Monthly Archives: August 2016
Bog standard: A brief look at toilet tissue eating
In previous blogs I have looked at pica (i.e., the eating of non-nutritive items or substances) and subtypes of pica such as geophagia (eating of soil, mud, clay, etc.), pagophagia (eating of ice), acuphagia (eating of metal), and coprophagia (eating of faeces). It wasn’t until I started to research on specific sub-types of pica, that I discovered how many different types of non-food substances had been identified in the academic and clinical literature. For instance, Dr. V.J. Louw and colleagues provided a long list in a 2007 issue of the South African Medical Journal including cravings for the heads of burnt matches (cautopyreiophagia), cigarettes and cigarette ashes, paper, starch (amylophagia), crayons, cardboard, stones (lithophagia), mothballs, hair (trichophagia), egg shells, foam rubber, aspirin, coins, vinyl gloves, popcorn (arabositophagia), and baking powder. Most of these are generally thought to be harmless but as Louw and colleagues note, a wide range of medical problems have been documented:
“These include abdominal problems (sometimes necessitating surgery), hypokalaemia, hyperkalaemia, dental injury, napthalene poisoning (in pica for toilet air-freshener blocks), phosphorus poisoning (in pica for burnt matches), peritoneal mesothelioma (geophagia of asbestos-rich soil), mercury poisoning (in paper pica), lead poisoning (in dried paint pica and geophagia), and a pre-eclampsia-like syndrome (baking powder pica)”.
In the clinical literature, the eating of paper has been occasionally documented (although anecdotal evidence suggests this is fairly common and I remember doing it myself as a child). A review paper on pica by Dr. Silvestre Frenk and colleagues in the Mexican journal Boletín Médico del Hospital Infantil de México highlighted dozens of pica-subtypes and created many new names for various pica sub-types. They proposed that people who eat paper display ‘papirophagia’ (in fact if you type ‘papirphagia’ into Google, you only get one hit – the paper by Silvestre and colleagues – although this blog may make it two!). Eating paper is not thought to be particularly harmful although I did find a case of mercury poisoning because of ‘paper pica’ (as the authors – Dr. F. Olynk and Dr. D. Sharpe – called it) in a 1982 issue of the New England Journal of Medicine.
One sub-type of papirophagia is the eating of toilet paper. As far as I am aware, there is only one case study in the literature and this was published back in 1981, Dr. J. Chisholm Jr. and Dr. H. Martín in the Journal of the National Medical Association. They described the case of a 37-year old black woman with an “unusually bizarre craving” for toilet tissue paper. The authors reported that:
“[The] woman was referred for evaluation of disturbed smell and loss of taste for over one year. These were associated with chronic fatigue and listlessness. During this same period of time, she rather embarrassedly admitted to an overwhelming desire to eat toilet tissue. Frequently, she would awaken at night and dash to her bathroom to eat toilet tissue. No other type(s) of pica were admitted. In addition, she gave a long history of menorrhagia and frequently passed vaginal blood clots during her menses. Her libido was normal and there was no history of poor wound healing, skin or mucous membrane lesions, or intestinal symptoms. Her dietary history suggested a high carbohydrate diet, and due to a mild exogenous obesity she intermittently resorted to a vegan-like diet that included beans and various seeds”
A variety of medical tests were carried out and she was diagnosed with combined iron and zinc deficiency. She was treated with iron and zinc tablets and within a week, both her taste and smell had returned, and her energy levels greatly improved. Zinc deficiencies can lead to a wide variety of clinical disorders including loss of small and taste, anorexia, dwarfism (i.e., growth retardation), impaired wound healing, and geophagia. The woman’s (sometimes) vegan diet may have been to blame for her zinc deficiency as the authors noted that:
“Although vegetables contain zinc, vegans should be made aware that zinc from plant sources is not readily absorbed because naturally occurring phytates, particularly high in beans and seeds, reduce zinc gastrointestinal absorption. Carbohydrates are very poor sources of zinc. Chronic iron deficiency secondary to chronic menorrhagia accounts well for the anemia, fatigue, and unusual pica for toilet tissue noted in this patient”.
Paper pica has occasionally been mentioned in other academic papers although details have typically been limited. For instance, a 1995 paper in the journal Birth by Dr. N.R. Cooksey on three cases of pica in pregnancy reported that one of the women chewed non-perfumed blue toilet paper during the first trimester of her pregnancy (and was forced by her mother to stop). There was also a 2003 paper published by Dr. Dumaguing in the Journal of Geriatric Psychiatry and Neurology examining pica in mentally ill geriatrics. One of the cases mentioned was a 76-year old patient that not only ingested their medication (an emollient cream for arthritis) but was also recorded eating toilet paper, napkins, Styrofoam cups, crayons, and other patients’ medications.
A more recent 2008 paper by Dr. Sera Young and her colleagues in the journal PLoS ONE, critically reviewed procedures and guidelines for interviews and sample collection in relation to pica substances. In describing the protocols involved, they referred to paper pica in the questions that should be asked:
“What is the local name, brand name, or type of pica substance desired or consumed? This will help others to know if this substance has already been studied and assist interested researchers in obtaining subsequent samples at a later date. Furthermore, different manufactured products may contain different materials, e.g. Crayola chalkboard chalk contains slightly different ingredients from other brands. Similarly, the consequences of toilet tissue paper consumption are different from those of eating pages of a novel; information would be lost if the substance was simply described as paper. For these reasons, the substance consumed should be described in as much detail and as accurately as possible”.
Personally (and based on anecdotal evidence), I think that papirophagia is not overly rare (especially among children – although I admit this may be more out of curiosity that craving) but the clinical literature suggests that it is a fairly rare disorder found amongst distinct sub-groups (pregnant women, the mentally ill). Given the fact that for most people eating paper would not cause any problems, this would provide the main reason why so few cases end up seeking medical, clinical, and/or psychological help.
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Chisholm Jr, J. C., & Martín, H. I. (1981). Hypozincemia, ageusia, dysosmia, and toilet tissue pica. Journal of the National Medical Association, 73(2), 163-164.
Cooksey, N.R. (1995). Pica and olfactory craving of pregnancy: How deep are the secrets? Birth, 22, 129-137.
Dumaguing, N.I., Singh, I., Sethi, M., & Devanand, D.P. (2003). Pica in the geriatric mentally ill: unrelenting and potentially fatal. Journal of Geriatric Psychiatry and Neurology, 16, 189-191.
Frenk, S., Faure, M.A., Nieto, S. & Olivares, Z. (2013). Pica. Boletín Médico del Hospital Infantil de México, 70(1), 55-61
Louw, V.J., Du Preez, P., Malan, A., Van Deventer, L., Van Wyk, D., & Joubert, G. (2007). Pica and food craving in adults with iron deficiency in Bloemfontein, South Africa. South African Medical Journal, 97, 1069-1071.
Olynyk, F., & Sharpe, D. H. (1982). Mercury poisoning in paper pica. The New England Journal of Medicine, 306, 1056 -1057.
Young, S.L., Wilson, M.J., Miller, D., Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS ONE, 3(9), e3147. doi:10.1371/journal.pone.0003147
Silver cross? The strange case of counterfactual thinking among Olympic athletes
As a psychologist, I’m very interested in how people decide what the reasons for a behaviour or action are. For instance, if Brazil wins the gold medal in football at the Olympics there might be a whole range of reasons that we attribute this success to (e.g., the skill of the team, the manager’s team selection, the influence of home crowd support, etc.). If they get knocked out early in the competition, we might attribute the failure to a related but slightly different set of reasons (e.g., the manager didn’t pick the best players, the referee was biased in his decision-making, etc.).
However, there is a lot of psychological research showing that – on occasions – our attributions about the outcome of sporting events (both failures and successes) can be relatively unrealistic. Psychologists explain reasoning in these cases as due to counterfactual thinking (CFT) because it runs counter to the facts of the situation. There are always things that have happened to us in our lives where we dwell on something that we have done and make attributions about the causes of those events, even though we can no longer do anything about it.
Olympians who perform below their best can waste lots of time ‘torturing’ themselves about their performance (e.g., sprinters may re-run races in their head and imagine what they could have done differently). This is known as upward CFT. The opposite phenomenon (i.e., downward CFT) is when a person spends loads of time thinking about how things could have been a lot worse.
Psychological research has demonstrated that CFT is more likely to occur when an outcome is upsetting, negative, and/or unexpected. A really good example of this was in the 1998 football World Cup when England’s David Beckham was sent off for kicking an opposition player during the quarter-final against Argentina. There is no way of knowing whether England would have won the game if Beckham hadn’t been sent off. However, immediately after England’s loss, there was an almost universal attribution by the British media and the British general public that the only reason we didn’t reach the semi-final was the sending off of David Beckham.
This was a classic example of downward CFT at a national level. If England had been losing at the time of Beckham’s red card, it is debatable whether such attention would have been given. Similar types of national downward CFT were displayed when Frank Lampard’s goal against Germany in the 2010 football World Cup was not given. Had the goal been given by the referee, England would have levelled the game at 2-2 and perhaps the outcome would have been very different (even though most neutral observers claim Germany’s 4-1 win was fully deserved).
My favourite study in the area of CFT was actually carried out on Olympians by American psychologists Victoria Medvec, Scott Madley and Thomas Gilovich. They published a paper in the Journal of Personality and Social Psychology entitled ‘When Less Is More: Counterfactual Thinking and Satisfaction Among Olympic Medalists’. They were interested in whether the effects of different counterfactual comparisons were strong enough to cause people who are objectively worse off to sometimes feel better than those in a superior state. They came up with an ingenious way to look at this by studying the medals won during athletic competition.
“We chose this domain of investigation because in athletic competition outcomes are typically defined with unusual precision. Someone finishes first, second, or third, for example, thereby earning a gold, silver, or bronze medal. With all else equal, one would expect the athletes’ levels of satisfaction to mirror this objective order. We suspected, however, that all else is not equal – that the nature of athletes’ counterfactual thoughts might cause their levels of satisfaction to depart from this simple, linear order”
And that’s exactly what they found because they found that bronze medalists tend to be happier than silver medalists – and they explained this by comparison between upward and downward CFT. They expected those who won silver medals to be more focused on why they failed to win a gold medal (upward CFT). For bronze medalists, they expected them to be more focused on the fact that they finished with a medal rather than nothing at all (downward CFT). Medvec and colleagues put it a lot more eloquently than I could:
“For the silver medalist, this exalted status was only one step away. To be sure, the silver medalist also finished only one step from winning a bronze, but such a downward social comparison does not involve much of a change in status (i.e., neither the bronze nor silver medalist won the event, but both won medals), and thus does not constitute as much of a counterfactual temptation. In contrast, bronze medalists are likely to focus their counterfactual thoughts downward. Like the qualitative jump between silver and gold, there is a categorical difference between finishing third and finishing fourth. Third place merits a medal whereas the fourth-place finisher is just one of the field. This type of categorical difference does not exist in the upward comparison between second and third place”.
Basically, the authors attributed their findings to the fact that the most compelling counterfactual alternative for the silver medalist is winning the gold, whereas for the bronze medalist it is finishing without a medal. Therefore, bronze medalists are happier than silver medalists with the outcome – even though the silver medalists did objectively better in the event. The authors also noted that CFT might be very long lasting for athletes. They briefly recalled the case of the 1500m middle distance runner Abel Kiviat, who won a silver medal at the 1912 Stockholm Olympics. Kiviat had all but won the race until the British athlete Arnold Jackson “came from nowhere” and won the race by one-tenth of a second. In a 1995 interview to the Los Angeles Times, the then 91-year old Kiviat said: “I wake up sometimes and say, ‘What the heck happened to me?’ It’s like a nightmare”.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Baron, R. A. (2000). Counterfactual thinking and venture formation: The potential effects of thinking about “what might have been”. Journal of business venturing, 15(1), 79-91
Byrne, R. M., & McEleney, A. (2000). Counterfactual thinking about actions and failures to act. Journal of Experimental Psychology: Learning, Memory, and Cognition, 26(5), 1318-1331.
Epstude, K., & Roese, N. J. (2008). The functional theory of counterfactual thinking. Personality and Social Psychology Review, 12(2), 168-192
Medvec, V. H., Madey, S. F., & Gilovich, T. (1995). When less is more: counterfactual thinking and satisfaction among Olympic medalists. Journal of Personality and Social Psychology, 69(4), 603-610.
Roese, N. J. (1997). Counterfactual thinking. Psychological bulletin, 121(1), 133-148.
Roese, N. J., & Olson, J. M. (2014). What might have been: The social psychology of counterfactual thinking. London: Psychology Press
“Just one more thing”: The psychology of ‘Columbo’
My favourite TV detective has always been Columbo (played by Peter Falk). I have watched every single one of the 69 episodes (as my family will attest) many times. While I am working, I will often have Columbo on in the background in the way that other people have music on in the background (although I do the latter as well). For those reading this that have not come across Columbo, here is a brief synopsis from Wikiquote:
“Columbo (1968, 1971-1978, 1989-2003) was an American crime fiction television show about Lieutenant Columbo, a homicide detective with the Los Angeles Police Department. He uses his deferential and absent-minded persona to lull criminal suspects into a false sense of security, by harassing and pestering suspects non-stop – without letting them know that they’re suspects – under the pretense that he’s simply being a pesky detective, in order to spy on them and agitate them into giving up clues”.
I have asked myself many times why I love the iconic show so much and it’s hard to put my finger on any single reason. One of the things I love about the show is that almost all the episodes are a ‘reverse whodunit’ (often referred to as an ‘open mystery’) in which the viewer knows the identity of the murderer(s) and we watch to see how Lt. Columbo uncovers who the killer or killers are. (I say “almost all” because there are actually a few episodes that are more typical ‘whodunits’ such as 1976’s ‘Last Salute To The Commodore’, 1992’s ‘No Time To Die’ [involving a kidnapping rather than a murder] and 1994’s ‘Undercover’). Another aspect I love is the inherent contradictions in Lt. Columbo’s day-to-day behaviour. His dishevelled clothing (the infamous beaten-up raincoat), his apparently bumbling absent-minded nature, and his habit of going off-topic in conversations, but knowing that he is actually one of the most astute and clever detectives that you are ever likely to meet (he would no-doubt fit the description of the stereotypical ‘absent-minded professor’). As a psychologist I find him fascinating. As an article about Columbo on the Cult TV Lounge rightly notes:
“The emphasis is on the psychological duel between detective and suspect, with (mercifully) no interest in social commentary and few concessions to the ‘realism’ that would become more and more of a fetish in TV cop shows during the course of the 70s. This is pure entertainment and it’s all the better for it”.
And finally, it is Lt. Columbo’s brilliant trademark ‘false exits’ that wrongfoot all the murderers. After most informal interrogations with the murderer, Columbo leaves the scene, only to return a few seconds later with the opening gambit of “there’s just one more thing” (or a variant of the phrase) only for it to be the most important question that he “forgot to ask”. As an obituary at the In The Dark website on Peter Falk noted:
“The more trivial the “thing” is, the more damning it proves. As an application of psychology, it’s a superb tactic and it slowly but surely grinds down the criminal’s resistance. Often the murderer’s exasperation at Columbo’s relentless badgering leads to rash actions and errors; the second murder, if there is one, is never as carefully planned as the first”.
As the selected (emboldened) quotes above show, psychology is an integral part of Columbo’s appeal. I was also surprised to find that clinical psychologists and forensic psychologists have used Lt. Columbo’s modus operandi in their day-to-day work. (In fact, even some writers claim that if you want to be a better writer you should watch Columbo according to an article by Shahan Mufti in the New York Times; also, a number of marketing gurus claim that Lt. Columbo can teach marketers a thing or two – check out ‘10 things marketeers can learn from Columbo’). For instance, in an article on motivational interviewing (MI) via the Australian Mental Health Academy describe the ‘Columbo approach’:
“Proponents of motivational interviewing owe a debt of gratitude to the 1970s television series Columbo…[Columbo] was a master of the skill of ‘deploying discrepancies’, and MI therapists/practitioners can use the same skill to get clients to help them make sense of their (the clients’) discrepancies. With the Columbo approach, an interviewer makes a curious enquiry about discrepant behaviours without being judgmental or blaming. In a non-confrontational manner, information that is contradictory is juxtaposed, allowing the therapist to address discrepancies between what clients say and their behaviour without evoking defensiveness or resistance. Wherever possible when deploying discrepancies, practitioners are encouraged to end the reflection on the side of change, as clients are more likely to elaborate on the last part of the statements”
The article then goes on to explicitly describe specific MI interventions using the ‘Columbo approach’. Another online article by Greg Lhamon (‘A simple trick to make a powerful last impression’) describes the ‘Columbo Technique’. Here is an abridged version:
“One way in which you can leave someone with a powerful last impression is to use…“the Columbo Technique”…named after the lovable yet shrewd TV detective from the 1970s…He was unassuming and appeared almost absent-minded as he questioned a murder suspect. Yet his seemingly random line of questioning was the process by which he built an airtight case against the suspect. At the conclusion of every interview, he did something unique: he’d thank the suspect profusely, step toward the door, stop, and then turn back, and say, “Oh, just one more thing.” Then he’d ask one last question, a particularly damning question that let the suspect know that Lieutenant Columbo was onto him. Like every form of good communication, sincerity is critical. It cannot be contrived. The goal is simply to make a strong, memorable point, not to manipulate someone. The process is simple: (1) hold back a critical piece of information and reserve it for the end of the meeting, (2) right before you part company, share the information or ask a question, and (3) enjoy the response you receive”.
A 2009 article in the American Bar Association Journal reported that the best way to interrogate a suspect is to ‘Think Columbo’. The advice given was that police should focus on what suspects say rather than their behaviour (such as fidgeting, sweating, and averting eyes during an interview). After reviewing interrogation tapes, Professor Ray Bull, a British forensic psychologist told the Times newspaper that British police use an investigative interviewing technique:
“These interviews sound much more like a chat in a bar. It’s a lot like the old Columbo show, you know, where he pretends to be an idiot but he’s gathered a lot of evidence.”
The ABA article also included comments from American psychologist Kevin Colwell, who said that suspects that lie in police interviews “often prepare a script that doesn’t have much detail”. Colwell recommended using interview techniques where the individual undergoing questioning should talk about the event in question more than once “adding details in retelling the event about things such as sounds and smells” and asking the person “to recall the event in reverse” and that:
“Those who tell the truth tend to add 20% to 30% more external detail than do those who are lying. Those who are adept at lying may start to feel more strain if the interviewer introduces evidence throughout the questioning that has been previously uncovered. Detective Columbo, it turns out, was not just made for TV”.
Another reason I love Columbo because a number of episodes featured psychologists and/or psychiatrists as the killer, most of who used their psychological expertise to carry out an ingenious murder. This included the episodes ‘Prescription Murder’ (1968 – the first ever episode; Dr. Ray Flemming who uses his high intelligence rather than his psychiatric expertise to murder his wife), ‘Double Exposure’ (1973; Dr. Bart Kepple, a consumer psychologist who uses subliminal advertising to lure his victim to be killed), ‘A Deadly State Of Mind’ (1975; Dr. Marcus Collier, a psychiatrist who uses hypnosis to make his victim jump from a high rise apartment), ‘How To Dial A Murder’ (1978; Dr. Eric Mason, a behavioural psychologist who uses classical conditioning to train his dogs to kill his victim), and ‘Sex And The Married Detective’ (1998; Dr. Joan Allenby, a sex therapist who uses her knowledge of psychosexual roleplay to ensnare and kill her lover). In one episode (‘How To Dial A Murder’), Columbo and the psychologist Dr. Eric Mason have an interesting exchange:
Dr. Eric Mason: You’re a fascinating man, Lieutenant. Columbo: To a psychologist, sir? Dr. Eric Mason: You pass yourself off as a puppy in a raincoat happily running around the yard digging holes all up in the garden, only you’re laying a mine field and wagging your tail.
As an ex-Professor of Gambling Studies, another aspect that I have noticed is how many episodes of Columbo feature gamblers and gambling that are often integral to the storyline. Gambling is a key feature in the episodes ‘Double Shock’ (1973; the murderer Norman Paris, a banker, is featured at a Las Vegas casino running up gambling debts), ‘A Friend in Deed’ (1974; the murderer Mark Halperin, a deputy police commissioner, is shown in his opening scene to be a regular casino gambler), ‘Uneasy Lies The Crown’ (1990; the murderer, Dr. Wesley Corman is a dentist and a compulsive gambler), ‘Death Hits The Jackpot’ (1991; photographer and murder victim Freddy Brower wins a $30 million on the lottery and is killed by his uncle Leon Lamarr), ‘A Bird In The Hand’ (1992; would-be murderer Harold McCain, a compulsive gambler tries to murder his millionaire uncle, owner of a US football team), ‘All in The Game’ (1993; murder victim Nick Franco is a playboy and high stakes poker player killed by his lover Laura Staton), and ‘Strange Bedfellows’ (1995; Randy McVeigh the murder victim owes money for gambling debts to the Mafia and is killed by his brother Graham who has ‘inherited’ his brother’s debt).
In another episode (‘Troubled Waters’, 1975), it turns out that the killer (Hayden Danzinger, an autocar executive) is also a regular casino gambler but this only comes to light late in the episode when Lt. Columbo talks to his wife (Sylvia Danzinger). Here we learn that Lt. Columbo thinks about slot machines:
Columbo: You see that fellow over there playing the slot machines? Waste of money. I’ve played it 44 times. I won once right at the beginning and I never won again. Sylvia Danzinger: You can’t beat ‘em. I don’t even try. Columbo: You’re not a gambler? Sylvia Danzinger: No, I prefer more quiet activities. Columbo: That’s funny. I was under the impression you and your husband went to Las Vegas quite a few times. Sylvia Danzinger: Oh, no. Hayden goes often but without me. I wouldn’t be caught dead there.
I’ve often wondered if gambling was an important issue (positive or negative) for Peter Falk in his private life, because when he wasn’t playing Lt. Columbo, it wasn’t unusual for him to be in gambling-related acting roles. Most notably, he played an ageing bookmaker Vinnie in the 1988 film Money Kings (also known under the title Vig, a film about the illegal world of gambling), and the 1988 film Pronto he played Harry Arno, a sports bookmaker who stole money from the local mafia boss Jimmy Capatorto. He also played the poker player Waller in a 1960 episode of Have Gun – Will Travel (‘Poker Fiend‘), and in the 1970 film Husbands he played Archie Black, one of three men undergoing mid-life crises following the death of their friend who then who all go to Europe to gamble, drink, and womanise.
If you’ve got this far, I’ll just leave you with the answers to a couple of my favourite Columbo trivia questions. The most asked question concerning Lt. Columbo (like Inspector Morse) is what was his first name. (When asked the same question in the series itself, Columbo would answer ‘Lieutenant’!). Lt. Columbo never once revealed his first name verbally in the series but did once flash his police badge in an early episode (‘Dead Weight’; Episode 3, Series 1) and accidentally revealed his name was Frank. The second most asked question is how Peter Falk lost his eye. Falk had his eye removed at the age of three years (due to cancer) and had a glass eye for the rest of his life. Although Falk had a glass eye, fans debated for years whether Lt. Columbo had only one eye. The answer was revealed in the 25th anniversary episode (‘A Trace of Murder’) when Lt. Columbo asked the murderer (Patrick Kinsley, a forensic expert) to look at something with him because “three eyes are better than one”!
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Burns, S. (2016). The Columbo Episode Guide. Located at: http://www.columbo-site.freeuk.com/episode.htm
Changing Minds (2013). The Columbo Technique. Located at: http://changingminds.org/techniques/questioning/columbo_technique.htm
Dawidziak, M. (1989). The Columbo Phile. Mysterious Press.
D For Doom (2015). Columbo, Season 1 (1971). Cult TV Lounge, July 3. Located at: http://cult-tv-lounge.blogspot.co.uk/2015/07/columbo-season-one-1971.html
Haynes, N. (2012). Guide to TV detectives: No.1. The Guardian, January 23. Located at: https://www.theguardian.com/tv-and-radio/tvandradioblog/2012/jan/23/natalie-haynes-detectives-columbo
Henley, J. (2013). 10 things marketeers can learn from Columbo – yes, Columbo. Rock The Deadline, November 24. Located at: http://rockthedeadline.com/blog/content-marketing/10-things-marketers-can-learn-from-columbo-yes-columbo/
Mental Health Academy (2015). Principles and techniques of motivational interviewing. January 12. Located at: http://www.aipc.net.au/articles/principles-and-techniques-of-motivational-interviewing/
Mufti, S. (2013). Want to write better? Watch Columbo. New York Times (The 6th Floor), September 25. Located at: http://6thfloor.blogs.nytimes.com/2013/09/25/want-to-write-better-watch-columbo/?_r=2
Telescoper (2011). In memorium: Peter Falk (1927-2011). In The Dark, https://telescoper.wordpress.com/2011/06/25/in-memoriam-peter-falk-1927-2011/
Weiss, D.C. (2009). The best way to interrogate: Think Columbo. American Bar Association, May 12. Located at: http://www.abajournal.com/news/article/the_best_way_to_interrogate_think_columbo/
Wikipedia (2016). Columbo. Located at: https://en.wikipedia.org/wiki/Columbo
Wikipedia (2016). List of Columbo episodes. Located at: https://en.wikipedia.org/wiki/List_of_Columbo_episodes
Wikipedia (2016). Peter Falk. Located at: https://en.wikipedia.org/wiki/Peter_Falk
Wikiquote (2016). Columbo. Located at: https://en.wikiquote.org/wiki/Columbo
Ride on high: Another look at the psychology (and cycleology) of ‘cycling addiction’
Back in 2012, I wrote an article on cycling addiction for my blog and classed the behaviour as a sub-type of exercise addiction. Recently (June 2016), I was interviewed by Cycling Weekly magazine for an article on addiction to cycling, so I thought it opportune to look at the issue again. Over the last five years or so there has been an increase in the amount of research into exercise addiction (as I have outlined in a number of papers with my Hungarian colleagues Attila Szabo and Zsolt Demetrovics – see ‘Further reading’ below). However, there has still been no empirical research specifically into cycling addiction. In his 1997 book Motivation and Emotion in Sport, Dr. John Kerr speculated that endurance type exercise activities (e.g. running, cycling, swimming, aerobics and weight training) were most often associated with exercise addiction and dependence but this was based more on anecdotal as opposed to scientific evidence.
For the Cycling Weekly article, I was interviewed by Dr. Josephine Perry (who just happed to be both a psychologist and a cyclist). She noted in her article that:
“As a regular cyclist, it’s very likely you take a close interest in performance and have a strong drive to improve coupled with a willingness to push yourself hard in training and racing. Sometimes you probably feel under attack from family or colleagues who question or tease you about your ‘obsessive’ cycling habit. You no doubt retaliate by citing the many benefits of cycling: the brilliant friendships, massive health improvements, toned body and all the places you get to explore on your bike. But do your critics occasionally have a point? Does your relentless drive to improve sometimes go too far and place you in danger of crossing the thin line from dedication into addiction? Addiction to cycling is defined by an incessant internal need to train hard every day without taking the time off that you need to rest and recover — not to mention attend to other commitments in your life. In other words, addiction is defined by harm. You ignore the pleas from family or friends to cut back. Your priorities get rearranged, and nothing is allowed to come between you and your bike. Once this line is crossed, the benefits of cycling begin to diminish. The addicted cyclist feels more aches and pains, becomes prone to physical injuries, regular colds and hidden illnesses”.
In a recent (2016) book chapter, my colleagues and I noted that exercise addiction (irrespective of the sub-type) is a condition in which a regularly exercising person loses control over her or his exercise behaviour, while acting compulsively and exhibiting dependence, resulting in negative consequences in their day-to-day health and/or life. This maladaptive exercise behaviour is characterized by severe withdrawal symptoms when exercise is not possible, similar to both chemical addictions (e.g., alcohol addiction) and other behavioural addictions (e.g., gambling addiction). Based on the scientific evidence, exercise addiction is relatively rare, ranging from 0.3% to 0.5% as noted in the only study published using a representative national sample of the general population that we carried out in Hungary back in 2012 (published in the journal Psychology of Sport and Exercise). Given that exercise addiction (in general) is rare, the prevalence of cycling addiction would therefore be even lower. However, that doesn’t mean it doesn’t exist.
A recent study carried out by Dr. Bernd Zeulner and his colleagues among 1,031 endurance athletes (that included an unspecified number of cyclists) assessed the prevalence of exercise addiction using the Exercise Addiction Inventory (EAI; a scale that I co-developed with my colleagues Attila Szabo and Annabel Terry). The study (published in the journal Advances in Physical Education) found that 2.7% had the potential to develop an exercise addiction and that is higher than the prevalence among the general population.
Another study published in the Journal of Clinical Sport Psychology by Dr. Jason Youngman and Dr. Duncan Simpson examined exercise addiction among 1,285 triathletes (cycling, swimming and running) also using the EAI. The study found that approximately 20% of triathletes were at risk for exercise addiction, and that training for longer distance races puts triathletes at greater risk for exercise addiction than training for shorter races. They also found that as the number of weekly training hours increased, so did a triathlete’s risk for exercise addiction. Despite the lack of empirical evidence specifically on cycling addiction, Dr. Perry also noted in her article that:
“[Addicted cyclists] can also become susceptible to burnout and all that comes with it: decreased performance, low mood, changes in appetite, difficulty sleeping and generally a feeling that the outcomes are not matching the intensity of the effort being put in. For a cycling addict, this loss of form and the feelings of difficulty can be devastating…Other research has found the risks are highest in those exercising over five times a week. With the average amount of training for serious amateur cyclists being around 10 hours a week, they are certainly in the higher-risk category”.
I am not sure which study Dr. Perry is referring to in this quote, but in my interview with her, I noted that from my perspective, any behaviour can be potentially addictive if the reward mechanisms are in place but that we should be cautious about imposing the ‘addiction’ label. I told her that we can’t define whether someone is addicted just by the behaviour that they display. It is all to do with the context of that behaviour in their life. More importantly, it’s is not about the amount of time spent engaging in the behaviour but what impact the behaviour has on them. As I explained:
“A healthy enthusiasm adds to their life. An addiction takes away from it. If you have no dependants and both you and your partner enjoy the sport and there is no conflict, it would not be classed as an addiction. If family conflict becomes a factor, the exercise habit becomes fraught with complications.”
I noted in my previous blog on cycling addiction that one of the traits that appears to be associated with exercise addiction is perfectionism according to a 1990 paper by Dr. Caroline Davis that appeared in the journal Personality and Individual Differences. Research (by Dr. Heather Hasenblaus among others) has also found that extraversion, neuroticism, and agreeableness predict exercise addiction symptoms. I also noted in my interview with Dr. Perry that some people (such as those with Type A personalities) appear to have their risk for exercise addiction built into them. Some cyclists will be those Type-A achievers who are reward-orientated to do the best they can, in whatever they do. If they take up a sport, those personality traits previously used to be successful and focused in other areas such as work go into the new area.
I also noted in my Cycling Weekly interview that there are a number of signs that can help you spot if your attitude towards cycling is unhealthy. The most obvious one is when cycling becomes the most important activity in your life, dominating thinking, feelings and behaviour. If you need to cycle more to get the same mood benefit that you used to, your mood changes significantly and/or you feel physical effects when you can’t cycle, you may also be at risk. If you start to resent your family, job, social life, hobbies or other interests getting in the way of you cycling, you need to consider if you have crossed the line. Those addicted to cycling are more likely to get into debt to fund their habit, become excessively controlling over their eating to regulate weight and competitiveness, and find it hard to balance work, social and family commitments with training.
I was also asked for my views on the treatment of cycling addiction and said that cognitive-behavioural therapy would likely be the most effective (as the addict would be guided to identify goals that motivate them and be helped to find safe and reasonable ways to reach those goals) but that the type of treatment depends on whether the addiction to cycling was primary or secondary. Primary addicts, who are actually addicted because they love their sport, will find it is very hard to give up. Telling them they can’t continue will be stressful in itself. Secondary addicts may be trying to lose weight or to escape negative, unpleasant feelings or difficulties in their lives, using cycling to control their thoughts. These cyclists are using exercise as a coping mechanism. The key here is finding out why they are doing it to such an extent in the first place. Most will find their addiction is symptomatic of something else.
After interviewing me about whether cycling can be potentially addictive, Dr. Perry summed up my own views arguably better than I could have done it myself:
“[Cycling addiction] is not just about how many hours you are doing on the bike, how much you love your riding, or how many bikes you have; what matters is the impact on your life. If your work and family life allows it without conflict, and you’re not feeling over-stressed or over-tired, then your commitment to cycling is just that – a commitment. If you are suffering from continual injuries and not recovering fully, have found yourself feeling burnt out, dips in mood, feel obliged to miss family or social events for training, resulting in arguments, then you need to ask yourself seriously: am I addicted?”
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.
Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Kökönyei, G., Urbán, R. and Demetrovics, Z. (2014). Exercise addiction – the emergence of a new disorder. Australasian Epidemiologist, 21(2), 36-40.
Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.
Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2011). Exercise addiction: Symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.
Davis, C. (1990). Weight and diet preoccupation and addictiveness: The role of exercise. Personality and Individual Differences, 11, 823-827.
Freimuth, M., Moniz, S., & Kim, S.R. (2011). Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. International Journal of Environmental Research and Public Health, 8(10), 4069-4081.
Griffiths, M. D. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.
Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39(6), e30-31.
Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.
Hausenblas, H.A., & Giacobbi, P.R. (2004). Relationship between exercise dependence symptoms and personality. Personality and Individual differences, 36(6), 1265-1273.
Kerr, J. H. (1997) Motivation and Emotion in Sport: Reversal Theory. Hove: Psychology Press.
Kerr, J.H., Lindner, K.J. & Blaydon, M. (2007). Exercise Dependence. Oxford: Rutledge.
Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.
Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.
Perry, J. (2016). Are you addicted to cycling? Cycling Weekly, July 21. Located at: http://www.cyclingweekly.co.uk/fitness/training/are-you-addicted-to-cycling-261852
Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.
Szabo, A., Griffiths, M.D. & Demetrovics, Z. (2016). Exercise addiction. In V. Preedy (Ed.), The Neuropathology Of Drug Addictions And Substance Misuse (Vol. 3) (pp. 984-992). London: Academic Press.
Terry, A., Szabo, A., & Griffiths, M. D. (2004). The exercise addiction inventory: A new brief screening tool. Addiction Research and Theory, 12, 489-499.
Youngman, J., & Simpson, D. (2014). Risk for exercise addiction: A comparison of triathletes training for sprint-, Olympic-, half-Ironman-, and Ironman-distance triathlons. Journal of Clinical Sport Psychology, 8, 19-37.
Zeulner, B., Ziemainz, H., Beyer, C., Hammon, M., & Janka, R. (2016). Disordered Eating and Exercise Dependence in Endurance Athletes. Advances in Physical Education, 6(2), 76.
Tickled: The strange (but true) story of competitive endurance tickling, catfishing, and trolling
Last month, an article that I wrote on knismolagnia (in which individuals derive sexual pleasure and arousal from tickling or being tickled) was featured in an online article in Vox about the documentary Tickled and the world of ‘competitive endurance tickling’ (CET). Given that endurance sports are by definition ‘extreme’ and that I have examined other extreme sports and endurance events in my previous blogs, I thought that CET would make an interesting topic to examine. Tickled was co-directed by the New Zealand journalist David Farrier and the videographer Dylan Reeve but turned out to be a far more interesting film than just about CET. It all started when Farrier came across an online advert placed by Jane O’Brien Media (JOBM):
“This is a shout out to TICKLISH MALE ATHLETIC FITNESS MODELS (aged 18-25) IN THE USA (all 50 states), CANADA, UK, AUSTRALIA, NEW ZEALAND AND JAPAN. What I’m shooting lately is unique. It’s been exploring several situations in which attractive, ticklish, and masculine guys are actually tickled in two different restrained formats, then involved in demonstrating some tickling skills themselves. Presently, I’ve been shooting all-male casts. It is important for you to understand from the get-go that this is not a fetish, or adult-oriented content endeavour. Also, no nudity or implied nudity work is a part of anything that I ever shoot. I repeat: recent shoots have featured all-male casts. This is a completely athletic activity with major competitive and endurance elements involved, including strategy and teamwork. I’m focused on Competitive Reality Endurance Tickling”.
It was when Farrier saw the phrase “Competitive Reality Endurance Tickling” that his journalistic instincts started to stir. The website advert said that successful applicants would be put up in a Los Angeles (US) hotel, have to wear Adidas branded clothes, and be paid US$1500 to participate. One of the CET participants Jordan Schillachi said in an online video: “This is a very competitive company…There’s probably 600 guys every 30 minutes sending pictures to want to get in”. By way of further background, the Wikipedia entry on Farrier noted that:
“In early 2014 Farrier began production of the feature-length documentary ‘Tickled’, which he co-directed with videographer Dylan Reeve. The project began when Farrier sought to do a ‘light entertainment’ piece about videos purported to depict ‘Competitive Endurance Tickling’. His inquiry to Jane O’Brien Media, the videos’ producer, was met with a hostile refusal to talk with him, prompting Farrier and Reeves to investigate further, and the film relates their efforts to find out more about the people involved in making the videos, and the person or persons behind them”.
If you type the words ‘competitive endurance tickling’ into Google, all the links that come up in the first two pages all concern the film Tickled and the various news reports and/or film reviews about it. The JOBM videos featuring CET all feature “young athletic men” who restrain and tickle each other and “compete to see who can stand to be tickled the longest”. Farrier simply wanted to find out more about the so-called ‘sport’ and contacted JOBM about the ‘sport’ and the videos it produced. Farrier received a “hostile” and homophobic response from JOBM that focused on Farrier’s bisexuality and asserting that CET is a “passionately and exclusively heterosexual athletic endurance activity”. The hostility Farrier received and the legal threats he received from JOBM spurred Farrier into making the film. Arguably using bullying tactics, JOBM tried their best to stop the documentary being made. Farrier and Reeve subsequently located where JOBM operated from in Los Angeles, and turn up unannounced at their premises but are turned away at the door of the JOBM offices. The Wikipedia entry on the film noted:
“Their research uncovers information about a person known as Terri DiSisto (or ‘Terri Tickle’), a pioneer of recruiting and distributing tickling videos online, in the 1990s. They interview another tickling-video producer, whose operations are a low-key affair. They speak to a few former participants in O’Brien’s videos, who describe coercive and manipulative treatment by the producers, such as defamation campaigns against them, exposing their personal information and contacting school or work associates to discredit them, in retaliation for challenging or speaking out against the company. A local recruiter in Muskegon, Michigan describes ‘audition’ videos he’d helped make, being published without the participants’ consent. Farrier and Reeve chance upon documents which link O’Brien to David D’Amato, the former school administrator behind the ‘Terri Tickle’ alias, who served a six-month prison sentence for disabling computer systems at two different universities on multiple dates. They determine that D’Amato now lives on a substantial inheritance from his father, a successful lawyer. After considerable effort to locate him, they confront him on the street, to which he responds with additional legal threats. Before returning to New Zealand, Farrier contacts D’Amato’s step-mother for comment; she implicitly confirms his “tickling” past, and he informs her of D’Amato’s ongoing involvement in it”.
The film exposes a ‘tickling ring’ that appears to have been operation for a couple of decades. The Vox article reports that the film tells three simultaneous stories:
“The first and most basic [story] is about people who like tickling and being tickled. The second, deeper story is about catfishing – the kind of systematic, continual deception you sometimes encounter when manipulative individuals obscure their identities online. The catfisher at the center of ‘Tickled’ may be shrouded in mystery, at least until the film really gets going, but they aren’t the stereotypical lonely human on the internet. Whoever’s responsible orchestrates an elaborate plot involving lawyers, a battery of legal threats and actual lawsuits, a cadre of real minions who willingly helped carry out the ruse, and a host of nubile young men who get paid to be tickled. And that leads to [the film’s] third and most compelling story, which is a story about power. ‘Tickled’ is what happens when you put power, wealth, and privilege into the hands of an internet troll with a single-minded goal: to crush his enemies and film people being tickled. ‘Tickled’ is a procedural; the process of how Farrier and Reeve uncover their story takes up most of the documentary’s narrative…‘Tickled’ occasionally gets into the nitty-gritty details of confirming the catfisher’s ultimate identity – by investigating website domains, stock photos, and more – in a way that might bore some viewers. But the clues Farrier and Reeve unearth along the way are generally so weird and unique that many people will find it riveting”.
The Vox article went on to question whether CET is just a creative name for a sexual fetish (which is where my previous article on knismolagnia made an appearance). Farrier’s view was that the videos might perhaps be about JOBM producing homoerotic fetish videos that they could make money from. (JOBM strenuously denied they sold the videos for such purposes. “This is not a fetish, or adult-oriented content endeavor”). The Vox article also said:
“Tickled explores the nature of tickling fetishes and the personalities of the people who wind up monetizing them: The documentary features one film producer who quit his day job after realizing he could make thousands of dollars a month by catering to people with this very specific fetish”.
When Farrier began writing about CET in 2014, online readers responded by saying that his writings reminded them of stories about an internet troll that had been operating with a similar modus operandi a couple of decades previously. Farrier cam to the conclusion that the troll and JOBM might in fact be one and the same. As Farrier observed:
“If you Googled ‘tickling videos’ and ‘internet,’ the story came up, so we made that connection very, very quickly. The circumstantial coincidence of how they [both] operated was very obvious, but going deeper than that was harder for us. To actually prove any of it – that’s the journey of this documentary. It’s good to go in cold and just let it unfold in front of you, and then, at the end of it, you should spend a little time thinking it all through again and decide how you feel. That’s what we did experiencing the whole thing, and I think that’s good for you as an audience as well”.
So if you want to know whether Farrier’s suspicions were confirmed, you’ll have to go and watch the film – but I’ll just end by noting that JOBM have now produced their own website (‘Tickled, The Truth’) to counter Farrier’s claims.
Dr Mark Griffiths, Professor of Behavioural Addiction, 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.
Blackwell, S. (2016). Tickling. Prodomme. Located at: http://www.prodomme.com/fetishes/tickling
Farrier, D. (2014). Homophobia and competitive tickling. 3 News, May 7. Located at: https://web.archive.org/web/20140603201419/http://www.3news.co.nz/Homophobia-and-competitive-tickling/tabid/418/articleID/343206/Default.aspx
Him and Her Sex Blog (2012). Knismolagnia. February 12. Located at: http://himandhersexblog.tumblr.com/post/17661996177/knismolagnia
Right Diagnosis (2012). Knismolagnia. Located at: http://www.rightdiagnosis.com/k/knismolagnia/intro.htm
Romano, A. (2016). New documentary ‘Tickled’ takes you into a world of sexual fetishes, catfishing, and internet secrets unearthed. Vox, June 21. Located at: http://www.vox.com/2016/6/21/11963566/tickled-competitive-tickling-documentary-explained
Wikipedia (2012). Catfishing. Located at: https://en.wikipedia.org/wiki/Catfishing
Wikipedia (2012). Tickled. Located at: https://en.wikipedia.org/wiki/Tickled
Wikipedia (2012). Tickling game. Located at: http://en.wikipedia.org/wiki/Tickling_game
drmarkgriffiths 