Relatively stressed: How to cope with family-related tensions this Christmas

As much as we all want Christmas to revolve around perfect presents, tasty food and drink, no work, and leisure time to be spent with close family and friends, it can be a psychologically tense and stressful time even among the most happy and well-adjusted families.

Not only is there the crowded shopping, the writing of copious Christmas cards, the wrapping of presents, and the travelling, but there is often the extra burden of obligatory extended family staying and/or visiting. Patience can be pushed to the outer limit throughout the festive period. Trying to satisfy multiple family members all of who have different needs is difficult at best.

Additionally, family reunions have the potential to bring about a range of deep- rooted emotions including jealousy, resentment, competitiveness, and (sibling) rivalry. Expectations may not be met. Instead of joy and happiness we may feel stressed, hurt and/or exhausted. So how do you cope with the family-related stresses and strains during the festive period? Here are my top ten tips.

• Keep expectations of time spent with family hopeful but realistic – You may not be able to change your family’s dynamics, but at least be aware of how your family can affect your psychological mood state. Some relatives may use the Christmas family reunion to play out family dynamics or re-enact old sibling rivalries. Knowing the problems you might expect from particular family members makes them easier to deal with should they arise. If possible, find ways to shorten or eliminate the family experiences that put you in a bad, anxious or depressed mood.

• Make your family time count – Instead of watching television or DVDs for hours on end, do something together as a family. Go for a walk after the Christmas dinner, play a karaoke video game, play a board game or a parlour game like charades. Basically, do anything where you have to interact with each other. Even making the Christmas dinner could be a communal activity where each adult and child has a specific job.

• Drink alcohol in moderation – Alcohol can be a double-edged sword so be mindful when drinking with family members. Alcohol’s disinhibiting effect can help facilitate friendly family interaction but drinking too much during family gatherings can sometimes lead to saying things that we later regret.

• Don’t take everything personally – The ability to step back from a stressful situation caused by a family member is a skill to be cultivated. Remember that any family member is an individual with moods and desires that are separate from their relationship with you. If something really irritates or stresses you, think about what triggered the feeling, then try to let it go and don’t take it personally.

• Take time out every day – Stress at Christmas time can sometimes arise just because there is a house full of people with little opportunity for “me” time. Try to find time in the day to do something on your own. Go for a brisk walk, pop to the newsagents, have a long bath, tidy up the kitchen while listening to a soccer match or the Ashes, or put your headphones on and listen to your favourite music. Do anything that gives you that much needed little ‘time out’ for the day.

• Be organized – Sounds easy but good organization can often be the key to a hassle-free day. Starting out each day with some kind of ‘game plan’ can help alleviate the typical stress that arises from the Christmas family politics.

• Be assertive – Again, easier said than done but learning the power of how to be politely assertive and just saying ‘no’ when faced with family obligations over Christmas can pay big stress-free dividends. Learn how to set boundaries with family so you can experience the true joy of the festive season.

• Beware the vicious circle – Children, as well as adults, can feel stressed during Christmas. Children often pick up on signs of your anxiety and they themselves can become stressed. This can lead to you feeling even more stressed. In short, a vicious circle where stress and anxiety feeds off each other. Try to hide the stress you feel, especially from children, as this may decrease the length of time you feel anxious.

• Be grateful for what you have in life – No matter how stressful your family may be over the festive period, it is always good to be grateful for the things you have in your life. As one psychologist noted in his blog: “If you are reading this online, then you are alive, have access to the internet, and have at least some free time to surf the net”.

• Remember that relationships are the most important thing we have – All of us need to remember that the Christmas feelings of joy and happiness come not from the gifts, decorations, food and drink, but from our relationships with other people. Christmas is about relationships – not only the relationship you have your family and friends, but also the relationship you have with yourself. If we make our close relationships the top priority, then the rest of the Christmas should fall naturally into place.

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Under pressure: A brief look at inflatable rubber suit fetishism

In previous blogs I have looked at various sexual fetishes that involve sexual arousal from being completely enveloped in some sort of outer garment such as rubberdolling and mummification. Another fetish that is (arguably) related is inflatable rubber suit fetishism (sometimes simply referred to body inflation fetishism – however, I think this term sounds more like people who actually inflate some parts of their actual body such as belly inflation and scrotal infusion that I have covered in previous blogs). Inflatable rubber suit fetishism was featured in a 2013 article by Elorm Kojo Ntumy on the Cracked website (‘The 6 Most Bizarre Safe For Work Fetishes’). In describing this fetish, Ntumy noted:

“Remember the scene in Charlie and the Chocolate Factory where Violet Beauregarde eats some forbidden candy and blows up like a balloon? And then they have to just roll her out of the room? Well, apparently some people can’t watch that scene without becoming inexplicably aroused. This fetish is pretty similar to balloon fetishes, or maybe it’s the opposite, because instead of popping the balloon, you are the balloon. Researchers have yet to determine what exactly it is about inflatable rubber suits getting filled with air that turns people on, but we have to admit that putting one of those on and just bouncing around would be fun as hell…The suits are often double-layered and designed in such a way that the outer layer gets filled with air and expands, while the second suit compresses and squeezes against the unfortunate (or fortunate, we guess) person enclosed within. So maybe that’s it? It’s like a full-body air massage? Either way, thanks to the Internet, we know there are a whole bunch of people who are into it…Inflatable suits are quite expensive, but the guys on this [body inflation] forum are helpful enough to provide DIY tips on how to build your very own personal sex blimp. Now, if one of these springs a leak, do you go zipping around the room making that farting sound?”

Some online articles claim this behaviour is a form of inflatophilia but the online Opentopia encyclopedia refers to inflatophilia as a sexual fetish in which individuals derive sexual attraction to (or are sexually aroused by) inflatable objects and/or toys. To me, this is more about inflatable objects that are external to the person rather than the person actually being inside the inflatable itself. According to the Wikipedia entry:

“Body inflation is the practice of inflating or pretending to inflate a part of one’s bod, often for sexual gratification. It is commonly done by inserting balloons underneath clothes or a skin-tight suit and then inflating them. Some people have specially made inflatable suits, commonly made from latex rubber, to make themselves bigger all over. One of the best-known examples is Mr. Blow Up, who appears in [Katherine Gates] Deviant Desires book. He wears air-inflated double-skinned latex suits, and has made a number of TV appearances in the UK, including Eurotrash. Sometimes the body is actually inflated also, such as by enema or drinking large amounts of liquid. Other inflatable fetishists generate erotic stories, artwork, video, and audio files to indulge their fantasies. Sexual roleplay is also fairly common, either in person or via online conversation. The notion of the fantasy scenarios ending in popping or explosion is often a divisive topic in the community. The first inflatable fetish community organized online in 1994, in the form of an e-mail list; as the popularity of online communication grew, so did the online community”.

On the Dangerous Minds website, Paul Gallagher wrote an article about his 2000 television interview with Mr. Blow Up (MBU) for a documentary he was making about the rise of online fetish websites. Gallagher described MBU as “one of the more interesting characters I met – alongside representatives from the wet and messy (‘sploshing’) communities, adult babies, furries and used panty-sellers”. According to Gallagher MBU was a Londoner and talked about “his love of being inside a latex suit that was pumped full of air”. MBU first became attracted to the idea of being enveloped in an air-filled rubber suit as a child when when playing with a beach ball. MBU often thought about what it would be like to be inside the ball as it bounced everywhere on the beach. Gallagher then went on to describe what happened in the documentary:

“Mr. Blow Up, with the help of his latex-clad wife, slipped into one of his talcum sprinkled outfits and sat on the sofa while she used a foot pump to blow-up his headdress. Just at the very moment I thought he might explode (like some sort of latex Mr. Creosote), Mr. B gave a thumbs up. He later explained how being so constrained made him feel happy, secure and excited”.

In my research for this article I came across many websites that sold inflatable suits as well as in-depth articles on how to put on such suits and how they are designed. For instance, the Latex Wiki (LW) website provided pictures and descriptions of inflatable catsuits, ballbody suits, and blueberry suits. The following descriptions are taken verbatim from three different pages of the LW website:

• “An inflatable catsuit is a latex suit that has two layers so air can be pumped between them, expanding the outer layer and pressing the inner layer against the wearer. This gives the wearer a sensation of much greater tightness than is possible with an ordinary catsuit. If the latex is thick enough, this type of suit can be used for bondage because the wearer is immobilised when the suit is inflated sufficiently. Some body inflation fetishists also use inflatable catsuits as a fantasy device to imagine that the wearer is inflating, or that they themselves are inflating. It has also been known to cross into the furry scene as well with furry inflation enthusiasts.
• A ballbody or balloon-body is an inflatable latex outfit that completely covers the upper body of the wearer and looks like a ball when fully inflated. It was invented and designed by SlinkySkin. 
• A blueberry suit is a special latex costume designed to inflate into a ball with just the user’s hands, feet and head sticking out. It refers to the film Willy Wonka and the Chocolate Factory when the character Violet turns into a blueberry”.

Unsurprisingly, there has never been any academic research on inflatable rubber suit fetishism so little is known about what the fetishists enjoy about the activity so much. However, I did find one enlightening article on the Body Inflation website by ‘funkyobrian’ written back in 2005. Again, the text below is taken verbatim from the website entry and written by someone who is only into ‘suit inflation’:

“I’m one of the few people who actually enjoys pure suit inflation. Here are some of the reasons why: 

• Suit inflation is technically much more feasible in real life than actual body inflation. Sure, body inflation can be done and people out there actually do it, but body inflation in real life has much more potential to become something deadly or hurtful if proper precautions aren’t taken. This is not to say suit inflation itself is 100% safe either, but you can imagine many more things going wrong with real-life body inflation.
• Half of the thrill of the fetish itself is the victim’s (or participant’s) reaction to what is happening…I have done some interesting discussions on the more erotic applications of a girl inflating their suit and ‘getting off’ on the whole experience. Plus in general. rubber and latex are considered to be one of the cornerstones of kinks, so inventive ways of stimulating oneself are quite plentiful. Photo studios like Fetisheyes and Rubber Eva have recently done more to explore inflatable suits and eroticism.
• Inflatable suits are in a way a strange mix of symbolism and suggestion. There’s a bit of excitement in wearing something that makes one body look like its blowing up like a balloon. There’s a sort of psychological element in playing a cruel trick on someone who is particularly vain and sticking them into a suit that transforms their proud figure into something cartoonish and bloated.

I guess this is my convoluted and pseudo-shrink way of expressing my bizarre preferences. But I just want to clarify why when a cute girl’s rubber suit inflates, some of us want to believe it is the SUIT inflating, not her body”

Someone else on the Body Inflation website (‘Fukeruba’) responded to funkyobrian’s analysis:

“You are not alone! I also enjoy a good suit inflation. My whole attraction with suit inflations is that it is in the realm of possibility that a person might get stuck in a big inflated suit, whereas a big body inflation is…more resigned to fantasy. Plus, I’m intrigued by the strong bondage issues that being stuck in a big immobilizing inflated suit represents. I’m into the whole inflating dive-suit [thing] in a big way…although I’ve done space suits and some other unidentifiable types of suits….I’ve done a few drawings where the inflatee thought that they were in an inflating suit, only to have it revealed that their inflating body was in fact causing the suit to bulge. Pretty good opportunity to showcase the whole shock/surprise/horror element in that situation”.

I have no idea how representative these motivations are to the experiences of other inflatable rubber suit fetishists but these insights are interesting and not things I would have speculated as being reasons for engaging in the activity. Given the potential dangers of this fetish I’m surprised that there are no papers from the medical community reporting on accidents from suits bursting.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Gallagher, P. (2015). The inflatable rubber fetish of Mr. Blow Up, Dangerous Minds, February 11. Located at: http://dangerousminds.net/comments/the_inflatable_rubber_fetish_of_mr._blow_up

Gates, K. (2000). Deviant Desires: Incredibly Strange Sex. New York: RE/Search Publications.

McIntyre, K.E. (2011). Looners: Inside the world of balloon fetishism. Berkeley Graduate School of Journalism, UC Berkeley, 27 April. Located at: http://escholarship.org/uc/item/40c3h6kk

Ntumy, E. K. (2013). The 6 Most Bizarre Safe For Work Fetishes. Cracked, November 2. Located at: http://www.cracked.com/article_20691_the-6-most-bizarre-safe-work-fetishes.html

Opentopia (2013). What is inflatable fetishism? Located at: http://encycl.opentopia.com/term/Inflatable_fetishism

Wikipedia (2015). Body inflation. Located at: http://en.wikipedia.org/wiki/Body_inflation

Blame it on the fame: The psychology of being ‘starstruck’

“We have an infatuation for famous. It’s gone global. It seems that, with the rise of fame generated through social media sites and TV, we all have this non-specific person, this idol, plonked on a pedestal, simply because they could be bothered to do something to get themselves out there…A lot of [celebrities are] known for their talent, work bloody hard for it, and that’s inspirational. That’s something to idolise – their drive and passion. But being starstruck because of somebody’s position or wealth or title – just think about it. Most of the people who would leave you starstruck will be everyday folk, just getting on with their thing, even if that’s earning £250,000 a week” (from ‘Starstruck, fame-obsessed and suckers for Hollywood culture’ by Bianca Chadda)

Regular readers of my blog will know that I have more than a passing interest in the psychology of fame. For instance, I have looked at many aspects of fame and celebrity including whether fame can be addictive, the role of celebrity endorsement in advertising, individuals that become sexually aroused by famous people (so-called celebriphilia), individuals that are obsessed with celebrity (i.e., celebrity worship syndrome), and whether celebrities are more prone to addictions than the general public, as well a speculative look at the psychology of various celebrities (including – amongst others – Iggy Pop, Lou Reed, Adam Ant, Roland Orzabal, Salvador Dali and Allen Jones).

The reason I mention this is because a few days ago (December 11), I was interviewed by Georgey Spanswick on BBC radio about the psychology of being ‘starstruck’. The first thing that occurred to me was what ‘starstruck’ actually means. I knew what my own perception of the term meant but when I began to look into it there are many different definitions of ‘starstruck’ (some of which hyphenate the word), many of which did not match my own definition. Here are a selection which highlight that some of those differences:

• “Star-struck – fascinated or greatly impressed by famous people, especially those connected with the cinema or the theatre” (Oxford Dictionary).
• “Star-struck – feeling great or too much respect for famous or important people, especially famous actors or performers” (Cambridge Dictionary).
• “Starstruck – particularly taken with celebrities (as movie stars)” (Merriam Webster Dictionary).
• Starstruck – Fascinated by or exhibiting a fascination with famous people” (Free Dictionary).
• “Star-struck – a star-struck person admires famous people very much, especially film stars and entertainers” (Macmillan Dictionary).
• “Starstruck – when you meet someone you are very fond of, like a celebrity, movie star, etc. and you get completely overwhelmed, paralyzed and/or speechless by the experience” (Urban Dictionary).

Of all the definitions listed above, it is actually the final one from the online Urban Dictionary that most matches my own conception. In fact, an article by Ainehi Edoro on the Brittle Paper website provides a lay person’s view on being starstruck and how it can leave an individual:

“What does it mean to be starstruck? You meet a celebrity and you are struck by a force that freezes you, holds you captive. You can’t think, your eyes are glazed over, your heart is beating really fast, open or closed, your mouth is useless – it’s either not making any sound or spewing out pure nonsense. In a flash, it’s all over. The celebrity disappears. And you’re left with a sense of loss that turns into regret and, perhaps, embarrassment”.

However, as there is no academic research on the topic of being starstruck (at least not to my knowledge), the rest of this article is pure speculation and uses non-academic sources. The most in-depth (and by that I simply mean longest) article that I came across on why people get starstruck (i.e., being completely overwhelmed and speechless when in the company of a celebrity) was by Lior on the Say Why I Do website. The article claimed there were five reasons that may contribute to being starstruck. These are being (i) excited from a feeling of anticipation of meeting a celebrity, (ii) pumped up from the effort of wanting to impress a celebrity, (iii) excited from receiving undeserved attention from a celebrity, (iv) starstruck because that is how other people act around a celebrity, and (v) excited from overwhelming sexual tension towards a celebrity. More specifically:

Excited from a feeling of anticipation of meeting a celebrity: This simply relates to the anticipation that is felt after taking an interest in someone that the individual has admired and revered for years (i.e., they have become “idealized” and “bigger than life”). What will the celebrity really be like to the individual? Will they meet the expectations of the individual?

Pumped up from the effort of wanting to impress a celebrity: This relates to the fact that when meeting someone an individual admires (in this case a celebrity), the individual is trying to make the best impression they can and to put forward a persona that the individual would like the celebrity to perceive them as. This can be a situation that brings about a lot of pressure resulting in being starstruck.

Excited from receiving undeserved attention from a celebrity: This relates to the idea that the individual perceives the celebrity as somehow better (i.e., more successful, attractive, and/or talented than themselves) and that to even acknowledge the individual’s existence is somehow undeserved. The lower the self-esteem of such individuals, the more undeserved they feel by attention from a celebrity.

Starstruck because that is how other people act around a celebrity: This simply relates to the idea that individuals feel starstruck because everyone around them does (or they perceive that everyone else does). Similar situations arise when a crowd goes wild, screams, cries and faints when watching their favourite pop bands. As Lior’s article notes:

“Before Frank Sinatra became a celebrity, it wasn’t common at all to see screaming fans. In 1942, a publicity stunt was done to promote the 25-year old Sinatra, where they planted a number of girls in the audience who were told to scream and swoon when he stepped on stage. What began as a publicity stunt spread through the whole theatre to become a mass hysteria of screaming and fainting. It’s in human nature to copy behaviour around us”.

Excited from overwhelming sexual tension towards a celebrity: This relates to the idea that many celebrities are sexually attractive to individuals that admire and revere them. As Lior notes:

“When some people find someone good looking, they may start to behave in a way that’s quite similar to being star-struck. Star struckness from sexual tension may arise for several reasons. It may be a manifestation of embarrassment about having had fantasies about the person who is now standing in front of you. It may be that every time you look at that person, your thoughts go to places you can’t quite control and that makes you unable to think straight”.

If you are someone who thinks they might be starstruck if you met someone famous, there are various articles on the internet that provide tips on meeting famous people either out in public or within the confines of your job (see ‘Further reading’ below). I’ve been fortunate to meet many celebrities in my line of work with all the media work that I do but I always tell myself that celebrities are human beings just like you or I. I treat them as I would any other human being. No worse, no better. I’m friendly and I’m professional (at least I hope I am). I’ve yet to be starstruck although I’ve never met anyone famous that inspired me to get to where I wanted to get. There is a well known cliché that you should never meet your heroes but if David Bowie or Paul McCartney fancy coming round to my house for dinner I’m pretty sure I wouldn’t be lost for words.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Chadda, B. (2013). Starstruck, fame-obsessed and suckers for Hollywood culture. Lots of Words, March 3. Located at: https://biancajchadda.wordpress.com/2013/03/06/starstruck-fame-obsessed-and-suckers-for-hollywood-culture/

Edora, A. (2012). Seven tips on how to avoid being starstruck. Brittle Paper. May 21. Located at: http://brittlepaper.com/2012/05/meet-celebrities-starstruck

Intern Like A Rock Star (2012). Starstruck: How to talk to celebrities you meet at work. January 2. Located at: http://www.internlikearockstar.com/2012/01/starstruck-how-to-talk-to-celebrities.html#sthash.JBtzCC9Y.dpbs

Lior (2011). Why do people get star struck? SayWhyIDo.com. February 7. Located at: http://www.saywhydoi.com/why-do-people-get-star-struck/

Tech’s appeal: Another look at Internet addiction

Generally speaking, Internet addiction (IA) has been characterized by excessive or poorly controlled preoccupation, urges, and/or behaviours regarding Internet use that lead to impairment or distress in several life domains. However, according to Dr. Kimberly Young, IA is a problematic behaviour akin to pathological gambling that can be operationally defined as an impulse-control disorder not involving the ingestion of psychoactive intoxicants.

Following the conceptual framework developed by Young and her colleagues to understand IA, five specific types of distinct online addictive behaviours were identified: (i) ‘cyber-sexual addiction’, (ii) ‘cyber-relationship addiction’, (iii) ‘net compulsions (i.e., obsessive online gambling, shopping, or trading), (iv) ‘information overload’, and (v) ‘computer addiction’ (i.e., obsessive computer game playing).

However, I have argued in many of my papers over the last 15 years that the Internet may simply be the means or ‘place’ where the most commonly reported addictive behaviours occur. In short, the Internet may be just a medium to fuel other addictions. Interestingly, new evidence pointing towards the need to make this distinction has been provided from the online gaming field where new studies (including some I have carried out with my Hungarian colleagues) have demonstrated that IA is not the same as other more specific addictive behaviours carried out online (i.e., gaming addiction), further magnifying the meaningfulness to differentiate between what may be called ‘generalized’ and ‘specific’ forms of online addictive behaviours, and also between IA and gaming addiction as these behaviours are conceptually different.

Additionally, the lack of formal diagnostic criteria to assess IA holds another methodological problem since researchers are systematically adopting modified criteria from other addictions to investigate IA. Although IA may share some commonalities with other substance-based addictions, it is unclear to what extent such criteria are useful and suitable to evaluate IA. Notwithstanding the existing difficulties in understanding and comparing IA with behaviours such as pathological gambling, recent research provided useful insights on this topic.

A recent study by Dr. Federico Tonioni (published in a 2014 issue of the journal Addictive Behaviors) involving two clinical (i.e., 31 IA patients and 11 pathological gamblers) and a control group (i.e., 38 healthy individuals) investigated whether IA patients presented different psychological symptoms, temperamental traits, coping strategies, and relational patterns in comparison to pathological gamblers, concluded that Internet-addicts presented higher mental and behavioural disengagement associated with significant more interpersonal impairment. Moreover, temperamental patterns, coping strategies, and social impairments appeared to be different across both disorders. Nonetheless, the similarities between IA and pathological gambling were essentially in terms of psychopathological symptoms such as depression, anxiety, and global functioning. Although, individuals with IA and pathological gambling appear to share similar psychological profiles, previous research has found little overlap between these two populations, therefore, both phenomena are separate disorders.

Despite the fact that initial conceptualizations of IA helped advance the current knowledge and understanding of IA in different aspects and contexts, it has become evident that the field has greatly evolved since then in several ways. As a result of these ongoing changes, behavioural addictions (more specifically Gambling Disorder and Internet Gaming Disorder) have now recently received official recognition in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Moreover, IA can also be characterized as a form of technological addiction, which I have operationally defined as a non-chemical (behavioural) addiction involving excessive human-machine interaction. In this theoretical framework, technological addictions such as IA represent a subset of behavioural addictions featuring six core components: (i) salience, (ii) mood modification, (iii) tolerance, (iv) withdrawal, (v) conflict, and (vi) relapse. The components model of addiction appears to be a more updated framework for understanding IA as a behavioural addiction not only conceptually but also empirically. Moreover, this theoretical framework has recently received empirical support from several studies, further evidencing its suitability and applicability to the understanding of IA.

For many in the IA field, problematic Internet use is considered to be a serious issue – albeit not yet officially recognised as a disorder – and has been described across the literature as being associated with a wide range of co-occurring psychiatric comorbidities alongside an array of dysfunctional behavioural patterns. For instance, IA has been recently associated with low life satisfaction, low academic performance, less motivation to study, poorer physical health, social anxiety, attention deficit/hyperactivity disorder and depression, poorer emotional wellbeing and substance use, higher impulsivity, cognitive distortion, deficient self-regulation, poorer family environment, higher mental distress, loneliness, among other negative psychological, biological, and neuronal aspects.

In a recent systematic literature review conducted by Dr. Wen Li and colleagues (and published in the journal Computers and Human Behavior), the authors reviewed a total of 42 empirical studies that assessed the family correlates of IA in adolescents and young adults. According to the authors, virtually all studies reported greater family dysfunction amongst IA families in comparison to non-IA families. More specifically, individuals with IA exhibited more often (i) greater global dissatisfaction with their families, (ii) less organized, cohesive, and adaptable families, (iii) greater inter-parental and parent-child conflict, and (iv) perceptions of their parents as more punitive, less supportive, warm, and involved. Furthermore, families were significantly more likely to have divorced parents or to be a single parent family.

Another recent systematic literature review conducted by Dr. Lawrence Lam published in the journal Current Psychiatry Reports examined the possible links between IA and sleep problems. After reviewing seven studies (that met strict inclusion criteria), it was concluded that on the whole, IA was associated with sleep problems that encompassed subjective insomnia, short sleep duration, and poor sleep quality. The findings also suggested that participants with insomnia were 1.5 times more likely to be addicted to the Internet in comparison to those without sleep problems. Despite the strong evidence found supporting the links between IA and sleep problems, the author noted that due to the cross-sectional nature of most studies reviewed, the generalizability of the findings was somewhat limited.

IA is a relatively recent phenomenon that clearly warrants further investigation, and empirical studies suggest it needs to be taken seriously by psychologists, psychiatrists, and neuroscientists. Although uncertainties still remain regarding its diagnostic and clinical characterization, it is likely that these extant difficulties will eventually be tackled and the field will evolve to a point where IA may merit full recognition as a behavioural addiction from official medical bodies (ie, American Psychiatric Association) similar to other more established behavioural addictions such as ‘Gambling Disorder’ and ‘Internet Gaming Disorder’. However, in order to achieve official status, researchers will have to adopt a more commonly agreed upon definition as to what IA is, and how it can be conceptualized and operationalized both qualitatively and quantitatively (as well as in clinically diagnostic terms).

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

Please note: This article was co-written with Halley Pontes and Daria Kuss.

Further reading

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

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

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

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.

Király, O., Griffiths, M.D., Urbán, R., Farkas, J., Kökönyei, G. Elekes, Z., Domokos Tamás, D. & Demetrovics, Z. (2014). Problematic internet use and problematic online gaming are not the same: Findings from a large nationally representative adolescent sample. Cyberpsychology, Behavior and Social Networking, 17, 749-754.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

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., Shorter, G.W., van Rooij, A.J., Griffiths, M.D., & Schoenmakers, T.M. (2014). Assessing Internet addiction using the parsimonious Internet addiction components model – A preliminary study. International Journal of Mental Health and Addiction, 12, 351-366.

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.

Lam, L.T. (2014). Internet Gaming Addiction, Problematic use of the Internet, and sleep problems: A systematic review. Current Psychiatry Reports, 16(4), 1-9.

Li, W., Garland, E.L., & Howard, M.O. (2014). Family factors in Internet addiction among Chinese youth: A review of English-and Chinese-language studies. Computers in Human. Behavior, 31, 393-411.

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.

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

Tonioni, F., Mazza, M., Autullo, G., Cappelluti, R., Catalano, V., Marano, G., … & Lai, C. (2014). Is Internet addiction a psychopathological condition distinct from pathological gambling?. Addictive Behaviors, 39(6), 1052-1056.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

Young, K. (1998). Caught in the net. New York: John Wiley

Young K. (1999). Internet addiction: Evaluation and treatment. Student British Medical Journal, 7, 351-352.

The dirty smack brigade: A beginner’s guide to erotic spanking

According to Dr. Anil Aggrawal in his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, “erotic spanking” (i.e., so called ‘spankophilia’) is the practice of spanking another person for the sexual gratification of either or both parties. He also reported that notable ‘spankophiles’ include poet Algernon Swinburne (as repeatedly implied in his poetry) and the philosopher Jean-Jacques Rousseau (as detailed in his autobiography Confessions).

Arguably the most well known (non-academic) spanking guide is Jules Markham’s 2005 book Consensual Spanking that examines (i) why people enjoy playing spanking games, (ii) how to conduct a spanking, (iii) how to receive a spanking, (iv) spanking safely, (v) organising a typical spanking session (vi) positions, postures and presentation of spanking, (vii) the use of spanking implements, (viii) aspects of spanking in role-play, (ix) basic control techniques, (x) sensual and erotic forms of spanking, (xi) spanking as foreplay, and (xii) domestic discipline. The Wikipedia entry on erotic spanking features reference to Markham’s book and Dr. Rebecca Plante’s paper on sexual spanking in a 2006 issue of the Journal of Homosexuality and notes:

‘[Spanking] activities range from a spontaneous smack on bare buttocks during a sexual activity, to occasional sexual roleplay to domestic discipline and may involve the use of a hand or the use of a variety of spanking implements…Erotic spanking may be administered to bare buttocks or normally dressed. Spanking can involve the use of bondage…The most common type of erotic spanking is administered on the bare buttocks but can also be combined with bondage in order to heighten sexual arousal and feelings of helplessness…A spanking may be carried out with the use of a bare hand, or with any of a variety of implements, including a paddle, strap, hairbrush, or belt. Other popular tools are canes, riding crops, whips, switiches, birches, sneakers, rolled-up newspapers, rulers or martinet”

Dr. Aggrawal reports that many spankophiles make use of a ‘spanking bench’ (and sometimes referred to as a ‘spanking horse’), a piece of furniture that is used to position the person who receives the spanking (i.e., a spankee), that may or may not have restraints. Aggrawal also makes reference to the nineteenth century British dominatrix Mrs. Theresa Berkley, someone that Aggrawal claims became famous for her invention of the Berkley Horse (a multi-functional device that combined spanking bench with several other sadomasochistic functions). The Wikipedia entry claims that:

“In some cultures, the spanking of women, by the male head of the family or by the husband (sometimes called domestic discipline) has been and sometimes continues to be a common and approved custom. In those cultures and in those times, it was the belief that the husband, as head of the family, had a right and even the duty to discipline his wife and children when he saw fit, and manuals were available to instruct the husband how to discipline his household. In most western countries, this practice has come to be regarded as unlawful and socially unacceptable wife-beating, domestic violence, or abuse. Today, spanking of an adult tends to be confined to erotic spanking or to BDSM contexts. The domestic discipline scenario is commonly invoked in erotic spanking, but with a bare bottom or totally nude, with bondage and less direct physical contact being a feature of BDSM”.

Most academic research papers (such as one on sexual paraphilias and fetishism by Dr. Michael Wiederman in a 2003 issue of The Family Journal) report that spanking is part of a much wider range of sadomasochistic activities including binding, gagging, blindfolding, whipping, choking, cutting, and piercing. For instance, a 1985 study by Dr. N. Breslow and colleagues and published in the Archives of Sexual Behavior examined the sexual activities of 182 sadomasochists (130 men, 52 women). The study found that the most preferred sexual activities for both sexes were spanking and involvement in master–slave relationships. A similar finding was reported by Dr. Charles Moser and Dr. E. Levitt in a 1987 study published in the Journal of Sex Research. They surveyed 225 sadomasochists recruited from a specialist SM magazine (178 men and 47 women), The most common SM behaviours were flagellation (spanking and whipping) and bondage (rope, chains, handcuffs, gags) of which 50% to 80% of participants engaged in.

A more recent 2001 Finnish study headed by Dr. Laurence Alison and published in the Archives if Sexual Behavior reported fairly similar findings. Again, flagellation (including spanking) and bondage were among the most popular activities. Most interestingly (and as I noted in a previous blog on sexual masochism), Alison and colleagues identified four sadomasochistic sub-groups based on the type of pain given and received. Spanking formed part of the first sub-group of sadomasochists. More specifically, these were:

• Typical pain administration: This involved practices such as spanking, caning, whipping, skin branding, 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.

In 2007, psychotherapist Brett Kahr published his book Sex and the Psyche and reported the results of a survey on adult sexual fantasies of 13,500 British men and women of all sexual orientations. Kahr reported that 18% of man and 7% of women had specific spanking fantasies. Spanking may also be associated with other sexual paraphilias. For instance, Dr. W. Arndt reported in his 1991 book Gender Disorders and the Paraphilias that among a small sample of 21 (of which 20 were male) klismaphilacs (i.e., individuals that derive sexual pleasure and arousal from enemas), 40% of the participants reported accompanying paraphilic interests that included mild spanking and other punishments (and suggesting sexually masochistic behaviour).

Although empirical evidence suggests that erotic spanking is not particularly prevalent among the general population (at least in terms of engaging in such behaviour regularly), most academic research appears to indicate that erotic spanking is towards the ‘softer’ end of sadomasochistic activities, and that almost all instances of erotic spanking are consensual, enjoyable, and non-problematic. Consequently, treatment for the behaviour is rarely sought.

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.

Arndt, W. B., Jr. (1991). Gender Disorders and the Paraphilias. Madison, CT: International Universities Press.

Breslow, N., Evans, L., & Langley, J. (1985). On the prevalence of roles of females in the sadomasochistic subculture: Report of an empirical study. Archives of Sexual Behavior, 14, 303–317.

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

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

Markham, J. (2005). Consensual Spanking. London: Adlibbed Ltd

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

Rebecca F. Plante (2006). Sexual spanking, the self, and the construction of deviance. Journal of Homosexuality, 50 (2–3), 59-79.

Wiederman, M. W. (2003). Paraphilia and fetishism. The Family Journal: Counseling and Therapy for Couples and Families, 11, 315-321.

The punch bunch: Aggressive behaviour in adult slot machine gamblers

I was idly looking through some of the academic papers I have published over the last 25 years and I was surprised by how a fair number of them examined aggressive behaviour in some way. Many of these concern the effect of video game violence on aggressive behaviour but I have also published papers examining sexual orientation and aggression, mindfulness and aggression, and gambling and aggression (see ‘Further Reading’ below for a selection of these).

Back when I was doing my PhD on slot machine addiction (1987-1990) I spent a lot of my time in amusement arcades watching fruit machine players. One thing that I noticed during my observational studies is how physically aggressive players could be when they lost (such as kicking or punching the machine if they lost a lot of money or being verbally aggressive towards staff and other players when things weren’t going the way they wanted). A number of studies have reported a link between gambling and aggressive behaviour although most of the research has concentrated on domestic violence between gamblers and their partners (i.e., problem gamblers taking out the frustration of losing lots of money on their partners).

In a paper in a 2005 issue of the Journal of Community and Applied Social Psychology, Dr. Adrian Parke and I speculated that there are two main types of aggressive act which are prevalent in slot machine gambling based on environmental and structural design factors – instrumental aggression and emotional aggression. Instrumental aggression differs from emotional aggression because there is an ulterior motive behind the act whereas emotional aggression is a result of being unpleasantly aroused. The Frustration-Aggression theory states that a barrier to expected goal attainment generates emotional aggression. Furthermore, the level of aggression is directly proportional to the (i) level of satisfaction they had expected, (ii) more they are prevented from achieving any of their goals and (iii) more often their attempts are resisted. Psychologists such as Dr. Leonard Berkowitz maintains that it is not the frustration that causes the aggressive urges, but the negative affect elicited by the frustration.

Dr. Parke and I also published some other papers on slot machine aggression during 2004 and 2005 in the International Journal of Mental Health and Addiction and Psychological Reports. We carried out a non-participant observation study and monitored the incidence of aggressive behaviour in 303 slot machine players over four 6-hour observation periods in a UK amusement arcade. We concluded that aggression was prevalent in the UK gambling arcade environment with an average of seven aggressive incidents per hour.

We also reported that the majority of aggressive incidents were verbal. Verbal aggression was directed towards members of staff, other gamblers and also the slot machines themselves. Verbal aggression towards members of staff, from an objective point of view, appeared to be caused by a misinterpretation of staff reactions towards incurred losses. With cues available to determine which slot machine will be profitable to play, selecting a machine with which the gambler incurs a loss can be interpreted as poor slot machine gambling skill. The psychologists Dr. Brad Bushman and Dr. Roy Baumeister argue that threatened egotism (an explicit dispute against one’s self value) is a strong risk factor for aggression reprisal. It is probable that in this situation the gamblers were motivated to rebuke such evaluations through an affrontive reprimand. For example:

“After losing all of the money he entered the premises with, participant 6 becomes verbally aggressive to an arcade staff member: ‘I should bring a bat into this place and break the fucking machine…What would you do? You wouldn’t have the balls to call the police.” (Parke & Griffiths, 2005; p. 53)

Given the apparent disproportionate aggressive reaction to minor provocation from staff members, there is scope to propose that rather than being a primary source of frustration and aggression, the phenomenon is evidence of Triggered Displaced Aggression. Displaced Aggression theory contends that individuals who are provoked but who are constrained against retaliating directly to the primary source may displace such anger onto unaccountable individuals. Triggered Displaced Aggression theory extends this position, by stating that after a preclusion of direct retaliation against the provocateur, minor triggers will produce an incommensurate level of aggression. Applying this theory to the phenomenon of verbal aggression towards staff members, it is probable that the gambler while frustrated and negatively aroused may be motivated to displace disproportionately high aggressive reactions onto staff members based on minor triggers such as amusement at incurred losses.

We also reported that verbal aggression directed towards other slot machine gamblers was probably a response to predatory play from opposing slot machine gamblers. With structural design factors enabling identification of slot machines that are profitable to play, naturally the environment becomes competitive. Gamblers become callous in their machine selection because the most effective way to make profits is to target machines that other gamblers have lost considerably on. Again, for the individual, self-esteem is likely to be diminished by permitting opponents to profit from experiencing loss. As a result it is probable that attempts are made to deflect such predatory behaviour with aggressive reprimands. For example:

“Participant 3 had gambled a considerable amount of money on one machine, and had no funds to continue playing. Participant 4 immediately began to play the same machine and win. Participant 3 retorted in an aggressive tone: ‘You watching me lose my money before. Wait till I lose everything and then play mate?’” (Parke & Griffiths, 2005; p.54)

Verbal aggression towards other slot machine gamblers could be understood from perspective of the Cognitive Neo-associationistic Model. (Fundamentally, this model suggests that aversive events produce negative affect, which transforms all associated stimuli into potential triggers of aggression). Applying this theory to the verbal aggression phenomenon, it is reasonable to propose that the experience of losing transforms environmental factors, such as opposing gamblers, into sources of aggression. Berkowitz has advocated two tiers of aggression activation. The first stage is simultaneous emotions of rudimentary fear and anger. The second stage is a second order evaluative phase where the individual considers the actual liability of environmental factors in anger creation. Naturally, as Berkowitz states, the individual’s attributional processes dictate whether they will actualise aggressive emotions. Put simply, an acknowledgement of the ability to isolate slot machines that are profitable to play based on identifying losing gamblers, is potentially a risk factor for acting aggressively towards other gamblers.

Finally, verbal aggression towards the slot machine is considered to be an emotionally aggressive act as a means to vent frustration rather than instrumentally preserve status as suggested above. Invariably, verbal emotional aggression was expressed through vilification and attribution of negative human characteristics to the machine such as sadism. Interestingly, such vilification was primarily sexually aggressive and constituted a feminisation of the slot machine. For example:

“This bitch is fucking me around…Are you going to fuck me around again this week?” (Parke & Griffiths, 2005; p.54)

We argued that the physical aggression towards the slot machine was believed to be an extension of tension release that was previously observed with verbal aggression towards the slot machine. For example:

“After considerable losses, Participant 8 began to slam the glass of the machine. After experiencing a near miss Participant 8 subsequently kicked the base of the machine.” (Parke & Griffiths, 2005; p.55)

Physical aggression was not directed towards opposing gamblers – perhaps identifying a boundary of conduct in order to remain within the gambling environment, as it was probable that such behaviour would result in getting thrown out of the premises. Essentially this does not equate to gamblers not be motivated to act physically aggressive to other slot machine gamblers, rather it only represents a reluctance to actualise such behaviour in the gambling environment.

It is probable that aggressive behaviour observed in the slot machine gambling environment is not solely based on structural and environmental factors. Individual differences of the gamblers are likely to affect the prevalence of aggressive behaviour, based on propositions of the General Aggression Model that suggests that trait hostility can develop through life experiences. It is possible that the participants in our observational study held aggression-related biases. For example, Dr. Karen Dill and her colleagues argue that trait hostility precipitates a hostile expectation bias (the expectation that aggressive behaviour will be used by others instrumentally) and a hostile perception bias (the propensity of interpreting interpersonal interactions as aggressive). For gamblers, it is probable that trait hostility is exacerbating aggressive reactions towards provocation from environmental and structural game design factors. Overall, our research concluded that gambling-induced aggression is a manifestation of the underlying conflict of engaging in dysfunctional behaviour while consciously acknowledging its detrimental effects.

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

Additional input: Dr. Adrian Parke (University of Lincoln, UK)

Further reading

Anderson, C.A. & Bushman, B.J. (2002). Human Aggression. Annual Review of Psychology, 53, 27-51.

Berkowitz, L. (1993). Aggression: Its causes, consequences, and control. Philadelphia: Temple University Press.

Berkowitz, L. (1989). The frustration-aggression hypothesis: Examination and reformulation. Psychological Bulletin, 106, 59-73.

Berkowitz, L. (1990). On the formation and regulation of anger and aggression: A cognitive-neoassociationistic analysis. American Psychologist, 45, 494-505.

Bushman, B. J. & Baumeister, R. F. (1998). Threatened egotism, narcissism, self-esteem, and direct and displaced aggression: Does self-love or self-hate lead to violence. Journal of Personality and Social Psychology, 75, 219-229.

Dill, K.E., Anderson, C.A., Anderson, K.B. & Deuser, W.E. (1997). Effects of personality on social expectations and social perceptions. Journal of Research in Personality, 31, 272-292.

Dollard, J., Doob, L.W., Miller, N.E., Mowrer, O.H. & Sears, R.R. (1939). Frustration and Aggression. New Haven, Connecticut: Yale University Press.

Griffiths, M.D. (1997). Video games and aggression. The Psychologist: Bulletin of the British Psychological Society, 10, 397-401.

Griffiths, M.D. (1998). Video games and aggression: A review of the literature. Aggression and Violent Behavior, 4, 203-212.

Griffiths, M.D., Parke, A. & Parke, J. (2003). Violence in gambling environments: A cause for concern? Justice of the Peace, 167, 424-426.

Griffiths, M.D., Parke, A. & Parke, J. (2005). Gambling-related violence: An issue for the police? Police Journal, 78, 223-227.

Grüsser, S.M., Thalemann, R. & Griffiths, M.D. (2007). Excessive computer game playing: Evidence for addiction and aggression? CyberPsychology and Behavior, 10, 290-292.

Mehroof, M. & Griffiths, M.D. (2010). Online gaming addiction: The role of sensation seeking, self-control, neuroticism, aggression, state anxiety and trait anxiety. Cyberpsychology, Behavior, and Social Networking, 13, 313-316.

Miller, N. Pederson, W.C., Earleywine, M. & Pollock, V.E. (2003). A theoretical model of triggered displaced aggression, Personality and Social Psychology Review, 7, 75-97.

Miller, N.E. (1941). The frustration-aggression hypothesis. Psychological Review, 48, 337-342.

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, A. & Griffiths, M.D. (2005). Aggressive behaviour in adult slot machine gamblers: An interpretative phenomenological analysis. Journal of Community and Applied Social Psychology, 15, 255-272.

Sergeant, M.J.T., Dickins, T.E., Davies, M.N.O., & Griffiths, M.D. (2006). Aggression, empathy and sexual orientation in males. Personality and Individual Differences, 40, 475-486.

Shonin, E.S., van Gordon, W., Slade, K. & Griffiths, M.D. (2013). Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review. Aggression and Violent Behavior, 18, 365-372.

Come undone: A beginner’s guide to Traumatic Masturbatory Syndrome

I’m not quite sure where I first read about it, but Traumatic Masturbatory Syndrome (TMS) appears to be a controversial phenomenon that is not widely accepted in the medical and sexological communities. According to the Healthy Strokes website:

“[Traumatic Masturbatory Syndrome] is the habit of masturbating in a face-down position against a bed or floor, which puts excessive pressure on the penis, and can interfere with sexual relations. The most common problems TMS sufferers have are inorgasmia – inability to reach orgasm during intercourse – or delayed orgasm. Many TMS sufferers also experience erectile dysfunction”. 

The term ‘Traumatic Masturbatory Syndrome’ originates from a 1998 paper in the Journal of Sex and Marital Therapy by Dr. Lawrence Sank. His paper described what he believed was “a previously unreported pattern of atypical masturbatory behavior, which presents as either an erectile or orgasmic disorder in men”. He outlined four case studies of men who masturbated daily in a prone position over many years. I wrote to Dr. Sank and he kindly sent me his paper. Sank’s paper began by outlining the fact that there are many texts and manuals for women on how to masturbate and how to overcome being non-orgasmic, but little for men. He pointed out that problems in erectile functioning and orgasm among males appears to result, not from their inability to masturbate but from the inability to masturbate correctly (Sank’s emphasis on the word ‘correctly’). The four cases that Sank reported on were all physically healthy and there were no problems urogenitally, neurologically, hormonally or vascularly. Here are brief summaries of the four cases Dr. Sank wrote about:

• Case 1 [Mr. A]: A 62-year old heterosexual married Black male who was referred for impotence – “He had been married over two years but the couple had not had successful intercourse…He learned at age 8, from his local priest, that any pleasure from touching his penis was the equivalent of ‘re-crucifying Jesus’…The compromise that Mr. A reached was to not use his hand but to rub his penis against his bed clothes and/or pillow without manual guidance. He believed that this would mitigate the seriousness of his sin…This method of sexual expression lasted through several decades of almost daily practice….Mr. A pursued a series of relationships with women…He would rub extremely vigorously against his partner usually to a point where any erection was lost… Mr. A’s masturbatory history is significant for the unique prone position that he engaged in daily over many years”.

• Case 2 [Mr. B]: A 35-year old gay single Asian male referred for an inability to attain or sustain any erection and an inability to achieve orgasm during intercourse – “Mr. B’s history was significant for the absence of what he called a ‘phallic oriented puberty’…He was not able to achieve orgasm until his early 20s. At that time all masturbation was accomplished by rubbing his penis against his mattress in a prone position while fantasizing about being penetrated by a male. He would do this on a daily basis, always eventuating in orgasm. In his late 20’s he found a male lover with whom he would characteristically engage in mutual, manual masturbation…Any stimulation by his partner eventuated in mutual exhaustion since no effort was sufficient, no matter how prodigious, to trigger Mr. B’s orgasm…Mr. B reported that masturbation, while in a prone position, felt ‘more natural’, was speedier, and required far less effort. Mr. B’s explanation was that he imagined his masturbatory preference to be a logical outgrowth of his shame at not having ‘good, working equipment’…Being face down allowed him to hide his embarrassment”.

• Case 3 [Mr. C]: A 24-year old gay white male referred for inability to reach orgasm – “When, on rare occasions, Mr. C did achieve orgasm, it was always with a flaccid penis and never accompanied by any pleasurable sensation…Positionally, Mr. C would invariably masturbate while lying on his stomach, his hands made into fists with his penis between his thumbs. He would thrust downward creating intense friction between the lateral portion of his penile shaft and the knuckles of his thumbs. There would be no erection. The frequency of masturbation was 5-7 times per week. Before treatment, when Mr. C tried masturbating in a more typical fashion he was capable of obtaining an erection but never a strong one nor was there any subsequent orgasm”.

• Case 4 [Mr. D]: A 35-year old heterosexual single white male referred for primary erectile dysfunction – “Mr. D masturbated on a daily basis since adolescence. The quality of the erection during masturbation was reported to be of ‘poor rigidity’…but always eventuated in orgasm. Positionally, Mr. D would be prone, lying on his face and chest, using both hands – one hand grasping his penis, the other hand placed over the first…Only subtle changes in pressure from his hand served to heighten his arousal to the point of obtaining a semi-rigid, non penetrable erection and then orgasm…He has never been able to sustain his erection beyond several seconds of intercourse nor has he achieved orgasm…When asked as to why he masturbated in this statistically unusual manner, Mr. D expressed surprise that it was so unusual and hypothesized that it must have arisen out of being a shameful activity at which he wouldn’t have wanted to be caught. In addition, the tight clutching of his penis during masturbation parallels Mr. C’s traumatizing handling of his penis during masturbation and Mr. A’s vigorous, exhaustive masturbatory rubbing against his bedding or partner”.

Dr. Sank duly acknowledged that the case material presented was anecdotal and he made it clear in his paper that he wasn’t suggesting the “distinguishing variables of position plus frequency or either, alone, are necessary or sufficient for causing the erectile or orgasmic dysfunctions described in these cases”. In the cases of A, C and D:

“The punishing handling of the penis might co-occur with these two variables because a prone position, due to its awkwardness and lack of freedom of motion, would seem to require a great deal of intensity if the subject is to derive the requisite pleasurable sensations associated with masturbatory activity. The daily regimen of masturbation might also have served to raise the threshold of sensation, thus requiring even more intense stimulatory activity to enable orgasm. Unfortunately this heightened intensity would likely raise the threshold for pleasurable sensation even higher…the proverbial vicious circle”

Dr. Sank reported that all his patients were successfully treated and overcame their presenting symptoms. Sank did not describe the treatment in any detail (saying it was beyond the scope of the paper) but involved the “re-sensitizing what the patient treats as a desensitized organ through both individualized behavioral exercises and psychotherapy when appropriate”.

On the basis of his admittedly anecdotal findings, Dr. Sank recommends that pubescent teenagers should be taught proper masturbatory techniques (either by parents, by teachers, and/or by paediatricians). However, as far as I am aware, no other academic or clinical paper has followed up the work of Sank. The Wikipedia entry relating to TMS was removed in 2009 (presumably because of lack of evidence). However, according to an article on masturbation on the Right Diagnosis website, some sources, still continue to give credence to the idea of TMS. The article cites the 1994 book by sex therapist Eva Margolies (Undressing The American Male) who condemned masturbation by rubbing against a pillow or mattress. The same article also quotes the work of and Dr. Josie Lipsith and her colleagues in a 2003 issue of Sexual and Relationship Therapy that suggests masturbation could play a part in male psychogenic sexual dysfunction (although this seems to be little more than citation of Dr. Sank’s original paper).

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Go Ask Alice (2006). Traumatic Masturbatory Syndrome. November 17. Located at: http://goaskalice.columbia.edu/traumatic-masturbatory-syndrome-tms

Healthy Strokes (2013). Facts about prone masturbation. Located at: http://www.healthystrokes.com

Lipsith, J., McCann, D. & Goldmeier, D. (2003). Male Psychogenic Sexual Dysfunction: The Role of Masturbation. Sexual and Relationship Therapy, 18, 448-471.

Margolies, E. (1994). Undressing the American Male: Men with Sexual Problems and What Women Can Do to Help Them. New York: Penguin.

Right Diagnosis (2013). Masturbation. Located at: http://www.rightdiagnosis.com/m/masturbation/wiki.htm

Sank, L.I. (1998). Traumatic masturbatory syndrome. Journal of Sex and Marital Therapy, 24, 37-42.