Monthly Archives: August 2013

Identity marred: A ‪beginner’s guide to Delusional Misidentification Syndrome‬s

Some of the strangest mental and neurological syndromes that exist involve delusional misidentification. There are many different types and they all come under the umbrella term Delusional Misidentification Syndrome (DMS)‬. It was Dr. Nikos Christodoulou who introduced the term in his 1986 edited collection The Delusional Misidentification Syndromes. All DMSs involve a belief by the affected individual that the identity of something (i.e., a person, place, object, etc.) has altered or changed in some way. There are many variants of DMS, and in most cases the delusion is monothematic (i.e., it only concerns one particular topic). Here is a brief summary of the different types:

The Fregoli delusion: This refers to an individual who has the belief that more than one person that they have met is the same person in more than one disguise. The disorder is named after Leopoldo Fregoli an Italian theatre actor who was known for his remarkable ability to quickly change his physical appearance while on stage. The first reported case was in 1927 (by Dr P. Courbon and Dr. G. Fail in a French psychiatry journal) when a female schizophrenic (aged 27 years) claimed that she was being persecuted by two actors that she had seen at the theatre. According to the woman the actors “pursued her closely, taking the form of people she knows or meets”. Compared to other forms of delusional misidentification, the Fregoli delusion is thought to be the least common.

The Capgras delusion: This refers to an individual who has the belief that someone (typically a spouse or close relative) has been replaced by an identical-looking imposter. The delusion was named in 1923 after a French psychiatrist (Dr. Joseph Capgras) reported the case of a French woman who believed that her husband (and some other people she knew) had been replaced by identical looking doubles. Females are slightly more likely than males to have the delusion (approximately 60% females and 40% males). The disorder is most likely to found in individuals that have a brain injury, schizophrenia and/or dementia, but has also been associated with other medical conditions including hypothyroidism, diabetes, and migraines. There was also a case study published in a 2010 issue of the journal Biological Psychiatry (by Dr. P.R. Corlett and colleagues) who reported that the delusion had been induced by a psychologically healthy following the taking of the drug ketamine.

Subjective doubles (aka Christodoulou syndrome): This refers to individuals who have the belief that there are (one or more) doubles of themselves (i.e., doppelgangers) that carry out actions and behaviours independently and lead a life of their own. The disorder was first identified by Dr. Nikos Christodoulou in a 1978 issue of the American Journal of Psychiatry. As with other DMSs, subjective doubles syndrome typically arises as a consequence of a mental disorder, brain injury (typically the right central hemisphere) or a neurological disorder. In rare instances, there may be comorbidity with the Capgras delusion and is then referred to ‘subjective Capgras syndrome’.

Intermetamorphosis: This refers to an individual who has the belief that people in their immediate vicinity change identities with each other but keep the same appearance. The disorder was first reported in 1932 by Dr. P. Courbon and Dr. J. Tusques (again in a French psychiatry journal), and again shares comorbidity with mental and/or neurological disorders. An interesting case study was published in a 2002 issue of the journal Cognitive Neuropsychiatry by Dr. M.F. Shanks and Dr. A. Venneri. They described a man with Alzheimer’s disease who mistook his wife for his dead mother and (at a later date) his sister. He later mistook his son for his brother and his daughter for another sister. As the delusion occurred when speaking on the telephone to these misidentified individuals he was not diagnosed with either visual agnosia (i.e., an inability of the brain to recognize or understand visual stimuli) or prosopagnosia (i.e., ‘face-blindness’ – the inability to recognize faces).

There are also some other conditions that could feasibly be classed as DMSs including (i) mirrored-self misidentification, (ii) reduplicative paramnesia, (iii) delusional companion syndrome, (iv) clonal pluralization of the self, and (v) the Cotard delusion (which I covered in a previous blog). Very briefly:

  • Mirrored-self misidentification: This refers to an individual who has the belief that when they look in the mirror they see someone else.
  • Reduplicative paramnesia: This refers to an individual who has the belief that something (e.g., a person, a body part, an object, or a place has been duplicated.
  • Delusional companion syndrome: This refers to an individual who has the belief that inanimate objects are actually alive.
  • Clonal pluralization of the self: This refers to individuals who have the belief that there are multiple copies of themselves (both physically and psychologically identical).
  • The Cotard delusion: This refers to an individual who has the belief that they are dead, don’t exist and/or immortal.

There are some cases reported where individuals have more than one DMS simultaneously. For instance, in very rare cases, a person may suffer from both the Fregoli delusion and the Capgras delusion at the same time. Such individuals often experience both depersonalization and derealization and typically co-occur with other mental disorders such as bipolar disorder, schizophrenia, obsessive-compulsive disorders, and/or other mood disorders. In general, DMS is thought to arise because of a dissociation between identification and recognition processes. The Wikipedia entry on the Fregoli delusion (which also examines other DMSs) concludes:

“The study of DMS currently remains controversial…Although there is a plethora of information on DMS, there are still many mysteries of the physiological and anatomical details of DMS. An accurate semiological analysis of higher visual anomalies and their corresponding topographic sites may help elucidate the aetiology of Fregoli’s and other misidentification disorders”.

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

Further reading

Christodoulou G.N. (1986). Delusional Misidentification Syndromes. Basel: Karger.

Christodoulou G.N. (1977). The syndrome of Capgras, British Journal of Psychiatry, 130, 556.

Christodoulou G.N. (1978). Syndrome of subjective doubles. American. Journal of Psychiatry, 135, 249.

Corlett, P.R., D’Souza, D.C. & Krystal, J.H. (2010). Capgras Syndrome induced by ketamine in a healthy subject. Biological Psychiatry, 68(1), e1–e2.

Ellis HD, Luauté JP, Retterstøl N (1994). “Delusional misidentification syndromes”. Psychopathology 27 (3-5): 117-120.

Benson DF, Gardner H, Meadows JC (February 1976). Reduplicative paramnesia. Neurology 26, 147-151.

Berrios G.E., Luque R. (1995). Cotard Syndrome: clinical analysis of 100 cases. Acta Psychiatrica Scandinavica 91, 185-188.

Shanks MF, Venneri A (2002). The emergence of delusional companions in Alzheimer’s disease: An unusual misidentification syndrome. Cognitive Neuropsychiatry, 7, 317-328.

Vörös, V., Tényi, T., Simon, M. & Trixler, M. (2003). Clonal pluralization of the self: A new form of delusional misidentification syndrome. Psychopathology 36, 46-48.

Sno, H.N. (1994). A continuum of misidentification symptoms. Psychopathology, 27, 144-147.

Needle work: A beginner’s guide to belonophilia

A year ago, the Sydney Morning Herald (SMH) reported the case of a 58-year old Australian facial surgeon (Arthur Bosanquet) who was disqualified from practicing as a dentist after admitting to the Dental Tribunal of New South Wales that he had a “needle fetish” with an underlying homosexual/bisexual interest that led to the sexual abuse of three teenage patients. He was initially jailed for nine months for both indecent and common assaults but on appeal these were downgraded to suspended sentences. As the article in the SMH noted:

“[Bosanquet] devised a bogus university study which tricked the young men into masturbating in front of him…The surgeon blamed his behaviour on his needle fetish, sexual interests, and too much work…The tribunal heard evidence that, in several cases, Bosanquet offered the young men money to complete the study, which focused on taking blood pressure readings and blood samples before and after masturbation. The incidents, which spanned an eight-year period, included two occasions where he conducted the ‘study’ at the patients’ homes”

In another case last year reported by Asia One News, a 40-year old man from Kuala Lumpur had pricked “scores of needles into his lover’s body” claiming that he had been performing acupuncture on her. His lover was forced to endure his fetishistic use of needles and was threatened with stabbing if she did not let her become his human pin cushion. He threatened to knife her if she did not submit to his fetish. The report noted:

“The woman was startled from her slumber by a sharp piercing feeling on her body. The man pointed a knife at her and threatened to kill her, saying he was going to perform acupuncture on her. Afraid, she gave in to the agonizing ‘treatment’. The man told her that he, too, needed the treatment and wanted her to prick needles into his body. The victim, worried that the matter could get out of hand, told her boyfriend she needed to wash up and prepare for work. She pleaded with him to remove the needles and pins from her face, hands and body. During the brief respite, the frightened woman stealthily left the house and fled to the Sungai Besi police station to lodge a report”.

In his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr Anil Aggrawal defines belonophilia as the deriving of sexual pleasure and arousal from pins or needles and both of the above cases appear to belonophiles (although I only have media stories as ‘evidence’).

In a previous blog on piquerism (sexual arousal from penetrating another person’s body with sharp objects such as pins, razors, knives, etc.) I briefly looked at the case of 25-year-old American (Frank Ranieri) who was accused of paying large amounts of money to at least five young females in exchange for poking their buttocks with sharp objects (e.g., pens, pins, nails, etc.) while masturbating. Although Ranieri was a piquerist, it could also be argued that he was (in part at least a belonophile). As one article on the case noted:

“Ranieri was charged with two counts of second-degree assault as a sexual felony for paying a 17-year-old Richmond Valley teen about $6,000 to be his erotic pincushion for about a year and a half…Ranieri liked to see pins go through muscle and flesh…He didn’t see much wrong with it”.

Although media stories relating to ‘needle fetishes’ appear to be relatively rare, clinical and medical case studies in the academic literature are almost non-existent. One of the very few academic case studies of pin fetishism was published back in a 1954 issue of the medical journal The Lancet. Dr. W. Mitchell and two other colleagues reported the case of an epileptic male with a safety pin fetish (in fact, there is a known association between epilepsy and sexual fetishism). For as long as he could remember, the patient had had a safety pin fetish and often entered a trance-like state when gazing at a safety pin. The man claimed that during his early childhood, contemplation of an actual or imagined safety pin evoked a feeling described by the man as “thought satisfaction”. During his teenage years, the `thought satisfaction’ developed into absence seizures, and then motor automatisms. At the age of 38-years, the patient was given a temporal lobectomy. This completely eliminated both the epilepsy and his fetishistic desire for safety pins.

The sexualization of pin and needles has long been part of sexual sado-masochistic practices and is known as ‘needle play’. The Informed Consent website has an article on the practices and notes that:

Needle play is the practice of inserting needles under the skin of the submissive. Needle play is considered [a form of] Edge Play and care should be taken to follow all appropriate safety precautions when engaging in play in order to avoid injury or infection. Only use sterile needles approved for medical use, and not reuse them after they have been used. The basic idea is that the needle should travel just underneath the surface of ordinary skin, to emerge through the skin a short distance from where it was inserted. The needle tips have a bevel. With regard to the skin being pierced, the bevel may be up or down (it’s personal preference). Shallower [equals] More Pain, Larger Diameter Needle [equals] More Pain. Do not stick needles into internal organs, bones, eyes, etc. Again, the idea is that the needle should travel just underneath ordinary skin, passing only through skin and the subcutaneous layers just underneath the surface”.

The Informed Consent website also makes reference to very specific types of needle play including genital play piercing and nipple piercing. The article claims that those individuals that like “intense nipple play” also like temporary nipple piercing. The article also notes that:

“The needle can be thrust through back of the nipple, taking care to include areolar tissue. An entire rosette of needles can be inserted. This of course can be dangerous, with potential exchange of bodily fluids and other infection. Don’t pierce wrists, hands, or spines, or near them. In general, piercing near a nerve tract (e.g., near joints); avoid piercing where bones are close to the skin surface. Waist to shoulders is usually fine, though one should avoid the armpit and sternum. The primary danger in play piercing is infection. Be sure that the person you are playing with would recognize the signs of infection should they occur”.

The Wikipedia entry on play piercing briefly examines both needle play and recreational acupuncture and defines such practices as temporary where the main reason for engaging in the behaviour is to enjoy the experience rather than permanent body decoration. Other motivations for engaging in needle play include (i) a mode of self-expression, (ii) spiritual self-discovery, (iii) sexual pleasure, (iv) simple entertainment, (v) raising awareness, (vi) relieving boredom, and/or (vii) as “part of a ritual imitating mock tribal cultures”. The article also claims:

“Play piercing can produce an intense natural endorphin high which can last for hours and can induce orgasm in many of the people who experience it. The experience of multiple piercings in an erotically or spiritually charged context is qualitatively very different from the experience most people have had with phlebotomists in medical settings, in part because the needle is placed ‘through’ the skin at a secant so that both ends are accessible, rather than ‘into’ the skin”.

Whether ‘needle play’ can really be classed as a ‘needle fetish’ as part of belonophilia is debatable. The (online non-academic) needle play literature appears to be more rooted in erotic piercing that needle fetishes per se. There are certainly a growing number of academic papers on sexual piercing since Dr. Neil Buhrich’s research in a 1983 issue of the Archives of Sexual Behavior (so I’ll leave that for another blog). Genuine ‘needle fetishism’ appears to be very rare.

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

Further reading

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

Asia One News (2012). Man has ‘acupuncture’ fetish, January 4. Located at:

Buhrich, N. (1983). The association of erotic piercing with homosexuality, sadomasochism, bondage, fetishism, and tattoos. Archives of Sexual Behavior, 12, 167-171.

Fuller, B. (2012). Dentist disqualified over ‘needle fetish’. Sydney Morning Herald, August 21. Located at:

Informed Consent (2012). Needle play. Located at:

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

Mitchell, W. & Falconer, M.A. & Hill, D. (1954). Epilepsy with fetishism relieved by temporal lobe lobectomy. Lancet, 2, 626-630.

PervScan (2007). Piquerism in New York. June 12. Located at:

Spencer, P.N. (2007). Bizarre allegations at pin-fetish arraignment. Staten Island Advance, June 6. Located at:

Wikipedia (2012). Play piercing. Located at:

Care in the (gaming) community: Social responsibility and the videogame industry

In recent years, the problematic use of online videogames has received increased attention not only from the media, but also from psychologists, psychiatrists, mental health organizations and gamers themselves. A number of studies from different cultures are providing evidence that somewhere around 7 to 11% of gamers seem to be having real problems to the point that they are considered pathological gamers. In extreme cases, some gamers are reported to have been playing for 40, 60, and even 90 hours in a single gaming session.

While it may be difficult to distinguish between a healthy and unhealthy usage of online videogames, there is sufficient evidence to describe some excessive gaming as problematic and/or addictive when it pervades and disrupts other aspects of life making it an issue worthy of extensive investigation. In some cases this leads to symptoms commonly experienced by substance addicts, namely salience, mood modification, craving and tolerance. Research suggests that some gamers are struggling to keep their playing habits under control and consequently compromise their academic achievement, real-life relationships, family relationships, physical health, and psychological wellbeing.

Despite a decade of research, there is significant disagreement on whether pathological gaming can be conceptualized as an impulse control disorder and/or a behavioural addiction such as pathological gambling. While acknowledging the potential for some gamers to engage in pathological use, most researchers argue in favour of creating an official diagnosis for pathological gaming. However, others disagree and advise caution about the potential for exaggeration of a real but uncommon problem. As well as the divergence of opinions in the scholarly community, there is insufficient evidence to reach any definitive conclusions or an operational definition of pathological gaming, its diagnosis criteria and prevalence. While the academic debate is likely to continue for a while, it is clear that for a small minority of gamers, pathological gaming leads to negative life consequences.

Against this backdrop, comparable with the cautionary health messages on tobacco and alcohol packaging, warning messages about risk of overuse have recently started to appear on the loading screens of popular online games. For example:

  • World of Warcraft – ‘Take everything in moderation (even World of Warcraft)’ and ‘Bring your friends to Azeroth, but don’t forget to go outside of Azeroth with them as well’;
  • Final Fantasy XI – ‘Exploring Vana’diel is a thrilling experience. During your time here, you will be able to talk, join, and adventure with many other individuals in an experience that is unique to online games. That being said, we have no desire to see your real life suffer as a consequence. Don’t forget your family, your friends, your school, or your work.’

These and similar warning messages raise the question of why the online videogame industry warns its players not to overuse their product. Does the videogame industry really believe that their products have addictive features that can lead to negative consequences and the functional impairment of gamers’ lives? This leads to the important issue of whether the giving of such messages by online videogame companies means they have done enough to fulfil their social responsibility or do they have they a wider role to play? Furthermore, these warning messages suggest that the online videogame industry knows how high the percentage of over-users is, how much time gamers’ spend playing, and what specific features makes a particular game more engrossing and addictive than others. While they do not directly admit this, by showing these warning messages, they do take some responsibility into their own hands.

Companies in the online video games sector have started to face criticism around the addictive and problematic nature of the use involved with certain online games and their violent content, suggesting that it is a controversial industry. Gaining broader societal acceptance has become a critical factor for companies in controversial industries where failure to meet stakeholders’ societal expectations result in their legitimacy being challenged. Unlike the gambling industry, which has a long history of forced governmental regulation and in which CSR has become a crucial issue, the online videogame industry has, by and large to date, escaped governmental action. However, there are some isolated examples of governmental interventions. For example, China introduced controls to deter people from playing online videogames for longer than three hours, while Thailand’s government banned Grand Theft Auto 4 when a student murdered a taxi driver while trying to recreate a scene from the game ‘to see if it was as easy as in the game’. In addition, the Australian classification board refused the original version of Fallout 3 due to the high level of realistic drug use thus forcing its developer Bethesda Softworks to release a censored version.

In the USA, the sales of ‘Mature’ (M) or ‘Adults Only’ (AO) rated games to minors has been an issue of much concern to public officials, and the Video Games Ratings Enforcement Act introduced to the US House of Representatives requires an ID check for M- and AO-rated game purchases (US Congress, 2006). The majority of game publishers have decided to get controversial games rated by voluntary rating systems. For example, the Entertainment Software Rating Board (ESRB) rates games in the USA and Canada, the British Board of Film Classification (BBFC) in the UK, and the Pan European Game Information (PEGI) in Europe. While the ESRB and PEGI ratings are not legally binding, the BBFC ratings are backed up by the British law, thus making it illegal to sell the game to anyone under the indicated age. Few publishers in the online videogame industry have attempted to develop and sell a game with the strictest ESRB rating of AO. While rating systems are helpful, a study commissioned by the UK games industry found that parents let their children play games with adult or 18+ ratings, because they perceived age ratings as a guide but not as a definite prohibition.

Online videogame developers and publishers need to look into the structural features of the game design, for example, character development, rapid absorption rate, and multi-player features, that make them addictive and/or problematic for some gamers. This undertaking falls mainly on the game developers as they hold the codes for making the games less addictive. For example, long quests can be shortened to minimize the time spent in the game to obtain a certain prized item. Blizzard Entertainment, the makers of World of Warcraft, introduced some down-tuning of hardcore game-play mechanisms that encouraged excessive gaming. Initially, a symbolic and unique in-game title was rewarded to players who progress their character to the maximum level of 80 fastest. However, after several pages of forum debate in which players expressed their concern, an official Blizzard representative announced the removal of the title from the game.

Many games make use of variable ratio reinforcement schedules, which provides a very intense experience, thus increasing the addictiveness of the virtual world. Although, the potentially addictive design features of MMORPGs might not be intentional there is an obligation on the developers to consider ways of limiting harm. One way of doing this can be for developers to make design changes on time limits as many gamers schedule and plan according to the in-game periods of time. For example, long quests could be shortened, the amount of experience points needed to reach the next level could be lowered, spawns could be timed to appear more frequently to give gamers increased chances of receiving specifically wanted items and by speeding the processes of difficult task, gamers will be able to leave the game much earlier after completing their tasks. Implementing these changes to MMORPGs would show that game developers are taking CSR seriously and that they are concerned with more than revenue.

In terms of effective care policies for the gamers, the most observable act until now by the online videogame publishers is the initiation of warning messages. Through these messages, the industry is seemingly addressing CSR in the area of excessive use of videogames, albeit to a rather limited extent. Furthermore, some games (such as WoW) have a parental mode that allows parents to restrict playing time for their children.

Online videogame publishers should make provision for suitable referral services. Presently, they provide neither referral services nor customer care with regard to videogame addiction. Although the time constraints policies applied in China might not be a viable option in Europe, companies can potentially identify from their databases extreme or problematic gamers who are spending an excessive amount of time in the game and offer them contact information for a referral service in their country. Empirical evidence from the gambling industry suggests that similar initiatives and other social-responsibility tools are appreciated by players. There is also recent empirical evidence from the gambling studies field that the setting of time limits helps the most gaming intense players the most. In the context of online gambling, I have suggested that it is not the gaming industry’s responsibility to treat gamblers but it is their responsibility to provide referrals for problem gamblers to specialist helping agencies. I have argued that it is better for the industry to refer their problem customers to online help that offers a high degree of anonymity (as this is preferred by online gamblers). This is an important finding for the online videogame industry to take on board, as it seems that it is not currently taken into consideration in their CSR practices. Online videogame companies need to take social responsibility for the extreme and problematic usage of their products. The proportion of gamers who develop problems and/or become addicts may stay roughly constant but as online videogames get better and better, and increasing numbers of people discover them, the number of addicts is most probably going to rise.

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

Additional input: Dr. Shumaila Yousafzai and Dr. Zaheer Hussain

Further reading

Auer, M., & Griffiths, M.D. (2013). Voluntary limit setting and player choice in most intense online gamblers: An empirical study of gambling behaviour. Journal of Gambling Studies, DOI 10.1007/s10899-012-9332-y.

Cai, Y., Jo, H., & Pan, C. (2012). Doing well while doing bad? CSR in controversial industry sectors. Journal of Business Ethics, 108, 467–480.

Ferguson, C. J., Coulson, M., & Barnett, J. (2011). A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. Journal of Psychiatric Research, 45, 1573–1578.

Griffiths, M.D. (2010). Age ratings on video games: Are the effective? Education and Health, 28, 65-67.

Griffiths, M.D., & Meredith, A. (2009). Videogame addiction and treatment. Journal of Contemporary Psychotherapy, 39, 47-53.

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

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

Griffiths, M.D., Wood, R.T.A., Parke, J. & Parke, A. (2007). Gaming research and best practice: Gaming industry, social responsibility and academia. Casino and Gaming International, 3(3), 97-103.

Hussain, Z., Griffiths, M.D. & Baguley, T. (2012).Online gaming addiction: classification, prediction and associated risk factors. Addiction Research & Theory 20(5), 359-371.

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., 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.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.

Porter, G., Starcevic, V., Berle, D., & Fenech , P. (2010). Recognizing problem video game use. Australia Newzealad Journal of Psychiatry, 44(2),120 –128.

Van Rooij, A., Meerkerk, G., Schoenmakers, T., Griffiths, M., & van de Mheen, D. (2010). Video game addiction and social responsibility. Addiction Research & Theory, 18(5): 489-493.

Yousafzai, S.Y., Hussain, Z. & Griffiths, M.D. (2013). Social responsibility in online videogaming: What should the videogame industry do? Addiction Research and Theory, DOI: 10.3109/16066359.2013.812203

Feeling cut up: A brief look at clitoridectomy

Arguably one of the world’s most abhorrent surgical and/or ritualistic practices is the removal of the clitoris, i.e., a clitoridectomy (sometimes referred to as a clitorectomy). Apart from cases of medical necessity (e.g., the spreading of cancer to the clitoris), the vast majority of occurrences can really be best described as female genital mutilation and defined by the World Health Organisation (WHO) as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons”. In societies where clitoridectomies are performed as part of tribal rituals (such as those by the Maasai in Kenya and Northern Tanzania), the main reason for them is by male societies trying to inhibit the act of female masturbation.

According to the World Health Organisation’s online report about female genital mutilation (FGM), clitoridectomies have no health benefits for females, that approximately 140 million girls and women worldwide (but mostly in Africa where about three million girls are at risk for FGM annually.) have been genitally mutilated (usually between infancy and 15 years old), and that FGM is mostly carried out by “traditional circumcisers” although there is a increasing trend for it to be carried out by health care providers (over 18% according to the WHO). They also note that FGM can be classified into four major types: (which I have reproduced verbatim from their report):

  • Clitoridectomy: Partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
  • Excision: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are “the lips” that surround the vagina).
  • Infibulation: Narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.
  • Other: All other harmful procedures to the female genitalia for non-medical purposes (e.g. pricking, piercing, incising, scraping and cauterizing the genital area).

The WHO report also briefly examined the cultural, religious and social causes of FGM. The WHO noted:

“The causes of female genital mutilation include a mix of cultural, religious and social factors within families and communities. Where FGM is a social convention, the social pressure to conform to what others do and have been doing is a strong motivation to perpetuate the practice. FGM is often considered a necessary part of raising a girl properly, and a way to prepare her for adulthood and marriage. FGM is in many communities believed to reduce a woman’s libido and therefore believed to help her resist ‘illicit’ sexual acts….FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are ‘clean’ and ‘beautiful’ after removal of body parts that are considered ‘male’ or ‘unclean’. Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice”

In a recent (2012) issue of medical journal The Lancet, Dr. Pierre Foldes and his colleagues assessed the immediate and long-term outcomes of reconstructive surgery following genital mutilation. They surveyed 2,938 females (consecutive cases between 1998 and 2009 with an average age of 29 years; 866 of them were re-surveyed at a one-year follow-up interview) that had received reconstructive surgery at the Poissy-St Germain Hospital (in France) following genital mutilation. Most of the women operated upon were from Africa (Senegal, Mali and the Ivory Coast) although Foldes and his colleagues reported that 564 of the women had been genitally mutilated while living in France. The authors reported:

“Expectations before surgery were identity recovery for 2933 patients (99%), improved sex life for 2378 patients (81%), and pain reduction for 847 patients (29%). At 1-year follow-up, 363 women (42%) had a hoodless glans, 239 (28%) had a normal clitoris, 210 (24%) had a visible projection, 51 (6%) had a palpable projection, and three (0·4%) had no change. Most patients reported an improvement, or at least no worsening, in pain (821 of 840 patients) and clitoral pleasure (815 of 834 patients). At 1 year, 430 (51%) of 841 women experienced orgasms. Immediate complications after surgery (haematoma, suture failure, moderate fever) were noted in 155 (5%) of the 2938 patients, and 108 (4%) were briefly re-admitted to hospital”.

On the basis of these findings, Dr. Foldes’ report concluded that the reconstructive surgeries that had been carried out following female genital mutilation appeared to be associated with both reduced pain and restored pleasure (including the ability to have clitoral orgasms).

The vast majority of FGM occurs as a result of third party intervention. However, there are a few isolated cases of clitoral/labial self-mutilation in the clinical and medical literature. (I also examined more general female genital self-mutilation in a previous blog particularly in relation to internal vaginal self-mutilation). A recent paper by Dr. David Veale and Joe Daniels published in a 2012 issue of the Archives of Sexual Behavior examined what they believe is the only case of a women who wanted a clitoridectomy for cosmetic reasons. Prior to this case, they noted that there had been only two previous reports in the literature of self-mutilation of the clitoris/labia (one by Dr. Krasucki and colleagues in a 1995 issue of the British Journal of Medical Psychology and Dr. Wise and colleagues in a 1989 issue of the Journal of Sex and Marital Therapy). Both of the women in these cases of clitoral/labial self-mutilation were associated with severe psychosis/schizophrenia. Veale and Daniels reported that:

“The patient was a 33-year-old married woman with two children who lived with her husband. She was not from a culture that conducted FGM but she believes she was taught about it at school…She can remember starting to dislike her genitalia and pubic hair very gradually since about the age of 13. As she was at boarding school, it was not possible to shave her pubic hair until she left at the age of 18…Her motivation for shaving was a desire for ‘’simplicity and bareness’. She had continued to wax and shave her pubic hair for the past 14 years and was in the process of permanent hair removal, feeling it was more hygienic as well as preferred by her husband. Her dislike of her genitalia continued to increase gradually during adolescence with the growth of secondary sexual characteristics, including the labia minora. The changes in the labia minora became more pronounced with pregnancy and birth of two children born vaginally…She had tried piercing her inner labia and clitoral hood as a form of distraction. However, she found the piercings uncomfortable, which drew further attention to her dislike, so she removed them. Cosmetic labiaplasty had been performed about 1 year prior to assessment. She reported this as much improving the cosmetic appearance of her genitalia and reducing her self-consciousness.

She had become aware that she could do something surgically about her genitalia from her late teens. She had no concerns about the rest of her body and had had no other cosmetic procedures in her lifetime. When assessed, she knew that the appearance of her genitalia looked normal, but she felt they were ugly and hated the look of them. However, her concerns did not amount to a preoccupation (one of criteria for a diagnosis of body dysmorphic disorder…She felt self-conscious in a swimsuit and would not use public changing rooms. She denied that she was being coerced towards surgery or that any sadomasochism was involved…She understood that a clitoridectomy could lead to anorgasmia. However, she believed that the orgasms she experienced during intercourse or by masturbation were mainly vaginal and not clitoral. Improving the aesthetics of the genitalia was more important to her than achieving orgasm and would reduce her anxiety in sexual intimacy…In summary, she had a longstanding aversion to her genitalia associated with an extreme desire for a cosmetic procedure. Such a request, in the absence of any cultural beliefs, would suggest to most clinicians that a patient was very disturbed. However…she had no evidence of any psychiatric disorder or personality disorder”.

Following a full psychiatric check and interviews with the woman’s husband, a clitoridectomy was performed. Veale and Daniels were fully aware that the request for a voluntary clitoridectomy was extremely rare and unusual. However, the post-operative, the woman was extremely grateful and satisfied with the results (even at follow-up nearly two years later). She reported that her sex life had improved and there was no desire to modify any other part of her body. They concluded that although cases of wanting voluntary clitoridectomy are exceedingly rare, there is always the possibility that in the future others may seek such a procedure on cosmetic grounds but that those wanting such a radical operation will require very careful assessment before any operation took place.

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

Further reading

Foldes, P., Cuzin, B. & Andro, A. Reconstructive surgery after female genital mutilation: a prospective cohort study. The Lancet, 380, 134-141.

Krasucki, C., Kemp, R., & David, A. (1995). A case of female genital self- mutilation in schizophrenia. British Journal of Medical Psychology, 68, 179–186.

Veale, D. & Daniels, J. (2012). Cosmetic clitoridectomy in a 33-year-old woman. Archives of Sex Behavior, 41, 725-730.

Wikipedia (2012), Clitoridectomy. Located at:

Wise, T. N., Dietricha, M., & Segalle, E. (1989). Female genital self- mutilation: Case reports and literature review. Journal of Sex and Marital Therapy, 15, 269–274.

World Health Organisation (2012). Female genital mutilation (Fact Sheet 241), February. Located at:

Lack of ball control: Gambling addiction among football players

Earlier this month, ex-England footballer Kenny Sansom made the news after he was found homeless sleeping on a park bench following his self-admitted addictions to both gambling and alcohol. Gambling by footballers is nothing new of course. Back in 2006, the media lapped up the story that Wayne Rooney allegedly ran up gambling debts of £700,000 with the Goldchip betting company. At the time, the Government’s (then) Sports Minister, Richard Caborn, warned the England team footballers not to bet on World Cup matches endorsing the decision by football’s world governing body (FIFA) to outlaw players betting on the tournament. Today’s blog briefly looks at the issue of gambling addiction amongst footballers and whether it is an issue that clubs must take seriously.

So why do professional footballers gamble? Gambling and football have always been inextricably linked. Whether it is the football pools, a punt on who will win the FA Cup final, or a spread bet on the number of yellow cards to be handed out during the next World Cup, gamblers love betting on the outcome of football matches. But there are also good psychological reasons that encourage top players to gamble – particularly if looked at from the player’s perspective.

It is the night before a big match. Premiership players are confined to staying in a hotel. No sex. No alcohol. No junk food. Basically, no access to all the things they love. To pass time, footballers may watch television, play cards, or play a video game believing these are ‘healthier’ for them. The difficulty in detecting gambling addictions is likely to be one factor in its growth over other forms of addiction – especially as many players are more health-conscious and the testing for alcohol and drugs is now more rigorous. However, any of these ‘healthier’ activities when taken to excess can cause problems. England goalkeeper David James once claimed his loss of form was because of his round-the-clock video game playing. In short, the top players are very well paid and inevitably have lots of time on their hands. By their own admission, ex-Arsenal and England players like Paul Merson and Tony Adams lost millions of pounds gambling and regularly attended Gamblers Anonymous along with treatment for other addictions to alcohol and cocaine. Paul Merson claims to have lost £7 million to gambling and cocaine, and was still having severe gambling problems over a decade after his football career had ended.

It would also seem to be the case that there is a psychosocial subculture of gambling by footballers. The ex-England striker Kevin Phillips claimed that when he was part of Kevin Keegan’s England squad (as a Sunderland player in the 1990s), he was alienated by the other players for not taking part with the other players in the team’s pre-match gambling activities. Phillips’ ex-strike partner at Sunderland, Niall Quinn, knows only too well the inherent dangers of gambling. While playing for Arsenal he regularly lost his whole week’s wages at the bookmakers inside an hour of getting it. Whilst he was never truly out of control, he did have to re-mortgage his flat to pay off gambling debts. Quinn says he was lucky not to be paid the kind of wages players get today as he would have lost more. Ex-footballer (and now TV and radio football pundit) Steve Claridge claimed in his autobiography to have blown £1m on gambling, while the ex-Northern Ireland winger Keith Gillespie became addicted after placing bets for team-mates.

More recently, there have been a number of high profile cases of top footballers with gambling problems. These include the West Ham and Stoke winger Matthew Etherington and ex-England striker David Bentley who was reported to be placing up to 100 bets a day on everything from horses and greyhounds to online poker and bingo. Another high profile case to hit the headlines was Icelandic ex-Chelsea player Eidur Gudjohnsen who was alleged to be in £6 million in debt because of his gambling despite a £3 million-a-year wages at his current club Monaco. While he was at Manchester United, the Dutch striker Ruud Van Nistelrooy said that “obscene” wages were fuelling constant gambling by other players in the team.

I am often asked by the press to comment on why footballers gamble and whether they are more susceptible to gambling addiction. One player I was asked to comment on was ex-England striker Michael Owen (whose friend Stephen Smith – somewhat ironically – ran the company that Wayne Rooney ran up his debts with). It was clear that to me that Owen did not have a gambling problem and could easily afford to lose the amounts he was alleged to have lost. However, it could be argued that he and players like Wayne Rooney are role models for many teenagers. As a psychologist I have some concerns about the messages that high profile footballers send out about gambling to vulnerable individuals. Teenagers are less likely than adults to be able to make informed choices because they are young and impressionable. Footballers who gamble are unconsciously giving out the message to adolescents that gambling is something that goes hand-in-hand with being a top footballer.

Tony Adams alleged that every football club in England has a problem with gambling addiction. This was one of the primary reasons why set up his own charity (Sporting Chance) to help footballers with addiction problems. At present, this appears to be the main source of help for footballers who are problem gamblers, although Gamblers Anonymous also appears to be another popular outlet for help. Press reports from the mid-2000s indicated that up to 60 Premiership football players were being treated for gambling addiction. Adams alleged that some players – despite being on vast wages – even stole from their children’s savings to cover their losses. He said footballers that were gambling addicts “lose their self-respect and before you know where they are, they are nicking money out of their kids’ savings to have a bet. It is something about which clubs need to be aware. It is difficult to trace – but it can cause a lot of damage.” Peter Kay, the Chief Executive of the Sporting Chance clinic claims that footballer’s passion for football predisposes them to gambling problems. He said:

“If you have the kind of driven, obsessive character that it takes to become a professional footballer, with that tunnel-vision, then you are predisposed. I have not come across a football club where gambling does not play a part in the players’ lives. If a player is dropped from the team, this can often lead to depression and a craving for the buzz of football – sometimes found in gambling. It is acceptable to gamble. There have always been famous gamblers in football and for most it is enjoyable. But for around 10 per cent it is an addiction”.

Although the English Football Association has strict rules on gambling by footballers, these are not a deterrent to gamble and as outlined above, there are many reasons why footballers may gamble to excess compared to other less ‘healthy’ behaviours like excessive drinking or drug taking. It is a shame that addictions to drugs and alcohol tend to generate more sympathy among the general public as many people view gambling as a self-inflicted vice. But gambling to excess can be just as destructive because of the huge financial consequences. Therefore, time rich and money rich young footballers need to be educated about the potential downsides of excessive and/or high stakes gambling. Through the work of the Sporting Chance clinic, this is beginning to happen, but as footballers’ wages continue to increase, gambling is one activity that may place an increasing role in the lives of the players.

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

Further reading

Adams, T. and Ridley, I. (1999), Addicted. London: Harper Collins.

BBC Online News (2007). Etherington in gambling admission. February 24. Located at: (Last accessed December 10, 2009).

Burt, J. (2003). Adams charity claims gambling addiction is rife. The Independent, January 16. Located at; (Last accessed December 10, 2009).

Chaytor, R. (2008), Paul Merson gambles away £300,000 home. Daily Mirror, November 1. Located at: (Last accessed December 10, 2009).

Claridge, S. & Ridley, I. (2000). Tales From The Boot Camps. London: Orion.

Griffiths, M.D. (2006). All in the game. Inside Edge: The Gambling Magazine, July (Issue 28), p. 67.

Griffiths, M.D. (2010). Gambling addiction among footballers: causes and consequences. World Sports Law Report, 8(3), 14-16.

Menezes, J. de (2013). Former England star Kenny Sansom admits he’s ‘homeless, a drunk and sleeping on a park bench’. The Independent, August 1. Located at:

Merson, P. (1996). Rock Bottom. London: Bloomsbury.

Peake, A. (2009). Eidur down £6M: Gambling has ace Gudjohnsen owing two banks. The Sun, December 3, p.25.

Winter, H. (2008). David Bentley had to fight gambling addiction. Daily Telegraph, April 10. Located at: (Last accessed December 10, 2009).

Heard mentality: A brief look at headphone fetishism

“Just wondering why some of us like seeing pictures of women in headphones? I think it can be a bit creepy and fetishist. Do we have reclusive guys on this board that (a) don’t have girlfriends and (b) are also so enamored with gear that they want their dream girl to be utilizing or associated with said gear? I will say that if I ever desire to see women in headphones, please slap me. I really don’t want to get that deep into gear-love!” (American male, post at Head-Fi website)

I can honestly say one of the strangest sites that I’ve come across in my search for weird sexual fetishes is the Headph0ne Fet1sh website. Not surprisingly, it’s a site dedicated to “all manner of ladies wearing all kinds of headphones”. There appears to be thousands of photographs and video clips of attractive woman wearing headphones. Even the site itself acknowledges that its topic matter is strange and that the attraction is aesthetic rather than overtly sexual:

“You might wonder why such a strange fetish has a huge website devoted to it, well the answer is simple – it has lots of really devoted fans, who scour the internet day and night to find awesome pictures for the site. There are many more popular fetishes, the websites of which don’t add up to the content of this one site for this fetish. So don’t knock it until you’ve tried it…You won’t find any explicitly sexual images on the site, as this fetish tends be more orientated towards an aesthetic appreciation of ladies in headphones, rather than the more run-of-the-mill ‘wearing the fetish object during sex’ sort of thing. There are visitors to this site who do enjoy that sort of thing, but they are in the minority”.

I also came across a webpage hosted by The Church of Headphone Fetish that appears to be more geared towards anime-type illustration material rather than the photograph and video clips found on the Headph0ne Fet1sh website (a similar selection of headphone fetish illustrations – although not just restricted to anime – can also be found on the Deviant Art website). The opening blurb (in the style of a vicar’s sermon) and somewhat tongue-in-cheek announced:

“All rise. In the name of past headphone girls, current headphone girls, and future headphone girls, amen. We thank you, headphone goddess, for blessing us with past headphone girls, current headphone girls, and future headphone girls. When all other fetishes fail, headphones rose majestically to the challenge. Reestablished the otaku/perverted spirit inside all men, rekindled our fire of passion for the mighty search engine of Google. And so today we offer our utmost respect for the Goddess of Headphone, and will recruit countless believers in the name of headphones. May the eternal light of Headphone Fetish guide us to salvation”.

Headphone fetishism would appear to be a relatively rare sexual activity, as it doesn’t appear 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. Furthermore, there is not a single reference to headphone fetishism in any academic article or book that I am aware of. Therefore, I went online in search of people that had confessed to this strange fetish. I have to admit that it was fairly slim pickings but I did find the following admissions:

  • Extract 1: “I dunno why, but I find hot girls with a headphone hot. True story. And I hope I am not the only one” (9mm, heterosexual male)
  • Extract 2: “I don’t know why but I find girls with headphones extremely attractive! She could be a normal girl, everyday run of the mill average 6.5-7 [out of 10], but put a pair of phones on her, and she shoots up to an 8-9 to me automatically! It’s crazy how attractive they get to me. Not just these pics specifically, but in general, it’s a BIG turn-on and I would absolutely lose it if they wore a skirt, tank top and knee socks while rockin’ out with a pair of oversized headphones” (Steven, heterosexual male)
  • Extract 3: Anyone else find headphones kind of sexy, especially when paired with another fetish? I was wearing headphones the other day to block out distracting outside noise when I noticed. I kind of like the way they feel. It was kind of…sexy. Now that I’ve discovered some sexy sounds/songs they’re kind of like a kinky sex toy” (Erobert, homosexual male)
  • Extract 4: I don’t have any fetishes (that I’ll admit to publicly). But I have to confess that hot women in headphones touches a chord. Earbuds just don’t do it for me, ya know? But princess Leia’s ludicrous locks? Mmmm. What is it about muffins around the ears I like so much? I don’t know what is. Maybe it’s because every picture of a girl you see with headphones on – she’s happy – or intensely channeling her muse – singing….something” (David, heterosexual male)
  • Extract 5: “I am [a headphone fetish sex man]. [Although] headsets are often used in bondage experiences, I find headphones highly sexy, especially huge, complicated and elaborate military headsets…This is the source of a lot of fantasies and erotic situations. I’ve wide collection of pics with men in headsets and headphones” (Ted, homosexual male)
  • Extract 6: “I have a headphone fetish…Then, I stumbled on Headphone Muslims and my eyes were opened to the brilliance of pretty anime-style girls wearing new and antique high-quality headphones! Musume is a Japanese term for ‘girl’…But what’s so cute about a girl wearing headphones? Is it the way the phones look like large ears? Is it the way the headphone cord tends to run and drape and tangle across the girl’s body, somewhat like a snake or a string of flowers? Or, maybe it’s the deep sense of relaxation that the girls seem to possess? Well, whatever it is, the image is certainly rather sexy, in a geeky way at least” (Jae Mie, heterosexual male).

To be honest, I can’t really be sure that any of these quotes in any way show a genuine fetish (as most seem to be a sexual preference rather than an exclusive focus for sexual arousal). However, if they are honest quotes (and I have no reason to suspect otherwise), the only conclusions I can draw are that the fetish is (i) male-based, (ii) found across the sexual orientation spectrum as both heterosexual and homosexual appear to have such sexual preferences, and (iii) not just restricted to real humans (as some appear to be sexually attracted to cartoon-like representations). This latter observation suggests there may be some psychological and behavioural overlaps with toonophilia (which I covered in a previous blog). There may also be overlaps with other sexual behaviours such as sadomasochistic bondage. The person in Extract 3 above (Erobert) also noted in his posting on the topic that:

“I guess we are out there as a sub fetish group – a very small one at that…I like sleek headphones; though large one’s aren’t bad either. Very hot when used in bondage, some sexy scenarios like listening to erotic music or sounds are a big turn-on. Or binural sounds that reportedly can cause an orgasm. Wouldn’t mind being tested a test subject for that”

In the absence of scientific research, why anyone should be sexually attracted to headphones is anyone’s guess. David Täht, writing on his Postcards From The Bleeding Edge website speculated as to what makes wearing headphones so fetishistic. He said:

‘I think it’s because as a female they are so alien to males…that wearing a pair of big cans is a bold statement ‘I’m listening to music’. There are so many ways you use that or can use that. Right from the start you can relate to what they are doing and their attention is focused on the music, i.e., not another man so you can’t even use the music/phones, as a pickup line”

The Is It Normal? website included a discussion thread on headphone fetish following a post from someone who started a discussion thread by saying girls wearing headphones are extremely attractive”. The site also featured a poll for its readers and the overwhelming majority (86%) responded by saying headphone fetish is normal (although I have no idea how many people voted – it might just have been the six people who took part in the discussion). Elsewhere, another online discussion on the Banging Tunes website prompted one discussant to say that headphone fetish is strange [but] not as odd as balloons or clowns but still very strange”. Personally, if headphone fetish really exists, my own view is that its etiology is most likely explained by behavioural conditioning in childhood and adolescence.

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. (1992). Encyclopedia of Unusual Sex Practices. Fort Lee, NJ: Barricade Books.

Risky businesses: Why should employers have a ‘gambling at work’ policy?

Most of us work in organizations that have policies on behaviours such as drinking alcohol and cigarette smoking. However, very few companies have a ‘gambling at work’ policy. One problem gambler in a position of financial trust can bring down a whole organization – Nick Leeson being a case in point when he single-handedly brought down Barings Bank). Leeson’s (albeit somewhat extreme) antics demonstrate that organisations need to acknowledge that gambling with company money can be disastrous for the company if things go horribly wrong. While no company expects an employee gambling to bring about their collapse, Leeson’s case does at least highlight gambling as an issue that companies ought to think about in terms of risk assessment.

Gambling is a popular leisure activity and recent national surveys into gambling participation show that around two-thirds of adults gamble annually and that problem gambling affects just under 1% of the British population. There are a number of socio-demographic factors associated with problem gambling. These included being male, having a parent who was or who has been a problem gambler, being single, and having a low income. Other research shows that those who experience unemployment, poor health, housing, and low educational qualifications have significantly higher rates of problem gambling than the general population.

It is clear that the social and health costs of problem gambling can be large on both an individual and societal level. Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, family neglect, and bankruptcy. There can also be adverse health consequences for both the problem gambler and their partner including depression, insomnia, intestinal disorders, migraines, and other stress-related disorders.

For most people, gambling is not a serious problem and in some cases may even be of benefit in team building and/or creating a collegiate atmosphere in the workplace (e.g., National Lottery syndicates, office sweepstakes). However, for those whose gambling starts to become more of a problem, it can affect both the organisation and other work colleagues. Typically problem gambling at work can lead to many negative “warning signs” such as misuse of time, mysterious disappearances, long lunches, late to work, leaving early from work, unusual vacation patterns, unexplained sick leave, internet and telephone misuse, etc. However, new forms of gambling, such as gambling via the internet or mobile phones at work, means that many of these warning signs are unlikely to be picked up. However, just because problem gambling is difficult to spot does not mean that managers should not include it in risk assessments and/or planning procedures. Listed below are some practical steps that can be taken to help minimise the potential problem.

  • Take the issue of gambling seriously. Gambling (in all its many forms) has not been viewed as an occupational issue at any serious level. Managers, in conjunction with Human Resources Departments need to ensure they are aware of the issue and the potential risks it can bring to both their employees and the whole organisation. They also need to be aware that for employees who deal with finances, the consequences for the company should that person be a problem gambler can be very great.
  • Raise awareness of gambling issues at work. This can be done through e-mail circulation, leaflets, and posters on general notice boards. Most countries (including the UK) have national and /or local gambling agencies that can supply useful educational literature (including posters). Telephone numbers for these organisations can usually be found in most telephone directories.
  • Ask employees to be vigilant. Problem gambling at work can have serious repercussions not only for the individual but also for those employees who befriend a problem gambler, and the organisation itself. Fellow staff members need to know the signs and symptoms of problem gambling. Employee behaviours such as asking to borrow money all the time might be indicative of a gambling problem.
  • Give employees access to diagnostic gambling checklists. Make sure that any literature or poster within the workplace includes a self-diagnostic checklist so that employees can check themselves to see if they might have (or be developing) a gambling problem.
  • Check internet “bookmarks” of your staff. In some jurisdictions across the world, employers can legally access the e-mails and internet content of their employees. One of the easiest checks is to simply look at an employee’s list of “bookmarked” websites. If they are gambling on the internet regularly, internet gambling sites are almost certainly likely to be bookmarked.
  • Develop a “Gambling at Work” policy. As mentioned at the start of this blog, many organisations have policies for behaviours such as smoking or drinking alcohol in the workplace. Employers should develop their own gambling policies by liaison between Human Resource Services and local gambling agencies. A risk assessment policy in relation to gambling would also be helpful.
  • Give support to identified problem gamblers.  Most large organisations have counselling services and other forms of support for employees who find themselves in difficulties. Problem gambling needs to be treated sympathetically (like other more bona fide addictions such as alcoholism). Employee support services must also be educated about the potential problems of workplace gambling.

Problem gambling can clearly be a hidden activity and the growing availability of internet gambling and mobile phone gambling is making it easier to gamble from the workplace. Thankfully, it would appear that for most people, gambling is not a serious problem. For those whose gambling starts to become more of a problem, it can affect both the organisation and other work colleagues (and in extreme cases cause major problems for the company as a whole). Managers clearly need to have their awareness of this issue raised, and once this has happened, they need to raise awareness of the issue among the work force. Gambling is a social issue, a health issue and an occupational issue. Although not high on the list for most employers, the issues highlighted here suggest that it should at least be on the list somewhere.

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

Further reading

Griffiths, M.D. (2002). Internet gambling in the workplace. In M. Anandarajan & C. Simmers (Eds.). Managing Web Usage in the Workplace: A Social, Ethical and Legal Perspective. pp. 148-167. Hershey, Pennsylvania: Idea Publishing.

Griffiths, M.D.  (2002).  Occupational health issues concerning Internet use in the workplace. Work and Stress, 16, 283-287.

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M. D. (2006). Pathological gambling. In T. Plante (Ed.), Abnormal Psychology in the 21st Century (pp. 73-98). New York: Greenwood.

Griffiths, M.D. (2009). Internet gambling in the workplace. Journal of Workplace Learning, 21, 658-670.

Griffiths, M.D. (2010). Internet abuse and internet addiction in the workplace. Journal of Worplace Learning, 7, 463-472.

Griffiths, M.D. (2010). The hidden addiction: Gambling in the workplace. Counselling at Work, 70, 20-23.

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 lot of hot air? The public’s reaction to eproctophilia

A couple of weeks ago, my case study published in the Archives of Sexual Behavior about eproctophilia (i.e., sexual arousal from flatulence), was given press coverage in over 100 newspaper and magazine stories around the world including those in the UK, Ireland, US, Greece, Italy, Germany, Holland, Spain, China, Malaysia, Kenya, South Africa, and Ghana (e.g., New York Daily News, Huffington Post, Daily Telegraph, Daily Mirror, The Sun, Daily Star, Metro, Times of Malta, Irish Examiner, Asian Image, and Cosmopolitan). Although it is not that unusual for one of my research papers to get international press coverage, I couldn’t help but notice the amount of negative and/or somewhat sarcastic coverage I got from some quarters. I lost count of the number of reader responses that used the words “hot air” in their reactions to the story on various news sites. Another write-up of the story that did the rounds on most US radio websites began the article with the sarcastic comment: Well done, science. I’d put this discovery right up there with the cure for polio and the artificial heart”.

Before my case study hit the popular press, the first person to cover my paper was Marc Abrahams on his Improbable Research (IR) website under the headline “Academic Study of a Young Man’s Sexual Attraction to Human Gas”. For those who don’t know, the underlying philosophy of the IR website is to feature “research that makes people laugh and then think”. While I realize that my eproctophilia case study might inadvertently make people laugh, I never wrote it up to be the object (or should that be subject?) of humour. I genuinely did it to highlight there are no boundaries to the limits of human sexual focus and arousal. Thankfully, Abrahams’ report of my article wasn’t too damning (most probably because he was aware of my gambling research and had written about my career in gambling studies back in a 2010 issue of The Guardian newspaper). The IR story noted that:

“Professor Mark D Griffiths of Nottingham Trent University has published a remarkable new study. Here’s how we know this study is remarkable:  The university’s press office sent copies of it to many prominent science journalists, remarking that (1) ‘It’s the world’s first paper on eproctophilia – sexual arousal from flatulence’ and (2) ‘Professor Griffiths would be more than happy to talk to you in more detail’. A remarkable number of those journalists immediately sent it on to us at the Annals of Improbable Research. We are, in this blog entry you are reading right now, remarking upon that study. There is more. Lots more. In other respects, too, Professor Griffiths is an expert. So renowned is he that Wikipedia devoted an entire web page to him. One of the many things on which he is an expert is the academic study of gamblers. We have celebrated some of his abundant work on that subject. (We express our thanks, and other emotions, to the many journalists who instinctively decided that they should alert us to the existence of Professor Griffiths’s new line of research.) BONUS (unrelated): The 1998 Ig Nobel Prize for literature was awarded to Dr. Mara Sidoli of Washington, DC, for her illuminating report, ‘Farting as a Defence Against Unspeakable Dread’ [Journal of Analytical Psychology, vol. 41, no. 2, 1996, pp. 165-78.]”

I also got six emails from those in and around the eproctophile community evenly split between those who (i) thought the newspaper stories had either trivialized their sexual preference and/or were wondering why it had made the news given that the “fetish has been around for ages”, and (ii) thanked me for bringing it to the public’s attention. For instance, one man wrote to me and said:

“I read about your study on flatulence fetish in the Metro and want to thank you for bringing it to the public attention. I have a very coloured past in the sex industry and had many clients with this fetish – each embarrassed about being aroused by flatulence and feeling alone in their fetish. No matter how long I reassured them they would not believe me that there were others out there just like them. It brought a glow to my heart hoping they could find comfort in the article about your study and know they are not alone. They were all very lovely, polite and well educated gentlemen and I thank you deeply for showing them they are not alone”

Another eproctophile wrote to me and said:

“I read an article claiming you have recently published a case study called ‘Eproctophilia in a Young Adult Male’. As someone with eproctophilia, I find the idea of a case study on the subject fascinating…Do you have any ideas on where I can read it? If you have any further questions on the subject, I’d be more than willing to answer. Either way, thanks for your time”.

Given the wide media coverage my case study generated, I didn’t send out a press release and I only did three interviews about the published paper. The first interview I did was with BBC News Online and the very first question I was asked by the journalist was “Is this a serious study?” I then pointed out that the Archives of Sexual Behavior is arguably the best academic journal covering sexuality issues in the world, and that a quick look at my blog would confirm that I am seriously interested in the psychology of sexual paraphilias. After being interviewed at length by the BBC journalist, the story failed to make it onto the BBC’s news website.

The second interview I did was with Lauren Cox for the Live Science website. Unsurprisingly, I thought this was the best story on the topic as this was the only story published where a journalist had actually interviewed me. The only downside was that Cox’ story came out at least 48-72 hours after most of the other media coverage. However, Cox’ story was as much about how the internet was facilitating research on sexual paraphilias as it was about eproctophilia.

One upside of all the press coverage I got was the many additional referrals to my blog. For instance, I got lots of referrals from the Gassy Erotica website (an online fart fetish forum that caters for eproctophiles). I also got referrals from those in the pornography industry who know only too well there is a niche market for eproctophiles. One website that featured my case study was surprised how much press attention I had got given the known demand for eproctophile videos. More specifically, in a section called ‘Fart sniffers’ on the I Shoot Porn website, Billy Watson wrote:

“’Eproctophiles are said to spend an abnormal amount of time thinking about flatulence, and have recurring intense sexual urges and fantasies involving flatulence.’ This from Professor Mark Griffiths’ blog. While I can’t vouch for Dr. Griffiths, recently the ‘world’s [first] recorded case’ of so-called ‘eproctophilia’ has been recorded in a 22-year-old man from Illinois…I could have saved the British psychologist who interviewed Brad a lot of time by showing him the FARTING section over at Clips4Sale. My old pal Cinnamon Love made a nice chunk of change blowing big ones for her C4S clients. Urban Legend has a VHS tape featuring none other than Chuck Berry (Roll Over Beethoven) taking direct blasts from a blonde girl’s ass”.

Just for the record, I am well aware of the Clips4Sale website and have made reference to it in relation to other niche paraphilias in previous blogs (but admittedly not in relation to eproctophilia). So, will these recent experiences put me off publishing more paraphilia papers? In short, no. I am already working on a number of other case study papers but my guess is those will not garner the publicity generated for eproctophilia.

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, FL: CRC Press.

Griffiths, M. D. (2012). The use of online methodologies in studying paraphilia: A review. Journal of Behavioral Addictions, 1, 143-150.

Griffiths, M.D. (2013). Eproctophilia in a young adult male: A case study. Archives of Sexual Behavior, DOI 10.1007/s10508-013-0156-3.

Going to the dogs: A brief look at cynophilia

Regular readers of my blog will know that I am not averse to looking at various types of human zoophilic behaviour. So far, I have written articles on zoophilia in general, zoophilia classification, zoosadism (sexual pleasure from being sadistic to animals), necrobestiality (sex with dead animals), and very specific forms of zoophilia including delphinophilia (sex with dolphins), porcinophilia (sex with pigs), equinophilia (sex with horses), herpetophilia (sex with lizards), ophidiophilia (sex with snakes), ornithophilia (sex with birds including avisodomy), musophilia (sexual stimulation from mice including felching), formicophilia (sexual stimulation from insects), and melissophilia (sexual stimulation from bees and bee stings). Today’s blog takes a brief look at cynophilia (sex with dogs).

In 2006, Dr. Lisa Shaffer and Dr. Julie Penn developed a comprehensive paraphilia classification system and published it as a book chapter in Dr. William Hickey’s book Sex Crimes and Paraphilia. Within this they included a list of various types of zoophilia and reported that cynophilia referred to sexual arousal from having sex with dogs (and that canophilia was sexual arousal from dogs, which I am assuming means that the person being aroused may not have had actual sexual contact with a dog).

Last year in Florida (USA), the Tampa Bay Times reported the case of Eric Atunes, a 29-year old man who was accused of having oral sex with a dog. As it turned out, the Pinellas-Pasco State Attorney’s Office “declined to pursue a charge of animal cruelty under the state’s new bestiality law” but it was confirmed that Atunes (an employee at the Pinellas County Humane Society) had six photographs on his mobile phone of himself performing sexual acts with his girlfriend’s three-legged dog, Ruby. The case was dropped because there is no law in Florida forbidding people having oral sex with animals. The newspaper reported that:

“Assistant State Attorney Beverly Andringa said her office declined to prosecute Antunes for bestiality because, out of the six photographs found on his cellphone, only one would meet the strict criteria of the statute. Officials also aren’t certain when all the photos were taken. Some might have predated the new law”.

In Georgia (USA), a 19-year-old man Bernard Archer was arrested after being caught on camera having sexual intercourse with pit bull dogs and charged with two counts of bestiality. A newspaper report said that:

“Dispatch advised [that] home owners witnessed a young black male having sexual intercourse with two dogs. WGCL-TV reports that Archer was hired to clean the cages of several pit bulls by Dr. Cathryn Lafayette, a local resident who owned the dogs. [On] Saturday [March 3], Lafayette was woken up from a nap by the Newton County police, who informed her of Archer’s crimes against her animals. Though initially skeptical of the claims, she was convinced when authorities showed her video evidence”.

I mention these recent cases just by way of establishing that sexual contact by human beings with dogs not only occurs but is reported on a fairly regular basis (i.e., both of these cases were from the last twelve months in the same country). There are also cases of what Dr. Anil Aggrawal would class as ‘cynophilia by proxy’ (based on a paper he had published in a recent issue of the Journal of Forensic and Legal Medicine,) where one person forces another (typically a man forcing his wife or partner) to have sex with a dog. Dr Aggrawal explains:

“This happened in R v Bourne (1952) 36 Cr App R 125 (CCA), in which the husband forced his wife to submit to a dog inserting its penis into her vagina. The husband was convicted of aiding and abetting his wife to commit buggery and sentenced to eight years in prison. The wife was not punished, since she acted under duress. In R v. Tierney (1990) 12 Cr. App. R(S) 216, the defendant took photographs of his wife having intercourse with his Alsatian dog for his own continuing satisfaction. In this case, three monthsimprisonment was given to the accused, but not to his wife, because she consented to perform the act in desperation in order to retain her husbands affections”.

Dr. Aggrawal also noted that in ancient. Rome, the practice of canine bestiality was so common that professional people (the Belluri) supplied dogs specifically for this purpose. Much more recently, academic studies of zoophilia have typically collected their data online from non-clinical samples. These zoophiles typically have a preference for zoophilic sex and rarely seek treatment as they are happy and content with their sexual orientation. In a 2001 issue of the Journal of Small Animal Practice, Dr. H. Munro and Dr. M. Thrusfield (2001) reported that they had collected data on animal abuse from over 400 British vets. They reported that 6% of their cases involved sexual abuse based on their observations of injuries in the animals’ genital and anal areas. Of these, 21 cases referred to dogs and three to cats. Dr Andrea Beetz reported that among the 32 male zoophiles she surveyed, 78% had had sex with dogs. Dr Hani Miletski reported that among the 93 zoophiles she surveyed that most of her sample preferred sex with dogs (87% males; 100% females).

I have come across very few articles (academic or non-academic) purely on the topic of cynophilia. One of the most detailed (written by a zoophile) is at the Vivid Random Existence (VRE) website (an online essay on Cynosexuality (or cynophilia): the sexual attraction to dogs’). I do not endorse any of the (anonymous) author’s comments and the essay is written from a pro-zoophilia standpoint. The author of the essay notes that:

“Among all possible variants of zoosexuality, cynosexuality is one of the most common because the zoosexual size comparison rule — the fact is that there are many dog breeds, such as the Great Dane, which are physically capable of having sex with humans (without abuse occurring). This is why cynosexuality is fairly common among zoosexuals”.

The author then provides numerous quotes from many different cynophiles to highlight the commonility of this particular sub-type of zoophilia. Here are a just a few of the many examples cited taken from online zoophile forums such as the Beast Forum. (Please be warned that these are sexually explicit and you may find what is said offensive):

  • Extract 1: “I’ve only had experience with my one dog, but it is quite an amazing sensation, hot, tight, and slippery. A dog’s body temperature is a few degrees higher than a human’s, and with the extremely sensitive flesh of the human penis, makes for quite a pleasurable combination” (Neverfox)
  • Extract 2: “I have been with both species [humans and dogs] and my preference would have to be [the dog]; tighter, warmer and always wet” (St Benard)
  • Extract 3: “My male dog used to tell me that he was interested in sex or wants it…He would sniff at my crotch and paw at me. He only does this when he wants sex. This is Consent, both by me and by him. Any Zoo knows that animals if they want it, it may ask a human for sex. Zoos know that animals consent. There is no question about it!” (Anonymous)
  • Extract 4: “I have had sex with a female dog and it is wonderful! They never turn you down, are always horny… so why the hell not! Why deprive a dog of a sex life? Best of all, you can’t get pregnant and can’t get a STD from them!” (Dglover)
  • Extract 5: “Take it from me you will be addicted once you have a dog’s cock entering your [anus], but be careful the first time as his knot can really hurt if you have never had anything inside you before” (Oscarsbitch)

The author of the VRE essay uses these quotes to make a number of distinct points. The first point made is that the quotes indicate that some zoophiles prefer sex with dogs to sex with humans (and that zoophilic activity does not have to occur where there is an absence of a human sexual partner). This has already been confirmed in the empirical studies of academic researchers like Dr. Beetz and Dr. Miletski. The essay author also say the quotes “prove that most zoosexual people are devoted to their animals and treat them with respect, kindness and compassion; these kinds of people would never harm an animal…Additionally, it would appear as though dogs don’t mind having sex with people; in fact, some of them apparently like it!” The zoophiles may well be kind and respect the dogs concerned, but as I argued in previous blogs on both herpetophilia and delpinophilia, the animals cannot give informed consent, so therefore such sexual activity is (in my view) morally wrong.

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.

Aggrawal, A. (2011). A new classification of zoophilia. Journal of Forensic and Legal Medicine, 18, 73-78.

Beetz, A. M. (2004). Bestiality/zoophilia: A scarcely investigated phenomenon between crime, paraphilia, and love. Journal of Forensic Psychology Practice, 4, 1-36.

CBS Atlanta (2012). Cops: teen caught having sex with dogs on camera. March 7. Located at:

Jamison, P. & Morel, L.C. (2012). Man who had sex with dog won’t be charged because of unusual reason. Tampa Bay Times, June 20. Located at:

Miletski, H. (2000). Bestiality and zoophilia: An exploratory study. Scandinavian Journal of Sexology, 3, 149–150.

Miletski, H. (2001). Zoophilia – implications for therapy. Journal of Sex Education and Therapy, 26, 85–89.

Munro, H.M.C., & Thrusfield, M.V. (2001). “Battered pets”: Sexual abuse. Journal of Small Animal Practice, 42, 333-337.

Shaffer, L. & Penn, J. (2006). A comprehensive paraphilia classification system. In E.W. Hickey (Ed.), Sex crimes and paraphilia. New Jersey: Pearson Prentice Hall.

Vivid Random Existence (2010). Cynosexuality (or cynophilia): the sexual attraction to dogs. November 14. Located at:

Williams, C. J., & Weinberg, M. S. (2003). Zoophilia in men: A study of sexual interest in animals. Archives of Sexual Behavior, 32, 523–535.

Non-prescription addiction: A brief look at nasal spray dependence

I’m not quite sure about how I came across it, but I unearthed an article on the Discovery Fit and Health website entitled ‘Can nasal sprays be addictive?’ Apparently Oprah Winfrey did a whole episode of her show on the phenomenon (but I must have missed that one). The article noted that nasal sprays (such as Sinex) contain decongestants (such as oxymetazoline, xylometazoline and ephedrine) that constrict the blood vessels inside the nose. More specifically:

“When you have a cold, the flu or allergies, these blood vessels become swollen and dilated. This stimulates the nasal membranes to produce large amounts of mucus. Like stepping on a garden hose, constricting the blood vessels reduces the blood flow to your nostrils. The swollen vessels shrink, and this helps to dry things up. Unfortunately, your nose can become tolerant to the decongestant’s effect if you use it for too long. Tolerance in general happens because your body launches a biological counterattack against the effects of a drug”…You end up using more and more to get rid of your stuffy nose. And each time you sniff more decongestant, your body redoubles its efforts against the resulting constriction”.

The labelling on nasal sprays typically advise not using the product for more than three days in a row because of the diminished effect as the tolerance to the decongestant properties builds up. Anecdotal accounts of ‘nasal spray addiction’ appear quite often in the popular press. For instance, a 2008 story in the Daily Mail recounted the story of 27-year Gloucestershire woman Allyson Forbes, a hay fever sufferer who claimed to be addicted to her nasal spray. Dr George Du Toit, a London-based allergy consultant was interviewed for the story and was quoted as saying:

“These products are not actually addictive in the true sense of the word – you cannot develop a chemical or physical addiction – but they are psychologically addictive because of the initial relief they induce…Patients need increasing doses of the medication to achieve the same response. This rebound condition is called rhinitis medicamentosa (RM), where permanently swollen intranasal tissues can damage the lining of the nose. The products should not be used for longer than seven consecutive days…RM typically occurs after five to seven days of use”.

Another person interviewed for the story was the chemist Sultan Sid Dajani (Royal Pharmaceutical Society) who said:

“People often don’t want to talk about this kind of dependence because they are embarrassed. Chronic abusers who are long-term users of these medications, known as nasodilators, are committing an unwitting form of self-harm and I feel every sympathy for them. On average, I see five people a week who have this problem and I’m an independent chemist, so goodness knows how many there are regularly buying in chains and supermarkets. Addictions to these nasodilators are more common than addictions to over-the-counter medicines, such as codeine”.

Allyson said she had to use her nasal medicine four times a day and says she doesn’t “feel physically addicted” and knows that the addiction is psychologically-based and “is in [her] head”. If you feel you may be suffering from an addiction to nasal sprays are even articles on the internet that claim they can help you such as ‘How do you beat a dependency on nose spray?’ (at the Wiki Answers website). There’s even a totally dedicated website that deals with treating nasal spray addiction ( Other stories (such as one at the Medical News Today website) sensationally claim that millions suffer from addiction to [over-the-counter] nasal sprays” while a story in the New York Times ran the headline “Nasal sprays can bring on vicious cycle”.

Looking at the psychological and medical literature, there is a lot less that has been published on whether nasal sprays can be addictive. However, there is actually quite an established literature on psychiatric conditions associated with respiratory drugs (including decongestants found in nasal sprays). Dr. Richard Hall and colleagues in a 1985 issue of the journal Psychosomatics reviewed the incidence of psychiatric reactions to medically prescribed and over-the-counter respiratory drugs. The concluded that such psychiatric conditions are most associated with heavy and chronic users of such drugs. However, they also found that toxicity was scarce and poorly defined.

In relation to addiction, I only managed to locate three academic papers that reported ‘addiction’ to nasal sprays. In a 2006 issue of Journal of Investigational Allergology and Clinical Immunology, Dr. J.T. Ramey and colleagues reviewed the literature relating to rhinitis medicamentosa (RM). They noted that:

“Psychological dependence and an abstinence syndrome consisting of headaches, restlessness, and anxiety following discontinuation of nasal decongestants have been reported, leading some authors to use the word ‘addiction’ when describing this syndrome”.

Dr. Ramey and colleagues’ paper based this observation on three case reports published between 1969 and 1984. One case was reported by Dr. M. Pearson and colleagues in a 1969 issue of the American Journal of Psychiatry. They described a man with rhinitis medicamentosa who carried four gallons of phenylephrine aboard a wartime ship because of his addiction to this medication. In another case study reported by Dr S. Snow and colleagues in the British Journal of Psychiatry, toxic psychosis was highlighted in a 26-year old male patient said to be addicted to phenylephrine in nasal spray form. The man was also reported as experiencing tactile and visual hallucinations, visual illusions and paranoid delusions. These papers suggest the possibility of addiction to nasal spray but given the fact so few case studies have been reported in the medical literature, the incidence would appear to be very rare (and certainly not the “millions” reported in some website stories).

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

Further reading

Discovery Fit and Health (2013). Can nasal sprays be addictive? Located at:

Estridge, B. (2008). Hay fever has left me addicted to nose spray. Daily Mail, September 6. Located at:

Fleece, L., Mizes, J. S., Jolly, P.A., & Baldwin, R.L. (1984). Rhinitis medicamentosa. Conceptualization, incidence, and treatment. The Alabama Journal of Medical Sciences, 21(2), 205.

Hall, R., Beresford, T., Stickney, S., Nasdahl, C., & Coleman, J. (1985). Psychiatric reactions produced by respiratory drugs. Psychosomatics, 26, 605-616.

Pearson, M.M. & Little, R.B. (1969). The addictive process in unusual addictions: A further elaboration of etiology. American Journal of Psychiatry, 125, 1166-1171.

Ramey, J.T., Bailen, E., & Lockey, R.F. (2006). Rhinitis medicamentosa. Journal of Investigational Allergology and Clinical Immunology, 16(3), 148.

Snow, S.S., Logan, T.P., & Hollender, M.H. (1980). Nasal spray’ addiction’ and psychosis: A case report. British Journal of Psychiatry, 136, 297-299.