Monthly Archives: December 2014

Stats entertainment (Part 3): A 2014 review of my personal blog

My last blog of 2014 was not written by me but was prepared by the stats helper. I thought a few of you might be interested in the kind of person that reads my blogs. I also wanted to wish all my readers a happy new year and thank you for taking the time to read my posts.

Here’s an excerpt:

The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 1,200,000 times in 2014. If it were an exhibit at the Louvre Museum, it would take about 52 days for that many people to see it.

Click here to see the complete report.

Germanic street preachers: The psychology of Krautrock

Regular readers of my blog will be aware that I describe myself as a music obsessive with an eclectic taste ranging from Iggy Pop and Adam Ant through to the Velvet Underground and Throbbing Gristle. Another genre of music that I have more than a passing interest is that of ‘Krautrock’ (see my previous blog on Kraftwerk and their alleged addiction to cycling). Krautrock (as you can probably guess) is a somewhat derogatory term – believed to have been coined by the renowned music journalist Ian MacDonald – to describe a number of German bands that came to the fore in the British music scene in the early 1970s (most notably Amon Düül, Faust, Can, Kraftwerk, Neu!, Kluster, Cluster, Harmonia, Popol Vuh, Ash Ra Tempel, and Tangerine Dream).

Krautrock (as defined by the British media) has traditionally been viewed as electronic in nature (although many of the compositions in the late 1960s were far from electronica and utilized ‘found sounds’ from whatever was to hand) with an emphasis on improvisation and somewhat minimalistic arrangements. The Wikipedia entry on Krautrock also notes that:

“The term is a result of the English-speaking world’s reception of the music at the time and not a reference to any one particular scene, style, or movement, as many Krautrock artists were not familiar with one another…Largely divorced from the traditional blues and rock and roll influences of British and American rock music up to that time, the period contributed to the evolution of electronic music and ambient music as well as the birth of post-punt, alternative rock, and new-age music”.

Given my profession, it won’t surprise you to know that as much as I love music itself, I am also interested in the psychology of the musicians too. When it comes to Krautrock, I have argued for the best part of 20 years (to anyone that would listen) that the psychology of the archetypal Krautrocker in the late 1960s was likely to be influenced by being raised in post-second world war Germany. It was only over the holiday period that my thoughts were confirmed by the artists themselves (in interviews with journalists and musicologists).

More specifically, I read two excellent books on different aspects of ‘extreme music’ over the Christmas period – Future Days: Krautrock and the Building of Modern Germany (by David Stubbs), and Assimilate: A Critical History of Industrial Music (by S. Alexander Reed). Alongside this, I also watched the wonderful three-hour documentary DVD Kraftwerk and the Electronic Revolution, the BBC 4 documentary, Krautrock: The Rebirth of Germany, and the 2008 film The Baader Meinhof Complex (about the Red Army Faction, left-wing German militant group and based on the 1985 non-fiction book of the same name by Stefan Aust).

These books and films all made reference to the cultural, political, and psychological climate in post-war West Germany. There were a number of repeated themes that I couldn’t fail to notice. Firstly, many of the middle classes holding a lot of the important jobs (mayors, town leaders, judges, professors, teachers) were still Nazi sympathizers. Secondly, children born after 1945 were generally not told about their history by either their parents or their schoolteachers. Thirdly, in the late 1950s and early 1960s, teenagers said they experienced feelings of guilt but didn’t know what for. On the musical front, West Germany’s pre- and post-war musical legacy was “Schlager” music (described by music journalist Adam Sweeting as a genre unpleasantly redolent of the sentimental slop with which Josef Goebbels had saturated the Third Reich”). As Wikipedia notes that:

“Schlager music (German: Schlager, synonym of “hit-songs” or “hits”), also known in the United States as entertainer music or German hit mix, is a style of popular or electronic music…Typical schlager tracks are either sweet, highly sentimental ballads with a simple, catchy melody or light pop tunes. Lyrics typically center on love, relationships and feelings”.

By the late 1960s, many older teenagers and students were united in their politics (the most high profile touch point arguably being the student protests across Europe in 1968). They were also united in their dislike of schlager music except they didn’t really know they were united. Pockets of underground music sprouted up across a number of towns and cities across Germany. Key bands in the history of Krautrock were formed in Dusseldorf (Neu!, Kraftwerk), Cologne (Can), Berlin (Kluster, Tangerine Dream), Munich (Amon Düül), and Wumme (Faust). Bands playing in one city had no idea that bands were forming in other parts of Germany with similar ideological, political and psychological roots. More bizarre was that none of these bands – at least initially – had no following in Germany itself. Most fans of these bands were in the UK rather than their homeland. It was the British music press (NME, Sounds) and DJs (most notably John Peel) that were waving the German flag.

Arguably, the most overtly political of the emerging Krautrock bands was Munich’s Amon Düül. Their band members lived in a radical West German commune including the gang that formed the Red Army Faction (RAF) in 1970 (the so-called Baader-Meinhof Group (or Baader-Meinhof Gang including Andreas Baader, and Ulrike Meinhof). The members of Amon Düül quickly dissociated themselves from the RAF saying that their comrades were going too far in making their political presence known. In fact, the band members ended up falling out with themselves leading to different versions of the band with the second incarnation (Amon Düül 2) becoming the most revered.

Another important hotbed of anti-schlager musical development was the formation of the Zodiak Free Arts Lab (also known as the Zodiak Club) by experimental musician Conny Schnitzler in West Berlin. The Zodiak Club provided a hub where anyone could come and play whatever they wanted amongst like-minded people pushing the boundaries of music with whatever was at hand. Schnitzler himself was an early member of Tangerine Dream as well as the founding member of later Krautrock bands such as Kluster and Eruption. The other important figure in West Berlin’s burgeoning Krautrock scene was Hans-Joachim Roedelius who played with Schnitzler in Kluster but then went on to form Cluster with Deiter Moebius (another key player in the Krautrock movement) but without Schnitzler.

In relation to the psychology of Krautrock, Michael Rother (an early member of Kraftwerk, co-founder of Neu!, and later in ‘supergroup’ Harmonia) was interviewed by David Stubbs in his book Future Days. Rother had actually studied psychology and that as a German he strived for an alternative identity, and a new personality almost:

“Studies into psychology also assisted Rother in realizing that as a young man coming of age in Germany in the late 1960s, he could not be impervious to the cultural, social and political forces ranging at that time, all of which would have a profound impact on his musical identity. He rejected out of hand the burgeoning violence and ‘lunacy’ of terrorist movements such as the Baader-Meinhof group, whom he regarded as on the wrong road altogether. At the same time, the horrors of the Vietnam War acted as a jolting reminder of the need to wrench oneself away from Anglo-American hegemony, to create oneself as a personality anew”.

Rother’s perceptions and psychological insights appear to have been shared by many other individuals forming bands across West Germany in the late 1960s. The complete silence by parents and teachers towards children about the actions of Hitler and the Nazis (most notably the genocide of the Jewish people living in Germany) left post-war adolescents psychologically ill at ease about their national and cultural identities. They needed to create something unique, something identifiably German, and something they would feel proud of. The new music of Krautrock met such criteria. But was the music really that new? Some (including myself) would argue that much of the burgeoning music in Munich, Dusseldorf, Cologne and Berlin had its’ roots in ‘musique concrète’ (“concrete music”) and the work of Karlheinz Stockhausen.

Developed by French composer Pierre Schaeffer at the Studio d’Essai (“Experimental Studio”) of the French radio system, musique concrète is a form of electroacoustic music. It comprises an experimental technique of musical composition that uses recorded sounds as raw material to create a montage of sound (often referred to as ‘found sounds’ but can include recordings of voice and musical instruments). Musique concrète compositions don’t follow any conventional musical rules of melody, rhythm or harmony. Many musicologists view musique concrete as a precursor to electronica. Furthermore, many groups from Throbbing Gristle to Depeche Mode have sampled ‘found sounds’ in their musical output as well as many of the earlier pioneers in Krautrock.

The roots of Krautrock can also be traced back to one of Germany’s musical giants, Karlheinz Stockhausen. I’ve been aware of Stockhausen’s work through his influence on the Beatles (Stockhausen is one of the figures on their 1967 Sgt. Pepper’s Lonely Hearts Club Band LP cover). Although in the public’s mind it was John Lennon that was associated with the more avant-garde recordings by the Beatles (‘Revolution 9’ and ‘What’s The New Mary Jane’) and his first solo albums with second wife Yoko Ono (Two Virgins, Life With The Lions, and Wedding Album), it was actually Paul McCartney who first developed an interest in avant-garde composers such as Stockhausen. (In fact, prior to his relationship with Ono, Lennon was famously quoted as saying “Avant-garde is French for bullshit”). Evidence for McCartney’s interest in Stockhausen and the avant-garde is the still unreleased Beatles composition ‘The Carnival of Light’ recorded in January 1967 for The Million Volt Light and Sound Rave held at the Roundhouse Theatre).

Stockhausen is seen by many as one of the greatest musical innovators and visionaries of the twentieth century. His electronic compositions were way ahead of his time, and had a large influence on many more modern day recording artists including Frank Zappa, Pete Townsend (The Who), Roger Waters (Pink Floyd), and Björk. In relation to Krautrock, two members of Can (Irmin Schmidt and Holger Czukay) were actually tutored by Stockhausen at the Cologne Courses for New Music, and Kraftwerk claim they also studied under him.

In terms of Krautrock’s influence on modern music, it doesn’t matter whether it was genuinely new. It was genuinely (West) German and grew largely from individuals’ psychological and/or political reaction to their experiences of growing up in post-war Germany following the fall of Nazism. The content of the output may not have been psychologically-based, but the attitude and spirit in making such music arguably was. We are all products of our genetics and our environment, and post-war teenagers born after 1945 in Germany experienced a culture and an immediate history that most can never ever experience. The Krautrockers fighting (artistically, culturally and literally) against the ‘establishment’ in late 1960s brought about some of the greatest music ever produced, and I for one, am eternally grateful for the pleasure it has brought in my own life.

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

Further reading

Blaney, J. (2005). John Lennon: Listen to this Book. Guildford: Paper Jukebox, Biddles Ltd.

Buckley, D. (2012). Kraftwerk Publication. London: Omnibus.

Cope, J. (1996). Krautrocksampler (Second Edition). Head Heritage.

Reed, S.A. (2013). Assimilate: A Critical History of Industrial Music. New York: Oxford University Press.

Stubbs, D. (2014). Future Days: Krautrock and the Building of Modern Germany. London: Faber & Faber.

Wikipedia (2014). Krautrock. Located at:

Wikipedia (2014). Musique concrète. Located at:ète

Strange fascinations: A brief look at unusual compulsive and addictive behaviours

In previous blogs, I have examined lots of strange types of addictive and compulsive behaviours including compulsive singing, compulsive hoarding, carrot eating addiction, Argentine tango addiction, compulsive nose-picking, compulsive punning, compulsive helping, obsessive teeth whitening, compulsive list-making, chewing gum addiction, hair dryer addictionwealth addiction, and Google Glass addiction (to name just a few).

However, while doing some research for a paper I am writing on ‘fishing addiction’ (yes, honestly), I came across an interesting paper on unusual compulsive behaviours caused by individuals receiving medication for Parkinson’s disease ([PD] a degenerative disorder of the central nervous system) and multiple system atrophy ([MSA] a degenerative neurological disorder in which nerve cells inside the brain start to degenerate and with symptoms similar to Parkinson’s disease).

In the gambling studies field there are now numerous papers that have been published showing that some Parkinson’s patients develop compulsive gambling after being treated for PD. According to the website, those undergoing PD treatment can have many side effects including addictive gambling, obsessive shopping, binge eating, and hypersexuality. The website also notes other types of compulsive behaviour that have been associated with PD medication including “punding or compulsive hobbyism [when someone does things such as collecting, sorting or continually handling objects]. It may also be experienced as (i) a deep fascination with taking technical equipment apart without always knowing how to put it back together again, (ii) hoarding things, (iii) pointless driving or walking, and (iv) talking in long monologues without any real content”.

The paper that caught my eye was published in a 2007 issue of the journal Parkinsonism and Related Disorders by Dr. Andrew McKeon and his colleagues. They reported seven case studies of unusual compulsive behaviours after treating their patients with dopamine agonist therapy (i.e., treatment that activates dopamine receptors in the body). The paper described some compulsive behaviours that most people would not necessarily associate with being problematic. Below is a brief description of the seven cases that I have taken verbatim from the paper.

  • Patient 1: “A 65-year-old female with PD for 9 years developed compulsive eating, and also felt compelled to repetitively weigh herself at frequent intervals during the day and at night. She found her behavior both purposeless and repetitive. Obsessive thoughts were also a feature, as the patient ‘had to’ weigh herself three times each occasion she used the weighing scales”.
  • Patient 2: “A 67-year-old female with PD for 8 years played computer games and solitaire card games for hours on end, often continuing to do so through the night. She did not enjoy the experience and found it purposeless, but did so as she felt she had ‘to be doing something’. She also developed compulsive eating and gambling”.
  • Patient 3: “A 48-year-old male with PD for 5 years, with little prior interest, developed an intense interest and fascination with fishing. His wife was concerned that he fished incessantly for days on end, and his interest did not abate despite never catching anything. This patient also developed compulsive shopping, spending large amounts of time and money in thrift stores”.
  • Patient 4: “A 53-year-old male with PD for 13 years became intensely interested in lawn care. He would use a machine to blow leaves for 6h without rest, finding it difficult to disengage from the activity, as he found the repetitive behavior soothing. He also developed compulsive gambling”.
  • Patient 5: “The wife of a 52-year-old male with an 11-year history of PD complained that her husband now spent all of his time on his hobbies, to the detriment of their marriage. The patient made small stained glass windows, day and night. In addition, he would frequently stay awake arranging rocks into piles in their yard, intending to build a wall, but never doing so. He would start multiple projects but complete nothing. He was also noted to have become hypersexual, demanding sexual intercourse from his wife several times daily”.
  • Patient 6: “This 60-year-old male, with a history of alcohol abuse and ultimately diagnosed with MSA, relentlessly watched the clock, locked and unlocked doors and continually arranged and lined up small objects on his desk. He also became hyperphagic and hypersexual, developing an intense fascination with pornographic films”.
  • Patient 7: “The wife of a 59-year-old male with PD for 1 year described how her husband dressed and undressed several times daily. On one occasion, while guests were at their house for dinner, he spent most of his time in his bedroom repeatedly changing from one pair of trousers into another. This behavior deteriorated considerably on increasing levodopa dose to 1100mg/day, and on a subsequent occasion after reducing quetiapine from 100 to 75 mg/day”.

These cases highlight that the compulsive behaviours that develop following dopamine agonist therapy often co-occur with one or more other compulsive behaviour and that much of these behaviours are repetitive and unwanted. As the authors noted:

“The temporal association between medication initiation and the onset of these behaviors led to our suspicion that medications were causative. In the aggregate, these patients illustrate that the behaviors provoked by drug therapy in parkinsonism cover a broad spectrum, ranging from purposeless and repetitive to complex, reward-oriented behaviors. Punding is the term typically applied to the former, and was seen in Patient 5 (arranging rocks into piles) and Patient 6 (lining up small objects on a desk)…Previous descriptions of pathological behaviors occur- ring with dopaminergic therapy in PD have been notable for the absence of obsessive thoughts accompanying compulsive behaviors, unlike Patient 1 who was remark- able for a counting ritual accompanying repetitive use of a weighing scale. In six of the seven cases, other reward- seeking behaviors (gambling, shopping, hypersexuality or overeating) were present and contemporaneous with these other unusual compulsive behaviors. This suggests that all of these behaviors, while phenomenologically distinct, are all part of the range of psychopathology encapsulated by obsessive-compulsive spectrum disorders”.

According to the website, PD sufferers are more likely to experience impulsive and compulsive behaviour if the person is (i) diagnosed with Parkinson’s at a young age, (ii) male, (iii) single and live alone, (iv) a smoker, and (v) someone with a personal or family history of addictive behaviour. The same article also notes that if the PD sufferer has a history of ‘risk-taking’, such as gambling, drug abuse or alcoholism, [they] may be more likely to develop dopamine addiction”. This is where the PD sufferer takes more of their medication than is needed to control their Parkinson’s symptoms (and known as dopamine dysregulation syndrome). Similarly, Dr. McKeon and colleagues concluded:

“Previously described associated clinical features include a prior history of depressed mood (four patients in this series), disinhibition, irritability and appetite disturbance…A history of problems with impulse control prior to the diagnosis of PD may be a risk factor for developing compulsive behaviors with dopaminergic therapies…although this only pertained to Patient 6…The compulsions were not found to be troublesome by three patients, with complaints regarding behavioral change coming from the patient’s spouse. Our observations affirm the need to check with both patient and family at follow-up visits for the emergence of a variety of troublesome pathological behaviors that may result from dopaminergic therapy, particularly dopamine agonists”.

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

Further reading

Dodd, M. L., Klos, K. J., Bower, J. H., Geda, Y. E., Josephs, K. A., & Ahlskog, J. E. (2005). Pathological gambling caused by drugs used to treat Parkinson disease. Archives of Neurology, 62, 1377-1381.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

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

Klos, K. J., Bower, J. H., Josephs, K. A., Matsumoto, J. Y., & Ahlskog, J. E. (2005). Pathological hypersexuality predominantly linked to adjuvant dopamine agonist therapy in Parkinson’s disease and multiple system atrophy. Parkinsonism and Related Disorders, 11, 381-386.

McKeon, A., Josephs, K. A., Klos, K. J., Hecksel, K., Bower, J. H., Michael Bostwick, J., & Eric Ahlskog, J. (2007). Unusual compulsive behaviors primarily related to dopamine agonist therapy in Parkinson’s disease and multiple system atrophy. Parkinsonism and Related Disorders, 13(8), 516-519.

Nirenberg, M. J., & Waters, C. (2006). Compulsive eating and weight gain related to dopamine agonist use. Movement Disorders, 21, 524-529.

Pontone, G., Williams, J. R., Bassett, S. S., & Marsh, L. (2006). Clinical features associated with impulse control disorders in Parkinson disease. Neurology, 67, 1258-1261.

Voon, V., Hassan, K., Zurowski, M., De Souza, M., Thomsen, T., Fox, S.,…& Miyasaki, J. (2006). Prevalence of repetitive and reward-seeking behaviors in Parkinson disease. Neurology, 67, 1254-1257.

Hoover damn! A brief look at sexual injury by vacuum cleaners

While researching an article on bizarre sexual injuries, I recently came across a paper on penile skin loss in a 2014 issue of Surgical Science by a group of plastic surgeons led by Dr. Adel Tolba. In the paper, the authors noted that penile skin loss “can result from traction by mechanical devices, such as farm or industrial machinery, or by suction devices, such as vacuum cleaners”. This got me wondering to what extent sexual injuries caused by vacuum cleaners had been reported in the medical literature. The earliest paper that I could on the topic was published in a 1960 issue of the British Medical Journal by Dr. Miles Fox and Dr. E.L. Barrett, and simply entitled ‘Vacuum cleaner injury of the penis’. They reported three cases of similar looking penile injuries caused by three British men seeking sexual stimulation from a vacuum cleaner.

  • Case 1: “A widower aged 57 attended hospital…because of penile lacerations…Returning from having a few drinks in a public-house and seeking erotic satisfaction, he introduced his penis into the end of a vacuum cleaner tube and switched on the machine. However, pain soon caused him to stop, and then he found his penis was congested and bleeding. On examination the glans penis was extensively lacerated, the lacerations appearing almost ‘explosive’ in nature. The urethra was not involved. The lacerations were sutured with catgut, and a soft rubber catheter was introduced for several days. Recovery was uneventful”.
  • Case 2: “A 28-year-old bachelor attended hospital…with similar extensive lacerations of the glans penis extending into the external urethral meatus. The prepuce was also lacerated. He had produced the injuries in exactly the same manner as the [patient in Case 1 above]. Circumcision was performed, the lacerations of the glans were sutured with catgut, and a self-retaining urethral catheter was introduced. Healing was satisfactory without any sign of stricture”.
  • Case 3: “A widower aged 75 [years] attended hospital…in great mental distress and complaining of pain, swelling, and laceration of the penis. He stated that while cleaning the stairs his penis had accidentally slipped into the end of a Hoover ‘Dustette’ vacuum cleaner. However he then attempted to obtain erotic stimulation by switching the motor on and off…The lacerations were not extensive enough to warrant suture or circumcision, and healed satisfactorily in two weeks”

Fox and Barrett described the use of masturbation via a vacuum cleaner as “rather ingenious but had disastrous results”. They concluded that no previous cases of penile injury by vacuum cleaner had ever previously been reported in the medical literature.

In 1973, Dr. Robert Zufall published a letter in the Journal of the American Medical Association (JAMA) describing a penile laceration caused by a vacuum cleaner. Dr. Zufall did not mention any sexual motive for the injury but a follow-up letter in the JAMA by Dr. Rodney Mannion responded that:

“[Dr. Zufall] appears to regard these injuries as possibly accidental. We in urology tend to believe that they occur as a form of masturbation. I have had a patient with this injury who admits to this practice, and a number of urologists also have had similar cases as we discovered at a meeting of the New England Section of the American Urologists Association in October 1972. Many of the urologists present knew of this injury”.

In 1980, another four case studies of penile sexual injuries caused by vacuum cleaners were published in the British Medical Journal by Dr. N. Citron and Dr. P. Wade:

  • Case 1: “A 60-year-old man said that he was changing the plug of his 
Hoover Dustette vacuum cleaner in the nude while his wife was out shopping. 
It ‘turned itself on’ and caught his penis, causing tears around the external 
meatus and deeply lacerating the side of the glans. The external meatus was 
reconstructed and the multiple lacerations of the glans repaired with catgut. 
The final result was some scarring of the glans, but the foreskin moved easily 
over it”.
  • Case 2: “A 65-year-old railway signalman was in his signal box when he 
bent down to pick up his tools and ‘caught his penis in a Hoover Dustette, 
which happened to be switched on’. He suffered extensive lacerations to the 
glans, which were repaired with catgut with a good result”.
  • Case 3: “A 49-year-old man was vacuuming his friend’s staircase in a loose-fitting dressing gown, when, intending to switch the machine off, he 
leaned across to reach the plug: ‘at that moment his dressing gown became 
undone and his penis was sucked into the vacuum cleaner’. Because he had a 
phimosis [a condition in males where the foreskin cannot be fully retracted over the glans penis] he suffered multiple lacerations to the foreskin as well as 
lacerations to the distal part of the shaft of the penis, including the 
external meatus. His wounds were repaired with catgut and the phimosis 
reduced with a dorsal slit”.
  • Case 4: “This patient was aged 68 [years], and no history was available except 
that the injury was caused by a vacuum cleaner. The injury extended through 
the corpora cavernosa and the corpus spongiosum and caused complete division 
of the urethra proximal to the corona. A two-stage urethroplasty was 
performed, and the final result was satisfactory”.

Citron and Wade then noted that (apart from the patient with phimosis) that the injuries were predominantly lacerations to the [penile] glans, “presumably because the 
foreskin was retracted at the time”. The final case was the most serious and required significant surgery to repair the damage. It was also noted that 
at least two of the penile injuries were caused by a Hoover Dustette (as was one in the 1960 paper), which 
the authors noted had fan blades of about six inches from the inlet. They concluded that the “patients may 
well have thought that the penis would be clear of the fan but were driven to 
new lengths by the novelty of the experience and came to grief”. In response to this paper, Dr. J.T. Hill wrote a letter to the British Medical Journal and noted that:

“In a series of 57 penile injuries reported at the annual meeting of the British Association of Urological Surgeons in June 1980, I reported three patients with this condition. Their ages were, typically, 66, 55, and 60 years. They had suffered degloving injuries and two patients required suturing of multiple lacerations and one required split skin grafting. All three patients underwent urethral catheterization for urinary retention”.

In a 1979 issue of European Urology, Dr. U. Wenderoth and Dr. U. Jonas examined 48 masturbation injuries. Of these, they reported that 12 comprised ‘foreign bodies’ introduced into the urethra and urinary bladder while the other 36 cases comprised ‘vacuum cleaner injuries’ to the penis. In 1984, Dr. Jack McAninch and his colleagues published a paper in the Journal of Trauma-Injury Infection and Critical Care that examined major injuries to the testicles, penis, and genital skin from trauma in 62 of their patients over a six-year period (1977 to 1983). They reported seven suction-end vacuum cleaner injuries in their sample.

In 1985, Dr. Ralph Benson wrote a paper in the journal Urology asking whether vacuum cleaner injuries to the penis were a common urologic problem. He presented five cases studies of such penile injuries (including a case of a man that had lost the glans of his penis). He concluded that contrary to apparent public appreciation, injury due to this form of autostimulation may not be unusual”.

An Italian paper Rossi et al in a 1991 issue of Minerva Urologica e Nefrologica reported the case of penile injury caused by masturbating using a vacuum cleaner. The vacuum cleaner caused skin lesions and urethral lacerations (but were successfully treated). The authors stressed “the extreme rarity of the case”. Since then academic papers in the topic appear to have dried up somewhat.

In 1998, a news story made worldwide headlines when a 51-year-old man from Long Branch (New Jersey, USA) cut off half an inch of his penis (and nearly bled to death) after masturbating with a
vacuum cleaner. He first told legal and medical authorities that he had been stabbed in his penis by someone as he slept. However, it later became apparent that he was trying to gain sexual pleasure from the vacuum cleaner’s suction. However, he hadn’t realised there was a blade that pushed dust into the vacuum cleaner’s bag. Fortunately, medics at Monmouth Medical Center stopped the bleeding (saving the man’s life) but
were unable to reattach the severed part of his penis. As far as I am aware, this case was never reported in the medical literature and only in the popular press.

The most recent (possible) case that I have come across was a 2005 case study published in a German journal by Dr. J. Falk and his colleagues. They reported the case of a 61-year-old man that was admitted to hospital with a partially severed penis. The authors reported:

“The head of the penis (glans) had been completely severed, and the skin of the shaft and the corpora cavernosa had been ripped open. In the hospital the patient reported that his penis got caught in the hose attachment of an old Kobold vacuum cleaner that he was using to inflate an air mattress. He later made contradictory statements in his report to the insurance company, so we were asked to reconstruct the circumstances of the accident. The literature available to us only makes clinical observations about similar accidents, always with the assumption that the vacuum cleaner was used during masturbation or in order to achieve an erection. According to our reconstruction of the accident and an investigation of the vacuum cleaner attachment, however, we could not rule out the possibility of a household accident as described by the patient”.

The lack of more recent (and definitive) reports about masturbatory penile injuries caused by vacuum cleaners in the medical literature suggests they are either less commonplace than they used to be and/or there are as many as there have ever have been over the last few decades but are not as journal-worthy (as they are no longer novel).

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

Further reading

Benson, R. (1985). Vacuum cleaner injury to penis: A common urologic problem? Urology, 25(1), 41-44.

Citron, N.D., & Wade, P.J. (1980). Penile injuries from vacuum cleaners. British Medical Journal, 281(6232), 26.

Falk, J., Riepert, T., & Rothschild, M. A. (2005). [Traumatic partial amputation of a penis – A reconstruction of the circumstances of the accident]. Versicherungsmedizin/herausgegeben von Verband der Lebensversicherungs-Unternehmen eV und Verband der Privaten Krankenversicherung eV, 57(1), 17-19

Fox, M., & Barrett, E.L. (1960). ‘Vacuum cleaner injury’ of the penis. British Medical Journal, 1(5190),1942.

Hill, J. T. (1980). Penile injuries from vacuum cleaners. British Medical Journal, 281(6238), 519.

Mannion, R.A. (1973). Penile Laceration. Journal of the American Medical Association, 224, 1763-1763

McAninch, J.W., Kahn, R.I., Jeffrey, R.B., Laing, F.C., & Krieger, M.J. (1984). Major traumatic and septic genital injuries. Journal of Trauma-Injury, Infection, and Critical Care, 24, 291-298.

Morey, A.F., & Rozanski, T. A. (2007). Genital and lower urinary tract trauma. Campbell-Walsh Urology, 3, 49-50.

Nolan, J. (1998). Love story with a cutting edge., may 14. Located at:

Pryor, J. P., Hill, J. T., Packham, D. A., & Yates‐Bell, A. J. (1981). Penile injuries with particular reference to injury to the erectile tissue. British Journal of Urology, 53(1), 42-46.

Rossi, M., Cascini, F., & Torcigliani, S. (1991). [Penile injuries caused by masturbation with a vacuum cleaner. Description of a case and review of the literature]. Minerva Urologica e Nefrologica, 44(1), 43-45.

Tolba, A. M., Azab, A. A. H., Nasr, M. A., & Salah, E. (2014). Dartos fascio-myo-cutaneous flap for penile skin loss: A simple flap with an immense potential. Surgical Science, 5, 6-9.

Wenderoth, U., & Jonas, U. (1979). Curiosity in urology? Masturbation injuries. European Urology, 6, 312-313.

Zufall, R. (1973). Laceration of penis from hand vacuum cleaner. Journal of the American Medical Association, 224, 630.

Double trouble: Syndrome of subjective doubles‬

In a previous blog on Delusional Misidentification Syndromes, I briefly mentioned the rare syndrome of ‘subjective doubles’ (SSD). Also known as Christodoulou syndrome (after the Greek psychiatrist Dr. George Nikos Christodoulou who first wrote about the syndrome), SSD 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 but that have part or sometimes all of the SDD sufferer’s personality. If the sufferer believes that (some or all of) their personality has been transferred to their doppelganger, they may also experience depersonalization (i.e., a problem of self-awareness in which individuals feel they have little control over social situations and feel they are watching themselves act in a vague and dreamlike state. 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. The Wikipedia entry on SSD cited the case of a man who became depersonalized after an operation and was convinced his brain had been placed into someone else’s head and then claimed he recognized the other person.

In the original paper on SSD in a 1978 issue of the American Journal of Psychiatry, Dr. Christodoulou described the case of a young 18-year-old woman who claimed that a female neighbour had (via an “elaborate transformation” involving “metapmophosis”) acquired all of her physical characteristics (“same face, same build, same clothes, same everything’) and become an identical double. To become her double, the female case study believed her doppelganger had used a mask, wig, and special makeup. Her female neighbour wasn’t the only doppelganger as the woman also claimed at least one other woman had become her doppelganger. In rare instances, there may be comorbidity with the Capgras delusion (another misidentification syndrome) and is then referred to ‘subjective Capgras syndrome’. In fact, there are a number of different sub-types of SDD. As the online Dictionary of Hallucinations notes:

A subdivision of the syndrome of subjective doubles yields a ‘Capgras type’ (characterized by the delusional conviction that unseen doubles are active in the affected individual’s environment), an ‘autoscopic type’ (in which doubles of the self are perceived, ‘projected’ onto other people or objects, as in pareidolia), and a ‘reverse type’ (in which the affected individual believes to be an impostor or to be about to be replaced by someone else). The syndrome of subjective doubles is associated with various psychiatric disorders (notably the group of so-called schizophrenia spectrum disorders) and neurological disorders (notably disorders of the right parieto-temporal lobe). Conceptually and phenomenologically, the syndrome of subjective doubles constitutes the counterpart of a syndrome called ‘mirrored self-misidentification’, in which the affected individual is unable to identify his or her mirror image as oneself”.

Although most sources cite Dr. Christodoulou’s paper in the American Journal of Psychiatry as the first recorded case of SSD, he actually published a paper a year earlier in a 1977 issue of Acta Psychiatrica Belgica on the treatment of the syndrome of doubles. In this paper, Christodoulou used biological methods to treat 20 psychiatric patients with SDD or the related syndromes (Frégoli, intermetamorphosis, Capgras) aged 17 to 67 years of age. His patients were treated with ECT, antidepressants, neuroleptics, and antiepileptics (in some cases given singly whereas others were in combination). It was reported that:

“Results show that (a) the syndrome of doubles responded to various biological treatment methods; (b) in depression, it responded to tricyclic antidepressants; (c) in schizophrenia or organic psychosis, it usually responded to neurolytics; (d) in schizophrenia, it had more chances of responding to trifluoperazine given alone or in association with other psychopharmacological drugs; and (e) in certain cases, combination of antipsychotic treatment with treatment of coexisting organic dysfunctions appeared to be important”.

In another 1978 paper (in the Journal of Nervous and Mental Disease), Dr. Christodoulou described the course and prognosis of 20 patients with the syndrome of doubles (including Capgras syndrome, Fregoli syndrome, intermetamorphosis syndrome, and SDD – and presumably the same cases reported in the 1977 paper). He reported that the onset of the syndromes occurred either synchronously or at a later stage than the onset of the associated psychosis. In seven of the 20 cases, the syndrome failed to remit. In the remaining 13 cases, remission occurred either synchronously with or later than the remission of the basic psychosis. In all cases where there was comorbid depression, the syndromes cleared shortly after the successful treatment of the depressive illness. It was also noted that relapse of the basic psychotic condition in the setting of which the syndrome had originally developed was usually accompanied by the syndrome reappearing. In one of his most recent papers (from a 2009 issue of Current Psychiatry Reports), Christodoulou and three of his colleagues noted that:

“The delusional misidentification syndromes [including SDD] are rare psychopathologic phenomena that occur primarily in the setting of schizophrenic illness, affective disorder, and organic illness. They are grouped together because they often co-occur and interchange, and their basic theme is the concept of the double. They are distinguished as hypoidentifications (Capgras’ syndrome) and hyperidentifications (the other three syndromes [including SDD]).,,[We] propose that the appearance of these syndromes must alert physicians to investigate the existence of possible organic contributions”.

Compared to other misidentification syndromes, SDD appears to be relatively rare and is often comorbid with other similar conditions. For instance, in a 1986 issue of the Journal of Clinical Psychiatry, Dr. A.B. Joseph described the case of a 30-year old white male who had SDD along with paranoid schizophrenia, Cotard’s syndrome, Capgras delusion, and palinopsia (visual perseveration). Joseph concluded that cerebral dysfunctions in the confluence of the parietal, temporal, and occipital regions of the brain appeared to account for the disorders. Similarly, a 1996 paper in the journal Australasian Psychiatry, Dr. S. Atwal and Dr. M. Khan reported an unusual case of Capgras syndrome coexisting with three related syndromes (Fregoli syndrome, intermetamorphosis syndrome, and SDD).

In a more recent 1991 paper in the journal Psychological Medicine, Dr. H. Forstl and his colleagues examined the psychiatric, neurological and medical aspects of 260 cases suffering misidentification syndromes. Among the sample SDD was relatively rare as 174 cases had a Capgras syndrome misidentifying other persons, 18 a Fregoli syndrome, 11 intermetamorphosis, 17 reduplicative paramnesia and the rest had other forms or combinations of mistaken identification (including SDD). The most common comorbid disorders among those who misidentified themselves or other were schizophrenia (n=127; mostly paranoid schizophrenia), affective disorder (n=29), and organic mental syndromes including dementia (n=46). The authors reported that:

“The misidentification of persons can be a manifestation of any organic or functional psychosis, but the misidentification of place is frequently associated with neurological diseases, predominantly of the right hemisphere. Misidentification syndromes show a great degree of overlap and do not represent distinctive syndromes nor can they be regarded as an expression of a particular disorder. These patients deserve special diagnostic and therapeutic attention because of the possible underlying disorders and their potentially dangerous behaviour”.

Finally, I thought I would leave you with a paper from a 2005 issue of the journal Psychopathology that reported some extreme cases involving delusional misidentification syndromes (DMS) and the danger associated with them. Dr. M. Aziz and his colleagues reported on three cases with histories of paranoid schizophrenia tall of who developed DMSs:

“Two of them acted out on delusional thinking toward their sons. Case 1 managed to kill her son and Case 2 was caught twice trying to choke him. Our case reports suggest that the degree of threat perceived by the patient from the delusionally misidentified object is the most important factor in determining the patient’s response to the delusions. Alcohol and substance intoxication facilitated the patients’ acting out on their delusions, but did not explain the genesis of the delusions. There is a need to continue to study patients with DMS in order to provide opportunity for greater understanding of the psychopathology of DMS”.

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

Further reading

Atwal, S., & Khan, M. H. (1986). Coexistence of Capgras and its related syndromes in a single patient. Australasian Psychiatry, 20, 496-498.

Aziz, M.A., Razik, G.N., & Donn, J.E. (2005). Dangerousness and management of delusional misidentification syndrome. Psychopathology, 38(2), 97-102.

Christodoulou, G.N. (1977). Treatment of the syndrome of doubles. Acta Psychiatrica Belgica, 77(2), 254-259.

Christodoulou, G.N. (1978). Syndrome of subjective doubles. American Journal of Psychiatry, 135, 249-251.

Christodoulou, G.N. (1978). Course and prognosis of the syndrome of doubles. Journal of Nervous and Mental Disease 166, 73-78.

Christodoulou, G.N., Margariti, M., Kontaxakis, V. P., & Christodoulou, N. G. (2009). The delusional misidentification syndromes: strange, fascinating, and instructive. Current Psychiatry Reports, 11(3), 185-189

Dictionary of Hallucinations (2013). Syndrome of subjective doubles. Located at:

Enoch, D., Ball, H. (2001). Uncommon Psychiatric Syndromes (Fourth Edition). London: John Wright & Sons.

Forstl, H.A.N.S., Almeida, O. P., Owen, A. M., Burns, A., & Howard, R. (1991). Psychiatric, neurological and medical aspects of misidentification syndromes: A review of 260 cases. Psychological Medicine, 21, 905-910.

Joseph, A.B. (1986). Cotard’s syndrome in a patient with coexistent Capgras’ syndrome, syndrome of subjective doubles, and palinopsia. Journal of Clinical Psychiatry, 47, 605-606.

A touch too much? A brief look at hyphephilia

In a previous blog I briefly examined frotteurism (in which a person derives sexual pleasure or gratification from rubbing, especially the genitals, against another non-consensual person, typically in a public place such as a crowded train, or in crowded places such as malls, elevators, on busy sidewalks, and on public transportation vehicles). This behaviour is closely related to (or a sub-type) of ‘toucherism’ depending upon which source you read. Some descriptions of toucherism claim that the individual touches or fondles other people (rather than rubbing) to gain sexual arousal. For instance, the online Psychology Dictionary define toucherism as carnal interest and stimulation gathered from touching a stranger on an erotic area of their body, especially the buttocks, breasts, or genitalia. This is frequently done as an alleged in tight spaces”. Similarly, the Wikipedia entry says that:

“Toucherism refers to sexual arousal based on grabbing or rubbing one’s hands against an unexpecting (and non-consenting) person. It usually involves touching breasts, buttocks or genital areas, often while quickly walking across the victim’s path…[The late Czech-Canadian] sexologist Kurt Freund described toucherism as a courtship disorder”

In fact, Freund wrote numerous papers claiming that behaviours such as toucherism, frotteurism, and exhibitionism are caused by ‘courtship disorders’. According to Freund, normal courtship comprises four phases: (i) location of a partner, (ii) pre-tactile interactions, (iii) tactile interactions, and (iv) genital union. Freund proposed that toucherism is a disturbance of the third phase of the courtship disorder. Similarly, Professor John Money proposed the ‘‘lovemap’’ theory (in his 1986 Lovemaps book) suggesting that paraphiliac behaviour occurs when an abnormal lovemap develops which interferes with the ability to participate in loving sexual intercourse.

The reason why I began this article by briefly re-visiting frotteurism and toucherism is that there is a tactile fetishistic behaviour called ‘hyphephilia’ that I would argue is a sub-type of toucherism but not necessarily a sub-type of frotteurism (suggesting that toucherism and frotteurism may be two separate sexual paraphilias). In his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr. Anil Aggrawal defines hyphephilia as a paraphilia in which individuals derive sexual arousal from touching skin, hair, leather, or fur (although these could be very specific paraphilias – such as trichophilia that describes those individuals that derive sexual arousal from human hair). This is similar (but not the same) to the online English Encyclopedia that notes:

“In psychiatry, [hyphephilia is] a sexual perversion in which sexual arousal and orgasm depend upon touching or rubbing the partner`s skin or hair, or upon the sensations related to feeling fur, leather, fabric, or other substances in association with sexual activity with the partner”.

The Right Diagnosis medical website adds an arguably zoophilic element by claiming that the symptoms of hyphephilia are a (i) sexual interest in the feel and smell of animal skin, fur or leather, (ii) recurring intense sexual fantasies involving the feel and smell of animal skin, fur or leather, (iii) recurring intense sexual urges involving the feel and smell of animal skin, fur or leather, and/or sexual preference for the feel and smell of animal skin, fur or leather. Finally, Dr. George Pranzarone in his 2000 Dictionary of Sexology is a little more technical and says that:

“Hyphephilia [is] one of a group of paraphilias of the fetishistic/talismanic type in which the sexuoerotic stimulus is associated with the touching, rubbing, or the feel of skin, hair, leather, fur, and fabric, especially if worn in proximity to erotically significant parts of the body”.

Dr. Eric Hickey (in his book Serial Murderers and Their Victims) notes that paraphilic behaviour is very common among those that commit sexual crimes but that the two activities (sex offending and paraphilias) may be two independent constructs and that one does not necessarily affect the other. Hickey asserts that hyphephilia is one of the so-called ‘preparatory paraphilias’ (as opposed to the ‘attack paraphilias’). Attack paraphilias are described by Hickey as being sexually violent (towards other individuals including children in extreme circumstances). Preparatory paraphilias are defined by Hickey as those “that have been found as part of the lust killer’s sexual fantasies and activities”. However, Hickey notes that individuals that engage in preparatory paraphilias do not necessarily go on to become serial killers.

Like many paraphilic and fetishistic behaviours, there is no scientific agreement concerning the cause of hyphephilia. This probably depends on the person rather than a single characteristic factor. Most experts would no doubt attribute hyphephilic behaviour to an initially random or accidental touching of the specific item that the individual subsequently finds sexually arousing. Through processes such as classical and operant conditioning, successive repetitions of the associative pairings of the behaviour would then reinforce the behaviour and result in the behaviour being repeated.

One of the few references I came across that mentioned hyphephilia is an interesting paper by Dr. Stephen J. Gould in a 1991 volume of Advances in Consumer Research. He claimed the field of sex research had been overlooked by consumer research, and that John Money’s concept of ‘lovemaps’ could be applied. More specifically, he asserted:

“I want to suggest that there exist what we can call consumer lovemaps. This concept represents an adaptation of Money’s (1984) lovemap theory. He defines a lovemap as that which ‘carries the program of a person’s erotic fantasies and their corresponding practices’. Based on the lovemap concept, Money has developed a typology of paraphilias (perversions) each with their own lovemap (e.g. autonepiophilia – diaperism; hyphephilia – lover of fabrics). Each also follows certain strategies of sexual response – the two examples of autonepiophilia and hyphephilia, for instance, represent a fetishistic sexual strategy. In this context, we may define a consumer lovemap as including those aspects of the more general lovemap which involve consumption, i.e. the purchase and use of products in the process of attracting a mate, engaging in sexual activity, and developing and maintaining sexual-love relationships”.

Here, hyphephilia is simply defined as someone that derives sexual arousal from the touching of fabrics. This is not uncommon as a number of online articles also simply define hyphephilia as such. For instance, an article (‘A passion for fabrics’) by Sylvie Marot began by noting:

“[French psychiatrist Gaëtan Gatian de Clérambault wrote] ‘We love to run our hand across fur; we would like silk to slide itself across the back of our hand. Fur calls for an active caress in its form: silk caresses with a uniform sweetness a skin that becomes passive; then it reveals, so to speak, a nervousness in its breaks and cries’. To classify this specific research on the aphrodisiac virtues of silk, two neologisms appeared necessary to him: hyphephilia – the erotics of fabric – and aptophilia – ecstasy of the touch. The man (the fetishist?), who loved dearly ‘the cry of silk’, was able to identify with a maniacal precision the different points of a hem – ‘scallop, buttonhole, flange, blanket stick, tab, etc.’. Like some of his patients, seamstresses by profession, he was not content to merely enjoy fabrics, conceiving for himself draped figures manufactured at his request according to his own drawings”.

Although hyphephilia is unlikely to be problematic for many, those that want therapy are likely to receive the same types of therapeutic intervention that are recommended for frotteurism (behaviour therapy, reality therapy, cognitive-behavioural therapy, etc.) – although the most critical thing is that the person that seeks such treatment must want to actively change such behaviour. The Right Diagnosis website claims that:

“Treatment [for hyphephilia] is generally not sought unless the condition becomes problematic for the person in some way and they feel compelled to address their condition. The majority of people simply learn to accept their fetish and manage to achieve gratification in an appropriate manner”

In his 1998 book Gay, Straight, and In-Between, Professor John Money described hyphephilia as a “touchy-feely paraphilia”. The case that Money described was arguably extreme and doesn’t quite fit the definitions I outlined above. He reported:

“In a particular case [a female hyphephilac] entailed the feel of…small dogs placed between the legs and rubbed against the genitals. The way of attaining orgasm surpassed that of ordinary sexual intercourse, which was so aversive that it was discontinued in the marriage. The paraphilic activity had its onset in a dismal history of illegitimacy and childhood neglect and traumatic abuse. In adolescence, there was a history of noncopulatory sexual activity with a middle-aged male relative. In the manner typical for paraphilia, the feel of rubbing a small live creature between the legs was a stratagem for preserving lust as a commodity separate from love, which, in her life experiences, had always been either unattainable or warped. The moral struggle to be rid of the paraphilia was intense and not successful”.

My own reading of this case is that it is more a case of zoophilic frotteurism than hyphephilia (although the criterion of ‘touching of fur’ for sexual arousal is arguably met). In other papers, Professor Money also described formicophilia (i.e., being sexually aroused by insects crawling and/or nibbling on an individual’s genitals) as a ‘touchy-feely’ paraphilia that belongs in the “hyphephilic subgroup of fetishistic paraphilias”. Personally, I wouldn’t class formicophilia as a form of hyphephilia on the basis of any definition that I have come across.

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.

Cantor, J. M., Blanchard, R., & Barbaree, H. E. (2009). Sexual disorders. In P. H. Blaney & T. Millon (Eds.), Oxford Textbook of Psychopathology (2nd ed.) (pp. 527–548). New York: Oxford University Press.

Dewaraja, R. & Money, J. (1986). Transcultural sexology: Formicophilia, a newly named paraphilia in a young Buddhist male. Journal of Sex and Marital Therapy, 12, 139-145.

Freund, K. (1990). Courtship disorders: Toward a biosocial understanding of voyeurism, exhibitionism, toucherism, and the preferential rape pattern. In. L. Ellis & H. Hoffman (Eds.), Crime in biological, social, and moral contexts (pp. 100–114). New York: Praeger.

Freund, K., Seto, M. C., & Kuban, M. (1997). Frotteurism and the theory of courtship disorder. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual Deviance: Theory, Assessment, and Treatment (pp. 111-130). New York: Guilford Press.

Gould, S. J. (1991). Toward a theory of sexuality and consumption: Consumer Lovemaps. In R.H. Holman & M.R. Solomon (Eds.), Advances in Consumer Research Volume 18 (pp. 381-383). Provo, UT: Association for Consumer Research.

Hickey, E. W. (2010). Serial Murderers and Their Victims (Fifth Edition). Pacific Grove, CA: Brooks/Cole.

Money, J. (1986). Lovemaps: Clinical concepts of sexual/erotic health and pathology, paraphilia, and gender transposition in childhood, adolescence, and maturity. New York: Irvington.

Money, J. (1998). Gay, Straight, and In-Between: The Sexology of Erotic Orientation. New York: Oxford University Press.

Pranzarone, G.F. (2000). The Dictionary of Sexology. Located at:

Psychology Dictionary (2014). What is toucherism? Located at:

Wikipedia (2014). Toucherism. Located at:

Back to the ‘why’ fronts: A brief look at gambling motivation

In the three decades that I have been studying gambling, the question that I am most asked is ‘Why do people gamble?’ and variations on it, such as ‘Why do people gamble when most people consistently lose?’ All surveys of gambling have shown that there are a broad range motivational factors that are central to gambling, and that attitudes towards gambling are positively related to availability and cultural acceptability. However, this perspective fails to take into account many key findings and observations in gambling research. Surveys have also shown that not everyone gambles and some people gamble more than others (e.g., professional gamblers, problem gamblers). Research has consistently shown that people often gamble for reasons other than broad social and economic reasons. These other motivations may vary according to personal characteristics of the gambler and the type of gambling activity. Additionally, broad social and economic theories fail to explain why certain gambling activities are more popular or ‘addictive’ than others.

Variations in gambling preferences are thought to result from both differences in accessibility and motivation. Older people tend to choose activities that minimise the need for complex decision-making or concentration (e.g., bingo, slot machines), whereas gender differences have been attributed to a number of factors, including variations in sex-role socialisation, cultural differences and theories of motivation. Stereotypically, women tend to prefer chance-based games and men tend to prefer skill-based games. Even some games that are predominantly chance-based, men attempt to impose some level of skill. For instance, poker – which people regard as skill-based – has a massive amount of chance involved. Similarly, men often, in their own minds, change playing a slot machine from a chance-based event into a more skill-based activity via cognitive processes such as the illusion of control. The other factor to consider is that (in general) women don’t like it when other people see them losing. On a slot machine, no-one sees the player is losing so it’s very often a very guilt-free, private experience. Men, on the other hand, even when they lose big, there’s a machismo attached to it that says: “Yes, I’ve lost £500 but I can afford it.”

Variations in motivation are also frequently observed among people who participate in the same gambling activity. For example, slot machine players may gamble to win money, for enjoyment and excitement, to socialise and to escape negative feelings. Some people gamble for one reason only, whereas others gamble for a variety of reasons. A further complexity is that people’s motivations for gambling have a strong temporal dimension; that is, they do not remain stable over time. As people progress from social to regular and finally to excessive gambling, there are often significant changes in their reasons for gambling. Whereas a person might have initially gambled to obtain enjoyment, excitement and socialisation, the progression to problem gambling is almost always accompanied by an increased preoccupation with winning money and chasing losses.

Gambling is clearly a multifaceted rather than unitary phenomenon. Consequently, many factors may come into play in various ways and at different levels of analysis (e.g., biological, social, or psychological). Theories may be complementary rather than mutually exclusive, which suggests that limitations of individual theories might be overcome through the combination of ideas from different perspectives. This has often been discussed before in terms of recommendations for an ‘eclectic’ approach to gambling or a distinction between proximal and distal influences upon gambling. However, for the most part, such discussions have been descriptive rather than analytical, and so far, few attempts have been made to explain why an adherence to singular perspectives is untenable.

Gambling is one of those activities where people effectively can get something for nothing, which is why some people will take risks. The attraction of a lotter for example is that, for a very small stake, the individual can have a life-changing experience (and things are further complicated by the fact that most lottery players don’t see the activity as gambling). People who enjoy playing roulette or betting on a football match enjoy the betting or gaming experience itself. In short, each gambling activity has its own unique psychology (although there are undoubted overlaps).

Most economists claim that gamblers are primarily driven by the profit motive. However, the psychological evidence is overwhelming that other desires affect gambling actions. Put simply, for most gamblers, our actions contradict the desire to maximize profits. Whilst I am no Freudian, there appear to be a whole range of unconscious factors at play in gambling. For instance, if players make a successful bluff during a card game, it’s human nature to want to let people to know how smart they are. The golden rule in poker is never to give anything away but the human psyche works in such a way that we usually want to show off once in a while. Our psychological make-up also means that we let pride get in the way of minimizing losses. There are always games that should have been avoided but players end up staying in them long after they knew it was a mistake. None of us like to lose to who we think are weaker players, or admit that the game was too hard. How many times does a player continue playing because they want to try and get the better of a great player or show off because there is someone they are trying to impress? Although it’s a cliché, pride before a fall is commonplace. These short-term psychological satisfactions will almost always have a negative impact on long-term profits.

Because there are many non-financial types of rewards from many different sources while gambling, some people view losses as the price of entry. To these players (and I include myself as one of them), winning may be a bonus. However, most of us don’t like losing – and we especially don’t like persistent losing, regardless of whether there are other types of reinforcement. In the cold light of day, we are all rational human beings. In the height of action, rationality often goes out the window. I’ve done it myself at the roulette table and standing in front of a slot machine. While gambling I have felt omnipotent. It is only after I walk away penniless that the non-financial rewards are short-term and not worth it.

Understanding our own psychological motives is clearly important while gambling. Most players know the strategies they should be adopting but fail to apply them in real gambling situations. Players do not lack the information. It is far more profitable to learn why we don’t apply the lessons we have already learned, then ensure that we apply them. Until we understand and control our own motives — including the unconscious ones — we cannot possibly play to our best ability.

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

Further reading

Calado, F., Alexandre, J. & Griffiths, M.D. (2014). Mom, Dad it’s only a game! Perceived gambling and gaming behaviors among adolescents and young adults: An exploratory study. International Journal of Mental Health and Addiction, in press.

Griffiths, M.D. (1990). The dangers of social psychology research. BPS Social Psychology Newsletter, 23, 20-23.

Griffiths, M.D. (1999). The psychology of the near miss (revisited). British Journal of Psychology, 90, 441-445.

Griffiths, M.D. (2006). An overview of pathological gambling. In T. Plante (Ed.), Mental Disorders of the New Millennium. Vol. I: Behavioral Issues. pp. 73-98. New York: Greenwood.

Griffiths, M.D. (2007). Gambling psychology: Motivation, emotion and control, Casino and Gaming International, (3)4 (November), 71-76.

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

McCormack. A. & Griffiths, M.D. (2012). What differentiates professional poker players from recreational poker players? A qualitative interview study. International Journal of Mental Health and Addiction, 10, 243-257.

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

Parke, A. & Griffiths, M.D. (2012). Beyond illusion of control: An interpretative phenomenological analysis of gambling in the context of information technology. Addiction Research and Theory, 20, 250-260.

Insect asides: The psychology of Adam Ant

As regular readers of my blog will know, I have had a longstanding professional interest in the psychology of sexually paraphilic behaviour. My interest in the topic first began when I was a 14-year old teenager listening to Adam and the Ants B-sides (all of which were about different types of extreme and/or unusual sexual behaviours. In one of my previous blogs, I argued that Adam Ant’s music has covered more atypical sexual behaviours than any other recording artist that I can think of (e.g. sadism, masochism, bondage, fetishism, transvestism, voyeurism, etc.). There is little doubt that Adam’s music had a great influence on my career, but what were Adam’s influences that made him the person he became?

In addition to the sexual content of his lyrics, Adam’s earliest stage personas were also very sexual. Adam bought his clothes from ‘SEX’, the shop run by Malcolm McLaren and Vivienne Westwood which was also infamous for selling rubber and leather fetish wear. (McLaren later briefly became The Ants manager and even tried to get Adam and his band to star in a pornographic film with female punk band The Slits). The first t-shirt he ever bought there was provocative and controversial (featuring the ‘Cambridge Rapist‘). One of McLaren’s best-selling t-shirts (‘Vive Le Rock‘) later became the title of Adam’s 1985 single and album. Adam’s interest in sex was all-consuming and spilled over into most areas of his and The Ants lives. It was common at early gigs for Adam to be dressed in bondage gear.

One infamous incident happened at their debut gig at the Institute of Contemporary Arts in London (10th May 1977). To get the gig, Adam said his band were a country and western band. He then got on stage dressed in bondage trousers and a leather head mask, and performed the future S&M classic Beat My Guest (later to be a B-side of their first No. 1 hit Stand and Deliver). Predictably, they were ‘asked to leave’ after that opening number.

Early gigs (1977-1979) were known as places to buy lots of eye-catching merchandise (t-shirts, badges, posters etc.) featuring sadomasochistic and bondage sex-themes designed by Adam. Advertisements for the 1979 tour were the first to use the slogan ‘Antmusic for Sexpeople’. To Adam, ‘sexpeople’ were people who got off on sexual phenomena, who liked sexual imagery and enjoyed being sexual. In a Melody Maker interview he said ‘What weʼre basically dealing with here with is taboos, and a lot of my work as a kind of music therapy‘. Adam’s first major interview as cover star in (the now defunct) Sounds was where he was described as ‘the face that launched a thousand whips’. His breakthrough album Kings of the Wild Frontier (1980) may have surprised his new young fan base as it came with a free booklet full of sexual imagery.

Although Adam clearly has musical influences, most of those he talks about or name checks in his songs appear to have more to do with image than music or his overriding interest in sex. Early influences like Johnny Kidd and the Pirates may have inspired some of his later images. The first record he bought was Magical Mystery Tour by The Beatles, but rarely makes reference to them as any kind of musical influence. The early 1970s appear to have thrown up more influences where music and sexuality was talked about in relation to the person if not their songs (Jim Morrison, David Bowie, Iggy Pop, New York Dolls, Lou Reed, Roxy Music). For instance, he loved the New York Dolls ‘because they looked like drag queens‘. His inspiration for forming Adam & the Ants was seeing the Sex Pistols very first gig when they supported the first band he was in (a short-lived band called Bazooka Joe). It was after this that a plethora of sexual punky songs were written for the Ants.

In an interview with Derek Hardman (Inside Out magazine, 1979), Adam described the lyrical content of his songs as dealing with ‘subjects of interest, mystery and imagination‘ and that they came from ‘living my life, reading, films, events and history‘. This quote also carries the implicit assumption that musical influences paid little (if any) part in his lyrical obsessions. The only thing that really connects sex with music is the perception that being a ‘popstar’ will bring more sexual opportunities. For instance in the Antbox book, Adam says:

“I remember being in a room with four girls watching [Marc] Bolan on ‘Top of the Pops’ and it was the first time I had actually watched four girls just absolutely dripping, climaxing , looking at a guy… Whatever it is, I want some!”

Very few of his musical heroes wrote explicit songs about sex and it is clear that the (sometimes) extreme sexuality of his lyrics originate elsewhere. By digging a little deeper it becomes abundantly clear that his interest in art lay the foundations of his sexual interests. By looking at the individuals who Adam held in high esteem, it becomes very clear that Adam’s predisposition towards sex comes not from musical influences but from figures in the 20th century art world. Adam originally wanted a career in Art after seeing an exhibition of Pop Art at the Tate Gallery in London (1971). He ended up studying Graphic Design at Hornsey College of Art (now part of Middlesex University) in North London. His favourite class was the ‘Erotic Arts’ course taught by art historian Peter Webb. This concentrated on Indian, Chinese, and Japanese traditions of erotic painting, drawing, and sculpture. Adam was also interested by women’s role in society and he was the only male at his college to take the class in ‘Women In Society’.

Adam was inspired by the iconographic images of Andy Warhol, the autoerotic paintings of Allen Jones, the neo-sadomasochistic fantasies of Hans Bellmer, and ‘sexpop’ travellers like Eduardo Paolozzi, Francis Bacon and Stanley Spencer. All these people clearly influenced his music. In 1977, Adam said:

“The S&M thing stems from [when] I was at College Art School, with John Ellis (of the Vibrators), and all the time I was at Art College I was very influenced by Allen Jones the artist. All my college work is pretty much like this, this is just a musical equivalent of what I was visually doing at college. Iʼm not personally into S&M, I mean I never smacked the arse of anybody. It’s the power and the imagery. There’s a certain imagery involved with that which I find magnetic. It’s not done viciously, if you read S&M mags and spank mags or anything like that, it’s done with an essence of humour…war dress and stuff, that just appeals to my imagination.

While at Art College, Adam did a thesis on sexual perversion:

I read lots of books and discovered much to my surprise that it wasn’t just a kick, it was a deadly serious subject. A very sort of medical thing and I found I got a source of material for my songs. I wrote a song called ‘Rubber Peoplewhich is a serious look at rubber fetishism. And I also wrote one about transvestism. Theyʼre not serious, none of my songs are serious, I mean fucking hell. Theyʼre serious to me. But the thing is that with, say, ‘Transvestism’ people just laugh at people. If somebody’s wearing a pair of rubber underpants under a pin-stripe suits it’s funny, y’know. But I don’t think itʼs funny. I don’t think it’s any more strange than watching fucking ‘Crossroads every night”

It was perhaps Adam’s art heroes that most influenced him. By looking very briefly at each of Adam’s artistic heroes, it is easy to see where the inspiration for many of his early lyrics came from. The most important influences were Allen Jones, Stanley Spencer, Eduardo Paolozzi, Hans Bellmer, Francis Bacon (name checked in the song ‘Piccadilly‘), and Andy Warhol. These brief sketches show that his early music is a direct
 musical equivalent of his heroes’ artwork (particularly Jones, Bellmer and Paolozzi). The influence of Warhol, Bacon and Spencer is more subtle. These three individuals all produced controversial work (which Adam found inspiring).

It might also be argued that all three had a somewhat troubled or tortured sexuality. This again, may have been of interest to Adam. The only other artists that Adam has singled out are Pablo Picasso and the Italian futurists. Adam was impressed by Picasso’s “genius, energy and sexuality” and was the subject of one of Adam’s best album tracks ‘Picasso Visits The Planet of the Apes. A whole song (‘Animals and Men) is devoted to the Italian futurists on the debut album (Dirk Wears White Sox). In this song he writes about the influence of Filippo Marinetti (1876-1944), Giacomo Balla (1871-1958), Umberto Boccioni (1882-1916) and Carlo Carra (1881-1966). The Futurists were a 20th century avant garde movement in Italian art, sculpture, literature, music, cinema and photography. Their manifesto broke with the past and celebrated modern technology, dynamism and power. The combination of different art media was appealing to Adam although there was nothing overtly sexual in the work of its exponents.

Film – like art – was also important to Adam, and as a teenage usher at the Muswell Hill Odeon he saw lots of films in his formative years. Adam has gone on record many times to say that his film hero is Dirk Bogarde. The Ants first album (the aforementioned Dirk Wears White Sox) was named after him and some of his films provided inspiration for his songs. Many of his most notorious films (The Servant, Death In Venice, The Night Porter) dealt with taboo areas with which Adam identified and/or had a fascination with. All these films feature taboo sexual subjects (or at least taboo at the time the film was made) and probably appealed to Adam because of their taboo nature. These were all a direct influence on Adam’s early songwriting.

Outside of Dirk Bogarde and his films, Adam cites his film heroes as Clint Eastwood, Steve McQueen, Mongomery Clift and Charles Bronson. Adam makes few references to films or film stars in his song writing, although there are name checks for Michael Caine, John Wayne, Terence Stamp, and Charles Hawtrey in ‘Friends, Clint Eastwood in ‘Los Rancheros, Steve McQueen in ‘Steve McQueen, Robert de Niro in ‘Christian Dior, and Bruce Lee in ‘Bruce Lee. He also dedicated one song that he wrote about the film Psycho (‘Norman) to its star Anthony Perkins. Again, these film stars and their films (bar Bogarde) have had little influence on his sexually themed songs.

There are very few references to literary heroes in Adam’s work and even less that is sex-related. The gay playwright Joe Orton (1933-1967) is one influence who has impacted on Adam’s life. Adam wrote one song about Orton’s homosexual relationship with his lover Kenneth Halliwell (‘Prick Up Your Ears’ on the Redux LP). However, the lyrics didn’t fit the pirate theme of the second album (Kings of the Wild Frontier) and were changed. This song eventually became ‘The Magnificent Five. In 1985, as part of his acting career, Adam performed in Joe Orton’s play Entertaining Mr. Sloane on stage at the Manchester Royal Exchange. Adam claimed that the ‘idea of playing a psychotic bisexual thug was good’. Ortonʼs comedies (Entertaining Mr. Sloane, Loot, and What The Butler Saw) are all black, stylish, and violent. Furthermore, they all have an emphasis on corruption and sexual perversion. With such content it is easy to see why Adam enjoyed these. However, it is not known when Adam was first aware of Orton’s work. The likelihood is that his appreciation of Orton was after many of his initial songs were written.

The German philosopher and poet Friedrich Nietzsche (1844-1900) was also one of Adamʼs literary inspirations and the subject of early live favourite ‘Nietzsche Baby. Nietzsche is most well known for his rejection of Christian morality (which no doubt appealed to Adam) and the ‘revision of all values’. Despite the influence, there was little in his writings that would have inspired Adam’s sex- related writings. Passing reference to both the US ‘beat generation’ writer Jack Kerouac (1922-1969) and the French novelist and playwright Albert Camus (1913-1960; a protagonist of the ‘Theatre of the Absurd‘ movement) make an appearance on his 1985 song ‘Anger Inc..‘ Again, these influences appear to be post-musical success and would have had little impact on his early sexual songwriting.

As a psychologist myself, I couldnʼt help make reference to Adam’s ‘psychological’ influences. The only time he has made reference specifically to a psychologist is a name check of Erich Fromm in his song ‘Friends’. It is obvious that Adam has read some of Fromm’s work as there are Frommian influences in his work. The ‘dog 
eat dog’ personality type (consciously or unconsciously) 
inspired his first big hit single (‘Dog Eat Dog). The ‘masochistic’ personality type
permeates many of his early songs. The ‘marketing’ subtypes
who concern themselves with image and style (and who feel
inadequate if they are not admired) could be argued to be
Adam himself. Alternatively he may have seen himself as the ‘productive’ type because of his creativity and ability to change himself.

By just scratching a little deeper at the surface of Adam’s influences, we see the roots of his lyrical sexuality. As time has gone on, less and less of Adamʼs songs have concerned sex. Furthermore, more love songs have made an appearance ( the LP Wonderful being a prime example). Maybe this is just an overt sign of the maturation process. Whatever it is, there is little to take away Adam’s crown as the king of sexual diversity.

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

Further reading

Ant, A. (2007). Stand and Deliver: The Autobiography. London: Pan.

Griffiths, M.D (1999). Adam Ant: Sex and perversion for teenyboppers. Headpress: The Journal of Sex, Death and Religion, 19, 116-119.

Wikipedia (2013). Adam and the Ants. Located at:

Wikipedia (2013). Adam Ant. Located at:

Let’s get physical: Exercise addiction (revisited)

At present, exercise addiction is not officially recognised in any medical or psychological diagnostic frameworks such as the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) or the World Health Association’s International Classification of Diseases. However, there has been a lot of research into whether exercise can be classed as a bona fide addiction. In spite of the widespread usage of the term ‘exercise addiction’ there are many different terminologies that describe excessive exercise syndrome. Such terms include ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Exercise addiction has been conceptualised as a behavioural addiction. The symptoms and consequences of exercise addiction have often been characterised by six common components of addiction: salience, mood modification, tolerance, withdrawal symptoms, personal conflict, and relapse.

For some people, exercise addiction is a primary problem in the person’s life whereas in others it can be a secondary problem as a consequence of other psychological dysfunctions (like eating disorders such as anorexia nervosa). In the former case, the dysfunction is considered as primary exercise addiction, while in the latter case it is termed as secondary exercise addiction because it co-occurs with another dysfunction. The differentiating feature between the two is that in primary exercise addiction the objective is the exercise itself, whereas in secondary exercise addiction the objective is weight loss, where excessive exercise is one of the primary means in achieving the desired objective.

The incentive or motive for fulfilling planned exercise is an important distinguishing characteristic between addicted and nonaddicted exercisers. The reason people exercise is often for an intangible reward such as feeling in shape, looking good, being with friends, staying healthy, building muscles, losing weight, etc. The personal experience of the anticipated reward reinforces and strengthens the exercise behaviour. Committed exercisers maintain their exercise for benefiting or gaining from their activity and thus, their behaviour is motivated via positive reinforcement. However, empirical research has demonstrated that addicted exercisers have to exercise in order to avoid negative feelings or withdrawal. The individual’s exercise may become a chore that has to be fulfilled, or otherwise an unwanted event would occur (such as the inability to cope with stress, or gaining weight, becoming moody, etc.). Every time a person undertakes behaviour to avoid something negative, bad, and/or unpleasant, the motive behind that behaviour acts as a negative reinforcement. In these situations, the person feels they have to do it rather than wanting to do it.

Mood modification is a key factor among the symptoms of exercise addiction and suggests there is a self-medication aspect of exercise that facilitates the distinction between normal and abnormal exercise. Addicts do not simply exercise to experience the joy of it, but rather to escape negative, unpleasant feelings and everyday difficulties.

The Exercise Addiction Inventory is one of the most recent and most widely used screening tools in the research area of exercise addiction, primarily because of its brevity and excellent psychometric properties (i.e., reliability and validity). The EAI comprises only six statements, each corresponding to one of the symptoms in the ’components’ model of addiction. Each statement is rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The EAI cut-off score for individuals considered at-risk of exercise addiction is 24 out of 30. To date, the only nationally representative study examining exercise addiction is a study that I co-authored with some Hungarian colleagues. We surveyed over 2,700 Hungarian adults aged 18–64 years and assessed exercise addiction using the EAI. Results showed that the proportion of the people at risk for exercise addiction was 0.5%.

There are numerous theories that deal with both the causes of exercise addiction and the process and mechanisms of its development and maintenance. A significant number of psychological theories are based on learning theory or the cognitive psychology approach. According to the theory of functioning, both positive reinforcers (e.g., a feeling of euphoria following exercise or muscle growth from exercise) and negative reinforcers (e.g. an end to unpleasant feelings through exercise or avoidance of the presumed negative effect of missed exercise) may lie behind the development and maintenance of exercise addiction which, according to the fundamental principles of learning theory, may contribute to the establishment of compulsive and addictive exercise that may be viewed as maladaptive.

One of my research colleagues, Dr. Attila Szabo stresses the role of cognitive appraisal mechanisms in the development of the vicious cycle that leads to excessive exercise. The process starts when the habitual exerciser uses exercise as a means of coping with stress, and the affected individual learns to depend on exercise at times of stress. The addicted exerciser is then trapped in a vicious cycle of needing increased amounts of exercise to deal with the consistently increasing life stress, part of which is caused by exercise itself.

It also appears that the issue of self-assessment represents a further significant factor among the psychological factors in the sense that during exercise, the physical strength experienced through exercise in a person dissatisfied with his or her body or body image contributes to the formation of a more positive self-image and self-assessment. It has also been shown that exercise activities (such as weightlifting) have a positive effect on body image and self-esteem both in men and in women. Perfectionism, obsessive-compulsive functioning, and heightened anxiety have also been claimed to be determining factors in exercise addiction.

The public promotion of healthy and appropriate exercise patterns may reduce the incidence of exercise addiction. It is important in public health programs and campaigns to (i) stress the healthy nature of regular exercise and (ii) communicate the message that exercise when taken to excess can be potentially harmful. It is important to raise awareness of potential harm within the population of regular exercisers. Some psychologists claim that individuals with exercise addiction have a poor understanding of the negative health consequences of excessive exercising, of the mechanism of exercise adaptation, and the need for rest between exercise sessions. The use of education may be an effective step in the prevention and treatment of exercise addiction.

As with other addictive disorders, the environment of regular exercisers also plays a significant role in recognising this condition early. In more severe cases psychotherapeutic interventions may be needed. When treating exercise addiction, abstinence from exercise may not be a required and/or realistic goal, because exercise has many benefits for health and no one would advocate doing no exercise. Therefore, the typical treatment goal would more likely be be to return to moderate and controlled exercise. In some cases, a different form of exercise may be recommended.


Joanna is a 25-year old student, well-educated female, from a stable family background, who realized that she had a problem surrounding exercise, and more specifically the martial art Jiu-Jitsu. Here, Joanna’s behavior is described in terms of the main components of addiction:

  • Salience: Jiu-Jitsu is the most important activity in Joanna’s life. Even when not actually engaged in the activity, she is thinking about the next training session or competition. She estimates that she spends approximately six hours a day (and sometimes much more) involved in training (e.g., weight training, jogging, general exercise, etc.).
  • Tolerance: Joanna started Jiu-Jitsu at an evening class once a week during her teenage years and built up slowly over a period of about five years. She now exercises every single day, and the lengths of the sessions have become longer and longer (suggesting tolerance).
  • Withdrawal: Joanna claims she becomes highly agitated and irritable if she is unable to exercise. She claims she also gets headaches and feels nauseous if she goes for more than a day without training or has to miss a scheduled session.
  • Mood modification: Joanna experiences mood changes in a number of ways. She feels very high and ‘buzzed up’ if she has done well in a Jiu-Jitsu competition (especially so if she wins). She also feels high if she has trained hard and for a long time.
  • Conflict: Joanna’s relationship with her long-term partner ended as a result of her exercise. She claimed she never spent much time with him and was not even bothered about their break-up. Her university work suffered because of the lack of time and concentration.
  • Loss of control: Joanna claims she cannot stop herself engaging in exercise when she “gets the urge”. Once she has started, she has to do a minimum of a few hours of exercise.
  • Relapse: Joanna has continually tried to stop and/or cut down but claims she cannot. She becomes highly anxious if she is unable to engage in exercise and then has to go out and train to make herself feel better. She is well aware that exercise has taken over her life but feels powerless to stop it.
  • Negative consequences: Joanna spends money beyond her means to maintain her exercising habit (e.g., on entrance fees for weight training, swimming, entrance fees enter Jiu-Jitsu tournaments across the country, etc.). She has resorted to socially unacceptable means (e.g., stealing) in order to get money to fund herself

In short, exercise is the most important thing in Joana’s life, and the number of hours engaged in physical activity per week has increased substantially over a five-year period. She displays withdrawal symptoms when she does not exercise, and experiences euphoric experiences related to various aspects of her exercising (e.g., training hard, winning competitions, etc.). She experiences conflict over exercise in many areas of her life and acknowledges she has a problem. Furthermore, she has lost friends, her relationship has broken down, her academic work has suffered, and she has considerable debt.

Note: An expanded version of this article was first published by

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

Further reading

Allegre, B., Souville, M., Therme, P., & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.

Allegre, B., Therme, P., & Griffiths, M. D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of ‘ultra-marathoners’. International Journal of Mental Health and Addiction, 5, 233-243.

Berczik, K., Szabó, A., Griffiths, M. D., Kurimay, T., Kun, B., Urbán, R., & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychomaetric examination of the Exercise Dependence Scale-Revised. Measurement in Phisical Education and Exercise Science, 8, 183-201.

Griffiths, M. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, e30-31.

Hausenblas H. A., & Downs, S. D. (2002a) Exercise dependence: a systematic review. Psychology of Sport Exercise, 3, 89-123.

Hausenblas, H. A., & Downs, S. D. (2002). How much is too much? The development and validation of the exercise dependence scale. Psychology and Health, 17, 387-404.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

Sussman, S., Lisha, N., & Griffiths, M. D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Szabo, A. (2000). Physical activity as a source of psychological dysfunction. In S. J. Biddle, K. R. Fox & S. H. Boutcher (Eds.), Physical Activity and Psychological Well-Being (pp. 130-153). London: Routledge.

Szabo, A., & Griffiths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

Terry, A., Szabo, A., & Griffiths, M. (2004). The exercise addiction inventory: a new brief screening tool. Addiction Research and Theory, 12, 489-499.

Loving on the edge: A brief look at extreme sexual behaviour

In my previous blogs I have examined a wide variety of different – but potentially dangerous – sexual fetishes and paraphilias including sexual masochism, autoerotic asphyxiation (breathplay/hypoxyphilia), enema play (klismaphilia), scat play (coprophilia), watersports (urophilia), and electricity play (electrophilia). All of these sexual behaviours could arguably be classed as ‘edgeplay’. The online Urban Dictionary, edgeplay is “sexual play that is very extreme in nature. Said to be on the edge of safety and sometimes even sanity. Can be very dangerous if not practiced correctly. [Examples include] breathplay, bloodplay, humiliation play, Total Power Exchange (TPE), [and] rape roleplay”. According to ‘lunaKM’ who describes herself as a “full-time slave in an M/s relationship” and the editor (and founder) of the online Submissive Guide, edgeplay has three definitions (that I have reproduced verbatim below)

  • Definition 1: Edgeplay is SM play that involves a chance of harm, either physically or emotionally. It’s also subjective to the players involved; what is risky for me might not be risky for you and visa versa. A few examples of edge play under this definition are fireplay, gunplay, rough body play including punching and wrestling, breath play and blood play.
  • Definition 2: Edgeplay can also literally mean play with an edge. Such examples of play are cutting, knives, swords and other sharp implements. These forms of edge play also fall under the broad term in [the definition above]
  • Definition 3: Any practice which challenges the limits or boundaries of one or more of the participants.

In his book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr. Anil Aggrawal notes that edgeplay is dangerous in many different ways as the activities may involve (i) increased risk of spreading disease (e.g., through cutting or bloodplay), (ii) psychological danger (e.g., humiliation play, incest fantasies, rape roleplay), (iii) challenging social taboos (ageplay, scat fetishism, and racial slurs), and (iv) even permanent harm or death (e.g., gunplay and breathplay). Such activities can be done alone, with a partner, or with a group of people. From what I have read anecdotally online, edgeplay enthusiasts claim they know the human body better than most medical professionals, and attempt to exercise as much safety as is humanly possible when going to the point of near death and then resuscitation.

The Wikipedia entry on edgeplay also roots edgeplay within BDSM sexual practices but adds that it is a “subjective term for types of sexual play that are considered to be pushing on the edge of the traditional SSC [safe, sane and consensual] creed [and] considered more RACK [Risk-Ware Consensual Kink]”. The article also notes that such sexual acts involve risking serious (and sometimes permanent) harm including possible death. The same article also notes that what constitutes edgeplay may depend upon both an individual’s viewpoint and may change over time. Activities such as ‘ageplay’ (a form of roleplaying in which an individual acts or treats another as if they were a different age, for example a baby or toddler) or ‘rape roleplay’ (involving imagining or pretending being coerced or coercing another into sex) may be considered ‘edgy’ by some but not others. Activities such as ‘scatplay’ (coprophilia) that were considered edgy in the 1990s have arguably shifted into mainstream BDSM practices.

Journalist Rachel Rabbit White is one of the few people to have written an article on edgeplay. As she writes:

“Edgeplay is a sex thing. It is a BDSM thing. And while BDSM among consenting adults is considered cool and OK by most reasonable people, edgeplay is sort of not OK. Edgeplay refers to acts are those deemed not safe, sane, or consensual, which are the watchwords for “normal” kinky sex. This is the BDSM that is never going to end up in a bestselling erotica novel for moms….Like every flavor of kinkster, edgeplay enthusiasts talk to each other online…There’s a group devoted to the topic on FetLife, the sex-based social networking site. One of the group’s threads asks members what the ‘edgiest’ thing they’ve ever done is. Responses ranged from ‘gun play with a cop’ to ‘as a black woman, going to a 1920s themed party chained to my white partner and dressed as a piccaninny’ to ‘smearing Icy Hot on his fresh Prince Albert piercing – while he slept’. I can’t imagine a world in which that last one is sexy but just because it isn’t my thing doesn’t mean it’s wrong”.

She also confirms that what is considered ‘edgy’ has changed over the last three decades. She claims that in the 1980s and 1990s sexual activities such as scatplay, ageplay, puppyplay, and suspension by skin hook piercings were not allowed at BDSM sex conventions. However, all of these can now be found at such events. This is because “attitudes about what should be forbidden seems to have shifted thanks to people getting better [sexually] educated”. Much of this has coupled the rise of the internet where there are now numerous ‘how to’ guides on almost every type of ‘adult’ sexual activity, and articles on sexual ethics. One of the interviewees for her article (Madeline) describes edgeplay (somewhat paradoxically) as a “consensual non-consent” where activities like ‘rapeplay’ do not involve ‘safewords’ (typically used by BDSM practitioners to signal for the activity to cease). Madeline “talks lovingly” about the rapeplay between her and her husband, and claims it keeps “their long-term relationship tender and fresh, and likewise, their trusting relationship allows them to do rape play”. The article also notes that:

“Rather than glorifying [edgeplay], the BDSM community might be headed in the direction of eradicating the idea of ‘edge’ altogether. That way, the focus can be on how to communicate consent – rather than labeling acts ‘good’ or ‘bad’”.

Another article on edgeplay published by The Dominant Guide by an edgeplay practitioner also made some interesting observations. For instance:

“To understand what edge play is you must first understand that there are actually two types of edge play, personal edge play and general edge play. Personal edge play is any activity that pushes one’s personal limits. It can be anything; there honestly is no limit to what someone might consider stretching their personal boundaries. If someone were afraid of single tail [whips], then using a single tail [whip] on them would be edge play to that individual. If someone were afraid of closed in spaces, then putting him or her in a cage would be considered edge play. So you see personal edge play is different for everyone, but one thing is true in all forms, this type of play is dramatic both mentally and physically. The second type of edge play is what most people refer to as edge play. This is any activity that by common consensus is to be considered pushing the limits of safety and or sanity. Normally people consider such activities as blood play, breath play, gunplay, fireplay, needleplay and knifeplay to be edgeplay”.

The article also discusses whether those into edgeplay are insane to do what they do. (I am well aware that ‘insanity’ is a legal terms and not a psychological one, but this was the word used in the article). The author of the article asserts:

Can something be considered insane if you are aware of the risks and accept all the possible outcomes…ask a skydiver, or perhaps an astronaut, even a policeman or fireman. Every activity has some level of risk, it is only when one ignores the risks or does not logically think out all possible dangers that the action may be considered insane. If one enters into an activity informed, and educated of the risks then the activity should not be considered insane, but is should be considered dangerous, hence edge play”.

The author also claims that edgeplay is “an extremely fascinating type of BDSM” because it challenges participants mentally, physically and emotionally. I will leave you with this encapsulation of why edgeplay enthusiasts do what they do. They feel fear, pain, love, and trust takes them “to a level of experience that [they] can reach by no other manner. This activity will stretch all boundaries and affirm the relationship between two individuals in a way that no other activity can”.

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.

Caged Heart (2006). Canes & caning: Introducing Edgeplay into your relationship. Yahoo! Voices, August 2. Located at:

London Fetish Fair (2014). Edgeplay Top 10 Medical Play Kit. Located at:

Norische (2013). Standing on the edge: Is it edge play or not? Dominant Guide, April 26. Located at:

Sir Bamm! (undated). Edge Play. Located at:

White, R.R. (2012). Edgeplay isn’t your grandmother’s BDSM scene. Vice, September 12. Located at:

Wikipedia (2014). Edgeplay. Located at: