Acting up: A brief look at the ‘Hollywood Phenomenon’ delusion

In a previous blog I briefly examined Delusional Misidentification Syndromes (DMSs). These are arguably some of the strangest mental and neurological syndromes that exist. All DMSs involve a belief by the affected individual that the identity of something (i.e., a person, place, object, etc.) has altered or changed in some way. There are many variants of DMS, and in most cases the delusion is monothematic (i.e., it only concerns one particular topic). The DMSs that are most written about are:

• The Fregoli delusion (individuals who have the belief that more than one person that they have met is the same person in more than one disguise).
• The Capgras delusion (individuals who have the belief that someone (typically a spouse or close relative) has been replaced by an identical-looking imposter.
• Subjective doubles (aka Christodoulou syndrome) (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.
• Intermetamorphosis: (individuals who have the belief that people in their immediate vicinity change identities with each other but keep the same appearance.

According to Dr. K.W. De Pauw and Dr. T.K. Szulecka in a 1988 issue of the British Journal of Psychiatry, those with DMSs are “more likely to commit violent crimes against persons than those with chronic, undifferentiated psychoses”. In their paper, De Pauw and Szulecka reviewed the literature concerning violence associated with DMSs and reported four case studies of individuals that were “either perpetrators or victims of assaults as a consequence of the syndromes of Fragoli, Intermetamorphosis, Subjective Doubles and Capgras”. After this paper was published, Dr. A.P. Shubsachs and Dr. A. Young responded to the paper (also in the British Journal of Psychiatry) with a short account of two case studies with a “variant of delusional misidentification environment”.

The two cases had a delusion that was described as the ‘Hollywood Phenomenon’ and comprised the belief “that the patient’s environment has been changed to a film or theatre set peopled by actors and in which the patient has a role to play”. (This also appears to be similar to the ‘Truman Show’ Delusion that I described in a previous blog and is “a novel delusion, primarily persecutory in form, in which the patient believes that he is being filmed, and that the films are being broadcast for the entertainment of others”).

Shubsachs and Young asserted that the ‘Hollywood Phenomenon’ (HP) was a symptom rather than a syndrome. They also reported that based on their tow case studies, HP can occur along with atypical Capgras phenomenon, and may result in violence, verbal hostility, and non co-operation. Here are the two case studies in the authors’ own words (taken verbatim from the British Journal of Psychiatry):

• Case 1: “Mr. A, a 22-year-old single Australian man with a history of two admissions for bipolar affective disorder, left Australia in the early stages of a manic episode. On arrival in the UK his condition deteriorated, with elevated mood, decreased sleep, excess energy, and accelerated thoughts. He recognised that he was relapsing and consulted a GP, who arranged an urgent out-patient appointment. Before that appointment he became convinced he was ‘an actor and that everything that was going on was a film’ in which he was the main player. He stole a car which he deliberately crashed because ‘it was a stunt car and I was a stunt man who was supposed to crash it…it was rigged so I wouldn’t get hurt’. He was arrested and later assaulted the police surgeon with what he erroneously believed was a bottle of ‘harmless sugar glass’ causing severe injuries. Mr A. claimed that he, the surgeon, and the police were all play actors and that his actions would have ‘no real consequence’. Remanded in prison for psychiatric reports, he was intermittently violent in response to similar misidentifications until he became euthymic following medication. He was transferred Hospital Order, and on admission had insight into his previous delusions”.
• Case 2: “Miss B. exhibited both a Capgras phenomenon and a ‘Hollywood phenomenon’. She was a single retired midwife in late middle age, living alone. She had had several admissions with a diagnosis of depressive psychosis or schizophrenia. On this occasion she was depressed with early morning wakening, psychomotor retardation, appetite and weight loss, and felt hopeless and worthless. She believed relatives were impostors and was verbally aggressive towards them. She believed that the hospital was a film set peopled by actors, the admitting doctor a film director, and that the purpose of the interview was to obtain a script for the film. While she struggled and was verbally hostile at attempts to detain her, there was no serious violence. She recovered fully after ECT”.

Shubsachs and Young claimed that the HP delusion was both uncommon and under-reported, and that both of the cases that they described involved “affective illness without organic impairment”. They then went on to claim that they didn’t think that the ‘Hollywood Phenomenon’ was “specific for affective disorders” (and asked if other psychiatrists reading their case studies could provide other examples). They concluded that the HP “differs from the superficially similar transient experience in derealisation in that it has a real, not an ‘as if’ quality, is enduring, and has all the features of a delusion including the tendency to be acted upon”.

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

Further reading

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

De Pauw, K. W., & Szulecka, T. K. (1988). Dangerous delusions. Violence and the misidentification syndromes. British Journal of Psychiatry, 152(1), 91-96.

Ellis, H.D., Luauté, J.P. & Retterstøl, N. (1994). Delusional misidentification syndromes. Psychopathology, 27(3-5), 117-120.

Enoch, M.D. & Trethowan, W. (1979). Uncommon Psychiatric Syndromes. Oxford: Butterworth-Heinemann; 1979.

Fusar-Poli, P., Howes, O., Valmaggia, L., & McGuire, P. (2008). ’’Truman’’ signs and vulnerability to psychosis. British Journal of Psychiatry, 193, 168.

Gold, J. & Gold, I. (2012). The “Truman Show” delusion: Psychosis in the global village. Cognitive Neuropsychiatry, 17, 455.

Shubsachs, A.P., & Young, A. (1988). Dangerous delusions: The ‘Hollywood phenomenon’. British Journal of Psychiatry, 152(5), 722-722.

The piles high club: A very brief look at haemorrhoid fetishes

If there’s any subject likely to cause embarrassment (if you have them) and/or laughter (if you haven’t) it’s haemorrhoids (i.e., ‘piles’). I’m sure most of you reading this know what haemorrhoids are, but if you don’t, then Wikipedia’s anatomical description might be helpful (although the website’s photographs made me a little queasy):

“Hemorrhoids (US English) or haemorrhoids (UK)…are vascular structures in the anal canal which help with stool control. They become pathological or piles when swollen or inflamed. In their physiological state, they act as a cushion composed of arterio-venous channels and connective tissue”.

One thing that never ceases to amaze me is what other human beings find sexually attractive (as evidenced by many of my previous blogs such as those who are sexually attracted to ugly people (teratophilia), amputees (acrotomophilia), and those with physical deformities (abasiophilia). The only reason I am writing this blog was because I came across this online snippet:

“If you find a guy who’s not disgusted, sure you can. I had a mate with a hemorrhoid fetish once. He used to brag about how he loved popping them out”.

I have to admit that I was more than a little suspect about whether anybody could be genuinely turned on and sexually aroused by somebody else’s haemorrhoids but I decided to look into it. One thing that convinced me there is a niche market for almost anything, is the number of hard core pornography videos that cater for those with a sexual interest in haemorrhoids (or at the very least a penchant for watching those with haemorrhoids having sex – such as the Heavy-R and Muchosucko websites – please be warned that these are very sexually explicit and may upset some people). These videos are clearly made by those who believe they can make money from people who want to watch this type of thing. However, it could always be the case that watching people with haemorrhoids having sex are not watching for sexual purposes but are viewing out of horrified curiosity.

In a previous blog that I wrote on retained rectal foreign bodies, I came across a 2003 paper by Dr. Wen-Chieh Huang and colleagues published in the Journal of the Chinese Medical Association. Their paper examined ten cases of males (average age of 57 years) who had reported to Taipei Veterans General Hospital because they had got an object stuck inside their rectal passage. The reason I mention this paper is because two of the ten men (one aged 50 years in a case from 1999, and the other aged 76 years from a case in 1991) had got sexual vibrators stuck inside their rectal passage after using them to “smooth” their haemorrhoids. It is unclear as to whether the smoothing of the haemorrhoids caused sexual stimulation but the fact that it was a sexual vibrator at least suggests the practice was more than just therapeutic.

It won’t surprise anyone that there is absolutely nothing written about haemorrhoid fetishes either academically or clinically. However, the online Urban Dictionary has an article on ‘Jarmel Berries’ (which I have to admit that I had never heard of) but relates to the sexualization of haemorrhoids. The article noted:

“Created in Colorado in 2005, this deviant sexual practice consists of an oral fetish with hemorrhoids. This act involves one male licking and ‘oral pleasuring’ the hemorrhoids of the other male participant that were created from rough homosexual sodomy. The Jarmel Berries refer to the ‘mouth-watering’ attraction the deviants feel towards a disturbing twist to ‘salad tossing’. This practice has gained popularity through the homosexual prison population across the mid-west, and has traveled as far east as Virginia…This practice has been mentioned in several rap songs, referring to the tough life of prisoners in multiple federal and state detention centers where the Jarmel Berries act has been reported by officials to have grown into an act of hate and domination. It has been reported that the larger or stronger prisoners in the penitentiary facilities have used this act to show their dominance or ‘ownership of other prisoners…The Jarmel Berries term has also caught on with the Lesbian/Gay communities along the west coast in areas like San Diego, San Francisco, and Portland…Another popular variation of this term includes “Jarmel Jelly” (referring to bleeding of the hemorrhoids)”.

The Urban Dictionary also has a separate entry for ‘Jarmel Jelly’ and defined it as “any liquid substance that would seep out of an engorged or enflamed haemorrhoid”.

Personally, of all the different fetishes I have written about in my blog, I am less convinced by the existence of this sexual fetish than any other. I didn’t come across a single first-hand anecdotal account online although I can’t deny that ‘haemorrhoid porn’ exists. If you know any different, then let me know via my personal email address: mark.griffiths@ntu.ac.uk)

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

Further reading

Huang, W-C., Jiang, J-K., Wang, H-S., Yang, S-H., Chen, W-S., Lin, T-C., & Lin, J-K. (2003). Retained rectal foreign bodies. Journal of the Chinese Medical Association, 66, 606-611.

Urban Dictionary (2013). Jarmel Berries. Located at: http://www.urbandictionary.com/define.php?term=Jarmel%20Berries&defid=1700690

Wikipedia (2013). Hemorrhoid. Located at: http://en.wikipedia.org/wiki/Hemorrhoid

Gamblers anonymous: The psychology of live online casino gambling

Over the last decade, my research unit has carried out an increasing amount of research into the psychology of online gambling. In some of our recent research interviewing online gamblers, offline gamblers and non-gamblers, we found that people who gambled online did so because of its (i) convenience, (ii) greater value for money, (iii) the greater variety of games, and (iv) anonymity. Perhaps more interestingly, were the inhibiting reasons that stopped people from wanting to gamble online in the first place. The main inhibiting reason that stopped people gambling online was that offline gamblers and non-gamblers said the authenticity of gambling was significantly reduced when gambling online. We also found a number of other inhibitors of online gambling including (i) the reduced realism, (ii) the asocial nature of the internet, (iii) the use of electronic money, and (iv) concerns about the safety of online gambling websites. The reduced authenticity and realism may help to explain why online live action casino games are seen as increasingly popular among some types of gamblers.

This empirical research also chimes with my own personal psychology of online gambling. One of the main reasons I don’t like gambling at Internet casinos is that I believe the majority of game outcome are likely to be pre-programmed and/or predetermined. To me, this is somewhat akin to playing with imaginary dice! Our empirical research findings also help explain the rise of live online casino gambling. Players not only want increased realism and authenticity, but still have the added advantages of online anonymity while playing.

In online live casino gaming, the anonymity of the Internet allows players to privately engage in gambling without the fear of stigma. This anonymity may also provide the gambler with a greater sense of perceived control over the content, tone, and nature of the online experience. Anonymity may also increase feelings of comfort since there is a decreased ability to look for, and thus detect, signs of insincerity, disapproval, or judgment in facial expression, as would be typical in face-to-face interactions. For activities such as gambling, this may be a positive benefit particularly when losing as no-one will actually see the face of the loser. Anonymity may reduce social barriers to engaging in gambling, particularly those activities thought to be more skill-based gambling activities (such as poker or blackjack) that are relatively complex and often possess tacit social etiquette. The potential discomfort of committing a structural or social faux-pas in the gambling environment because of inexperience is minimized because the player’s identity remains concealed.

Furthermore, one of the main reasons why behaviour online is very different from offline is because it provides a ‘disinhibiting’ experience. One of the main consequences of disinhibition is that on the internet people lower their emotional guard and become much less restricted and inhibited in their actions.

The increase in online live casino gambling has happened alongside the rise of online betting exchanges – the type of online gambling where it could be argued that skill can – to some extent – be exercised. For gamblers, having a punt on live sporting events via betting exchanges is a psychologically safer option because punters know (or can check) who won a particular football or horse race. The playing of live action casino games via the Internet shares some of the psychological similarities of online betting exchanges.

The rise of live online gambling has been coupled with increasingly sophisticated gaming software, integrated e-cash systems, and increased realism (in the shape of “real” gambling via webcams, live remote wagering, and/or player and dealer avatars). These are all inter-linked facilitating factors. Another factor that I feel is really important in the rise of online gambling (including online live action casino games) is the inter-gambler competition. Obviously there is an overlap between competitiveness and skill but they are certainly not the same. What’s more recent research has suggested that being highly competitive may not necessarily be good for the gambler. For instance, Professor Howard Shaffer, a psychologist at Harvard University, claims that men are more likely to develop problematic gambling behaviour because of their conventionally high levels of aggression, impulsivity and competitiveness. Clearly, the idea of the competitiveness of the activity being one of the primary motivations to gamble is well supported.

Based on the fact that so little research has systematically examined the links between gambling and competitiveness, our research unit did some research into this area. We speculated that a gambler who is highly competitive will experience more arousal and stimulation, and be drawn to gambling as an outlet to release competitive instincts and drives. This is likely to occur more in activities like online poker and online live action casino games. Our research did indeed show that problem gamblers were significantly more likely than non-problem gamblers to be competitive.

Being highly competitive may help in explaining why in the face of sometimes negative and damaging financial consequences, gamblers persist in their habit. Psychological research in other areas has consistently shown that highly competitive individuals are more sensitive to social comparison with peers regarding their task performance. Applying this to a gambling situation, it is reasonable to suggest that competitive gamblers may be reluctant to stop gambling until they are in a positive state in relation to opposing gamblers, perhaps explaining why excessive gambling can sometimes occur.

Sociologists have speculated that factors of the human instinctual expressive needs, such as competition, can be temporarily satisfied when engaging in gambling activities. Evidence exists supporting gambling as an instrumental outlet for expressing competitive instinctual urges. The US sociologist Erving Goffman developed what he called the ‘deprivation-compensation’ theory to explain the relationship between gambling and competitiveness. He suggested that the stability of modern society no longer creates situations where competitive instincts are tested. Therefore, gambling is an artificial, self-imposed situation of instability that can be instrumental in creating an opportunity to test competitive capabilities. Again, online live action casino gambling is another gambling form that can facilitate such instinctive needs.

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

Further reading

Goffman, I. (1972). Where the action is. In: Interaction Ritual (pp. 149–270). Allen Lane, London.

Griffiths, M.D. (2010). Gambling addiction on the Internet. In K. Young & C. Nabuco de Abreu (Eds.), Internet Addiction: A Handbook for Evaluation and Treatment. pp. 91-111. New York: Wiley.

Griffiths, M.D. & Parke, J. (2003). The environmental psychology of gambling. In G. Reith (Ed.), Gambling: Who wins? Who Loses? pp. 277-292. New York: Prometheus Books.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2009). Socio-demographic correlates of internet gambling: findings from the 2007 British Gambling Prevalence Survey. CyberPsychology and Behavior, 12, 199-202.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Kuss, D. & Griffiths, M.D. (2012).  Internet gambling behavior. In Z. Yan (Ed.), Encyclopedia of Cyber Behavior (pp.735-753). Pennsylvania: IGI Global.

McCormack. A. & Griffiths, M.D. (2012). Motivating and inhibiting factors in online gambling behaviour: A grounded theory study. International Journal of Mental Health and Addiction, 10, 39-53.

McCormack, A. & Griffiths, M.D. (2013). A scoping study of the structural and situational characteristics of internet gambling. International Journal of Cyber Behavior, Psychology and Learning, 3(1), 29-49.

McCormack, A., Shorter, G. & Griffiths, M.D. (2013). An examination of participation in online gambling activities and the relationship with problem gambling. Journal of Behavioral Addictions, 2(1), 31-41.

McCormack, A., Shorter, G. & Griffiths, M.D. (2013). Characteristics and predictors of problem gambling on the internet. International Journal of Mental Health and Addiction, 11, 634-657.

Wardle, H. & Griffiths, M.D. (2011). Defining the ‘online gambler’: The British perspective. World Online Gambling Law Report, 10(2), 12-13.

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

Bosom buddies: A brief look at breast fetishism

Over the last year, I have received more than a dozen emails (all male) asking why I have not written a blog on ‘breast fetishism’. The main reason I have resisted writing such a blog is that it’s hard to determine where normal love of breasts ends and abnormal love of breasts begins. It won’t surprise anyone reading this that when it comes to male sexual arousal, female breasts are at the top of many men’s lists as the body part they find most sexually attractive. According to Dr. Anil Aggrawal in his book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, the sexual paraphilia of being aroused by female breasts is mammagymnophilia or mazophilia and comprises “a pronounced fetishistic sexual interest in the female breasts, their shape, movement, and especially their size”. He goes on to write that:

“[Breast fetishism is] also known as mastofact or breast partialism, it refers to an exclusive or almost exclusive reliance on breasts as a stimulus for sexual arousal. It is such a predominant feature of sexuality in the U.S., that Molly Haskell, a feminist and author from the USA, went as far as to say that ‘the mammary fixation is the most infantile and the most American of the sex fetishes’. British zoologist and ethologist Desmond Morris sees breast fetishism as a prime example of biosemiotics, by which human sexuality is influenced through signaling”.

While doing my undergraduate degree I did a project on the psychology of female orgasm and read almost every paper and book that I could on sexuality and female sexuality. I read Desmond Morris’ book The Naked Ape and was very interested in Morris’ theories on sexual signalling. If memory serves me, Morris argued that women’s breasts had evolved to look like female buttocks as humans had slowly changed the way they had sex from males mounting females from the rear to face-to-face sex. In the 1998 book Handbook of Evolutionary Psychology: Ideas, Issues, and Applications by Charles Crawford and Dennis Krebs (1998) it was theorized that humans’ permanently enlarged breasts allows females to “solicit male attention and investment even when they are not really fertile”. These hypotheses was also mentioned in the 2012 book The Chemistry Between Us: Love, Sex, and the Science of Attraction but rejected by the authors. Young and Alexander wrote:

“Biologically speaking the human male’s obsession with breasts is pretty weird. Men are the only male mammals fascinated by breasts in a sexual context. And women are the only female mammals whose breasts become enlarged at puberty, independent of pregnancy. We are also the only species in which males caress, massage and even orally stimulate the female breasts during foreplay and sex. Boys don’t learn on the playground that breasts are something that they should be interested in. It’s biological and deeply engrained in our brain. Man’s obsession with breasts is an unconscious evolutionary drive that helps humans forge loving, nurturing bonds”.

In fact, Young and Alexander forward a more biological explanation and went on to claim that it was oxytocin that best explained why women had developed breasts:

“When a woman gives birth, her newborn will engage in some pretty elaborate manipulations of its mother’s breasts. This stimulation sends signals along nerves and into the brain. There, the signals trigger the release of a neurochemical called oxytocin from the brain’s hypothalamus. This oxytocin release eventually stimulates smooth muscles in a woman’s breasts to eject milk, making it available to her nursing baby. But oxytocin release has other effects, too. When released at the baby’s instigation, the attention of the mother focuses on her baby. The infant becomes the most important thing in the world. Oxytocin and dopamine act together to help ‘imprint’ the newborn’s face, smell and sounds into the mother’s reward circuitry, making breastfeeding and nurturing a pleasurable experience that will motivate her to keep doing those activities to strengthen the mother-infant bond. This bond is not only the most beautiful of all social bonds, it can also be the most enduring, lasting a lifetime. When a lover touches, massages or nibbles a woman’s breasts, it sparks the same process of brain events as nursing.  Humans are also among the very few animals that have sexual intercourse face-to-face, looking into each other’s eyes. This quirk in human sexuality has evolved to exploit the ancient mother-infant bonding brain circuitry as a way to help form bonds between lovers. Because the release of oxytocin forces the brain’s attention to a partner’s face, smell and voice, the combination of oxytocin release during breast stimulation, and the increase of dopamine from the pleasure of foreplay and face-to-face sex, helps to forge an association of the lover’s face and eyes with the pleasurable feelings, building a bond in the women’s brain”

I was surprised to find there had been little empirical research on the role of breast and nipple stimulation in influencing sexual arousal during sex. In 2006, Dr. Roy Levin and Dr. Cindy Meston published a paper in the Journal of Sexual Medicine and claimed that there had never been a study that questioned people about breasts and sexual arousal. Consequently, Levin and Meston surveyed 301 “sexually experienced undergraduates” (148 males and 153 females mostly between the ages of 18 and 22). The authors reported:

“81.5% [of women] reported that stimulation of their nipples/ breasts caused or enhanced their sexual arousal, 78.2% agreed that when sexually aroused such manipulation increased their arousal, 59.1% had asked to have their nipples stimulated during lovemaking, and only 7.2% found that the manipulation decreased their arousal. In regard to the men, 51.7% reported that nipple stimulation caused or enhanced their sexual arousal, 39% agreed that when sexually aroused such manipulation increased their arousal, only 17.1% had asked to have their nipples stimulated, and only 7.5% found that such stimulation decreased their arousal”.

When it comes to breast fetishism, it could be argued that there are many different sub-types. Reading Dr. Aggrawal’s book alone there are many other types of sexual activity surrounding the fetishizing of the breast. This includes lactophilia (arousal from lactating breasts), oenosugia (pouring wine over female breasts and licking it off), mazophallating (the rubbing of the penis between breasts, and also know as coitus a mammilla), mazoperosis (sexual gratification from mutilating of female breasts – arguably the most extreme form of what Dr. Aggrawal describes as “tit torture, the sexual gratification from any of several erotic BDSM activities focusing solely on inflicting pain on the breast, nipples, and areola”), and ‘downblousing’:

“[Downblousing] is a variant of voyeurism where the voyeur is attracted to women bending downward so he can view their breasts down their shirt or blouse. Viewing a woman’s breast while sitting on a. higher level than the woman is also downblousing. A good example is a person sitting on first floor of a restaurant, viewing the breasts of an unsuspecting woman sitting on the ground floor taking surreptitious photographs, especially with camera-enabled cell phones, is also common among voyeurs. Many times, these photographs are then posted on the Internet for all to see. Many nations and jurisdictions have now outlawed downblousing”.

There are also other sexual behaviours that may (or may not) involve breasts as the focus of sexual arousal. For instance, anaclitism refers to “the sexual enjoyment arising from activities, or being exposed to objects normally associated with childhood (e.g., toilet training, breast sucking, playing with dolls)”. One breast-focused sexual fetish not mentioned by Dr. Aggrawal at all is ‘breast expansion fetishism’. According to the Nation Master website:

“Breast expansion fetishism is a sexual fetish characterized by pronounced sexual fantasies involving a woman whose breasts enlarge, either gradually or suddenly, sometimes to gargantuan proportions. Breast expansion fetishism may manifest as a form of inflation fetishism. Many breast expansion fetishists are fascinated by the processes by which women’s breasts can become larger, whether from age progression, pregnancy, weight gain or surgery. It is not uncommon for them to examine closely the careers of adult and mainstream entertainers and their increasing, or decreasing, bust sizes…Many breast-expansion fetishists are morphers. A morph is a photograph, an artwork, an animation which uses morphing techniques to expand a woman’s breasts”.

In the name of research I went onto Google Scholar and unsurprisingly turned up little academic. However, I was surprised to find many breast expansion sites including websites like the Big Breast Expansion, Overflowing Bra, Breast Expansion Grove (with lots of links to other breast expansion websites) and Boob Growth (please be warned these sites are sexually explicit if you click on the links) as well as sites like Literotica with a dedicated breast expansion page of fan fiction. Breast expansion is also very popular in both Manga and Anime cartoons.

I also found various first-person accounts of young adult males admitting to having such fetishes:

“I have a breast expansion fetish. No matter what, I always find myself coming back to this. In so many ways it’s amazing. Slowly, suddenly, sporadically, I like to see them grow. But I have my limits of when it gets stupidly huge (bigger than their body size). But I also have a thing of [breast expansion] on myself, like to be gender changed, then added in bigger boobs. I have been off and on with this stuff for years” (MD12, The Experience Project).

“I am searching for help and I hope I could find it here. My problem is…I have a breast expansion fetish. I [get an] erection when I [see] female breasts are growing. It started when I had seen [the] film ‘The Adventures of Pluto Nash’ in hospital. Since [then I am] always looking [for] comics, videos and pictures with growing breasts. Now I am 18 years old, I have marvelous girlfriend and we love each other. I told her about my problem and understand it, but she has forbidden me to masturbate on growing breasts…We have awesome sex but I still want to watch growing breasts. And don’t know what to do now. I don’t wont to lie, and masturbate when I [am] alone, and I don’t know how to beat this fetish. Often I am imagining [my girlfriend] with growing breasts…I hope you can help me”. (Joishi, PsychForums)

I also found what I thought was an article on the psychology of breast expansion but it was a male on the Overflowing Forum trying to analyse his own behaviour (but I found it of interest). Unfortunately, the original post has disappeared but I managed to cut and paste the self-analysis before it disappeared:

“I´m very interested in the psychology of breast expansion fetish – my obsession. I think the expansion aspect is one of many others. I like expansion stuff, but as a category it does not seem meaningful. To me, these aspects are of relevance (i) deviance [standing out from the norm], sensuality [a focus on the physical body], and emotional sensitivity [for symbolic power and interpersonal processes]. First, I´m generally attracted to stuff that defies the norm, like Lady Gaga and Beth Ditto or Slayer, the Marquis de Sade, monster movies. Second: I am fascinated by the body/mind duality of the human existence…Prominent flesh puts the focus on the body, the animal aspect of our being. And prominent breasts especially have sexual and/or nurturing connotations. Third, body parts can be seen [as] anatomical, but also on a symbolic level, they can be a means to express and execute power over others, or they can be presented as a gift – craving, desire, attention, power…a certain tension, an emotional disbalance is important for me. Big breasts can be just a nuisance for a girl or woman – for good reasons – or something they hardly care about, and then they lose most of their erotic power they could have on me”.

Like many other sexual paraphilias I have written about (such as macrophilia, microphilia, exophilia, and vorarephilia), much of the breast expansion community appears to base a lot of the online activity around fan fiction and fan art. As the Nation Master article on breast expansion notes:

“Breast expansion stories are often fantastical tales of women’s busts being enlarged by air, food, magic, medicine, alien technology or some other unseen force. Generally, the amount of enlargement is limited only by the imagination of the author, from as little as a cup size to as big as room-filling and beyond. Occasionally, there are other types of fetishes included in these stories, such as lactation, anthropomorphism, giantess, transgender, body inflation, penis expansion, or any of the processes under the umbrella term transformation fetish. Stories and pictures associated with breast expansion sometimes contain vivid depictions of sexual activity, but it is not a necessity of the fetish” 

This brief overview has highlighted that when it comes to breast fetishism and its many variants, that there is surprisingly little scientific research.

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.

Crawford, C. & Krebs, D, (1998). How Mate Choice Shaped Human Nature. Handbook of Evolutionary Psychology: Ideas, Issues, and Applications. London: Lawrence Erlbaum Associates,

Levin, R. J. (2006). The breast/nipple/areola complex and human sexuality. Sexual and Relationship Therapy, 21, 237-249

Levin, R., & Meston, C. (2006). Nipple/breast stimulation and sexual arousal in young men and women. Journal of Sexual Medicine, 3(3), 450-454.

Nation Master (2014). Breast expansion fetish. Located at: http://www.statemaster.com/encyclopedia/Breast-expansion-fetish

Wikipedia (2014). Breast fetishism. Located at: http://en.wikipedia.org/wiki/Breast_fetishism

Young, L. & Alexander, B. (2012). The Chemistry Between Us: Love, Sex, and the Science of Attraction. London: Penguin.

Primal suspects: The psychology of Tears for Fears

Because I am both a psychologist and self-confessed music obsessive, one of the questions I am often asked by my friends is ‘Who is the most psychologically influenced band?’ Based on my own musical tastes, I would have to say Tears for Fears (one of many bands named after something psychological – other contenders based on name alone include Pavlov’s Dog, Therapy?, Primal Scream, Madness, and The Mindbenders, to name a few).

Tears For Fears (TFF) were one of my favourite bands as a teenager and (if my memory serves me) I saw them support The Thompson Twins just as their third single (‘Mad World’) became their first British hit single. TFF were formed in 1981 by Roland Orzabal and Curt Smith after they left the Bath-based band Graduate (mostly remembered for their single ‘Elvis Should Play Ska’ from their debut – and only – LP Acting My Age). They briefly called the band ‘History of Headaches’ but eventually settled on TFF.

TFF’s name was inspired by primal therapy (as was the band Primal Scream). Even from a young age I was well aware of primal therapy as I was – and still am – a massive fan of The Beatles and John Lennon. Lennon underwent primal therapy in 1970 with its’ developer (US psychotherapist Dr. Arthur Janov). In fact, one of the reasons I chose to study psychology at university was because I had read Janov’s first book (The Primal Scream) just because of my love of Lennon’s work. As the Wikipedia entry on primal therapy notes:

“Primal therapy is a trauma-based psychotherapy trauma-based created by Arthur Janov, who argues that neurosis is caused by the repressed pain of childhood trauma. Janov argues that repressed pain can be sequentially brought to conscious awareness and resolved through re-experiencing the incident and fully expressing the resulting pain during therapy. Primal therapy was developed as a means of eliciting the repressed pain; the term Pain is capitalized in discussions of primal therapy when referring to any repressed emotional distress and its purported long-lasting psychological effects. Janov criticizes the talking therapies as they deal primarily with the cerebral cortex and higher-reasoning areas and do not access the source of Pain within the more basic parts of the central nervous system. Primal therapy is used to re-experience childhood pain – i.e., felt rather than conceptual memories – in an attempt to resolve the pain through complete processing and integration, becoming ‘real’. An intended objective of the therapy is to lessen or eliminate the hold early trauma exerts on adult life”.

The Primal Scream book recounts the primal therapy experiences that Janov had with 63 clients during a year-and-a-half period in the late 1960s (and who he claimed were all successfully ‘cured’ using his newly developed therapy). Unlike John Lennon, TFF never underwent primal therapy themselves (but read Janov’s work). It was actually Dr. Janov’s 1980 book Prisoners of Pain (Unlocking The Power Of The Mind To End Suffering) where he claimed “tears as a replacement for fears” (and hence the band’s chosen name). In a 2004 television interview, both Smith and Orzabal said they were disillusioned when they met Janov in the mid-1980s (claiming Janov had become quite “Hollywood” and asking TFF to write a musical based on his work).

Both Smith and Orzabal claimed to have had unhappy childhoods that led them to the work of Dr. Janov (they were too poor – unlike Lennon – to actually have primal therapy and described having such therapy as “an aspiration”). Most of their songs directly or indirectly referenced primal therapy. In fact, I would go as far as to say that the whole of their first album The Hurting was a concept LP. Orzabal claimed that “writing the title track was a strange piece of psychic osmosis…I had an acoustic guitar in my hand at the time and played [Curt] what he was describing: that’s how ‘The Hurting’ was written, and we knew for a long time it was the right name for our first album”.

A quick look at the album’s song titles shows how influenced they had been by primal therapy (such as the title track, ‘The Prisoner’, ‘Mad World’, Ideas As Opiates’, ‘Watch Me Bleed’, ‘Memories Fade’, ‘Start Of The Breakdown’, ‘Pale Shelter (You Don’t Give Me Love’, and ‘Change’). As Paul Sinclair notes in his sleeve notes for the latest box-set reissue:

“Like all great art, ‘The Hurting’ connects. The emotion grabs hold of your heart and gives it a squeeze. The Primal Therapy and Janov influence provide a satisfying consistency, and the band are comfortable in using the ‘C’ word [concept] in reference to ‘The Hurting’…[Orzabal adds] It’s a very consistent album with its own personality. There’s a strong message running through it and some of the song titles were taken from Janov’s writing”.

A number of commentators (including Sinclair) have made the observation that the whole album is about the transition between childhood and adulthood. Maybe that’s why I bought it as a teenager. In contrast to lyrics in The Smiths’ ‘Panic’ (“It says nothing to me about my life”), The Hurting “said something to me about my life”. Sinclair also notes:

“Deep analysis of the songs and navel gazing is not a condition of entry. The genius of ‘The Hurting’ is that on one level, it is just an album of great, melodic, hook-filled pop songs…In the end. ‘The Hurting’ was the album that the band needed to make. There was never going to be an alternative debut. The basic idea behind Janov’s Primal Therapy – the impact that the trauma of childhood had on your character as an adult – was the blood running through the veins of the record”.

Of course, TFF haven’t been the only band to have songs and/or an album influenced by psychologists and/or psychological theory (and of course Carl Jung and Sigmund Freud were both on the cover of The Beatles Sgt. Pepper’s Lonely Hearts Club Band). Arguably the most well known LP inspired by Dr. Janov’s therapy was John Lennon’s first ‘proper’ 1970 solo LP (John Lennon/Plastic Ono Band). Other artists have had direct inspiration from Freud (Freudiana by the Alan Parsons Project, the song ‘Psychotherapy’ by Melanie), Jung (Synchronicity by The Police) and Wilhelm Reich (Kate Bush’s single ‘Cloudbusting’ and Patti Smith’s ‘Birdland’). However, I would still contend that TFF were more psychologically influenced as primal therapy was their life philosophy (at least for a number of years).

Most people would probably argue that it was only The Hurting LP that was influenced by Dr. Janov but their later singles off their second LP Songs From The Big Chair are arguably primal therapy-related including ‘Mother’s Talk’ and ‘Shout’ (“Shout, shout, let it all out” could be the mission statement of primal therapy). However, Roland Orzabal claimed that neither were rooted in primal therapy:

“A lot of people think that ‘Shout’ is just another song about primal scream theory continuing the themes of the first album. It is actually more concerned with political protest. It came out in 1984 when a lot of people were still worried about the aftermath of The Cold War and it was basically an encouragement to protest…The song [Mothers Talk] stems from two ideas. One is something that mothers say to their children about pulling faces. They say the child will stay like that when the wind changes. The other idea is inspired by the anti-nuclear cartoon book ‘When The Wind Blows‘ by Raymond Briggs”.

However, ‘The Big Chair’ (B-side to ‘Shout’ and the inspiration for the title of the band’s second LP Songs From The Big Chair) has undeniable psychological roots. The song was inspired by the 1976 film Sybil (based on the 1973 non-fiction book by of the same name by Flora Rheta Schreiber). Sybil is about US psychiatric patient Sybil Dorsett (actually a pseudonym for Shirley Ardell Mason) who was treated for multiple personality disorder (now known as dissociative identity disorder) by her psychoanalyst (Dr. Cornelia Wilbur). ‘The Big Chair’ was in the therapist’s office where Sybil was treated and where she felt safest when talking about her traumatic childhood. Other songs hidden away on TFF B-sides cover aspects of traumatic psychology (‘My Life In The Suicide Ranks’) as well as ‘anti-science’ songs (‘Schrodinger’s Cat’ and ‘Déjà Vu & The Sins of Science’). However, like Christian historian Nathan Albright, I too believe the second LP and later 1986 single ‘Laid So Low’ are psychologically-based:

“Nor did the interest in psychology stop [with ‘The Hurting’]. Tears For Fears’ second album, “Songs From The Big Chair,” are a self-aware “multiple personality” exploration, a conceptual connection that is often forgotten because the hit singles from the album were so successful…Clearly, the musings about power and anger and memory that inform the work of Tears For Fears, the melancholy underpinnings of songs like ‘Watch Me Bleed’ and ‘Laid So Low (Tears Roll Down)’ are fairly easy to recognize, and draw greater meaning the more one knows about the band and its personal histories”.

As the years have passed, TFF’s songs have been less psychological but we are a product of our pasts and I would argue that the band’s output is still likely to be shaped by both their conscious and unconscious ideology. Smith was recently interviewed and he admitted that he still had an interest in various psychologies but that he no longer believed in primal therapy:

“Primal theory blames everything on your parents. So that teenage angst we were going through at the time. Since then, I think I’ve moved on to various different psychologies, but it’s something we’re both interested in. Since then, certainly, I’m not a huge believer in primal theory anymore, but I think that comes from having children”.

Maybe their most recent album (Everybody Loves A Happy Ending) has at last brought the band’s traumatic past to rest. Maybe the music itself became a kind of psychological therapy. As Nathan Albright concluded:

“The fact that [Tears For Fears] have a popular and critically acclaimed body of musical work is itself remarkable, but the fact that their work is heavily influenced by psychology, serving as therapy, serves as an inspiration. Rather than self-medication through drugs or alcohol, the two chose music as therapy, turning their lives into the inspiration for hauntingly beautiful songs in their debut concept album, ‘The Hurting’…And that is the most powerful legacy of Tears For Fears, in providing a way for both commercial viability as well as personal therapy. Many creative people [use] creativity as a way to wrestle with our own demons, and the fact that Tears For Fears were able to do it openly and honestly and sincerely, and successfully gives hope to the rest of us who have chosen to deal with our issues in the light, rather than engaging in false pretense”.

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

Further reading

Albright, N. (2012). Suffer the children: Tears For Fears and musical therapy. Edge Induced Cohesion, May 2. Located at: https://edgeinducedcohesion.wordpress.com/2012/05/02/suffer-the-children-tears-for-fears-and-musical-therapy/

Comaretta, L. (2014). Tears For Fears’ Curt Smith: Back in The Big Chair. Consequence of Sound, November 6. Located at: http://consequenceofsound.net/2014/11/tears-for-fears-curt-smith-back-in-the-big-chair/

Janov, A. (1970). The Primal Scream. New York: Dell Books.

Janov A (1977). Towards a new consciousness. Journal of Psychosomatic Research, 21, 333–339.

Janov, A. (1980). Prisoners of Pain: Unlocking The Power Of The Mind To End Suffering. New York: Anchor Books.

Sinclair, P. (2013). Tears For Fears: The Hurting. (Booklet in the Deluxe Reissue of ‘The Hurting’).

Wikipedia (2015). Arthur Janov. Located at: http://en.wikipedia.org/wiki/Arthur_Janov

Wikipedia (2015). Primal therapy. Located at: http://en.wikipedia.org/wiki/Primal_therapy

Wikipedia (2015). Tears For Fears. Located at: http://en.wikipedia.org/wiki/Tears_for_Fears

Coming to a different view: The Masturbation Fantasy Paradox

While researching an article on compulsive masturbation, I quite by chance came across a recent paper published by Wolter Seuntjens in the Journal of Unsolved Questions entitled ‘The Masturbation Fantasy Paradox: An Overlooked Phenomenon?’ (And yes, I too was amazed that there was a journal with such a name, although it colloquially calls itself JUNQ).

Seuntjens noted in his paper that masturbation is an activity that is often accompanied by fantasizing. However, he uses anecdotal evidence and material found in biographic and literary works to suggest some people are completely unable to fantasize about the person they are in love with during masturbation. This he describes as the ‘Masturbation Fantasy Paradox’ (MFP), a “putative phenomenon” that “may be a particular case of a more general principle put forward by Sigmund Freud”. Freud wrote an essay in 1912 concerning the paradoxes of love and desire. More specifically, in ‘On the universal tendency to debasement in the sphere of love’ Freud noted that “where such men love they have no desire and where they desire they cannot love”.

The whole thesis of the paper appears to rests on a few choice selections from autobiographical material supplied by comic actor and broadcaster (and all-round polymath) Stephen Fry, journalist and columnist Dermod Moore, and French writer and poet (and founder of the Surrealist movement) André Breton. More specifically, the extracts chosen by Seuntjens were:

• Extract 1: “Although I was to develop, like every male, into an enthusiastic, ardent and committed masturbator, he was never once, nor ever has been, the subject of a masturbatory fantasy. Many times I tried to cast him in some scene. I was directing for the erotic XXX cinema in my head, but it always happened that some part of me banished him from the set, or else the very sight of him on screen in the coarse porn flick running in my mind had the effect of a gallon of cold water. Sex was to enter our lives, but he was never wank fodder, never” (Stephen Fry in Moab is My Washpot).
• Extract 2: “I have no racy stories about shady events after lights-out in the tent. In fact, having recently discovered masturbation, I found camp frustrating for the lack of opportunity for relief. The fly-infested latrines were the only possible venues, but, unaccountably, self-abuse lost its allure there. However, I was in love with a boy in my patrol. I never really thought about sex with him, but we would roll around on the damp grass in mock combat, laughing and shouting “Help! Homo! Rape!” loudly enough, supposedly, to disguise our covert desire from the others. And from each other” (Dermod Moore in Diary of a Man [about his experience as a Boy Scout]).
• Extract 3: “In 1930, André Breton, while discussing sexuality in the loosely formed group of surrealists, remarked comparably: What do you think about when you masturbate? André Breton: It is accompanied by a series of fleeting images of different women (dream women) or I knew or know but never a woman I have loved”.

These three selections are presented as “direct observations” and then followed by an extract from a book The Ultimate Aphrodisiac by John Hole. In the novel, the book’s main protagonist Norman Ranburn says:

• Extract 4: “It didn’t matter that he might be in love with her. Love meant nothing at his age. Except, he discovered with some fascination, that he didn’t want to besmirch and overlay his vision of her with a dirty wanker’s fantasy”.

Unsurprisingly, Seuntjens notes there is no scientific research into the MFP and also claims there is little research on masturbatory fantasizing more generally. His first port of call are Nancy Friday’s books My Secret Garden (the best selling book on female sexual fantasies) and Men in Love, Men’s Sexual Fantasies: The Triumph of Love Over Rage. Two of Friday’s respondents arguably describe the MFP when they are reported as saying:

• Extract 5: “The funny thing is, when I’m dating someone I really care for, I never fantasize about them…Usually my thoughts center around a man I find fantastically attractive and very nice, i.e., a customer, a stranger on the street, someone I don’t know too well” (‘Beth Anne’).
• Extract 6: “By age twenty, still a virgin, I had had a succession of enchanting teen-age affairs – but since nice girls didn’t have sexual organs and certainly didn’t fuck, I didn’t even attempt to fondle a breast or introduce ‘French’ kissing. I didn’t even feel free to fantasize my latest love for masturbation purposes, usually resorting to her sister or one of her less attractive girl friends instead. One’s love had to be kept on a special Pedestal” (‘Don’).

Friday then goes onto speculate (in her book Forbidden Flowers: More Women’s Sexual Fantasies) that:

“One of the ironies of fantasy is that the hero of our erotic reveries is rarely the man we love. Perhaps it is the very fulfillment and satisfaction we get from him that leaves nothing to the imagination, and so we need these strangers in the night to people our imaginary sexual worlds. They bring us the excitement of the unknown”.

In an arguably more scientific piece of research, Seuntjens made reference to Dr. Brett Kahr’s 2007 book Sex and the Psyche that included reference to his British Sexual Fantasy Research Project comprising 13,553 participants and additional and in-depth face-to-face interviews with a further 122 people. Dr. Kahr made no direct reference to MFP but did note a more negative reason as to why some people do not fantasize about people they love:

“Many of the people whom I interviewed told me that they did not want to fantasize about the partner with whom they had had a row only hours before, the same partner who had spent all their money and had bored them with endless stories about their tedious work colleagues”.

Although the evidence presented by Seuntjens for the MFP was (at best) arguably anecdotal, it doesn’t mean that it doesn’t exist. If it does exist, the obvious question to ask why some people may ‘suffer’ from the MFP while others don’t. As Seuntjens concluded:

“If Freud intended the paradox primarily for the physical act of sex, the Masturbation Fantasy Paradox describes the phenomenon for the mental process of fantasizing. The Masturbation Fantasy Paradox, if it is a genuine phenomenon, may prove to be a special case of the more general paradox of love and desire so pointedly expressed in Freud’s dictum”.

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

Further reading

Freud, S. (1912). On the universal tendency to debasement in the sphere of love’. ‘Contributions to the psychology of love II’ in The Standard Edition of the Complete Psychological Works of Sigmund Freud (1957), Vol. XI, London: Hogarth Press.

Friday, N. (1973). My Secret Garden: Women’s Sexual Fantasies. New York: Pocket Books.

Friday, N. (1975). Forbidden Flowers: More Women’s Sexual Fantasies. London: Arrow Books.

Friday, N. (1980). Men in Love, Men’s Sexual Fantasies: The Triumph of Love Over Rage. London: Arrow Books.

Fry, S. (1997). Moab is My Washpot. London: Hutchinson.

Hole, J. (1996). The Ultimate Aphrodisiac. London: Hodder & Stoughton.

Kahr, B. (2007). Sex and the Psyche. London: Allen Lane

Moore, D. (2005). Diary of a Man. Dublin: Hot Press Books.

Pierre, J. (1992). Investigating Sex – Surrealist Discussions 1928-1932 (translated by Malcom Imrie). New York: Verso.

Seuntjens, W. (2013). The Masturbation Fantasy Paradox: An overlooked phenomenon? Journal of Unsolved Questions, 3(1), 9-12

Horticulture clash: Can gardening be addictive?

Back in November 2000, I appeared in numerous tabloid newspapers around the world in a story about ‘gardening addiction’ (such as one in the Daily Mail – ‘Professor says gardening is addictive’). It all began after I was interviewed by a journalist from the New Scientist magazine (Andy Coghlan). Coghlan wanted my reaction to a study published in the journal Biological Psychology led by my friend and colleague, Dr. Gerhard Meyer (with who I later co-edited the book Problem Gambling in Europe in 2009). Meyer and his colleagues had carried out a study on blackjack players and showed that they increased their heart rates while gambling (something that I also found in an earlier study I published on arousal in slot machine gamblers in a 1993 issue of the journal Addictive Behaviors). Meyer’s study also found that blackjack gamblers playing for money also had increased levels of salivary cortisol compared to blackjack gamblers playing for points.

I was asked by Coghlan whether I thought gambling could be a genuine addiction, even though it didn’t involve the ingestion of a psychoactive substance. I systematically went through my addiction components model (salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse) and spent about 15 minutes talking about my research on various behavioural addictions. When the New Scientist article was published, the only quote attributed to me was the following:

“Some people say you can’t have addiction unless you take a substance, but I would argue that gambling taken to excess is an addiction. If you accept that, you then accept that sex, computer games, even gardening, can be addictive. It opens up the floodgates to everything else”.

I had quite deliberately used the example of gardening to make the point that addiction should be assessed by standard addiction criteria and that if any behaviour fulfils all the criteria for addiction it should be classed as such irrespective of what the behaviour is. I also said in my interview with the New Scientist that I had never come across a case of gardening addiction but that it was theoretically possible. The New Scientist story was re-written by many different news outlets around the world. My comments were included in all of these stories. Some of these stories were reported with the focus being on the gambling study (such as the one reported by the BBC which you can read here). Others such as the Daily Mail and the New York Post (NYP) made my comments as the focus of the story. Here is what the NYP reported under the headline ‘Garden-variety junkies hooked on hobby’:

“Before you stop to smell the roses, you might want to think twice. People who enjoy gardening are as physically addicted as junkies and alcoholics, researchers claim. The findings by scientists at Bremen University in Germany are controversial because many experts refuse to believe that behavior can be addictive…The scientists also found the same is true of sex and gambling. They studied gamblers and measured the amounts of a stress hormone linked to addiction. Dr. Gerhard Meyer asked 10 gamblers in a casino to play blackjack, staking their own money. While the volunteers played, Meyer measured changes in their heart rates and levels of the stress hormone cortisol in their saliva. He then asked them to play for points rather than money, as a ‘control’ situation. Both heart rates and cortisol concentrations were markedly higher when the gamblers played for money…People who use addictive narcotics also have increased cortisol levels, which, in turn, can trigger the ‘addiction chemicals’ dopamine and seretonin in the brain. ‘Some people say you can’t have addiction unless you take a substance, but I would argue that gambling taken to excess is an addiction’, psychologist Mark Griffiths said. ‘If you accept that, you then accept that sex, computer games, even gardening, can be addictive. It opens up the floodgates to everything else’. If the new research is correct, gardening, gambling and sex, which involve pleasurable rewards for effort expended, could set up an addictive chemical pathway in the brain…Meyer says his findings might reduce the culpability of people who have committed crimes. If lawyers can attribute their clients’ crimes to physiological cravings rather than acts of free will, they may receive lighter sentences, he says”.

I spent much of the week in the media trying to get what I had actually said into context (and even appeared on Channel 4’s Big Breakfast television show defending what I had said). The Daily Mail article had sought comment from TV’s most high profile gardening expert Alan Titchmarsh who said: “[Gardening] is a very addictive pursuit. Once you’ve discovered the thrill of making things grow, you can’t stop. I get very twitchy if I can’t get outside and garden for a few days. It is an addiction – but a positive, useful addiction”. While I have no doubt Titchmarsh believed gardening to be a positive addiction (and would fulfil Dr. Bill Glasser’s criteria for positive addiction that I examined in a previous blog), it wouldn’t be an addiction using my own criteria. I wrote a letter to the New Scientist that they published on November 22 (2000) under the title ‘All kinds of addiction’. In that letter I wrote:

“My alleged comments about gardening addiction have been taken totally out of context and I would like to set the record straight, particularly as many of the national media appeared to have had a laugh at my expense following your press release on this story. My comments were made in reaction to the research by Meyer on gambling addiction, and whether I thought gambling was a true addiction because it didn’t involve a drug. I replied that any behaviour, be it gambling, sex, eating, Internet use, playing computer games or even, theoretically, gardening, that features all the core components of addiction, that is to say, mood-modifying effects, withdrawal symptoms, build-up of tolerance, total preoccupation with the activity, loss of control, neglect of everything else in their lives and relapse can be classed as an addiction. This was not reported in your article, leaving me wide open to misinterpretation. For the record, I have never said that gardening is addictive. What I have said is that any behaviour that fulfils the criteria for addiction can be operationally defined as addiction”.

On the same day (November 22), the Daily Mail also published an edited version of the letter I sent to the New Scientist buried away on page 73 (which you can read here) under the title ‘Eh, not quite’. In retrospect, I can smile about the whole incident, but I wasn’t smiling at the time. In a 2005 paper in the Journal of Substance Use, I subtly included a reference to the ‘gardening addiction’ story (or rather the lack of it) in a paper examining the nature of addiction:

“It is also important to acknowledge that the meanings of ‘addiction’, as the word is understood in both daily and academic usage, are contextual, and socially constructed (Howitt, 1991; Irvine, 1995; Truan, 1993). We must ask whether the term ‘addiction’ actually identifies a distinct phenomenon – something beyond problematic behaviour – whether socially constructed or physiologically based. If so, what are the principal features of this phenomenon? If we argue that it is hypothetically possible to be addicted to anything, it is still necessary to account for the fact that many people become addicted to alcohol but very few to gardening. Implicit within our understanding of the term ‘addiction’ is some measure of the negative consequences that must be experienced in order to justify the use of this word in its academic or clinical context. It seems reasonable at this stage to suggest that a combination of the kinds of rewards (physiological and psychological) and environment (physical, social and cultural) associated with any particular behaviour will have a major effect on determining the likelihood of an excessive level of involvement in any particular activity”.

I have still to come across anyone that I would say is genuinely addicted to gardening. However, I did come across an interesting paper on unusual compulsive behaviours caused by individuals receiving medication for Parkinson’s disease. The paper 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). One of the cases involved a man who developed a gardening compulsion:

“A 53-year-old male with [Parkinson’s disease] for 13 years became intensely interested in lawn care. He would use a machine to blow leaves for 6 [hours] without rest, finding it difficult to disengage from the activity, as he found the repetitive behavior soothing. He also developed compulsive gambling”.

This case study at least suggests that someone can develop addictive and/or compulsive like behaviour towards gardening but is obviously isolated and very rare (and in this case brought on by the medication taken). I am not aware of any empirical research on gardening addiction since my comments on the topic back in 2000. However, I still stick to my assertion that if the rewards are present (i.e., psychological, social, physiological, and/or financial), it is theoretically possible for people to become addicted to almost anything – even gardening.

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

Further reading

Glasser, W. (1976). Positive Addictions. New York, NY: Harper & Row.

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

Griffiths, M.D. (1993). Tolerance in gambling: An objective measure using the psychophysiological analysis of male fruit machine gamblers. Addictive Behaviors, 18, 365-372.

Griffiths, M.D. (2000). All kinds of addiction New Scientist, November 22, p 58.

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

Hoffmann, B. (2000). Garden-variety junkies ‘hooked’ on hobby: Study. New York Post, November 10. Located at: http://nypost.com/2000/11/10/garden-variety-junkies-hooked-on-hobby-study/

Howitt, D. (1991). Concerning Psychology. Milton Keynes: Open University Press.

Irvine, J. M. (1995). Reinventing perversion: Sex addiction and cultural anxieties. Journal of the History of Sexuality, 5, 429–450.

Meyer, G., Hauffa, B. P., Schedlowski, M., Pawlak, C., Stadler, M. A., & Exton, M. S. (2000). Casino gambling increases heart rate and salivary cortisol in regular gamblers. Biological Psychiatry, 48(9), 948-953.

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

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 & Related Disorders, 13(8), 516-519.

Truan, F. (1993). Addiction as a social construction: A postempirical view. Journal of Psychology, 127, 489-499.

Sexual heeling: A brief look at altocalciphilia

“Nothing has been invented yet that will do a better job than high heels at making a good pair of legs look great, or great ones look fabulous” (Stuart Weitzman, shoe designer).

“It is hard not to be sexy in a pair of high heels” (Tom Ford, Gucci designer and film director)

According to Dr. Russell Belk in a 2003 article (‘Shoes and Self’) in Advances In Consumer Research, individuals in the USA “buy approximately a billion pairs of footwear a year and 80 percent of these are estimated to be purchased for purposes of sexual attraction”. Belk’s figures come from Dr. William Rossi who has been writing scientific papers on shoes for decades. I have no idea whether these figures are (or were) accurate, but there is little doubt that when it comes to sexual fetishism, shoes – and particularly high heel shoes – are one of the most common types of object that people develop fetishes for.

Individuals with a shoe fetish derive sexual arousal from shoes and footwear as (according to the Wikipedia entry) “a matter of sexual preference, psychosexual disorder, and an alternative or complement to a relationship with a partner”. As I noted in my previous blog on foot fetishism (i.e., podophilia), shoe fetishism is also referred to as retifism (named after French novelist Nicolas-Edme Rétif). The Wikipedia entry on shoe fetishism also notes that:

Individuals with shoe fetishism can be erotically interested in either men’s or women’s shoes. Although shoes may appear to carry sexual connotations in mainstream culture (for example, women’s shoes are commonly sold as being ‘sexy’) this opinion refers to an ethnographic or cultural context, and is likely not intended to be taken literally. Another fetishism, which sometimes is seen as related to shoe fetishism, is boot fetishism”.

In a previous blog on sexual fetishism more generally, I wrote about a study led by Dr G. Scorolli on the relative prevalence of different fetishes using online fetish forum data. It was estimated (very conservatively in the authors’ opinion), that their sample size comprised at least 5000 fetishists (but was likely to be a lot more). Their results showed that there were 44,722 members of online fetish forums, among those people preferring objects related to body parts, footwear (shoes, boots, etc.) was the second most preferred (26,739 online fetish forum members; 32% of all ‘objects related to body parts) just behind objects wore on the legs and/or buttocks (33%).

As the opening quotes highlight, high heeled footwear is often associated with sexiness. Those that find allure of high heels sexually arousing are said to have altocalciphilia (a sub-type of shoe fetishism). The online medical website Right Diagnosis says that the defining features of altocalciphilia are (i) a sexual interest in high heels, (ii) an abnormal amount of time spent thinking about high heels, (iii) recurring intense sexual fantasies involving high heels, (iv) recurring intense sexual urges involving high heels, and/or (v) a sexual preference for high heels. I am not aware of any empirical research specifically into altocalciphilia but in researching this article, I did come across an interesting 2006 Master’s thesis by Ash Sancaktar who provided an analysis of shoes within the context of social history of fashion (including a chapter on shoe fetishism). In relation to high heel shoes, Sancaktar wrote that:

“There is no solid evidence that definite heels existed anywhere before 1500. According to legend, early 1500s the high heel may have been invented by Leonardo da Vinci (1452-1519). There are earlier records of high heel shoes that served a practical function such as heeled boots horse riders wore to grip their stirrups better. However, 1533 was the year that gave birth to the high heel that served no purpose other than beauty and vanity. Catherine de Medici, when she got married to the Duke of Orleans, wore shoes with two-inch heels because she was sensitive about her lack of height…The development of a proper heel with an arched sole was the dominant feature of shoes in the seventeenth century. Elevated shoes had been known from early Hellenic times however this phase of fashion was the first time shoes were associated with the female sex. It completely altered the posture of the wearer, encouraging both men and women to carry themselves in a way which set off the flowing lines and affected manner of the Baroque period…Practicality has little to do with female high heels. They have always been essentially about allure – as they are today”.

Sancaktar also notes the association between high heeled shoes and sadomasochism by making reference to the (semi-autobiographical) book Venus in Furs by Baron Leopold Von Sacher-Masoch (from whom the term ‘masochism’ originated). Sancaktar reported that Sacher-Masoch] wrote about his experiences with his mistress in which he allowed her to whip and walk on him before kissing the shoes that had caused him pain. Sacher-Masoch’s ideal woman was cruel and wore furs and high heels. Citing the work of Linda O’Keeffe and Valerie Steele, Sancaktar wrote:

“According to [Linda] O’Keeffe ‘Women may wear slippers, put on sneakers and slip into loafers, but they dress in high heels’ (O’Keeffe 1996, p. 72). Psychologically, high heels give permission to lead than to follow. A woman might become a towering seductress or she can choose to become the subject of the object of a male…According to [Valerie] Steele, one reason high heels are considered sexy is because they produce an erect ankle and extended leg. The arch of the foot is radically curved like a ballet dancer on point. The entire lower body is thrown into a state of tension resembling that of female sexual arousal (Steele 1998, p. 18). By tilting the pelvis, her lower back arches, her spine and legs lengthen and her chest thrust out. The breasts thrust forward, and the derriére protrudes. A woman in high heels looks taller and thinner. Her legs are emphasized and the leg muscles tighten, the calves appear shapelier. And because they are at an angle, her feet look smaller and more pointed”.

Valerie Steele also notes that fetishes come in various degrees (which I agree with) and uses the example of high heeled shoe fetishes to make her point and claims there are four different levels. She claims most people are among the two lowest levels (and basically equates to people finding high heels sexually appealing). Steele provides an example of someone at level three (a French writer who would follow high heeled women women in Paris). Her example of level four was the ex-publicist of Marla Maples’ who was found guilty of stealing Maples’ shoes. Steele said the publicist “denied being a fetishist, but admitted that he had a sexual relationship with Marla’s shoes”.

This need to steal shoes appears to be backed up by podophilia and retifism articles on the ToeSlayer website:

“Possession of shoes is important to the retifist and in cases of paraphilia, men may steal the shoes they are attracted to. Kiernan (1917, reported in Rossi, 1990) first described the term kleptomania which was used when theft took place when associated with sexual excitement. ‘Hephephilia’ is a term used when there is an uncontrollable urge to steal the objects of specific focus. Many hephephiliacs are ordinary people with no criminal intention other than a compulsion to possess the object of their desire due to a repressed or complicated sex life…Many retifists keep copious records of their activities all of which adds to their excitement…It is important exploring also the symbolism and fetishism of high heels. The erotic literature on shoe fetishism often associates high heels with the image of the ‘phallic woman’. According to [Valerie] Steele, submission to the powerful ‘phallic woman’ is a very popular fantasy”.

The same author (presumably a podophile himself) in a different article on the same website then explained:

“The allure of high heels (altocalciphilia) for some people is very strong. Subconsciously this may relate to a primal instinct to identify lame prey. Throughout recorded history limping in others has been seen both as a physical weakness as well as a sexually attractive impediment. Wearing high heeled shoes can accentuate the limping characteristics in a very tantalising way…High heels are also thought to place the female pelvis in a precoital position. Whether or not this is true, the idea by itself, may cause arousal. Long legs are thought a strong arousal signal (Lloyd-Elliott, 2006). Men may be attracted to women in heels because it appeals to their superior nature seeing a member of the opposite sex vulnerable…Today, heeled shoes are very much part of the bondage ritual (Rossi, 1997) and sado-masochists maybe attracted to the perceived pain associated with wearing high-heeled shoes”.

Most of the academic writing I have read on this topic is anecdotal at best. There is much speculating and theorizing but little data. However, there is no doubt that high heel fetishism exists and that of all fetishes it appears to be one of the most common.

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

Further reading

Belk, R.W. (2003). Shoes and self. Advances In Consumer Research, 30, 27-33.

Kunjukrishnan, R., Pawlak, A. & Varan, L.R. (1988). The clinical and forensic psychiatric issues of retifism. Canadian Journal of Psychiatry, 33, 819-825.

Kunzie, D. (2013). Fashion and Fetishism: Corsets, Tight Lacing and Other Forms of Body-Sculpture. The History Press

O’Keeffe, L. (1999). Scarpe Una Celebrazione di Scarpe da Sera, Sandali, Pantofole e Altro. Hong Kong: Sing Cheong Printing Company.

Rossi WA (1990). Foot and shoe fetishism: Part one. Journal of Current Podiatric Medicine, 39(9), 9-23.

Rossi WA (1990). Foot and shoe fetishism: Part two. Journal of Current Podiatric Medicine, 39(10), 16-20.

Sancaktar, A. (2006). An analysis of shoe within the context of social history of fashion (Doctoral dissertation, İzmir Institute of Technology)

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

Steele, V., 1998. Shoes, A Lexicon of Style, (Co & Bear Productions, London).

Steele, V. (2001). Fashion, fetish, fantasy. Masquerade and Identities: Essays on Gender, Sexuality and Marginality, 73-82

Wikipedia (2014). Boot fetishism. Located at: http://en.wikipedia.org/wiki/Boot_fetishism

Wikipedia (2014). Shoe fetishism. Located at: http://en.wikipedia.org/wiki/Shoe_fetishism

The junkie generation? Teenage “addiction” to social media

Earlier today I appeared live on my local radio station (BBC Radio Nottingham) commenting on a study released by the Allen Carr Addiction Clinics (ACAC) concerning teenage addiction (and more specifically addiction to social media). The study was a survey of 1,000 British teenagers aged 12 to 18 years old and the press release went with the heading “INFO UK BREEDING A GENERATION OF TEENAGE ADDICTS SAYS NEW STUDY” (their capital letters, not mine) with the sub-headline that “83% of UK teenagers would struggle to go ‘cold turkey’ from social media and their other vices for a month”.

As someone that has spent almost 30 years studying ‘technological addictions’ I was interested in the survey’s findings. I tried to get hold of the actual report by contacting the ACAC Press Office. They were very helpful and sent me a copy of the Excel file containing the raw data (entitled ‘Addicted Britain’). They also informed me that the data were collected for ACAC by the market research company OnePoll, and that the teenagers filled out the survey online (with parents’ permission). However, there is no actual published report with the findings (and more importantly, no methodological details). I asked ACAC if they knew the response rate (for instance, was the online survey sent to 10,000 teenagers to get their 1,000 responses that would give a response rate of 10%), and how were the teenagers recruited in the first place. Also, as the survey was carried out online, those teenagers who are the most tech-savvy and feel confident online, would be more likely to participate than those who don’t like (or rarely use) online applications. Before I comment on the survey itself, I would just like to provide some excerpts from the press release that was sent out:

“The explosion of social media, selfies and mobile devices is priming a generation of UK teenagers for a lifelong struggle with addiction…83% of UK teenagers admit they would struggle to give up their vices for a whole month. [The study] unveiled a worrying trend of growing numbers of young people constantly striving to find the next thrill, mostly via technology and social media. When asked which behaviours they could abstain from, UK teens said they would most struggle living without texting (66%), followed by social networking (58%), junk food (28%) and alcohol (6%). The report found that the average teen checks social media 11 times a days, sends 17 text messages and takes a ‘selfie’ picture every four days. This constant pursuit of stimulation, peer approval, instant gratification, and elements of narcissism are all potential indicators of addictive behaviour. The study highlights that parents across the UK are inadvertently becoming ‘co-dependents’ enabling their child’s addictions by providing them with cash albeit with the best of intentions”.

The first thing that struck me reading this text was the use of the word “vice”. Most dictionary definitions of a vice is “immoral or wicked behaviour” or “criminal activities involving prostitution, pornography, or drugs”. As far as I am concerned, social networking, junk food, and alcohol are not vices (especially social networking). The whole wording of the press release is written in a way to pathologise normal behaviours such as engaging in social media use. Also, asking teenagers about which behaviours they could not abstain from for a month tells us almost nothing about addiction. All it tells us is that the activities that teenagers most engage in are the ones they would find hardest not to do. This is just common sense. My main hobbies are listening to music on my i-Pod and reading. I would really have difficulty in not listening to my favourite music or reading for a whole month but I’m not addicted to music or reading.

The ACAC kindly sent me all the questions that were asked in the survey and there was no kind of addiction scale embedded in any of the questions asked. Basically, the survey does not investigate teenagers’ potential addictions, as no screening instrument for any behaviour asked about was included in the survey. There were some attitude questions asking whether activities like social networking could be addictive, but as I have argued in previous blogs, almost any activity that is constantly rewarding can be potentially addictive.

That’s not so say we shouldn’t be concerned about teenagers’ excessive use of technology as my own research has shown that a small minority of teenagers do appear to have problems and/or be addicted to various online activities. However, as my research has shown, doing something excessively doesn’t mean that it is addictive. As I have noted in a number of my academic papers, the difference between a healthy enthusiasm and an addiction is that healthy enthusiasm add to life and addictions take away from it. The perceived overuse of technology by the vast majority of teenagers is quite clearly something that is life-enhancing and positive with no detrimental effects whatsover.

Given that the vast majority of teenagers use the social media to communicate and interact with friends, I was surprised that ACAC’s findings were not closer to 100% saying that they couldn’t abstain for one month. Which teenagers would find it easy not to use social media for a month given how important it is in their day-to-day social lives? The findings in the press release also quote John Dicey (Global Managing Director and Senior Therapist of ACAC) who said:

“The findings of this report are cause for concern and highlight a generation of young people exhibiting many of the hallmarks of addictive behaviour. The explosion of technology we have seen since the late 90’s offers incredible opportunities to our youth – the constant stimulation provided by access to the internet for example can be a good or a bad thing. There’s a price to pay. This study indicates that huge numbers of young people are developing compulsions and behaviours that they’re not entirely in control of and cannot financially support. Unless we educate our young people as to the dangers of constant stimulation and consumption, we are sleepwalking towards an epidemic of adulthood addiction in the future”.

While my own research shows that a small minority of teenagers experience problems concerning various online activities, there was almost nothing in the ACAC report “huge numbers of young people are developing compulsions and behaviours that they’re not entirely in control of”. The use of the word “huge” is what we psychologists call a ‘fuzzy quantifier’ (as what is ‘huge’ to one person may not be ‘huge’ to another). Mr. Dicey’s conclusions simply cannot be made from the data collected. He says that the report shows that many teenagers are displaying the “hallmarks of addictive behaviour” but given no addiction screening instruments were used, the data do not show this. The press release uses the following findings to make the claim that “the abundance of technology that UK teens can access seems to be creating a generation of ‘tech addicts’!”

“One-third of UK teens (32%) admit they check social media more than 10 times a day. The report also found that the average teen checks social media 11 times day, which equals once every 1.5 hours they are awake. UK teens are also avid takers of ‘selfies’, with over a quarter taking more than 10 a month. The average teen takes 7.4 selfies a month, equalling one every four days on average…The plethora of technology available to teens is also having a worrying impact on their attention spans. 1 in 4 teens have over 20 apps on their smartphones, with the average teen having 13 apps on their device. The constant search for the ‘next thing’ is evidenced in how they use apps – 46% admitted that they stop using or delete an app less than a week after using it, freeing up storage space for a new app”.

Anyone that has teenagers (I have three screenagers myself) will tell you that the above statistics indicate adolescent normality not addiction. Checking social media 10 times a day does not indicate addiction in the slightest. Although I have never taken a selfie, I check my social media far more than 10 times a day. Deleting apps to make way for other apps is no different from me removing songs on my i-Pod every week to make way for other songs I want to listen to. Again, there is absolutely nothing in these statistics that provides evidence of adolescent addiction.

Anyone that is aware of my work will know that I take the issue of teenage technology use seriously and that I firmly believe that a small minority of adolescents experience addiction to various online applications. However, studies like the one done for ACAC do little for the area as the rhetoric of the claims are unsupported by their data.

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

Further reading

Griffiths, M.D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.

Griffiths, M.D., King, D.L. & Delfabbro, P.H. (2014). The technological convergence of gambling and gaming practices. In Richard, D.C.S., Blaszczynski, A. & Nower, L. (Eds.). The Wiley-Blackwell Handbook of Disordered Gambling (pp. 327-346). Chichester: Wiley.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, 4(1), 1-4.

Griffiths, M.D., Kuss, D.J. & Demetrovics, Z. (2014). Social networking addiction: An overview of preliminary findings. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.119-141). New York: Elsevier.

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

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

Kuss, D.J. & Griffiths, M.D. (2011). Addiction to social networks on the internet: A literature review of empirical research. International Journal of Environmental and Public Health, 8, 3528-3552.

Kuss, D.J., Griffiths, M.D. & Binder, J. (2013). Internet addiction in students: Prevalence and risk factors. Computers in Human Behavior, 29, 959-966.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Kuss, D.J., van Rooij, A.J., Shorter, G.W., Griffiths, M.D. & van de Mheen, D. (2013). Internet addiction in adolescents: Prevalence and risk factors. Computers in Human Behavior, 29, 1987-1996.