Monthly Archives: June 2013

Sex starved: A beginner’s guide to sexual anorexia

In previous blogs I have looked at anorexia nervosa in the context of addictive eating disorders, ‘tanorexia’ (excessive tanning) and ‘fanorexia’ (excessive following of a celebrity or sports team). Today’s blog takes a brief look at ‘sexual anorexia’ that according to Dr. Douglas Weiss in his 1998 book Sexual Anorexia, Beyond Sexual, Emotional and Spiritual Withholding, typically refers to “the active, almost compulsive withholding of emotional, spiritual and sexual intimacy from the primary partner”. The 12-Step group Sex and Love Addicts Anonymous offers this definition and analogy:

“As an eating disorder, anorexia is defined as the compulsive avoidance of food. In the area of sex and love, anorexia has a similar definition: Anorexia is the compulsive avoidance of giving or receiving social, sexual, or emotional nourishment”

A paper by Dr. Randy Hardman and Dr. David Gardner in a 1986 issue of the Journal of Sex Education and Therapy compared anorexia nervosa and sexual anorexia. They highlighted the four most significant characteristic similarities of these self-perpetuating disorders from both an intrapsychic and interpersonal level. These were (i) control (i.e., overt personal control and covert relationship power), (ii) fear (i.e., fear of losing control and fear of personal sexuality), (iii) anger (i.e., passive and active expressions of anger based on devaluation), and (iv) justification (i.e., an elaborate system of denial, delusion, and misperception).

Along with Dr. Weiss, most of the key writings on the topic have been written by Dr. Patrick Carnes (the author of many articles and books on sex addiction). Dr. Carnes defines sexual anorexia as: “an obsessive state in which the physical, mental and emotional task of avoiding sex dominates one’s life. Like self-starvation with food, deprivation with sex can make one feel powerful and defended against all hurts.” In a 1998 paper in the journal Sexual Addiction and Compulsivity, he also notes that: “the term “sexual anorexia” has been used to describe sexual aversion disorder [in the Diagnostic and Statistical Manual of Mental Disorders], a state in which the patient has a profound disgust and horror at anything sexual in themselves and others”.

According to the Wikipedia entry on sexual anorexia, the term ‘sexual anorexia’ has been around for over 35 years, and the first use it the term is generally attributed to psychologist Nathan Hare, a psychologist who coined the term in his 1975 PhD thesis. (However, I have failed to track this down, and none of the academic papers I have read on sexual anorexia ever mention Hare).

Dr. Carnes claims to have identified three causative factors in the formation of sexual anorexia. These are (i) a probable history of sexual exploitation or severely traumatic sexual rejection, (ii) family history of extremes in thought or behavior (often very repressive/religious or it’s polar opposite of “anything-goes” permissiveness), and (iii) cultural, social or religious influences that view sex negatively and supports sexual oppression and repression. Dr. Weiss adds that there are three key criteria in the formation of anorexia: (i) sexual abuse, (ii) attachment disorder with the opposite sex parent and (iii) sex addiction.

In his 1997 book Sexual Anorexia: Overcoming Sexual Self-Hatred, Dr. Carnes views the symptom cluster of the sexual anorexic as primarily sexual and includes: (i) a dread of sexual pleasure, (ii) a morbid and persistent fear of sexual contact, (iii) obsession and hyper-vigilance around sexual matters, (iv) avoidance of anything connected with sex, (v) preoccupation with others being sexual, (vi) distortions of body appearance, (vii) extreme loathing of body functions, (viii) obsessional self-doubt about sexual adequacy, (ix) rigid, judgmental attitudes about sexual behaviour, (x) excessive fear and preoccupation with sexually transmitted diseases, (xi) obsessive concern or worry about the sexual intentions of others, (xii) shame and self-loathing over sexual experiences, (xiii) depression about sexual adequacy and functioning, (xiv) intimacy avoidance because of sexual fear, and (xv) self-destructive behavior to limit, stop, or avoid sex.

The 1998 paper published in the journal Sexual Addiction and Compulsivity by Dr. Carnes is one of the very few in the literature to collect empirical data. The data were collected from 144 patients at his treatment clinic that were diagnosed with sexual anorexia. Of these, 41% were male and 59% female aged between 19 and 58 years (all of whom were Caucasian). The main findings were that:

  • 67% reported a history of sexual abuse
  • 41% reported a history of physical abuse
  • 86% reported a history of emotional abuse
  • 65% reported members of the immediate family as some type of addict
  • 40% reported having a sex addict in the immediate family
  • 60% described their family as “rigid”
  • 67% described their family as “disengaged”

Carnes also reported that over two-thirds of the sexually anorexic population claimed to have other compulsive and/or addictive problems including alcoholism (33%), substance abuse (25%), compulsive eating (25%), caffeine abuse (26%), nicotine addiction (23%), compulsive spending (22%), and/or bulimia/anorexia with food (19%). Of most interest was the fact that Carnes compared his group of sexual anorexics with a group of sex addicts (also from his treatment centre). Carnes concluded that:

“By contrasting that profile with data from sex addicts who were in the same patient pool, some important contrasts can be made. The data for sex addicts and sexual anorexics were very parallel in terms of family system, abuse history, and related patterns of addiction, compulsion, and deprivation. Even the criteria for sex addiction and sexual anorexia have important parallels in terms of powerlessness, obsession, consequences, and distress…Such comparisons tend to confirm the proposition that extreme sexual disorders stem from many of the same factors and are variations of the same illness. Of equal importance is the possibility that extreme behaviors in various disorders (food, chemical, sexual, financial) whether in excess or in deprivation are for many patients interchangeable parts representing much deeper patterns of distress”

Finally, if you would like to know if you are sexually anorexic, you can take this simple test that I found at the Freedom In Grace website (and appears to be based on the world of Weiss and Carnes). If you endorse five or more of the following nine statements you or your partner are currently struggling with sexual anorexia”.

  • Withholding love from partner
  • Withholding praise or appreciation from partner
  • Controlling by silence or anger
  • Ongoing or ungrounded criticism causing isolation
  • Withholding sex from your partner
  • Unwillingness or inability to discuss feelings with partner
  • Staying so busy that they have no relational time for the partner
  • Making the problems or issues about your partner instead of owning their own issues
  • Controlling or shaming partner with money issues

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

Further reading

Carnes, P. (1997). Sexual Anorexia: Overcoming Sexual Self-Hatred. Center City, MN: Hazelden.

Carnes, P. (1998). The case for sexual anorexia: An interim report on 144 patients with sexual disorders. Sexual Addiction and Compulsivity, 5, 293–309.

Hardman, R.K. & Gardner, D.J. (1986). Sexual anorexia: A look at inhibited sexual desire. Journal of Sex Education and Therapy, 12, 55-59.

Nelson, Laura (2003). Sexual addiction versus sexual anorexia and the church’s impact. Sexual Addiction and Compulsivity, 10, 179–191.

Sex and Love Addicts Anonymous (undated). Sexual anorexia. Located at:

Weiss, D. (1998). Sexual Anorexia, Beyond Sexual, Emotional and Spiritual Withholding. Fort Worth, TX: Discovery

Weiss, D. (2005). Sexual anorexia: A new paradigm for hyposexual desire disorder. Located at:

Wikipedia (2012). Sexual anorexia. Located at:

Small claims caught: A beginner’s guide to Alice in Wonderland Syndrome

While researching a blog on Cotard Syndrome I came across a case study of Alice in Wonderland Syndrome published by Dr. Eric Bui and his colleagues published in the Journal of Neuropsychiatry and Clinical Neurosciences. They wrote:

“A 74-year-old retired French executive was admitted to hospital for major depressive disorder with psychotic features triggered by prostate surgery 3 months previously…The patient was described by his wife as usually sociable, jolly, scrupulous and a perfectionist. On admission, the patient presented with a depressed mood, loss of pleasure and interest, disordered sleeping, severe fatigue, loss of appetite, psychomotor retardation, and persecutory (being broken into and burgled) as well as somatic (his stools being contaminated) delusions…Ten days after admission, the patient exhibited new delusional symptoms: he believed his hands and feet were shorter than usual and was convinced that his clothes had shrunk. Organic causes (intracranial tumor and infection, thyroid disease, and nutritional deficiency) were ruled out by physiological, laboratory, neurological, and ophthalmological investigations…The patient continued to be delusional and severely depressed…He was discharged on day 45 of hospitalization with complete remission”.

As can be probably be surmised from this brief case study, Alice in Wonderland Syndrome (AIWS) is a non-contagious disorientation disorder and refers to when a person’s sense of body image, vision, hearing, touch, space, and/or time are distorted. AIWS sufferers typically experience micropsia (a neurological condition that affects human visual perception in which objects are perceived to be smaller than they actually are and make people feel bigger than they are) or macropsia (a neurological condition that affects human visual perception in which objects are perceived to be larger than they actually are and makes people feel smaller than they actually are). They may also experience feelings of paranoia.

AIWS has nothing to do with a malfunctioning of the eyes, but is a change in how the world is perceived with those suffering seeing objects the wrong shape or size. Arguably the most disturbing symptom for sufferers is the perceived alteration of their body image. AIWS sufferers become confused about the size and shape of their body (or specific body parts). Time perception may also be affected with many sufferers reporting that time seems to pass incredibly slowly as if they were on an LSD trip. Sufferers (most commonly thought to be children and migraine sufferers) often become very frightened, scared and panic-stricken, although it can often be treated successfully through complete rest and relaxation (and in most cases is a relatively temporary condition). Some research appears to indicate that AIWS can be due to abnormal amounts of electrical activity that causes blood to flow abnormally in the brain areas that process texture and visual perception.

AIWS was named after the 1865 book Alice’s Adventures in Wonderland by Lewis Carroll, but is also known as Todd Syndrome named after the psychiatrist who first wrote about the condition in a 1955 issue of the Canadian Medical Association Journal. (Interestingly, a short article by Dr. Klaus Podoll and Dr. Derek Robinson in The Lancet from 1999 highlighted that Carroll was a migraine sufferer and that his book may have been inspired by his own personal experiences!). Todd’s original paper reported five patients (of which four were female) all of who suffered from severe migraines. All of these patients described their body, body parts and/or objects around them changing in size (with two of them also having time disorientation too). On the basis of these five cases, Todd coined the term ‘Alice in Wonderland Syndrome’ (although such hallucinations had been noted three years prior to this by Dr. C.W. Lippman in a 1952 paper on certain hallucinations peculiar to migraine”).

The condition has also been associated with other medical conditions besides migraines, including (mononucleosis) infections, and severe depression, and (in extreme cases) brain tumours. A paper by Dr. Nabil Kitchener in a 2004 issue of the International Journal of Child Neuropsychiatry also noted that AIWS can also be the presenting manifestations in some patients with epilepsy, hyperpyrexia (i.e., extremely elevated body temperatures), typhoid encephalopathy, and other psychiatric disorders. In a 2005 paper in the journal European Neurology, Dr. Valmantas Budrys also reported that AWS could occur in hypnagogic, delirious states, encephalitis, cerebral lesions, drug intoxication, and schizophrenia.

In a literature review on organic depersonalization in the Journal of Neuropsychiatry and Clinical Neuroscience, Dr. Michelle Lambert and her colleagues examined the literature on AIWS. The noted that since Todd’s case studies were published, the subsequent published case reports of body image distortion associated with AIWS, often included depersonalization and/or derealization. They suggested that such symptom were consistent with parietal lobe pathology. More specifically, they argued that the frequent accompanying symptoms of fear, anxiety, and panic implicate the role of the temporal lobe. Dr. Kitchener’s 2004 paper also concludes that AIWS manifestations are due to disturbed function of either medial temporal, hippocampal, tempro-occipital or tempro-parieto-occipital regions of the brain based on the research of Dr. Kuo and colleagues published in a 1998 study in the Pediatric Neurology journal.

However, the case study published by Dr. Bui and his colleagues that I began this blog suggested that AIWS may be similar to Cotard Syndrome (CS). As the authors noted, that:

“Cotard Syndrome comprises any one of a series of delusions ranging from the belief that one has lost organs to the conviction that one is dead. Since Cotard’s syndrome is also usually associated with severe depression and improves rapidly with ECT [electro-convulsive therapy], it is possible that the somatic delusions experienced by our [AIWS] patient were a variant of this syndrome. According to our observations, the psychotic features of major depressive disorder might present in the form of Alice in Wonderland syndrome although the relationship between this syndrome and Cotard’s syndrome remains to be determined”.

Depending upon co-morbid conditions, medical treatments include beta blockers, anti-depressants, and anti-convulsants, AIWS has also been reported in both the Pediatric Infectious Diseases Journal (1987) and British Journal of Ophthalmology (1992) as one of the early signs of the Epstein-Barr Virus, one of the most common human viruses and of the herpes family. Most commonly it causes glandular fever but is associated with various forms of cancer including Hodgkin’s lymphoma. Chronic AIWS is untreatable and time is the only healer. Sharing experiences with other sufferers is also thought to be therapeutically beneficial (although I know of no clinical support for the claim).

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

Further reading

Budrys, V. (2005). Neurological eponyms derived from literature and visual art. European Neurology, 53, 171-178.

Bui, E., Chatagner, A. & Schmitt, L. (2010). Alice in Wonderland Syndrome in major depressive disorder. Journal of Neuropsychiatry and Clinical Neurosciences, 22, 352.e16-352.e16.

Cinbis, M. & Aysun, S. (1992). Alice in Wonderland syndrome as an initial manifestation of Epstein-Barr virus infection (case report). British Journal of Ophthalmology, 76, 316.

Eshel, G.M., Eyov, A., & Lahat, E., et al (1987). Alice in Wonderland syndrome, a manifestation of acute Epstein-Barr virus infection (brief report). Pediatric Infectious Diseases Journal, 6, 68.

Kew, J., Wright, A., & Halligan, P.W. (1998). Somesthetic aura: The experience of “Alice in Wonderland”. The Lancet, 351, 1934.

Kitchener, N. (2004). Alice in Wonderland Syndrome. International Journal of Child Neuropsychiatry, 1, 107-112.

Kuo, Y, Chiu, N.C., Shen, E.Y., Ho, C.S., Wu, M.C. (1998). Cerebral perfusion in children with “Alice in Wonderland” syndrome. Pediatric Neurology, 19, 105-108.

Lahat, E., Eshel, G., & Arlazoroff A (1990). “Alice in Wonderland” syndrome and infectious mononucleosis in children (letter). Journal of Neurology, Neurosurgery and Psychiatry, 53, 1104.

Lambert, M.V., Sierra, M., Phillips, M.L. & David, A.S. The spectrum of organic depersonalization: A review plus four new cases. Journal of Neuropsychiatry and Clinical Neuroscience, 14, 141-154.

Lippman, C.W. (1952). Certain hallucinations peculiar to migraine. Journal of Nervous and Mental Diseases, 116, 346-351.

Podoll, K., Ebel, H., Robinson, D., & Nicola, U. (2002). Obligatory and facultative symptoms of the Alice in wonderland syndrome. Minerva Medicine, 93, 287-293.

Podoll, K. & Robinson, D. (1999). Lewis Carroll’s migraine experiences. The Lancet, 353, 1366.

Rolak, L.A. (1991). Literary neurologic syndromes. Alice in Wonderland. Archives of Neurology, 48, 649–651.

Todd, J. (1955). The syndrome of Alice in Wonderland. Canadian Medical Association Journal, 73, 701–704.

From the university of perversity (Part 2): An A to Z of non-researched sexual paraphilias and strange sexual behaviours

In a previous blog I did an A-Z of sexual paraphilias about which we know almost nothing. Today’s blog takes a brief A to Z look at another 26 unusual and/or strange sexual behaviours where (as far as I am aware) there is absolutely no empirical or clinical research on the topic. The majority of the paraphilias below can be found in either Dr. Anil Aggrawal’s book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices and/or Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices (although a few were also taken from such sources as the Write World’s dedicated webpage on ‘philias’ and the online Urban Dictionary).

  • Autodermatophagia: This behaviour involves eating one’s own flesh as a form of erotic auto-masochism. The only place I’ve seen this mentioned is in Dr. Aggrawal’s book and appears to be a sub-variant of autosarcophogy (i.e., self-cannibalism) that I covered in a previous blog.
  • Brontophilia: This behaviour involves people who derive sexual arousal from thunderstorms. It was also the inspiration for the song Brontophilia (Satanic Anal Thunder) by the group Spasm (Google it if you don’t believe me!)
  • Cryptoscopophilia: This is the desire to see behaviour of others in privacy of their home (although some sources claim it is not necessarily sexual). The One Look website lists three different websites that have definitions including the online Urban Dictionary that defines it as “the urge to look through the windows of homes upon walking past them. Usually done for sexual satisfaction/curiosity reasons”. This appears to be a sub-type of voyeurism.
  • Dermaphilia: This is a behaviour in which the sexual stimulus for arousal comes from skin. The Sex Lexis definition website is a little more specific and claims that it is common among leather fetishists who becomes sexually aroused “when coming in direct contact with the skin or leather from animals or humans, from wearing leather clothing”.
  • Ederacinism: This is possibly one of the most unbelievable behaviours on this list and refers to the tearing out of sexual organs by the roots as in a frenzied way to punish oneself for sexual cravings. This would appear to be a sub-variant of genital self-mutilation and/or Klingsor Syndrome (that I covered in previous blogs).
  • Furtling: According to Dr. Aggrawal’s book, this behaviour involves the use of a person’s fingers underneath cut-outs in genital areas of photos as a way of gaining sexual arousal. It is also listed in a Spanish article on sexual paraphilias by Dr. Ruben Serrano in the Revista Venezolana de Urologia.
  • Gynotikolobomassophilia: This apparently refers to sexual pleasure from nibbling on a woman’s earlobe (aural sex?). At least four websites list this as a bona fide sexual activity according to the One Look webpage.
  • Hodophilia: This behaviour refers to individuals that derive sexual arousal from travelling (at least according to Dr. Aggrawal’s book). It is unclear whether this refers to modes of travelling (such as those who derive sexual pleasure from riding in cars or trains) or whether it refers to deriving sexual pleasure from being a tourist.
  • Icolagnia: Again found in Dr. Aggrawal’s book and is defined as those individuals who derive sexual arousal from contemplation of, or contact with, sculptures or pictures. This would seem to overlap with more specific sexual paraphilias such as agalmatophilia (sexual arousal from statues and/or manquins) that I covered in a previous blog.
  • Judeophilia: According to the Write World website, this behaviour involves “abnormal” sexual affection towards Jewish people. I have never come across this in any reputable sexual text.
  • Kokigami: According to the online Urban Dictionary, this involves the wrapping of the penis in a paper costume. The roots of Kokigami apparently lie in the eighth-century Japanese aristocrats who practiced the art of Tsutsumi (i.e., a man wrapped his penis with silk and ribbons in elaborate designs as a gift to lovers. He would then enjoy the physical sensations as his lover carefully unwrapped her prize.
  • Lygerastia: This is mentioned in Dr. Brenda Love’s sex encyclopedia and refers to tendency to being sexually aroused by being in darkness. This would appear to share psychological and behavioural overlaps with amaurophilia (sexual arousal from blindness) that I covered in a previous blog.
  • Melolagnia: This behaviour refers to those individuals who derive sexual arousal from music (and listed as a sexual paraphilia by both Dr. Love and Dr. Aggrawal).
  • Nanophilia: This refers to sexual arousal from having a short or small sexual partner. This is one of the few behaviours on this list that has been mentioned in an empirical research paper (as it was mentioned in the research on fetishes by Dr. C. Scorolli and colleagues in the International Journal of Impotence Research
  • Oenosugia: According to Dr. Aggrawal, this behaviour refers to the pouring wine over female breasts and licking it off. If you type ‘oenosugia’ into Google you get only two hits (one of which is Dr. Aggrawal’s book).
  • Phygephilia: I’m not sure how many people this could possibly refer to but Dr. Aggrawal defines this behaviour as sexual arousal from being a fugitive. The Inovun website defines it as “arousal from flight” (i.e., running away).
  • Queening: According to Dr. Anil Aggrawal, queening is a BDSM practice in where one sexual partner sits on or over another person’s face “typically to allow oral-genital or oral anal contact, or to practice ass worship or body worship”. In the book’s glossary of sexual terms, Dr. Aggrawal simply defines queening as “sitting on the side of a person’s face as a form of bondage”.
  • Rupophilia: According to the online Kinkopedia this behaviour refers to a sexual attraction towards dirt
(and presumably derives from the word ‘rupophobia’ that is a phobia towards dirt). This sexual paraphilia would seem to share similarities with mysophilia (i.e., sexual arousal from filth and unclean items) that I covered in a previous blog.
  • Savantophilia: According to Dr. Aggrawal, this behaviour refers to those who are sexually aroused by mentally challenged individuals. The only case that I am aware of that could potentially fit such a description is Jimmy Saville (see my previous blog for details).
  • Tripsophilia: According to the Sex Lexis website, this behaviour refers to being sexually arousal by being “messaged or otherwise manipulated”. Dr. Aggrawal describes the same behaviour as tripsolagnophilia.
  • Undinism: Dr. Aggrawal simply describes this behaviour as individuals who derive sexual arousal from water. This appears to be another name for aquaphilia (that I covered in a previous blog).
  • Vernalagnia: This is a seasonal behaviour and according to Dr. Aggrawal refers to an increase in sexual desire in the spring. Another online website simply defines it less sexually as a romantic mood brought on by spring”.
  • Wakamezake: This appears to be similar to oenosugia (above), and is a sexual term originating in Japan involving the drinking alcohol (such as sake) from a woman’s body. The Wikipedia entry on ‘food play’ provides a description: The woman closes her legs tight enough that the triangle between the thighs and mons pubis form a cup, and then pours sake down her chest into this triangle. Her partner then drinks the sake from there. The name comes from the idea that the woman’s pubic hair in the sake resembles soft seaweed (wakame) floating in the sea”.
  • Xenoglossophilia: I have yet to find this sexual act in any academic text but a few online websites define this as a sexual affection for foreign languages. I briefly mentioned this behaviour in a previous blog on xenophilia (sexual arousal from strangers) but asserted that such behaviour could hardly be classed as a sexual paraphilia.
  • Yoni worship: This refers to the worship of the female genitals (yoni is the Sanskrit word for the vagina). There are some interesting articles on Yoni worship at both the Basically Blah and Tantric Serenity websites.
  • Zeusophilia: I have yet to come across this behaviour in any reputable academic text, but a number of online websites (such as the Write World website) all claim that this behaviour refers to a sexual love of God or gods.

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.

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

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

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

Serrano, R.H. (2004). Parafilias. Revista Venezolana de Urologia, 50, 64-69

Write World (2013). Philias. Located at:

Screen play ideas: A speculative look at trends in video game addiction

Gaming addiction has become a topic of increasing research interest. Over the last decade there has been a significant increase in the number of scientific studies examining various aspects of video game addiction. This has resulted in a wide-ranging selection of review papers focusing on different aspects of the topic. These include general literature reviews of video game addiction, reviews of online (as opposed to offline) gaming addiction, reviews of the main methodological issues in studying video game addiction, reviews of structural characteristics and their relationship with video game addiction, reviews of video game addiction treatment, reviews of video game addiction and co-morbidity/convergence with other addictions such as gambling addiction and Internet addiction, and miscellaneous review papers on very specific aspects of video game addictions such as social responsibility, screening instruments, or reviews refuting that video game addiction even exists.

Furthermore, the amount and the quality of research in the gaming addiction field has progressed much over the last decade but is still in its infancy compared to other more established behavioural addictions, such as pathological gambling. Today’s blog briefly provides a considered (and somewhat speculative) examination of what might happen in the gaming addiction field from a number of different standpoints (e.g., methodological, conceptual, technological). These are taken from a paper I recently published in Current Psychiatry Reviews with Dr. Daniel King (University of Adelaide, Australia) and Daria Kuss (Nottingham Trent University, UK). These trends were loosely modeled on a 2011 paper I wrote on the technological trends in gambling and published in Casino and Gaming International.

  • There is likely to be an even bigger increase in empirical research into problematic video game playing and video game addiction. This will of course be dependent on both appropriate funding streams and/or whether gaming addiction ends up being included in future psychiatric disorder classifications (e.g., Diagnostic and Statistical Manual, International Classification of Diseases, etc.). Future research is likely to include more epidemiological and/or general population data on media use, leading to better insights into the onset and course of problematic video game play and addiction.
  • Given the many different screening instruments that have been developed over the last decade, there is likely to be a refinement of video game addiction measures and greater consensus on its conceptualization, either as a single disorder and/or incorporated into other known disorders (e.g., impulse control disorder). This is also likely to lead to improved assessment tools based on such conceptualization(s).
  • Measures of gaming use and subsequent behaviour are likely to diversify in terms of media use, including social networking sites (SNS) and associated Internet resources. Already, games such as Call of Duty and Battlefield 3 are being released with their own SNS (e.g., COD Elite) that track player behaviour and provide feedback to players as to how to improve their game (thus functionally reinforcing video game play and thus have implications for excessive and/or potentially addictive play).
  • Gaming on the move is likely to be a big growth area that may have implications for excessive gaming via ‘convenience’ hardware such as handheld gaming consoles, PDA devices, mobile phones, tablet computers, and MP3 players.
  • Given the fact that the Internet is gender-neutral, there is likely to be increasing feminization of gaming where increasing numbers of females not only engage in the playing of online games, but also develop problems as a result. Casual gaming online is already popular among females. However, the biggest difference between male and female gaming is likely to be content-based (e.g., males may prefer competitive type gaming experiences whereas females may prefer co-operative type gaming experiences).
  • Given the increasing number of research teams in the gambling field being given direct access to gambling companies behavioural tracking data, there is likely to be an increasing number of such collaborations in the gaming studies field.
  • Given the increased importance of additional research into the structural and situational characteristics of consumptive behaviours (e.g., smoking nicotine, drinking alcohol, gambling, etc.), it is likely that research on design features within games and their psychological impact (including potential addiction) will increase as well. Such research has already begun (including quite a few studies by our gaming research unit).
  • As the diagnosis of video game addiction becomes more legitimate in psychiatric and medical circles, it will lead to better randomized control trials on interventions for problematic video game play than the ones already carried out. There is also likely to be an increase in the online medium itself being used as a treatment channel. The reasons that people like to engage in some online leisure activities (i.e., the fact that the online environment is non-face-to-face, convenient, accessible, affordable, anonymous, non-threatening, non-alienating, non-stigmatizing, etc.) may also be the very same reasons why people would want to seek advice, help and treatment online rather than in face-to-face situations.

Based on our review paper there are several noticeable trends that can be drawn from our recent reviews of problematic video game play and video game addiction.

  • There has been a significant increase in empirical research decade by decade since the early 1980s.
  • There has been a noticeable (and arguably strategic) shift in researching the mode of video game play. In the 1980s, research mainly concerned ‘pay-to-play’ arcade video games. In the 1990s, research mainly concerned stand alone (offline) video games played at home on consoles, PCs or handheld devices. In the 2000s, research mainly concerned online massively multiplayer video games.
  • There has been a noticeable shift in how data are collected. Up until the early 2000s, data about video game behaviour was typically collected face-to-face, whereas contemporary studies collect data online, strategically targeting online forums where gamers are known to (virtually) congregate. These samples are typically self-selecting and (by default) unrepresentative of the general population. Therefore, generalization is almost always one of the methodological shortcomings of this data collection approach.
  • Survey study sample sizes have generally increased. In the 1980s and 1990s, sample sizes were typically in the low hundreds. In the 2000s, sample sizes in their thousands – even if unrepresentative – are not uncommon.
  • There has been a diversification in the way data are collected including experiments, physiological investigations, secondary analysis of existing data (such as that collected from online forums), and behavioural tracking studies.
  • There has been increased research on adult (i.e., non-child and non-adolescent) samples reflecting the fact that the demographics of gaming have changed.
  • There has been increasing sophistication in relation to issues concerning assessment and measurement of problematic video game play and video game addiction. In the last few years, instruments have been developed that have more robust psychometric properties in terms of reliability and validity. However, there are still some concerns as many of the most widely used screening instruments were adapted from adult screens and much of the video game literature has examined children and adolescents. In other papers I have co-written with Dr. King, we have asserted that to enable future advances in the development and testing of interventions for video game-related problems, there must be some consensus among clinicians and researchers as to the precise classification of these problems. (In fact, we’ve just had a major review paper accepted on assessing video game addiction in Clinical Psychology Review which I examined in a previous blog).

Clearly, there exist a number of gaps in current understanding of problematic video game play and video game addiction. There is a need for epidemiological research to determine the incidence and prevalence of clinically significant problems associated with video game play in the broader population. There are too few clinical studies that describe the unique features and symptoms of problematic video game play and/or video game addiction. While the current empirical base is relatively small, gaming addiction has become a more mainstream area for psychological and psychiatric research and is likely to become an area of significant importance given the widespread popularity of gaming.

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

Additional input: Daria Kuss and Daniel King

Further reading

Griffiths, M.D. (2010). Online video gaming: What should educational psychologists know? Educational Psychology in Practice, 26(1), 35-40.

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

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

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

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Video game structural characteristics: A new psychological taxonomy. International Journal of Mental Health and Addiction, 8, 90-106.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The role of structural characteristics in problem video game playing: A review. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. Located at:

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.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Cognitive behavioural therapy for problematic video game players: Conceptual considerations and practice issues. Journal of CyberTherapy and Rehabilitstion, 3, 261-273.

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

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2012). Clinical interventions for technology-based problems: Excessive Internet and video game use. Journal of Cognitive Psychotherapy: An International Quarterly, 26, 43-56.

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

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