading

Griffiths, M.D., Parke, J., Wood, R.T.A. & Rigbye, J. (2010). Online poker gambling in university students: Further findings from an online survey. International Journal of Mental Health and Addiction, 8, 82-89.

Hussain, Z. & Griffiths, M.D. (2008). Gender swapping and socialising in cyberspace: An exploratory study. CyberPsychology and Behavior, 11, 47-53.

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

Parke, A. & Griffiths, M.D. (2011). Poker gambling virtual communities: The use of Computer-Mediated Communication to develop cognitive poker gambling skills. International Journal of Cyber Behavior, Psychology and Learning, 1(2), 31-44.

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

Wood, R.T.A., Griffiths, M.D. & Parke, J. (2007). The acquisition, development, and maintenance of online poker playing in a student sample. CyberPsychology and Behavior, 10, 354-361.

Faecal attraction: A beginner’s guide to coprophilia

Coprophilia (also known as coprolagnia) is a paraphilia where people get sexual pleasure from faeces. Sexual excitement typically comes from either (i) watching somebody defecate on somebody else or (ii) they themselves defecating on somebody else. In rare instances, some people may become sexually aroused when they are defecated upon by somebody else. As Dr Judith Milner and colleagues wrote in the 2008 book ’Sexual Deviance: Theory, Assessment and Treatment’:

“Although some authors have defined the focus of coprophilia as the act of elimination (McCary, 1967), others have defined it as the act of consumption of excrement (Allen, 1969). To complicate the definition further, it appears that some individuals may have an interest in eliminating on one’s partner or in playing with the fecal matter. According to Smith (1976), a common analytic interpretation is that the excrement symbolically represents the penis and that the presence of the fecal matter serves as a defense against castration anxiety”

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it is classified under ‘Paraphilia Not Otherwise Specified’ (PNOS) along with other paraphilias such as necrophilia, zoophilia, klismaphilia, and telephone scatophilia. As with all paraphilias in the PNOS category, diagnosis is only made “if the behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning…Fantasies, behaviors, or objects are paraphilic only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of non-consenting individuals, lead to legal complications, interfere with social relationships)”. The psychologist Dr Tamara Penix (Eastern Michigan University, USA) says there are no data indicating successful treatment of coprophilia.

Surprisingly little scientific research has been carried out on coprophilia, probably because it is so rare. There are certainly pornographic films that include sexual defecation acts (notably some Japanese pornography). Some of these films include coprophiliacs engage in coprophagia (i.e., the eating of faeces and typically referred to more commonly as ‘scat’) which can provides a significant health risk in the form of hepatitis (perhaps another reason as to why the act is so rare). The psychiatrist, Dr Charles Lake (University of Kansa Medical Center, USA) notes that both coprophilia and coprophagia are traditionally considered characteristics of schizophrenia. However, there are case reports in the literature of non-psychotic coprophiliacs with normal intelligence such as one published in the Journal of Sex and Marital Therapy in 1995.

The most infamous copraphiliac was allegedly Adolf Hitler. This was alluded to in a recent 2011 biography of Hitler’s lover Eva Braun by Heike B. Gortemaker. However, other books on Hitler have been more explicit. For instance, Greg Hallet in his chapter ‘Hitler’s Sexuality’ (from his 2008 book ‘Hitler was a British Agent’) wrote:

“Hitler’s close boyhood friend from Linz, August Kubizek, wrote Adolf Hitler, Mein Jugendfreund (My Youth Friend), ‘Adolf did not engage in love affairs or flirtations. He always rejected the coquettish advances of girls or women. Women and girls took an interest in him but he always evaded their endeavours’…During deconstruction, it is customary that the person is sexually abused in the manner which is most embarrassing to that person. In Hitler’s case, he was sodomised, creating a submissive distant respect for homosexuals like his bodyguards and some of his highest-placed leaders. His natural bent was developed into coprophilia (being shat on)…With each deconstruction an embarrassing addiction is developed and filmed. With Hitler it was sadomasochism, coprophilia and homosexuality. That is, he liked to be verbally abused and slapped around, to have his head urinated on, his chest shat on, and to have sex with men”

The few studies that have been carried out have tended to be done on sadomasochist individuals (although even for sadomasochists this appears to be a rare activity for them to engage in). A study led by psychologist Dr Kenneth Sandnabba (Åbo Akademi University, Turku, Finland) and published in the Journal of Sex Research surveyed 164 Finnish male sadomasochists and reported that that 18% of them had engaged in at least one coprophilic act (6% as a masochist, 3% as a sadist, and 9% as both). There was no difference in sexual orientation with 18% of heterosexual sadomasochists and 17% of homosexual sadomasochists having engaged in at least one coprophilic act. The results also showed that the sadomasochists were socially well-adjusted and that their SM behavior was mainly a facilitative aspect of their sexual lives.

In a follow-up study published in the journal Deviant Behavior, Sandnabba and colleagues analysed data from a subset of twelve men from their study of sadomasochists who had also engaged in zoophilic activities. This group was then compared with a control group of sadomasochists from the same data set but who had not engaged in zoophilic activities. Results showed seven out of twelve zoophilic sadomasochists had engaged in coprophilic acts whereas only one in twelve non-zoophilic sadomasochists had engaged in coprophilic acts. In fact, the zoophilic sadomasochists were more likely to engage in a wide range of sexual behaviours including spanking, gagging, biting, urophilia (urinating on or being urinated on for sexual pleasure), fisting, coprophilia, skin branding, and transvestism (i.e., cross-dressing). The authors concluded that zoophilic sadomasochists were more sexually experimental than the non-zoophilic sadomasochistic controls.

An earlier study on a much bigger sample of paraphiliacs also reported that zoophiles appear to engage in many paraphilic behaviours including coprophilia. In their survey of 561 non-incarcerated paraphiliacs seeking treatment, Dr Gene Abel and colleagues found that all of the 14 zoophiles in their sample reported more than one paraphilia and seven of them reported at least five other paraphilas including coprophilia, urophilia, pedophilia, exhibitionism, voyeurism, frotteurism, telephone scatophilia, transvestic fetishism, fetishism, sexual sadism, and/or sexual masochism.

There doesn’t appear to be any consensus as to the origins of these highly unusual paraphilias although (as with most paraphilic behaviour) operant and classical conditioning would appear to play a major role. The following example is a self-report that I found in an online discussion group:

“It all started when I was young. I hated white underwear for some reason and when I wore them I’d be turned on. Eventually it felt odd and good that I urinated in them. I wet my bed for days when I was a young boy and stopped when my parents found out about it. When I was young, I hated bowel movements. It felt gross and stuff. After discovering masturbation, I eased my bowel movements by masturbating. It felt good, and my bowel movements weren’t so gross. I don’t know how it happened but the two finally caught up to each other and I became accustomed to the smell when I masturbated. Everything escalated as time went on, I’ve been in this fetish for a while now – since I was 12 years old. I am 18 now”

The origins of the coprophilic behaviour certainly appear (in this case) to be as a result of both classical and operant conditioning. However, other people suggest different etiological factors may contribute in the development of coprophilia. For instance, in Canada, Dave Hingsburger published a case study of an institutionalized and mentally handicapped man who engaged in coprophilic acts approximately three times a week. It was argued that the cause of the coprophilia was the patient’s maladaptive response to a severely limited institutional environment rather than any behavioural conditioning.

Whatever the origins, it is evident that compared to many other paraphilic behaviours, there is a dearth of empirical and clinical data relating to the acquisition, development, and maintenance of coprophilia.

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

Further reading

Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M. S., & Rouleau, J. L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.

Allen, C. (1969). A textbook of psychosexual disorders (2nd ed.). London: Oxford University Press.

Denson, R. (1982). Undinism: The fetishizaton of urine. Canadian Journal of Psychiatry, 27, 336–338.

Hallett, G. (2008). Hitler was a British agent. London: Progressive Books.

Hingsburger, D. (1989). Motives for coprophilia: Working with individuals who had been institutionalized with developmental handicaps. Journal of Sex Research, 26,139-140.

Karpman, B. (1948). Coprophilia: A collective review. Psychoanalytic Review, 35, 253–272.

Karpman, B. (1949). A modern Gulliver: A study in coprophilia. Psychoanalytic Review, 36, 260-282.

Lake, C.R. (2008). Hypothesis: Grandiosity and guilt cause paranoia; Paranoid schizophrenia is a psychotic mood disorder; a review. Schizophrenia Bulletin, 34, 1151-1162.

McCary, J. L. (1967). Human sexuality. New York: Van Nostrand Reinhold.

Milner, J.S., Dopke, C.A. & Crouch, J.L.  (2008). Paraphilia not Otherwise Specified: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp.384-418). New York: Guildford Press.

Penix, T.M. (2008). Paraphilia not Otherwise Specified: Assessment and treatment. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp.419-438). New York: Guildford Press.

Sandnabba, N.K., Santtila, P. & Nordling, N. (1999). Sexual behavior and social adaptation among sadomasochistically-oriented males. Journal of Sex Research, 36, 273-282.

Sandnabba, N.K. Santtila, P., Nordling, N. Beetz, A.M., Alison, L. (2002). Characteristics of a sample of sadomasochistically-oriented males with recent experience of sexual contact with animals. Deviant Behavior, 23, 511-529.

Smith, R. S. (1976). Voyeurism: A review of the literature. Archives of Sexual Behavior, 5, 585–608.

Wise, T.N. & Goldberg, R.L. (1995). Escalation of a fetish: Coprophagia in a nonpsychotic adult of normal intelligence. Journal of Sex and Marital Therapy, 21, 272-275.

Believing and deceiving: The power of positive thinking in the development of problem gambling

At the end of 2009, Dr Ryan McKay (Oxford University) and Professor Daniel Dennett (Tufts University) wrote an interesting paper on the evolution of misbelief. They examined the distinction between two general types of misbelief. Firstly, those resulting from a breakdown in the normal functioning of the belief formation system (e.g., delusions), and secondly, those arising in the normal course of that system’s operations (e.g., beliefs based on incomplete or inaccurate information). One area in which misbeliefs have been empirically examined but were not covered in that paper – especially in relation to the second type of misbelief – is in the area of problem gambling and gambling addiction. Today’s blog therefore examines the evolution and role of misbeliefs in relation to cognitive biases and positive illusions (i.e., erroneous perceptions) of gamblers.

Research in the gambling studies field has shown that erroneous perceptions can result from both types of misbelief outlined by McKay and Dennett (i.e., either through some kind of break in the normal functioning of the belief formation system, and in the normal course of that system’s operations). Despite the fact that the odds of almost all gambling activities are weighted strongly in favour of the gambling operator, gamblers – and particularly problem gamblers – continue to believe they can win money from gambling. This observation leads to the conclusion that gambling may be maintained by irrational or erroneous beliefs. For example, people overestimate the extent to which they can predict or influence gambling outcomes and tend to misjudge how much money they have won or lost. This hypothesis has been confirmed in numerous studies (including some of my own published studies) showing that people overestimate the degree of skill or control that can be exerted in chance activities.

Using the arguments put forward by McKay and Dennett (2009) to re-examine the empirical gambling literature on cognitive bias, it could perhaps be argued that many of the kinds of erroneous perceptions displayed by gamblers (e.g., hindsight biases, availability biases, confirmation biases, illusory correlations, representativeness biases, etc.) comprise ecologically rational decision-making strategies that inevitably operate when there are limitations of time and computational resources (i.e., the “take the best” heuristic). Furthermore, it could also be argued that the misbeliefs shown by some problem gamblers at the height of their disordered gambling may as Autralian psychologist Peter Butler describes as a “defense against depressive overwhelm”. Here, certain delusions shown by gamblers might be serving as plausible defensive functions.

Some research I carried out with Dr. Jonathan Parke (Salford University) and Dr Adrian Parke (Lincoln University) examined the role of positive thinking among gamblers. We noted the previous research in health and clinical settings showing that individuals often employ particular cognitive strategies in the face of adversity or while experiencing negative affect. Such health-related studies have found that cognitive experience is involved in compensating for a negative emotional state. Furthermore, self-aggrandizement, an exaggerated sense of optimism and over-estimating personal control, are found to be key responses to threatening information (such as being told the patient has a life-threatening illness). These observations have shown that despite some incongruence with reality, these misbeliefs are correlated with good (rather than poor) adjustment to the illness.

Despite the history of positive thinking styles in the health and clinical arena, there had not – until relatively recently – been any research on this area in relation to gambling behaviour. Therefore, we set out to determine whether (after gambling) gamblers compensate and reduce negative affect by identifying positive consequences from experiencing a loss. We identified nine types of ‘positive thinking’ experienced by gamblers (comparative thinking, prophylactic thinking, biased frequency thinking, responsibility avoidance, chasing validation, prioritization, resourcefulness, thoughtfulness, and fear reduction). Gamblers who were positive thinkers experienced significantly less guilt about losing than non-positive thinkers.

Here, the positive illusions displayed by gamblers are (following McKay and Dennett’s arguments) accruing benefit from misbelief directly not merely from the systems that produce it. However, unlike the positive illusions outlined by McKay and Dennett, we argued that in the case of gambling behaviour maintenance, this is one type of behaviour where positive illusions have a negative detrimental effect over time and that unlike most other areas of human behaviour, are maladaptive in this context.

Why gamblers should consistently demonstrate these biases and where they come from is not so clear. It is also unclear whether use of positive illusions depends on intrinsic factors (e.g., psychological mood state) and/or extrinsic factors (e.g., gambling history). It has been suggested that persistent gambling behaviour is thought to be the result of people’s overconfidence in their ability to win money. While research regarding positive illusions in gambling may be lacking, research has found that gambling behaviour is facilitated when players believe they have control over the event and when they feel that they are “nearly winning” even in the event of a losing outcome. It should also be noted that the fundamental difference between heuristics and positive illusions is that heuristics operate to remove doubt, whereas positive illusions operate to remove negative affect created by the adverse consequences of gambling. By overestimating benefits and reducing guilt, positive illusions disrupt the naturally occurring contingencies of reinforcement that might otherwise prevent excessive gambling.

While reduction of negative affect may be perceived as positive in many other contexts, it is maladaptive in gambling behaviour (at least on an individual level). However, it also appears that such misbeliefs may have continued to evolve among gamblers despite individual detriment. This is because many of the same types of positive illusions appear to be displayed by gamblers consistently over time.

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

Further reading 

Butler, P. V. (2000). Reverse Othello syndrome subsequent to traumatic brain injury.  Psychiatry: Interpersonal & Biological Processes, 63, 85-92.

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

Langer, E. J. (1975). The illusion of control. Journal of Personality and Social Psychology, 32, 311-328.

McKay, R.T. & Dennett, D.C. (2009). The evolution of misbelief. Behavioral and Brain Sciences, 32, 493-561.

Parke, J. & Griffiths, M.D. (2004). Gambling addiction and the evolution of the ‘near miss’. Addiction Theory and Research, 12, 407-411.

Parke, J., Griffiths, M.D. & Parke, A. (2007). Positive thinking among slot machine gamblers: A case of maladaptive coping? International Journal of Mental Health and Addiction, 5, 39-52.

Taylor, S. E. (1989). Positive illusions: Creative self-deception and the healthy mind. New York: Basic Books.

Wagenaar, W. A. (1988). Paradoxes in Gambling Behaviour. London: Erlbaum.

24-carrot hold: Can you have a compulsive craving for carrots?

“Eating raw carrots may be as addictive as cigarette smoking and every bit as difficult to give up” said The Independent newspaper back in 1992. The paper was reporting on a study by Czech researchers Ludek Cerný and Karel Cerný who published a paper in the British Journal of Addiction (BJA) concerning three case studies of people allegedly addicted to carrots. So can carrots really be addictive?

When I started to research this a little further, I was surprised to discover that there are many reports in the medical literature dating back almost 100 years of the consequences of excessive carrot eating. The most commonly reported consequence is that excessive carrot eating can cause people’s skin pigmentation to turn yellow (a condition that has since been given the name hypercarotenemia). In 1975, there was an infamous case that received widespread news coverage concerning the death of a 48-year old man who drank excessive amounts of carrot juice. The coroner actually attributed the man’s death as addiction to carrot juice although Dr Ivan Sharman (writing in an article in a 1985 issue of the British Medical Journal on hypercarotenemia) speculated that the person’s addiction to carrots may have reduced the patient’s intake of more nourishing food. Cases of hypercarotenemia have also been reported amongst people with anorexia, hypothyroidism, and Down’s Syndrome.

The 1992 BJA paper described three cases (one male and two females) who the authors claimed had developed a psychological dependence on carrots. The dependence was – in part – caused by the ‘active ingredients’ (including carotine) found in carrots. When unable to eat carrots, these people displayed symptoms of irritability and nervousness, and were said to have an inability to simply discontinue. All three people were cigarette smokers and the two women described their dependence on carrots as stronger than that of nicotine (whereas the man described it as slightly weaker). The man was eating “five bunches” of carrots daily and had – somewhat ironically – started eating carrots as a way of trying to reduce the amount of cigarettes that he smoked. When he gave up carrots, he resumed smoking. One of the women ate a kilogram of raw carrots a day, and was treated for ‘neurological disturbance’. The other woman – pregnant with her first child – started eating large quantities of carrots. She managed to stop eating carrots excessively for 15 years after the baby was born. However, following a stomach upset she relapsed. According to the authors, there was a happy outcome when the woman switched to radishes and developed a diet totally free of carrots!

In 1996, another paper was published in the Australian and New Zealand Journal of Psychiatry by Dr. Robert Kaplan (a consultant psychiatrist at the Liaison Clinic in Wollongong, Australia). The paper concerned the case of a 49-year-old female compulsive carrot eater who after a period of depression (caused by the breakdown of her marriage) started to eat 2-3kg of carrots every day, and lost interest in eating any other food. As in the cases outlined above, she was also a heavy smoker. As Dr Kaplan wrote:

“She rapidly lost interest in eating any other foods. Attempts to resist the craving were useless and she would get out of bed at night to eat more carrots. Her activities began to revolve around this activity, particularly the almost- daily visits to the supermarket. She became an expert in assessing the carrots, selecting them on size and shape: features which would determine the woodiness and succulence when eaten. As she put it: ‘I just wanted to eat a nice juicy carrot and couldn’t stop munching after that’…[She then developed a] noticeable orange/yellow discolouration of her face and hands. She explained that the carrot eating had overtaken her life and she had been too embarrassed to tell me about it at earlier visits. However, the skin discoloration was now quite visible and she felt self-conscious in public. In an attempt to overcome the problem she had stayed with her parents for several weeks, where they had encouraged her to eat normal meals. However, the craving continued and she became concerned about her appearance and the loss of control” (p.699).

The carrot eating continued and she was unable to stop eating carrots (she couldn’t last more than half a day before she gave in to the craving. Any attempt to stop eating carrots led to intense withdrawal symptoms (including anxiety, restlessness, shaking, craving, irritability, and insomnia). During a hysterectomy, the surgeon discovered that the woman’s internal organs were a bright yellow colour. Dr. Kaplan then noted:

“Losing her appetite, she stopped smoking cigarettes and eating carrots. The first few days lead to intense cravings for both substances, which settled, followed by cigarette cravings for a few more weeks. She felt that the postoperative distress and nicotine withdrawal symptoms had a combined effect which helped her overcome her carrot craving. Within 4 weeks, she felt she had overcome the carrot addiction, with cessation of both psychological and physical symptoms” (p.699).

The woman maintained her cessation of carrot eating although still occasionally craved cigarettes. Dr Kaplan reported that the thought of eating carrots now repulsed her. Interestingly, the woman believed that she couldn’t have stopped eating carrots without the discomfort produced by the nicotine withdrawal. It was concluded that compulsive carrot eating is a rare condition and that the basis for the addiction is most likely beta carotene (found in carrots). Although the woman was administered sertraline for her depression, it had no effect on the amount of carrots that she ate.

The idea that food can be addictive is not new and there are certainly reports of specific foodstuffs being addictive (chocolate perhaps being an obvious case in point). However, based on these few published case studies (particularly the one reported by Kaplan), it would appear that in extreme and very unusual circumstances, that carrots may indeed be addictive to some people.

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

Further reading

al-Jubouri, M.A., Coombes, E.J., Young, R.M. & McLaughlin, N.P. (1994). Xanthoderma: an unusual presentation of hypothyroidism. Journal of Clinical Pathology, 47, 850-851.

černý, L. & černý, K. (1992). Can carrots be addictive? An extraordinary form of drug dependence. British Journal of Addiction, 87, 1195-1197.

Corwin, R.L. & Grigson, P.S. (2009). Overview – food addiction: Fact or fiction? Journal of Nutrition, 139: 617–619.

Hess, A.F. & Myers, V.C. (1919) Carotenaemia: A new clinical picture. Journal of the American Medical Association, 73, 1743.

Kaplan, R. (1996), Carrot addiction. Australian and New Zealand Journal of Psychiatry, 30, 698-700.

Leitner, Z.A., Moore, T., & Sharman, I.M. (1975). Fatal self-medication with retinol and carrot juice. Proceedings of the Nutrition Society, 34, 44A.

Pelchat, M.L. (2009). Food addiction in humans. Journal of Nutrition, 139, 620-622.

Schoenfeld, Y., Shaklai, M., Ben-Baruch, N., Hirschorn, M. & Pinkhaus, J. (1982). Neutropenia induced by hypercarotenemia. The Lancet, i, 1245.

Sharman, I.M. (1985). Hypercarotenaemia. British Medical Journal, 290, 95-96.

Sherman, P., Leslie, K., Goldberg, E., Rybczynski, J. & St-Louis, P. (1994). Hypercarotenemia and transaminitis in female adolescents with eating disorders: A prospective, controlled study. Journal of Adolescent Health, 15, 205-209.

Storm W. (1990). Hypercarotenemia in children with Down’s syndrome. Journal of Mental Deficiency Research, 34, 283-286.

Carry on comping: Promotional competitions, engagement, and addiction

I’m not sure about anywhere else in the world, but here in the UK we have a section of the adult community who describe themselves as ‘compers’. Compers are people who make a hobby (and sometimes even a living) from entering competitions – particularly the ones that end with a ‘tie-breaker’ question such as: In no more than 25 words, complete the sentence “I like [insert name of brand] because…”. These competitions are typically free to enter (although a few companies charge a small administration fee or make money from the cost of a premium rate telephone call).

Back in the 1990s, I appeared on a number of television programmes along with people like Britain’s most famous comper at the time called “Rita the competer” who had won prizes worth hundreds of thousands of pounds including multiple houses, cars, holidays, and electrical goods. Most of the compers that I met at that time – all women I have to add – spent most (if not all) of their spare time cutting out and filling in competitions from magazines, newspapers and newsletters.

More recently, compers have gone digital and is inextricably linked to the rise of social media like Facebook and Twitter. The comping community has many ‘comping’ magazines, newsletters and websites (for instance sites such as Compers Corner, Crazy Compers, Compers Weekly, and Just Comps). There are also loads of blog sites updating compers of all the latest offline and (now mostly) online competitions. Today’s compers appear to spend hours on the main social media websites entering competitions run directly by commercial operators. There also appears to be more men becoming compers which may be due to it becoming an increasingly online activity (I say “appear” because I know of no empirical research that has ever been carried out on the ‘comping’ community). Now compers can enter dozens (even hundreds if you click on some of the comping sites listed above) of competitions every week without spending any of their own money on stamps and envelopes.

So why are there so many competitons out there? In order to remain competitive, commercial retailers need to make use of the wide variety “tools” at their disposal within the marketing management toolkit (e.g., sales promotions, advertising). However, there is growing awareness that non-price-based promotions (e.g., consumer competitions) add value for the consumer while meeting a range of marketing communications objectives (which is where the world of comping has originated).

A recent paper by Philip DesAutels and colleagues at the Luleå University of Technology (Sweden) noted that marketing goals for contests may be external to the contest (e.g., increasing product, service or brand awareness), or they may be internal to a contest (e.g., directly increasing product adoption or sales). More commonly, their goals are a combination of the two. Their research into sales promotion effectiveness introduces two measures of contest performance: in-contest engagement and post-contest product interest. They call on the research community to do further work into effective ways to measure and assess these two goals as they believe they “will serve as an immeasurable aid to practice and research”. They also note that activities that are intrinsically motivating are undertaken because they are interesting, enjoyable or satisfying. The act of doing them is the reward. Activities that are extrinsically motivating are undertaken to achieve rewards that are separate and distinct from the activity itself.

Earlier today I appeared on BBC Breakfast’s television show talking about the psychology of ‘compers’ and to what extent compers are like gamblers and to whether it is possible for compers to become ‘addicted to their hobby. The nearest comparison to comping in the gambling world – at least in terms of motivation to carry out the activity – is lottery gambling. The main motivating factor in both comping and playing the lottery is the chance to potentially win a large (often life changing or life enhancing) prize for very little financial outlay. It’s as simple as that. However, there are other similarities including the activity being fun, and the social interaction with friends who engage in like-minded activities.

In relation to ‘comping addiction’ I have never come across a case either professionally or personally that fulfill my criteria for addiction. However, my view as with any behaviour that offers the potential for constant rewards and reinforcement, it is theoretically possible. I’ve certainly met people (admittedly in the confines of a television studio) who claimed that ‘comping’ had taken over their life and that it was causing conflict in some aspect of their life (usually relationship conflict where husbands complained that their wives were spending all their leisure time doing competitions).

However, I really don’t think any of the excessive compers I have met were addicted to the behaviour because the activity was life affirming and life enhancing. As I never tire of telling my students or the media, the key difference between a healthy enthusiasm and an addiction is that healthy enthusiasms add to life whereas addictions take away from it. On that criteria alone, the chances of meeting someone addicted to comping is remote.

Finally, it is worth noting that as long ago as 1991, Ward and Hill wrote that “virtually no work has been done in advertising on the psychology of promotional games. Thus, much opportunity exists”. The 2011 paper by Philip DesAutels and colleagues said it “is therefore surprising that in the 20 years since the publication of Ward and Hill’s article, so little research has been undertaken to inform the theory and practice of promotional competitions and contests”.

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

Further reading

DesAutels, P., Berthon, P. & Salehi-Sangari, E. (2011). Rising to the challenge: A model of contest performance. Journal of Financial Services Marketing, 16, 263–274

Griffiths, M.D. (1997). Instant-win promotions: Part of the gambling environment? Education and Health, 15, 62-63.

Griffiths, M.D. (2003). Instant-win products and prize draws: Are these forms of gambling? Journal of Gambling Issues, 9. Located at:

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

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

Ward, J.C. and Hill, R.P. (1991) Designing effective promotional games: Opportunities and problems. Journal of Advertising, 20(3), 69-81.

Slots of fun? A brief overview of adolescent gambling

Last night I appeared in BBC Radio 1 documentary on gambling (“Don’t Bet On It: The Story of Young People and Gambling”) that had a specific focus on youth gambling. Having written two books on the topic, it is an area that I am highly passionate about and is an area that I will always want to do further research into. But what do we know empirically about adolescent gambling? There have been many studies examining the patterns of gambling and problem gambling among adolescents across many countries. A number of comprehensive reviews of adolescent gambling have examined the methods and results of all the adolescent prevalence surveys that have been carried out in North America (the United States and Canada), Europe and the Nordic countries, and Australasia (Australia and New Zealand).

In the United States, the prevalence of past year adolescent gambling in the only national study was 67% with a past year problem gambling rate of 1.3%. However, state-by-state across more than 20 studies show there are large variations ranging from 20% to 86% (past year adolescent gambling prevalence rates) and 0.9–5.7% (past year adolescent problem gambling prevalence rates). In Canada, there has been no national study, only provincial surveys. These have shown a past year adolescent gambling prevalence of 24–90% and a past year adolescent problem gambling rate of 2.2–8.1%.

In Europe, there have been relatively few studies of adolescent gambling and the quality is variable in terms of sample size, representativeness, and quality of data. Adolescent gambling prevalence rates have been reported for a number of countries. These include Belgium (42% lifetime prevalence), Estonia (75% lifetime prevalence), Finland (52% past year prevalence), Germany (62% past year prevalence), Great Britain (19–70% past year prevalence), Iceland (57–70% past year prevalence), Norway (74–82% past year prevalence), Romania (82% lifetime prevalence), Slovakia (27.5% lifetime prevalence), and Sweden (76% past year prevalence). Adolescent problem gambling prevalence rates have been reported for a number of countries. These include Estonia (3.4% lifetime prevalence), Finland (2.3% past year prevalence), Germany (3% past year prevalence), Great Britain (2–5.6% past year prevalence), Iceland (1.9–3.0% past year prevalence), Italy (6% past year prevalence), Norway (1.8–3.2% past year prevalence), Romania (7% lifetime prevalence), Spain (0.8%–4.6% past year prevalence), and Sweden (0.9% past year prevalence).

In Australia, there has also been no national study, only territory surveys. These have shown a past year adolescent problem gambling rate of 41–89% and a past year adolescent problem gambling rate of 1.0–4.4%. In New Zealand, the two national surveys have shown a past year adolescent gambling rate of 65–68% and past year adolescent gambling problem gambling prevalence rates of 3.8–13%.

From these reviews, a number of conclusions have been made. First, from a methodological perspective, the reviews show that school-based surveys and telephone surveys were the primary modalities used to collect data in adolescent prevalence surveys. Second, a methodological trend of increasing sample sizes over time was noted. Early adolescent gambling surveys in the late 1980s and early 1990s tended to include samples of only a few hundred whereas most recent surveys are much bigger. For instance, the five national prevalence surveys in Great Britain have typically had sample sizes of approximately 8000 or more. Third, it was noted that the most widely used problem gambling instruments are derived from adult problem gambling screens and may not be suited to assessing gambling-related problems in younger people. However, pending a better-validated problem gambling instrument for adolescents, these instruments are likely to continue to be viewed as the best approximations for the measurement of problem gambling among adolescents.

The reviews have also made a number of other generalizations. Male adolescents are more likely than female adolescents to gamble, and more likely to experience problems, a finding that is well established. However, there is no evidence that problem gambling among females indicates a more serious problem. It also appears that, while adolescents from certain ethnic groups are less likely to gamble than other adolescents (e.g., Native American and African American youth in North America, non-Francophone youth in Quebec, indigenous youth in Australia, and Pacific Island youth in New Zealand), they are more likely to gamble regularly when they do gamble and to experience problems. However, there may be other confounding variables such as socioeconomic status.

There are also other clear demographic patterns. For example, the most popular youth gambling activities tend to be private, peer-related activities such as card games and betting on sports. Older youth are more likely to engage in accessible forms of age-restricted gambling, such as lotteries. The one notable exception is in Great Britain where slot machines are legally available for adolescents to gamble on at seaside arcades and family leisure centers. Unlike most other countries, Great Britain’s adolescent problem gamblers are most likely to be experiencing gambling problems associated with slot machines. Other common demographic characteristics are that youth problem gamblers are more likely to start gambling at a younger age and to have parents who gamble.

Other research has shown that young problem gamblers are also more likely to have begun gambling at an early age, have had a big win early on in their playing career, and to be from a lower social class. In addition to the risk factors based on personal characteristics, the social and physical environment in which young people gamble and the gambling activity also play a part. Research has indicated that the most problematic and addictive gambling activities to be those (such as slot machines) that involve high event frequencies, short interval between stake and payout, near miss opportunities, a combination of very high prizes and/or frequent winning of small prizes, and suspension of judgment.

Like other potentially addictive behaviors, problem gambling in adolescence causes the individual to engage in negative behaviours. In Great Britain, research has indicated these negative behaviours include truanting in order to play the slot machines, stealing to fund slot machine playing, getting into trouble with teachers and/or parents over their machine playing, borrowing or the using of lunch money to play slot machines, poor schoolwork, and in some cases, aggressive behavior. One study demonstrated that around 4% of all juvenile crime in one English city was gambling-related based on over 1850 arrests in a one-year period.

Furthermore, teenage problem gamblers also appear to display bona fide signs of addiction including withdrawal effects, tolerance salience, mood modification, conflict, and relapse. Some young people gamble as a means of coping with everyday stresses and problems (avoidance) and as their gambling becomes more problematic so their problems, such as debt, increase and consequently their need to gamble also increases. This therefore creates a vicious circle whereby gambling behavior is experienced as both a problem and as a strategy for dealing with problems. It has also be noted that adolescent gambling is often part of a lifestyle that includes increased prevalence in many risky behaviors (such as smoking cigarettes, drinking alcohol, and taking illicit drugs).

Adolescent gambling, and more specifically adolescent problem gambling, is a cause for concern with a small but significant minority of adolescents having a severe gambling problem. Furthermore, the prevalence of problem gambling in adolescents tends to be approximately three to five times higher than that in adults (depending upon the jurisdiction and the opportunities for adolescents to gamble). This suggests that many adolescents stop gambling when they reach adulthood, although there have been no longitudinal studies to date. Retrospective reports in the literature suggest that many adolescent gamblers ‘mature out’ of gambling and that there are some events in the lives’ of older adolescent that may be triggers in spontaneous remission (such as getting a job, getting married, and birth of a child). However, these are anecdotal and further research is needed to help identify protective factors for problem gambling.

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

With additional input from: Dr Rachel Volberg (Gemini Research, USA), Dr Rina Gupta (McGill University, Canada), Dr Paul Delfabbro (University of Adelaide, Australia), and Dr Daniel Olason (University of Iceland, Iceland)

Further reading

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

Griffiths, M.D. (2008). Adolescent gambling in Great Britain. Education Today: Quarterly Journal of the College of Teachers. 58(1), 7-11.

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

Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Griffiths, M.D., Parke, J. & Derevensky, J. (2011). Online gambling among youth: Cause for concern? In J.L. Derevensky, D.T.L. Shek & J. Merrick (Eds.), Youth Gambling: The Hidden Addiction, pp. 125-143. Berlin: DeGruyter.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The convergence of gambling and digital media: Implications for gambling in young people. Journal of Gambling Studies, 26, 175-187.

Meyer, G., Hayer, T. & Griffiths, M.D. (2009). Problem Gaming in Europe: Challenges, Prevention, and Interventions. New York: Springer.

Volberg, R., Gupta, R., Griffiths, M.D., Olason, D. & Delfabbro, P.H. (2010). An international perspective on youth gambling prevalence studies. International Journal of Adolescent Medicine and Health, 22, 3-38.

Enema of the state of mind: A beginner’s guide to klismaphilia

Klismaphilia – a term coined by Dr Joanne Denko in the reporting of two case studies early 1970s (‘klisma’ is the Greek word for ‘enema’) – is a very unusual variant in sexual expression in which an individual obtains sexual pleasure from receiving enemas (i.e., the cleansing of the colonic canal via anal douching). Less commonly, some people also get sexual pleasure from the giving of enemas to other people. Typically, it is warm water that is used to clean the lower rectum although other substances have been reported including coffee, yogurt, air, whisky, wine, beer, cocaine, epoxy resin and even cement (see case study below). For instance, Dr Anil Hernandas and colleagues from Medway Maritime Hospital (in Gillingham, UK) reported a unique case of a unemployed 27-year old patient self-administering epoxy resin (a liquid used as a masonry adhesive) for anal sexual gratification. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders classifies it under the diagnosis of “Paraphilias, Not Otherwise Specified”.

Dr Alfred Kinsey’s surveys of sexual behaviour of males and females in the late 1940s and early 1950s research specifically mentioned women using enemas as a masturbatory aid but no such practice was reported by males. Although Kinsey’s research provided evidence that klismaphilia was engaged in by women, as with most paraphilias, it is typically males who are more likely to be klismaphiliacs. Published research on klismaphiliacs is rare and it is thought that most klismaphiliacs keep their engagement in this activity very secret.

The little research into klismaphilia suggests that the act of receiving enemas can cause intense stimulation and produce pleasurable sensations (e.g., gaining pleasure from a large, water distended belly or the feeling of internal pressure). Enemas cause mechanical distension of rectum that then cause stimulation of nerve endings supplying the pelvic organs (i.e., stimulating the rectal stretch receptors). It has also been reported that drugs that are administered rectally (including aqueous and alcoholic solutions) are absorbed very rapidly and has a “mainlining effect” similar to that of intravenous drug injection.

Typically, klismaphiliacs retrospectively report discovering these very particular sexual desires after being given enemas sometime in their childhood. Published case studies suggest that klismaphilia ost likely arises in those children who received them as children by a loving and affectionate mother. This association of loving attention with anal stimulation may eroticize the experience for some people so that as adults they may manifest a need to receive an enema as a substitute for or necessary prerequisite to genital intercourse.

Following the publication of her two case studies, Dr Joanne Danko published a study in the mid-1970s on 15 klismaphiliacs. Based on these limited data, she concluded that klismaphiliacs comprised one of three groups she labeled Type A, Type B and Type C.

  • Type A: These individuals were unhappy, believed their klismaphilic behaviour as abnormal, and kept the behaviour compartmentalized. The behaviour originated in childhood and the enemas were usually self-administered. Some of the cases in this group also engaged in other paraphilic behaviour (e.g., fetishism, masochism, coprophilia).
  • Type B: These individuals were similar to Type A individuals, but accepted the condition and were more likely to engage in klismaphilia with their sexual partner.
  • Type C: These individuals engaged in multiple paraphilic behaviours with other similar like-mined individuals, and their klismaphilia was integrated with a range of other praphilic behaviours (e.g., transvestism, masochism).

Back in 1991, the American sexologist Dr William Arndt placed advertisements in sex magazines to recruit klismaphiliacs. He managed to survey 22 individuals (all males except for one female) and aged 25 to 54 years. Most were homosexual (80%; the other 20% were bisexual) although nearly two-thirds were married (or had been married). They typically engaged in enema use twice a week and half of the klismaphiliacs reported the enemas were self-administered. The remainder gave and/or received enemas from their sexual partner. Just over one-third of the sample (40%) had other paraphilic interests that typically revolved around sexual masochism (e.g., being spanked).

In a 1982 American Journal of Psychotherapy paper, Jeremy Agnew (1982) provided a physiological perspective on klismaphilia concentrating on the ritualization of insertion, filling, and expulsion components. He compared the physiological similarities between rectal stimulation and vaginal intercourse and said that the behaviour was reinforcing. This observation – taken together with the work of Dr Danko – suggests that much of the klismaphiliac’s behaviour is maintained by both classical and operant conditioning. In a later 2000 paper, Agnew also noted that some individuals receive such extreme pleasure from the practice that they reach orgasm. He also links klismaphilia with sadomasochistic activities.

Accidental rectal trauma and the lodging of foreign bodies in the gastrointestinal tract have been widely reported in the medical literature. Arguably the most notorious case of klismaphilia is that reported by Dr Peter Stephens and Dr Mark Taff in the American Journal of American Pathology. They wrote about a young man who turned up at the hospital complaining of rectal pain. After an examination by the doctor, it became apparent that there was a stony hard mass lodged in the man’s rectum. Upon further questioning, the patient revealed that four hours earlier, he and his boyfriend had been “fooling around” and that after stirring a batch of concrete mix, the patient had laid on his back with his feet against the wall at a 45 degree angle while his boyfriend poured the mixture through a funnel into his rectum. The concrete had set and was eventually removed. On removal, a ping-pong ball was also found. The reason a ping-pong ball was also found in the rectum was because klismaphiliacs use the ball as a plug to promote retention and increase stimulation. The use of such a device suggests the person was an experienced klismaphiliac.  As Dr Anil Hernandas and colleagues conclude as the exploration of anal eroticism increases in popularity, more and more cases of complications as a direct result of their abuse are likely to be encountered”.

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

Further reading

Agnew, J. (1982). Klismaphilia: A physiological perspective. American Journal of Psychotherapy, 36, 554–566.

Agnew, J. (2000). Klismaphilia. Venereology, 13(2), 75-79

Arndt, W.B. (1991). Gender disorders and the paraphilias. Madison, CT: International Universities Press.

Boglioli, L.R., Taff, M.L., Stephens, P.J. & Money, J. (1991). A case of autoerotic asphyxia associated with multiplex paraphilia. American Journal of Forensic Medicine and Pathology, 12, 64– 73.

Denko, J.D. (1973). Klismaphilia: Enema as a sexual preference. American Journal of Psychotherapy, 27, 232–250.

Denko, J.D. (1976). Klismaphilia: Amplification of the erotic enema deviance. American Journal of Psychotherapy, 30, 236–255.

Hemandas, A.H., Muller, G.W. & Ahmed, I. (2005). Rectal Impaction With Epoxy Resin: A Case Report. Journal of Gastrointestinal Surgery, 9, 747–749.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., Gebhard, P.H. (1953). Sexual Behavior in the Human Female. Philadelphia, PA: W.B. Saunders Company.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., (1948). Sexual Behavior in the Human Male. Philadelphia, PA: W.B. Saunders Company.

Stephens, P. & Taff, M. (1987). Rectal impaction following enema with a concrete mix. American Journal of Forensic Medicine and Pathology, 8, 179–182

Stake and chips: Gambling spend and the psychology of interpretation

Although a number of researchers in the field have stated that data about expenditure on gambling is important to collect when doing prevalence surveys, getting accurate and reliable data is not easy to do. The question ‘How much do you spend on gambling?’ appears simple to answer but can be interpreted in many different ways. For instance, consider the following scenario used by Professor Alex Blaszczynski and colleagues at the University of Sydney:

“You recently decided to gamble $120 on your favourite form of gambling. You initially won $60 but then following a bad run of luck, lost $100. Feeling tired, you decided to leave and return home”

When participants in the study were given this scenario above, and asked “How much did you spend on gambling?” they made a number of different interpretations. There are four basic interpretations that ‘spend’ could relate to:

  • Stake: This refers to the amount staked (i.e. the amount bet on an individual event, such as a football match, a fixed odds betting terminal or a lottery ticket).
  • Outlay: This refers to the sum of multiple bets risked during a whole gambling session.
  • Turnover: This refers to the total amount gambled, including any re-invested winnings.
  • Net expenditure: This refers to the amount gambled minus any winnings.

In this particular study, approximately two-thirds of the participants (64%), answered $40 (i.e., net expenditure) in the scenario above [i.e., $120-($120+$60-$100)]. Around one-sixth of the participants (17%) answered $120 (i.e., stake). A small number of participants answered $160. Here the participants reasoned the spend was equal to $120+$100-$60. Alternatively some answered $100 that equated to the amount lost. Finally, a very small number of participants (n=5) answered $180 (i.e., turnover), where the participants reasoned that spend was equal to investment plus winnings.

There are also issues surrounding what constitutes an individual session (especially if the person gambling goes to the toilet or has a snack or drink between or during a gambling episode). What this simple study shows is that questions relating to expenditure need to be very precise. Blaszczynski and his colleagues argued that the most relevant estimate of gambling expenditure is net expenditure, as it reflects the actual amount of money the gambler has gambled, and also represents the true cost of gambling to the individual. In the 2007 British Gambling Prevalence Survey (BGPS), participants who had spent money on gambling in the past seven days were first asked for each activity that they had gambled on. “Overall, in the last seven days did you win or lose money?” To this particular question the gamblers could either answer that they lost, won, broke even, or were still awaiting the result. If gamblers had lost money they were asked how much, and were asked to tick one of six boxes indicating the total amount lost. Similarly, if gamblers had won money they were asked how much, and could tick one of six boxes indicating the total amount won. They were also asked to what extent the previous week’s gambling activity had been typical.

The results relating to net expenditure were interesting and perhaps somewhat predictable based on what has been reported in previous literature. Gamblers appeared to over-estimate how much they had won in the previous week, meaning that net expenditure was ‘positive’ on many of the gambling activities (i.e. on these activities, gamblers claimed to have won more than they had lost). A similar finding was also reported in the previous [1999] BGPS. Given that all sectors of the gaming industry make ‘considerable profits’, the results in the BGPS study clearly show that many gamblers do not appear to be making a realistic assessment of their previous week’s spending.

However, this does not necessarily mean that they are ‘lying’, as there is a lot of evidence that gamblers over-estimate winnings and under-estimate losses, due to cognitive biases and heuristics like the ‘fixation on absolute frequency bias’ (using absolute rather than relative frequency as measure of success), concrete information bias (when concrete information such as that based on vivid memories or conspicuous incidents dominates abstract information such as computations or statistical data), and/or flexible attributions (the tendency to attribute successes to one’s own skill and failures to other influences). In short, winning experiences tend to be recalled far more easily than losses (unless the losses are very substantial and have a major detrimental effect on the day-to-day functioning of the individual).

Remembering wins and discounting losses is a consistent finding in the gambling literature. This is more likely to occur on those gambling activities that are played several days a week, rather than those activities that are engaged in once a week such as the National Lottery Draw and the football pools. It is in these latter activities that participants are more likely to have accurate recall of wins and losses, as the weekly outlay is usually identical every week (e.g. buying two lottery tickets every week or being part of a lottery syndicate). The results in the 2007 BGPS do indeed seem to indicate this is the case, with activities such as the National Lottery Draw, and the football pools, reporting weekly net losses.

Furthermore, there are other more general effects (like social desirability) that may be skewing the results in a more socially positive direction. There is also the general observation that people tend to overestimate positive outcomes and underestimate negative ones that has been applied to the psychology of gambling. Most of the positive net expenditures were fairly modest, but on those gambling activities where skill has the potential to be used, the net expenditures were much greater (e.g. online poker as part of online gambling, blackjack as part of casino table games). The results showing that the smaller the number of participants gambling on the particular activity, the greater the overall net win claimed, highlights the fact that individual variability was likely to be more pronounced among lower numbers of participants. It is also likely that some of the activities do indeed include gamblers who genuinely win more than they lose (online poker being a good example). However, the number of people doing this regularly is likely to be relatively small, as there are always more losers than winners in such activities.

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

Further reading

Blaszczynski, A., Dumlao, V. & Lange, M. (1997). How much do you spend gambling? Ambiguities in survey question items. Journal of Gambling Studies, 13, 237-252.

Gilovich, T. (1983). Biased evaluation and persistence in gambling. Journal of Personality and Social Psychology, 44, 1110-1126.

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

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

Wagenaar, W. (1988). Paradoxes of Gambling Behaviour. Hove: Lawrence Erlbaum Associates.

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