Gonna make you sweat: The weird and wonderful world of the Woolies

“There are some people who love wool so much that they make bodysuits out of them, to wear them constantly. There is even a French wool fetishist forum to discuss their love for wool clothing. Some of these advanced knitters take their clothing experience to the next level” (from ‘8 Freakiest Fetishes’, Oddee website, June 18, 2009).

Today’s blog arguably demonstrates that human beings appear to have the capacity to fetishize almost anything. ‘Woolies’ are individuals that derive sexual pleasure and arousal from wearing wool typically in the form of full body ‘wool suits’. (I also ought to mention that ‘woolies’ appears to be the collective name used in Europe whereas in America such people are often referred to as ‘sweaterers’ – in this blog I will use the term ‘woolies’ irrespective of where such people are located). Given the fact that (i) there is absolutely no scientific research on woolies, and (ii) woolies do not make an appearance in either Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices or Dr. Anil Aggrawal’s Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices suggests one of two things – either that the fetish does not really exist, or that it is a relatively newly realized fetish.

There is certainly a lot of anecdotal evidence that woolies exist. On a personal level, I was recently interviewed for a television documentary about the practice (Discovery Channel’s Forbidden), and was asked to comment on the case studies that appeared in the programme. For instance, one of the woolies featured was an American male, Scott from Florida, who (perhaps unsurprisingly) runs a small company selling sweaters and has had a “lifelong obsession” with wool. As a boy he claimed he would steal sweaters to hide in his school locker and in the woods near his house. He now has a collection of about 3000 sweaters, and claims to be being sexually attracted to anyone wearing a sweater, including men (even though he is heterosexual). The programme’s research team told me that:

“Scott wears a sweater out as much as possible, he’s also got a special two-piece with knitted pants that he wear around the house. Scott describes it as a secret fetish because no one knows that he’s actually getting turned-on just by walking the streets in his sweater. Scott regularly holds sweater photo-shoots. Here he’ll introduce us to other like-minded ‘sweaterers’ who travel to meet up with him and have some sweater fun and model the gear”.

The programme also featured a German woman (‘Lady Mohair’) who sells full-body knitted outfits to people worldwide. She introduces the audience to a few of her more “eccentric” woolies such as ‘Knuti’ who assumes the persona of a woolly polar bear persona.However, there are also various online discussion forums for those who engage in the behaviour (such as the Woolfreaks website). Perhaps the largest collection of sexualized (as opposed to sexy) costumes worn by woolies can be found on the French online fetish forum Doctissimo (be warned, some of the photographs are very sexually explicit in the form of crotchless costumes).

A recent 2013 article on woolies was published on the Sangbleu website. The article claimed that:

“The wool fetish is possibly one of the most mundane but simultaneously bizarre fetishes in existence. ‘Woolies’ as they have become to be known partake in the enjoyment of feeling the warm and fibrous softness of wool in its many different textures and knitted techniques upon their own or others skin. This could be from the subtleness of a woman wearing a turtleneck sweater or to the other extreme of being partially mummified in countless layers of blankets”.

From my own reading of the phenomenon, it is the latter “mummified” state of dress that appears to be the most fetishized as many of these fully dressed fetishists look like they are wearing woollen gimp suits. The (unnamed) author of the Sangbleu article attempted to join one of the online ‘woolies’ forums. It was noted that admission to the forum was processed by having to highlight whether (say) mohair or angora was the preferred fetish fabric. It was reported that:

“Some people were more particular and get off on the sensation of seeing their partners in particular knitted garments like heavily knitted socks, hats, leg warmers, or scarves. A lot of the images [on the forum site] demonstrate specially created full body suits to fulfill the need of being completely consumed by wool throughout the day. The totally surreal nature of resembling a friendly yeti in soft colours may not be what we all expect of normal sexuality but the amount of depth and variations that this fetish possesses expands on its sensual nature. Whether this constitutes the itchiness of wiry wool against the skin or the way in which clothing can trap the body with its heaviness, this fetish seems to have many more possibilities that how it initially appears”.

There’s also a website (i.e., Sweaterslut) that was set up as a dare and a way of gaining insight to the phenomenon by interviewing one of the leading woolies (i.e., Woolmaster) in the wool fetish community. The (again unnamed) author wrote that:

“For some time now I have been investigating that strange phenomenon called ‘sweater fetish’, a condition where a person is aroused by the sight of, or wearing, a woollen sweater. In the course of my investigations I came across a site maintained by a man named ‘Woolmaster’. In this site, Woolmaster kept a rich repository of stories and pictures depicting women and mostly men in sweaters. It seemed to me that Woolmaster suffered from the schizophrenic character so common among sadomasochists: he could not decide whether to imagine himself as the ‘sweaterer’ or the ‘sweatered’. This was what led me to ask him for details, which in turn led to this strange dare [to set up the Sweaterslut website]”.

I would speculate that on some level, woolies are not really that different from those fetishists into rubber, leather or latex (although I personally see materials like latex and leather as far more inherently ‘sexy’ than wool). The research team on the television show I contributed to told me that:

“This warm, fuzzy, world of wooly lovers is small but diverse. Some fetishize total wooly enclose. They’ll wrap themselves up in layers and layers and sweat it out for hours! It’s often about a feeling of security. Many own specially made full-body knitted suits, and bizarre looking head coverings, designed to keep them covered from head to toe in wool. The demand and desire for these strange outfits is met by a handful of professional knitters around the world who have made it their business to cater to obsessive wool lovers”.

The only other article of any length that I have found on woolies was at the Myshka NYC website. The (presumably female) author Myshka appears to assume that woolies are in some way sexual masochists and claims:

“This branch of huggable submissives have joined warm and fuzzy knit outfits, covering every square inch of the body of course, with the traditional dress codes of shiny, black leather and clear plastic bags as in the S&M community as acceptable, kinky fodder. Are these enthusiasts merely adults that couldn’t bear the postpartum depression that comes with giving up your childhood blanket or are they instinctively stimulated and aroused by the around-the-clock sensation of wool touching skin…Made of wool and mohair, these stifling suits of armor gained popularity among the sexual underground when a French designer and fetishist began knitting full-size costumes for bedroom play. It seems that from their inception, the hand-crafted bodysuits were enough to rouse the more damaged deviants that floated to the surface…You might be thinking ‘Tactile obsession is nothing new to BDSM or fetish culture’ and you’d be right”.

I realize that in the absence of any academic research today’s blog has leaned more towards anecdotal journalism than something more considered and empirical. However, my own view is that wool fetishists exist but that like many other niche fetishes I have covered on my blogs, the incidence and prevalence is likely to be very small.

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

Further reading

Morgan, G. (2009). 8 Freakiest Fetishes. Oddee, June 18. Located at: http://www.oddee.com/item_96718.aspx

Myshka NYC (2011). Woolies and the snuggly wobbly fetish you’ve never heard of. August 10. Located at: http://mishkanyc.com/bloglin/2011/07/23/woolies-and-the-snuggly-wubbly-fetish-ive-never-heard-of/

Sangbleu (2012). Wool fetish. June 7. Located at: http://sangbleu.com/2013/06/07/wool-fetish/

Blood pressures: Interview with a [female] vampire

In a previous blog I briefly examined clinical vampirism as a sexual paraphilia. In that blog I noted that there had been very little empirical research on clinical vampirism and that most of what is known comes from clinical case studies. Furthermore, vampirism (i) is rarely a single clinical condition, (ii) may or may not be associated with other psychiatric and/or psychological disorders (e.g., severe psychopathy, schizophrenia, hysteria, mental retardation), and (iii) may or may not necessarily include sexual arousal. Other related conditions include odaxelagnia (deriving sexual pleasure from biting), haematolagnia (deriving sexual satisfaction from the drinking of blood), and haematophilia (deriving sexual satisfaction from blood in general), and auto-haemofetishism (i.e., deriving sexual pleasure from sight of blood drawn into a syringe during intravenous drug practice).

More recently I was contacted by a female ‘vampire’ (I use the term lightly in this instance) who has read my original article wanted to share her story with me. She gave me permission to disseminate her story with my blog readers on the understanding that I guaranteed her anonymity, confidentiality, and used her preferred name of ‘Countess Maria’ (CM) throughout the article. (She also signed herself as ‘The Young Madam’ but I will use CM for the remainder of this article). Obviously, I have no way of verifying anything that CM communicated to me, but on a personal level I have no reason to doubt the veracity of her claims. All of our communication was via email under her real name (which I then checked out online on a specific social networking site and I am 100% sure that she is who she says she is). She also said she “would be honored to have you feature my story.  I have answered your questions…as I honor your intellect and respect…being a professor is indeed a respectable, hardy, and challenging profession which is why I greatly respect an honor such profession”. More specifically, she added:

CM: “Whom I share this information must take it to the grave with them; except for you. You may share my story if and only if you use my name I have used for years ‘Countess Marie’. I do indeed consider myself a Countess due to what I have endured through humanitarian efforts as well as my ever strong want, need, and desire to help humanity – even if humanity shuns me for who I am”.

I asked CM for some socio-demographic information and she told me that she was 23 years of age, described herself as an African American and was currently employed as a Pharmacy Technician. Based on what she told me, she was well educated with various medical qualifications including Pharmacy Technician and Animal Care Certification. I also asked her about her religious beliefs and she responded: “Christian with great noble intent (‘I will gladly share my last piece of bread with my fellow man’). I live by that statement and I intend to follow through”. She also went ion to say: “I am finally in my studied job, as a Pharmacy Technician.  I have always had a thing for helping people…this is just one if the many ways I can help.  My dream in life is to be a great humanitarian and grow to greatness in helping those around me…I love who I am, and I am always wanting to follow my path.

In her account, CM didn’t really label herself a vampire but admitted that she liked drinking blood, and that many of the acts she engaged in would be labelled as vampire-like by others. She also talked about her first experiences of blood-sucking:

CM: “It is my understanding that you wish to hear about my further expansion on my clinical vampirism. Truthfully, I don’t really put a label on what it is I do. I have been consuming blood since I was young. The first cut I ever got was from a tree branch. I sucked my arm for several hours because the taste was delicious”.

At that point, CM didn’t really view her activity as in any way wrong but over time she began to realize that blood sucking was not considered normal behaviour and that she was socially ostracized by those who knew about her love of blood:

CM: “As I furthered in age through the years I noticed that I was considered different and odd, but I kept to myself about it. My love, my best friends, and you are the only people to know I consume blood…I would also like to add I have been called everything in the book for consuming blood; Monster, Demon, Grim’s Helper, and all the names in the middle…[Even] my friends called me [these things] at first because they did not understand what it mean for me”

However, CM went to great lengths to tell me that her love of blood did not involve the sucking of blood from other humans:

CM: “Make no mistake…I have never consumed blood from any human being – [only] myself. I consume pork blood, beef blood, and if that cannot be obtained I buy steaks and cook them very rare just enough for blood to spill out of it. I enjoy eating food, but it’s not really fun if it lacks in my nutrition. I add blood to juice, tea, desserts, cakes, salads, and disguise it in all sorts of ways”.

CM claimed she would never do anything that impacted on other humans and that morally it would be wrong to enforce her own beliefs and desires on others. She also believes that blood consumption is what keeps her alive:

“I never feed anyone else my blood food. I cook human food properly for guests for I know I am the only one who enjoys the taste of blood. To many, it is bitter and irony-metallic tasting. I cannot relate, due to the fact that for me, it tastes like fine wine. Without blood, I know that I would surely die. I need blood to live. I have always felt that way. Nothing on Earth will ever change my thoughts on the matter. I love blood…To me blood is life or death”.

CM also told me she had been diagnosed with anemia and I asked her whether believed that her love of blood may be because she has anemia:

“I will always love blood. I know that as far as my health goes, it actually favors blood consumption. I was told I almost died by slowly falling into a coma from sleeping for almost 4 straight days. The entire time I was asleep it only felt like seconds, but when I awoke, everyone was worried…I was diagnosed with being anemic, as well as hyperthyroidism. My hyperthyroidism is such [that] I will be on Levothyroxin until the day I die. My blood naturally lacks the iron (due to being anemic) so consuming blood helps me in many ways…I feel that my anemia further shows me that when I feel dizzy or “off centered” that I should consume blood.  I only consume pig or beef blood…NEVER human blood”.

As she had read my article clinical vampirism as a sexual paraphilia I also asked CM if her consuming of blood was in any way sexually motivate. She responded by saying:

“The sight of blood is a turn on for me, but only inside of a container.  If someone is bleeding of course I would help aid them and stop the pain.  If I see frozen blood in the grocery store or walk in the meat section at the market for too long, all I can smell is the blood, which causes arousal for me.  I don’t stay in butcher shops long for that reason”.

This suggests that blood for CM (in some circumstances) is sexually arousing and that there may be paraphilic elements in her reason for liking blood. Whether CM is typical of other ‘vampires’ is not clear. But given the little we know about people that love drinking blood, I am grateful to CM for her time in answering my questions and her honesty in relation to the development and motivations underpinning her hobby.

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

Further reading

Benezech, M., Bourgeois, M., Boukhabza, D. & Yesavage, J. (1981). Cannibalism and vampirism in paranoid schizophrenia. Journal of Clinical Psychiatry, 42(7), 290.

Gubb, K., Segal, J., Khota1, A, Dicks, A. (2006). Clinical Vampirism: a review and illustrative case report. South African Psychiatry Review, 9, 163-168.

Halevy, A., Levi, Y., Ahnaker, A. & Orda, R. (1989). Auto-vampirism: An unusual cause of anaemia. Journal of the Royal Society of Medicine, 82, 630-631.

Hemphill R.E. & Zabow T. (1983) Clinical vampirism. A presentation of 3 cases and a re-evaluation of Haigh, the ‘acid-bath murderer’. South African Medical Journal, 63(8), 278-81.

Kelly, B.D., Abood, Z. & Shanley, D. (1999). Vampirism and schizophrenia. Irish Journal of Psychological Medicine, 16, 114-117.

Jaffe, P., & DiCataldo, F. (1994). Clinical vampirism: Blending myth and reality. Bulletin of the American Academy of Psychiatry and the Law, 22, 533-544.

Miller, T.W., Veltkamp, L.J., Kraus, R.F., Lane T. & Heister, T. (1999). An adolescent vampire cult in rural America: clinical issues and case study. Child Psychiatry and Human Development 29, 209-19.

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

Noll, R. (1992). Vampires, Werewolves and Demons: Twentieth Century Reports in the Psychiatric Literature. New York: Brunner/Mazel.

Prins, H. (1985). Vampirism: A clinical condition. British Journal of Psychiatry, 146, 666-668.

Vanden Bergh, R. L., & Kelly, J. F. (1964). Vampirism: A review with new observations. Archives of General Psychiatry, 11, 543-547.

Wilson N. (2000) A psychoanalytic contribution to psychic vampirism: a case vignette. American Journal of Psychoanalysis, 60, 177-86.

Yates, P.M., Hucker, S.J. & Kingston, W.A. (2008). Sexual sadism: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment. pp.213-230. New York: Guildford Press.

The highs of the prize: Are instant-win products a form of gambling?

A nine-year old boy walks into a shop and buys a packet of potato chips. An eight-year old girl walks into the same shop and buys a chocolate bar. Nothing particularly unusual except this particular packet of potato chips poses the question “Is there a spicy £100,000 inside?” in big letters on the front of the packet with the added rider “1000’s of real £5 notes to be won!” The bar of chocolate offers “£1 million in cash prizes – win instantly. Look inside to see if your a winner!!”. The boy opens up the bag of crisps but it contains nothing but crisps. He is very disappointed. The little girl opens up the chocolate bar and sees the all to familiar phrase “Sorry. You haven’t won this time but keep trying. Remember there’s £1 million in cash prizes to be won”. She too is very disappointed. Both of them decide to buy the product again to see if their luck will change. It doesn’t. This time a different chocolate bar says “Sorry this is not a winning bar. Better luck next time!” The most they are likely to win is another packet of crisps or some more chocolates.

This scenario describes a typical instant win product (whereby a consumer buys a particular product with the chance of instantly winning something else of financial value). This type of instant-win marketing has been around for some time and is not particularly new but it is the younger generation that is being targeted. In a different environment, it could be argued that these two children are “chasing” their losses in the same way a gambler chases theirs. All over the world, this type of marketing is becoming more prevalent with big multi-national companies also employing its use to increase sales (e.g., MacDonalds).

In gambling situations after losing money, gamblers often gamble again straight away or return another day in order to get even. This is commonly referred to as “chasing” losses. Chasing is symptomatic of problem gambling and is often characterized by unrealistic optimism on the gambler’s part. All bets are made in an effort to recoup their losses. The result is that instead of “cutting their losses” gamblers get deeper into debt pre-occupying themselves with gambling, determined that a big win will repay their loans and solve all their problems. Although not on this scale, the scenario outlined above appears to be a chasing-like experience akin to that found in gambling. To children, this type of behaviour appears to be a gambling-type experience and is similar to other gambling pre-cursors that I have highlighted in some of my papers such as the playing of marbles, card flipping, and sports card playing. For instance, in sports card playing, it is not uncommon for adolescents to keep buying packs of cards to get their favorite baseball or football star. Products like crisps and chocolate are popular and appeal not only to the young but to adults too. However, the fact that such promotions are often coupled with the appearance of teenage idols (e.g., famous pop groups or top soccer sporting heroes) suggests that it is younger people that are being aimed for.

Manufacturers of instant-win products claim that people buy their products because customers want them. They further claim that the appeal of a promotion is secondary to the appeal of the product. This may well be true with most people but instant-win promotions obviously increase sales otherwise so many companies would not resort to it in the first place. It would appear that most people have no problem on moral (or other) grounds with companies who use this type of promotion. However, there are those (such as those who work in the area of youth gambling) who wonder whether this type of promotion exploits the vulnerable in some way (i.e., children and adolescents). The question to ask is whether young children and adolescents are actually engaging in a form of gambling by buying these types of products.

Gambling is normally defined as the staking of money (or something of financial value) on the uncertain outcome of a future event. Technically, instant-win promotions are not a form of gambling. This is because (by law) manufacturers are required to state that “no purchase is necessary”. This whole practice it is little more than a lottery except that in very small letters at the bottom of the packet there is the added phrase “No purchase necessary – see back for details”. However, very few people would know this unless they bought the product in the first place, and secondly, the likelihood is that a vast majority will not do this anyway – particularly children and adolescents.

The small print usually reads “No purchase necessary. Should you wish to enter this promotion without purchasing a promotional pack, please send your name and address clearly printed on a plain piece of paper. If you are under 18, please ask a parent or guardian to sign your entry. An independently supervised draw will be made on your behalf, and should you be a winner, a prize will be sent to you within 28 days”. I have tried writing to companies to ascertain how many people utilize this route but (to date) I have been unsuccessful in gaining any further information. It is highly likely that very few people write to the companies concerned. There is a high likelihood that the companies in question have the empirical evidence but unfortunately it is not in the public domain. If it is assumed that the number of people who actually write to the companies for their names to be put into an independently supervised draw is very low, it can be argued that to all intents and purposes that people who buy such products are engaged in a form of gambling.

Since the introduction of the UK National Lottery and instant scratchcards in the mid-1990s, a “something-for-nothing” culture appears to have developed where people want to win big prizes on lots of different things. Children themselves are growing up in an environment where gambling is endemic. Having examined a variety of instant-win promotions, I am in little doubt that they should be viewed as gambling pre-cursors in that they are gambling-like experiences without being a form of gambling with which anyone can identify. It is unlikely that great numbers of children will develop a problem with this activity, but there is the potential concern that a small minority will. Research has consistently shown that the earlier that a child starts to gamble the more likely they are to develop a gambling problem.

Evidence that instant-win products are problematic to young children is mostly anecdotal. For instance, a number of years ago, I appeared on a UK daytime television programme with a mother and her two children (aged nine and ten years of age) who literally spent all their disposable income on instant-win promotions. These two children had spent hundreds of pounds of their pocket money in the hope of winning the elusive prizes offered but never won more than another bag of potato chips. The mother claimed they had “the gambling bug” and was “terrified they will have problems when they grow up”. She claimed she had done her utmost to stop them using their pocket money in this way but as soon as her back was turned they were off to the local corner shop to buy instant-win products. This wasn’t just restricted to products they enjoyed anyway. For instance, when they went to the supermarket to shop the children just fill up the shopping trolley with anything that has an instant-win promotion including tins of cat food – even though they didn’t have a cat!

Harsh critics of instant-win promotions might advocate a complete banning of these types of marketing endeavors. However, this is impractical if not somewhat over the top. What is more, there is no empirical evidence (to date) that there is a problem. However, this does not mean that such practices should not be monitored. Instant-win marketing appears to be on the increase and it may be that young children are particularly vulnerable to this type of promotion if anecdotal case study accounts are anything to go by.

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

Further reading

Griffiths, M.D. (1989). Gambling in children and adolescents. Journal of Gambling Behavior, 5, 66-83.

Griffiths, M.D. (1995). Adolescent Gambling. London : Routledge.

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

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

Griffiths, M.D. (2003). Instant-win products and prize draws: Are these forms of gambling? Journal of Gambling Issues, 9. Located at: http://jgi.camh.net/doi/full/10.4309/jgi.2003.9.5

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

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

Griffiths, M.D. (2013). Responsible marketing and advertising of gambling. i-Gaming Business Affiliate, August/September, 50.

Griffiths, M.D., King, D.L. & Delfabbro, P.H. (2009). Adolescent gambling-like experiences: Are they a cause for concern? Education and Health, 27, 27-30.

Hayer, T. & Griffiths, M.D. (2015). The prevention and treatment of problem gambling in adolescence. In T.P. Gullotta & G. Adams (Eds). Handbook of Adolescent Behavioral Problems: Evidence-based Approaches to Prevention and Treatment (Second Edition) (pp. 539-558). New York: Kluwer.

Zangeneh, M., Griffiths, M.D. & Parke, J. (2008). The marketing of gambling. In Zangeneh, M., Blaszczynski, A., and Turner, N. (Eds.), In The Pursuit Of Winning (pp. 135-153). New York: Springer.

Coming to a head-ache: A brief look at coital cephalalgia

“Not tonight dear, I’ve got a headache” is a staple (and somewhat stereotypical) phrase typically used by women in various television sitcoms to politely turn down their husband’s sexual advances. However, there is a small minority of individuals where sexual activity can actually trigger headaches (known in the clinical and medical literature as ‘coital cephalalgia’ and ‘benign coital headache’) often occurring at the brink of orgasm. (Here, the term ‘benign’ defines a primary headache syndrome not caused by any intracranial disorder). Often characterized by sufferers as a “severe pain behind the eyes” it can be short-term or long-lasting (up to days in extreme cases), and can affect both sexes across the age spectrum. According to the National Headache Foundation, around 1 in 5 women and 1 in 20 men experience “exertional headaches” (i.e., headaches caused by increased blood pressure in the brain that typically occurs during exercise). Such exercise can in a minority of cases include sexual activity.

One of the earliest recorded cases of coital cephalalgia – at least one of the earliest I found when I did an online literature search – was published in a 1974 issue of the Irish Journal of Medical Science by Dr. Edward Martin. He published six case studies of “a benign syndrome of recurrent headache during sexual intercourse”. For instance, one of his cases was a 42-year old male engineer that claimed he suffered migraine headaches during sex (lasting from 10 to 60 minutes). It first occurred just two weeks after marrying his wife and then carried on at regular intervals. The headache always occurred “abruptly at the onset of orgasm”. After about a year, the headaches subsided to the point where they were only occasional. (Other articles I have read say that the first paper published on this topic was by Dr. J.W. Lance who wrote a paper entitled ‘Headaches related to sexual activity’ in the Journal of Neurology, Neurosurgery, and Psychiatry. However, that paper was published two years after the one by Dr. Martin). Another early paper published by Dr. M. Porter and Dr. J. Jankovic, in a 1981 issue of the Archives of Neurology reported eight cases of benign coital cephalalgia (BCC), “an acute headache that is time related to sexual intercourse” (and a variant of migraine). The authors reported that all eight sufferers were successfully treated with propranolol hydrochloride.

In a 1988 issue of Cephalalgia, Dr. J.M. Martinez and his colleagues reported three cases of benign coital cephalalgia (all of who had a history of migraine). Comparing their own cases with those that had previously been published, they concluded that such sex-related headaches may have resulted from heart problems (“ischaemic disturbances”) triggered by “haemodynamic changes occurring in orgasm”. There is also some evidence that the condition may have a partly genetic basis as a 1986 paper By Dr. D.R. Johns in the Archives of Neurology reported four cases of benign sexual headache (BSH) in four sisters from the same family. He reported the most severely affected of the sisters was successfully treated with propranolol hydrochloride (as reported above), and that BSH was a variant of migraine.

In a 2005 review paper by Polish medic Dr. I. Domitrz, I. (published in the journal Ginekologia Polska) on primary headaches associated with sexual activity], it was noted that BCH was rare and that:

“The pathogenesis of this type of headache remains unknown. Clinical manifestation is typical and connected with three phases of sexual activity. Coital cephalalgia is divided into two subtypes: preorgasmic and orgasmic headache. Some authors specify the third type–postural type. Preorgasmic headache starts as a dull bilateral ache and increases with sexual excitement. Orgasmic headache has sudden, intense character and occurs at orgasm. Postural headache has been reported to develop after coitus”.

In a 1992 issue of the journal Cephalalgia, Danish doctors Dr. J.R. Østergaard and Dr. M. Kraft studied the natural history of patients with a diagnosis of benign coital headache (BCH) that presented themselves for treatment in their clinic over a 13-year period (1978-1991). Of the 32 patients that had been treated for BCH, 26 of them participated in their follow-up study. They reported that 13 patients (50% of their sample) had recurrent attacks of coital headaches separated by intervals of up to 10 years. Of these 13, eleven of them “suffered a concomitant primary headache whereas this was present in only one of those patients without recurrent attacks of coital headache”. Apart from one patient who suffered blurred vision, the headaches were not too severe as there were no reports of vomiting, visual disturbances, sensory/motor disturbances, or unconsciousness. The paper concluded that BCH can clearly be “distinguished from headaches due to cerebral aneurysm or arteriovenous malformation rupture. The presence of a concomitant primary headache syndrome is a risk-factor for recurrence of coital headache”.

Arguably the most well known researcher in the field of sexual headaches is the German Dr. Achim Frese who has published a whole series of papers with his team on the topic. In a 2005 review paper in the journal Practical Neurology, Frese and his colleague Dr. Stefan Evers noted that:

“The frequency of headache associated with sexual activity is unknown. In the only population-based epidemiological study, the lifetime prevalence was about 1% with a wide confi dence interval, similar to the frequency of benign cough headache and benign exertional headache (Rasmussen & Olesen 1992). Very likely, the frequency is underestimated because patients often feel too embarrassed to report intimate details about their sexual activities. We estimate that patients with headache associated with sexual activity account for about 1% of all headache patients who are referred to our supraregional headache clinics”.

In 2003, Frese and colleagues examined the demographic and clinical features of headaches associated with sexual activity (HSA) in the journal Neurology. Between Over a five-year period (1996-2001), they interviewed 51 patients with the diagnosis of HAS. The average age of onset was just under 40 years of age and there were approximately three times more males with HSA. They also reported that 11 of their participants had HSA type 1 (i.e., dull subtype), which gradually increased with increasing sexual excitement. The remaining 40 participants had HSA type 2 (i.e., explosive subtype). There were no participants with HSA type 3 (i.e., postural subtype). HSA wasn’t dependent on any specific sexual habits and most often occurred during sexual activity with their usual partner (94%) and during masturbation (35%). There were no differences between HSA types 1 and 2 in relation to demographic factors, clinical features, or comorbidity, except for a higher probability of stopping the attack by breaking off sexual activity in HSA type 1.

In 2007, Frese and his colleagues published a paper in the journal Cephalagia looking at the prognosis and treatment of HSA. In this study they followed up 60 HSA cases in an eight-year period (1996-2004). Of the 45 cases that had experienced just single attacks prior to baseline examination, the vast majority (n=37) had no further attacks. The most effective treatment was the use of beta-blockers. They also reported that:

“Seven patients suffered from at least one further bout with an average duration of 2.1 months. One patient developed a chronic course of the disease after an episodic start. Of the 15 patients with chronic disease at the first examination, seven were in remission and five had ongoing attacks at follow-up…Episodic HSA occurs in approximately three-quarters and chronic HSA in approximately one-quarter of patients. Even in chronic HAS, the prognosis is favourable, with remission rates of 69% during an observation period of 3 years”.

In an earlier 2003 paper (also in the journal Cephalgia), Frese and colleagues examined the cognitive processes of people with type 2 HSA (i.e., the explosive subtype) by measuring event-related potentials (ERPs). They measured visual ERPs in 24 individuals with HSA outside the headache period. These individuals were then compared to a control group (age- and sex-matched). They found that those with HSA type 2 have a loss of cognitive habituation as measured by ERP and that their ERP patterns were very similar to that in observed migraine sufferers.

Earlier this year, Frese and colleagues published an observational study in the journal Cephalagia examining whether having sex could actually alleviate headaches (including migraines). From their previous research, they noted that headaches associated with sexual activity were well-known but that some case reports in the literature suggest that sexual activity during a headache might relieve the pain (in at least some patients). The research team sent a questionnaire to 800 migraine patients and 200 patients with other kinds of headache (called ‘cluster’ headaches). The paper reported that:

“In migraine, 34% of the patients had experience with sexual activity during an attack; out of these patients, 60% reported an improvement of their migraine attack (70% of them reported moderate to complete relief) and 33% reported worsening. In cluster headache, 31% of the patients had experience with sexual activity during an attack; out of these patients, 37% reported an improvement of their cluster headache attack (91% of them reported moderate to complete relief) and 50% reported worsening. Some patients, in particular male migraine patients, even used sexual activity as a therapeutic tool. The majority of patients with migraine or cluster headache do not have sexual activity during headache attacks. Our data suggest, however, that sexual activity can lead to partial or complete relief of headache in some migraine and a few cluster headache patients”

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

Further reading

Chakravarty, A. (2006). Primary headaches associated with sexual activity—some observations in Indian patients. Cephalalgia, 26, 202-207

Domitrz, I. (2005). Primary headache associated with sexual activity]. Ginekologia polska, 76, 995-999

Frese, A., Eikermann, A., Frese, K., Schwaag, S., Husstedt, I. W., & Evers, S. (2003). Headache associated with sexual activity Demography, clinical features, and comorbidity. Neurology, 61, 796-800.

Frese, A., & Evers, S. (2005). Primary headache syndromes associated with sexual activity. Practical Neurology, 5, 350-355.

Frese, A., Frese, K., Ringelstein, E. B., Husstedt, I. W., & Evers, S. (2003). Cognitive processing in headache associated with sexual activity. Cephalalgia, 23, 545-551

Frese, A., Gantenbein, A., Marziniak, M., Husstedt, I. W., Goadsby, P. J., & Evers, S. (2006). Triptans in orgasmic headache. Cephalalgia, 26, 1458-1461

Frese, A., Rahmann, A., Gregor, N., Biehl, K., Husstedt, I. W., & Evers, S. (2007). Headache associated with sexual activity: prognosis and treatment options. Cephalalgia, 27, 1265-1270

 

Hambach, A., Evers, S., Summ, O., Husstedt, I. W., & Frese, A. (2013). The impact of sexual activity on idiopathic headaches: An observational study. Cephalalgia, 33, 384-389

Johns, D. R. (1986). Benign sexual headache within a family. Archives of Neurology, 43, 1158-1160.

Lance, J.W. (1976). Headaches related to sexual activity. Journal of Neurology, Neurosurgery and Psychiatry. 39, 1226-30.

Martin, E. A. (1974). Headache during sexual intercourse (coital cephalalgia). Irish Journal of Medical Science, 143, 342-345.

Martinez, J. M., Roig, C., & Arboix, A. (1988). Complicated coital cephalalgia: three cases with benign evolution. Cephalalgia, 8, 265-268

Ostergaard, J. R., & Kraft, M. (1992). Benign coital headache. Cephalalgia, 12, 353-355

Pascual, J., Iglesias, F., Oterino, A., Vazquez-Barquero, A., & Berciano, J. (1996). Cough, exertional, and sexual headaches An analysis of 72 benign and symptomatic cases. Neurology, 46, 1520-1524

Porter, M. & Jankovic, J. (1981). Benign coital cephalalgia: differential diagnosis and treatment. Archives of Neurology, 38(11), 710-712.

Rasmussen, B.K. & Olesen, J. (1992) Symptomatic and nonsymptomatic headaches in a general population. Neurology, 42, 1225–31.

Silbert, P. L., Edis, R. H., Stewart-Wynne, E. G., & Gubbay, S. S. (1991). Benign vascular sexual headache and exertional headache: interrelationships and long-term prognosis. Journal of Neurology, Neurosurgery and Psychiatry, 54, 417-421

Aid and a bet: A brief look at the prevention of problem gambling

While prevention efforts targeting addictive disorders are widely used, there are relatively limited data are available on their effectiveness (particularly in the gambling studies field). According to the US Preventive Services Task Force, prevention has historically been divided into three stages. The term primary prevention has been used to describe measures employed to “prevent the onset of a targeted condition”. Secondary prevention has been used to describe measures that “identify and treat asymptomatic persons who have already developed risk factors or pre-clinical disease but in whom the condition is not clinically apparent”. Tertiary prevention has been used to describe “efforts targeting individuals with identified disease in which the goals involve restoration of function, including minimizing or preventing disease-related adverse consequences”. These divisions of prevention thus focus on different targets, with primary efforts tending to target the general population, secondary efforts at risk or vulnerable groups, and tertiary efforts individuals with an identified disorder.

Primary prevention is typically considered the most cost-effective form of prevention as it helps reduce suffering, cost and burden associated with a disorder. Primary prevention efforts related to problem gambling have generally involved education initiatives. Examples include television commercials, billboards, posters, and postcards, that may feature brief problem gambling screening instruments or advertise gambling helplines and treatment services. Despite widespread use, most primary prevention efforts in gambling have not been empirically validated.

The content and impact of primary prevention is strongly influenced by knowledge of the impact of the behaviour or disorder being prevented. For example, prevention efforts targeting tobacco smoking cessation have changed significantly as more information concerning the health impact of tobacco smoke have become available. Unfortunately, few large-scale, well-designed studies have investigated the health impact of different levels or types of gambling (e.g., recreational, problem, and pathological).

Some primary prevention efforts targeting children and adolescents may influence adult gambling behaviors. Some of these studies have published promising results but all studies have shortcomings (e.g., cross-sectional designs that don’t allow for assessment of lasting positive effects on gambling attitudes or behaviour). Basically, it’s unclear if the positive effects found will be maintained into adulthood or if the same interventions employed on adolescent populations would be effective for adults. Research on prevention programs outside of the gambling field has suggested that regardless of delivery mode (didactic lecture, videotapes, posters, pamphlets, guest speakers etc.), the ‘information only’ approach has relatively little effect on behavioural change.

Another feature to be considered in primary prevention is the impact of gambling availability on the development of problem gambling. Over the past several decades, there has been a rapid increase in the availability of legalized gambling worldwide. Data suggest that concurrent with the increase in availability there have been increase in the rates of recreational, problem and pathological gambling. The extent to which gambling should be regulated and/or restricted remains an area of active debate, with the decisions holding considerable potential impact on public health and prevention efforts. In summary, although primary prevention efforts related to adult gambling exist, they are relatively few in number, particularly when considering the public health impact of problem gambling.

Secondary prevention efforts involve measures that target individuals with risk factors for or pre-clinical forms of a disorder. Secondary prevention measures in general constitute important interventions in general medical settings. Although it is likely that generalist physicians encounter individuals with gambling problems in their provision of clinical care, the extent to which they are trained to examine for or feel comfortable in assessing gambling problems warrants consideration. However, a significant minority of gamblers report health problems as a direct result of their gambling. This indicates that gambling in its most excessive forms should be viewed as a serious health issue to be taken seriously by the medical profession. Adverse health consequences for both the gambler and their partner include depression, insomnia, intestinal disorders, migraines, and other stress-related disorders. General practitioners routinely ask patients about smoking and drinking but gambling is something that is not generally discussed. Problem gambling may be perceived as a somewhat ‘grey area’ in the field of medicine and it is therefore is very easy to deny that medics should be playing a role. If the main aim of practitioners is to ensure the health of their clients, then it is quite clear that an awareness of gambling and the issues surrounding should be an important part of basic knowledge.

Efficient screening methods for problematic gambling behaviours could be of significant value in general medical settings. Several brief screening instruments for problem and pathological have been developed. Although it is likely too early to develop practice guideline for problem and pathological gambling prevention efforts within a general medical setting, generalist physicians could regularly assess patients’ gambling histories, sensitively broach the topic of the possible existence of gambling problems with those patients suspected of engaging problematically in gambling, thoughtfully motivate individuals with gambling problems to seek treatment, and appropriately refer individuals with gambling problems to a self-help group or a gambling to facilitate engagement in locally available gambling treatment.

Brief screening instruments could also be of significant utility in other settings, including mental health and addiction treatment offices, jails and other forensic facilities, and gambling venues. Individuals within these settings should be aware of the high rates of problem gambling in specific groups (e.g., males, adolescents, and individuals with histories of incarceration or psychiatric [including substance use] disorders). Given the high rates of co-occurrence of gambling and other psychiatric disorders, screening of individuals with problem or pathological gambling for other psychiatric disorders (and vice versa) could enhance tertiary prevention efforts (i.e., providing treatment that more effectively reduces the harm associated with each disorder).

Individuals attending gambling venues represent important areas for secondary prevention efforts. Many gambling venues train their staff to identify potential problem or pathological gamblers and advertise within the facilities methods for patrons to obtain help (e.g., through gambling helplines and/or self-exclusion programs). Specific populations, although at arguably lower risk, might require unique prevention efforts. For example, gambling problems are more prevalent in men than women, and there exist gender-related differences in problem gambling behaviours (e.g., women generally beginning to gamble and developing problems with gambling later in life). As such, prevention efforts for men and women might preferentially target specific venues or age groups.

Tertiary prevention efforts, involving reducing disorder-related harm in affected individuals, include treatment efforts, and behavioural and pharmacological therapies for problem gambling. ‘Early’ tertiary prevention efforts involve moving individuals with recently recognized gambling problems into treatment (e.g., through gambling helplines) and non-treatment-related methods for helping individuals with gambling problems refrain from gambling (e.g., through availability and maintenance of casino self-exclusion policies).

Gambling helplines are widely around the world. Information from helpline callers can help enhance prevention efforts. However, further work is needed to examine directly the effectiveness of helplines with regard to treatment referral follow-up. That is, information obtained from callers willing to be called back several months following initial contact with the helpline would be valuable in assessing the extent to which problem gamblers have benefited from the helpline intervention. Self-exclusion policies exist in casinos and other gambling venues (e.g., bookmakers) around the world. Although the precise rules and regulations vary according to geographic location and individual casino, they generally involve voluntary self-exclusion for a period of time (e.g., 6 months to five years).

Increased knowledge regarding the impact of different types/levels of gambling behaviours on health and wellbeing would be extremely valuable in generating guidelines for healthy gambling and primary prevention efforts. An increased understanding of high-risk and vulnerable populations, facilitated through biological, psychological/psychiatric and social investigations, and the natural histories of gambling behaviors within these groups will help enhance secondary and early tertiary prevention efforts. As in other fields of medicine, the effectiveness of individual prevention strategies will need to be empirically validated. Targeted efforts in these areas should lead to a decrease in suffering attributable to problem gambling.

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

Further reading 

Griffiths, M.D. (2003). Adolescent gambling: Risk factors and implications for prevention, intervention, and treatment. In D. Romer (Ed.), Reducing Adolescent Risk: Toward An Integrated Approach (pp. 223-238). London: Sage.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association.

Griffiths, M.D. (2008). Youth gambling education and prevention: Does it work? Education and Health, 26, 23-26.

Griffiths, M.D. (2010). The gaming industry’s role in the prevention and treatment of problem gambling. Casino and Gaming International, 6(1), 87-90.

Griffiths, M.D. (2012). Self-exclusion services for online gamblers: Are they about responsible gambling or problem gambling? World Online Gambling Law Report, 11(6), 9-10.

Hayer^, T., Griffiths, M.D. & Meyer, G. (2005). The prevention and treatment of problem gambling in adolescence. In T.P. Gullotta & G. Adams (Eds). Handbook of Adolescent Behavioral Problems: Evidence-Based Approaches to Prevention and Treatment (pp. 467-486). New York: Springer.

Hayer, T. & Griffiths, M.D. (in press). The prevention and treatment of problem gambling in adolescence. In T.P. Gullotta & G. Adams (Eds). Handbook of Adolescent Behavioral Problems: Evidence-based Approaches to Prevention and Treatment (Second Edition). New York: Kluwer.

Korn, D., Shaffer HJ. (1999). Gambling and the health of the public: Adopting a public health perspective. Journal of Gambling Studies, 15, 289-365.

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

Potenza, M. & Griffiths, M.D. (2004). Prevention efforts and the role of the clinician. In J.E. Grant & M. N. Potenza (Eds.), Pathological Gambling: A Clinical Guide To Treatment (pp. 145-157). Washington DC: American Psychiatric Publishing Inc.

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

Shaffer, H., Korn DA. (2002). Gambling and related mental disorders: A public health analysis. Annual Review of Public Health, 23, 171-212.

US Preventive Services Task Force (1996). Guide to clinical preventative services (2nd edition). Baltimore, MD: Williams & Wilkens.

When push comes to love: A brief look at childbirth fetishism

In a previous blog, I examined maieusiophilia a sexual paraphilia and/or fetish in which an individual derives sexual pleasure and sexual arousal from particular aspects of human female pregnancy. In his book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr. Anil Aggrawal defines maieusiophilia as gaining sexual arousal from pregnant women and/or female childbirth. However, other sources define maieusiophilia more broadly to include sexual attraction to women who also appear pregnant, attraction to lactation and/or attraction to particular stages of pregnancy from impregnation through to childbirth. It is this latter aspect (i.e., childbirth) that today’s blog briefly examines. It was while I was researching that previous blog that I came across various online admissions like the following:

Extract 1: “I don’t know why but I find myself turned on by women giving birth. I am sure I am not a maieusophile (i.e. those who have a fetish for pregnant women), but I have a fetish for the childbirth process itself. I enjoy watching births and the more uncomfortable it is for the mothers, I like it more…I am also a female and straight. I have a boyfriend, and I am looking forward to marrying him and having kids with him in the future. I am excited to experience childbirth also”

Extract 2: “I do have one fetish I have that I guess you could consider sort-of sexual, and I don’t normally tell people about that one, but I have a pregnancy/childbirth fetish.  I feel aroused, I guess you could say, when one of those two topics are brought into play, but I would never, ever want to have sex with a pregnant woman or be pregnant myself. I don’t want kids and I have no desire to even be touched by anybody, much less have sex”

Extract 3: “Do some guys get sexually turned on by watching childbirth (of their wife)? Is it much different than just watching a video of it? I’ve heard it can be the woman’s biggest orgasm”.

There are also dedicated websites that provide links to fetish pictures and stories of childbirth. I included the third extract because in my research for this article, I did keep coming across stories where women were claiming that childbirth was the ‘strongest’ orgasm that they had ever had. There was even a television documentary on the topic simply called Orgasmic Birth that was first transmitted in January 2008 and reported in the New York Times. The documentary was made by Debra Pasacli-Bonaro – a childbirth educator – who poses the question: ‘What would happen if women were taught to enjoy birth rather than endure it?’ She says the primary message of her film is that women can “journey through labor and birth” in a variety of different ways and that giving birth can be a positive and pleasurable experience rather than a painful one. Pascal-Brown was quoted as saying:

“I hope women watching and men watching don’t feel that what we’re saying is every woman should have an orgasmic birth. [The film reveals] the best kept secret [of child birth] – that some women report having an orgasm as the baby exits the birth canal”

The film also features Dr. Christine Northrup author of the 2010 book Women’s Bodies, Women’s Wisdom who claims that orgasms during childbirth are the results of chemistry and anatomy. More specifically, she claims that:

“When the baby’s coming down the birth canal, remember, it’s going through the exact same positions as something going in, the penis going into the vagina, to cause an orgasm. And labor itself is associated with a huge hormonal change in the body, way more prolactin, way more oxytocin, way more beta-endorphins — these are the molecules of ecstasy”.

As far as I am aware, there is no empirical research on the fetishized aspects of childbirth but I did come across an interesting paper on the pornography of childbirth by Dr. Robyn Longhurst in the journal ACME: An International E-Journal for Critical Geographies. The paper focused on the moral issues surrounding the case of New Zealand ‘adult actress’ and former stripper Nikki Devi’s desire to give birth as part of a pornographic film called Ripe. In New Zealand, the Department of Child, Youth and Family Services wanted to separate the mother and child if the film was completed, but the New Zealand laws were not clear on whether the act of giving birth in a pornographic film was a form of child abuse. Longhurst noted that the aim of her paper was:

“…to draw on the story of Nikki and pornographic film maker Steve Crow’s quest to have a birth filmed for a pornographic movie to illustrate that certain sexual acts rouse anxieties and even disgust…The moral boundary between what is considered ‘normal’ and what is considered ‘perverse’ is constantly struggled over and is temporally and spatially specific. This pornography of birth shows that what counts as moral is tied up with issues of gender, sexuality, class, race and so on, but also with ‘geographical objects of space, place, landscape, territory, boundary and movement’ (Cresswell, 2005)…This article shows how Nikki, through media discourse, was constructed as a person who belonged in certain places and spaces (brothels, strip clubs) but not in others (hospital birthing wards). The media represented Nikki as immoral but this morality turns out to be based on a very contingent set of societal rules and expectations…There are societal expectations that birthing will be enacted in particular ways. Regardless of whether it be a ‘natural’ birth, a pain-assisted birth, a forceps delivery or a caesarean section the expectation is still that birthing women ought to behave in culturally and gendered ‘appropriate’ ways. Nikki’s plan to be filmed giving birth for a pornographic movie was not seen by most as an ‘appropriate’ way to birth”

Longhurst followed all the media coverage surrounding the case including two dedicated 60 Minutes television documentaries and reports in a wide variety of NZ newspapers to critically examine how the story was reported and portrayed. She also followed all the media interviews with the two main protagonists (i.e. Nikki Devi and the film’s director Steve Crow). She then went on to argue that that the coverage showed there were “unwritten rules and regulations govern what is deemed (in)appropriate behavior for particular bodies in particular spaces producing ‘a changing sexual landscape’”.

After the first documentary (entitled ‘Naked Ambition’) had been aired, Longhurst reported that the NZ media immediately began to debate the issue as well as the rights of unborn children. From the media coverage I read myself, Devi appeared to be vilified by the NZ press (and dubbed the ‘porn mum’). Politicians and the public alike wanted to know whether it was lawful to film the childbirth for a pornographic film. Longhurst made some really interesting observations:

“‘Coupling’ pregnancy and especially birth with sexual gratification challenges mainstream notions of pregnant and birthing women as modest, ‘motherly’, and focused completely on their infant. Becoming mothers’ must not ‘flaunt’ their sexuality even though (or maybe, because) the pregnant, and especially the birthing body is a body that is [assumed to be] clearly marked as having participated in sexual intercourse (Longhurst, 2000). Nikki’s transgression, therefore, prompted something of a moral panic…In examining moral judgments as to whether birthing women ought to be engaged in invoking sexual feelings for commercial gain it is imperative to consider the relationship between bodies and spaces, in this case, a delivery suite in a public hospital. Seeking a court order to stop the filming of the birth of Nikki’s baby could be read as an attempt to reinstate the purity of the delivery suite – a space where mother and child meet, bond, and establish a positive and loving relationship. When it was proposed that the delivery suite would become the site of a pornographic movie, lines between purity and perversity…became blurred. While viewing and shooting pornography might be ‘tolerated’ at sites that are seen to be deviant such as sex shops, clubs, strip joints, warehouses, porn studios, private homes, it was not ‘tolerated’ in a hospital birthing ward”

It does appear that the film was finally made and got a distribution deal as I went online and saw it advertised on various websites. As one website said:

“The controversial new movie they tried to ban. Filmed completely in New Zealand and starring an all-kiwi cast. Nikki, a pregnant wife with time on her hands and a passion for sex, indulges herself behind the back of her workaholic husband. 

A complex web of affairs, desires and obsessions…Follow Nikki through her term of pregnancy as she and her naughty neighbours show you what being neighbourly is all about”.

Similar moral questions about ‘appropriateness’ of giving childbirth outside of ‘traditional’ settings have been raised in the more recent case of the artist Marni Kotak who gave birth in front of a live audience as part of her art installation The Birth of Baby X in Brooklyn’s Microscope Gallery’s ‘birthing room’ (New York). In an interview with New York’s Village Voice newspaper, Kotak said that:

“I hope that people will see that human life itself is the most profound work of art, and that therefore giving birth, the greatest expression of life, is the highest form of art. Real life is the best performance art”.

A Daily Mail article after the birth of her son Ajax reported that a video of the birth has now been added to Kotak’s proposed 18-year project (Raising Baby X) in which Kotak will document her child’s upbringing until college with weekly video podcasts.

From everything that I’ve read, sexual arousal from either experiencing and/or watching childbirth appears to be very rare but does seem to be prevalent in a minority of individuals. Whether it ever becomes the topic of scientific research remains to be seen, although I’m sure more academic articles about the morality issues may appear in philosophy-minded journals in the years to come.

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.

Bastion Works (2012). Maieusiophilia. Located at: http://bastionworks.com/Mikipedia/index.php?title=Maieusiophilia

Cresswell, T. (2005). Moral geographies. In, David Atkinson, Peter Jackson, David Sibley & Neil Washbourne (Eds.) Cultural Geography: A Critical Dictionary of Key Concepts. (pp.128-134). New York: Taurus.

Longhurst, R. (2000). ‘Corporeographies’ of pregnancy: ‘bikini babes’. Environment and Planning D: Society and Space 18, 453-472.

Longhurst, R. (2006). A pornography of birth: crossing moral boundaries. ACME: An International E-Journal for Critical Geographies, 5(2), 209-229.

Northrup, C. (2010). Women’s Bodies, Women’s Wisdom: Creating Physical and Emotional Health and Healing. London: Bantam.

Wikipedia (2012). Pregnancy fetishism. Located at: http://en.wikipedia.org/wiki/Pregnancy_fetishism

Slots of fun: What should parents and teachers know about adolescent gambling? (Part 2)

Today’s blog is the second part of a two-part article (the first of which can be found here). The previous blog briefly examined risk factors in adolescent gamblers and signs of problem gambling in adolescents. The three lists below highlight some early warning signs of a possible gambling problem, some definite signs and a thumbnail profile of a problem gambler. This is followed by some (hopefully) helpful tips and hints.

Early warning signs of a gambling addiction

• Unexplained absences from home
• Continual lying about day-to-day movements
• Constant shortage of money
• General increase in secretiveness
• Neglect of studies, family, friends, health and appearance
• Agitation (if unable to gamble)
• Mood swings
• Loss of friends and social life
• Gambling seen as a legitimate way of making money

Signs of a definite gambling problem

• Large debts (which are always explained away)
• Trouble at school or college about non-attendance
• Unexplained borrowing from family and friends
• Unwillingness to repay borrowed money
• Total preoccupation with gambling and spending money on gambling
• Gambling alone for long periods
• Constantly chasing losses in an attempt to win money back
• Constantly gambling until all money is gone
• Complete alienation and rejection from family and friends
• Lying about the extent of their gambling to family and friends
• Committing crimes as a way of getting money for gambling or paying off debts
• Gambling overriding all other interests and obligations

Profile of the problem adolescent gambler

• Unwilling to accept reality and has a lack of responsibility for gambling
• Gambles to escape deeper problems (and the gambling environment may even be a substitute for parental affection)
• Insecure and feels inferior to parents and elders
• Wants good things without making an effort and loves games of chance
• Likes to be a ‘big shot’ and feels it’s important to win (gambling offers them status and a way of defining achievement)
• Likes to compete
• Feels guilty with losses acting as a punishing behaviour
• May be depressed
• Low self-esteem and confidence
• Other compulsive and/or addictive traits

Finally it is worth noting some of the ‘trigger’ situations and circumstances that a gambling problem might first come to light. Paul Bellringer has highlighted an array of situations that provide an opportunity to help the gambler focus on their need to change. These are:

• Acceptance by the gambler that control has been lost: This is the step before they ask for help.
• Asking for help: Having realised for themselves that gambling has taken control over their life, they may reach out to those closest to them
• Observation of too much time spent in a gambling environment: Such observations by friends or family may provoke discussion as to how this is affecting the life of a gambler.
• Getting in to financial trouble/Accumulation of debts: This might be a crisis point at which problem gambling might raise its head for the first time.
• Uncovered lies: Realization that the gambler has been caught lying may lead to admissions about their gambling problems
• Dwindling social circles/Losing close relationships: These observation may again lead to problem gambling being discovered by family or friends.
• Discovered crime: This is usually a real crisis point that the family may discover the truth for the first time.
• Homelessness: Being thrown out of the family home may be the trigger for problem gamblers to be honest for the first time about the mess they are in. 

Discovering that you are the parent of an adolescent problem gambler can be highly stressful – particularly as it is often a problem that parents feel they have to face on their own. Before getting involved with their children parents have to understand the problem as well as the process of problem gambling. By the time a young gambler acknowledges they have a problem, the family may have already gone through a lot of emotional turmoil including feelings of anger, sadness, puzzlement and guilt. Parents should try and get in touch with a helping agency as soon as possible. The following points are appropriate for parents either during or as a follow-up to their initial contact with a helping agency.

• Remember that you are not the only family facing this problem.
• You may be able to help your child by talking the problem through but it is probably better if a skilled person outside the family is also involved.
• Keep in mind that it is a serious matter and that the gambler cannot “just give up”.
• Take a firm stand; whilst it might feel easier to give in to demands and to believe everything they say, this allows your child to avoid facing the problem.
• Remember that your child likes to gamble and is getting something from the activity quite apart from money.
• Do not forget that gamblers are good at lying – to themselves as well as you
• Let your child know that you believe it is a problem even though they may not admit it.
• Encourage your child all the time as they have to be motivated to change
• Be prepared to accept that your child may not be motivated to change until they are faced with an acute crisis.
• Leave the responsibility for gambling and its consequences with the gambler, but also help them to face up to it and to work at overcoming the dependency.
• Do not condemn them, as it is likely to be unhelpful and may drive them further into gambling.
• Setting firm and fair boundaries for your child’s behaviour is appropriate and is likely to be constructive in providing a framework with which to address the dependency.
• Despite what your child may have done it is important to let them know that you still love them. This should be done even if you have to make a ‘tough love’ decision such as asking them to leave home.
• Do not trust them with money until the dependency has been broken. If they are agreeable it is a helpful strategy for a defined short period of time to manage their money for them. In addition, help develop their financial management skills.
• Encourage other alternative activities. Try to identify other activities that the child is good at and encourage them in that.
• Give praise for any achievements (however small) although don’t go over the top.
• Provide opportunities to contribute to the family or the running of the house to develop responsibility.
• Try to listen with understanding and look at them with pleasure. Communication channels between child and parent can easily be blocked so simple measures can pay big dividends.
• Bear in mind that as a parent you will need support too through this long process of helping the child. You will need the support of your family and may also need additional support from a helping agency.

Having successfully broken a dependency on gambling, it is important to put in place measures that will help prevent gambling relapses. Useful strategies include the following:

• Place a limit on future gambling, or avoid gambling altogether.
• Internalise learning and avoid reverting to ingrained reactions to difficult or stressful situations.
• Watch for situations and circumstances that trigger the urge to gamble and be ready to face them.
• Nurture self-esteem – work at feeling good about yourself.
• Develop a range of interests that, preferably, meet similar needs to those that were previously being met by gambling.
• Spend time and energy working at building good human relationships.
• Reassess the significance of money and endeavour to reduce its importance in your life.
• Continue to explore, on occasion, reasons why gambling became so significant in your life.

Other more general steps that gamblers should be encouraged to do include:

• Be honest with themselves and others
• Deal with all outstanding debts
• Accept responsibility for their gambling
• Abstain from gambling while trying to break the dependency
• Talk about how gambling makes them feel
• Take one day at a time
• Keep a record of ‘gambling-free’ days
• Be positive and not give up after a ‘slip’ or a ‘lapse’
• Reward themselves after a gambling-free period
• Develop alternative interests

Parents and practitioners should also be aware that problems are likely to be avoided when the young gambler keeps in control of the situation and ensures that their gambling remains a social activity. The following brief guide is aimed particularly for working with young gamblers but applicable to everyone. It will help ensure that gambling remains an enjoyable and problem-free experience. It is wise to remember that:

• When you are gambling you are buying entertainment, not investing money
• You are unlikely to make money from gambling
• The gaming industry and the government are the real winners
• You should only gamble with money that you can afford to lose
• You should set strict limits on how much you will gamble
• To make profit from gambling you should quit when ahead
• Gambling should only take up a small amount of your time and interest
• Problems will arise if you become preoccupied with gambling
• Gambling within your means is a fun and exciting activity
• Gambling outside your means is likely to create serious problems
• You should not gamble to escape from worries or pressures
• The feeling of being powerful and in control when gambling is a delusion
• A gambling dependency is as damaging as other addictions
• Always gamble responsibly

Hopefully the two parts of this blog have highlighted a potential danger among children and adolescence. It covered risk factors, warning signs to look for, and strategies to help those with a problem. Through education and awareness, it is hoped that gambling problems will be viewed no differently from other potentially addictive substances and that schools will take the issue seriously.

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

Further reading

Bellringer, P. (1999). Understanding Problem Gamblers. London : Free Association Books.

Griffiths, M.D. (1995). Adolescent Gambling. London: Routledge.

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

Griffiths, M.D. (2003). Adolescent gambling: Risk factors and implications for prevention, intervention, and treatment. In D. Romer (Ed.), Reducing Adolescent Risk: Toward An Integrated Approach (pp. 223-238). London: Sage.

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

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

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

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

Griffiths, M.D. & Wood, R.T.A. (2000). Risk factors in adolescence: The case of gambling, video-game playing and the internet. Journal of Gambling Studies, 16, 199-225.

Slots of fun: What should parents and teachers know about adolescent gambling? (Part 1)

Research has consistently shown that a small but significant minority of adolescents have a gambling problem. It has also been noted that adolescents may be more susceptible to problem gambling than adults. In Great Britain, the most recent statistics suggest that around 2% of adolescents have a gambling problem. This figure is two to three times higher than that identified in the adult population. On this evidence, young people are clearly more vulnerable to the negative consequences of gambling than adults.

A typical finding of many adolescent gambling studies has been that problem gambling appears to be a primarily male phenomenon. It also appears that adults may to some extent be fostering adolescent gambling. For example, a strong correlation has been found between adolescent gambling and parental gambling. Similarly, many studies have indicated a strong link between adult problem gamblers and later problem gambling amongst their children. Other factors that have been linked with adolescent problem gambling include working class youth culture, delinquency, alcohol and substance abuse, poor school performance, theft and truancy.

One consequence of the research into adolescent gambling is that we can now start to put together a ‘risk factor model’ of those individuals who might be at the most risk of developing problem gambling tendencies. Based on summaries of empirical research, a number of clear risk factors in the development of problem adolescent gambling emerge. Adolescent problem gamblers are more likely to:

• Be male (16-25 years)
• Have begun gambling at an early age (as young as 8 years of age)
• Have had a big win earlier in their gambling careers
• Consistently chase losses
• Gamble on their own
• Have parents who gamble
• Feel depressed before a gambling session
• Have low self-esteem
• Use gambling to cultivate status among peers
• Be excited and aroused during gambling
• Be irrational (i.e. have erroneous perceptions) during gambling
• Use gambling as a means of escape
• Have bad grades at school
• Engage in other addictive behaviours (smoking, drinking alcohol, illegal drug use)
• Come from the lower social classes
• Have parents who have a gambling (or other addiction) problem
• Have a history of delinquency
• Steal money to fund their gambling
• Truant from school to go gambling

There are also some general background factors that might increase the risk of becoming a problem gambler. Common factors include:

• Broken, disruptive or very poor family
• Difficult and stressful situations within the home
• Heavy emphasis on money within the family
• The death of a parent or parental figure in their childhood
• Serious injury or illness in the family or themselves
• Infidelity by parents
• High incidence of abuse (verbal, physical and/or sexual)
• Feeling of rejection as a child
• Feelings of belittlement and disempowerment

This list is probably not exhaustive but incorporates what is known empirically and anecdotally about adolescent problem gambling. As research into the area grows, new items to such a list will be added while factors, signs and symptoms already on these lists will be adapted and modified. Gambling has often been termed the ‘hidden addiction’. The main reasons for this arise from the problem with the identification. This is because:

• There are no observable signs or symptoms like other addictions (e.g. alcoholism, heroin addiction etc.)
• Money shortages and debts can be explained away with ease in a materialistic society
• Adolescent gamblers do not believe they have a problem or wish to hide the fact
• Adolescent gamblers are exceedingly plausible and become adept at lying to mask the truth
• Adolescent gambling may be only one of several excessive behaviours

Although there have been some reports of a personality change in young gamblers many parents may attribute the change to adolescence itself (i.e., evasive behaviour, mood swings etc. are commonly associated with adolescence). It is quite often the case that many parents do not even realize they have a problem until their son or daughter is in trouble with the police. I have noted there are a number of possible warning signs to look for although individually, many of these signs could be put down to adolescence. However, if several of them apply to a child or adolescent it could be that they will have a gambling problem. The signs include:

• No interest in school highlighted by a sudden drop in the standard of schoolwork
• Unexplained free time such as going out each evening and being evasive about where they have been
• Coming home later than expected from school each day and not being able to account for it
• A marked change in overall behaviour (that perhaps only a parent would notice). Such personality changes could include becoming sullen, irritable, restless, moody, touchy, bad-tempered or constantly on the defensive
• Constant shortage of money
• Constant borrowing of money
• Money missing from home (e.g., from mother’s purse or father’s wallet)
• Selling personal possessions and not being able to account for the money
• Criminal activity (e.g., shoplifting in order to sell things to get money for gambling)
• Coming home hungry each afternoon after school (because lunch money has been spent on gambling)
• Loss of interest in activities they used to enjoy
• Lack of concentration
• A “couldn’t care less” attitude
• Lack of friends and/or falling out with friends
• Not taking care of their appearance or personal hygiene
• Constantly telling lies (particularly over money)

However, many of these ‘warning signs’ are not necessarily unique to gambling addictions and can also be indicative of other addictions (e.g. alcohol and other drugs). Confirming that gambling is indeed the problem may prove equally as difficult as spotting the problem in the first place. Directly asking an individual if they have a problem is likely to lead to an outright denial. Talking with them about their use of leisure time, money and spending preferences, and their view about gambling in general is likely to be more effective. Part 2 to follow in my next blog!

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

Further reading

Bellringer, P. (1999). Understanding Problem Gamblers. London : Free Association Books.

Griffiths, M.D. (1995). Adolescent Gambling. London: Routledge.

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

Griffiths, M.D. (2003). Adolescent gambling: Risk factors and implications for prevention, intervention, and treatment. In D. Romer (Ed.), Reducing Adolescent Risk: Toward An Integrated Approach (pp. 223-238). London: Sage.

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

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

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

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

Griffiths, M.D. & Wood, R.T.A. (2000). Risk factors in adolescence: The case of gambling, video-game playing and the internet. Journal of Gambling Studies, 16, 199-225.