Monthly Archives: April 2013

Habit forming: A brief look at nun fetishism

“In terrible news for nun fetishists everywhere, the nun beauty contest has been cancelled. The Italian priest who had planned the online ‘pageant’ for nuns has suspended the project, saying he was misinterpreted and never had any intention of putting sisters on a beauty catwalk. Apparently, he’s been feeling some heat from the higher-ups.‘My superiors were not happy. The local bishop was not happy, but they did not understand me either,’ Father Antonio Rungi told Reuters by telephone from his convent in southern Italy on Tuesday. ‘It was not at all my intention to put nuns on the catwalk,’ said Rungi, a priest of the Passionists religious order, speaking from his convent in the town of Mondragone. Rungi’s idea appeared in newspapers around the world after he floated the idea of a contest for nuns on his blog, referred to by some as ‘Sister Italy 2008.’ ‘It was interpreted as more of a physical thing. Now, no-one is saying that nuns can’t be beautiful, but I was thinking about something more complete,’ he said” (Metro newspaper, 27/8/2013).

What Does a Squad of Gun-Toting Fetish Nuns Have to Do With Hitman: Absolution? [The] release of the official Hitman: Absolution E3 trailer…teases us with an image depicting eight ladies dressed in vinyl nun costumes wielding a wide variety of powerful firearms. Could Hitman: Absolution feature the world’s first nun-based online multiplayer? God I hope so…There could be any number of explanation as to why [the game’s developer] is rolling out nuns in high heels so late in the game” (

Hitman: Absolution‘s 2012 trailer depicting Agent 47 brutally dispatching a group of killers dressed as sexy nuns caused quite a stir. People called it exploitatitive. People called it misogynistic…It seems silly to me that Square Enix decided to play up the fetish nun angle…only to have Agent 47 viciously take them all out in [the] trailer” (

I came across these opening stories a few months ago and filed the away as I thought it might make the start to a short blog on ‘nun fetishism’. Obviously, the words ‘nun fetish’ used in these contexts don’t really equate into genuine ‘nun fetishes’ but the news snippets did make me go away and look into the whether such a fetish really exists.

I’ve actually mentioned nuns in a previous blog on ‘uniform fetishes’. In that blog I mentioned the Visual Dictionary of Sex (edited by Dr. Eric J Trimmer) his reference to uniforms and sexual fantasy. Dr. Trimmer reported that in the fetish world of dressing-up, the rough rank order of sexual uniform popularity has nun’s uniforms as the least popular (as the list in order of sexual preference was cheerleader, waitress, nurse, maid, secretary, office worker, schoolgirl, fitness trainer, prison guard, postal worker, military, Cleopatra, ballerina, cab driver, and nun). I have no idea on what empirical basis Dr. Trimmer made his claims although the Wikipedia entry on uniform fetishism also made similar types of claims. It claimed the most popular sexy uniforms were police officer, soldier, schoolgirl, nurse, French maid, waitress, cheerleader and Playboy bunny. However, the article also made reference to some people regarding nun’s habits and aprons as sexy uniforms.

As far as I am aware, there is no academic literature on nun fetishes although there is online anecdotal evidence in the form of dedicated nun fetish sites – such as the (i) Fetish For Nuns, (ii) Whore Nun and (iii) Badjojo websites (please be warned these are sexually explicit sites if you click on the links) – and individuals confessing their sexual arousal towards nuns on various online forums. For instance:

  • Extract 1: “I have a nun fetish. Is that weird? [However], how in the heck would one go about seducing a nun?”
  • Extract 2: “I have a nun fetish. And thank god for the internet. Great times we’re living in, because it would have been hard back in the 80s”
  • Extract 3: “[I have a] fetish for religous outfits (nun habit, Muslim burka, etc.). I was wondering if there are other out there that also find these very restrictive clothes erotic. While this is completely the opposite effect they should have one you I think this is what makes them so appealing to some. I know in some adult shops you can buy sexy latex and PVC version of the nun’s habit…So, which religious outfit do you find the most fetish like? And in what material to you prefer them? Cloth, PVC, Lycra, Latex?”
  • Extract 4: There are fetishes for almost every normal thing you can think of. Wetsuit fetishism falls under the greater section of rubber fetishism. Religious outfits fall into one or more categories depending on what materials they are made off. For example on their own they can be seen as uniform fetish but if you make them of say latex or rubber then would fall into rubber fetishism as well.The reason why I like them is their bondage/submissive qualities…that is really a massive turn on”

In a short 2008 online article on ‘bizarre underground fetish convents’, the Trend Hunter website reported that nuns dressed in rubber are an immensely popular facet of the underground fetish community”. The article highlighted (along with lots of anecdotal photographic evidence) that such people are typically clothed in latex or leather nun uniforms, and may optionally wear a gas mask (see my previous blog on gas mask fetishism). The article also claims that:

“The subversion of a nun, a paragon of religious virtue, by the latex fetish community is both fantastic and messed up. No wonder this underground cultural icon of a nun in a gas mask is found in art that ranges from street art to sculptures. Chances are good that if you start looking, it won’t be long before you see your first rubber nun”.

In a blog post on ‘Latex Nun Fetishists’, the dominatrix ‘Mistress Maryse’ noted that the majority of her clients were Catholic and that within her dominatrix work, religion is always an interesting topic that is up for discussion. More specifically she said that her clients’ religious views:

“…can provide a lot of insight into where their fetishes might have originated, as well as offer some good material for a future scene. I’ve wanted to do a sadistic nun scene for a while, but I haven’t had any takers. That’s until one of my clients, ‘Mike’ recently e-mailed me and expressed interest in either doing a nun or evil school-girl session. The irony (or perhaps it’s not that surprising) is that Mike was raised atheist. I think my Catholic [submissives] still have some fear [and] playing around with this theme is uncomfortable (which, of course, makes it perfect for a scene!). Mike, being the dear that he is, has offered to buy me a new latex nun uniform from Westward Bound

A short article on the Latex Wiki website argues that since nuns are members of a female monastic order taking vows of sexual abstinence and chastity, the fetish community has taken the nun’s image and perverted it. The article claims:

“The fetish nun is now as much of an icon of sexual perversion as a real nun is of sexual purity. Many fetish designers have taken the theme of the nun and produced their own take on the nun’s habit in latex or PVC. Such outfits may include for example a miniskirt, stockings, fishnet tights or high heels. Fetish nuns are a common sight at fetish clubs. Much of the pleasure may derive from the thought of having sexual intercourse with a virgin, or the contrast between the real behaviour of the person and symbols of sexual abstinence”.

In my research for this blog I came across an interesting website that focused on 1970s and 1980s ‘Nunsploitation’ video clips and “nuns behaving badly in bizarre fetish films” such as the trio of Italian films, The Sinful Nuns of Saint Valentine (1974), Images from a Convent (1979) and Convent of Sinners (1986) 
and the 1975 Mexican film Satánico Pandemonium. As the anonymous author commented that it was particularly the underground cult cinema in Italy, Spain and Mexico where Catholic guilt was most likely transmuted “into sexual fetishism involving naughty nuns, masochism, sadism, whipping and lesbianism”. Pierluigi Puccini has a more mainstream selection of films on his Nun’s Habit’s: A Cinematic Fetish webpage including The Devils (directed by Ken Russell, 1971), Killer Nun (directed by Giulio Berruti, 1978), Love Letters of a Portuguese Nun (directed by Jesus Franco, 1977), The Story of a Cloistered Nun (directed by Domenico Paolella, 1973), and To The Devil A Daughter (directed by Peter Sykes, 1976).

In a 2005 book chapter by Richard Zacks in Russ Kick’s Everything You Know About Sex is Wrong, he described what he claimed was “unquestionably the longest and kinkiest list of medieval sexual practices still in existence”. The reason I mention this is because Zacks tracked down a medieval text that refers to having sex with nuns. He wrote that in 1012, a German bishop called Burchard of Worms wrote a 21-volume text including a long section on sexual sins. In Chapter 5 of Volume 19, Burchard lists 194 different sexual sins. In this list there is a section entitled ‘Questions for Men’ relating to the penance for having sex with a nun. More specifically, the entry reads:

“Have you committed fornication with a nun, that is to say, a bride of Christ? If you have done this, you shall do penance for forty days on bread and water, which they call a “carina,” and [repeat it] for the next seven years; and as long as you live, you shall observe all six holy days on bread and water”

In one online opinion piece, Jodi Dean briefly wrote about fetishized religions and claimed the only one that she could think of was Catholicism:

“The Catholic schoolgirl’s uniform is the most obvious, but sexualized nun toys and habits, and games about priests are close behind, traditional fetishist scenes predictable to the point of boredom…I think that charismatic Christianity could probably slink into the category; baptism scenes can have a wet t-shirt quality and the laying on of hands is intense to the point of eroticism. But I almost think this is derivative of Catholicism…What is it about some religions that makes them available for fetishization?”

A fair amount of discussion was generated in response to Dean’s thoughts on religious fetishism. One respondent speculated that the important element was the ‘icon heavy ritualism’ and that any religion in which people were raised in an icon-rich background was ripe for fetishization (and parody). One of the respondents (Mehmet Catagay) made some interesting observations:

“Unlike a fantasy that enables love to pass through the real to field the imaginary, an object of fetishism operates as ‘the return of the repressed’, the substitute material filling the cavity which originates from the act of denial of the symbolic castration. Therefore, the pervert subject of fetishism could cross the boundary of the symbolic only by use of the object of fetishism as the authorization certificate, i.e. the transit visa for the passage from the symbolic to the real…As regards to the Catholicism that you mention as the only fetishized religion that you come up with, for my part, I don’t see an exceptionally distinctive characteristic in the Catholic practice of Christianity that reinforces nunsploitation and nun fetishism. I think any particular outfit, especially uniforms, (the uniform of the women of God in the naughty nun case) that relates the human body with Lacanian big Other has the potential to serve as an object of fetishism that substitute the missing symbolic phallus and make the sexual intercourse possible while the complication of the denial of symbolic castration is still in the view”.

My search for academic material on nun fetishism proved fruitless (although I did come across some interesting research papers on the sex lives of nuns which I will look at in a future blog). Nun fetishism appears to be a niche market when it comes to genuine sexual fetishes but this is purely based on the fact that I found a lack of empirical evidence.

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

Further reading

Gerber, A. (2005). Sex by numbers: Excerpts from The Book of Sex Lists. In R. Kick (Ed.), Everything You Know About Sex is Wrong (pp.340-344).  New York: The Disinformation Company.

Fahey, M. (2012). What Does a Squad of Gun-Toting Fetish Nuns Have to Do With Hitman: Absolution? Kotaku, May 29. Located at:

Fahey, M. (2012). Agent 47 Brutally Slaughters Nuns in the Bizarre Hitman: Absolution E3 Trailer. Kotaku, May 30. Located at:

Metro (2008). Nun beauty contest won’t become a habit. August 27. Located at:

Latex Wiki (2012). Nun. October 28. Located at:

Trend Hunter (2008). Bizarre underground fetish convents. November 24. Located at:

Trimmer, E.J. (1978). The Visual Dictionary of Sex. London: Macmillan.

Wikipedia (2013). Uniform fetishism. Located at:

Zacks, R. (2005). Burchard’s Medieval sexual menu. In R. Kick (Ed.), Everything You Know About Sex is Wrong (pp.327-329). New York: The Disinformation Company.

Hands on experience: A brief look at ‘Touch The Truck’ and endurance television

I apologize in advance for the rather frivolous nature of today’s blog but the topic I am going to briefly talk about comes under the banner of ‘extreme’ behaviour. Back in the early 2000s, I would be the first to admit that I was a bit of a ‘rent-a-quote’ when it came to national newspaper interviews here in the UK. It was when Dr. Rachel Bromnick (a psychologist at Lincoln University) wrote into the Guardian newspaper with this letter under the headline ‘The Prolific Professor’ that I realised I needed to start being a little more selective with who I gave interviews with:

“I was interested to read Professor Mark Griffiths’ confession [in the August 10, 2002 edition of The Guardian] that he was a collector (I knew he was a psychologist). I wonder if he hoards his own cuttings? If so, he must have a house full of paper to add to his stamps, postcards, books etc, because whenever I read a paper, magazine or journal, there he is. For those who wish to add to their Professor Griffiths cutting collection, he was also to be found quoted on the same day in the main section of the Guardian (Labour’s big gamble on casino debts, page 3)”.

The reason I mention this because I recently came across a newspaper article that I had written for my local newspaper (the Nottingham Evening Post, now re-named to the shorter Nottingham Post) that in all honesty I don’t even recall writing. At the time, I was constantly being asked by the British media about reality television shows (particularly about the new Big Brother programme), because at the time I was doing research into the psychology of fame with Dr. Adam Joinson).

One of the television shows that was aired back in 2001 on Channel 5 was a bizarre show called Touch the Truck which I would define as an ‘physical endurance game show’ that was part of the channel’s reality television programming. If you have no idea what I am talking about (and I guess most of you won’t as the series was never re-commissioned in the UK), the Wikipedia entry says:

Touch the Truck was a British Channel 5 endurance gameshow which aired in 2001. It was hosted by Dale Winton and involved a group of 20 contestants holding onto a truck with the last person left touching the truck winning it. The show was filmed at the Lakeside Shopping Centre, Thurrock, Essex. Jerry Middleton, 39, from Winchester, Hampshire, was the winner who managed to stay awake touching the vehicle for 81 hours 43 minutes and 31 seconds…The format was devised by Glenn Barden and Dave Hills and is owned by Vashca. It has been subsequently licensed to the Philippines, Indonesia, Portugal and Turkey”.

The show only ran for five episodes and the format of the show was arguably based on an annual competition that is held in the US, and was turned into a 1990s film (Hands on a Hardbody). I also saw a similar ‘touch the car’ competition on a recent repeat (2005) episode of the wonderful US comedy My Name Is Earl (check out Episode 10, Season 1: White Lie Christmas). The Wikipedia entry on the film said that:

Hands on a Hard Body: The Documentary is a 1997 film directed by S.R. Bindler documenting an endurance competition that took place in Longview, Texas. The yearly competition pits twenty-four contestants against each other to see who can keep their hand on a pickup truck for the longest amount of time. Whoever endures the longest without leaning on the truck or squatting wins the truck. Five minute breaks are issued every hour and fifteen minute breaks every six hours. The documentary follows the 1995 competition which lasted for seventy-seven continuous hours”.

When the show hit the airwaves on March 11 (2001), I remember doing various radio interviews and being asked about the psychological motivations of the contestants taking part, and about the psychological effects of the participants as the competition progressed. I honestly can’t recall what I said to the broadcast media but (as I said earlier) I came across an article that I wrote for the Nottingham Evening Post about the show. I’m a little embarrassed at re-reading what I wrote but here are some of the things I said. Obviously my thoughts were for my local paper and not an academic paper:

“What a bizarre piece of television but what compelling television…It’s an endurance test and people want to almost share the agonies and the miseries that people go through. In a way, you live vicariously through them. It’s emotional and sometimes draining to watch them. As long as there is medical supervision, there is no problem in what they are doing…People aren’t bonkers for doing it, they want to win [the car], they want to win a big prize. It might be equivalent to a year’s salary, so it’s quite an incentive. The only thing I would say is that you would need training to do it. All of us may think it’s easy, but it’s not…People were hallucinating, and an Albanian-born man started speaking in Albanian, even though he didn’t realise it. Daydreams, headaches, these are all known side effects. On the Channel 5 show there was a woman who was so tired, she was forgetting to breathe and her blood pressure was dropping, so you do need medical people on hand who can stop you if necessary. It’s a person’s own choice if they want to do something like this. Hopefully no-one is going to have long-term damage from this. Certainly no long-term psychological harm. It seems that [Channel 5] has chosen people who are used to standing for long periods. Personally, I couldn’t do it for more than an hour”.

The show only lasted one series on British television (presumably because the viewing figures were not as good as the channel expected). Over at the UK Game Shows website, the overview of the show said:

Touch the Truck is a typical attempt by people who don’t normally commission [or] make game shows to do a game show. Such people think that game shows should be all about (a) tacky sets and lighting, (b) fabulous prizes, (c) cheesy catchphrases by the bucket-load, (d) real ‘characters’ as contestants. With the prospect of truckers, tonnes of throbbing metal and 20 members of the public who can’t run away, they’ve been able to wheel in Dale Winton, the consummate professional, to try and generate mass hysteria…The programme is more like a documentary on the effects of trying to stay awake as long as possible. People going mad is quite interesting, although there wasn’t as much of that as perhaps the producers were hoping for…Ultimately, the concept lost all credibility on day 2 when the favourite was pulled out of the competition against his own will for ‘medical reasons’ whereas he looked and sounded perfectly fine”.

My own vague recollection was that the show was compelling to watch (I was going to say it was ‘car crash TV’ but it didn’t seem like a good analogy to use), but maybe it was because I knew I was going to be asked to make comments on it by the media.

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

Further reading

Griffiths, M.D. (2001). Driving test not a mini marathon: A psychologist’s view. Nottingham Evening Post, March 22, p.19.

UK Game Shows (2013). Touch the Truck. Located at:

Wikipedia (2013). Hands on a Hardbody. Located at:

Wikipedia (2013). Touch the truck. Located at:

Graveheart: A very brief look at coimetrophilia

“A dreaded sunny day/So let’s go where we’re happy

And I meet you at the cemetry gates/Oh, Keats and Yeats are on your side

A dreaded sunny day/So let’s go where we’re wanted

And I meet you at the cemetry gates/Keats and Yeats are on your side

But you lose /’Cause weird lover Wilde is on mine”

I’m sure some of you reading this will have immediately spotted these deliberately misspelled lyrics by Morrissey are from the song ‘Cemetry Gates’ on arguably The Smiths’ best album The Queen Is Dead. I’m a massive fan of The Smiths (almost to the point of obsession) and have a bulging collection of books, magazines, vinyl, and CDs. They would be one of my specialist subjects should I ever appear on BBC television programme Mastermind. Anyway, I’ve started today’s blog with these lyrics because in his youth, one of Morrissey’s self-confessed hobbies was to visit the cemeteries in Manchester with his lifelong friend Linder Sterling (artist and singer with the band Ludus, and sleeve designer of the single ‘Orgasm Addict’ by the Buzzcocks). 

Anyway, this rambling introduction is by way of introducing the topic of coimetromania (aka koimetromania) and coimetrophilia (aka koimetrophilia). Coimetromania (according to the English Word Information website) is defined as (i) an abnormal attraction to and desire to visit cemeteries, (ii) a compulsion to examine the various graves and other burial aspects of cemeteries, and/or (iii) in some situations in psychiatry, someone who has a morbid attraction to graves and cemeteries. The name comes from the Greek word ‘koimeterion’ which roughly translates to “sleeping-room, burial-place; grave, grave yard; final resting place”.

If you’ve read any of the biographies of The Smiths and Morrissey (by Johnny Rogan, Simon Goddard and Tony Fletcher), all of them make reference to the cemetery walks by Morrissey and Sterling, and Morrissey appears to have had a morbid fascination with gravestones and cemeteries (at least in his early 20s), so much so that he penned one of his most (in)famous songs about them. This appears to be a close cousin of the sexual paraphilia coimetrophilia that the English Word Information website defines as (i) a special fondness and interest in cemeteries or graveyards; especially, in collecting epitaphs that are written on the tombstones, and/or (ii) a fascination with seeing gravestones and sarcophagi (plural of sarcophagus). The Centre for Sexual Pleasure and Health (an organization that provides adults with a safe, space to learn medically accurate, sex positive information about sexual pleasure, health, and advocacy issues) also has a small entry on coimetrophilia:

“Love getting it on in spooky places? Think graveyards are pretty sweet? Perhaps you get turned on by things that are dead, but not actually to things are dead. Not to be confused with necrophilia, coimetrophilia is the love of cemeteries. Aside from there being a lot of history in cemeteries, some are downright beautiful. Throughout history cemeteries have been spiritual places, and that might help!”

Given that coimetrophilia doesn’t make an appearance in either Dr. Anil Aggrawal’s Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices or Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices suggests that if such a sexual paraphilia exists, it is incredibly rare. It would also seem to be related to placophilia (which I briefly mentioned in a previous blog on non-researched sexual paraphilias). Placophilia is where individuals derive sexual pleasure and arousal from tombstones (which does make it into Dr. Aggrawal’s book but not Brenda Love’s encyclopedia). As I mentioned in a previous blog, after finding out what placophobia was, the musician and author Julian Cope claimed he must be a placophile on a post at his Head Heritage website (although my guess is that his love for tombstones is not sexual).

Literature on coimetrophilia (and placophilia) is almost non-existent and there had certainly been no academic or clinical research on the topic. Given that coimetrophilia is yet another word that was derived from the opposite phobia (i.e., coimetrophobia, a morbid fear of cemeteries and graveyards), it could well be that coimetrophilia is a hypothetical paraphilia rather than a real one. My online search for articles on coimetrophilia threw up only one article on the Are We There Yet?? website entitled ‘I’m a coimetrophiliac – who knew?’ However, none of this first person account was sexually based but just someone (called Linda) talking about their love and fascination of graveyards and tombstones”

“So there we have it, I’m a Coimetrophiliac and now that I know that I guess it’s easy to understand why I go to so many cemeteries and take pictures!  And here all these years I thought I was just slightly morbid or something!  Truth be told, there are some absolutely gorgeous cemeteries with wonderful tributes to loved ones who have passed on as well as some cemeteries with a lot of interesting history in them so who wouldn’t find them fascinating?”

In a previous blog on human fascination with death, I wrote about Luis Squarisi a Brazilian man who claimed he was ‘addicted to funerals’. Many newspaper stories claimed that Squarisi (who was 42-years old at the time) had attended every funeral in his hometown of Batatais for more than 20 years. The story also claimed that in order to attend every funeral, Squarisi had given up his job to “feed his addiction to funerals”. It probably won’t surprise you to learn that I don’t consider Mr. Squarisi’s activity an addiction at all (although the habitual daily ringing of the hospitals and funeral parlour combined with the giving up of his job might potentially be indicators for some types of addiction or compulsion), but from the little I have read about him, I wouldn’t be surprised if he’s now developed coimetromania.

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.

Fletcher, T. (2013). A Light That Never Goes Out: The Enduring Saga of the Smiths. London: William Heinemann.

Goddard, S. (2009). Mozipedia: The Encyclopedia of Morrissey and The Smiths. London: Ebury Press.

Goddard, S. (2004). The Smiths: Songs That Saved Your Life (Revised & Expanded Edition). Reynolds & Hearn Ltd

Rogan, J. (1992). Morrissey and Marr: The Severed Alliance. London: Omnibus.

Thumb dine with me: Can adult thumb-sucking be viewed as an addiction?

“When I got to pre-school, I discovered that thumb sucking was not the social norm. Other kids teased me: ‘Only babies suck their thumbs!’ This was terrible news. I didn’t want to be a baby, but there was no way for me to stop doing the only thing in the world that soothed me; the one thing I could do, in a violent home, to comfort myself and feel safe. So I compromised: I stopped sucking my thumb in public…But at home, or during any moment of privacy…my left thumb went automatically into my mouth. Rather than tapering off as I aged, my thumb sucking intensified, and I added a small swatch of cotton blanket to the ritual, rubbing it against my upper lip until it was soft and grey. My parents had split up, and I was moving from place to place with my mother and stepfamily, so nobody really had the energy to monitor my behavior. If anybody did notice and say something to me (‘Stop that, you’re going to ruin your teeth!’), I just popped the thumb out and waited 30 seconds before the coast was clear again” (Janice Erlbaum)

The opening quote is taken from Janice Erlbaum’s blog article “I was an adult thumbsucker” (a habit she managed to kick when she was 26 years old). From Erlbaum’s full account, I wouldn’t class the behaviour as an addiction although depending on what definition of addiction is used, an argument could perhaps be made. I have to admit that adult thumb sucking is something which I have often thought about as someone I know well has sucked her right thumb all her life. She’s now in her early forties and has two completely different shaped thumbs (one ‘normal’ and the other flat and very elongated) as a result of four decades of constant thumb sucking. She also tells me that her upper mouth palate has also changed shape and her thumb fits perfectly into the upper groove in her mouth. She also has a number of little routines she performs while sucking her thumb including the caressing of her eyelashes with her right index finger which when thumb-sucking is close to her eyes. She only ever does it when relaxing (such as when she’s watching television) and has learned not to do it in public. During her junior years and early adolescence, her parents tried to get her to stop, and at one point she was given a substance to coat her thumb in (which tasted disgusting when she put her thumb in her mouth). It didn’t work. She still sucked her thumb and put up with the horrible taste.

Most parents reading this will be aware that thumb-sucking tends to emerge in infancy (although there is some evidence that babies can suck their thumbs inside the womb. For instance, Professor Peter Hepper and his colleagues [Queen’s University, Belfast, Northern Ireland) have followed up children who were known to have sucked their thumbs as fetuses). Constant thumb-sucking is not necessarily problematic but depending on how the thumb is sucked, it can cause protruding teeth and other dental problems such as anterior open bite, malocclusion (i.e., misalignment of teeth or incorrect relation between the teeth of the two dental arches), and mucosal trauma. Other problems include deformity of the thumb (something which I have seen for myself first-hand) and speech problems. Thumb-suckers are also more prone to infections such as impetigo around the mouth (i.e., a highly contagious bacterial infection of the surface layers of the skin, which causes sores and blisters), and paronychia of the thumb (i.e., a skin infection that occurs around the nails). Basically, as children get older, the more of a problem thumb sucking is from a medical perspective. As one review of thumb sucking in the American Family Physician journal concluded:

“Major complications of thumb sucking, usually corrects spontaneously if thumb sucking ceases by six years of age. Thumb sucking in a child less than two years of age requires no treatment. In a three- to four-year-old child, thumb sucking may be secondary to changes in the child’s emotional environment, and treatment should be directed at correcting the underlying problem. Thumb sucking that persists beyond the age of six years should be treated”.

An article on thumb-sucking in Psychology Today by psychologist Dr. Susan Heitler looked at the topic of thumb-sucking. Dr. Heitler had been a thumb-sucker herself until she was nine-years old and had to endure “years of orthodonture” because of her childhood thumb-sucking. Her own daughter was also a thumb-sucker and her dentist told her that “trying to end thumbsucking will do more harm than good”, advice that she was not happy with given her own experiences. In her article, she wrote:

“Looks are hugely important to one’s success in life.  Allowing thumbsucking to damage facial appearance is wrong advice.  By the time a child is four or five, with the habit no longer socially appropriate and permanent teeth coming shortly, the risks of continuing to thumb or finger suck clearly outweigh the benefits…When does a bad habit qualify as an addiction?  Usually it’s a function of how much the habit has become physiologically essential so that people feel craving when it is missing. That definitely happens with thumbsucking”.

Dr. Heitler’s article referred to empirical research that had been carried out on thumb-sucking although none of the main findings had any detail as to who had carried out the work, where the research was published, or what methodologies were employed (apart from very general information). Here are some of the main things she reported:

“In a study with premature infants, researchers found that infants who sucked their thumbs or a pacifier had shorter hospital stays. That was because rhythmic sucking soothed them so that they spent less energy in crying. In addition, sucking re-optimized their heart beats and breathing patterns if they were beginning to get upset…In studies of children who do or do not suck a thumb, finger or pacifier, it turns out that the suckers become emotionally more independent at a younger age. Researchers put a child and mom on one end of a long room. On the far end were appealing toys. The suckers ventured further and played with the toys away from Mom longer than the non-suckers…They just had higher self-confidence in being able to handle independent play, knowing that if they felt stressed they could suck for a bit, feel better, and resume playing on their own. It’s generally not until they become toddlers that the downsides of thumbsucking begin to outweigh the gains. Kids then tend to suck when they are trying to fall asleep, when they bored, when they are idling between activities, or to self-soothe when they are upset”.

One online article on thumb-sucking reports that it is a common activity among infants (30%-40% of those yet to start school) and around 10%-20% of children aged over six years. In a more academic source, Dr. Sherry Ellington and colleagues (in a 2000 issue of the Journal of Applied Behavior Analysis reported that thumb sucking is estimated to occur in 23% to 46% of children aged 1 to 4 years. As with the article by Dr. Heitler, it claims that thumb-sucking may have a psychological benefit for young children as it “allows them to consolidate emotions and handle their stresses”.

In a 1953 paper in the International Journal of Psychoanalysis, the Dr. Donald Winnicot presented his theory of transitional objects and phenomena. Dr. Winnicott compared thumb sucking with the use of external objects such as children’s use of comfort blankets drawing parallels  between the two. He also a claims that childish actions like thumb sucking and objects like cuddly toys are the source of manifold adult behavior, amongst many others sexual fetishism. It is also claimed (particularly by psychodynamic psychologists) that such actions stem back to childhood trauma and that behaviours like thumb-sucking help facilitate the need to feel comforted and secure. Another early longitudinal study by Dr. Marjorie Honzik and Dr. John McKee published in the Journal of Pediatrics reported that after the first year of being born, girls more likely to suck their thumbs than boys. The main reason was speculated that girls’ greater orality may involve greater pleasure from tactile stimulation”.

There doesn’t appear to be much empirical research on adult thumb sucking. A small 1996 study in the Journal of Clinical Psychiatry led by Dr. F. Castellanous found that in 12 intellectually normal adults with stereotypic movement disorder, eight of them displayed thumb-sucking and/or rocking behaviour (and 11 of them had an affective anxiety disorder suggesting that behaviours such as thumb-sucking may be engaged in to help reduce anxiety). A 2008 literature review by Dr Orlando Tanaka and colleagues in the American Journal of Orthodontics and Dentofacial Orthopedics reported some evidence that thumb-sucking might turn into nail biting. This might explain why there is such a seemingly low prevalence of thumb-sucking in adults. All the evidence suggests that thumb sucking in adults is not an addiction but in some people may be symptomatic of other underlying disorders.

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

Further reading

Articles 2day (2012). Tic disorder and thumb sucking. July 2012. Located at:

Batista, E. (2012). Adult thumb sucking, January 12. Located at:

Castellanous, F.X., Ritchie, G.F., Marsh, W.L. & Rapoport, J.L. (1996). DSM-IV stereotypic movement disorder: persistence of stereotypies of infancy in intellectually normal adolescents and adults. Journal of Clinical Psychiatry, 57, 116-122.

Ellington, S.A., Miltenberger, R.G., Stricker, J.M., Garlinghouse, M.A., Roberts, J. & Galensky, T.I. (2000). Analysis and treatment of finger sucking. Journal of Applied Behavioral Analysis, 33, 41-52.

Erlbaum, J. (2012). It happened to me: I was an adult thumb sucker. August 2. Located at:

Friman, P. C. (1987). Thumb sucking in childhood. Feelings and Their Medical Significance, 29, 11-14.

Heitler, S. (2012). Lessons from thumbsucking, the earliest addiction. Psychology Today, January 26. Located at:

Hepper, P., Wells, D.L. & Lynch, C. (2004). Prenatal thumbsucking is related to postnatal handedness. Neuropsychologia, 43, 313-315.

Honzik, M.P. & John P. McKee, J.P. (1960). The sex difference in thumb-sucking. Journal of Pediatrics, 61, 726-732.

Leung, A.K. & Robson, W.L. (1991). Thumb sucking. American Family Physician, 44, 1724-1728.

Luke, L. S., & Howard, L. (1983). The effects of thumb sucking on orofacial structures and speech: A review. The Compendium of Continuing Education, 4, 575–579.

Tanaka, O.M., Vitral, R.W.F., Tanaka, G.Y., Pulido A. & Guerrero, & Camargoe, E.S. (2008). Nailbiting, or onychophagia: A special habit. American Journal of Orthodontics and Dentofacial Orthopedics, 134, 305-308.

Winnicott, D. (1953)  Transitional objects and transitional phenomena. International Journal of Psychoanalysis, 34, 89-97.

Breath duties: A brief look at gas mask fetishism

In a previous blog, I examined mask fetishism that involves individuals who derive sexual pleasure and arousal from either wearing masks and/or seeing others wearing masks. Today’s blog takes a more detailed look at gas mask fetishism. As with mask fetishism more generally, there is little in the way of academic or clinical research on gas mask fetishism, and much of what is known can best be described as anecdotal.

Gas mask fetishism appears to have potential overlap with other types of paraphilic and/or fetishistic behaviour, particularly hypoxyphilia (i.e., deriving sexual pleasure and arousal from oxygen deprivation). For instance, a recent 2011 paper in the Romanian Journal of Legal Medicine led by Dr. Oleg Skugarevsky, examined a couple of deaths due to hypoxyphilia, one of which was wearing a gas mask at the scene of death. They noted that:

[Hypoxyphiliacs] use a variety of techniques to produce the hypoxia like strangulation, suffocation or reduction of the oxygen in the inspired air that may be achieved with plastic bags or gas masks that may allow inhaling some anesthetic gases (chloroform, nitrous oxide) and volatile chemicals (isopropyl nitrite and isobutyl nitrite (“poppers”)”.

A recent (and interesting) 2011 multi-authored paper led by Joe Marshall (Nottingham University, UK) examined the entertainment value of gas masks in a paper entitled: “The gas mask: A probe for exploring fearsome interactions”. They argued that a range of popular entertainment clearly demonstrates that there is “widespread and growing public appetite for extreme, visceral, and horrifying experiences”. Their idea of a gas mask interface emerged out of a long-term project “to develop interactive entertainments using biological sensing, which led to the idea of exploring the aesthetics of respiration monitoring as a form of engaging spectacle and gaming interaction”. Reflecting on their experiences with gas masks as part of the entertainment experience, they identified six key dimensions in designing fearsome interactions, some of which I think are applicable to the use of gas masks in sexual play and gas mask fetishism.

  • The cultural dimension: Many scholars have argued that emotions and culture are intertwined, therefore, when it comes to the use of gas masks in a leisure context, it has to take into account the cultural context. Marshall and colleagues argue that gas masks clearly have a very striking and unusual aesthetic with strong cultural associations. Clearly, gas masks are likely to evoke images of warfare, law enforcement, riot control police, etc. For those using gas masks as part of bondage and BDSM play, these associations of power and strength may be an important part of sexual roleplay. Marshall and colleagues themselves also note that:“[Gas masks] are also associated with sexual behaviour as part of sexual practices surrounding breathplay and erotic asphyxiation. Moreover, bondage wear is now increasingly fashionable – for example London’s Torture Garden fetish and body modification nightclub has moved over the last 20 years from being a semi-legal club, regularly shut down by the police, to become a well established entertainment and fetish clothing brand. Interestingly, other researchers have noted [human-computer interaction’s] ‘tendency to desexualise technology and have sought to raise an agenda for researching ‘sexual interactions. It is therefore important to recognise that gas masks may suggest various fearsome and/or sexual associations and possibly heighten both kinds of arousal”
  • The visceral dimension: Marshall and colleagues note there is “a striking physicality to donning a gas mask which may amplify the fearsome nature of horror experiences in several more direct ways”. This again is likely to enhance the experience for sadomasochists who utilize gas mask equipment. As they also note, for many this results in “an unusual and somewhat uncomfortable physical sensation, while others may experience something closer to claustrophobia”. As I noted in a previous blog on claustrophilia (i.e., deriving sexual pleasure and arousal from being confined in small places), gas masks for this type of paraphiliac might be a sensual turn on.
  • The control dimension: Marshall and colleagues note that an important aspect of fearsome experiences is the “committing to a scary and unknown experience and not being able to back out, either physically or socially”. This again, is critical in some BDSM scenarios and is critical in ‘breath play’ aspects of sadomasochistic activity. Additionally, it allows one dominant participant to control, through their breathing, the physical experience of a submissive other and “playing on the fear and thrill of being controlled by, and controlling, others”.
  • The social dimension: Marshall and colleagues note that by enclosing a person’s face in a gas mask creates a situation whereby the mask wearer is made anonymous. This leads to effects that may be especially important in BDSM situations. Firstly, the wearer feels isolated and/or dehumanized. Secondly, those viewing the person wearing the gas mask may see the person as anonymous and (potentially) non-human.
  • The performance dimension: Marshall and colleagues argue that the performance dimension has the potential to amplify the scary and fearsome nature of interactions while wearing a gas mask. This form of viewing via gas mask has the potential keeping social interactions somewhat ambiguous, allowing the participant to interpret the situation themselves. This again may be an important part of fantasy-based BDSM play, and the anticipation of what may happen may be more sexually exciting for the mask wearer than what happens in actuality.
  • The engineering dimension: Finally, Marshall and colleagues acknowledge the significant engineering challenges involved in creating wearable sensors that are sufficiently robust to operate within leisure contexts (although personally I don’t think there are many implications for sexual use from an engineering perspective).

Marshall and his colleagues concluded that many popular entertainments involve people voluntarily undergoing fearsome experiences (and my own take on this is that it can involve sexual behaviour and experiences). Ultimately, they argued that the creation of scary experiences has to take account of the multi-faceted nature of fear, that involves cultural, visceral, social, and control factors outlined above.

I’ve yet to come across any focused research on gas mask fetishes and/or sexuality. There are a few first person articles examining the issue although not from the user perspective. I’ll leave you with perhaps the most interesting by artist Callidus who examined gas mask fetishism from an aesthetic perspective after coming across (by accident) some gas mask imagery:

“I’m not sure why gas mask imagery has never really appealed to me; any more than I understand why its such a turn-on for others…When I came across this particular series of images, what really grabbed my interest was the contrast…Contrast is the foundation of all design. Whether its contrast between form, color, or aesthetic, the difference between A and B is where interesting things happen. In this case, I found the contrast between the beautiful lines of the female form and the harsh, industrial design of a gas mask to be very striking…I find bondage to be especially potent here. The image of a woman encased in this foreboding mask, unable to shut out the sights or sounds engulfing her senses while her limbs are restrained from affecting any sort of aid. It works for me”

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

Further reading

Bebbington, P.E. (1977). Treatment of male sexual deviation by use of a vibrator: Case report. Archives of Sexual Behavior, 6, 21-24.

Callidus (2011). I don’t have a gas mask fetish…and yet. August 3. Located at:

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

Marshall, J., Walker, B., Benford, S., Tomlinson, G, Egglestone, S.R., Reeves, S. Brundell, P., Tennent, P., Cranwell, J., Harter, P. & Longhurst, J. (2011). The gas mask: A probe for exploring fearsome interactions. Proceedings of the 2011 Annual Conference Extended Abstracts on Human Factors in Computing Systems (pp.127-136). New York, NY.

Nation Master (2012). Mask fetishism. Located at:

Skugarevsky, O., Ehrlich, E., & Sheleg, S. (2011). Accidental strangulation resulted from hypoxyphilia associated with multiple paraphilias and substance abuse: a psychological autopsy case report. Romanian Journal of Legal Medicine, 19, 249-252.

Scaling up: A brief look at the latest tool to assess addictive gaming

To date, there has been a lack of agreement among researchers as to the precise name and definition of video game addiction (both online and offline). However, there is a general consensus that excessive gaming can lead to a wide range of physical and psychological problems, and therefore necessary to explore the nature and the scale of the phenomenon. In doing so, it is important to use psychometrically validated measurement tools. Unfortunately, there is lack of these in the literature so far. Along with some colleagues (led by Dr. Daniel King), we recently published a paper examining all the instruments that have been used to assess problematic video gaming in the journal Clinical Psychology Review.

Our paper noted that pathological video-gaming, or its proposed DSM-V classification of “Internet Use Disorder”, is of increasing interest to scholars and practitioners in allied health disciplines. Our systematic review was designed to evaluate the standards in pathological video-gaming instrumentation and guidelines for sound psychometric assessment. We assessed a total of 63 quantitative studies, including eighteen instruments (representing 58,415 participants). Our findings indicated that the instruments were generally characterized as inconsistent. The strengths of available measures included: (i) short length and ease of scoring, (ii) excellent internal consistency and convergent validity, and (iii) potentially adequate data for development of standardized norms for adolescent populations. However, the key limitations included: (a) inconsistent coverage of core addiction indicators, (b) varying cut-off scores to indicate clinical status, (c) a lack of a temporal dimension, (d) untested or inconsistent dimensionality, and (e) inadequate data on predictive validity and inter-rater reliability. An emerging consensus suggested that pathological video-gaming is commonly defined by (1) withdrawal, (2) loss of control, and (3) conflict.

Most of the tools in current use have been modified from other questionnaires without their reliability and validity being tested. This includes those based on internet addiction (e.g., Kimberley Young’s Internet Addiction Test), pathological gambling (using the DSM–IV criteria), or behavioural addictions. An additional problem is that many of the measures focus exclusively on Massively Multiplayer Online Role Playing Game (MMORPG) users. In order to cover the whole range of online gamers, I recently helped co-develop an empirically based questionnaire consisting of 18 items called the Problematic Online Gaming Questionnaire (POGQ) that we published in the journal PLoS ONE.

In a recent 2011 study, some of my Hungarian colleagues (led by Dr. Koronczai) claimed in the journal Cyberpsychology, Behavior and Social Networking that a suitable measure should fit the following six criteria. It should have: (i) comprehensiveness (i.e., examining more, possibly all, aspects of problematic online gaming); (ii) brevity (in order to assess the more impulsive population as well and to facilitate incorporation into time-limited surveys); (iii) reliability and validity for different methods of data collection (e.g., online, paper-and-pencil self-rating, face-to-face); (iv) reliability and validity for different age groups (e.g., adolescents and adults); (v) cross-cultural reliability and validity; (vi) been validated on clinical samples. The measure should also serve as a basis for defining cutoff scores for dependence.

The POGQ is a short comprehensive measure and therefore fits to the first two requirements. It was also found to be a psychometrically adequate measure in a large convenience sample of adult online gamers. However, there is great need for a measure that is also suitable for survey type research in an offline data collection setting, and is reliable and valid for adolescents. Therefore, we modified the original POGQ to a 12-item version and applied it to an offline adolescent sample using pen-and-pencil data collection method (and published the findings in the journal Cyberpsychology, Behavior and Social Networking). This way both the third and the fourth points of the six criteria above were fulfilled.

The aim of or most recent study was twofold. The first goal was to explore the psychometric properties of the POGQ on a nationally representative adolescent sample as until recently it had only been used on adult gamer samples. The second goal was to assess the prevalence of problematic online gaming in a nationwide adolescent sample, as there have been only two nationally representative studies carried out on adolescents in the US and Germany.

The results of or study showed that the 12-item POGQ-SF had appropriate psychometric properties according to the statistical analysis performed on a nationally representative sample of adolescents. The analysis showed that 8.2% of gamers (4.6% of the whole sample) belonged to the at-risk group. We also found an additional 13.3% of adolescents (23.9% of gamers) showed symptoms of problematic online gaming above the average. Gamers belonging to the at-risk class were more likely to be male, more likely to play for five or more hours a day, have lower grade point average, have lower self-esteem, and higher depression score than gamers belonging to the other two classes. All these results are in line with findings of other studies confirming the validity of the measurement tool.

Despite the robustness of the study, an important limitation was that it was only carried out among Hungarian adolescents. For generalizability it must be applied and psychometrically tested on cross-cultural samples as well (see the aforementioned Criterion 5). It is also a future goal to confirm the POGQ on clinical samples (Criterion 6). This would allow all the six criteria requirements presented in the introduction to be met. The current POGQ is both short (Criterion 2) and comprehensive (Criterion 1), and assesses problematic online gaming in different age groups (Criterion 4) with different data collection methods (Criterion 3). We hope that the POGQ will facilitate future research and will serve as an adequate tool for assessing problematic online gaming.

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

Further reading

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.

Gentile, D. (2009). Pathological video-game use among youth ages 8 to 18: A national study. Psychological Science, 20, 594-602.

Gentile, D.A., Choo, H., Liau, A., et al. (2011). Pathological video game use among youths: A two-year longitudinal study. Pediatrics, 127, E319-E329.

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

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

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in children and adolescents: A review of empirical reearch. Journal of Behavioral Addictions, 1, 3-22.

Pápay, O., Urbán, R., Griffiths, M.D., Nagygyörgy, K., Farkas, J. Kökönyei, G., Felvinczi, K., Oláh, A., Elekes, Z., Demetrovics, Z. (2013). Psychometric properties of the Problematic Online Gaming Questionnaire Short-Form (POGQ-SF) and prevalence of problematic online gaming in a national sample of adolescents. Cyberpsychology, Behavior, and Social Networking, doi:10.1089/cyber.2012.0484.

Rehbein, F., Kleimann, M, & Mossle, T. (2010). Prevalence and risk factors of video game dependency in adolescence: results of a German nationwide survey. CyberPsychology, Behavior and Social Networking, 13, 269–277.

Prophylactic shock: How dangerous is a ‘used condom fetish’?

If you are a regular reader of my blog, you will know that I have covered some pretty weird sexual fetishes since I started writing it. Nothing ever surprises me when it comes to what humans find sexually arousing, but a few months ago I came across a short paper published in a 2009 issue of Sexually Transmitted Infections (which I’ve since discovered is the world’s longest running journal on sexual health) which took me a little by surprise. It was written by Vincent Tremayne (Staff Nurse, Southampton University Hospitals NHS Trust) and entitled Used condoms: a dangerous fetish?” Tremayne’s article is the only academically written publication that I have ever read that explores the topic of ‘used condom fetishes’ (I did some other searches of academic databases but failed to locate a single other paper on the topic). He noted that:

“For someone with a condom fetish, this might mean gaining pleasure from looking at pictures or videos portraying people ingesting or masturbating with used condoms. Others might search for discarded condoms to masturbate in to or ingest the contents. Some men ‘condom hunt’ in areas where people have public sex, such as car parks or wooded areas”

Tremayne’s own research indicated that used condoms can be purchased online. He made reference to a particular fetish website (Condom Swappers) which allows men to swap used condoms (by mail) for (presumably) sexual purposes. In the name of research I checked out the site and can report that at the time I accessed the site there were currently 3,984 members (with nearly 11,000 posts on 182 different topics, over 15,000 photographs, and 358 videos). There were also 45 specialist sub-groups within this particular used condom community. Most of the members appear to be gay or bisexual although that is my impression rather than anything empirically based. Tremayne reported that most of the membership (at the time of his paper) were men from the United Kingdom and the United States.

Tremayne’s interest in the topic of used condom fetishes came from his concerns about whether men who engaged in this particular sexual practice were at risk of contracting a sexually transmitted infection (STI). Tremayne reported that:

“Some might consider this practice to be risk-free as it is accepted that organisms causing STIs cannot live outside the human body. However, a few reports suggest that some microorganisms survive in the right conditions. [A 1986 study by Dr. L. Reznick and colleagues] experimented with a highly concentrated preparation of HIV to see how long it would live in differing environments. The virus was recovered after a week from an aqueous environment at room temperature and for more than 3 days following drying. This study used a falsely concentrated viral preparation, but it is not known how long HIV could survive in a knotted condom, sent in a sealed envelope and received within a day or two”.

There are also other studies indicating that micro-organisms that cause STIs can survive on public toilets. For instance, 1999 study published in the journal Infection Control and Hospital Epidemiology (by Dr. I. Potasman and colleagues) tested for the presence of three specific STI microorganisms (i.e., Ureaplasma urealyticum [UU], Mycoplasma hominis [MH], and Chlamydia trachomatis [CT]) in 50 public toilet bowls. They reported that five (of the 50) bowls (10%) were contaminated with at least one of these microorganism. More specifically, UU was detected in four toilet bowls, MH in three, and CT in one (with UU surviving on the rim of the toilet for up to two hours. Tremayne also reported that there is at least one case in the medical literature of a man contracting gonorrhea following the use of an inflatable doll. I tracked down the original case study published in the journal Genitourinary Medicine:

“The skipper from a trawler, who had been 3 months at sea, sought advice for urethral discharge. His symptoms had lasted for two weeks. A urethral smear showed typical intracellular gram-negative diplococci, and a culture was positive for [gonorrhea]. There had been no woman on board the trawler; he denied homosexual contacts; and there was no doubt that the onset of the symptoms was more than two months after leaving the port. A few days before onset of his symptoms, [the skipper] had roused the engineer in his cabin during the night because of engine trouble. After the engineer had left his cabin the skipper found an inflatable doll with artificial vagina in his bed, and he was tempted to have ‘intercourse’ with the doll…The engineer was examined, and was found to have gonorrhea. He had observed a mild urethral discharge since they left port… He admitted to having ejaculated into the ‘vagina’ of the doll just before the skipper called him, without washing the doll afterwards”

Other researchers have noted that gonorrheal cells can survive on various materials stored at room temperature. For instance, Dr. A. Srivastava has reported in the Journal of Medical Microbiology, that live gonorrhea calls can be recovered up to three days on both hard and soft materials. Because of this (and other evidence), Tremayne speculated that:

“It is possible that those who satisfy their used condom fetish are placing themselves at risk. It is conceivable that STIs could be transmitted by the act of masturbating, ingesting or inserting the contents into the anus. At some point, this could mean that sexual health professionals could be meeting men presenting with STIs without the implied sexual contact”.

As far as I can ascertain, there is no research and no statistics on how prevalent ‘used condom fetishes’ are but I would expect them to be fairly rare. There are certainly online accounts suggesting that some people engage it the imbibing of the contents of used condoms (check out this online forum discussion – but be warned you may find the content distasteful – no pun intended), and other anecdotal cases I came across online suggest that heterosexual females may sometimes have an attraction for such behaviour (such as an online account by Lisa). Tremayne’s paper raises interesting (theoretical) possibilities as to whether ‘used condom fetish’ could result in the spread of an STI. However, it would appear that – to date – there are no recorded instances of an STI being contracted via a used condom.

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

Further reading

Gilbaugh, J.H., & Fuchs, P.C. (1979). The gonococcus and the toilet seat. New England Journal of Medicine, 301, 91-93.

Kleist, E., & Moi, H. (1993). Transmission of gonorrhoea through an inflatable doll. Genitourinary Medicine, 69, 322.

Neinstein, L.S., Goldenring, J., & Carpenter S. (1984). Nonsexual transmission of sexually transmitted diseases: an infrequent occurrence. Pediatrics, 74, 67-76.

Srivastava A. (1980). Survival of gonococci in urethral secretions with reference to nonsexual transmission of gonococcal infections. Journal of Medical Microbiology, 13, 593-596.

Potasman, I., Oren, A, & Srugo, I. (1999). Isolation of ureaplasma urealyticum and mycoplasma hominis from public toilet bowls. Infection Control and Hospital Epidemiology, 20, 66–68.

Tremayne, T. (2009). Used condoms: a dangerous fetish? Sexually Transmitted Infection, 85, 483.

House calls: A look at the rise of online bingo

Yesterday, BBC Online News published a report about online bingo (and which I provided some comments about). Given the popularity of bingo in numerous countries throughout the world, it is surprising how little scientific research has been carried out on the activity. To date, most of the research (including some of my own) has examined offline bingo (which is unsurprising given that playing bingo online is a relatively new phenomenon), and most of the published research is from a sociological perspective typically involving small-scale interview studies and/or observation of players in bingo halls. Research carried out between 1980 and 2005 has tended to report that the majority of bingo players are working class women who play the game primarily to socialize with their friends in what they perceive to be a very ‘safe’ (and somewhat non-masculine) environment.

Research carried out by the American sociologists Constance Chapple and Stacey Nofziger and published in the journal Deviant Behavior confirm these general findings but add that winning money eventually becomes an important motivation as constantly losing leads to the bingo playing ceasing (even if the main reason for playing bingo is sociability). Their research also reported that loneliness and boredom can also be critical factors in why women play bingo. Through the alleviation of boredom, bingo playing leads to the meeting of other like-minded people, and also helps to alleviate the loneliness. Online bingo sites have attempted to facilitate the sociability element by incorporating online chat options, the social rules are different online compared to offline. Whereas in offline bingo chatting is typically forbidden during game play, it is actively encouraged when playing bingo online. Online chat functions appear to be an effective retention tool by online bingo operators, and are specifically aimed at female players.

Online and offline bingo appear to have many similarities in terms of demographics. Online bingo sites (and the marketing and advertising they produce) tend to target women – particularly because bingo is the only form of gambling where women significantly outnumber men. For instance, we found in the most recent British Gambling Prevalence Survey (BGPS) published in 2011, that 9% of the British adult population had played online and/or offline bingo in last year. Although men were more likely than women to participate in most forms of gambling activity, twice as many women (12%) had played bingo in the last year compared to men (6%).

One of the most noticeable trends that I have written about in the last few years is the feminization of gambling. I have argued that one of the reasons that greater numbers of women are gambling is because remote gambling environments (such as internet gambling and mobile phone gambling) are gender-neutral. In the same way that female bingo players view the offline environments in which they play ‘safe’, this is even more so online. While playing online bingo, females do not feel alienated and stigmatized as they sometimes feel in more male-dominated gambling environments such as betting shops and casinos. Furthermore, the perceived anonymity of playing online is another key factor that facilitates the playing of bingo online.

There also appears to be a new type of bingo player – one that only plays bingo online. In our most recent BGPS study, we found that 19% of all bingo players gambled online only (with 4% playing both online and offline, and the majority – 77% – playing offline bingo only). As we predicted, playing bingo was highest among oldest people with 11% of those over 75 years having played bingo in the last year. However, more interesting was the fact that the bingo playing was almost as popular among the young with 10% of those aged 16 to 24 years having played bingo in the 12 months prior to the survey. Interestingly (and perhaps unsurprisingly), this group (being arguably more tech-savvy) was more likely to be playing bingo online, and women were significantly more likely than men to play bingo online at least once a week.

In the same way that online poker sites are now trying to attract more women, some online bingo sites appear to be trying to attract more men. This is being done on many levels including the use of more neutral (unisex) colours in website design, non-cash prizes that appeal across gender lines, and less female-centric marketing and advertising. There are also an increasing number of online casinos that have introduced online bingo to its game portfolio. Such tactics are what we psychologists call ‘foot-in-the-door’ techniques (the most obvious of which are marketing tactics like sign-up cash bonuses or ‘play-for-free and win real money’ offers) where acquisition incentives are given in an attempt to either cross-sell games and/or create longer-term repeat business.

Journalistic stories about the rise in popularity of online bingo sites claim that the most recent statistics suggest that many men also enjoy online bingo and that the numbers of men playing online are on the increase. However, I have not been able to verify such claims, and even if I could, statistics never tell the whole story. As Ebbe Skovdah (a Danish football manager) once stated – “statistics are like mini-skirts, they give you good ideas but they hide the most important things!”.

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

Further reading

Chapple, C. & Nofgizer, S. (2000). Bingo!: Hints of deviance in the accounts of sociability and profit of bingo players. Deviant Behavior: An Interdisciplinary Journal, 21, 489–517.

Griffiths, M.D. (2010). Online gambling, social responsibility and ‘foot-in-the-door techniques. i-Gaming Business, 62, 100-101.

Griffiths, M.D. (2011). Technological trends and the psychosocial impact on gambling. Casino and Gaming International, 7(1), 77-80.

Griffiths, M.D. (2012). Gambling, stigma, and the rise of online bingo. i-Gaming Business Affiliate, December/January, 34-35.

Griffiths, M.D. (2012). The psychology of online and offline bingo. i-Gaming Business Affiliate, October/November, 38.

Griffiths, M.D. & Bingham, C. (2002). Bingo playing in the UK: The influence of demographic factors on play.  International Gambling Studies, 2, 51-60.

Griffiths, M.D. & Bingham, C. (2005). A study of superstitious beliefs among bingo players. Journal of Gambling Issues, 13. Located at:

Wardle, H., Moody, A., Griffiths, M.D., Orford, J. & and Volberg, R. (2011). Defining the online gambler and patterns of behaviour integration: Evidence from the British Gambling Prevalence Survey 2010. International Gambling Studies, 11, 339-356.

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

A range of air styles: A brief overview of inflatophilia

According to the online Opentopia encyclopedia, inflatophilia refers to a sexual fetish in which individuals derive sexual attraction to (or are sexually aroused by) inflatable objects and/or toys. Most people’s conception of an inflatophile may be rooted in fictional characters from popular culture. For instance, I remember very vividly listening to the track Be My Girl – Sally on The Police’s debut LP Outlandos D’Amour about a man who fell in love with an inflatable doll.

And then by lucky chance I saw in a special magazine

An ad that was unusual, the like I’d never seen

“Experience something different with our new imported toy

She’s loving, warm, inflatable and a guarantee of joy.”

She came all wrapped in cardboard, all pink and shrivelled down

A breath of air was all she needed to make her lose that frown

I took her to the bedroom and pumped her with some life

And later in a moment that girl became my wife

And so I sit her in the corner and sometimes stroke her hair

And when I’m feeling naughty I blow her up with air

She’s cuddly and she’s bouncy, she’s like a rubber ball

I bounce her in the kitchen and I bounce her in the hall

And now my life is different since Sally came my way

I wake up in the morning and have her on a tray

She’s everything they say she was and I wear a permanent grin

And I only have to worry in case my girl wears thin

A more literary (but ultimately similar) account was provided by Bryan Ferry when he sung on Roxy Music’s In Every Dream Home A Heartache (and featuring the seminal concluding lyric “I blew up your body/but you blew my mind!“). However, inflatophiles are not restricted to blow-up dolls but may be sexually aroused and excited by one or more inflatable objects such as beach and swimming pool inflatables (beach balls, swimming rings, air mats, lilos, etc.) and animal inflatables (e.g., blow up dolphins). The Opentopia article claims that inflatophiles are most attracted and turned on by inflatables that are animal-shaped (although there is no supporting evidence for the claim).

The fetish appears to have psychological and behavioural overlaps with balloon fetishism (that I covered in a previous blog), and like ‘looners’ (i.e., balloon fetishists), inflatophiles have been categorized into one of three sub-types. According to the Opentopia article, these three groups are based on the activity preference related to the inflatable object(s) and comprise:

  • Poppers: These individuals derive sexual pleasure and arousal from ‘popping’ (i.e., puncturing) their inflatable objects and/ or trying to re-inflate the inflatable that has popped.
  • Inflators: These individuals derive sexual pleasure and arousal while their inflatable objects are filled with air while sitting or lying on top of them.
  • Deflators: These individuals derive their sexual pleasure and arousal from releasing the air in their inflatable objects while sitting or lying on top of them.

These groups are not mutually exclusive and inflatophiles may belong to one or more of the three sub-types. The inflating or deflating may be carried out by the inflatophiles themselves or may be done by others (e.g., their sexual partners). The Opentopia article is the only article I am aware of that tries to theorize about the origins of inflatophilia. Personally, I feel that the behaviour is best explained through various behavioural conditioning processes that occur in childhood and/or adolescence (most notably, classical conditioning), but the Opentopia article claims:

“Likings for inflatable objects are generally both Freudian and Proustian and arise from an early age linked to associations with innocent happy experiences. These can extend as far as the first experiences of babyhood and childhood, associated with senses of texture and smell. The associated senses include the feel of mother’s skin, feel and smell of materials in early childhood (of blankets, sheets, satin, vinyl linings of perambulators), birthday parties with balloons, happy holidays at the beach, distinctive smells of inflatable toys merged with smells of brands of skin care worn by the mother. These take on a new meaning during puberty when other outlets for sexual needs are unavailable and preferences of interaction with inflatable objects develop”.

To me, the associations listed in the above quote could still form the basis of classically conditioned responses rather than some psychoanalytic explanation (in fact, I’m still not sure where the Freudian or Proustian perspective is in the quote as to me, it reads like classic associative learning). The Opentopia article also speculates on the differences between the sub-types of inflatophile. The article claims that”

“[The] division between ‘poppers’ and ‘non-poppers’ probably derives from associations of the event at which balloons were enjoyed or not enjoyed, or whether they were burst and caused excitement or whether they survived the party and were enjoyed for their ‘skin feel’ at a later time afterwards. The associations with memories of former happy experiences coupled with the intense pleasure of first sexual experience is a potent recipe for a lasting impression which will be carried forward into activity throughout adulthood. Many comment that the bouncing or changing shape of a balloon when squeezed, or other types of inflatable, gives the illusion of the object being ‘alive’ in some way, so the object is not merely inanimate. A predisposition to the fetish is enhanced by the packaging of lilos or beach airmats with photographs of attractive semi-naked bikini clad women displaying the object. This reinforces the concept of femininity with the object and allows a fantasy of substitution in the fetishist’s psyche in the absence of a real female”.

Again, the theoretical underpinning for the sub-types of inflatophile appears (from the above description at least) to be rooted in classical conditioning (i.e., associative pairing). Finally, the article also claims that inflatophiles are “usually open to non-fetish sexual activity, so their fetish does not generally get in the way of their involved relationships”. It also claims (without any supporting evidence) that:

“Partners of inflatable fetishists are more secure in the knowledge that their partner has a satisfying outlet for excess sexual needs during times of sexual unavailability of the partner rather than seeking additional or other partners. For this reason they usually make reliable and well-balanced life partners”.

After reading about inflatophiles, I went in search of inflatophiles online and came across numerous self-confessions to engaging in the fetish. Here are a few typical examples that seem to confirm some of the claims made in the Opentopia article:

  • Extract 1: “Anyone else have a Inflatables fetish? [Such as] riding or having sex with inflatable things like vinyl pool toy animals, blow-up dolls, kids’ swim floaties, etc. I am one of these fetishists, how many of us are there?”
  • Extract 2: I have been humping beach balls since I was a kid I have humped the head rest of inflatable rafts also. If we went swimming at someone’s house and they had a beach ball I would always sneak off with it, hump it and never got caught though the possibility of getting caught was part of the thrill. I also have an exercise ball that I have humped. Next is a blow up doll. I just have a fetish for inflatables”.
  • Extract 3: So all of you men help me out here, my husband has this fetish and I’ve done my very best to go along and have fun with it to excite him the best I can…but I know that he had dolls in the past and wants one but has made me feel like he enjoys the feel of a doll or inflatable more than me??? He’s actually very shy about it, I even asked for suggestions. Is there a way I could make myself feel like the doll does??”
  • Extract 4: I’m a teenage guy and inflatable stuff feels like heaven to me! Anything soft and shiny, pool toys mostly. Beach balls, air Mats, inner tubes, when my body comes in contact with it I get all aroused and hard and can really get freaky with them. I also like inflating and deflating them…I know weird”

Another article that explored inflatable fetishism was a journalistic account by Daniel Rolnik in the Los Angeles based After Dark magazine. Rolnik wrote that:

“My discovery of this strange sub-cult [of inflatable fetishism] began when I innocently favorited a photo of an inflatable horse toy on a popular art website. I simply thought it looked hilarious and judging by the user’s other pics, it didn’t seem like anything “alt” was going on. But that all changed when I got a message from the photographer featuring a link to the blog Hollow Paws, which had a discrete sentence in the upper right hand corner that made it all clear: A website for furries who love inflatable critters…I asked the blogger what people exactly did with the inflatables featured in [the featured articles]…Moments later I received an answer: ‘…Sometimes they hump them’. Horrified, yet intrigued, I began to uncover a secret world of anonymous patrons who do everything from wear full motocross gear and aggressively hump vinyl Shamu pool rafts until they explode, to fabricators who design prosthetic vaginas for plastic dolphins”.

Rolnik also observed that inflatophiles can be differentiated into sub-types (‘poppers’ and ‘non-poppers’) but claimed the two types “detest” each other based on the very specific online forums devoted to various inflatable fetishes (such as the Blow To Pop website). Rolnik also interviewed psychiatrist Dr. Soroya Bacchus about the psychology of inflatophilia, and Dr. Bacchus was quoted as saying:

“When I heard about this fetish, they didn’t seem too different from the people who have intercourse with blow-up dolls. They both suffer from a sexual function disorder that is categorized in the realm of paraphilia — meaning a love of some object, whether it’s an inanimate one or a non-consenting partner. The basic component is arousal, so sometimes there might be actual ejaculation on the toys, but oftentimes in cases of paraphilia it happens afterwards during masturbation. These kinds of disorders tend to feed on themselves”.

Dr. Bacchus appears to castigate all inflatophiles as suffering from sexual function disorder. However, my anecdotal reading suggests that most inflatophiles use inflatables as an adjunct to their ‘normal’ sex life rather than as a replacement. If this is the case, I personally don’t see the person as suffering from a sexual function disorder. As with many idiosyncratic fetishes, there has been no empirical or clinical research on inflatophilia, so nothing is known about how prevalent the behaviour is. The existence of more than a sprinkling of dedicated online forums and websites certainly suggest there is a small and committed inflatophile community. It would appear that the fetish is relatively benign and of little problem to its participants, which probably explains why there has been little interest from psychologists and clinicians.

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

Further reading

Abel, G.G., Coffey, L. & Osborn, C.A. (2008). Sexual arousal patterns: normal and deviant. Psychiatric Clinics of North America, 31, 643-655.

Brundage, S. (2002). Fetish Confessions: Telling loved ones about your fetish is as easy as solving fractured quadratic equations. The Wave Magazine, July 31. Located at:

Gates, K. (2000). Deviant Desires: Incredibly Strange Sex. New York: RE/Search Publications.

Malfouka (undated). So hot and ready to pop: The world of looners. Maximum Awesome. Located at:

Rolnik, D. (2012). Exploring the looner fetish – People who f*ck inflatable pool toys. After Dark LA, July 17. Located at:

McIntyre, K.E. (2011).  Looners: Inside the world of balloon fetishism. Berkeley Graduate School of Journalism, UC Berkeley, 27 April. Located at:

Opentopia (2013). What is inflatable fetishism? Located at:

Wikipedia (2012). Balloon fetish. Located at:

An eye for an I! A beginner’s guide to auto-enucleation

I have to say that I have no idea what it must be like to lose an eye (i.e., enucleation) but one thing I can’t possibly begin to imagine is what it must like is to remove my own eye (i.e., auto-enucleation). However, there are many clinical and medical reports of people that self-mutilate by stabbing or removing their eye(s). Arguably the most infamous auto-enucleator was Oedipus (in Sophocles’ play) who removed both his eyes after he realized he had unwittingly slept with his own mother and killed his own father.

The psychiatrist Dr. Armando Favazza defines self-mutilation as “the deliberate, direct, non-suicidal destruction or alteration of one’s body tissue”. Dr. Niraj Ahuja and Dr. Adrian Lloyd writing in the Australian and New Zealand Journal of Psychiatry also add that self-mutilation relates to bodily self-damage without wishing to die. Dr. Favazza also believes there are three fundamentally different types of self-mutilation. Enucleation is included in the first type (major self-mutilation) and is the least common. Other forms of self-mutilation in this category include self-castration, penectomy (cutting off one’s own penis) and self-limb amputation.

The second type includes “monotonously repetitive and sometimes rhythmic acts such as head-banging, hitting, and self-biting” (which according to Dr Favazza occur mostly in “moderate to severely mentally retarded persons as well as in cases of autism and Tourette’s syndrome”). The final and most common forms of bodily self-mutilation are moderately superficial and include a compulsive sub-type (e.g., hair-pulling, skin scratching and nail-biting), as well as an episodic/repetitive sub-type (e.g., skin-cutting, skin carving, burning, needle sticking, bone breaking, and wound picking). Many of these self-harming behaviours are a symptom and/or an associated feature in a number of mental personality disorders (e.g., anti-social, borderline, and histrionic personality disorders).

Reports of auto-enucleation in the medical literature were first described in the 1840s. By the early 1900s, the act of removing one’s own eye was actually termed ‘Oedipism’ by Blonel. Auto-enucleation is (of course) exceedingly rare although a couple of studies in the American Journal of Ophthalmology (in 1984) and an analysis of 1,146 enucleations between 1980 and 1990 in the British Journal of Ophthalmology (in 1994) estimated there were 2.8 to 4.3 per 100,000 in the population. However, some papers (such as those by Dr. Favazza) on major self-mutilation have put the incidence as low as one in 4 million.

Enucleators are also known to be at increased risk of further self-harming, and (predictably) are more likely to be living in psychiatric institutions when the auto-enucleation event occurs. They are also at increased risk of removing the second eye at a later date if they didn’t pull out both eyes to start with. A review by Dr. H.R. Krauss and colleagues in a 1984 issue of the Survey of Opthalmology examined 50 cases of self-enucleation and reported that 19 of them had bilateral auto-enucleation (i.e., had removed both of their eyes). A 2007 paper by Dr. Alireza Ghaffari-Nejad and colleagues in the Archives of Iranian Medicine examined the many theories behind self-harming behaviour. They briefly overviewed theories ranging from Fruedian psychoanalytic theory to biologically-based theories. They wrote:

Psychoanalytically self-injurious behaviour has been linked to castration and explained as a process of failure to resolve oedipal complex, repressed impulses, self punishment, focal suicide and aggression turned inwards especially in cases of depression. [Other authors] have postulated interpersonal loss preceding self-injurious behaviour and linked it to rejection sensitivity…Biologically serotonergic depletion preceding self-mutilation has been linked to aggression and depression…Some authors have claimed strong moral, religious and delusional component”

A recent literature review by Dr. Alexander Fan in the journal Psychiatry reported that the vast majority of auto-enucleation cases suffer from psychotic illness (particularly schizophrenia) although other medical and/or psychiatric conditions associated with auto-enucleation include obsessive-compulsive neuroses, severe depression, post-traumatic stress disorders, drug-induced psychoses, bipolar mania. There are also case studies where auto-enucleation has been linked with structural brain lesions, Down Syndrome, epilepsy, neurosyphilis, and Lesch-Nyhan syndrome (juvenile gout). These are similar to other forms of extreme self-mutilation. For instance, self-mutilation in schizophrenia in response to auditory hallucinations has often been described as Van Gogh Syndrome (in reference to the painter’s self-excision of his own left ear)

Other reviews of the psychiatric literature have reported that those who remove their own eyes commonly have delusions (typically sexual and/or religious) and that when asked about motivations for self-harming include reasons such as guilt, atonement, sin, evil, etc. Although some authors have noted that enucleators with religious beliefs are often Christian, other case studies have made reference to other religious faiths (e.g., Muslims). Finally, another paper by Favazza in Hospital and Community Psychiatry concluded that:

“Males in a first episode of a schizophrenic illness that is characterized by delusions associated with a body part or religious delusions are at the greatest risk for MSM [major self-mutilation]. However, MSM of this severity is so rare that it cannot be predicted accurately unless there has been a previous attempt at self-injury or the patient has spoken about wanting to remove or injure an organ. Threatened ocular mutilation deserves special mention because it may occur in a hospital setting, and the case histories suggest that one-to-one nursing is not always be sufficient to prevent enucleation”.

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

Further reading

Berguaa, A., Sperling, W. & Kuchlea M. (2002). Self-enucleation in drug-related psychosis. Ophthalmologica, 216, 269-271.

Eric, J.C., Nevitt, M.P., Hodge, D. &  Ballard, D.J. (1984). Incidence of enucleation in a defined population. American Journal of Ophthalmology, 113, 138-44.

Fan, A.H. (2007). Autoenucleation: A case report and literature review. Psychiatry, October, 60-62.

Favazza, Armando (1998) ‘Introduction’, in Marilee Strong A Bright Red Scream: Self-mutilation and the Language of Pain. New York: Viking.

Favazza, A. & Rosenthal R. (1993). Diagnostic issues in self-mutilation. Hospital and Community Psychiatry, 44, 134-140.

Field, H. & Waldfogel, S. (1995). Severe ocular self-injury. General Hospital Psychiatry, 17, 224-227.

Gamulescu, M.A., Serguhn, S., Aigner, J.M., Lohmann, C.P., & Roider J. (2001). Enucleation as a form of self-aggression, two case reports and review of the literature. Klin Monatsbl Augenheilkd, 218, 451-454.

Ghaffari-Nejad, A., Kerdegari, M., & Reihani-Kermani, H. (2007) Self-mutilation of the nose in a schizophrenic patient with Cotard Syndrome. Archives of Iranian Medicine, 10, 540-542.

Gottrau, P., Holbach, L.M. & Nauman, G.O. (1994). Clinicopathological review of 1,146 enucleations (1980-90). British Journal of Ophthalmology, 78, 260-5.

Jeffreys, S. (2000). ‘Body art’ and social status: Cutting, tattooing and piercing from a feminist perspective Feminism and Psychology, 10, 409-429.

Krauss, H., Yee, R. & Foos, R. (1994). Autoenucleation. Survey of Ophthalmology, 29, 179-87.

MacLean, C. & Robertson, B.M. (1976). Self enucleation and psychosis. Archives of General Psychiatry, 33, 242-249.

Patil, B. & James, N. (2004). Bilateral self-enucleation of eyes. Eye, 18, 431-432.

Patton N. (2004). Self-inflicted eye injuries: A review. Eye, 18, 867-872.

Rao, K.N. & Begum, S. (1996) Self enucleation in depression; A case report. Indian Journal of Psychiatry, 38, 267-70

Witherspoon, D., Feist, F., Morris, R. & Feist, R. (1989). Ocular self-mutilation. Annals of Ophthalmology, 21, 255-259.