Search Results for sex addiction

Lust discussed: A brief overview of our recent papers on sex addiction

Following my recent blogs where I outlined some of the papers that my colleagues and I have published on mindfulness, Internet addiction, gaming addiction, youth gambling, exercise addiction, and shopping addiction, here is a round-up of recent papers that my colleagues and I have published on sex addiction.

Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.

  • At present, the prevalence of rates of sexual addiction in the UK is unknown. This study investigated what treatment services were available within British Mental Health Trusts (MHTs) that are currently provided for those who experience compulsive and/or addictive sexual behaviours within the National Health Service (NHS) system. In March and April 2013, a total of 58 letters were sent by email to all Mental Health Trusts in the UK requesting information about (i) sexual addiction services and (ii) past 5-year treatment of sexual addiction. The request for information was sent to all MHTs under the Freedom of Information Act (2001). Results showed that 53 of the 58 MHTs (91 %) did not provide any service (specialist or otherwise) for treating those with problematic sexual behaviours. Based on the responses provided, only five MHTs reported having had treated sexual addiction as a disorder that took primacy over the past 5 years. There was also some evidence to suggest that the NHS may potentially treat sexual addiction as a secondary disorder that is intrinsic and/or co-morbid to the initial referral made by the GP. In light of these findings, implications for the treatment of sex addiction in a British context are discussed.

Dhuffar, M. & Griffiths, M.D. (2014). Understanding the role of shame and its consequences in female hypersexual behaviours: A pilot study. Journal of Behavioural Addictions, 3, 231–237.

  • Background and aims: Hypersexuality and sexual addiction among females is a little understudied phenomenon. Shame is thought to be intrinsic to hypersexual behaviours, especially in women. Therefore, the aim of this study was to understand both hypersexual behaviours and consequences of hypersexual behaviours and their respective contributions to shame in a British sample of females (n = 102). Methods: Data were collected online via Survey Monkey. Results: Results showed the Sexual Behaviour History (SBH) and the Hypersexual Disorder Questionnaire (HDQ) had significant positive correlation with scores on the Shame Inventory. The results indicated that hypersexual behaviours were able to predict a small percentage of the variability in shame once sexual orientation (heterosexual vs. non-heterosexual) and religious beliefs (belief vs. no belief) were controlled for. Results also showed there was no evidence that religious affiliation and/or religious beliefs had an influence on the levels of hypersexuality and consequences of sexual behaviours as predictors of shame. Conclusions: While women in the UK are rapidly shifting to a feminist way of thinking with or without technology, hypersexual disorder may often be misdiagnosed and misunderstood because of the lack of understanding and how it is conceptualised. The implications of these findings are discussed.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.

  • Researchers have suggested that the advances of the Internet over the past two decades have gradually eliminated traditional offline methods of obtaining sexual material. Additionally, research on cybersex and/or online sex addictions has increased alongside the development of online technology. The present study extended the findings from Griffiths’ (2012) systematic empirical review of online sex addiction by additionally investigating empirical studies that implemented and/or documented clinical treatments for online sex addiction in adults. A total of nine studies were identified and then each underwent a CONSORT evaluation. The main findings of the present review provide some evidence to suggest that some treatments (both psychological and/or pharmacological) provide positive outcomes among those experiencing difficulties with online sex addiction. Similar to Griffiths’ original review, this study recommends that further research is warranted to establish the efficacy of empirically driven treatments for online sex addiction.

Dhuffar, M. & Griffiths, M.D. (2015). Understanding conceptualisations of female sex addiction and recovery using Interpretative Phenomenological Analysis. Psychology Research, 5, 585-603.

  • Relatively little research has been carried out into female sex addiction. There is even less regarding understandings of lived experiences of sex addiction among females. Consequently, the purpose of the present study was to examine the experiences of female sex addiction (from onset to recovery). This was done by investigating the experiences and conceptualisations of three women who self-reported as having had a historical problem with sex addiction. An interpretative phenomenological analysis (IPA) methodology was applied in the current research process in which three female participants shared their journey through the onset, progression, and recovery of sex addiction. The IPA produced five superordinate themes that accounted for the varying degrees of sexual addiction among a British sample of females: (1) “Focus on self as a sex addict”; (2) “Uncontrollable desire”; (3) “Undesirable feelings”; (4) “Derision”; and (5) “Self help, treatment and recovery”. The implications of these findings towards the understanding and the need for the implementation of treatment are discussed.

Dhuffar, M., Pontes, H.M. & Griffiths, M.D. (2015). The role of negative mood states and consequences of hypersexual behaviours in predicting hypersexuality among university students. Journal of Behavioural Addictions, 4, 181–188.

  • The issue of whether hypersexual behaviours exist among university students is controversial because many of these individuals engage in sexual exploration during their time at university. To date, little is known about the correlates of hypersexual behaviours among university students in the UK. Therefore, the aims of this exploratory study were two-fold. Firstly, to explore and establish the correlates of hypersexual behaviours, and secondly, to investigate whether hypersexuality among university students can be predicted by variables relating to negative mood states (i.e., emotional dysregulation, loneliness, shame, and life satisfaction) and consequences of hypersexual behaviour.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addictions, in press.

  • Sex addiction is a disorder that can have serious adverse functional consequences. Treatment effectiveness research for sex addiction is currently underdeveloped, and interventions are generally based on guidelines for treating other behavioural (as well as chemical) addictions. Consequently, there is a need to clinically evaluate tailored treatments that target the specific symptoms of sex addiction. It has been proposed that second-generation mindfulness-based interventions (SG-MBIs) may be an appropriate treatment for sex addiction because in addition to helping individuals increase perceptual distance from craving for desired objects and experiences, some SG-MBIs specifically contain meditations intended to undermine attachment to sex and/or the human body. To date, no study exploring the utility of mindfulness for treating sex addiction has been conducted. This paper presents an in-depth clinical case study of a male individual suffering from sex addiction that underwent treatment utilising an SG-MBI known as Meditation Awareness Training (MAT). Following completion of MAT, the participant demonstrated clinically significant improvements regarding the addictive sexual behaviour, as well less depression and psychological distress. The MAT intervention also led to improvements in sleep quality, job satisfaction, and non-attachment to self and experiences. Salutary outcomes were maintained at six-month follow-up. The current study extends the literature exploring the applications of mindfulness for treating behavioural addiction, and findings of this case study indicate that further clinical investigation into the role of mindfulness for treating sex addiction is warranted.

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

Further reading

Griffiths, M.D. (2000). Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.

Griffiths, M.D. (2001). Addicted to love: The psychology of sex addiction. Psychology Review, 8, 20-23.

Griffiths, M.D. (2001). Sex on the internet: Observations and implications for sex addiction. Journal of Sex Research, 38, 333-342.

Griffiths, M.D. (2004). Sex addiction on the Internet. Janus Head: Journal of Interdisciplinary Studies in Literature, Continental Philosophy, Phenomenological Psychology and the Arts, 7(2), 188-217.

Griffiths, M.D. (2010). Addicted to sex? Psychology Review, 16(1), 27-29.

Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Research and Theory, 20, 111-124.

Griffiths, M.D. (2012). The use of online methodologies in studying paraphilia: A review. Journal of Behavioral Addictions, 1, 143-150.

Griffiths, M.D. & Dhuffar, M. (2014). Collecting behavioural addiction treatment data using Freedom of Information requests. SAGE Research Methods Cases. Located at: DOI: http://dx.doi.org/10.4135/978144627305014533925

The must of lust discussed: Why isn’t sex addiction in the DSM-5?

Please note: A shorter and slightly different version of this blog first appeared on addiction.com

Sex addiction appears to be a highly controversial area among both the general public and those who work in the addiction field. Some psychologists adhere to the position that unless the behaviour involves the ingestion of a psychoactive substance (e.g., alcohol, nicotine, cocaine heroin), then it can’t really be considered an addiction. But I’m not one of them. If it were up to me, I would have given serious consideration to including sex addiction in the latest (fifth) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Given that ‘gambling disorder’ was reclassified from a disorder of impulse control to a behavioural addiction in the DSM-5, there is now no theoretical reason why other behavioural addictions can’t be added in the years to come. So why wasn’t sex addiction included in the latest DSM-5? Here are some possible reasons.

Some researchers think that sex addiction just doesn’t exist (for moral and theoretical reasons): Many scholars have attacked the whole concept of sex addiction saying it is a complete myth. It’s not hard to see why, as many of the claims appear to have good face validity. Many sociologists would argue that ‘sex addiction’ is little more than a label for sexual behaviour that significantly deviates from society’s norms. The most conventional attack on sex addiction is a variation on the position outlined in my introduction (i.e., that ‘addiction’ is a physiological condition caused by ingestion of physiological substances, and must therefore be defined physiologically). There are also attacks on more moral grounds with people saying that if excessive sexual behaviour is classed as an addiction it undermines individuals’ responsibility for their behaviour (although this argument could be said of almost any addiction).

The word ‘addiction’ has become meaningless: There are also those researchers within the social sciences who claim that the every day use of the word ‘addiction’ has rendered the term meaningless (such as people saying that their favorite television show is ‘addictive viewing’ or that certain books are ‘addictive reading’). Related to this is that those that work in the field don’t agree on what the disorder (e.g. ‘sex addiction’, ‘sexual addiction’, ‘hypersexuality disorder’, ‘compulsive sexual behaviour’, ‘pornography addiction’, etc.) should be called and whether it is a syndrome (i.e., a group of symptoms that consistently occur together, or a condition characterized by a set of associated symptoms) or whether there are many different sub-types (pathological promiscuity, compulsive masturbation, etc.). 

There is a lack of empirical evidence about sex addiction: One of the main reasons that sex addiction is not yet included in the DSM-5 is that the empirical research in the area is relatively weak. Although there has been a lot of research, there has never been any nationally representative prevalence surveys of sex addiction using validated addiction criteria, and a lot of research studies are based upon those people who turn up for treatment. Like Internet Gaming Disorder (which is now in the appendix of the DSM-5), sex addiction (or more likely ‘Hypersexual Disorder’) will not be included as a separate mental disorder until the (i) defining features of sex addiction have been identified, (ii) reliability and validity of specific sex addiction criteria have been obtained cross-culturally, (iii) prevalence rates of sex addiction have been determined in representative epidemiological samples across the world, and (iv) etiology and associated biological features of sex addiction have been evaluated.

The term ‘sex addiction’ is used an excuse to justify infidelity: One of the reasons why sex addiction may not be taken seriously is that the term is often used by high profile celebrities as an excuse by those individuals who have been sexually unfaithful to their partners (e.g., Tiger Woods, Michael Douglas, David Duchovny, Russell Brand). In some of these cases, sex addiction is used to justify the individual’s serial infidelity. This is what social psychologists refer to as a ‘functional attribution’. For instance, the golfer Tiger Woods claimed an addiction to sex after his wife found out that he had many sexual relationships during their marriage. If his wife had never found out, I doubt whether Woods would have claimed he was addicted to sex. I would argue that many celebrities are in a position where they were bombarded with sexual advances from other individuals and succumbed. But how many people wouldn’t do the same thing if they had the opportunity? It becomes a problem only when you’re discovered, when it’s in danger of harming the celebrity’s brand image.

The evidence for sex addiction is inflated by those with a vested interest: One of the real issues in the field of sex addiction is that we really have no idea of how many people genuinely experience sex addiction. Sex addiction specialists like Patrick Carnes claims that up to 6% of all adults are addicted to sex. If this was really the case I would expect there to be sex addiction clinics and self-help support groups in every major city across the world – but that isn’t the case. However, that doesn’t mean sex addiction doesn’t exist, only that the size of the problem isn’t on the scale that Carnes suggests. Coupled with this is that those therapists that treat sex addiction have a vested interest. Out simply, there are many therapists worldwide who make a living out of treating the disorder. Getting the disorder recognized by leading psychological and psychiatric organizations (e.g., American Psychiatric Association, World Health Organization) legitimizes the work of sex addiction counselors and therapists so it is not surprising when such individuals claim how widespread the disorder is.

There may of course be other reasons why sex addiction is not considered a genuine disorder. Compared to behavioural addictions like gambling disorder, the empirical evidence base is weak. There is little in the way of neurobiological research (increasingly seen as ‘gold standard’ research when it comes to legitimizing addictions as genuine). But carrying out research on those who claim to have sex addiction can face ethical problems. For instance, is it ethical to show hardcore pornography to a self-admitted pornography addict while participating in a brain neuroimaging experiment? Is the viewing of such material likely to stimulate and enhance the individual’s sexual urges and result in a relapse following the experiment? There are also issues surrounding cultural norms. The normality and abnormality of sexual behaviour lies on a continuum but what is considered normal and appropriate in one culture may not be viewed similarly in another (what is often referred to by sociologists as ‘normative ambiguity’). Personally, I believe that sex addiction is a reality but that it affects a small minority of individuals. However, many sex therapists claim it is on the increase, particularly because the Internet has made sexual material so easy to access. Maybe if sex addiction does eventually make it into future editions of the DSM, it will be one of the sub-categories of Internet Addiction Disorder rather than a standalone category.

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

Further reading

Dhuffar, M. & Griffiths, M.D. (2014). Understanding the role of shame and its consequences in female hypersexual behaviours: A pilot study. Journal of Behavioural Addictions, 3, 231–237.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, DOI 10.1007/s40429-015-0055-x

Goodman, A. (1992). Sexual addiction: Designation and treatment. Journal of Sex and Marital Therapy, 18, 303-314.

Griffiths, M.D. (2000). Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.

Griffiths, M.D. (2001). Sex on the internet: Observations and implications for sex addiction. Journal of Sex Research, 38, 333-342.

Griffiths, M.D. (2001). Addicted to love: The psychology of sex addiction. Psychology Review, 8, 20-23.

Griffiths, M.D. (2010). Addicted to sex? Psychology Review, 16(1), 27-29.

Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Research and Theory, 20, 111-124.

Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.

Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400.

Orford, J. (2001). Excessive sexuality. In J. Orford, Excessive Appetites: A Psychological View of the Addictions. Chichester: Wiley.

Each to their own: Five weird (non-sexual) addictions, compulsions and obsessions

On a recent rainy Sunday afternoon and out of sheer boredom I typed in the words ‘weird addictions’ into Google. There were a large number involving various sexual acts that I will leave for another blog. Today’s article briefly overviews what I found that didn’t involve sex along with a brief commentary on the extent to which these behaviours can really be said to be an addiction, compulsion or obsession.

Tanning addiction: Addiction to tanning – typically involving the repeated daily use of sun beds by women – is something that I have commented on a number of times in the British national media and relates to an apparent unhealthy dependence on tanning as a way of raising a person’s self-esteem. Back in the 1990s, the media often referred to this condition as “tanorexia”, and this term has now been taken up by some members of the academic research community. For instance, a study carried out in 2008 on 400 students and published in the American Journal of Health Behavior reported that 27% of the students were classified as “tanning dependent”. Personally, I am not convinced that this is a real dependence and/or addiction based on the empirical evidence to date, but I will look at this issue in more depth in a future blog.

‘BlackBerry’ addiction: There are countlessmedia reports of males in management and other professional occupations who are allegedly addicted to their Blackberry (or ‘Crackberry’ as the media often likes to term it). Symptoms include such things as (i) hearing a “phantom rings” and/or experiencing phantom vibrations, (ii) constantly checking e-mails and/or texts. Apparently, the content of emails and texts makes the person feel important and (like ‘tanorexia’) helps raise a person’s self esteem. Although I have often written and researched into ‘technological addictions’ I have yet to come across a case of genuine case of Blackberry addiction myself. If such an addiction does exist, there are also issues around whether the Blackberry is just a means to fuel particular addictive behaviour (e.g., texting) or whether people are addicted to the Blackberry itself.

Cosmetic surgery addiction:Again, there are many examples in the popular media of patients who allegedly have an addiction to plastic surgery.  There are certainly well documented cases of high profile individuals who have undergone countless operations in their desire to achieve (what they perceive to be) the perfect face and/or body (Michael Jackson, Cher, Jocelyn ‘Cat Woman’ Wildenstein, David Gest, Micky Rourke). Such people appear to be initially satisfied once they have had the procedure in question but then start to think “just one more (operation)”. Again, I am unconvinced that any of these high profile cases are “addicted” to plastic surgery but like ‘tanorexia’ there is certainly the desire to look good as a way of feeling good about themselves. However, there are cases of individuals who seek out constant plastic surgery because they suffer from Body Dysmorphic Disorder (BDD). BDD can affect sexes and typically manifests itself as a preoccupation with an imagined physical defect or an exaggerated concern about a minimal defect. This may lead the BDD sufferer to a cosmetic surgeon in an attempt to try to change or eliminate the perceived defect. The patient is never happy with the changes so it begins another cycle of surgery. The exact cause or causes of BDD is unknown, but most clinicians believe it to be a complex disorder with biopsychosocial underpinnings.

Addiction to chewing ice: On first glance, ice chewing might seem to be a completely made up behaviour yet compared to the other activities on this list, there is quite an established empirical literature. Ice eating is known in the scientific literature by the name of pagophagia and is a particular expression of the more general phenomenon of pica (an eating disorder whose name derives from the Latin word for magpie, a bird known for its peculiar eating behaviours). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Pica more often occurs in pregnant women, children, and adults of lower socioeconomic status. Other types of pica in addition to ice chewing include the eating of clay and soil (geophagia) and starch (amylophagia). Pagophagia is also closely associated with iron deficiency anemia. Empirical reviews suggest that pagophagia (and pica more generally) is part of the obsessive-compulsive disorder spectrum of diseases. Some case studies even suggest that ice chewing compromises their ability to maintain jobs or personal relationships. Although there are some claims in the literature that pagophagia can be addictive, the more likely is that it may be a compulsion in extreme cases.

Compulsive lying: Telling lies is widespread yet there appears to be some empirical evidence that in extreme cases it can be chronic, compulsive and/or pathological. Often, compulsive lying may be an adjunct to other mental illnesses such as Munchausen’s Syndrome (where a person persistently seeks medical treatment for illnesses that do not exist) or pathological gambling (where persistent lying is needed to prevent others realizing there is a gambling problem). Other sufferers may include those with False Memory Syndrome where the person actually believes the lies that they tell. Writings relating to pathological lying first appeared in the psychiatric literature over 100 years ago and have been given names such as ‘pseudologia fantastica and ‘mythomania’. Pathological lying has been defined by Dr Charles Dike and his colleagues at Yale University as “falsification entirely disproportionate to any discernible end in view, may be extensive and very complicated, and may manifest over a period of years or even a lifetime”. It s thought to affect men and women equally with an onset in late adolescence. There are no reliable prevalence figures although one study estimated that one in a 1000 repeat juvenile offenders suffered from it.  A study published in the British Journal of Psychiatry reported differences in brain structure between pathological liars and control groups. Pathological liars showed a relatively widespread increase in white matter (approximately one-quarter to one-third more than controls) and suggested that this increase may predispose some individuals to pathological lying.

These five activities were just the tip of the iceberg. I also came across alleged addictions to heavy metal music, teeth whitening, body modification (piercing and tattoos), animal hoarding, and reading. They will have to wait for another time.

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

Further reading

Chatterjee, A. (2007). Cosmetic neurology and cosmetic surgery: Parallels, predictions, and challenges.Cambridge Quarterly of Healthcare Ethics, 16, 129-137.

Dike, C.C., Baranoski, M. & Griffith, E.E. (2005). Pathological lying revisited. Journal of the American Academy of Psychiatry and the Law, 33, 342–349.

Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemadej, U.J., Cole, O.J., Westney, O.E.,  Jones, S. Laryea, H. &  Westney, L.S. (1994). Pica in an urban environment. Journal of Nutrition (Supplement), 124, 954-962.

Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Griffiths, M.D. (2008). Internet and video-game addiction. In C. Essau (Ed.), Adolescent Addiction: Epidemiology, Assessment and Treatment. pp.231-267.  San Diego: Elselvier.

Hata, T., Mandai, T., Ishida, K., Ito, S., Deguchi, H. & Hosoda, M. (2009). A rapid recovery from pagophagia following treatment for iron deficiency anemia and TMJ disorder accompanied by masked depression. Kawasaki Medical Journal, 35, 329-332.

Heckman, C.J., Egleston, B.L., Wilson, D.B. & Ingersoll, K.S. (2008). A preliminary investigation of the predictors of tanning dependence. American Journal of Health Behavior, 32, 451-464

Joshi, S. & Lalbeg, V.K. (2011). Texting mania – A social dilemma. International Journal of Research in Commerce, Economics, and Management, 1(3), 132-135.

King, B.H. & Ford, C.V. (1988). Pseudologia fantastica. Acta Psychiatrica Scandinavica, 77, 1-6

Kirchner, J.T (2001). Management of Pica: A Medical Enigma. American Family Physician, 63, 1177-1178.

Osman, Y.M., Wali, Y.A. & Osman, O.M. (2005). craving for ice and iron-deficiency anemia: a case series. Pediatric Hematology and Oncology, 22, 127-131.

Yang, Y., Raine, A., Narr, K., Lencz, T., LaCasse, L. Colleti, P., & Toga, A. (2007). Localisation of increased prefrontal white matter in pathological liars. British Journal of Psychiatry, 190, 174-175.

Sexual perversions and paraphilias: Compulsion, obsession or addiction?

Back in 1986, during the second year of my undergraduate psychology degree, we had a psychiatrist called Dr Alex Oswald come in give a guest lecture on sexual paraphilias. It was the best (and most interesting) lecture I have ever seen. I had always taken an interest in human sexual behaviour but this was unlike any lecture I had ever had before. It was also the stimulus for my (now) lifelong academic interest in extreme sexual behaviours.

The German psychiatrist Richard Von Krafft-Ebing is usually credited with first identifying paraphilias in his 1886 book Psychopathia Sexualis (Sexual Psychopathy). Paraphilias (from the Greek “beyond usual or typical love”) are uncommon types of sexual expression and often more commonly described as sexual deviations, sexual perversions or disorders of sexual preference. To many people, the may appear bizarre and/or socially unacceptable, and represent the extreme end of the sexual continuum. They are typically accompanied by intense sexual arousal to unconventional and/or non-sexual stimuli. In some cases, the behaviour may only occur sporadically whereas for others it may be compulsive and/or addictive. Many sexologists (such as the late Professor John Money of the John Hopkins University) have described some paraphilic behaviours as “fixated” and for those affected the desire is insistent and demanding.

It is thought that paraphilias are rare and affect only a very small percentage of adults. It has been difficult for researchers in the field to estimate the proportion of the population that experience paraphilic behaviours because much of the scientific literature is based on case studies (which suffer from problems around reliability because of their self-report nature). As paraphilias typically offer pleasure, many individuals affected do not seek psychiatric treatment. Furthermore, reliable statistics are further compounded by the fact that many paraphilic acts are illegal. Because of the illegality, paraphiliacs often experience high levels of shame and guilt and (like those who experience pleasure from the behaviour) may not seek medical or psychiatric help. For those that do seek professional help the disorders are often difficult to treat. Therapeutic success is more likely to be related to curbing or suppressing the behaviour rather than eliminating it altogether.

Although the statistics are biased by differential reporting and prosecution, there is general agreement among the psychiatric community that all paraphilias are male dominated (with at 90% of all those affected being men and with some estimates suggesting the ratio is as high as 30 to 1). Research also indicates that some paraphilias appear to be more common than others. For instance, the most common paraphilias reported in the scientific literature appear to be masochism, sadism and fetishism. Within clinics that treat sex offenders, the most common paraphilias are (perhaps unsurprisingly) paedophilia, voyeurism and exhibitionism.

It is also known that atypical sexual behaviours often cluster and/or overlap (either simultaneously or sequentially). For instance, some research has reported that paraphiliacs commonly experience two to three concurrent paraphilas with around 5% experiencing up to 10 concurrently. The onset of paraphilic behaviour is typically initiated during early adolescence through a complex biopsychosocial network of causes. The behaviour usually reaches its full development by the age of 20 years. Some of the causes of paraphilic behaviour are known to include various genetic and hormonal abnormalities, pre-natal neuro-developmental factors, neuro-cognitive and brain dysfunctional, maladaptive learning, and dysfunctional family life during childhood.

Paraphilas are rarely described as addictions as most of the debate surrounds whether they are impulse control disorders or whether they fall within the spectrum of obsessive-compulsive disorders. Arguably, the best criteria for diagnosis of a paraphilia is found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). In the DSM-IV-TR, a paraphilic disorder has to meet two essential criteria. The first criterion is that the essential features of a paraphilia are recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving (i) non-human objects, (ii) the suffering or humiliation of oneself or one’s partner, or (iii) children or other non-consenting persons that occur over a period of at least six months. The second criterion is that a diagnosis is made if the behaviour, sexual urges, and/or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The element of coercion is another key distinguishing characteristic of paraphilias. Some paraphilias (e.g., sadism, masochism, fetishism, hypoxyphiilia, urophilia, coprophilia, klismaphilia) – which I will be discussing in future blogs – are engaged in alone, or include consensual adults who participate in, observe, or tolerate the particular paraphiliac behaviour. These atypical non-coercive behaviours are considered by many in the psychiatric community to be relatively benign or harmless because there is no violation of anyone’s rights. Atypical coercive paraphilic behaviours are considered much more serious and almost always require therapeutic intervention (e.g., exhibitionism, voyeurism, frotteurism, necrophilia, zoophilia).

Finally, it is also worth noting that some practitioners working in the field have made distinctions between what are referred to as optional, preferred and exclusive paraphilias. An optional paraphilia is a behaviour that provides an alternative route to becoming sexually aroused. For instance, a male with fairly normal sexual interests might occasionally enhance their sexual arousal by wearing women’s high-heeled shoes and fishnet stockings while having sex. In preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but is still able to engage in conventional sex. For instance, a male might prefer – whenever possible – to wear women’s high-heeled shoes and fishnet stockings during sex. In exclusive paraphilias, a person is unable to become sexually aroused in the absence of the paraphilia. In this case, a male would be unlikely to get sexually aroused during sex unless he was wearing high-heeled shoes and fishnet stockings.

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

Further reading

Abel, G. G., & Osborn, C. (1992). The paraphilias: The extent and nature of sexually deviant and criminal behavior. Psychiatric Clinics of North America, 15, 675–689.

Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M., & Rouleau, J.-L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revised). Washington, DC: Author.

Krueger, R. B., Kaplan, M. (2001). The paraphilic and hypersexual disorders: An overview. Journal of Psychiatric Practice, 7, 391-403.

Money, J. (1994). Principles of Developmental Sexology. New York: Continuum.

Raymond, N.C., & Grant, J.E. (2008). Sexual disorders: Dysfunction, gender identity, and paraphilias. The Medical Basis of Psychiatry, 1, 267-283.

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

Sex and gambling addictions: Is there a relationship?

From a psychological perspective it was Freud who made the first serious contribution to the psychology of gambling by claiming that gambling was a repetitious substitute for masturbation. He argued there were many parallels between the two behaviours including the importance of ‘play’, the exciting and frantic activity of the hands, the irresistibility of the urge, the intoxicating pleasure, the repeated resolutions to stop the activity, and the enormous feelings of guilt once the activity was completed. Freud also made reference to the privacy, solitude, manipulation, and specificity of the two activities. Other psychoanalysts claimed that gambling was analogous to foreplay, winning with orgasm, and losing with castration and defecation. Freud and his followers argued that gamblers had an “unconscious desire to lose” and that losing money was an act of masochistic self-punishment known as the “pleasure-pain tension”.

Believe it or not, Freud’s theories on the psychology of gambling stemmed from just one single case study – the Russian novelist Dostoyevsky. What’s more, Freud never even met him and based his ideas on the reading of Dostoyevsky’s semi-autobiographical novel The Gambler. As a psychologist rooted in the scientific method, I think Freud’s theories are little more than an amusing historical footnote. However, there are two aspects of Freud’s thinking that deserve further exploration. Firstly, Freud passionately believed that many of our motivations and desires are unconscious. Having spent many years asking gamblers why they do the things that they do, it becomes obvious that many gamblers can’t put into words their primary reasons for engaging in the activity they love so much. To me, there do appear to be inexplicable unconscious motivations. Secondly, there are many anecdotal observations on the relationship between gambling and sex.

Gambling lore holds that some heavy gamblers experience orgasm while being totally absorbed in the gambling experience. Whilst I have never come across such a case there are many examples of gamblers who make such comparisons. For instance, an infamous problem gambler known as ‘Charlie K’ claimed “every time I tapped out at a racetrack, it was just like a massive orgasm”. Actual orgasm during gambling is most probably a myth or unusual personal peculiarity although the ‘thrill’ and ‘high’ that many gamblers report while gambling, may be similar to the emotional arousal experienced during sex. On the other hand, it is perhaps worth noting that there are case studies in the psychological literature suggesting that one of the side effects of problem gambling may be impotence!

There is also the language of gambling. Psychoanalysts claim that the language used by gamblers gives clues to both the anal and genital sexuality of gambling. Dice playing is known as ‘craps’ and players use the phrases “to come” and “come-line”. The numbers ‘10’ and ‘4’ are known as “Big Dick” and “little Dick” respectively. The combined stakes are known as “the pot” and there are enema overtones in the phrase “to be cleaned out” when the gambler loses everything.  A show-off gambler is described as “cocky” or a “Posing Dick”. Furthermore, many card games bring sex to mind including ‘poker’ (male genitalia), ‘stud poker’ (intercourse) and ‘solo’ (masturbation). In addition, gamblers often express their feelings using sexual analogies. Gamblers often claim that they get the same kick out of gambling as they do about sex or comment on how they “would like to get a piece of Lady Luck”. Conversely, sex for the gambler can take on gambling overtones with men who “chase women” or try to “score with women”. Easy ‘pick-ups’ are referred to as “a safe bet” or “sure fire winner”.

There is very little in the way of anthropological research on sex and gambling. However, a number of psychologists and sociologists have made reference to the Mojave, a tribe where gambling involves strict sexual segregation. Here, women and male transvestites (called “lucky gamblers”), play a specialised gambling game called ‘Utoh’ that is steeped in sexual ritual. The game consists of four wooden dice painted red and black (symbolising boys and girls) which are thrown with the aim of landing them all with the same colour. To affect an opponent’s luck, players shout such phrases as “you have a big penis” and engage in activities such as “anus goosing” and “genitalia grabbing”. The Mojave also believe that sexual dreams bring good luck in gambling. Men of the tribe will go as far as wagering their own wives, who if husbands lose, become sexual mates of the winners

Although the case of the Mojave is interesting, it is clearly untypical of society at large. However, evolutionary psychologists claim that successful male gamblers should attract more attractive female sexual partners. The (somewhat) simplistic argument for this is that over time, males who have successfully gambled – that is, taken more risks – will have accumulated more resources and therefore (in evolutionary terms) be more attractive to females. This certainly seems to fit the James Bond Hollywood blockbuster image of a gambler. It is not uncommon to see such gamblers portrayed as ‘macho’, heroic, virile, and dominant. Unfortunately, such a theory has little validity in Western society as there are numerous less risky ways to accumulate wealth and resources.

Finally, there have also been a few studies (all based in North America) that have looked at the comorbid relationships between gambling addiction and sex addiction. Back in 1991, Henry Lesieur and Richard Rosenthal reported two conference papers of small samples of adult gambling addicts in which 12% and 14% were potentially sexually addicted. In a bigger (and much more recent) study by Jon Grant and Marvin Steinberg, one on five (19.6%) met the criteria for sexual addiction among their 225 adult pathological gamblers. Otto Kausch reported that among 94 adult gambling addicts, just below a third (31%) suffered from sexual addiction. Patrick Carnes and colleagues reported that among a sample of 1,604 adult residential treatment sex addicts, 6% reported addiction to gambling, Obviously there are major methodological shortcomings of all these studies particularly because they include small, non-representative, and self-selected samples. However, they do suggest that there may be some relationship between addictive gambling and addictive sex for some people.

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

Further reading

Carnes, P.J., Murray, R.E., & Charpentier, L. (2005). Bargains with chaos: Sex addicts and addiction interaction disorder. Sexual Addiction & Compulsivity, 12, 79-120.

Freud, S. (1928). Dostoyevsky and parracide. In J. Strachey (Ed.). The standard edition of the complete psychological works of Sigmund Freud. Hogarth Press: London.

Grant, J.E., Steinberg, M.A. (2005). Compulsive sexual behavior and pathological gambling. Sexual Addiction & Compulsivity, 12, 235-244.

Kausch, O. (2003). Patterns of substance abuse among treatment-seeking pathological gamblers. Journal of Substance Abuse Treatment, 25, 263-270.

Lesieur, H.R., & Rosenthal, R. J. (1991). Pathological gambling: A review of the literature (Prepared for the American Psychiatric Association Task Force on DSM-IV Committee on Disorders of Impulse Control Not Elsewhere Classified). Journal of Gambling Studies, 7, 5-39.

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

From the university of perversity: An A to Z of non-researched sexual paraphilias (Part 5)

Today’s blog is the fifth part in my review of little researched (and in most cases non-researched) sexual paraphilias and strange sexual behaviours. (You can read Part 1 here, Part 2 here, Part 3 here, and Part 4 here). I’ve tried to locate information on all of these alleged sexual behaviours listed below and in some cases have found nothing more than a definition (some of which were in Dr. Anil Aggrawal’s book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices and/or Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices).

  • Antholagnia: This refers to deriving sexual arousal from smelling flowers (and the arousal may depend on the sight and/or smell of the flowers), and is a specific form of olfactophilia (sexual arousal from smell which I looked at in a previous blog). The Kinkly website notes (without empirical evidence to back up any of the claims made) that: “People with antholagnia typically have a preference for certain flowers, just as most people are sexually aroused by certain body types. They are likely to become aroused while visiting a florist shop, a floral nursery, or a botanical garden. They may also seek out images of flowers online for sexual gratification”.
  • Blennophilia: This refers to deriving sexual arousal towards slime. It is also known as myxophilia and appears to be a specific form of salirophilia (sexual arousal from mess and dirt), a paraphilia that I recently published a case study about in the Journal of Concurrent Disorders.
  • Chezolagnia:  This refers to deriving sexual arousal from masturbating while defecating. However, some definitions refer to it being a condition in which an individual derives sexual excitation and/or gratification from the act of defecation but this wider definition refers to coprophilia (which I looked at in a previous blog).
  • Dermatophilia: A few websites refer to this as deriving sexual arousal from skin lesions and/or skin diseases although it appears this this is just the lexical opposite of dermatophobia. I did write a previous blog on acnephilia which could arguably be a specific type of dermatophilia.
  • Epistaxiophilia: This refers to deriving sexual pleasure from nosebleeds (presumably seeing others have nosebleeds rather than the individuals themselves). I did write a previous blog on the relationships between sex and nosebleeds but did not mention epistaxiophilia.
  • Febriphilia: This refers to deriving of sexual arousal from fever. I’ve only ever seen this listed on a few websites such as the Alpha Dictionary. I did find one person claiming to have this paraphilia: “I have a very, um, unusual fetish. It’s known as febriphilia. So far, I’ve heard of no one that shares this attraction, and I’m starting to wonder if there are any closet febriphiles out there. I’ve always liked weakness, helplessness, and illnesses in general, but fevers are the biggest thing. Someone being warmer than usual is, for some reason, something I find very attractive”. Someone did eventually respond over four years later and said: “I have to say you are not alone…There are not many febriphiles out there, it’s very hard to find people who share our attraction, but take solace in the fact that you are not alone and you are not a freak”.
  • Geniophilia: Over the years I’ve written blogs on fetishes for almost every body part but I’ve never written one on geniophilia (which refers to deriving sexual arousal from chins). This was listed in the JMAC Times as being among the “19 strangest turn-ons ever”.
  • Hexakosioihexekontahexaphilia: This refers to deriving sexual pleasure from the number ‘666’. This appears to be a hypothetical paraphilia although the band Vulgarizer did have a track of this name on their album Adonyne.
  • Idrophrodisia: This refers to deriving sexual arousal from the odour of perspiration, especially from the genitals. This appears to be a sub-type of osmophilia (deriving sexual pleasure and arousal caused by bodily odours, such as sweat, urine or menses, and which I looked at in a previous blog).
  • Japanophilia: This refers to deriving sexual arousal from Japanese people. However, most people use the word ‘Japanophile’ in a non-sexual context as referring to the love of all things Japanese (in fact, one reader of my blog emailed me to ask if I was a Japanophile given the many blogs I had written on various aspects of Japanese sexual behaviour including Oshouji, Tamakeri, Shokushu Goukan, Nyotaimori, Omorashi, and Burusera).
  • Kymophilia: Sometimes spelt ‘cymophilia’, this refers to deriving sexual arousal towards waves or wave-like motions. I’ve not some across any evidence that this actually exists but it appears on many other online lists of paraphilias.
  • Lutraphilia: This is a very specific type of zoophilia and refers to deriving sexual arousal from otters. I would like to think this is totally hypothetical but there are otter videos on various zoophile online forums. I didn’t click on the videos as you can’t un-see what you have seen. There are also sex toys in the shape of otters. You have been warned.
  • Metrophilia: This refers to deriving sexual arousal from poetry (presumably erotic poetry although definitions never mention this) and could arguably be a sub-type of narratophilia (sexual arousal from sexual story telling).
  • Nosocomephilia: This refers to deriving sexual arousal from hospitals. This may be a sub-aspect of medical fetishism which I have written about at length in a number of different previous blogs).
  • Ochophilia: This refers to deriving sexual arousal from vehicles and is presumably the more generic name for various sub-types of objectum sexuality including individuals who have had sexual relationships with their cars (such as those I have looked at in previous blogs here and here).
  • Porphyrophilia: We all know that the musician Prince appeared to love all things sexual and maybe he had porphyrophilia which refers to deriving sexual pleasure from the colour purple.
  • ‘Queer women’ fetishism: This type of fetishism was outlined in an article in Mel magazine about heterosexual men whose preferred sexual partner is a lesbian.
  • Rheophilia: This refers to deriving sexual arousal from spending time in running water. This may be a sub-type of aquaphilia (sexual arousal from water and/or watery environments including bathtubs or swimming pools) and ablutophilia (sexual arousal from baths or showers) which I looked at in a previous blog.
  • Staurophilia: This refers to deriving sexual arousal from crosses or crucifixes. I haven’t seen any evidence that this is a genuine paraphilia although the band Fetish Altar had a track entitled ‘The Latex Crucifix’ (the b-side of ‘Sodomize Angelic Figures’).
  • Thlipsosis: This refers to deriving sexual arousal from being pinched or pinching others and is a sadomasochistic behaviour. This is not a plug for the Medical Toys website but they have a lot of products on their ‘Thlipsosis’ page.
  • Urethral fetishism: In previous blogs I have examined urethral sex play in its many forms and with its own lexicon (so if you want to read about it in more detail, read more here).
  • Venustraphilia: I’m a little unclear how this is a paraphilia because this refers to deriving sexual arousal from beautiful women.
  • Wiccaphilia: This refers to deriving sexual arousal from witches and witchcraft and I wrote an article on this paraphilia previously.
  • Xyrophilia: This behaviour refers to those individuals who derive sexual arousal from razors (and its name is derived from its opposite condition – xyrophobia). However, there are online forums for razor fetishists and there may be crossover with those that have blood fetishes (which I’ve looked at in various previous blogs).
  • ‘Yellow Fever’ fetish: I don’t want to be accused of being racist or passive racism so I will leave this definition to Yuan Ren writing in the Daily Telegraph: “Ever heard of yellow fever?No, not the disease you can pick up when travelling to certain countries. I’m talking about when Caucasian men develop an acute sexual preference for East Asian women – even becoming a fetish, for some”.
  • Zip fetishism: Recent news stories have highlighted men who have zip fetishes. On the ‘Is It Normal?’ website, a whole thread was devoted to the topic with various individuals claiming they had such a fetish.

Dr. Mark Griffiths, Distinguished 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.

Bering, J. (2014). Perv: The Sexual Deviant In All Of Us. London: Doubleday.

Downing, L. (2010). John Money’s ‘Normophilia’: diagnosing sexual normality in late-twentieth-century Anglo-American sexology. Psychology and Sexuality, 1(3), 275-287.

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

Griffiths, M.D. (2019). Salirophilia and other co-occurring paraphilias in a middle-aged male: A case study. Journal of Concurrent Disorders, 1(2), 1-8.

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

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

Serrano, R.H. (2004). Parafilias. Revista Venezolana de Urologia, 50, 64-69.

Shaffer, L. & Penn, J. (2006). A comprehensive paraphilia classification system. In E.W. Hickey (Ed.), Sex crimes and paraphilia. New Jersey: Pearson Prentice Hall.

Write World (2013). Philias. Located at: http://writeworld.tumblr.com/philiaquirks

Bed-ly serious: A brief look at ‘sleeping addiction’

As a life-long insomniac, I’ve always been interest in sleep at a personal level. In 1984, when I was studying for my psychology degree, the first ever research seminar I attended was one on the psychology of sleep by Dr. Jim Horne (who was, and I think still is, at Loughborough University). I found the lecture really interesting and although I never pursued a career in sleep research it was at that point that I started to take an interest more professionally. In my blog I’ve written a number of articles on various aspects of sleep including sexsomnia (engaging in sexual acts while sleeping, for instance, while sleepwalking), somnophilia (engaging in sexual acts while individuals are sleeping), Sleeping Beauty paraphilia (a sub-type of somnophilia in which individuals are sexually aroused by watching other people sleep), and lucid dreaming (where individuals are aware they are dreaming and exert some kind of control over the content of the dream),

More recently, I’ve been a co-author on a number of research papers in journals such as Sleep Medicine Reviews, Journal of Sleep Research, and Sleep and Biological Rhythms (see ‘Further reading below) but these have all involved either the effects of internet addiction on sleep or the psychometric evaluation of insomnia screening instruments rather than being about the psychology of sleep.

In a previous A-Z article on “strange and bizarre addictions” I included ‘sleep addiction’ as one of the entries. Obviously I don’t believe that sleeping can be an addiction (at least not by my own criteria) but the term ‘sleep addiction’ is sometimes used to describe the behaviour of individuals who sleep too much. Conditions such as hypersomnia (the opposite of insomnia) has been referred to ‘sleeping addiction’ (in the populist literature at least). In a 2010 issue of the Rhode Island Medical Journal, Stanley Aronson wrote a short article entitled ‘Those esoteric, exoteric and fantabulous diagnoses’ and listed clinomania as the compulsion to stay in bed. Given the use of the word ‘compulsive’ in this definition, there is an argument to consider clinomania as an addiction or at least a behaviour with addictive type elements.

In an online article entitled ‘Sleep addiction’, Amber Merton also mentioned clinomania in relation to an addiction to sleep:

“If you are obsessed with sleeping or have an intense desire to stay in bed, you could be suffering from a condition called clinomania. That doesn’t mean that there aren’t people who can experience symptoms similar to addiction and even withdrawal in association with sleep, or lack thereof”.

The reference to ‘addiction-like’ symptoms appears to have some validity based on these self-report accounts I found online. All of these individuals mention various similarities between their constant need for sleep and addiction. I have highlighted these to emphasize my assertions that some of the consequences are at the very least addiction-like:

  • Extract 1: “I believe someone can become psychologically dependent on sleep. I am 47 and have used sleep for 40 years to escape from life…I typically sleep 4-6 hours too much each day. Sleep feels like an addiction to me because I crave it several times a day and am looking forward to how I can sneak it in. I don’t seem to be able to control it with will power for very long…I only have short periods when this isn’t a problem. When I am under stress it is at its worse. If I have any free or unstructured time, I can’t control how much I sleep excessively. When my time is heavily scheduled, I really struggle with keeping a full schedule and crave the time off when I can sleep for hours. If I know I’ll have a few hours in between activities free, I will find ways to sneak in some sleep. I am embarrassed about this, don’t tell the people around me the extent of the problems and devise ways to sneak in sleep without people knowing”.
  • Extract 2: “I love sleeping. It feels so good I think I could even become addicted if I didn’t HAVE to wake up. I sleep about 12 hours every day and could sleep more if I didn’t have to do daily necessities. I am aware of the fact that people who generally sleep more than they are supposed to, die sooner and have other various health problems. To be honest I would rather sleep than do most things. I even choose sleep over sex a lot”.
  • Extract 3: “I often sleep for 12-20 hours at a time. I have depression and am on anti-depressants. I just love sleeping. It’s so safe and comfy. I don’t know how else to explain it. It’s just amazing”.
  • Extract 4: “I sleep AT LEAST 12 hours a day. But on days off I’ve been known to sleep for about 15-20 hours. [I am] addicted to sleep. I’ve cancelled social outings with friends pretending to be sick when really I just wanted to sleep in. I love sleep and I can’t get enough of it. I’ve slept through the entire weekend multiple times before, only waking up Monday morning when my alarm rang. And even after that much wonderful sleep I was still tired. The second I come home from work every day I eat, shower, and then crawl into bed and sleep the entire evening and night away. My alarm’s the only thing that can wake me up anymore…As for why I love sleep so much, I see a lot of people saying it’s an escape for them. For me it’s more, I don’t like people or going out or socializing, so sleep is my drug of choice. Is it bad? Maybe. Do I care? Not really…I more than love it, and it’s not hurting anyone if we’re being honest”.
  • Extract 5: “I feel like I’m addicted to sleep. Here’s why I think though. I suffered for 13 years with depression and while I know I am still getting over it I don’t feel that’s the reason I’m addicted. During those 13 years I would have serious bouts of chronic insomnia. The doctors tried to many different sleeping medications, meditation, clinics to help me find a routine for natural sleep without meds. Nothing worked. Now I live in Thailand and my doctor here recommended melatonin tablets, all natural as your brain is supposed to produce it anyway to tell you when it’s dark it’s time to sleep and when it’s like light it’s time to wake up. She thinks my brain fails to produce certain chemicals as such with serotonin and now figured melatonin. Since I have been taking a melatonin supplement, I sleep so well, I fall asleep within 20 minutes and I sleep for AT LEAST 8 hours. When I wake up I just want to go back to sleep again because it feels amazing. I don’t feel like it’s part of my anxiety or my depression, I just think it’s because I had insomnia for so long its addictive!
  • Extract 6: “To be honest if I could I would sleep my life away. My so called normal sleeping pattern: I am awake all night. Fall asleep around 4am-8am. Sleep 12 hours. Repeat. My mind is a broken record, constantly repeating the trauma. I do suffer from depression and anxiety. Sleep is my addiction. When I sleep I feel SAFE regardless?”
  • Extract 7: “I’ve been addicted to sleep (the escape from an abusive childhood, depression, and PTSD) since I was ten years old! I want to change though because my body is a mess. I’ve slept for 4 days and sometimes more with short awake periods to eat a little and use the potty. Not enough though, because now my body doesn’t work properly…Oversleeping has its consequences”.
  • Extract 8: “I’m so pleased that I have found this site and other people who are addicted to sleep as this problem has plagued my adult life and I would like it to stop. Take today for instance, I woke at 5.30am and was quite awake feeling a little anxious but I could not wait to get to sleep again, so I did and stayed in bed till around 2.20 pm. I have many days like this and as the lady above the sleep state is quite lucid and I do seem to enjoy it rather than getting up and living life for real”.

Again, I reiterate that none of these individuals are addicted to sleep but in addition to the addiction-like descriptions, there is also crossover in the motivations for excessive sleep and motivations underlying addictions (most noticeably the association with depression, anxiety, psychological trauma, and using the activity as an escape). In relation to addiction, these extracts include references to salience (engaging in sleep to the neglect of everything else in their life), cravings (for sleep), the sleep being excessive, repetitive and habitual, sleep leading to negative consequences (conflict), and loss of control. The fact that many of these individuals describe their behaviour as an addiction or addictive doesn’t mean that it is.

While there is no academic paper that I know of that has ever claimed sleep can be a genuine addiction there are countless clinical and empirical papers examining excessive sleep (i.e., hypersomnia) and the different etiological pathways that can lead to hypersomnia. Although hypersomnia is not an addiction, those with the condition (like addicts) can suffer many negative side-effects from the relatively minor (e.g., low energy, fatigue, headaches, loss of appetite, restlessness, hallucinations) to the more severe (e.g., diabetes, obesity, heart disease, clinical depression, memory loss, suicidal ideation, and in extreme cases, death). In one online article I came across, the similarity between hypersomnia and addiction in relation to depression was evident:

It’s important to note that in some cases separating cause from effect here can be muddled. For instance, does over sleeping contribute to depression or does depression contribute to oversleeping? Or are both oversleeping and depression the effect of a larger underlying cause? Furthermore, once a person is experiencing both, could they act to reinforce the other as a feedback loop?”

This observation could just as easily be made about most addictions (substance or behavioural). Finally, it’s worth noting that there are many sub-types of hypersomnia and excessive sleep. In a good review of hypersomnia [HS] in Current Neurology and Neuroscience Reports, Dr. Yves Dauvilliers notes the following hypersomnia sub-types (including narcolepsy which can include excessive sleep but isn’t usually classed as a type of hypersomnia; also note that ‘idiopathic’ means of unknown cause) which I have paraphrased below:

  • Narcolepsy: This is a disabling neurologic disorder characterized by excessive daytime sleep (EDS) and cataplexy (i.e., a sudden loss of voluntary muscular tone without any alteration of consciousness in relation with strong emotive reactions such as laughter, joking).
  • Narcolepsy without cataplexy: This is simply a variant of narcolepsy with cataplexy (but without the cataplexy).
  • Idiopathic hypersomnia: Idiopathic HS is rare and remains a relatively poorly defined condition due to the absence of specific symptoms such as cataplexy or sleep apneas (i.e., loss of breathing while sleeping).
  • Recurrent hypersomnia: This HS is characterized by repeated episodes of excessive sleep (at least 16 hours a day) lasting from a few days up to several weeks. The most well-known recurrent HS is Kleine-Levin syndrome which comprises both cognitive disturbances (feelings of confusion and unreality) and behavioural disturbances (such as overeating and hypersexual behaviour during symptomatic episodes).
  • Hypersomnia associated with neurologic disorders: This type of HS causes EDS and can be a result of brain tumours, dysfunction in the thalamus, hypothalamus, or brainstem that may mimic idiopathic HS or narcolepsy.
  • Hypersomnia associated with infectious disorders: This type of HS can be a result of viral infection such as HIV pneumonia, Whipple’s disease (a systemic disease most likely caused by a gram-positive bacterium), or Guillain-Barré syndrome (a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system).
  • Hypersomnia associated with metabolic or endocrine disorders: This type of HS can be a result of conditions such as hyperthyroidism, diabetes, hepatic encephalopathy (a liver dysfunction among individuals with cirrhosis), and acromegaly (a hormonal disorder that develops when the pituitary gland produces too much growth hormone).
  • Hypersomnia caused by drugs: This type of HS is secondary to many different types of drug medication including hypnotics, anxiolytics, antidepressants, neuroleptics, anti-histamines, and anti-epileptics.
  • Hypersomnia not caused by drugs or known physiologic conditions: This type of HS can be caused by a range of disorders such as depressive disorder, seasonal affective disorder, and abnormal personality traits.

None of these types of HS is an addiction but clearly the negative consequences can be just as serious for the individual.

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

Further reading

Alimoradi, Z., Lin, C-Y., Broström, A., Bülow, P.H., Bajalan, Z., Griffiths, M.D., Ohayon, M.M. & Pakpour, A.H. (2019). Internet addiction and sleep problems: A systematic review and meta-analysis. Sleep Medicine Review, 47, 51-61.

Aronson, S. M. (2010). Those esoteric, exoteric and fantabulous diagnoses. Rhode Island Medical Journal, 93(5), 163.

Bener, A., Yildirim, E., Torun, P., Çatan, F., Bolat, E., Alıç, S., Akyel, S., & Griffiths, M.D. (2019). Internet addiction, fatigue, and sleep problems among students: A largescale survey study. International Journal of Mental Health and Addiction. doi: 10.1007/s11469-018-9937-1

Billiard, M., & Dauvilliers, Y. (2001). Idiopathic hypersomnia. Sleep Medicine Reviews, 5(5), 349-358.

Dauvilliers, Y. (2006). Differential diagnosis in hypersomnia. Current Neurology and Neuroscience Reports, 6(2), 156-162.

Domenighini, A. (2016). Can you be addicted to sleep? Vice, January 24. Located at: https://www.vice.com/en_us/article/mg7e33/can-you-be-addicted-to-sleep

Hawi, N.S., Samaha, M., & Griffiths, M.D. (2018). Internet gaming disorder in Lebanon: Relationships with age, sleep habits, and academic achievement. Journal of Behavioral Addiction, 7, 70-78.

Mamun, M.A. & Griffiths, M.D. (2019). Internet addiction and sleep quality: A response to Jahan et al. (2019). Sleep and Biological Rhythms. doi: 10.1007/s41105-019-00233-0

Merton, A. (2008). Sleep addiction. Located at: https://www.plushbeds.com/blog/sleep-disorders/sleep-addiction/

Mignot, E. J. (2012). A practical guide to the therapy of narcolepsy and hypersomnia syndromes. Neurotherapeutics, 9(4), 739-752.

Pakpour, A., Lin, C-Y., Cheng, A.S., Imani, V., Ulander, M., Browall, M. Griffiths, M.D., Broström, A. (2019). A thorough psychometric comparison between Athens Insomnia Scale and Insomnia Severity Index among patients with advanced cancer. Journal of Sleep Research. doi: 10.1111/jsr.12891.

Can you stomach it? Another look at ‘bellypunching’ for sexual arousal

In a previous blog, I briefly looked at gastergastrizophilia (a sadomasochistic sexual paraphilia in which individuals derive sexual pleasure and arousal from bellypunching). I also noted that I had never seen it listed in any reputable academic source (and that it did not appear in either Dr. Anil Aggrawal’s Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices or Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices). I also wondered whether it really existed. Since writing that blog I’ve had a few people write to me saying that it definitely exists (see the comment section of my previous blog). I also described it as “one of the weirdest sounding sexual paraphilias that I have come across”. Last week I received some feedback from a man who criticized my article on the topic. I always welcome feedback (however critical) so I thought I would use today’s blog to respond to the criticism I received. I have included all the feedback I received along with my responses. Although I have the name and email address of the man who contacted me, I have decided not to use them in this article as he did not give me permission to do so (although if he does, I will update this accordingly).

Gutpuncher: I must admit – coming from a phycologist [sic] – I find that opening statement (“one of the weirdest sounding sexual paraphilias that I have come across”) to be an exceedingly derogatory and leading comment, immediately stamping all that is to follow with a big, bold stigma… That statement is as perverted as it is pejorative. It erroneously throws all who enjoy and practice this fetish into the fringe of lawlessness and make them sexual deviants without ethics or conscience. It’s the insane equivalent of saying, “we have no idea how many people actually engage in sex, because the participants themselves aren’t really sure of what is consent and what is rape.” REALLY?! EVERYONE with whom I have EVER participated in this fetish, myself very much included, has ALWAYS done so with complete and total CONSENT. The only reason we might not so quickly stand up to be counted –– is we’re not so keen on pointed fingers labeling us as “weird.

My response: Obviously I am a psychologist not a ‘phycologist’. But more seriously, what I actually wrote was that it one of the “weirdest sounding” paraphilias. To me, ‘gastergastrizophilia’ does sound weird compared to hundreds of other paraphilias that I have written about. I used the word ‘weird’ as a synonym for ‘strange’ or ‘unusual’. I think ‘Gutpuncher’ interpreted “one of the weirdest sounding paraphilias” as being “one of the weirdest paraphilias” which is somewhat different. Having said that, even if I had written what ‘Gutpuncher’ appears to think I have written, I would still argue that the use of ‘weird’ is a legitimate word to use (and I think most individuals would agree). Also, ‘Gutpuncher’ appears to think that calling an activity “weird” means that the person doing it is ‘weird’ but this is simply not true. I have a number of self-acknowledged weird hobbies (some of which I’ve written about such as being a record collecting completist who will happily pay lots of money for something that I may not even like) but this does not make me (as an individual) weird. The activity and the individual are two distinct things. But I’d just like to reiterate, what I actually wrote was that ‘gastergastrizophilia’ is weird-sounding.

Gutpuncher: Having just come across your article, though, I honestly don’t even know if the true purpose of your blog is to actually “help” anyone with real questions, concerns, or confusion about their own lives or sexuality. After a quick check and realizing that your expertise lies in gaming and gambling addictions, quite possibly your dealing with matters of sexuality here may just be a fun outlet, a way of creating a relaxed, man-of-the-people presence here on the internet, without any real offerings of advice or council – well, other than proclaiming certain things as “weird.”

My response: My blog page clearly states on every article that I have ever published: “Welcome to my blog! If you are interested in addictive, obsessional, compulsive and/or extreme behaviours, you’ve come to the right place”. The primary purpose of my blog is to write about things that I think people might want to read. My aim is not to help people, but if it does, that’s great, but it’s not the primary purpose. ‘Gutpuncher’ says my “expertise lies in gaming and gambling addictions” and that “dealing with matters of sexuality here may just be a fun outlet”. I do indeed have expertise in gambling and gaming addictions as well as in many other behavioural addictions. While gambling and gaming are among my main areas of expertise, I’ve also published over 50 academic papers (as well as many populist articles) on human sexual behaviour including papers on paraphilias (a small selection of which I list in the ‘Further reading’ section below). I think this more than qualifies me to write about human sexual behaviour. Even if I didn’t have expertise in researching sexual behaviour, it still wouldn’t invalidate me from writing about things that interest me (which sex does).

Gutpuncher: I also take great offense at the included quote (though not your own, but presented nonetheless to be considered) that “nobody has any real numbers, in part because the participants themselves don’t know where the line actually divides consent and abuse.”

My response: Any quotes that I use in blogs are fully referenced and are the views of the person writing it. Quotes used may or may not match my own views. This doesn’t mean I can’t use them. The quote came from the Wikipedia entry on ‘bellypunching’ and it’s the only article on the topic that I found when I wrote the article at the time.

Gutpuncher: But still, as a male who (purely from a homoerotic perspective) finds great pleasure in this fetish (known in male form as “Gutpunching” or “ab punching”), and as one who has personally connected with 60+ other males in the flesh who – most definitely – also find arousal in this sexual proclivity, and as someone who has personally witnessed hundreds and hundreds of other males online (through profile-posting websites and video uploads) who also claim this fetish as their own, I wonder why the male perspective has been entirely ignored here? Since this blog post was to give a look, however “brief,” at the subject, that seems to me a rather large omission. Again, quite possibly, this blog may playfully lean toward titillation instead of factual inclusivity, and “gay” stuff may add a whole other unappealing level of “weird.” But, this fetish IS most assuredly both a female and a MALE subject, to be correct.

My response: This is useful anecdotal information from someone who has first-hand experience of the gutpunching community. I wrote my article on gastergastrizophilia in August 2015 (i.e., four years ago). As with all my blogs, I researched the area and referenced everything I was able to locate scientifically and empirically (I found nothing published on any academic database) and anecdotally (i.e., searching online). I referenced everything that I found and only located one article (on Wikipedia) and also found some first-person accounts on the Dark Fetish website, as well as reference to hundreds of bellypunching videos. I didn’t ignore (or deliberately omit) anything and I wrote about what I found. I look forward to you sending me more information so that I can do a follow-up article.

Dr. Mark Griffiths, Distinguished 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.

Bőthe, B., Bartók, R., Tóth-Király, I., Reid, R.C., Griffiths, M.D., Demetrovics, Z., Orosz, G. (2018). Hypersexuality, gender, and sexual orientation: A largescale psychometric survey study. Archives of Sexual Behavior, 47, 2265-2276.

Bőthe, B., Kovács, M., Tóth-Király, I., Reid, R.C., Griffiths, M.D., Orosz, G., Demetrovics, Z. (2019). The psychometric properties Hypersexual Behavior Inventory using a large-scale nonclinical sample. Journal of Sex Research, 56, 180-190.

Bőthe, B., Tóth-Király, I., Zsila, Á., Griffiths, M.D., Demetrovics, Z., Orosz, G. (2018). The development of the Problematic Pornography Consumption Scale (PPCS). Journal of Sex Research, 55, 395-406.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.

Dhuffar, M. & Griffiths, M.D. (2014). Understanding the role of shame and its consequences in female hypersexual behaviours: A pilot study. Journal of Behavioural Addictions, 3, 231–237.

Dhuffar, M.K. & Griffiths, M.D. (2015). Understanding conceptualisations of female sex addiction and recovery using Interpretative Phenomenological Analysis. Psychology Research, 5, 585-603.

Dhuffar, M., Pontes, H.M. & Griffiths, M.D. (2015). The role of negative mood states and consequences of hypersexual behaviours in predicting hypersexuality among university students. Journal of Behavioural Addictions, 4, 181–188.

Dhuffar, M. & Griffiths, M.D. (2016). Barriers to female sex addiction treatment in the UK. Journal of Behavioural Addictions, 5, 562–567.

Fernandez, D. & Griffiths, M.D. (2019). Psychometric instruments for problematic pornography use: A systematic review. Evaluation and the Health Professions. Epub ahead of print, doi: 10.1177/0163278719861688

Greenhill, R. & Griffiths, M.D. (2015). Compassion, dominance/submission, and curled lips: A thematic analysis of dacryphilic experience. International Journal of Sexual Health, 27, 337-350.

Greenhill, R. & Griffiths, M.D. (2016). Sexual interest as performance, intellect and pathological dilemma: A critical discursive case study of dacryphilia. Psychology and Sexuality, 7, 265-278.

Griffiths, M.D. (1999). Dying for it: Autoerotic deaths. Bizarre, 24, 62-65.

Griffiths, M.D. (2000).  Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.

Griffiths, M.D.  (2001).  Sex on the internet: Observations and implications for sex addiction. Journal of Sex Research, 38, 333-342.

Griffiths, M.D. (2001). Stumped! Amputee fetishes. Bizarre, 44, 70-74.

Griffiths, M.D. (2010). Addicted to sex? Psychology Review, 16(1), 27-29.

Griffiths, M.D. (2012). The use of online methodologies in studying paraphilias: A review. Journal of Behavioral Addictions, 1, 143-150.

Griffiths, M.D. (2013). Eproctophilia in a young adult male: A case study. Archives of Sexual Behavior, 42, 1383-1386.

Griffiths, M.D. (2019). Paraphilias and the press – Don’t always believe what you read. Medical Journal Armed Forces India, 75, 232-233.

Griffiths, M.D. (2019). Salirophilia and other co-occurring paraphilias in a middle-aged male: A case study. Journal of Concurrent Disorders, 1(2), 1-8.

Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.

The Full Wiki (2013). Bellypunching. Located at: http://www.thefullwiki.org/Bellypunching

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

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addictions, 5, 363–372.

Stars in their highs: The psychology of ‘addiction to fame’ (revisited)

A couple of weeks ago, I was contacted by The Face magazine who wanted to know if fame can be addictive. I looked at this issue in one of my first articles published on this website as well as a number of other articles related to fame (such as ones on Celebrity Worship Syndrome, the psychology of being starstruck, celebriphilia [the pathological desire to have sex with a celebrity], celebrity endorsements in gambling advertising, and whether famous people are more susceptible to addictive behaviour). I ended up doing the interview via email and given that when The Face eventually publish their article I am unlikely to get more than a few soundbites, I thought I would publish my responses to the questions I was asked here.

The Face: Why do we desire fame?

Obviously not everyone wants to be famous but for those that desire it there are many reasons why they would want it. On a pragmatic level it is because fame might lead to benefits such as having more money, power, being pampered, living a life of luxury and/or greater sexual success, etc. On a psychological level it may lead to something that overcomes feelings of insecurity or feeds a need to be adored by others. Many people are famous as a by-product of what they do (e.g., being a professional sportsman, politician, etc.). Here, the desire is to do well in the chosen profession and fame is not usually the primary motivating factor. However, it is also worth noting that once someone has become famous and then are unable to maintain their public profile (e.g., a footballer retiring from the sport), those who desire fame will often do other things (e.g., reality TV) as a way of keeping themselves in the public eye.

The Face: Is fame an addiction?

Addiction to anything relies on constant rewards (what we psychologists call ‘reinforcement’). You cannot become addicted to something that doesn’t have constant rewards – and being famous can obviously bring constant rewards. I would class something as being an addiction if it fulfils six criteria. All of these have to be present to be a genuine addiction.

  • Salience –This occurs when fame becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of being famous (e.g. the euphoric feelings that accompany the activities that they engage in).
  • Tolerance – This is the process whereby increasing amounts of time spent trying to achieve and/or maintain fame.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.), that occur when the person feels they are no longer famous and/or in the public eye.
  • Conflict – This is when the desire to be famous results in conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control about achieving and/or maintaining fame).
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive time spent trying to achieve and/or maintain fame.

My own view is that it is theoretically possible for individuals to be addicted to fame but the number that would fulfil all my criteria would be few and far between.

The Face: You have asked the question of what substance the people addicted to fame are actually addicted to. Couldn’t it just be validation? 

The ‘object’ of fame addiction is likely to be highly idiosyncratic and individualistic (just like those individuals who are addicted to work). The rewards and reinforcements will be different for different people. Validation is a plausible generic factor as is feeling of wanting to be adored.

The Face: Is there any biological similarity between what an addictive substance like cocaine does to the brain and what fame does? 

There is no empirical evidence to answer such a question but on a biological level, anything that we do that makes us feel good leads to increases in serotonin (which at a basic level leads to feelings of positive wellbeing and happiness) which leads to an increase in the body’s own drug-like chemicals (endorphins – opioid neuropeptides), and ultimately leading to increases of the neurotransmitter dopamine (often characterised as the body’s own chemical ‘pleasure’ producer)

The Face: Does the behaviour of people ‘addicted’ to fame mirror that of other addicts?

If we are going to call fame an ‘addiction’ it has to mirror the signs, symptoms, and consequences of other addictions. Consequently, very few people would be classed as addicted using my criteria above. For many individuals, fame might have addictive elements rather than being an addiction per se.

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

Further reading

Griffiths, M.D. & Joinson, A. (1998). Max-imum impact: The psychology of fame. Psychology Post, 6, 8-9.

Halpern, J. (2007). Fame Junkies. New York: Houghton Mifflin Harcourt

McGuinness, K. (2012). Are Celebrities More Prone to Addiction? The Fix, January, 18. Located at: http://www.thefix.com/content/fame-and-drug-addiction-celebrity-addicts100001

Rockwell, D. & Giles, D.C. (2009). Being a celebrity: A phenomenology of fame. Journal of Phenomenological Psychology, 40, 178-210.

Streeter, L.G. (2011), Doctor helps people beat their fame addiction. Palm Beach Post, October 3. Located at:  http://www.palmbeachpost.com/health/doctor-helps-people-beat-their-fame-addiction-1892781.html

Turner, M. (2007). Addicted to fame: Stars and fans share affliction. MSNBC Entertainment News, August 9. Located at: http://today.msnbc.msn.com/id/20199608/ns/today-entertainment/t/addicted-fame-stars-fans-share-affliction/

Needers of the pack: A brief look at addiction to Solitaire

A few days ago I was interviewed by Business Insider about the addictiveness of the card game Solitaire (also known as Klondike and Patience). The ‘hook’ for the Business Insider article (no pun intended) was that May 22 is National Solitaire Day (NSD). A quick look on the online National Day Calendar confirmed that NSD does indeed exist (a celebration day that only began for the first time last year) and the website also pointed out that the game is over 200 years’ old and that Solitaire “truly went viral” in 1990 when Microsoft included the Microsoft Solitaire game in Windows 3.0 (as a way to teach people how to use the mouse on their computers). The NSD webpage notes that:

“Over the past 28 years, Microsoft Solitaire has been providing great entertainment to hundreds of millions of players in every corner of the world…In 2012, Microsoft evolved Solitaire into the Microsoft Solitaire Collection, which features five of the top Solitaire games in one app. Since then, the game has been played by over 242 million people and has become so popular that each year 33 billion games are played with over 3.2 trillion cards dealt!”

Back in 2000, a short article on internet addiction in The Lancet by Peter Mitchell noted that one of the pioneers in internet addiction research, the clinical psychologist Maressa Hecht Orzack claimed to have a problem (a “near addiction”) playing Solitaire. Orzack was quoted in Mitchell’s article as saying: “So now I don’t have a computer at work. [My playing Solitaire] was getting that serious”. Orzack was also quoted in the Business Insider article. Her Solitaire playing was a “growing obsession” and she neglected her work and lost sleep because of her Solitaire playing. She said: “I kept playing solitaire more and more – my late husband would find me asleep at the computer. I was missing deadlines. I knew something had to be done”.

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As far as I am aware, there is no empirical research about addiction to Solitaire, and I’ve never come across a published case study. However, I have mentioned Solitaire in a number of my papers over the years but all of them were in my critique of Dr. Kimberley Young’s taxonomy of the different types of internet addiction. Young claimed there were five different types of internet addiction (‘cyber-sexual addiction’, cyber-relationship addiction, ‘net compulsions’, ‘information overload’ and ‘computer addiction’). In a number of my publications in journals such as the Student British Medical Journal (1999), Addiction Research (2000), and the International Journal of Mental Health and Addiction (2006), I argued that the typology was flawed and that most of the examples Young provided were addictions on the internet, not addictions to the internet (and echoing my assertion that individuals are no more addicted to the internet than alcoholics are addicted to bottles).

The reference to Solitaire was in relation to Young’s final type of internet addiction – ‘computer addiction’. One of her examples of ‘computer addiction’ as the playing of Solitaire on computers. (I found this strange particularly because the example didn’t even rely on being on the internet – it was merely about individuals being addicted to playing Solitaire on computers and laptops). Young never provided any empirical evidence that she had ever met or treated anyone with an addiction to Solitaire, just that being addicted to Solitaire would be classed as a ‘computer addiction’ in her typology.

Young is not the only social scientist to use Solitaire as an example in an addiction typology. In a 2008 paper published in the Journal of Applied Social Science, Jawad Fatayer outlined what he believes are the four types of addiction – alpha addictions (addictions that impact the body and physical health such as nicotine addiction and food addiction), beta addictions (addictions that impact the mind and the body such as alcohol and other drug addictions), gamma addictions (all behavioural addictions), and delta addictions (two or more addictions experiences simultaneously). Addiction to Solitaire was listed as a gamma addiction (but again, there was no empirical evidence to support the claim that Solitaire addiction actually exists).

Business Insider spoke to two other psychologists in addition to myself. Dr. Chris Ferguson (with whom I have co-authored a few papers) said:

“It’s important to recognize the difference between really liking something and having a clinical addiction. People (say) ‘I’m addicted to cupcakes’, ‘I’m addicted to chocolate’ meaning ‘This is a really fun thing that I like to do a lot’. There’s a huge debate that goes on in the field right now about whether video games can be compared to things like substance abuse, or if video games are more similar to hobby-like activities that many people enjoy — and some people might overdo…a fixation with Solitaire is more of a behavioral addiction – an obsessive behavioral pattern that can be a sign of underlying mental distress or illness. People who have mental health issues, or are simply under stress, tend to be drawn to things that are fun and distracting. And that’s mostly good, actually. It’s just that sometimes, for some individuals, they may begin to really overdo those activities as a form of escapism…It’s not about technology. It’s about mental health”.

A clinical psychologist, Anthony Bean said:

“There are some clear signs that Solitaire might be playing too big a role in your life. (If you’re) noticing you’re putting more time than other areas into the game and, let’s say, not paying attention to your family, not paying attention to work, not paying attention to school”.

My contribution to the Business Insider was taken from an email I sent the journalist. Very little of what I sent was used. I was asked two specific questions: (i) what characteristics of the game Solitaire might make it addicting? and (ii) what should people be aware of as signs of a disruptive addiction to Solitaire (or gaming in general)?

In answer to the first question, I wrote that addictions rely on constant rewards (what psychologists refer to as reinforcement) and each game of Solitaire can be played quickly and individuals can be quickly rewarded if they win (positive reinforcement) but when they lose, the feeling of disappointment or cognitive regret can be eliminated by playing again straight away (negative reinforcement – playing as way to relive a dysphoric mood state). I also stated that addictions typically result as a coping mechanism to other things in a person’s life. They use such behaviours as a way of escape and the repetitive playing of games can help in such circumstances. For the overwhelming majority of people, such playing behaviour will be an adaptive coping mechanism but if the game takes over all other aspects of the person’s life and compromises their relationships and their education/occupation (depending upon their age), this becomes a poor coping strategy because the short-term benefits are heavily outweighed by the long-term costs.

In relation to the second question, I outlined what I believe to be the six core criteria of addictive behaviour and outlined them with what I believed a genuine Solitaire addiction would constitute. My response was purely hypothetical because I have never met or even heard of anyone being genuinely addicted to Solitaire. So, hypothetically, Solitaire addiction would comprise anyone that fulfilled all of the following six criteria:

  • Salience –This occurs when Solitaire becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour). For instance, even if the person is not actually playing Solitaire they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with Solitaire).
  • Mood modification –This refers to the subjective experiences that people report as a consequence of playing Solitaire and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’).
  • Tolerance –This is the process whereby increasing amounts of time spent playing Solitaire are required to achieve the former mood modifying effects. This basically means that for someone engaged in Solitaire, they gradually build up the amount of the time they spend playing Solitaire every day.
  • Withdrawal symptoms– These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.), that occur when the person is unable to play Solitaire because they are ill, have no computer connection, etc.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time playing Solitaire
  • Relapse– This is the tendency for repeated reversions to earlier patterns of excessive Solitaire playing to recur and for even the most extreme patterns typical at the height of excessive Solitaire playing to be quickly restored after periods of control.

Finally, I just want to reiterate that I know of no evidence to support the contention that there are individuals genuinely addicted to Solitaire. However, I do think it’s theoretically possible even though I’ve yet to meet or hear about such individuals.

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

Further reading

Fatayer, J. (2008). Addiction types: A clinical sociology perspective. Journal of Applied Social Science, 2(1), 88-93.

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

Griffiths, M.D. (1999). Internet addiction: Internet fuels other addictions. Student British Medical Journal, 7, 428-429.

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

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

Mitchell, P. (2000). Internet addiction: genuine diagnosis or not? The Lancet, 355(9204), 632.

National Day Calendar (2018). National Solitaire Day. Located at: https://nationaldaycalendar.com/national-solitaire-day-may-22/

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

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