Category Archives: Adolescence

Choking aside: Another look at self-asphyxial risk-taking behaviour in adolescence

In a previous blog I examined the ‘choking game’ (also known by dozens of names including the ‘fainting game’ and ‘suffocation roulette’). This was a game that I played a couple of times as an adolescent (although we called it ‘Headrush’). This was a game where I would have my breathing temporarily stopped by someone holding onto my chest after a deep expiration and hyperventilation (so that I could not breathe). It induced feelings of light-headedness and dizziness followed by temporary unconsciousness (usually lasting 10 to 15 seconds).

This activity that I engaged in as a teenager is an example of self-asphyxial risk-taking behaviour (SARTB). It also appears that what I did when I was an adolescent was a form of ‘self-induced hypocapnia’ (i.e., a state of reduced carbon dioxide in the blood). It has also been reported that these ‘games’ can be played alone and typically involve self-strangulation, or sometimes with others, and where like my own experiences, the cutting off of the oxygen supply was carried out by somebody else.

Reports of SARTB date back to the early 1950s in the medical literature (for instance, Dr. P. Howard and his colleagues reported a case in a 1951 issue of the British Medical Journal). SARTB has been defined by R.L. Toblin and colleagues in a 2008 issue of the Journal of Safety Research as self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia. As with autoerotic asphyxiation (i.e., suffocation as a way of enhancing sexual arousal), the aim of SARTB is to intentionally cut off the oxygen supply to the brain to experience a feeling of euphoria (the only difference being that in children’s games, it is not done for a sexual reason).

How prevalent the activity is debatable as most of the academically published studies are case reports (usually when a problem – and in some cases, death – has occurred). However, a comprehensive systematic review of SARTB was recently published by Busse et al (2015). They attempted to assess the prevalence of engagement in SARTB and associated morbidity and mortality in children and adolescents (and up to early adulthood). Busse and colleagues examined every survey and case study that had been published on SARTB, and more specifically examining the behaviour among those aged 
0–20 years (excluding any study where the motive was autoerotic, suicidal or self-harm). They reported that 36 studies had examined child and adolescent SARTB in 10 different countries (North America and France being the most common, but also reports in the UK).

Risk factors for SARTB were hard to assess because most of the studies examining such risks did not control for other confounding variables. However, five of the studies reported an association between SARTB and a number of other risky behaviours including substance misuse, risky sexual behaviours, poor mental health, poor dietary behaviours, and engagement in risky sports. The review also reported that there did not seem to be any association between SARTB and engagement in physical activity, and experiencing accidents, and/or hospital admissions. It was also noted that a number of other behaviours increased the likelihood of engaging in SARTB including experiences of violence, being more impulsive, having a thrill-seeking personality, and having lower school achievement. However, only six of the 36 studies they reviewed reported the potential for SARTB to be associated with other risky behaviours. No consistent findings were found between SARTB and gender, age and other demographic factors (such as socio-economic status).

Examining the studies as a whole, Busse and colleagues reported that awareness of SARTB ranged from 36% to 91%, and that the median lifetime prevalence of engagement in SARTB was 7.4% (however, these were studies that used convenience sampling, therefore none of the studies were necessarily representative). In the SARTB literature, a total of 99 fatal cases were reported (and of the 24 detailed case reports, most of the deaths occurred when individuals were engaged in SARTB alone and used some type of ligature).

In a different analysis in the Journal of Safety Research, Dr. R.L. Toblin and colleagues used US news media reports to estimate the incidence of deaths from SARTB. Their report identified 82 probable SARTB deaths among youths aged 6-19 years during 1995 and 2007. Of these 82 cases, 71 (86.6%) were male, and the mean age of death was just over 13 years of age. The study also noted that deaths were recorded in 31 US states and were not clustered by location, season or day of week. Busse and colleagues assert the importance of education and prevention and more specifically note:

“As it has been suggested that knowledge and identification of symptoms and signs of engagement in [SARTB] could have possibly enabled early identification and possible prevention of fatal cases, we believe that clinicians, paediatricians, health professionals and teachers should receive education on the symptoms and signs of [SARTB]. The need to educate health professionals has been highlighted as awareness of [SARTB] will enable these individuals to identify symptoms and signs and to act as educators to young people and their parents…We further recommend that more research is carried out together with young people to develop appropriate education material. In line with recommendations from others, we further recommend removing existing videos about [SARTB] from the internet and ensuring that preventative website rather than promotional websites appear first on internet searches” (p.8).

This brief examination of the literature suggests that a significant minority of adolescents have engaged in SARTB and that in extreme cases it may lead to death. Despite being known about for over 60 years, the data concerning SARTB are still limited and relatively little is known about the associated risk factors. However, SARTB certainly appears to be an activity that parents and teachers should be made more aware of even if the prevalence of such activity among children and adolescents is low.

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

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Busse, H., Harrop, T., Gunnell, D. & Kipping, R. (2015). Prevalence and associated harm of engagement in self-asphyxial behaviours (‘choking game’)
in young people: A systematic review. Archives of Disease in Childhood, doi:10.1136/archdischild-2015-308187.

Drake, J.A., Price, J.H., Kolm-Valdivia, N. & Wielinski, M. (2010). Association of adolescent choking game activity with selected risk behaviors. Academic Pediatrics, 10, 410-416.

Egge, M.K., Berkowitz, C.D., Toms, C. & Sathyavagiswaran, L. (2010). The choking game: A cause of unintentional strangulation. Pediatric Emergency Care, 26, 206-208.

Griffiths, M.D. (2015). A brief review of self-asphyxial risk-taking behaviour in adolescents. Education and Health, 33, 59-61.

Howard, P., Leathart, G. L., Dornhorst, A.C., & Sharpey-Schafer, E.P. (1951). The mess trick and the fainting lark. British Medical Journal, 2, 382-384.

MacNab, A.J., Deevska, M., Gagnon, F., Cannon, W.G. & Andrew, T (2009). Asphyxial games or “the choking game”: A potentially fatal risk behavior. Injury Prevention, 14, 45-49.

Shlamovitz, G.Z., Assia, A., Ben-Sira, L. & Rachmel, A. (2003). “Suffocation roulette”: A case of recurrent syncope in an adolescent boy. Annals of Emergency Medicine, 41, 223-226.

Toblin, R.L., Paulozzi, L.J., Gilchrist, J. & Russell, P.J. (2008). Unintentional strangulation deaths from the “choking game” among youths aged 6-19 years -United States, 1995-2007. Journal of Safety Research, 39, 445-448.

Urkin, J. & Merrick, J. (2006). The choking game or suffocation roulette in adolescence (editorial). International Journal of Adolescent Medicine and Health, 18, 207-208.

Shock ‘n’ roll: The art of Allen Jones and sexual fetishism

“I’m a friend of Mr. Pastry/I’m a friend of Allen Jones/I’m a friend of Shirley Bassey/I’m a friend of your chromosomes” (Opening verse to ‘Friends’, song by Adam and the Ants)

It was Adam and the Ants song ‘Friends’ where I first heard the name of the British pop artist Allen Jones. The song was first officially released in 1981 as the B-side of ‘Ant Rap’ but earlier versions had been recorded for a 1978 John Peel session and during the sessions for the 1979 Dirk Wears White Sox album. The Dirk version was eventually released on the 1982 ‘Antmusic EP’ (and ended up being Adam and the Ants last single before Adam Ant went solo).

In two previous blogs, I have looked at both the psychology of Adam Ant and an in-depth look at all his songs about sexual fetishism and paraphilias (based on an academic article that I originally wrote for Headpress: The Journal of Sex, Death and Religion). In one of those articles, I noted that Adam’s predisposition towards sex came not from musical influences but from figures in the 20th century art world. Adam Ant’s final year thesis was on sexual perversion and he was inspired by the iconographic images of Andy Warhol, the autoerotic paintings of Allen Jones, the neo-sadomasochistic fantasies of Hans Bellmer, and ‘sexpop’ travellers like Eduardo Paolozzi, Francis Bacon and Stanley Spencer. In 1977, Adam said:

The S&M thing stems from (when) I was at College Art School, with John Ellis (of The Vibrators), and all the time I was at Art College I was very influenced by Allen Jones the artist. All my college work is pretty much like this, this is just a musical equivalent of what I was visually doing at college”

As a teenager I collected badges and the ones designed by Adam Ant were clearly indebted to Allen Jones’ interest in fetishism (you can check out the designs in more detail here). Others in the pop world noted this including Justine Frischmann of Elastica. In a Melody Maker article by Simon Reynolds, Frischmann noted that Adam Ant “epitomised the brilliantly elegant side of punk, using all that Allen Jones type imagery like that table which was a woman on all fours with a glass top on her back. All his paintings were developed from Fifties porn – lots of airbrushed women in black leather. The Antz used a lot of that imagery. On one level, it’s very titillating, but it’s also very pop. So we’re gonna make the next album S & M, with us all in black leather. Actually, I think Madonna‘s ruined that for everyone, ruined the concept of pervy sex forever”.

Jones (born in 1937 in Southampton, UK) is arguably Adam’s greatest single influence and has been cited by Adam in many early interviews. He is best known for his use of slick fetishistic and obsessive objects, often of a sexual character (legs, stockings, shoes, etc.) taken from pornographic and women’s fashion magazines (with rubber fetishism and BDSM themes being very prominent). He was an early and leading figure in the pop-art movement as part of the so-called “dynamic generation” at the Royal College of Art (along with David Hockney, Patrick Caulfield, Peter Phillips, and Frank Bowing), and from where he was expelled in 1960 because of his controversial paintings. He was Britain’s ‘shock art’ bad boy decades before Damien Hirst. His early work was influenced by the Futurism school or art, and by reading the psychology of Freud and Jung, as well as the philosophy of Nietzsche. One of Adam’s songs ‘Ligotage’ (French for bondage) was directly inspired by his paintings. In the Wikipedia entry on Jones, he is quoted as saying:

“I wanted to kick over the traces of what was considered acceptable in art. I wanted to find a new language for representation… to get away from the idea that figurative art was romantic, that it wasn’t tough”.

It was in the late 1960s that Jones first started sculpting what art historian Marco Livingstone describes in his 1979 book Sheer Magic by Allen Jones as “life-size images of women as furniture with fetishist and sado-masochist overtones.” The three most (in)famous works (sharing as art curator Edith Devaney argued “a visual language”) were the erotic sculptures Hat Stand, Table and Chair made of fiberglass that featured busty mannequins dressed (or rather barely dressed) in patent leather. These works were met with both acclaim and disdain both in and outside of the art world with critics perceiving the sculptures as being misogynistic. Livingstone later went on to say “these works still carry a powerful emotive charge, ensnaring every viewer’s psychology and sexual outlook regardless of age, gender or experience”. One of the better descriptions of the three pieces was by Zoe Williams of The Guardian in an article provocatively entitledIs Allen Jones’s sculpture the most sexist art ever?’:

“’Hat Stand’ is a mannequin in radial leather knickers and thigh-high boots. ‘Chair’ is the most famous of the three: a woman lies on her back, with her knees against her chest and a cushion on top of her. That’s the seat, her calves make the chair’s back. While all the clothes – black leather gloves, boots and a strap – reference bondage, she also looks dead, trussed up ready for some inept suburban disposal. ‘Table’, being topless, is more classically provocative. It would be pushing it to say the figure was adopting a more active shape, though: she’s on all fours, holding up a pane of glass with her back, her head looking down into a hand mirror. Yet the physics of the position make her look more like a doll than a corpse…Does Allen Jones’s art expose how female stereotypes are performed and maintained, by presenting us with overtly sexualised hyperboles, or is it just another part of the age-old tradition to objectify and sexualise women? The debate goes on… One thing is sure though, Jones’s work still provokes reactions”.

More infamy followed when the sculptures were referenced in one of cinema’s most controversial films of all time – A Clockwork Orange directed by Stanley Kubrick (in 1971). In a later interview, Jones recalled a telephone call from Kubrick. “[Kubrick said], ‘I’m a very famous film director, this will be seen all over the world and your name will be known.’ I held the phone away from my ear, I was just staggered anyone would say that. It showed an ego that dwarfed that of any artist I’ve known”. Because of this, Jones declined Kubrick’s offer but the director’s prop team made copies of his work. His BDSM designs were also a key feature of the 1975 film Maîtresse about a female dominatrix directed by Barbet Schroeder (and which also caused controversy because of its very graphic depictions of sado-masochism). Zoe Williams in her article for The Guardian goes as far to say: Jones’s images have been so influential that almost no image of woman-as-object or woman-as-other-object can be created, even 40 years later, that doesn’t nod to them”.

In 2014, the Royal Academy of Arts hosted a retrospective of Jones’ work and Richard Dorment in the Daily Telegraph asserted: “you could argue that Jones’s work isn’t really about women; it’s about men and how they look at and think about women. Men use various strategies to neutralise or control desire. One is to fetishise the female body…[while] another is for the man to appropriate it”. The brief biography of Jones on the Artsation website also noted that: Allen Jones was accused of being sexist and depicting women as undignified, mere willing objects of lust. Jones obviously never intended to show women in such a way, he wanted to question prohibitions and moral boundaries. ‘Nothing is as it seems’, the artist once said and also in this case one should not confuse the appearance of the object with its message. With his objects the artist carries trivialities like sexual connotations from advertising and show business into fine art to stylize and satirize them”.

Bizarrely, perhaps one of Jones’ unforeseen legacies is that his work appears to have unwittingly spawned a new sexual paraphilia – namely forniphilia. As I noted in my previous article on forniphilia, it is a form of sexual objectification and is viewed by many as a form of sexual bondage as the human body is typically incorporated into the shape of a piece of furniture where the person has to stay still for extended periods of time. The difference between Jones’ art and forniphilia is that forniphilia involves real humans whereas Jones’ works of art uses ‘humans’ made of fibreglass. The term ‘forniphilia’ was allegedly coined by Jeff Gord, the man behind The House of Gord (“The Home of Ultra Bondage”). In The House of Gord, there are many types of furniture that women had been temporarily turned into. This included many different types of table, lamps, pedestals, various types of chair (office chair, rocking chair, etc.), footstools, ceiling decorations (including chandeliers), lawn sprinklers, and bird tables. If Jones’ art was the direct inspiration for Gord and his followers, I wouldn’t be surprised. But even if it wasn’t, Jones’ work will continue to live on and will continue to garner controversy and feminist critique.

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

Further reading

Ant, A. (2007). Stand and Deliver: The Autobiography. London: Pan.

Artsation (2015). Allen Jones – Biography. Located at:

Deurell, J. (2014). 10 key facts about Allen Jones. AnOther, November 10. Located at:

Dorment, R. (2014). Allen Jones, Royal Academy, review: ‘dangerous, perverse and brilliant’. Daily Telegraph, November 14. Located at:

Gregory, H. (2014). Fetish, fantasy & “women as furniture”: The complicated legacy of Allen Jones., December 3. Located at:

Griffiths, M.D (1999). Adam Ant: Sex and perversion for teenyboppers. Headpress: The Journal of Sex, Death and Religion, 19, 116-119.

Guadagnini, W. (2004). Pop Art UK: British Pop Art 1956-1972. Milan: Silvana.

Levy, P. (2014). A Fetish for Art. Touring Pop artist Allen Jones’s London workspace. Wall Street Journal, November 14. Located at:

Livingstone. M. (1979). Sheer Magic by Allen Jones. London: Thomas & Hudson.

Wikipedia (2013). Allen Jones (artist). Located at:

Williams, Z. (2014). Is Allen Jones’s sculpture the most sexist art ever? The Guardian, November 10. Located at:

Ringing the changes: Can disordered mobile phone use be considered a behavioural addiction?

Over the last decade, I have published various papers on excessive mobile phone use both in general and related to particular aspects of mobile phone use (such as gambling and gaming via mobile phones (see ‘Further reading’ below). Recently, some colleagues and I (and led by Dr. Joël Billieux) published a new review in the journal Current Addiction Reports examining disordered mobile phone use.

I don’t think many people would say that their lives are worse because of mobile phones as the positives appear to greatly outweigh the negatives. However, in the scientific literature, excessive mobile phone use has been linked with self-reported dependence and addiction-like symptoms, sleep interference, financial problems, dangerous use (phoning while driving), prohibited use (phoning in banned areas), and mobile phone-based aggressive behaviours (e.g., cyberbullying).

Despite accumulating evidence that mobile phone use can become problematic and lead to negative consequences, its incidence, prevalence, and symptomatology remain a matter of much debate. For instance, our recent review noted that prevalence studies conducted within the last decade have reported highly variable rates of problematic use ranging from just above 0% to more than 35%. This is mainly due to the fact most studies in the field have been conducted in the absence of a theoretical rationale.

Too often, excessive mobile phone use has simply been conceptualized as a behavioural addiction and subsequently develop screening tools using items adapted from the substance use and pathological gambling literature, without taking into account either the specificities of mobile phone “addiction” (e.g., dysfunctional mobile phone use may often be related to interpersonal processes) or the fact that the most recent generation of mobile phones (i.e., smartphones) are tools that – like the internet – allow the involvement in a wide range of activities going far beyond traditional oral and written (SMS) communication between individuals (e.g., gaming, gambling, social networking, shopping, etc.).

The first scientific studies examining problematic mobile phone use (PMPU) were published a decade ago. Since then, the number of published studies on the topic has grown substantially. At present, several terms are frequently used to describe the phenomenon, the more popular being ‘mobile phone (or smartphone) addiction’, ‘mobile phone (or smartphone) dependence’ or ‘nomophobia’ (that refers to the fear of not being able to use the mobile phone).

PMPU is generally conceptualized as a behavioural addiction including the core components of addictive behaviours, such as cognitive salience, loss of control, mood modification, tolerance, withdrawal, conflict and relapse. Accordingly, the criteria (and screening tools developed using such criteria) that have been proposed to diagnose an addiction to the mobile phone have been directly transposed from those classifying and diagnosing other addictive behaviours, i.e., the criteria for substance use and pathological gambling. For example, in a recent study published in the Journal of Behavioral Addictions, Dr. Peter Smetaniuk reported a prevalence of PMPU around 20% in U.S. undergraduate students using adapted survey items that were initially developed to diagnose disordered gambling.

Although many scholars believe that PMPU is a behavioural addiction, evidence is still lacking that either confirms or rejects such conceptualization. Indeed, the fact that this condition can be considered as an addiction is to date only supported by exploratory studies relying on self-report data collected via convenience samples. More specifically, there is a crucial lack of evidence that similar neurobiological and psychological mechanisms are involved in the aetiology of mobile phone addiction compared to other chemical and behavioural addictions. Such types of evidence played a major role in the recent recognition of Gambling Disorder and Internet Gaming Disorder as addictive disorders in the latest (fifth) addiction of the DSM (i.e., DSM-5) In particular, three key features of addictive behaviours, namely loss of control, tolerance and withdrawal, have – to date – received very limited empirical support in the field of mobile phone addiction research.

Given these concerns, it appears that the empirical evidence supporting the conceptualization of PMPU as a genuine addictive behaviour is currently scarce. However, this does not mean that PMPU is not a genuine addictive behaviour (at least for a subgroup of individuals displaying PMPU symptoms), but rather that the nature and amount of the available data at the present time are not sufficient to draw definitive and valid conclusions. Therefore, further studies are required. In particular, longitudinal and experimental research is needed to obtain behavioural and neurobiological correlates of PMPU. In the absence of such types of data, all attempts to consider PMPU within the framework of behavioural addictions will remain tentative. It is worth noting here that it took decades of empirical research before disordered gambling was officially recognized as an addiction (as opposed to a disorder of impulse control) in the DSM-5.

The current conceptual chaos surrounding PMPU research can also be related to the fact that while the number of empirical studies is growing quickly, these studies have (to date) primarily been based on concepts borrowed from other disorders (e.g., problematic Internet use, pathological gambling, substance abuse, etc.). This approach is atheoretical and lacks specificity with regard to the phenomenon under investigation. In fact, by adopting such a ‘confirmatory approach’ relying on deductive quantitative studies, important findings that are unique to the experience of PMPU have been neglected. As an illustration, no qualitative analyses of PMPU exist, and only a few models have been proposed. This implies that most studies have been conducted without a theoretical rationale that goes beyond transposing what is known about addictions in the analysis of PMPU.

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

Additional input: Joël Billieux, Pierre Maurage, Olatz Lopez-Fernandez and Daria J. Kuss

Further reading

Bianchi, A. & Phillips, J.G. (2005). Psychological predictors of problem mobile phone use. Cyberpsychology and Behavior, 8, 39–51.

Billieux, J. (2012). Problematic use of the mobile phone: A literature review and a pathways model. Current Psychiatry Reviews, 8, 299–307.

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2, 154-162.

Carbonell, X., Chamarro, A., Beranuy, M., Griffiths, M.D. Obert, U., Cladellas, R. & Talarn, A. (2012). Problematic Internet and cell phone use in Spanish teenagers and young students. Anales de Psicologia, 28, 789-796.

Chóliz M. (2010). Mobile phone addiction: a point of issue. Addiction. 105, 373-374.

Griffiths, M.D. (2007). Mobile phone gambling. In D. Taniar (Ed.), Encyclopedia of Mobile Computing and Commerce (pp.553-556). Pennsylvania: Information Science Reference.

Griffiths, M.D. (2013). Adolescent mobile phone addiction: A cause for concern? Education and Health, 31, 76-78.

Lopez-Fernandez, O., Honrubia-Serrano, L., Freixa-Blanxart, M., & Gibson, W. (2014). Prevalence of problematic mobile phone use in British adolescents. Cyberpsychology, Behavior and Social Networking, 17, 91-98.

Lopez-Fernandez, O., Kuss, D.J., Griffiths, M.D., & Billieux, J. (2015). The conceptualization and assessment of problematic mobile phone use. In Z. Yan (Ed.), Encyclopedia of Mobile Phone Behavior (Volumes 1, 2, & 3) (pp. 591-606). Hershey, PA: IGI Global.

Smetaniuk, P. (2014). A preliminary investigation into the prevalence and prediction of problematic cell phone use. Journal of Behavioral Addictions, 3(1), 41-53.

A battle of Witts: A brief look at ‘Taboos’ and the work of The Passage

“If music be the food of love, play on. Give me excess of it” (Duke Orsino in Twelfth Night by William Shakespeare)

Today’s blog is not academic but it’s about an academic (but I’ll come to that later). Back in the early 1980s when I was in my early teenage years, my obsession for music was fed by listening to the John Peel show every weekday night. I still have dozens of cassettes of the songs that I taped off the show that I still cannot throw away (and before you ask, yes I am a hoarder when it comes to anything music-related). It was 1981 when I first heard a song that has become one of my all-time favourites – ‘Taboos’ by post-punk band The Passage. From the opening verse I was transfixed. Here was a group writing songs about sexual dysfunction in both a cerebral and humorous way. Around this time I was also a massive fan of Adam and the Ants, particularly their songs on sexual perversions and paraphilias (which I have already documented in two previous blogs on the psychology of Adam Ant, and Ant as a portrait in pop perversion)

The Passage formed March 1978 in Manchester and the band was led by Richard ‘Dick’ Witts (formerly a percussionist in the Halle Orchestra) and the only ever present member until they split up in 1983. Their early material as been likened to The Fall (not totally a surprise given that The Passage’s first bassist Tony Friel also played bass in The Fall), and like The Fall there was a constant change of line-ups with Witts being the equivalent of The Fall’s lead singer Mark E. Smith. Witts was also an occasional television presenter of music programmes (such as The Oxford Road Show). Witts also recalled the story of Morrissey auditioning for them before he formed The Smiths (“‘As we were spineless about singing we once auditioned a bunch of hopefuls, including a certain Steve Morrissey, who we thought a bit too glum for the likes of us”).


Between November 1980 and March 1983, The Passage released four great albums (Pindrop; For All And None; Degenerates; and Enflame) on three different record labels (first Object Music, then Virgin subsidiary label Night & Day, and finally with legendary indie label Cherry Red). The LPs were all re-released in 2003 on the LTM label along with a compilation album (BBC Sessions). There’s also a ‘best of’ CD collection with the homophonically titled Seedy (geddit? A prime example of Witts’ wit) which is well worth getting as a primer to their later recorded output. Much of their music was critically lauded including (then NME critic and later a member of the band Art of Noise) Paul Morley who compared them to Joy Division (a band that was actually the support act at one of The Passage’s early gigs). Morley’s review of their debut LP noted:

‘With the disquieting Pindrop, The Passage can be accepted as major even by the cowardly, cautious and cynical: it’s a work of disciplined intellectual aggression, frantic emotions and powerfully idiomatic musicality. Pindrop is densely shaded, erratically mixed (which often works in its favour), rough edged, heavy in an unloveable sense of the word…It’s as shocking a beautiful nightmare, as stormy and aware a debut LP as [Joy Division’s] Unknown Pleasures. Where you gasp a lot. Comparisons will harm. Their sound is their own. It’s the shock of the new – new shades, textures, noises, pulses, atmospheres, energies, the opening up of new realms of feeling.’

One of the things I loved about The Passage was they were never afraid to write songs that were lyrically intellectually political and/or sexual (e.g., ‘Troops Out’, ‘Carnal’, ‘Taboos’, ‘XoYo’). Their ‘love songs’ (to use a quote from the Soft Cell’s song ‘Perversity‘) are “deliciously twisted” (e.g., ’16 Hours’. Love Is As’, ‘Revelation’, ‘Time Will Tell’). In fact, a number of music critics would talk about Witts’ “rigorously intellectual approach” to music and lyric writing. Their second album (For All and None) even took its title from the four-part philosophical novel by German philosopher Friedrich Nietzsche (i.e., Thus Spoke Zarathustra: A Book for All and None). In the song ‘My One Request’, Witts refrain “Love, fear, power, hope” appears to be his manifesto on life. In a lengthy interview with Johnny Black for indie fanzine Masterbag about his continued fascination with form and structure:

“‘We’ve done 53 songs now and they’re all based on just three words,’ says Witts, beginning to illustrate his musical triangle on a paper napkin. At the corners of the triangle he writes the words and speaks them as he does so. ‘Fear, power and…love.’ ‘Another triangle takes shape while he tells me about power. ‘Power is ambiguous, it depends on how it’s used. In the same way, a knife can be used to cut bread, or to slit a throat.’ ‘The second triangle is ready, and at each corner he writes, semitone, minor third, major third, then pushes the napkin over to me. ‘Within these triangles you can sum up everything about Western music.’ The Witts fixation with structure (and triangles) is reflected even in the design of their album covers. ‘We use only black, red and white, which are symbolic colours. The red flag, the black flag for anarchy, black and white united fight – all these things…There are three people in the group and I associate those colours with us. I’m red, Andrew [Wilson] blue, and Paul [Mahoney] is white.”

I should also note that the track ‘Love Song’ from their New Love Songs EP was the first song I ever heard that featured the word ‘c**t’ in a rhyming couplet (‘I love you/Cos I need a c**t/I love you/To use you back and front’). (As a possibly amusing aside, I was the first ever academic to get the word ‘f**kwit’ into the British Journal of Psychology in a study examining the role of cognitive bias in slot machine gambling – see ‘Further reading’ below). The same song also referred to fellatio (but Adam and the Ants had already covered the topic in the song Cleopatra on their 1980 debut LP Dirk Wears White Sox). The Passage are arguably one of the most unsung bands of the 1980s. Perhaps the best tribute to the band was from Nick Currie (aka the musician Momus) who said:

“[The Passage were] one of the greatest, yet least known of 80s groups. I bought ‘Pindrop’ after hearing a track on [the John Peel show]. The album (slightly murkier, more introverted and mysterious sounding than later releases) was like nothing else being made at the time. Totally electronic, spooky, intelligent, political, passionate as hell, like Laurie Anderson crossed with The Fall. ‘Degenerates’ and ‘Enflame’ are also great records, Brechtian politics melded to angular, caustic lyrics. The Passage were very un-English in their willingness to write about sex and politics. I think you’d have to see them as libertarians in a peculiarly Protestant mode, like Quakers or Methodist radicals or something”.

Which brings me to arguably their two greatest songs – ‘Taboos’ and ‘XoYo’ – both about sex but both very different both musically and lyrically (sexual dysfunction versus sexual liberation). Both songs are on the 2003 CD reissue of the Degenerates LP and most people that have heard of The Passage probably prefer ‘XoYo’ because they are likely to be one of the 100,000+ music lovers (like myself) that bought the Cherry Red indie classic sampler album Pillows and Prayers on which it also appeared. The opening quote by Shakespeare is actually the first lyric on ‘XoYo’ (which you can listen to here) and it fits perfectly with the lyrical content of the song (you can read all the lyrics here as they also work as prose).

The ‘Taboos’ single (which you can listen to here) was recorded at Stockport’s Strawberry Studio in August 1981. Witts was apparently unhappy with the mix (although I think it’s great) as he was quoted as saying: “I drowned the drumming with timpani and other percussion, in particular Taboos which now sounds more like an Orange Order marching band than the [Phil] SpectorWall of Sound‘ I had in mind”. Lyrically, I just loved the whole song. Below are the lyrics to the whole song that I transcribed myself as (unlike ‘XoYo’), they don’t appear to be published anywhere online:

“I use this magazine that gives instructions/It tells me many things about seduction/It comes in monthly parts, there’s 16 sections/I need nine more for the complete collection

In Number 6 there’s chapters on disorders/And Number 7’s all about withdrawal/In Number 8 there’s pictures of positions/I’m stuck till I receive the ninth edition

Whoever hopes to dance with me/Must abandon all such guides and schemes/And measure up a million ways and means/Take to heart strange choreography

We have to wait until we’ve read them through/With things like this we’re better safe than sorry/I have it written here, four things to do/Each one a cornerstone of carnal knowledge

It makes you go blind/By closing your mind/Obstructing the view/Too many taboos/Too many taboos

We really should wait till we’ve read them through/You know we’re/always better safe than sorry/You see it written here a thousand rules/Certain regulations should be followed

Perhaps these studies on cassette are wisest/While they play you try the exercises/Just one of 15 minutes would be plenty/My body can’t take all five C-120s

Whoever hopes to dance with me/Must leave behind what’s being heard and seen/And stepping through a thousand routes and dreams/Take to heart new choreography

It makes you go blind/Disclosing the mind/A little taboos/Two million taboos

Let’s wait until we’ve seen the TV series/A programme titled ‘All Your Bedroom Queries’/You may will think I’m making lame excuses/I just don’t like, you know it more than I do

My only option is to write about/A verse or two of hollow lies about you/So you’d be flattered by my sharp deception/And words were made to exercise deception

Whoever wants to dance with me/Must abandon traps and trickery/Take to heart new choreography/Take by storm strange choreography

It makes you go blind/By closing the mind/Obstructing the view/Too many taboos/Too many taboos”

‘Taboos’ (words and music: Dick Witts and Andy Wilson)

Since The Passage disbanded, Witts has put his musical talents to good use. He became an academic and university lecturer in modern music and has taught at Edinburgh University, Goldsmiths University (London) and Edge Hill University (Ormskirk, Lancashire). He’s also written some great books including ones on Nico and The Velvet Underground (that you can download at his academic website). Hopefully after reading this, a few more people will delve into The Passage’s back catalogue and discover one of the great cult bands of the 1980s.

Note: I would like to thank both Dick Witts and Keith Nuttall (at for their help in compiling this article.

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

Further reading

Griffiths, M.D. (1994). The role of cognitive bias and skill in fruit machine gambling. British Journal of Psychology, 85, 351-369.

Nice, J. (2003). The Passage\Biography. LTM Recordings. Located at:

Reynolds, S. (2006). Rip It Up and Start Again: Postpunk, 1978–1984. New York: Penguin.

Wikipedia (2015). Richard Witts. Located at:

Wikipedia (2015). The Passage (band). Located at:

Ghost modernism: Should parents worry about their children playing supernatural games?

(Note: A version of this article was first published in The Independent)

Supernatural games have been played for decades by children and adolescents all around the world. The most popular games – often played on Halloween – include holding séances and playing on a Ouija board to summon up the spirit world, playing hide-and-seek in the pitch black dark, ‘Bloody Mary’ (staring into a mirror, alone in the dark and saying “Bloody Mary” three times to summon up a ghoulish woman), and ‘Candy Man’ (again staring into a mirror and saying “Candy Man” five times to summon up the ghost of a black slave covered in blood and where thousands of bees emerge from his mouth).

The latest game that has done the rounds is the ‘Charlie Charlie Challenge’ (also known as ‘Charlie Pencil’ and ‘The Pencil Game’) and viewed by some as a rudimentary Ouija board. Both of my younger children saw the game on social media although neither has played it. The game is very simple to play and like ‘Bloody Mary’ and ‘Candy Man’ is played to invoke a spirit (this time a dead Mexican called Charlie). The game simply involves placing two pencils on a piece of blank paper in the shape of the cross with the words ‘yes’ and ‘no’ written on either side of the pencils. Players say the phrase “Charlie, Charlie can we play?” in order to connect with the demon. Players then ask questions of the demon and the pencils move to indicate his answer.


There has been no academic research into the playing of supernatural games by children but there is anecdotal evidence that such games are popular. For instance, according to one news report in the Daily Mail, the sales of Ouija boards increased by 300% in December 2014 and are marketed for children and adolescents as they are sold in places like Toys R Us.

The obvious questions to ask is why our children like to play these scary games in the first place and is there is any harm that children can experience from playing such games? Although there has been no research on the playing of supernatural games there has been a little research on why we like watching scary supernatural films. Psychological research has shown that when it comes to the supernatural the three main reasons we watch supernatural horror films are for tension (generated by the suspense, mystery, terror, etc.), relevance (that may relate to personal relevance, cultural meaningfulness, the fear of death, etc.), and (somewhat paradoxically given the second reason) unrealism (i.e., being so far removed from our day-to-day existence). However, the research that has been carried out tends to be on student populations rather than younger children and adolescents. The reasons why school-aged children may want to watch or engage in supernatural practices are likely to be far more mundane such as teenage bravado to try and impress others around them or as a ‘rites of passage’ activity (i.e., engaging in an activity that is normally done by adults and makes the child feel more grown-up).

Although I don’t subscribe to the theories forwarded by the psychoanalyst Dr. Carl Jung, he believed the liking for supernatural horror films tapped into our ‘primordial archetypes’ buried deep in our collective subconscious. However, as with almost all psychoanalytic theorizing, such notions are hard to scientifically test. Another psychoanalytic theory – although arguably dating back to Aristotle – is the notion of catharsis (i.e., that we watch and engage in frightening activities as a way of purging negative emotions and/or as a way to relieve pent-up frustrations).

When it comes to whether playing supernatural games are harmful for children, there are two schools of thought but there is no empirical evidence to support either position. There are those that emphatically claim that the playing of such games is not a dangerous activity. Opposed to this view are those (often religious) people that claim that using Ouija boards and playing supernatural games are dangerous. For instance, Father Stephen McCarthy, a Catholic priest claimed the ‘Charlie Charlie Challenge’ was a demonic activity. In an open letter to students he said:

“There is a dangerous game going around on social media which openly encourages impressionable young people to summon demons. I want to remind you all there is no such thing as ‘innocently playing with demons’. Please be sure to NOT participate and encourage others to avoid participation as well. The problem with opening yourself up to demonic activity is that it opens a window of possibilities which is not easily closed.”

As both a psychologist and a father of three adolescents, I have yet to see any evidence that the playing of such games does any psychological harm although it’s not an activity that I would actively encourage either. As a teenager and as a university student I playfully engaged in séances and at one party used a Ouija board and it never did me any harm. Some may even argue that such activities are ‘character building’. However, there may be children and adolescents of a more sensitive disposition where such games might have a more long-lasting negative detrimental effect. The truth of the matter is that we simply have no idea about what effects of playing games like the ‘Charlie Charlie Challenge’ have on the psyche or behaviour.

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

Further reading

Hess, J.P. (2010). The psychology of scary movies. Filmmaker IQ. Located at:

Hoekstra, S. J., Harris, R. J., & Helmick, A. L. (1999). Autobiographical memories about the experience of seeing frightening movies in childhood. Media Psychology, 1, 117-140.

Johnston, D.D. (1995). Adolescents’ motivations for viewing graphic horror. Human Communication Research, 21(4), 522-552.

O’Brien, L. (2013). The curious appeal of horror movies: Why do we like to feel scared? IGN, September 9. Located at:

Tor-mental problems: Protecting children from online bullying

I have never claimed to be an expert in cyberbullying but I often get asked to do media interviews on the topic (often in connection to high profile cases involving trolling). Any of us that have spent time online can think of incidents where things have escalated on Facebook and other social media. Cyberbullying typically refers to a child being tormented, threatened, harassed, humiliated, embarrassed or otherwise targeted by another child using digital technology such as the internet or mobile phones. The methods used are limited only by the child’s imagination and access to technology. More worryingly, cyber-bullying has been on the increase over the last few years.

The media often ask me for insight in to why that tends to happen in these situations and the psychology behind people interacting online as opposed to face-to-face. For example do people tend to feel more protected online? Do they tend to take on a different identity? One of the main reasons why behaviour online is very different from it offline is because it provides a ‘disinhibiting’ experience. This is where people lower their emotional guard and become much less inhibited in their actions. The main reason for this well known phenomenon is because when people are interacting with others online it is non-face-to-face, it is perceived as a very anonymous environment, and it is non-threatening. On the positive side, this disinhibition process can lead people to develop deep and complex emotional attachments and can even fall in love online. On the negative side, people may carry out behaviours online that they would never dream of doing offline including, in some instances, criminal behaviour such as cyber-bullying in online social networking sites.

The other things I tend to get asked are how common cyberbullying is and what sort of people tend to get involved in online bullying. Research here in the UK and US has shown that about 10% of children and teenagers have been cyber-bullied in the previous month (across all technological media including social media) with about one in six children being cyber-bullied at least once in their lifetime. As children get older the incidence of cyberbullying increases as a greater proportion of older children have access to mobile phones and the internet. Some studies have shown as many as 95% of teenagers on social networking sites have witnessed cruel behaviour and 55% witness this type of behaviour frequently. Amongst teenagers, some research appears to suggest that online cyberbullies are slightly more likely to be girls than boys although findings are a little inconsistent. There is also some research showing that up to one in five teenagers will also join in and cyberbully after an initial abusive post by someone else. Other research studies have found that of all the types of cyberbullying, most of it (approximately 85%) is now done on social networking sites rather than emails and texts. Cyberbullying is not usually a one-off communication, unless it involves a death threat or a threat of serious bodily harm. Children often know it when they see it, while parents may be more worried about the crude language used by children (rather than the hurtful effect of rude and embarrassing posts or texts has on their children).

In preventing cyberbullying via social media, schools can work with the parents to stop and remedy cyberbullying situations. All schools need to amend policies against bullying to include social media (as well as the internet more generally and text messaging abuse), with training for teachers and pupils on handling it. Unfortunately there is no ‘one size fits all’ solution as there are many different forms of cyberbullying. However, there are a number of basic things that parents can do. As with other types of bullying it is important for parents to listen to their child and react with sympathy even when it is online in sites like Facebook. If you are a parent like me, you can try the following tips to help keep your child safe as you can from cyberbullying:

  • Get your son or daughter to show you any offensive or abusive post they’ve received and keep a record of them as evidence.
  • Tell your child never to respond to any abusive post as this is often what the bully wants the victim to do.
  • Tell your son or daughter to avoid giving their name, email address or mobile phone number on social networking sites to people outside their trusted circle of family and friends.
  • Try to identify the individual doing the cyberbullying.
  • Consider contacting the cyberbully’s parents. Their parents may be very concerned to learn that their child has been cyberbullying others in social networking sites, and may be able put a stop to it.
  • Change email address or mobile number if the cyberbullying continues.
  • Where possible, use blocking software to prevent the cyberbully getting abusive material through in the first place.
  • Even if the cyberbully is anonymous – using a fake name or someone else’s identity for example – there may be a way to track them through your service provider.
  • Report any cyberbullying to your child’s school, the service provider and/or the site moderator.
  • If all else fails, contact the police – especially if it involves threats of violence, extortion, obscene or harassing messages or pornography.

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

Further reading

Adrian, A. (2010). Beyond griefing: Virtual crime. Computer Law and Security Review, 26, 640-648.

Griffiths, M.D. (2009). Cyberbullying – what to do if your child is targeted and tormented. Nottingham Evening Post, March 31, pp.14-15.

Griffiths, M.D. (2013). Why do people turn nasty [in social media]?. Nottingham Post, June 28, p.8.

Griffiths, M.D. (2014). Adolescent trolling in online environments: A brief overview. Education and Health, 32, 85-87.

Herring, S., Job-Sluder, K., Scheckler, R. & Barab, S. (2002). Searching for safety online: Managing “Trolling” in a feminist forum. The Information Society, 18, 371-384.

Millman, C., Whitty, M., Winder, B. & Griffiths, M.D. (2012). Perceived criminality of cyber-harassing behaviours among undergraduate students in the United Kingdom. International Journal of Cyber Behavior, Psychology and Learning, 2(4), 49-59.

Rice, L. (2013). It’s time for more Lolz NOT trolls. vinspired, January 13. Located at:

Shachaf, P. & Hara, N. (2010). Beyond vandalism: Wikipedia trolls. Journal of Information Science, 36(3), 357-370.

Thacker, S. & Griffiths, M.D. (2012). An exploratory study of trolling in online video gaming. International Journal of Cyber Behavior, Psychology and Learning, in press.

Widyanto, L., & Griffiths, M. D. (2011). An empirical study of problematic internet use and self-esteem. International Journal of Cyber Behaviour, Psychology and Learning, 1(1), 13-24.

Willard, N. (2006). Cyberbullying and cyberthreats: responding to the challenge of online social cruelty, threats, and distress. Center for Safe and Responsible Internet Use.

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

Parke, J. & Griffiths, M.D. (2002). Slot machine gamblers – Why are they so hard to study? Journal of Gambling Issues, 6. Located at:

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

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

Distraction plans: Excessive smartphone use and pain perception

In a previous blog I outlined many physical syndromes that had been reported in the 1980s medical literature, a number of which related to excessive video game playing. This included ‘Space Invader’s Wrist’ (published in the New England Journal of Medicine), ‘Pseudovideoma’ (Journal of Hand Surgery), ‘Pac-Man Phalanx’ (Arthritis and Rheumatism) and ‘Joystick Digit’ (Journal of the American Medical Association). More recently, other new medical complaints have been reported related to excessive mobile phone use including a report of ‘Blackberry thumb’ in a 2013 issue of the Canadian Medical Association Journal. 

Earlier this month saw the publication of a case report involving a tendon rupture in a man excessively playing a video game on his smartphone. The report appeared in JAMA Internal Medicine by Dr. Andrew Doan and his colleagues (the same Dr. Doan that reported a case study of someone “addicted” to Google Glass that I examined in a previous blog). The authors of the latest report wrote:

“We describe a patient with rupture of the extensor pollicis longus tendon associated with excessive video game play on his smartphone. A 29-year-old, right hand–dominant man presented with chronic left thumb pain and loss of active motion. Before the onset of symptoms, he reported playing a video game on his smartphone all day for 6 to 8 weeks. He played with his left hand while using his right hand for other tasks, stating that ‘playing was a kind of secondary thing, but it was constantly on.’ When playing the video game, the patient reported that he felt no pain. He reported no injuries or prior operations to either hand. He denied a history of inflammatory arthritis, quinolone use, or other predisposing medical condition for ten-don rupture. On physical examination, the left extensor pollicis longus tendon was not palpable, and no tendon motion was noted with wrist tenodesis. The thumb metacarpophalangeal range of motion was 10° to 80°, and thumb interphalangeal range of motion was 30° to 70°. The findings on physical examination of the patient’s right hand were unremarkable. The clinical diagnosis was rupture of the left extensor pollicis longus tendon. A magnetic resonance imaging study of his left hand revealed tendon attenuation and rupture of the tendon. Radiographic studies of the wrist found no bone spurs or prior or current fractures. The patient subsequently underwent an extensor indicis proprius (1 of 2 tendons that extend the index finger) to extensor pollicis longus tendon transfer. During surgery, rupture of the extensor pollicis longus tendon was seen between the metacarpophalangeal and wrist joints”

One of the things that I found interesting was that despite the tendon rupture, when the man was actually playing the game, he felt no pain. This is something I know only too well from personal experience. Unfortunately, I have a chronic and degenerative spinal complaint (herniated discs in my neck) but I feel no pain whatsoever when I am cognitively distracted. I find that work is a much better analgesic than dihydrocodeine (i.e., when I am working I feel no pain whatsoever). However, playing video games come a close second as when I am engaged in video game playing (even on simple casual games), the fact that it takes up all my cognitive resources means that I don’t feel any pain. This is nothing new and many medics are aware of the therapeutic benefits of gaming. There are now many studies showing that children undergoing chemotherapy need much less pain relief if they play video games after their treatment compared to children that don’t play video games. (In fact I’ve written a number of papers and book chapters on ‘video game therapy’ – see ‘Further reading’ below). This case report then went on to say:

“Video games suppress pain perception in pediatric patients and during burn treatments. Visual distraction and neuroendocrine hypothalamic-pituitary-adrenal arousal provide a plausible explanation for why the patient did not feel pain from his injury. Without the expected physiologic negative pain feedback, excessive gaming may have led to tendon attenuation and subsequent attritional rupture of the tendon. Attritional rupture at the midtendon differs from high- energy ruptures that occur where the tendon is thinnest or be- tween tendon and bone. Although this is only a single case report, research might consider whether video games have a role in clinical pain management and as nonpharmacologic alternatives during uncomfortable or painful medical procedures. They may also have a role in reducing stress. It may be interesting to ascertain whether various games differ in their ability to reduce the perception of pain…Research might also consider whether pain reduction is a reason some individuals play video games excessively, manifest addiction, or sustain injuries associated with video gaming”.

This conclusion does appear to suggest that the authors are unaware of the many hundreds of studies that have examined the therapeutic benefits of gaming (in fact there’s even an academic journal dedicated to such studies appropriately called the Games For Health Journal). As I have noted in a number of my writings about video gaming as a medical intervention for children:

  • Videogames are likely to engage much of a person’s individual active attention because of the cognitive and motor activity required.
  • Videogames allow the possibility to achieve sustained achievement because of the level of difficulty (i.e., challenge) of most games during extended play.
  • Videogames appear to appeal most to adolescents.

Consequently, videogames have also been used in a number of studies as ‘distractor tasks’. This latest case report highlights the simultaneous potential positive and negatives of gaming within a single individual but also highlights the fact that video gaming is both mobile and spreading to many more types of hardware. I’m now wondering which medical team will be the first to write about a new medical syndrome relating to the new Apple Watch.

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

Further reading

Behr, J.T. (1984). Pseudovideoma. Journal of Hand Surgery, 9(4), 613.

Gibofsky, A. (1983). Pac‐Man phalanx. Arthritis and Rheumatism, 26(1), 120.

Gilman, L., Cage, D.N., Horn, A. Bishop, F., Klam, W.P. & Doan, A.P. (2015). Tendon rupture associated with excessive smartphone gaming. JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.0753

Griffiths, M.D. (2003). The therapeutic use of videogames in childhood and adolescence. Clinical Child Psychology and Psychiatry, 8, 547-554.

Griffiths, M.D. (2005). Video games and health. British Medical Journal, 331, 122-123.

Griffiths, M.D. (2005). The therapeutic value of videogames. In J. Goldstein & J. Raessens (Eds.), Handbook of Computer Game Studies (pp. 161-171). Boston: MIT Press.

Griffiths, M. D., Kuss, D.J., & Ortiz de Gortari, A. (2013). Videogames as therapy: A review of the medical and psychological literature. In I. M. Miranda & M. M. Cruz-Cunha (Eds.), Handbook of research on ICTs for healthcare and social services: Developments and applications (pp.43-68). Pennsylvania: IGI Global.

McCowan, T.C. (1981). Space Invader’s wrist. New England Journal of Medicine, 304,1368.

Osterman, A. L., Weinberg, P., & Miller, G. (1987). Joystick digit. Journal of the American Medical Association, 257(6), 782.

O’Sullivan, B. (2013). Beyond BlackBerry thumb. CMAJ, 185, 185-186.

Soe, G.B., Gersten, L. M., Wilkins, J., Patzakis, M. J., & Harvey, J.P. (1987). Infection associated with joystick mimicking a spider bite. Western Journal of Medicine, 146(6), 748.

Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2014). Internet Addiction Disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program. Addictive Behaviors,

Disarray of light: A brief look at ‘chaos addiction’

A few weeks ago, three independent things happened that has led me to writing this article. Firstly, I received an email from one of my blog readers who wrote:

“I’m a recovering addict. I still find that hard to admit even after time in therapy and the support of my loved ones, but to say it out loud can sometimes be a help. One part of my therapy, which really did strike a chord was something called ‘Chaos Addiction’. It was suggested to me that my addictive behaviors were fueled by a need to constantly have things in my life that were ‘in flux’ – to experience the ‘predictably unpredictable’. Looking back over my life, it hit home…I’d love it if you might think about sharing this with your site’s readership”.

Secondly, a couple of days later I was given a CD-R by one of my friends that included the song ‘Addicted to Chaos’ by the group Megadeth (from their 1994 album Youthanasia). Thirdly, a couple of days after that I was watching the film Chasing Lanes where the lead character in the film Doyle Gipson (played by Samuel L Jackson) is told by his Alcoholics Anonymous sponsor (played by William Hurt) that he was ‘addicted to chaos’ rather than alcohol.

I have never come across the term ‘chaos addiction’ prior to the email I was sent. As far as I am aware, there has never been any empirical research on the topic although Dr. Keith Lee did write a 2007 book (Addicted to chaos: The journey from extreme to serene) of his own experiences on the topic. Using case studies, the book examines individuals that have become “addicted to intensity out of the chaos and toward mind/body harmony, higher consciousness, and a deeply spiritual transformation”. More specifically:

“In a culture where the ‘extreme theme’ has become the norm, people are increasingly seduced into believing that intensity equals being alive. When that happens, the mind becomes wired for drama and the soul is starved of meaningful purpose. This type of life may produce heart-pounding excitement, but the absence of this addictive energy can bring about withdrawal, fear, and restlessness that is unbearable”.

In researching this article I came across a number of online articles dealing with ‘addiction to chaos’. The term has been applied to the actress Lindsay Lohan following a television interview with Oprah Winfrey (and the many articles that followed that honed in on her ‘addiction to chaos).

A short piece in Business Week by Clate Mask claimed that it is entrepreneurs that are frequently addicted to chaos (based on his “experiences and observations working with thousands and thousands of entrepreneurs over the years” along with his top three signs he sees as being addicted to chaos: (i) their business life revolves around the in-box, (ii) they can’t step away from the business, (ii) they are strangely proud they have so little free time. Clate then goes on to claim that:

“If you find yourself experiencing these symptoms, you are probably addicted to chaos. Get help. Business ownership should bring you more time, money, and control. If you’re not getting that, make some changes to your mindset and your business systems so you can find the freedom you were looking for when you started your business in the first place”.

However, to me, this appears to be more like addiction to work rather than addiction to chaos (see ‘Further reading’ below for my papers on workaholism).

An online article by Silvia Mordini discussed about her personal experiences and how she now uses yoga to provide grounding and stability in her life. (In fact, there are quite a few papers on treating addictions with yoga including a recent systematic review of randomized control trials by Paul Posadski and his colleagues in the journal Focus on Alternative and Complementary Therapies – see ‘Further reading’ below). As Mordini confessed:

“My past addiction to chaos simply hurt me too much. I got sick of the constant mental tug-o-war with myself.  I’m not interested in feeling impatient with one thought and having to pull or push at the next one. Impatience promotes chaos and doesn’t feel good. The antidote to this is patience. Patience feels good. It feels like a return to mental stability no matter the chaos around us or what other people are thinking or doing…[The grounding that yoga brings] serves us as a simplifying force in order to stabilize our minds. When grounded, we plug back into our best selves and become fully present and balanced. Our energy stabilizes. Once centered, we are able to clearly see the circumstances of our lives. We no longer over-respond or over-worry because the static noise of chaos doesn’t pull us apart”.

She then goes on to provide her readers with five practical ways to promote stability and overcome addiction to chaos: (i) practice yoga, (ii) meditate, (iii) use a mantra (she suggests “I will let go of the need to be needed/I will let go of the need to be accepted/I will let go of the need to be accomplished), unplug from technology, and (v) get your hands and feet dirty (do some gardening, go for a walk on the beach, etc.). Obviously there is no clinical research confirming that these strategies would help overcome ‘chaos addiction’ but engaging in them certainly won’t do anyone any harm.

Another online article (‘Addicted to Chaos’) by addiction counselor Rita Barsky notes that many addicts grew up within dysfunctional families and noted:

“We never felt safe in our family of origin and the only thing we knew for sure was that nothing was for sure. Life was totally unpredictable and we became conditioned to living in chaos. When I talk about chaos in our lives, it was often not the kind that can be seen. In fact, many alcoholic/addict mothers were also super controllers and on the surface, our lives appeared to be perfect. The unsafe and chaotic living conditions of our lives were not visible or obvious to the outside world. Despite the appearance of everything being under control, we experienced continued chaos, developed a tolerance for chaos and I believe became addicted to chaos. I think it is important to say I have never done a scientific experiment to investigate this theory. It is based on observation of numerous alcoholic/addicts and their behavior”.

This was clearly written from experience and appears to have some face validity. Interestingly, Barsky then goes on to say:

“During the recovery process life becomes more manageable and less chaotic. The alcoholic/addict begins to feel a sense of autonomy and safety. A feeling of calm settles over their life. The paradox for the alcoholic/addict is that feeling calm is so unfamiliar it induces anxiety. There is a sense of waiting for the other shoe to drop. When there is a crisis, whether real or perceived, we actually experience a physical exhilaration and it feels remarkably like being active. From there it can be a very short distance to a relapse. Even if we don’t pick up we are not in a sober frame of mind. Addiction to chaos can be very damaging. Once engaged in someone else’s crisis we abandon ourselves and often develop resentments, especially if it is someone we love or are close to. Family chaos is the ‘best’ because it’s so familiar and we can really get off on it. When there is a crisis with family or friends we feel compelled to listen to every sordid detail and/or take action. We are unable to let go, we need to be in the mix even though it is painful and upsetting. It requires tremendous effort to detach and not jump in with both feet to the detriment to our well being”.

I find this account compelling because it’s written by someone that appears to have gone through this herself, and has now applied her therapeutic expertise retrospectively to understand the underlying psychology of what was occurring at the height of the addiction. Another compelling account is at Molly Field’s Yoga Blog.

“My object of desire is Chaos. My therapist told me at the end of my first session ever that I have a Chaos addiction…I’m not kidding: this stuff’s insidious. If it weren’t for my awareness of my ability to lose my temper over little-seeming things (aka scars from my past), I’d never know about the Addiction to Chaos. It’s because I grew up with it, was surrounded by it and trained by some of the world’s finest Chaos foments that I became one myself…My relationship with Chaos had become so much a part of my fabric of being that if I didn’t sense it, I would make it”.

Finally, I’ll leave you with the only tool that I have come across that claims to provide a diagnostic indication of whether someone is addicted to chaos. I need to point out that this came from the website of former psychologist Phil McGraw, the US television host of Dr. Phil. I have reproduced everything below verbatim (so when it says that “you are addicted to chaos” if you endorsed five or more of the ten items, that is the view of Dr. Phil – whenever I have co-developed a scale, I at least add the words “You may have a problem” rather than “You have got a problem”).

“While most people try to avoid drama, research shows that others have figured out how to trigger the body’s stress response, just for the rush. Take the test and find out if you’re creating chaos in your everyday life!

Directions: Answer the following questions ‘True’ or ‘False’

  • Do you usually yell and scream to make your point?
  • Do you ramp things up to win every argument? 

  • If you get sick, do you feel that EVERYONE should know about it?
When you argue, do you ever break things or knock them over? 

  • Does being calm or bored sound like the worst thing to you? 

  • Do you ever yell at strangers if you feel that they are in your way? 

  • Do you hate it when you are not the center of attention? 

  • Is there usually a crisis to solve in your life? 

  • Do you break up or threaten a break up with a mate often? 

  • Are you usually the one who starts fights?

Results: If you answered ‘True’ to five or more of the questions above, you are addicted to chaos”

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

Further reading

Barsky, R. (2007). Addicted to Chaos. A Sober Mind, December 2. Located at:

Field, M. (2012). Recovering from an addiction to chaos. The Yoga Blog, April 7. Located at:

Griffiths, M.D. (2005). Workaholism is still a useful construct Addiction Research and Theory, 13, 97-100.

Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Jakub, L. Addicted to chaos: Oprah’s interview with Lindsay Lohan. Hello Giggles, August 19. Located at:

Kramer, L. (2015). Are you addicted to chaos?, January, 15. Located at:

Lee, J.K. (2007). Addicted to chaos: The journey from extreme to serene. Transformational Life Coaching and Consultancy.

Mask, C. (2011). Three signs you’re addicted to chaos. Business Week, March 18. Located at:

Posadzki, P., Choi, J., Lee, M. S., & Ernst, E. (2014). Yoga for addictions: a systematic review of randomised clinical trials. Focus on Alternative and Complementary Therapies, 19(1), 1-8.

Mordini, S. (2013). Are you addicted to chaos and drama? Mind Body Green, January 15. Located at:

Played to death: What turns online gaming into a health risk?

Please note that the following article is a slightly extended version of an article that was first published by CNN International

Last month, a 32-year old male gamer was found dead at a Taiwanese Internet café following a non-stop three-day gaming session. This followed the death of another male gamer who died in Taipei at the start of the year following a five-day gaming binge.

While these cases are extremely rare, it does beg the question of why gaming can lead to such excessive behaviour. I have spent nearly three decades studying videogame addiction and there are many studies published in both the medical and psychological literature showing that very excessive gaming can lead to a variety of health problems that range from repetitive strain injuries and obesity, through to auditory and visual hallucinations and addiction. I have to stress that there is lots of scientific research showing the many educational and therapeutic benefits of playing but there is definitely a small minority of gamers that develop problems as a result of gaming overuse.

But what is it that makes gaming so compulsive and addictive for the small minority? For me, addiction boils down to constant reinforcement, or put more simply, being constantly rewarded while playing the game. Gaming rewards can be physiological (such as feeling ‘high’ or getting a ‘buzz’ while playing or beating your personal high score), psychological (such as feeling you have complete control in a specific situation or knowing that your strategic play helped you win), social (such as being congratulated by fellow gamers when doing something well in the game) and, in some cases, financial (such as winning a gaming tournament). Most of these rewards are – at least to some extent – unpredictable. Not knowing when the next reward will come keeps some players in the game. In short, they carry on gaming even though they may not have received an immediate reward. They simply hope that another reward is ‘just around the corner’ and keep on playing.

Added to this is the shift over the last decade from standalone console gaming to massively multiplayer online games where games never end and gamers have to compete and/or collaborate with other gamers in real time (instead of being able to pause the game and come back and play from the point at which the player left it). Many excessive gamers report that they hate logging off and leaving such games. They don’t like it as they don’t know what is going on in the game when they are not online.

The last five years has seen large increase in the number of scientific studies on problematic gaming. In May 2013, the American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). For the first time, the DSM-5 included ‘internet gaming disorder’ (IGD) as a psychological condition that warrants future research. Throughout my research career I have argued that although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences such as total preoccupation, mood modification, cravings, tolerance, withdrawal symptoms, conflict with work, education and other people, and loss of control. These similarities likely reflect a common etiology of addictive behaviour.

So when does a healthy enthusiasm turn into an addiction? At the simplest level, healthy enthusiams add to life and addictions take away from it. But how much is too much? This is difficult to answer as I know many gamers who play many hours every day without any detrimental effects. The DSM-5 lists nine criteria for IGD. If any gamer endorses five or more of the following criteria they would likely be diagnosed as having IGD: (1) preoccupation with internet games; (2) withdrawal symptoms when internet gaming is taken away; (3) the need to spend increasing amounts of time engaged in internet gaming, (4) unsuccessful attempts to control participation in internet gaming; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, internet gaming; (6) continued excessive use of internet games despite knowledge of psychosocial problems; (7) deception of family members, therapists, or others regarding the amount of internet gaming; (8) use of the internet gaming to escape or relieve a negative mood;  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in internet games.

The good news is that only a small minority of gamers suffer form IGD. Most online games are fun and exciting to play. But like any activity that is taken to excess, in a minority of cases the activity can become addictive. Any activity if done for days on end could lead to severe health problems and even death – and gaming is no exception. Instead of demonizing games, we need to educate gamers about the potential dangers of very excessive use.

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

Further reading

Griffiths, M.D. (2014). Gaming addiction in adolescence (revisited). Education and Health, 32, 125-129.

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

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

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

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

Kuss, D.J. & Griffiths, M.D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2, 347-374.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in adolescence: A literature review of empirical research. Journal of Behavioral Addictions, 1, 3-22.

Lopez-Fernandez, O., Honrubia-Serrano, M.L., Baguley, T. & Griffiths, M.D. (2014). Pathological video game playing in Spanish and British adolescents: Towards the Internet Gaming Disorder symptomatology. Computers in Human Behavior, 41, 304–312.

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

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

Spekman, M.L.C., Konijn, E.A, Roelofsma, P.H.M.P. & Griffiths, M.D. (2013). Gaming addiction, definition, and measurement: A large-scale empirical study, Computers in Human Behavior, 29, 2150-2155.


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