Net losses: Another look at problematic online gaming

I have examined problematic and/or addictive video gaming in a number of my previous blogs. Despite the increasing amount of empirical research into problematic online gaming, the phenomenon still sadly lacks a consensual definition. Some researchers (including myself, and others such as John Charlton and Ian Danforth) consider video games as the starting point for examining the characteristics of this specific pathology, while other researchers consider the internet as the main platform that unites different addictive internet activities including online games (such as my friends and colleagues Tony Van Rooij and Kimberley Young). There are also recent studies that have made an effort to integrate both approaches (such as some work I carried out with Zsolt Demetrovics and his team of Hungarian researchers in the journal PLoS ONE).

I have noted in a number of my papers on addiction (particularly in a paper I had published in a 2005 issue of the Journal of Substance Use) that although each addiction has several particular and idiosyncratic characteristics, they have more commonalities than differences that may reflect a common etiology of addictive behaviour. Using the ‘components’ model of addiction, within a biopsychosocial framework, I consider online game addiction a specific type of video game addiction that can be categorized as a nonfinancial type of pathological gambling. I developed the components of video game addiction theory by modifying Iain Brown’s earlier addiction criteria. These are:

(1) Salience: This is when video gaming becomes the most important activity in the person’s life and dominates his/her thinking (i.e., preoccupations and cognitive distortions), feelings (i.e., cravings) and behaviour (i.e., deterioration of socialized behaviour);

(2) Mood modification: This is the subjective experience that people report as a consequence of engaging in video game play (i.e. they experience an arousing ‘buzz’ or a ‘high’ or, paradoxically, a tranquillizing and/or distressing feel of ‘escape’ or ‘numbing’).

(3) Tolerance: This is the process whereby increasing amounts of video game play are required to achieve the former effects, meaning that for persons engaged in video game playing, they gradually build up the amount of the time they spend online engaged in the behaviour.

(4) Withdrawal symptoms: These are the unpleasant feeling states or physical effects that occur when video gaming is discontinued or suddenly reduced, for example, the shakes, moodiness, irritability, etc.

(5) Conflict: This refers to the conflicts between the video game player and those around them (i.e., interpersonal conflict), conflicts with other activities (e.g., job, schoolwork, social life, hobbies and interests) or from within the individual themselves (i.e., intrapsychic conflict and/or subjective feelings of loss of control) which are concerned with spending too much time engaged in video game play.

(6) Relapse: This is the tendency for repeated reversions to earlier patterns of video game play to recur and for even the most extreme patterns typical at the height of excessive video game play to be quickly restored after periods of abstinence or control.

John Charlton and Ian Danforth analyzed these six criteria and found that tolerance, mood modification and cognitive salience were indicators of high engagement, while the other components – withdrawal symptoms, conflict, relapse and behavioural salience – played a central role in the development of addiction.

Researchers such as Guy Porter and Vladan Starcevic don’t differentiate between problematic video game use and problematic online game use. They conceptualized problematic video game use as excessive use of one or more video games resulting in a preoccupation with and a loss of control over playing video games, and various negative psychosocial and/or physical consequences. Their criteria for problematic video game use didn’t include other features usually associated with dependence or addiction, such as tolerance and physical symptoms of withdrawal, because in their opinion there is no clear evidence that problem video game use is associated with these phenomena.

Arguably the most well known representative of the internet-based approach is Kimberley Young who developed her theoretical framework for problematic online gaming based on her internet addiction criteria which were based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – (Fourth Edition, DSM-IV) criteria for pathological gambling. Her theory states that online game addicts gradually lose control over their game play, that is, they are unable to decrease the amount of time spent playing while immersing themselves increasingly in this particular recreational activity, and eventually develop problems in their real life. The idea that internet/online video game addiction can be assessed by the combination of an internet addiction score and the amount of time spent gaming are also reflective of the internet-based approach.

Integrative approaches try to take into consideration both aforementioned approaches. For instance, a 2010 paper by M.G. Kim and J. Kim in Computers in Human Behavior claimed that neither the first nor the second approach can adequately capture the unique features of online games such as Massively Multiplayer Online Role-Playing Games (MMORPGs), therefore it’s absolutely necessary to create an integrated approach. They argued that “internet users are no more addicted to the internet than alcoholics are addicted to bottles” which means that the internet is just one channel through which people may access whatever content they want (e.g., gambling, shopping, chatting, sex, etc.) and therefore users of the internet may be addicted to the particular content or services that the Internet provides, rather than the channel itself. On the other hand, online games differ from traditional stand-alone games, such as offline video games, in important aspects such as the social dimension or the role-playing dimension that allow interaction with other real players.

Their multidimensional Problematic Online Game Use (POGU) model reflects this integrated approach fairly well. It was theoretically developed on the basis of several studies and theories (such as those by Iain Brown, John Charlton, Ian Danforth, Kimberley Young and myself), and resulted in five underlying dimensions: euphoria, health problems, conflict, failure of self-control, and preference of virtual relationship. A 2012 study I carried out with Zsolt Demetrovics and his team also support the integrative approach and stresses the need to include all types of online games in addiction models in order to make comparisons between genres and gamer populations possible (such as those who play online Real-Time Strategy (RTS) games and online First Person Shooter (FPS) games in addition to the widely researched MMORPG players). According to this model, six dimensions cover the phenomenon of problematic online gaming – preoccupation, overuse, immersion, social isolation, interpersonal conflicts, and withdrawal. Personally, I believe that online game addiction can be defined as one type of behavioural addiction. In fact ‘internet gaming disorder’ has just been included in the appendices of the new DSM-5 in order to encourage research to determine whether this particular condition should be added to the manual as a disorder in the future.

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

Additional input: Orsolya Pápay, Katalin Nagygyörgy and Zsolt Demetrovics

Further reading

Charlton, J. P., & Danforth, I.D.W. (2007). Distinguishing addiction and high engagement in the context of online game playing. Computers in Human Behavior, 23(3), 1531-1548.

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M.D., Pápay, O. & Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5): e36417. doi:10.1371/journal.pone.0036417.

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

Han, D. H., Hwang, J. W., & Renshaw, P. F. (2010). Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. Experimental and Clinical Psychopharmacology, 18, 297-304.

Kim, M.G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.

King, D.L., Haagsma, M.C.^, Delfabbro, P.H., Gradisar, M.S.^, Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Peters, C. S., & Malesky, L. A. (2008). Problematic usage among highly-engaged players of massively multiplayer online role playing games. Cyberpsychology & Behavior, 11(4), 480-483.

Pontes, H. & Griffiths, M.D. (2014). The assessment of internet gaming disorder in clinical research. Clinical Research and Regulatory Affairs, 31(2-4), 35-48.

Pontes, H., Király, O. Demetrovics, Z. & Griffiths, M.D. (2014). The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: The development of the IGD-20 Test. PLoS ONE, 9(10): e110137. doi:10.1371/journal.pone.0110137.

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143.

Porter, G., Starcevic, V., Berle, D., & Fenech, P. (2010). Recognizing problem video game use. The Australian and New Zealand Journal of Psychiatry, 44, 120-128.

Van Rooij, A. J., Schoenmakers, T. M., Vermulst, A. A., Van den Eijnden, R. J., & Van de Mheen, D. (2011). Online video game addiction: identification of addicted adolescent gamers. Addiction, 106(1), 205-212.

Young, K. S. (1998a). Caught in the Net: How to recognize the signs of Internet addiction and a winning strategy for recovery. New York: Wiley.

Young, K. S. (1999). Internet addiction: Symptoms, evaluation, and treatment. In L. Vande Creek & T. Jackson (Eds.), Innovations in clinical practice: A source book (pp. 17, 19–31). Sarasota, FL: Professional Resource Press.

Water feature: A brief look at psychogenic polydipsia, hyponatraemia, and ‘aquaholism’

Over the weekend I went to the cinema with my oldest son to watch Mad Max: Fury Road. The reason I mention this is because King Immortan Joe in the film (who live in a world where water is a scarce commodity) tells his thirsty subjects “Do not become addicted to water, it will take hold of you”. As soon as I got home after the film, I was straight onto Google and Google Scholar to see whether there had been anything written on ‘water addiction’. Unsurprisingly, there were lots of newspaper reports of individuals being ‘addicted’ to water but little in the academic literature. For instance, one American online article told the story of Sasha Kennedy:

“[Sasha] is addicted to water, drinking 25 liters of the stuff a day, far exceeding the USDA Recommended Daily Water Intake of 2.7 liters…What surprised me most was that the condition had a name: Psychogenic polydipsia. It is ‘an uncommon clinical disorder characterized by excessive water-drinking in the absence of a physiologic stimulus to drink’ and is typically found among mental patients on phenothiazine medications. Kennedy appears to be completely sane, although she does experience the dry mouth sensation characteristic of the condition…You’d think drinking so much water would do something to her health, but medical experts confirmed that there is nothing wrong with her. She doesn’t even have hypoatremia, where cells swell due to too much water in the blood. She’s perfectly healthy and her blood isn’t diluted. Then again, her habit started when she was two years old, so maybe her body acclimatized. Her lifestyle, however, is drastically affected by her addiction. She has to go to the toilet 40 times a day and can only get about an hour of sleep every night before having to wake up to drink some water or go to the loo. She carries large bottles of water with her everywhere she goes, and once quit her job because the tap water quality wasn’t up to par”.

Another case was reported by the UK’s Daily Mail who recounted the story of 22-year old “aquaholic” Sarah Schapira who (at the time the article was written) drank seven litres of water every day, and like Sasha above spent a lot of time in the toilet. Schapira stated:

“My argument has always been that water is good for you and helps you to detox. We’ve all been told about the benefits of water, so I drink lots and lots of it, from the minute I wake up to the minute I go to bed. If I don’t have my bottle of water I feel paranoid. And if I try not to drink for an hour, I start to feel dehydrated and I get throbbing headaches. But it has got to the stage where I don’t know how to give it up. It used to make me feel really good and healthy but not any more. I know I ought to cut down but I’m not sure how I can”.

Polydipsia (which in practical terms means drinking more than three litres of water a day) often goes hand-in-hand with hyponatraemia (i.e., low sodium concentration in the blood) and in extreme cases can lead to excessive water drinkers slipping into a coma. The low levels of sodium causes the brain to swell which in turn constricts the blood supply to the brain when the brain compresses against the skull’s inner surface. Another person interviewed for the Daily Mail story was 26-year-old Rachel Bennett, a marketing agent from North London who drank also drank seven litres of water a day which led to headaches and dizziness. She said:

“My friends used to tease me about the amount I drank, but I dismissed their fears because I always thought it was so good for me. It got to the stage where I felt I couldn’t function without it. If I woke without a bottle of water by my bed, I would feel really paranoid. I couldn’t drink tap water – that tasted awful – instead I drank Evian by the gallon. It’s expensive, too – I could spend over £30 a week on water – but I had got to the stage where I got a huge buzz from drinking so much”.

In researching this article, I was surprised to find dozens and dozens of academic papers on psychogenic polydipsia (PPD). For instance, a paper by Dr. Brian Dundas and colleagues in a 2007 issue of Current Psychiatry Reports noted that PPD is a clinical syndrome characterized by polyuria (constantly going to the toilet) and polydipsia (constantly drinking too much water), and is common among individuals with psychiatric disorders. They also noted that:

“The underlying pathophysiology of this syndrome is unclear, and multiple factors have been implicated, including a hypothalamic defect and adverse medication effects. Hyponatremia in PPD can progress to water intoxication and is characterized by symptoms of confusion, lethargy, and psychosis, and seizures or death. Evaluation of psychiatric patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria, hyponatremia”.

A 2000 study in European Psychiatry by Dr. E. Mercier-Guidez and Dr. G. Loas examined water intoxication in 353 French psychiatric inpatients. They reported that water intoxication can lead to irreversible brain damage and that around one-fifth of deaths among schizophrenics below the age of 53 years are caused this way. The study reported that 38 of the psychiatric patients (11%) suffered from polydipsia with one-third of them at risk of water intoxication. They also reported that being polydipsic was significantly associated with being male, a cigarette smoker and celibate. Those with polydipsia were highly prevalent among those with schizophrenia, mental retardation, pervasive developmental disorders and somatic disorders.

A comprehensive review by Dr. Victor Vieweg and Dr. Robert Leadbetter in the journal CNS Drugs examined the polydipsia-hyponatraemia syndrome (PHS). They reported that PHS occurs in approximately 5%-10% of institutionalised, chronically psychotic patients, of which four-fifths have schizophrenia. Major clinical features are polydipsia and dilutional hyponatraemia. Patents with PHS can experience delirium, generalised seizures, coma and death. The main ways to treat such individuals are fluid restriction, daily bodyweight monitoring, behavioural approaches, and supplemental oral sodium chloride administration. However, these interventions can be expensive as they require experienced and dedicated multidisciplinary staff. They also report that:

“A number of pharmacological treatments have been assessed for PHS including the combination of lithium and phenytoin, demeclocycline, propranolol, ACE inhibitors, selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors, typical antipsychotic drugs, clozapine and risperidone. Of these agents, the most promising are the combination of lithium and phenytoin, and clozapine…Long term strategies include behavioural interventions and the combination of lithium and phenytoin, and clozapine”.

Unsurprisingly, I found almost nothing on being addicted to water. A 2010 review article on PPD by Dr. D. Hutcheon and Dr. M. Bevilacqua in the Annals of the American Psychotherapy Association claimed:

“One way to assess a patient’s ability to limit polydipsia is to examine their objective reasons why polydipsia is so important in their lives. This can be initiated during psychosocial rehabilitation group meetings held semi-weekly (e.g., two 15-minute sessions per week). In these meetings, many patients have described a euphoric quality associated with polydipsia, although others have admitted to increased irritability. Most patients have noted a desire for stimulation, similar to other substances of abuse such as alcohol or street drugs. Developing an understanding of what influences a patient to develop an addiction for polydipsia can improve management of this dysregulation of fluid intake…During the treatment period in a structured inpatient setting, many patients diagnosed with psychogenic polydipsia, whether falling in the range of mild, moderate, or severe addiction, are unable to sustain a comfortable discharge to an open ward…psychogenic polydipsia can become an addiction with no demonstrable cure if left untreated… Due to the nature of the addiction and potential for self-injurious behavior, treatment requires a milieu that balances maximizing the patients’ dignity with their safety, which demands close scrutiny by the multidisciplinary team”.

I also found an old case study from a 1973 issue of the British Journal of Addiction on ‘water dependence’. This paper reported that the excessive drinking of water can dilute electrolytes in an individual’s brain and cause intoxication. A couple of papers by Dr. Bennett Foddy and Dr. Julian Savulescu have cited this case study in their own writings on addiction. In a 2010 issue of Philosophy, Psychiatry and Psychology, they noted:

“Of course, it can be claimed that a person who is addicted to sugar or water is diseased, and that their brain has changed in such a way as to make their sugar- or water-seeking behavior involuntary. Yet we know how sugar interacts with the brain to form a sensitization effect, and it is identical to how drugs – and sugar – interact with the brain of a non-addicted person. If addictions are formed through a pharmacological process, it is the exact same process that forms a person’s likes and dislikes of any pleasurable stimulus. Terms like ‘addiction’ and ‘dependence’ can reasonably be employed when a person’s likes become particularly strong, but it should be understood that these terms denote a difference in degree, not a difference in kind…The only relevant difference between drugs and sugar is that drugs produce a higher level of brain reward relative to the volume of the dose. It is easier to get addicted to heroin than to sugar, because you can do it by taking a quarter gram at a time. It is very hard to get addicted to water, because you must force down liters of it every day”.

This interesting extract argues that it is theoretically possible for someone to become addicted to water and that there is no real difference to drug addictions in terms of conceptualization and mechanism – just that the sheer amount of water that needs to be drunk to have a negative effect is large and highly unlikely.

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

Further reading

Daily Mail (2005). Aquaholics: Addicted to drinking water. May 16. Located at: http://www.dailymail.co.uk/health/article-348917/Aquaholics-Addicted-drinking-water.html

de Leon, J., Verghese, C., Tracy, J. I., Josiassen, R. C., & Simpson, G. M. (1994). Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. Biological Psychiatry, 35(6), 408-419.

Dundas, B., Harris, M., & Narasimhan, M. (2007). Psychogenic polydipsia review: etiology, differential, and treatment. Current Psychiatry Reports, 9(3), 236-241.

Edelstein, E.L. (1973). A case of water dependence. British Journal of Addiction to Alcohol and Other Drugs, 68, 365–367.

Foddy, B., & Savulescu, J. (2007). Addiction is not an affliction: Addictive desires are merely pleasure-oriented desires. American Journal of Bioethics, 7(1), 29-32

Foddy, B., & Savulescu, J. (2010). A liberal account of addiction. Philosophy, Psychiatry, and Psychology, 17(1), 1-22.

Hutcheon, D., & Bevilacqua, M. (2010). Psychogenic polydipsia: A review of past and current interventions for treating psychiatric inpatients diagnosed with psychogenic polydipsia (PPD). Annals of the American Psychotherapy Association, 13(1). Located at: http://www.biomedsearch.com/article/Psychogenic-polydipsia-review-past-current/222558218.html

Teoh, S.Y. (2012). Woman addicted to water drinks 100 glasses a day. The Mary Sue, July 12. Located at: http://www.themarysue.com/woman-addicted-to-water/#geekosystem

Vieweg, W.V.R., & Leadbetter, R.A. (1997). Polydipsia-Hyponatraemia Syndrome. CNS Drugs, 7(2), 121-138.

Verghese, C., de Leon, J., & Josiassen, R. C. (1996). Problems and progress in the diagnosis and treatment of polydipsia and hyponatremia. Schizophrenia Bulletin, 22(3), 455-464.

Hirsute yourself: A brief look at female body hair fetishism

In previous blogs I have examined a number of fetishes and sexual paraphilias related to human body hair including trichophilia/hirsutophilia (sexual arousal for hair, usually head hair), pogonophilia (sexual arousal from beards), and haircut fetishism (sexual arousal from seeing someone get their haircut either voluntary or through coercion). Another sub-type of trichophilia is men that get sexual pleasure and arousal from women that are abnormally hairy (including but not limited to overly hairy pubic hair, underarm hair, hairy arms, hairy legs, and hair around nipples). As far as I am aware, there is no academic research on this topic although a quick Google search with the term ‘hairy women’ reveals dozens of websites catering for (presumably) men that get their sexual kicks from hirsute women.

Other required viewing would no doubt include the television documentary F*** Off, I’m A Hairy Woman (first screened in 2007). The programme was hosted by female stand-up comic and Guardian newspaper columnist Shazia Mirza, and its focus was body image and stereotypes about women’s androgenic hair. The programme followed Shazia Mirza over a six-month period in which she let all her body hair grow for six months. As the Wikipedia entry on the show noted:

“Her introduction posed the question, ‘what would it be like if we lived in a world where beautiful women were allowed to be hairy?’ To find out, [Mirza] decided to take the plunge and grow out [her] body hair. Can [she] learn to love it, and can [she] convince the rest of the world to love it too? After six months, she advertised for other hairy women to put on a catwalk show, wearing lingerie made of body hair designed and made by artist Tracey Moberly”.

There are a few online articles about some men’s love of hairy women including a 2010 Ezine Article on ‘Men looking for a hairy woman – tips on how to find them’ (and is actually about how hairy women can date men rather than vice-versa). The author – Angelina Andrews – claims that on most internet polls ‘hirsute fetishes’ are among the top ten most popular male fetishes. While I don’t dispute this, most of this relates to general ‘hair on head’ fetishism rather than hirsute female fetishism more specifically. The article claims:

“Most [hairy] women like yourself will be tempted to join a ‘hairy dating’ website. I would strongly advise against it. These sites actually have very few members right now. Most people with a fetish for female hair tend to just join conventional dating sites. You will also find that these sites for hirsute lady lovers are overly pricey. Most men have no idea about hairy dating sites. They tend to join huge dating communities. This is where you should join too…These popular sites have advanced profile matching technology. What this means is they tend to match your profile with people who might be interested in it. All you have to do is write down that you have body hair and you would love to meet a male hirsute fetishist. On most sites this will be enough to send your profile to relevant men”.

In the name of academic research I went searching on the internet for evidence (outside of pornographic videos) to see if there were individuals that claimed to be sexually aroused by female body hair. Below are typical extracts various online forums from both men that claim to have a fetish for female body hair and from women that have dated men with a fetish for female body hair:

• Extract 1: “My boyfriend has a fetish for hairy women? Is this normal? He is also trying to convince me to let all my body hair grow. Should I do it?”
• Extract 2: “I am a 31-year-old male with a fetish for very hairy women”
• Extract 3: “I always had a fetish for hairy women. [I] was wondering if any other guys out there like me. I would really like to meet and perhaps date a girl who’s hairy or hirsute. It’s just really hard to find someone like that – especially since everyone today is smooth like a little girl. If you’re out there, then message me please. I am 20 [years old]”
• Extract 4: “I have had guys tell me about some crazy fetishes in my life. I even had a few guys – American and European mainly – tell me they don’t mind their girl being hairy. Some find it sexy! I have some comfort in knowing that men still find me beautiful even in knowing about my flaws! But it is still an odd fetish but different strokes for different folks, I guess! I even Googled the term and found a LOT of fetish/porn photos of hairy women. Not sure how I feel about it yet”
• Extract 5: “Any fetish makes me feel objectified…I’ve met a couple of guys who i suspect had a hair fetish, my arms were all they could look at, talk about and lust after, wanting to touch them when I had just met them, I had to slap their hands away to keep them from touching my arms. I normally feel whatever floats your boat as long as everybody is happy, but they make me feel so uncomfortable to be objectifying something that is part of a medical condition I have been fighting so long [i.e., polycystic ovary syndrome that results in high levels of male hormones in the body]. I’m self-conscious about my extra hair…[and] I don’t want somebody worshiping the very things I would change about my body. But if two people enjoy somebodies fetish together that’s ok, it’s just not for me. When guys show up here to talk about their fetish it really ticks me off”
• Extract 6: “I love hair on women. Not necessarily on the legs, but I love a hairy crotch and hairy armpits. I know hairy is a fetish in porn a lot, but it doesn’t seem any other people I know share this ‘fetish’. I actually made one of my ex-girlfriends grow hers out because it was shaven. Then she shaved it back and I got really pissed off”

Although there is little detail in these extracts (and I can’t ensure the veracity of such claims), they suggest that (i) there are males out there that are sexually aroused by hairy women, (ii) that such males appear to be in young adulthood (in their twenties and thirties), (iii) that women that are the subject of such desires may not like to be objectified in such a way, and (iv) that it may be culturally determined (such as coming from Europe or America). All of this is (of course) highly speculative and given that there is unlikely to be a great surge of interest academically to research the topic, I can’t see ‘the facts’ becoming any clearer anytime soon.

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.

Andrews, A. (2010). Men looking for a hairy woman – tips on how to find them. Ezine Articles, November 16. Located at: http://ezinearticles.com/?Men-Looking-For-A-Hairy-Woman—Tips-To-Find-Them!&id=5393555

Bindel, J. (2010). Women: Embrace your facial hair. The Guardian, August 20. http://www.theguardian.com/lifeandstyle/2010/aug/20/women-facial-hair

Goulian, J-J. (2014). In defense of hairy women: Searching for a fair standard of beauty. Vice, February 11. http://www.vice.com/read/in-defense-of-hairy-women-0000222-v21n2

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

Wikipedia (2014). F*** Off, I’m A Hairy Woman. Located at: http://en.wikipedia.org/wiki/F***_Off,_I’m_a_Hairy_Woman

Place your bets: Has problem gambling in Great Britain decreased?

In the summer of 2014 I was commissioned to review problem gambling in Great Britain (the fall out of which I wrote about in detail in a previous blog). Earlier last year, a detailed report by Heather Wardle and her colleagues examined gambling behaviour in England and Scotland by combining the 2012 data from the Health Survey for England (HSE; n=8,291 aged 16 years and over) and the 2012 Scottish Health Survey (SHeS; n=4,815). To be included in the final data analysis, participants had to have completed at least one of the gambling participation questions. This resulted in a total sample of 11,774 participants. So what did the research find? Here is a brief summary of the main results:

• Two-thirds of the sample (65%) had gambled in the past year, with men (68%) gambling more than women (62%). As with the British Gambling Prevalence Survey (BGPS), past year participation was greatly influenced by the playing of the bi-weekly National Lottery (lotto) game. Removal of those individuals that only played the National Lottery meant that 43% had gambled during the past year (46% males and 40% females).

• Gambling was more likely to be carried out by younger people (50% among those aged 16-24 years and 52% among those aged 25-34 years).

• The findings were similar to the previous BGPS reports and showed that the most popular forms of gambling were playing the National Lottery (52%; 56% males and 49% females), scratchcards (19%; 19% males and 20% females), other lottery games (14%; 14% both males and females), horse race betting (10%; 12% males and 8% females), machines in a bookmaker (3%; 5% males and 1% females), slot machines (7%; 10% males and 4% females), online betting with a bookmaker (5%; 8% males and 2% females), offline sports betting (5%; 8% males and 1% females), private betting (5%; 8% males and 2% females), casino table games (3%; 5% males and 1% females), offline dog race betting (3%; 4% males and 2% females), online casino, slots and/or bing (3%; 4% males and 2% females), betting exchanges (1%; males 2% and females 0%), poker in pubs and clubs (1%; 2% males and 0% females), spread betting (1%; 1% males and 0% females).

• The only form of gambling (excluding lottery games) where females were more likely to gamble was playing bingo (5%; 7% females and 3% males).

• Most participants gambled on one or two different activities a year (1.7 mean average across the total sample).

• Problem gambling assessed using the Problem Gambling Severity (PGSI) criteria was reported to be 0.4%, with males (0.7%) being significantly more likely to be problem gamblers than females (0.1%). This equates to approximately 180,200 British adults aged 16 years and over.

• Problem gambling assessed using the criteria of the fourth Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was reported to be 0.5%, with males (0.8%) being significantly more likely to be problem gamblers than females (0.1%). This equates to approximately 224,100 British adults aged 16 years and over.

• Using the PGSI screen, problem gambling rates were highest among young men aged 16-24 years (1.7%) and lowest among men aged 65-74 years (0.4%). Using the DSM-IV screen, problem gambling rates were highest among young men aged 16-24 years (2.1%) and lowest among men aged over 74 years (0.4%).

• Problem gambling rates were also examined by type of gambling activity. Results showed that among past year gamblers, problem gambling was highest among spread betting (20.9%), played poker in pubs or clubs (13.2%), bet on other events with a bookmaker (12.9%), bet with a betting exchange (10.6%) and played machines in bookmakers (7.2%).

• The activities with the lowest rates of problem gambling were playing the National Lottery (0.9%) and scratchcards (1.7%).

• Problem gambling rates were highest among individuals that had participated in seven or more activities in the past year (8.6%) and lowest among those that had participated in a single activity (0.1%).

The authors also carried out a latent class analysis and identified seven different types of gambler among both males and females. The male groups comprised:

• Cluster A: non-gamblers (33%)
• Cluster B: National Lottery only gamblers (22%)
• Cluster C: National Lottery and scratchcard gamblers only (20%)
• Cluster D: Minimal, no National Lottery [gambling on 1-2 activities] (9%)
• Cluster E: Moderate [gambling on 3-6 activities] (12%)
• Cluster F: Multiple [gambling on 6-10 activities] (3%)
• Cluster G: multiple, high [gambling on at least 11 activities] (1%).

The female groups comprised:

• Cluster A: non-gamblers (40%)
• Cluster B: National Lottery only gamblers (21%)
• Cluster C: National Lottery and scratchcard gamblers only (7%)
• Cluster D: Minimal, no National Lottery (8%)
• Cluster E: moderate, less varied [2-3 gambling activities, mainly lottery-related] (8%)
• Cluster F: moderate, more varied [2-3 gambling activities but wider range of activities] (6%)
• Cluster G: multiple [gambling on at least four activities] (6%)

Using these groupings, the prevalence of male problem gambling was highest among those in Cluster G: multiple high group (25.0%) followed by Cluster F: multiple group (3.3%) and Cluster E: moderate group (2.6%). The prevalence of problem gambling was lowest among those in the Cluster B; National Lottery Draw only group (0.1%) followed by Cluster C: minimal – lotteries and scratchcards group (0.7%). The prevalence of female problem gambling was highest among those in the Cluster G: multiple group (1.8%) followed by those in Cluster F: moderate – more varied group (0.6%). The number of female gamblers was too low to carry out any further analysis. The report also examined problem gambling (either DSM-IV or PGSI) by gambling activity type.

• The prevalence of problem gambling was highest among spread-bettors (20.9%), poker players in pubs or clubs (13.2%), bettors on events other than sports or horse/dog races (12.9%), betting exchange users (10.6%) and those that played machines in bookmakers (7.2%).

• The lowest problem gambling prevalence rates were among those that played the National Lottery (0.9%) and scratchcards (1.7%).

• These figures are very similar to those found in the 2010 BGPS study although problem gambling among those that played machines in bookmakers was lower (7.2%) than in the 2010 BGPS study (8.8%).

• As with the BGPS 2010 study, the prevalence of problem gambling was highest among those who had participated in seven or more activities in the past year (8.6%) and lowest among those who had taken part in just one activity (0.1%). Furthermore, problem gamblers participated in an average 6.6 activities in the past year.

Given that the same instruments were used to assess problem gambling, the results of the most recent surveys using data combined from the Health Survey for England (HSE) and Scottish Health Survey (SHeS) compared with the most recent British Gambling Prevalence Survey (BGPS) do seem to suggest that problem gambling in Great Britain has decreased over the last few years (from 0.9% to 0.5%). However, Seabury and Wardle again urged caution and noted:

“Comparisons of the combined HSE/SHeS data with the BGPS estimates should be made with caution. While the methods and questions used in each survey were the same, the survey vehicle was not. HSE and SHeS are general population health surveys, whereas the BGPS series was specifically designed to understand gambling behaviour and attitudes to gambling in greater detail. It is widely acknowledged that different survey vehicles can generate different estimates using the same measures because they can appeal to different types of people, with varying patterns of behaviour…Overall, problem gambling rates in Britain appear to be relatively stable, though we caution readers against viewing the combined health survey results as a continuation of the BGPS time series”.

There are other important caveats to take into account including the differences between the two screen tools used in the BGPS, HSE and SHeS studies. Although highly correlated, evidence from all the British surveys suggests that the PGSI and DSM-IV screens capture slightly different groups of problem gamblers. For instance, a 2010 study that I co-authored with Jim Orford, Heather Wardle, and others (in the journal International Gambling Studies) using data from the 2007 BGPS showed that the PGSI may under-estimate certain forms of gambling-related harm (particularly by women) that are more likely to be picked up by some of the DSM-IV items. Our analysis also suggested that the DSM-IV appears to measure two different factors (i.e., gambling-related harm and gambling dependence) rather than a single one. Another important distinction is that the two screens were developed for very different purposes (even though they are attempting to assess the same construct). The PGSI was specifically developed for use in population surveys whereas the DSM-IV was developed with clinical populations in mind. Given these differences, it is therefore unsurprising that national surveys that utilize the screens end up with slightly different results comprising slightly different groups of people.

It also needs stressing (as noted by the authors of most of the national gambling surveys in Great Britain) that the absolute number of problem gamblers identified in any of the surveys published to date has equated to approximately 60 people. To detect any significant differences statistically between any of the studies carried out to date requires very large sample sizes. Given the very low numbers of problem gamblers and the tiny number of pathological gamblers, it is hard to assess with complete accuracy whether there have been any significant changes in problem and pathological gambling between all the published studies over time. Wardle and her colleagues concluded that:

“Overall, based on this evidence, it appears that problem gambling rates in England and Scotland are broadly stable. Whilst problem gambling rates according to either the DSM-IV or the PGSI were higher in 2010, the estimate between 2007 and the health surveys data were similar. Likewise, problem gambling rates according to the DSM-IV and the PGSI individually did not vary statistically between surveys, meaning that they were relatively similar” (p.130).

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

Further reading

Griffiths, M.D. (2014). Problem gambling in Great Britain: A brief review. London: Association of British Bookmakers.

Orford, J., Wardle, H., Griffiths, M.D., Sproston, K. & Erens, B. (2010). PGSI and DSM-IV in the 2007 British Gambling Prevalence Survey: Reliability, item response, factor structure and inter-scale agreement. International Gambling Studies, 10, 31-44.

Seabury, C. & Wardle, H. (2014). Gambling behaviour in England and Scotland. Birmingham: Gambling Commission.

Wardle, H. (2013). Gambling Behaviour. In Rutherford, L., Hinchliffe S., Sharp, C. (Eds.), The Scottish Health Survey: Vol 1: Main report. Edinburgh.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., & Seabury, C. (2013). Gambling Behaviour. In Craig, R., Mindell, J. (Eds.) Health Survey for England 2012 [Vol 1]. Health, social care and lifestyles. Leeds: Health and Social Care Information Centre.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M. D., Constantine, R., & Pigott, S. (2007). The British Gambling Prevalence Survey 2007. London: National Centre for Social Research.

Wardle, H., Sutton, R., Philo, D., Hussey, D. & Nass, L. (2013). Examining Machine Gambling in the British Gambling Prevalence Survey. Report by NatCen to the Gambling Commission, Birmingham.

Viagra falls: Is there a relationship between sex and nosebleeds?

In previous blogs I have covered a number of different topics relating to various human behaviours involving blood including haematophagia (the eating and/or drinking of blood products), haemolacria (the crying of blood), clinical vampirism as a sexual paraphilia, and menophilia (sexual arousal from women menstruating). Today’s blog adds to the list by taking a brief look at sex and nosebleeds (medically known as epistaxis).

There are many causes of nosebleeds. The two most common are nose picking and being exposed to dry air for long periods. Other reasons include having high blood pressure, having a cold or flu, allergic rhinitis (nose allergies), acute sinusitis, heavy alcohol use, being exposed to chemical irritants, being on certain medications (such as blood thinners and non-steroidal anti-inflammatory drugs), nose trauma, cocaine use, and haemophilia. Added to this, there is plenty of anecdotal evidence of people claiming to get nosebleeds during vigorous sex.

However, an article in Culture Smash by Brian Ashcroft quoted an otolaryngologist, Dr. Kouichirou Kanaya (an ear, nose, and throat specialist) who was quoted as saying:

“The notion that sexual arousal causes the heart rate and blood pressure to rise is something that’s a well documented fact; however, in actuality, sexual arousal and bloody noses have no direct connection”

However, while researching this article I came across a number of medical papers showing that there is one area where nosebleeds have been related to sexual activity. More specifically, there have been a number of cases in the literature where men taking sildenafil (Viagra) and/or tadalafil (Cialis) have had nosebleeds during sex. For instance, Dr. L.A. Hicklin and colleagues reported two cases in a 2002 issue of the Journal of the Royal Society of Medicine. These are reported verbatim below followed by a 2006 case by Dr. G. Pomara and colleagues in the International Journal of Impotence Research, and a 2005 case by Dr. H. Ismail and Dr. P.G. Harries in the journal Acta oto-laryngologica:

• Case 1: “A man in his late 50s was admitted from the emergency department with heavy prolonged epistaxis…During the admission the patient volunteered that, in the hours before his first nose-bleed, he had been engaging in energetic sexual activity. To enhance his sexual performance he had taken 50 mg sildenafil. Over the subsequent few days he had had several short but heavy epistaxes, and on the day of admission bleeding had continued for 6 hours without stopping. With packing and bed rest the bleeding gradually settled and he was discharged after six days”.
• Case 2: “A man in his early 70s was admitted from the emergency department after 5 hours of epistaxis. He had taken sildenafil to enhance his sexual performance in the morning before his epistaxis…This was his first nose-bleed requiring medical attention…[After] two days and he was discharged home with no further epistaxis”.
• Case 3: “A 32-year-old male presented to our department for recurrent epistaxis during sexual intercourses…During the consultation, he volunteered that the trigger for the epistaxis appeared to have been misuse of phosphodiesterase (PDE)-5 inhibitors, Viagra and Cialis. This first report of epistaxis after PDE-5 inhibitors in a young patient underline the possibility that in the next years the number of similar cases might increase due to the diffusion of PDE-5 inhibitor misuse in recreational settings”.
• Case 4: “A 66-year-old male presented to our department with recurrent epistaxis. On examination it was not possible to identify the source of the bleeding, despite various measures…During a consultation the patient volunteered that the trigger for the epistaxis appeared to have been energetic sexual activity. To enhance his sexual performance he had taken Viagra; however, on stopping the Viagra and changing to the newer drug Cialis, the episodes of epistaxis continued. We document what we believe to be the first case of epistaxis caused by Cialis”.

So why would Viagra and Cialis cause nosebleeds? Given that these medications help engorge erectile tissue, the nose also contains erectile tissue and the authors of these case reports believe that nasal engorgement also took place and lead to the nosebleeds. The phenomenon may be under-reported because individuals that use Viagra to enhance their sex lives may be too embarrassed to discuss this with doctors if it relates to sexual dysfunction. (I also came across a case report in a 2009 issue of the Indian Journal of Chest Diseases and Allied Sciences by Dr. R. Dixit and colleagues of a 38-year old man persistently coughing up of blood [haemoptysis] whenever he used Viagra during sex).

Another interesting angle on sexual nosebleeds comes from Japanese cartoon animation (and more specifically Manga comics). In an online article entitled ‘Nosebleeds: Manga just wouldn’t be the same without them’, the author argues that Manga cartoons contain a number of specific tropes (i.e., a significant or recurrent theme). These tropes (amongst others) included nosebleeds, sweat drops, snot bubbles, and popping veins. Sexual nosebleeds were the number one trope in the article. The article noted that:

“A nosebleed, in the wonderful world of manga, equates to sexual arousal. I saw this trope for the first time in Dragonball, when Bulma lifts her dress and the lecherous Master Roshi spurts blood from his nose. Although Bulma was commando at the time, nosebleeds can be triggered by seeing something as mild as a pair of panties. In the case of the boy in the following image, it seems his bloody nose was triggered more by a fetish for swimsuits rather than the girl wearing them: Clearly, horn dogs don’t spontaneously get nosebleeds in real life. So why is it so in manga? I think it’s generally accepted that a rush of blood to the head and the resulting nosebleed is a visual metaphor for blood rushing to, er, somewhere else – which probably explains why I’ve only ever seen guys get nosebleeds, although I could be wrong about that”.

I’ve never watched a full Manga cartoon in my life but from everything I’ve read, male nosebleeds are common cliché in anime cartoons and are known as ‘hanaji’. According to the online Urban Dictionary, hanaji is “when you see a boy get a nosebleed in anime, [and] usually means his blood pressure has suddenly severely increased from seeing a really cute girl”. In an article by Brian Ashcroft for Culture Smash, he also noted the nosebleed trope in Manga cartoons:

“A character, male or female, gets excited—often sexually excited. Blood dribbles, or squirts, out of the character’s nose. The notion that arousal or excitement induces bloody noses…isn’t just part of anime or manga iconography. It’s also become an old wives’ tale of sorts…The trope is very much a Japanese one, appearing throughout the country’s popular culture and with various nuances in anime and manga. It is not a new trope and has existed for years…Manga artist Yasuji Tanioka is believed to be the first one to introduce the motif with his early 1970s manga Yasuji no Mettameta Gaki Dou Kouza. Other manga artists liked the expression and began replicating it in their own work”.

In relation to the nosebleed trope in anime cartoons, Dr. Kouichirou Kanaya (the ear, nose, and throat specialist quoted above) speculated that:

“Bloody noses are probably used to show in a powerful way just how excessively large the change induced by sexual arousal is. It’s a climax, and in manga, it often seems to be code for ejaculation”.

There are also anecdotal cases of nosebleed fetishes (called epistaxiophilia). However, the love of nosebleeds appears to have been created by using the name of nosebleed phobia (epistaxiophobia) and changing the suffix ‘phobia’ for ‘philia’. To my knowledge, there has never been an academic paper or clinical case study published on epistaxiophilia. However, I did come across a number of online confessions of individuals that admitted (if they are true) that they were sexually aroused by nosebleeds. Here are some extracts that I found in various online forums:

• Extract 1: “Was just reading a thread on r/Askmen about men who get nosebleeds during sex. My brain processed SEX and NOSEBLEEDS and I immediately imagined myself riding a guy home when he suddenly got a nose bleed. I was strangely turned on by that idea. I don’t think I’d be comfortable sharing this newly discovered turn on with any of my friends because I feel like it’s so damn weird” (Female, Reddit, AskWomen forum)
• Extract 2: “Nosebleed fetish? Does anyone have it? I normally don’t like blood but I find nosebleeds really hot. I wouldn’t ever hurt my loved one, but I have to admit that I’m quite aggressive towards normal people because of it” (Inwealorwoe [Male], Yahoo! Answers)
• Extract 3: “I’ll completely understand and I won’t take offense if you run from this post flailing and gagging…For the longest time, I’ve had a nosebleed Maybe that links to the fact that I’ve also got haematophilia and a vampire fetish. But you know what I really like? When someone sneezes while they have a nosebleed” (Proclaimer, Female, 21 years old)
• Extract 4: “I think it’s incredibly sexy when a guy has a nosebleed. Sneezing while having a nosebleed. I would agree that nosebleeds are probably a turn-on for me because of the whole vulnerability/loss of control factor. Same as with sneezing and colds and things like that” (Helter Skelter, female, 19 years old)
• Extract 5: “I actually do have a blood/vampire fetish. I often find myself getting very thirsty as well as aroused when watching vampires feed in movies. However I don’t really find nosebleeds all that appealing. I’m not disgusted by it or anything, but it just wouldn’t really do anything for me. I guess it’s just not the type of bleeding that I’m attracted to. I can see how it might be appealing to others though” (Shayla, female 31 years)

Obviously I cannot vouch for the veracity of these claims but I have no reason to doubt them (and the final extract liked other blood fetishes but not a nosebleed fetish). There is no detail in any of these extracts to speculate as to why anyone develops a fetish to nosebleeds. However I’ll leave you with a reply to the person in Extract 2 above:

“[Nose bleed fetishes] makes sense. A sexual therapist said that our sexual fantasies are derived from non-sexual things in our life. So your fetish for nosebleeds could actually stem from something non-sexual in your life. For example, it probably turns you on because it makes you feel empowered and aggressive, since if the person you are with has a nosebleed it means you must have been rough with them. So I would say that your fetish is probably normal, because many people are turned on by feeling empowered and aggressive. Sounds normal to me” (The Way It Is, Yahoo! Answers)”.

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

Further reading

Ashcroft, B. (2012). Sexual arousal doesn’t cause bloody noses, says medical science! Culture Smash, October 19. Located at: http://kotaku.com/5953124/sexual-arousal-doesnt-cause-bloody-noses-says-medical-science

Dixit, R., Jakhmola, P., Sharma, S., Arya, M., & Parmej, A. R. (2009). Recurrent haemoptysis following sildenafil administration. Indian Journal of Chest Diseases and Allied Sciences, 15, 119-120.

Hicklin, L.A., Ryan, C., Wong, D.K.K., & Hinton, A.E. (2002). Nose-bleeds after sildenafil (Viagra). Journal of the Royal Society of Medicine, 95(8), 402-403.

Ismail, H., & Harries, P. G. (2005). Recurrent epistaxis after treatment with tadalafil (Cialis). Acta oto-laryngologica, 125(3), 334-335.

Pomara, G., Morelli, G., Menchini-Fabris, F., Dinelli, N., Campo, G., LiGuori, G., & Selli, C. (2006). Epistaxis after PDE-5 inhibitors misuse. International Journal of Impotence Research, 18(2), 213-214.

Candle with care: A beginner’s guide to wax play‬

“I love hot wax. My wife loves to drip it and pour it all over my body. I have dipped my [penis] in the wax and the feeling during the dipping and the sex after was great. We did remove the wax from any part that was going to penetrate. I have a very high threshold for pain. I normally don’t use any painkillers for such things as root canal’s, extractions, stitches or road rash from motorcycle accidents. I don’t get turned on in the slightest from any of this I just don’t feel pain like everyone else. I think it is very normal to have this fetish. It is a major turn on to me. You might want to experiment with different types of wax. Some have a higher melting point than others. Oh we have and have realized she likes to use the waxes with the higher melting points. She loves to see me squirm but in a good way” (Wiki Answers)

According to Dr. Anil Aggrawal in his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices ‘wax play’ is a form of sexually sensual play that involves warm or hot wax typically dripped from candles or ladled onto the individual’s naked skin (the individual typically being sexually masochistic). He also claimed that wax play was often combined with other BDSM and/or sexual activities. Dr. Aggrawal also makes reference to ‘wax play’ in a short section on ‘navel torture’. More specifically her reports that navel torture involves “infliction of intense sensory stimulation and pain to a person’s navel. Examples are sucking or pulling the navel out (often with a syringe), dripping hot oil or wax into the navel, and poking pins into the navel”. The Wikipedia entry on wax play provides a list for those that want to attempt such practices. The article informed readers that:

“Pure paraffin wax melts at around 130 to 135 degrees Fahrenheit (54 to 57 Celsius). Adding stearine makes the wax harder and melt at a higher temperature. Adding mineral oil makes the wax softer and melt at a lower temperature. Soft candles in glass jars usually have mineral oil in their blend and burn cooler at around 120 degrees Fahrenheit (49C), Pillar candles are mostly paraffin and burn warmer at around 140 degrees Fahrenheit (60C). Taper candles have lots of stearine and burn hotter still at around 160 degrees Fahrenheit (71C). Beeswax candles burn about 10 degrees Fahrenheit (6 C) hotter than equivalent paraffin candles. Although there are many web sites that repeat the same advice that color additives make candles burn hotter, actual experiments performed by two different researchers show that this is usually not the case. Increasing the distance the wax falls by 1 meter will drop the temperature about 5 degrees Fahrenheit (3C) at the risk of splatter. If ordinary candles are too hot, a special wax blend with a high concentration of mineral oil can be heated to lower temperatures in a crock pot or double boiler”.

In the ‘safety notes’ section, the article reminds readers that wax temperature can range from simply ‘warm’ to ‘dangerously hot’ and can cause serious burns (and that wax play practitioners should be careful that wax doesn’t “splatter into the eyes”. Obviously, different masochists can withstand different temperatures depending upon their individual tolerance levels. It then goes on to say that:

“Wax may be difficult to remove, particularly from areas with hair. A flea comb or a sharp knife may be necessary for wax removal; use of a knife for this purpose requires special skills, though a plastic card can work as well. Applying mineral oil or lotion before play can make wax removal easier…Wax heated in any sort of pot must be stirred vigorously or there can be dangerous temperature variations. Some people may be allergic to perfumes and dyes. Whatever is above a burning candle can get very hot, even at distances that may be surprising. Candles may break and set fire to objects underneath or nearby. Wax is difficult to wash out of clothes and bed linens. People with certain diseases, skin conditions, or taking certain medications may require additional precautions”.

A few academic studies into sadomasochism have examined various niche practices including wax play. For instance, in a previous blog on psychrocism (individuals who derive sexual pleasure and sexual arousal from either by being cold) I quoted from Brenda Love’s Encyclopedia of Unusual Sex Practices that said:

“Exposure to intense cold creates a sharp sensation that is similar to other physical stimuli that produce tension. The mind changes its focus from intellectual pursuits to physical awareness. Many [sadomasochistic] players use cold contact to heighten awareness of skin sensations. They often alternate cold with heat, such as ice cubes and candle wax”.

More empirically, a 1987 study published in the Journal of Sex Research by Dr. Charles Moser and Dr. E.E. Levitt surveyed 225 sadomasochists (178 men and 47 women). The most commonly reported SM behaviours (in 50% to 80% of participants) were flagellation (whipping, spanking) and bondage (chains, rope, gags, chains, handcuffs). Painful activities (for instance, the use of hot wax, ice, face slapping, biting) were reported by 37–41% of participants, though more dangerous painful activities (burning, branding, tattooing, piercing, insertion of pins) were much less frequently reported (7% to 18% of participants).

A more recent Finnish study published in the Archives of Sexual Behavior by Dr. Laurence Alison and his colleagues reported fairly similar findings to that of Moser and Levitt. Again, the most popular activities were flagellation and bondage. Less reported SM activities were the most harmful harm (piercing, asphyxiation, electric shocks, use of blades/knives, fisting, etc.). These researchers also explored the variations in sadomasochistic activities, and wax play fell into the ‘typical’ pain administration group. These were:

• Typical pain administration: This involved practices such as spanking, caning, whipping, skin branding, use of hot wax, electric shocks, etc.
• Humiliation: This involved verbal humiliation, gagging, face slapping, flagellation, etc. Heterosexuals were more likely than gay men to engage in these types of activity.
• Physical restriction: This included bondage, use of handcuffs, use of chains, wrestling, use of ice, wearing straight jackets, hypoxyphilia, and mummifying.
• Hyper-masculine pain administration: This involved rimming, dildo use, cock binding, being urinated upon, being given an enema, fisting, being defecated upon, and catheter insertion. Gay men were more likely than heterosexuals to engage in these types of activity.

A 2002 follow-up study by the same team on the same sample of sadomasochists (also in the Archives of Sexual Behavior led by Dr. Pekka Santtila) reported that 35% of their participants had engaged in hot wax play. From these few studies it would appear that wax play among SM practitioners is relatively prevalent although there appear to be few data about how regularly wax play is engaged in.

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.

Alison, L., Santtila, P., Sandnabba, N.K., & Nordling, N. (2001). Sadomasochistically oriented behavior: Diversity in practice and meaning. Archives of Sexual Behavior, 30, 1-12.

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

Moser, C. & Levitt, E.E. (1987). An exploratory descriptive study of a sadomasochistically oriented sample. Journal of Sex Research, 23, 322–337.

Norische (2008). Candlelight moments: Basics of wax play. Idaho BDSM. Located at: http://www.idahobdsm.com/articles/howto/waxplay.html

Safer+Saner (2006). Wax play. Located at: http://www.safersaner.org/Safer_WaxPlay.html

Sandnabba, N.K., Santtila, P., Alison, L., & Nordling, N. (2002). Demographics, sexual behaviour, family background and abuse experiences of practitioners of sadomasochistic sex: A review of recent research. Sexual and Relationship Therapy, 17, 39-55.

Spectrum (2004). The Toybag Guide to Hot Wax and Temperature Play. Emeryville, California: Greenery Press.

Wikipedia (2014). Wax play. Located at: http://en.wikipedia.org/wiki/Wax_play

Unfruitful approaches: Why are slot machine players so hard to study?

Anyone that researches in the area of slot machine gambling will know how difficult to can be to collect data from this group of gamblers. Over a decade ago, Dr. Jonathan Parke and I published a paper in the Journal of Gambling Issues on why slot machine players are so hard to study. Almost all of the things we wrote in that paper are still highly relevant today, so this blog briefly examines some of the issues we raised. The following explanations represented our experiences of several research efforts in attempting to examine the psychology of slot machine gamblers in the UK, Canada and the United States. Our explanations are roughly divided into three categories. More specifically, these relate to what we called (i) player-specific factors, (ii) researcher-specific factors, and (iii) miscellaneous external factors.

Player-specific factors: There are a number of player-specific factors that can impede the collection of reliable and valid data. These include factors such as activity engrossment, dishonesty/social desirability, motivational distortion, fear of ignorance, guilt/embarrassment, infringement of player anonymity, unconscious motivation/lack of self-understanding, chasing, and lack of incentive. These are explained in more detail below:

• Activity engrossment – Slot machine gamblers can become fixated on their playing almost to the point where they ‘tune out’ to everything else around them. We have observed that many gamblers will often miss meals and/or utilise devices (such as catheters) so that they do not have to take toilet breaks. Given these observations, there is sometimes little chance that we as researchers can persuade them to participate in research studies – especially when they are gambling on the machine when approached.
• Dishonesty/Social desirability – It is well known that some gamblers will lie and be dishonest about their gambling behaviour. Social and problem gamblers alike are subject to social desirability factors and will be dishonest about the extent of their gambling activities to researchers (in addition to those close to them). This obviously has implications for the reliability and validity of any data collected.
• Motivational distortion – Many slot machine gamblers experience low self-esteem and when participating in research may provide ego-boosting responses that lead to motivational distortion. For this reason, many report that they win more (or lose less) than they actually do. Again, this self-report data has implications for reliability and validity of the data.
• Fear of ignorance – We have observed that many slot machine gamblers report to understand how the slot machine works when in fact they know very little. This appears to be a ‘face-saving’ mechanism so that they do not appear to be stupid and/or ignorant to the researchers.
• Guilt/embarrassment – Slot machine gamblers can often be guilty and/or embarrassed to be in the gambling environment in the first place. They like to convince themselves that they are not ‘gamblers’ but simply ‘social players’ who visit gambling environments infrequently. We have found that gamblers will often cite their infrequency of gambling as a reason or excuse not participate in an interview or fill out a questionnaire. Connected with this, some gamblers just simply do not want to face up to the fact that they gamble.
• Infringement of player anonymity – Some slot machine gamblers clearly play on machines as a means of escape. Many gamblers will perceive the gaming establishment in which they are gambling as a ‘private’ (rather than public) arena. As such, researchers who approach them may be viewed as people who are infringing on their anonymity.
• Unconscious motivation and lack of self-understanding – Unfortunately, many slot machine gamblers do not understand why they gamble themselves. Therefore, articulating this accurately to researchers can be very difficult. Furthermore, many gamblers experience the ‘pull’ of the slot machine where they feel compelled to play despite their better judgment but cannot articulate why.
• Chasing – When trying to carry out research in the playing environments (e.g., arcades, casinos, bingo halls, etc.), many regular gamblers do not want to leave ‘their’ slot machine in case someone “snipes” their machine while they are elsewhere. Understandably, gamblers are more concerned with chasing losses than participating in an interview or filling out a questionnaire for a researcher.
• Lack of incentive – Some slot machine gamblers simply refuse to take part in research because they feel that there is “nothing in it for them” (i.e., a lack of incentive). Furthermore, very few gamblers take the view that their gambling habits and experiences can be helpful to others.

Researcher-specific factors: In addition to player-specific factors, there are also some researcher-specific factors that can impede the collection of data from slot machine gamblers. Most of these factors concern research issues relating to participant and non-participant observational techniques (i.e., blending in, subjective sampling and interpretation, and lack of gambling knowledge). These are expanded on further below:

• Blending in – The most important aspect of non-participant observation work while monitoring fruit machine players is the art of being inconspicuous. If the researcher fails to ‘blend in’, slot machine gamblers soon realise they are being watched. As a result, they are increasingly likely to change their behaviour in some way. For instance, some players will get nervous and/or agitated and stop playing immediately whereas others will do the exact opposite and try to show off by exaggerating their playing ritual. Furthermore, these gamblers will discourage spectators as they are often considered to be “skimmers” (individuals trying to make profits by playing “other peoples machines”). Blending into the setting depends upon a number of factors. If the gambling establishment is crowded, it is very easy to just wander around without looking too suspicious. The researcher’s experience, age and sex can also affect the situation. In the UK, amusement arcades are generally frequented by young men and elderly women. The general rule is that the older the researcher gets, the harder it will be for them to mingle in successfully. If the arcade is not too crowded then there is little choice but to be one of the ‘punters’. The researcher will probably need to stay in the arcade for lengthy periods of time, therefore spending money is unavoidable unless the researcher has a job there – an approach that Dr. Parke took to collect data.
• Subjective sampling and interpretation – When the researcher is in the gambling environment, they cannot possibly study everyone at all times, in all places. Therefore it is a matter of personal choice as to what data are recorded, collected and observed. This obviously impacts on the reliability and validity of the findings. Furthermore, many of the data collected during observation will be qualitative in nature and therefore will not lend themselves to quantitative data analysis.
• Lack of gambling knowledge – Lack of ‘street knowledge’ about slot machine gamblers and the environments they frequent (e.g., terminology that players use, knowledge of the machine features, gambling etiquette, etc.) can lead to misguided assumptions. For instance, non-participant observation may lead to the recording of irrelevant data and/or an idiosyncratic interpretation of something that is widely known amongst gamblers. As above, this can lead to subjective interpretation issues.

External factors: In addition to player-specific and researcher-specific factors, there are also some external factors that can impede the collection of data from slot machine gamblers. Most of these factors concern the gaming industry’s reactions to researchers being in their establishments although there are other factors too. These are briefly outlined below:

• Gaming establishment design – It is clear from many of the arcades and casinos that we have done research in over the years that many are not ideally designed for doing covert research in. Non-participant observation is often very difficult in small establishments or in places where the clientele numbers are low.
• “Gatekeeper” issues and beaurocratic obstacles – The questions of ‘how?’ and ‘where?’ to access to the research situation can be gained raise ethical questions. Access is often determined by “informants” (quite often an acquaintance of the researcher) or “gatekeepers” (usually the manager of the organisation etc.). Getting permission to carry out research in a gambling establishment can be very difficult and is often the hardest obstacle that a researcher has to overcome to collect the data required. Many establishments do not have the power to make devolved decisions and have to seek the permission of their head office. The prevention of access by the industry can be for many reasons but the main ones are highlighted next.
• Management concerns – From the perspective of arcade or casino managers, the last thing they want are researchers that disturb their clientele (i.e., their players), by taking them away from their gambling and/or out of the establishment. Furthermore, they do not want us to give their customers any chance to make gamblers feel guilty about their gambling. In our experience, this is something that researchers are perceived by management to do. This obviously impacts on whether permission to carry out research is given in the first place.
• Industry perceptions – From the many years we have spent researching (and gambling on) slot machines, it has become evident that there are some people in the gaming industry that view researchers such as ourselves as ‘anti-gambling’ and/or that any research will report negatively about their clientele or establishment/organization. As with management concerns, this again impacts on whether permission to carry out research is given in the first place.

Dr. Parke and I envisaged that our explanations might enhance future research in this area by providing researchers with an understanding of some of the difficulties with data collection. Unfortunately, identification of slot machine gamblers is often limited to a “search and seek” method of trawling local gambling establishments (e.g., amusement arcades, casinos etc.). Therefore, researchers are often limited to collecting data during play rather than outside of it. Obviously data facilitation would be better if gamblers were not occupied by their machine gambling.

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

Further reading

Griffiths, M.D. (1991). The observational study of adolescent gambling in UK amusement arcades. Journal of Community and Applied Social Psychology, 1, 309-320.

Griffiths, M.D. (1994). The observational analysis of marketing methods in UK amusement arcades. Society for the Study of Gambling Newsletter, 24, 17-24.

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

Griffiths, M.D. (1996). Observing the social world of fruit-machine playing. Sociology Review, 6(1), 17-18.

Parke, A., & Griffiths, M.D. (2004). Aggressive behavior in slot machine gamblers: A preliminary observational study. Psychological Reports, 95, 109-114.

Parke, A. & Griffiths, M.D. (2005). Aggressive behaviour in adult slot machine gamblers: A qualitative observational study. International Journal of Mental Health and Addiction, 2, 50-58.

Parke, J. & Griffiths, M.D. (2002). Slot machine gamblers – Why are they so hard to study? Journal of Gambling Issues, 6. Located at: http://jgi.camh.net/doi/full/10.4309/jgi.2002.6.7

Parke, J. & Griffiths. M.D. (2008). Participant and non-participant observation in gambling environments. ENQUIRE, 1, 1-18.

Griffiths, M.D. (2011). A typology of UK slot machine gamblers: A longitudinal observational and interview study. International Journal of Mental Health and Addiction, 9, 606-626.

Animal passions: Why would anyone want to have sex with an animal?

Note: A shortened version of this article was first published in The Independent.

Last month, Denmark passed a law making bestiality a criminal offence from July 1st in a move to tackle animal-sex tourism. Bestiality (also known as zoophilia) is typically defined as relating to recurrent intense sexual fantasies, urges, and sexual activities with non-human animals. At present, there are still a number of countries where zoophilia is legal including Brazil, Mexico, Thailand, Finland, Hungary, and Romania. In the US there is no federal law against zoophilia although most states class it as a felony and/or misdemeanour although in some states it is technically legal (for example, Texas, Kentucky, Nevada, New Jersey, New Hampshire, Wyoming, West Virginia, and New Mexico).

Over the last few years I have written articles on the psychology of many different types of zoophilia including those who have engaged in sexual activities with dogs (cynophilia), cats (aelurophilia), horses (equinophilia), pigs (porcinophilia), birds (ornithophilia), dolphins (delphinophilia), lizards (herpetophilia), worms (vermiphilia), and insects (formicophilia). Dr. Alfred Kinsey shocked the US back in the 1950s when his infamous ‘Kinsey Reports’ claimed that 8% of males and 4% females had at least one sexual experience with an animal. Perhaps unsurprisingly, there was a much higher prevalence for zoophilic acts among people that who worked on farms (for instance, 17% males had experienced an orgasmic episode involving animals). According to Kinsey, the most frequent sexual acts that humans engaged in with animals comprised calves, sheep, donkeys, large fowl (ducks, geese), dogs and cats.

In the 1970s, world renowned sexologist Professor John Money claimed that zoophilic behaviours were usually transitory occurring when there is no other sexual outlet available. However, research carried out in the 2000s shows this not be the case. Up until the advent of the internet, almost every scientific or clinical study reported on zoophilia were case reports of individuals that has sought treatment for their unusual sexual preference. However, the internet brought many like-minded people together and there are dozens of websites where zoophiles chat to each other online and share their videos including the Beast Forum, the largest online zoophile community in the world with tens of thousands of members.

Almost all of the recently published studies have collected their data online from non-clinical samples. All of these studies report that the overwhelming majority of self-identified male and female zoophiles do not have sex with animals because there is no other sexual outlet but do so because it is their sexual preference. The most common reasons for engaging in zoophilic relationships were attraction to animals out of either a desire for affection, and a sexual attraction toward and/or a love for animals.

For instance, a study by Dr. Hani Miletski surveyed 93 zoophiles (82 males and 11 females). Only 12% of her sample said they engaged in sex with animals because there were no human partners available, and only 7% said it was because they were too shy to have sex with humans. For the females, the main reasons for having sex with animals was because they were sexually attracted to the animal (100%), had love and affection for the animal (67%) and/or because they said the animal wanted sex with them (67%). Most of Miletski’s sample preferred sex with dogs (87% males; 100% females) and/or horses (81% males; 73% females). Only 8% of males wanted to stop having sex with animals and none of the females. Unlike case study reports of zoophilia published prior to 2000, the studies published over the last 15 years using non-clinical samples report the vast majority of zoophiles do not appear to be suffering any significant clinical significant distress or impairment as a consequence of their behaviour.

In 2011, Dr Anil Aggrawal published a comprehensive typology of zoophilia in the Journal of Forensic and Legal Medicine. Dr. Aggrawal’s claimed there were ten different types of zoophile based on both the scientific and clinical literature, as well as some theoretical speculation. For instance:

• Human–animal role-players – those who never have sex with animals but become sexually aroused through wanting to have sex with humans who pretend to be animals.
• Romantic zoophiles – those who keeps animals as pets as a way to get psychosexually stimulated without actually having any kind of sexual contact with them.
• Zoophilic fantasizers – those who fantasize about having sexual intercourse with animals but never actually do.
• Tactile zoophiles – those who get sexual excitement from touching, stroking or fondling animals or their genitals but do not actually have sexual intercourse with animals.
• Fetishistic zoophiles – those who keep various animal parts (especially fur) that are used as erotic stimuli as a crucial part of their sexual activity (typically masturbation). (See my previous blog on the use of an animal part as a masturbatory aid)
• Sadistic bestials – those who derive sexual arousal from the torturing of animals (known as zoosadismhttps://drmarkgriffiths.wordpress.com/2012/08/06/stuff-love-a-beginners-guide-to-plushophilia/) but does not involve sexual intercourse with the animal.
• Opportunistic zoosexuals – those who have normal sexual encounters but would have sexual intercourse with animals if the opportunity arose.
• Regular zoosexuals – those who prefer sex with animals than sex with humans (but are capable of having sex with both). Such zoophiles will engage in a wide range of sexual activities with animals and love animals on an emotional level.
• Homicidal bestials – those who need to kill animals in order to have sex with them. Although capable of having sex with living animals, there is an insatiable desire to have sex with dead animals.
• Exclusive zoosexuals – those who only have sex with animals to the exclusion of human sexual partners.

Personally, I don’t view human-animal role players as zoophiles as this would include those in the Furry Fandom (individuals that dress up and interact socially as animals). There is no official definition of what a ‘furry’ actually is although most furries would agree that they share an interest in fictional anthromorphic animal characters that have human characteristics and personalities and/or mythological or imaginary creatures that possess human and/or superhuman capabilities. The furry fandom has also developed its own vocabulary including words such as ‘fursona’ (furry persona), ‘plushie’ (person who has sex with cuddly toys), and ‘yiff’ (furry pornography). A study by David J. Rust of 360 members of the furry community suggested less than 1% were plushophiles and that 2% were zoophiles.

Many zoophiles believe that in years to come, their sexual preference will be seen as no different to being gay or straight. This is not a view I adhere to especially because animals cannot give consent (although many zoophiles claim the animals they have sexual relationships with do give ‘consent’). The one thing we do know is that the internet has revolutionised the way we carry out our research and get access to ‘hard to reach’ groups. Thanks to online research, zoophilia is just one of many sexually atypical behaviours that we now know more about both behaviourally and psychologically.

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

Further reading

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

Beetz, Andrea (2002). Love, Violence, and Sexuality in Relationships between Humans and Animals. Germany: Shaker Verlag.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., Gebhard, P.H. (1953). Sexual Behavior in the Human Female. Philadelphia, PA: W.B. Saunders Company.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., (1948). Sexual Behavior in the Human Male. Philadelphia, PA: W.B. Saunders Company.

R.J. Maratea (2011). Screwing the pooch: Legitimizing accounts in a zoophilia on-line community. Deviant Behavior, 32, 918-943.

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

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

Miletski, H. (2002). Understanding bestiality and zoophilia. Germantown, MD: Ima Tek Inc.

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