Category Archives: Adolescence

World of the Weird: The A-Z of strange and bizarre addictions

Today’s blog takes a brief look at some of the stranger addictions that have been written about in the academic literature (or academics that have tried to argue these behaviours can be addictive). Some of these ‘addictions’ listed are not addictions by my own criteria but others have argued they are. The papers or books that have argued the case for the cited behaviour being a type of addiction are found in the ‘Further reading’ section.

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  • Argentine tango addiction: A French study published in a 2013 issue of the Journal of Behavioral Addictions by Remi Targhetta and colleagues argued that a minority of 1129 Argentine tango dancers they surveyed may be addicted to dancing. In 2015, I and some of my Hungarian colleagues developed the Dance Addiction Inventory (published in PLoS ONE) and also argued that a minority of dancers (more generally) might be addicted to dance and conceptualized the behaviour as a form of exercise addiction.
  • Badminton addiction: While there are many behaviours I could have chosen here including addictions to box set television watching (aka ‘box set bingeing), bargain hunting, bungee jumping, blogging, and bodybuilding, a recent 2018 paper published in NeuroQuantology by Minji Kwon and colleagues carried out a neuroimaging study on a sample 45 badminton players. Using the Korean Exercise Addiction Scale, 20% of the sample were defined as being addicted to badminton.
  • Carrot eating addiction: Again, there are many behaviours I could have chosen here including alleged addictions to crypto-trading, chaos, collecting, crosswords, and cycling, there are a number of published case studies in the psychological literature highlighting individuals addicted to eating carrots including papers by Ludek Černý and Karel Černý, K. (British Journal of Addiction, 1992), and Robert Kaplan (Australian and New Zealand Journal of Psychiatry, 1996).
  • Death addiction: A recent paper by Dr. Marc Reisinger entitled ‘Addiction to death’ in the journal CNS Spectrums attempted to argue that attraction to death be considered an addiction similar to gambling addiction. Reisinger related the concept to individuals who have left Europe to join the jihad in Syria, and outlined the case of 24-year-old French-Algerian Mohamed Merah who committed several attacks in Toulouse in 2012 and who ‘glorified’ death. Te paper claimed that this “addiction to death is taught by Salafist preachers, whose videos, readily accessible on the internet, are kind of advertisements for death, complete with depictions of soothing fountains and beautiful young girls”.
  • Entrepreneurship addiction: There are a couple of papers by April Spivack and Alexander McKelvie (a 2014 paper in the Journal of Business Venturing, and a 2018 paper Academy of Management) arguing that entrepreneurship can be addictive. They define ‘entrepreneurship addiction’ as “the excessive or compulsive engagement in entrepreneurial activities that results in a variety of social, emotional, and/or physiological problems and that despite the development of these problems, the entrepreneur is unable to resist the compulsion to engage in entrepreneurial activities”. They also make the case that that entrepreneurship addiction is different from workaholism.
  • Fortune telling addiction: Although I could have included addictions to financial trading or fame, a 2015 paper in the Journal of Behavioral Addictions by Marie Grall-Bronnec and her colleagues reported the case study of a woman (Helen) that was ‘addicted’ to fortune tellers. They used my addiction criteria to assess whether Helen was addicted to fortune telling, and argued that she was.
  • Google Glass addiction: In previous blogs I have written on addictions to gossip and gardening (although these were based more on non-academic literature). However, a 2015 paper published by Kathryn Yung and her colleagues in the journal Addictive Behaviors, published the first (and to my knowledge) only case of addiction to Google Glass (wearable computer-aided glasses with Bluetooth connectivity to internet-ready devices. The authors claimed that their paper, (i) showed that excessive and problematic uses of Google Glasscan be associated with involuntary movements to the temple area and short-term memory problems, and (ii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass.
  • Hacking addiction: Back in the late 1990s and early 2000s I wrote a number of papers on internet addiction and included ‘hacking addiction’ as a type of internet addiction. Given the criminal element of this type of internet addiction I wrote about it in criminological-based journals such as The Probation Journal (1997) and The Police Journal (2000). One of the most infamous cases that I have written about took place in London in 1993, where Paul Bedworth was accused of hacking-related crime causing over £500,000 worth of damage. On the basis of expert witness testimony, he was acquitted on the basis that he was addicted to hacking. Since then, various papers have been published arguing that hacking can be an addiction. For instance, in an in-depth interview study of 62 hackers, Siew Chan and Lee Yao used addiction as a framework to explain their participants’ behaviour (see their paper in the Review of Business Information Systems, 2005).
  • Internet search addiction: Although I was tempted to go for IVF addiction, I thought I would go for ‘internet search addiction’ which basically refers to constant ‘googling’ where individuals spend hours and hours every day using online databases to go searching for things. This behaviour was first alluded to by Kimberley Young in her 1999 classification of different types of internet addiction which she called ‘information overload’ and was defined as compulsive web surfing or database searches. More recently, Yifan Wang and her colleagues developed the Questionnaire on Internet Search Dependence (QISD) published in Frontiers in Public Health (FiPH). I criticized the QISD in a response paper published in FiPH, not because I didn’t think internet search addiction didn’t exist (because theoretically it might do, even though I’ve never come across a genuine case) but because the items in the instrument had very little to do with addiction.
  • Joyriding addiction: There have been a number of academic papers published on joyriding addiction. Arguably the most well-known study was published by Sue Kellett and Harriet Gross in a 2006 issue of Psychology, Crime and Law. The study comprised semi-structured interviews with 54 joyriders (aged 15 to 21 years of age) all of whom were convicted car thieves (“mainly in custodial care”). The results of the study indicated that all addiction criteria occurred within the joyriders’ accounts of their behaviour particularly ‘‘persistence despite knowledge and concern about the harmful consequences’’, ‘‘tolerance’’, ‘‘persistent desire and/or unsuccessful attempts to stop’’, “large amounts of time being spent thinking about and/or recovering from the behaviour’’ and “loss of control”. The paper also cited examples of ‘withdrawal’ symptoms when not joyriding, the giving up of other important activities so that they could go joyriding instead, and spending more time participating in joyriding than they had originally intended.
  • Killing addiction: The idea of serial killing being conceptualized as an addiction in popular culture is not new. For instance, Brian Masters book about British serial killer Dennis Nilsen (who killed at least 12 young men) was entitled Killing for Company: The Story of a Man Addicted to Murder, and Mikaela Sitford’s book about Harold Shipman, the British GP who killed over 200 people, was entitled Addicted to Murder: The True Story of Dr. Harold Shipman. In Eric Hickey’s 2010 book Serial Murderers and Their Victims, Hickey makes reference to an unpublished 1990 monograph by Dr. Victor Cline who outlined a four-factor addiction syndrome in relation to sexual serial killers who (so-called ‘lust murderers’ that I examined in a previous blog). One of the things that I have always argued throughout my career, is that someone cannot become addicted to an activity or a substance unless they are constantly being rewarded (either by continual positive and/or negative reinforcement). Given that serial killing is a discontinuous activity (i.e., it happens relatively infrequently rather than every hour or day) how could killing be an addiction? One answer is that the act of killing is part of the wider behaviour in that the preoccupation with killing can also include the re-enacting of past kills and the keeping of ‘trophies’ from the victims (which I overviewed in a previous blog).
  • Love addiction: In the psychological literature, the concept of love addiction has been around for some time dating back to works by Sigmund Freud. Arguably the most cited work in this area is the 1975 book Love and Addiction by Stanton Peele and Archie Brodsky. Their book suggested that some forms of love are actually forms of addiction, and tried to make the case that some forms of love addiction may be potentially more destructive and prevalent than widely recognized opiate drugs. There have also been a number of instruments developed assessing love addiction including the Love Addiction Scale (developed by Hunter, Nitschke, and Hogan, 1981), and the Passionate Love Scale (developed by Hatfield, and Sprecher, 1986).
  • Muscle dysmporphia as an addiction: In a paper I published with Andrew Foster and Gillian Shorter in a 2015 issue of the Journal of Behavioral Addictions, we argued that muscle dysmorphia (MD) could be classed as an addiction. MD is a condition characterised by a misconstrued body image in individuals who interpret their body size as both small or weak even though they may look normal or highly muscular. MD has been conceptualized as a body dysmorphic disorder, an eating disorder, and/or part of the obsessive-compulsive disorder symptomatology. Reviewing the most salient literature on MD, we proposed an alternative classification of MD that we termed the ‘Addiction to Body Image’ (ABI) model. We argued the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating specific foods, taking specific drugs (e.g., anabolic steroids), shopping for specific foods, food supplements, and/or physical exercise accessories, etc.. In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition (rather than addiction to exercise or certain types of eating disorder). Based on empirical evidence, we proposed that MD could be re-classed as an addiction due to the individual continuing to engage in maintenance behaviours that may cause long-term harm.
  • News addiction: Although I could have chosen nasal spray addiction or near death addiction, a recent 2017 paper on ‘news addiction’ was published in the Journal of the Dow University of Health Sciences Karachi by Ghulam Ishaq and colleagues. The authors used some of my papers on behavioural addiction to argue for the construct of ‘news addiction’ as a construct to be empirically investigated. The authors also developed their own 19-item News Addiction Scale (NAS) although the paper didn’t give any examples of any of the items in the NAS. In relation to personality types (and like other addictions), they found news addiction was positively correlated with neuroticism and negatively correlated with conscientiousness. Given that this is the only study on news addiction that I am aware of, I’ll need a lot more research evidence before I am convinced that it really exists.
  • Online auction addiction: A number of academics have made the claim that some individuals can become addicted to participating in online auctions. In a 2004 paper on internet addiction published in American Behavioral Scientist, Kimberley Young mentioned online auction [eBay] addiction in passing. The same observation was also made in a later 2009 paper by Tonino Cantelmi and Massimo Talls in the Journal of CyberTherapy and Rehabilitation. Other researchers have carried out empirical studies including a (i) 2007 paper by Cara Peters and Charles Bodkin in the Journal of Retailing and Consumer Services, (ii) 2008 paper by Chih-Chien Wang in the Proceedings of the Asia-Pacific Services Computing Conference, and (iii) 2011 study carried out by Dr. Ofir Turel and colleagues published in the MIS Quarerly. These papers indicated that those with problematic online auction use experienced (i) psychological distress, (ii) habitual usage, (iii) compulsive behaviour, (iv) negative consequences, and/or (v) dependence, withdrawal and self-regulation.
  • Pinball addiction: Although I could have listed alleged addictions to plastic surgery and poetry, as far as I am aware, I am the only academic to have published a paper on pinball addiction. Back in 1992, I published a case study in Psychological Reports. My paper featured the case of a young man (aged 25 years) who (based on classic addiction criteria) was totally hooked on pinball. It was the most important thing in his life, used the behaviour to modify his moods, got withdrawal symptoms if he was unable to play pinball, had engaged in repeated efforts to cut down or stop playing pinball, and compromised all other activities in his life (education, occupation and relationships). To me, this individual had a gaming addiction but it was pinball rather than videogame addiction.
  • Qat addiction: Qat (sometimes known as khat, kat, cat, and ghat) is a flowering plant traditionally used as a mild stimulant in African and Middle East countries (Somalia, Yemen, Ethiopia). Heavy qat users can experience many side effects including insomnia, anxiety, increased aggression, high blood pressure, and heart problems. There are numerous reports in the medical literature of qat addiction (see papers by Rita Manghi and colleagues in the Journal of Psychoactive Drugs, and Nezar Al-Hebshi and Nils Skuag in Addiction Biology).
  • Rock climbing addiction: Over the past two years, a couple of papers by Robert Heirene, David Shearer, and Gareth Roderique-Davies have looked at the addictive properties of rock climbing specifically concentrating on withdrawal symptoms and craving. In the first paper on withdrawal symptoms published in 2016 in the Journal of Behavioral Addictions, the authors highlighted some previous research suggesting that there are similarities in the phenomenology of substance-related addictions and extreme sports (in this case rock climbing). The study concluded that based on self-report, rock climbers experienced genuine withdrawal symptoms during abstinence from climbing and that these were comparable to individuals with substance and other behavioural addictions. In a second investigation just published in Frontiers in Psychology, the same team reported the development of the Rock Climbing Craving Questionnaire comprising three factors (‘positive reinforcement’, ‘negative reinforcement’ and ‘urge to climb’).
  • Study addiction: I was spoilt for choice on the letter ‘S’ and could have mentioned addictions to speeding, selfie-taking, shoplifting, Sudoko, and stock market speculation. However, there are now a number of published papers on ‘study addiction’ (individuals addicted to their academic study), three of which I have co-authored (all in the Journal of Behavioral Addictions and led by my colleague Pawel Atroszko). We have conceptualised study addiction as a type of work addiction (or a pre-cursor to work addiction) and in a series of studies (including longitudinal research) we have found empirical evidence of ‘study addiction’. Italian researchers (Yura Loscalzo and Marco Giannini) have also published research on ‘overstudying’ and ‘studyholism’ too (in the journals ARC Journal of Psychiatry, 2017; Social Indicators Research, 2018).
  • Tanning addiction: There is now lots of empirical research examining ‘tanorexia’ (individuals who crave tanning and spend every day on sunbeds). However, I along with my colleagues in Norway recently reconceptualised tanorexia as a ‘tanning addiction’ and developed a scale to assess it (which was recently published in a 2018 issue of the British Journal of Dermatology). Our study was the largest over study on tanning (over 23,000 participants) and our newly developed scale (the Bergen Tanning Addiction Scale) had good psychometric properties.
  • Upskirting addiction: Upskirting refers to taking a photograph (typically with a smartphone) up someone’s skirt without their permission. In the UK there have been a number of high profile court cases including Paul Appleby who managed to take 9000 upskirting photos in the space of just five weeks (suggesting that he was doing it all day every day to have taken so many photos), and Andrew MacRae who had amassed 49,000 upskirt photos and videos using hidden cameras at his workplace, on trains, and at the beach. Both men avoided a custodial sentence because their lawyers argued they were addicted and/or had a compulsion to upskirting. In a 2017 issue of the Law Gazette, forensic psychologist Julia Lam made countless references to upskirting in an overview of voyeuristic disorder. Dr. Lam also talked about her treatment of upskirting voyeurs and recounted one case which she claimed was a compulsion (and who was successfully treated). The case involved a male university student who was very sport active but who masturbated excessively whenever major sporting events or important exams were imminent as a coping strategy to relieve stress.
  • Virtual reality addiction: Back in 1995, in a paper I entitled ‘Technological addictions’ in the journal Clinical Psychology Forum, I asserted that addiction to virtual reality would be something that psychologists would be seeing more of in the future. Although I wrote the paper over 20 years ago, there is still little empirical evidence (as yet) that individuals have become addicted to virtual reality (VR). However, that is probably more to do with the fact that – until very recently – there had been little in the way of affordable VR headsets. (I ought to just add that when I use the term ‘VR addiction’ what I am really talking about is addiction to the applications that can be utilized via VR hardware rather than the VR hardware itself). Of all the behaviours on this list, this is the one where there is less good evidence for its existence. Perhaps of most psychological concern is the use of VR in video gaming. There is a small minority of players out there who are already experiencing genuine addictions to online gaming. VR takes immersive gaming to the next level, and for those that use games as a method of coping and escape from the problems they have in the real world it’s not hard to see how a minority of individuals will prefer to spend a significant amount of their waking time in VR environments rather than their real life.
  • Water addiction: In a blog I wrote back in 2015, I recounted some press stories on individuals who claimed they were ‘addicted’ to drinking water. My research into the topic led to a case study of ‘water dependence’ published a 1973 issue of the British Journal of Addiction by E.L. Edelstein. This paper reported that the excessive drinking of water can dilute electrolytes in an individual’s brain and cause intoxication. This led me to a condition called polydipsia (which in practical terms means drinking more than three litres of water a day) which often goes hand-in-hand with hyponatraemia (i.e., low sodium concentration in the blood) and in extreme cases can lead to excessive water drinkers slipping into a coma. There are also dozens and dozens of academic papers on psychogenic polydipsia (PPD). A paper by Dr. Brian Dundas and colleagues in a 2007 issue of Current Psychiatry Reports noted that PPD is a clinical syndrome characterized by polyuria (constantly going to the toilet) and polydipsia (constantly drinking too much water), and is common among individuals with psychiatric disorders. A 2000 study in European Psychiatry by E. Mercier-Guidez and G. Loas examined water intoxication in 353 French psychiatric inpatients. They reported that water intoxication can lead to irreversible brain damage and that around one-fifth of deaths among schizophrenics below the age of 53 years are caused this way. Whether ‘water intoxication’ is a symptom of being ‘addicted’ to water depends upon the definition of addiction being used.
  • X-ray addiction: OK, this one’s a little bit of a cheat but what I really wanted to concentrate on what has been unofficially termed factitious disorder (FD). According to Kamil Jaghab and colleagues in a 2006 issue of the Psychiatry journal FD is sometimes referred to as hospital addiction, pathomimia, or polysurgical addiction”. The primary characteristic of people suffering from FD is that they deliberately pretend to be ill in the absence of external incentives (such as criminal prosecution or financial gain). It is called a factitious because sufferers feign illness, pretend to have a disease, and/or fake psychological trauma typically to gain attention and/or sympathy from other people. Again, whether such behaviours can be viewed as an addiction depends upon the definition of addiction being used.
  • YouTube addiction: I unexpectedly found my research on internet addiction being cited in a news article by Paula Gaita on compulsive viewing of YouTube videos (‘Does compulsive YouTube viewing qualify as addiction?‘). The article was actually reporting a case study from a different news article published by PBS NewsHour by science correspondent Lesley McClurg (‘After compulsively watching YouTube, teenage girl lands in rehab for digital addiction’). The story profiled a student whose obsessive viewing of YouTube content led to extreme behaviour changes and eventually, depression and a suicide attempt. Not long after this, I and my colleague Janarthanan Balakrishnan published what we believe is the only ever study on YouTube addiction in the Journal of Behavioral Addictions. In a study of over 400 YouTube users we found that YouTube addiction was more associated with content creation than watching content
  • ‘Zedding’ addiction: OK, I’m using the Urban Dictionary’s synonym here as a way of including ‘sleep addiction’. The term ‘sleep addiction’ is sometimes used to describe the behavior 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.

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

Further reading

Al‐Hebshi, N., & Skaug, N. (2005). Khat (Catha edulis) – An updated review. Addiction Biology, 10(4), 299-307.

Andreassen, C.S., Pallesen, S. Torsheim, T., Demetrovics, Z. & Griffiths, M.D. (2018). Tanning addiction: Conceptualization, assessment, and correlates. British Journal of Dermatology. doi: 10.1111/bjd.16480

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

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2015). Study addiction – A new area of psychological study: Conceptualization, assessment, and preliminary empirical findings. Journal of Behavioral Addictions, 4, 75–84.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2016). Study addiction: A cross-cultural longitudinal study examining temporal stability and predictors of its changes. Journal of Behavioral Addictions, 5, 357–362.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D., Pallesen, S. (2016). The relationship between study addiction and work addiction: A cross-cultural longitudinal study. Journal of Behavioral Addiction, 5, 708–714.

Balakrishnan, J. & Griffiths, M.D. (2017). Social media addiction: What is the role of content in YouTube? Journal of Behavioral Addictions, 6, 364-377.

Black, D., Belsare, G., & Schlosser, S. (1999). Clinical features, psychiatric comorbidity, and health-related quality of life in persons reporting compulsive computer use behavior. Journal of Clinical Psychiatry, 60, 839-843.

Burn, C. (2016). Poesegraphilia – Addiction to the act of writing poetry. Poetry Changes Lives, May 27. Located at: http://www.poetrychangeslives.com/addiction-to-the-act-of-writing-poetry/

Cantelmi, T & Talls, M. (2009). Trapped in the web: The psychopathology of cyberspace. Journal of CyberTherapy and Rehabilitation, 2, 337-350.

Černý, L. & Černý, K. (1992). Can carrots be addictive? An extraordinary form of drug dependence. British Journal of Addiction, 87, 1195-1197.

Chan, S. H., & Yao, L. J. (2005). An empirical investigation of hacking behavior. The Review of Business Information Systems, 9(4), 42-58.

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

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

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

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

Foster, A.C., Shorter, G.W. & Griffiths, M.D. (2015). Muscle Dysmorphia: Could it be classified as an Addiction to Body Image? Journal of Behavioral Addictions, 4, 1-5.

Gaita, P. (2017). Does compulsive YouTube viewing qualify as addiction? The Fix, May 19. Located at: https://www.thefix.com/does-compulsive-youtube-viewing-qualify-addiction

Grall-Bronnec, M. Bulteau, S., Victorri-Vigneau, C., Bouju, G. & Sauvaget, A. (2015). Fortune telling addiction: Unfortunately a serious topic about a case report. Journal of Behavioral Addiction, 4, 27-31.

Griffiths, M.D. (1992). Pinball wizard: A case study of a pinball addict. Psychological Reports, 71, 160-162.

Griffiths, M.D. (2000). Computer crime and hacking: A serious issue for the police. Police Journal, 73, 18-24.

Griffiths, M.D. (2017). Commentary: Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 5, 95. doi: 10.3389/fpubh.2017.00095

Griffiths, M.D., Foster, A.C. & Shorter, G.W. (2015). Muscle dysmorphia as an addiction: A response to Nieuwoudt (2015) and Grant (2015). Journal of Behavioral Addictions, 4, 11-13.

Hatfield, E., & Sprecher, S. (1998). The passionate love scale. In Fisher, T.D., Davis, C.M., Yarber, W.L. & Davis, S. (Eds.). Handbook of sexuality-related measures (pp. 449-451). London: Sage.

Heirene, R. M., Shearer, D., Roderique-Davies, G., & Mellalieu, S. D. (2016). Addiction in extreme sports: An exploration of withdrawal states in rock climbers. Journal of Behavioral Addictions, 5(2), 332-341.

Hickey, E.W. (2010). Serial Murderers and Their Victims (Fifth Edition). Pacific Grove, CA: Brooks/Cole.

Hunter, M. S., Nitschke, C., & Hogan, L. 1981. A scale to measure love addiction. Psychological Reports, 48, 582-582.

Ishaq, G., Rafique, R., & Asif, M. (2017). Personality traits and news addiction: Mediating role of self-control. Journal of Dow University of Health Sciences, 11(2), 31-53.

Jaghab, K., Skodnek, K. B., & Padder, T. A. (2006). Munchausen’s syndrome and other factitious disorders in children: Case series and literature review. Psychiatry (Edgmont), 3(3), 46-55.

Kaplan, R. (1996), Carrot addiction. Australian and New Zealand Journal of Psychiatry, 30, 698-700.

Kellett, S.  & Gross, H. (2006). Addicted to joyriding? An exploration of young offenders’ accounts of their car crime. Psychology, Crime & Law, 12, 39-59.

Kennedy, J. G., Teague, J., & Fairbanks, L. (1980). Qat use in North Yemen and the problem of addiction: a study in medical anthropology. Culture, medicine and psychiatry, 4(4), 311-344.

Kwon, M., Kim, Y., Kim, H., & Kim, J. (2018). Does sport addiction enhance frontal executive function? The case of badminton. NeuroQuantology, 16(6), 13-21.

Lam, J. (2017). Fifty shades of sexual offending – Part 1. The Law Gazette, July. Located at: http://v1.lawgazette.com.sg/2017-07/1910.htm

Loscalzo, Y, & Giannini, M. (2017).  Evaluating the overstudy climate at school and in the family: The Overstudy Climate Scale (OCS). ARC Journal of Psychiatry, 2(3), 5-10.

Loscalzo, Y., & Giannini, M. (2018). Study engagement in Italian university students: A Confirmatory Factor Analysis of the Utrecht Work Engagement Scale—Student Version. Social Indicators Research, Epub ahead of print. https://doi.org/10.1007/s11205-018-1943-y

Manghi, R. A., Broers, B., Khan, R., Benguettat, D., Khazaal, Y., & Zullino, D. F. (2009). Khat use: lifestyle or addiction? Journal of Psychoactive Drugs, 41(1), 1-10.

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PLoS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

Masters, B. (1986). Killing for Company: The Story of a Man Addicted to Murder. New York: Stein and Day.

McClurg, L. (2017). After compulsively watching YouTube, teenage girl lands in rehab for ‘digital addiction’. PBS Newshour, May 16. Located at: http://www.pbs.org/newshour/rundown/compulsively-watching-youtube-teenage-girl-lands-rehab-digital-addiction/

Menninger, K. A. (1934). Polysurgery and polysurgical addiction. The Psychoanalytic Quarterly, 3(2), 173-199.

Mercier-Guidez, E., & Loas, G. (2000). Polydipsia and water intoxication in 353 psychiatric inpatients: an epidemiological and psychopathological study. European Psychiatry, 15(5), 306-311.

Orosz, G., Bőthe, B., & Tóth-Király, I. (2016). The development of the Problematic Series WatchingScale (PSWS). Journal of Behavioral Addictions, 5(1), 144-150.

Peele, S. & Brodsky, A. (1975), Love and addiction. New York: Taplinger.

Peters, C.  & Bodkin, C.D. (2007). An exploratory investigation of problematic online auction behaviors: Experiences of eBay users. Journal of Retailing and Consumer Services, 14(1), 1-16.

Reisinger, M. (2018). Addiction to death. CNS Spectrums, 23(2), 166-169.

Relangi, K. (2012). Gossip, the ugly addiction. Purple Room Healing, June 12. Located at: https://deadmanswill.wordpress.com/2012/06/02/gossip-the-ugly-addiction/

Roderique-Davies, G. R. D., Heirene, R. M., Mellalieu, S., & Shearer, D. A. (2018). Development and initial validation of a rock climbing craving questionnaire (RCCQ). Frontiers in Psychology, 9, 204. doi: 10.3389/fpsyg.2018.00204

Sitford, M. (2000). Addicted to Murder: The True Story of Dr. Harold Shipman. London: Virgin Publishing.

Sparrow, P. & Griffiths, M.D. (1997). Crime and IT: Hacking and pornography on the internet. Probation Journal, 44, 144-147.

Spivack, A., & McKelvie, A. (2018). Entrepreneurship addiction: Shedding light on the manifestation of the ‘dark side’ in work behavior patterns. The Academy of Management Perspectives. https://doi.org/10.5465/amp.2016.0185

Spivack, A. J., McKelvie, A., & Haynie, J. M. (2014). Habitual entrepreneurs: Possible cases of entrepreneurship addiction? Journal of Business Venturing, 29(5), 651-667.

Targhetta, R., Nalpas, B. & Perney, P. (2013). Argentine tango: Another behavioral addiction? Journal of Behavioral Addictions, 2, 179-186.

Turel, O., Serenko, A. & Giles, P. (2011). Integrating technology addiction and use: An empirical investigation of online auction users. MIS Quarterly, 35, 1043-1061.

Walton-Pattison, E., Dombrowski, S.U. & Presseau, J. (2017). ‘Just one more episode’: Frequency and theoretical correlates of television binge watching. Journal of Health Psychology, doi:1359105316643379

Wang, C-C. (2008). The influence of passion and compulsive buying on online auction addiction. Proceedings of the Asia-Pacific Services Computing Conference (pp. 1187 – 1192). IEEE.

Wang, Y., Wu, L., Zhou, H., Xu, J. & Dong, G. (2016). Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 4, 274. doi: 10.3389/fpubh.2016.00274

Wright, M. R. (1986). Surgical addiction: A complication of modern surgery? Archives of Otolaryngology–Head & Neck Surgery, 112(8), 870-872.

Wulfsohn, I. (2013). A dangerous addiction: Qat and its draining of Yemen’s water, economy, and people. Middle East Economy, 3(10), 1-5.

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

Young, K. S. (2004). Internet addiction: A new clinical phenomenon and its consequences. American Behavioral Scientist, 48, 402–415.

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, 41, 58-60.

Voyeurs and their lawyers: Can ‘upskirting’ be addictive?

Over the past few months, ‘upskirting’ has been in the British news, particularly in relation to making it a criminal offence. A campaign initiated by freelance writer Gina Martin was started after she became a victim of upskirting. For those who don’t know what I’m talking about, upskirting refers to taking a photograph (typically with a smartphone) up someone’s skirt without their permission. Martin published an account of her ordeal for the World Economic Forum in April 2018 and reported that:

“Last summer, I was standing in a crowd of 60,000, on a hot summer’s day in London, waiting for The Killers to come on stage, when a man – whose advances I’d rejected – took pictures of my crotch by putting his phone between my legs as I chatted to my sister blissfully unaware. A few minutes later, I saw one of his friends looking at an intrusive picture of a woman’s crotch covered by a thin strip of fabric. I knew it was me. I grabbed the phone off him and checked. Tears filled my eyes and I began drawing attention to him: ‘You guys have been taking pictures of my vagina! What is wrong with you!?’ He grabbed me and pushed his face in front of mine, bellowing that I give him his phone back. I didn’t…The police arrived and were lovely. I was, understandably, a mess and they patiently calmed me down. What the police then did was ask him to delete the images – my evidence – and then, they told me they couldn’t do anything. ‘We had to look at the image, and although it showed far more than you’d want anyone to see, it’s not technically a graphic image. There’s not much we can do. If you weren’t wearing knickers it would be a different story.’ I was completely humiliated and devastated”.

Following this incident, and because upskirting wasn’t an offence, Martin began a campaign to get the act criminalized. Upskirting is currently an offence in Scotland but not in England and Wales. Upskirting is one of many sexual acts that are present among those individuals that have a voyeuristic disorder. In an article for the Law Gazette in July 2017 (‘Fifty shades of sexual offending’), forensic psychologist Dr. Julia Lam made countless references to upskirting in an overview of voyeuristic disorder. She noted that:

“Voyeuristic Disorder is a paraphilic/psychosexual disorder in which an individual derives sexual pleasure and gratification from looking at naked bodies and genital organs, observing the disrobing or sexual acts of others…Instead of peeping in situ using high-powered binoculars, with advances in technology such as camera phones and pin-hole cameras, voyeurs can now record the private moments with their devices: taking upskirt photos of unsuspecting individuals on escalators, or filming women in various states of undress in toilets and changing rooms. Voyeuristic behaviour is on the rise…Learning theory suggests that an initially random or accidental observation of an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, may lead to sexual interest and arousal; with each successive repetition of the peeping act reinforcing and perpetuating the voyeuristic behaviour”.

She reported that voyeurism is the most common type of sexual offence and that voyeurs can be men or women but that “men are commonly the perpetrators in the peeping acts/upskirt, with women being the victims”. She noted that the lifetime prevalence of voyeuristic disorder is around 12% among men and 4% in women, and that the causes of voyeurism are unknown. She then went onto say:

“The new vocabulary ‘upskirt’ is both a verb (the practise of capturing an image/video of an unsuspecting and non-consenting person in a private moment) and a noun (i.e. the actual voyeuristic photos or videos made; referred as “voyeur photography”)…While most voyeurs film for self-gratification (i.e. using upskirt materials for fantasy and masturbation), there are offenders who make upskirt photos and videos specifically for uploading onto the internet (e.g. fetish and pornographic websites and video-sharing sites like YouTube) for monetary profit…Upskirt is considered a ‘serious’ crime in Singapore as it intrudes upon the privacy of unsuspecting and non-consenting individuals. Offences typically take place on escalators, in fitting rooms, public toilets or shower rooms; with the offenders trying to capture what is underneath the ‘skirts’ or private moments of the victims with a recording device which may or may not be disguise”.

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She also said that in recent years in Singapore, she had assessed “a considerable number” of voyeurs that had engaged in upskirting and who were arrested, prosecuted, and incarcerated for their actions. Most of these criminal voyeurs were ‘first-timers’ (i.e., arrested and charged with upskirting for the first time), had a long history of engaging in excessive masturbation and pornography use, and that the offences were non-violent. However, she did note that although they may have been arrested for the first time, their interest in peeping and upskirting usually stemmed from adolescence. Dr. Lam also claimed that:

“Getting apprehended for [upskirting] is more a norm than an exception in this group, as it is just a matter of time that the offender would be careless or daring enough to invite apprehension. Police arrest usually serves as a final ‘wake-up call’ that breaks the offending pattern, accompanied with a great sense of shame and embarrassment. Many of these voyeurs are amenable to treatment…Most of the sufferers of Voyeuristic Disorder who came for my assessment reported their urges to upskirt and use the materials to masturbate as overwhelming, to the extent that they gave in to temptation without considering the grave consequences of their acts”.

Dr. Lam also talked about her treating upskirting voyeurs and recounted one case which she claimed was a compulsion. The case involved a male university student who was very sport active but who masturbated excessively whenever major sporting events or important exams were imminent as a coping strategy to relieve stress. Upskirting was another one of his coping strategies and he was eventually arrested for his behaviour. Dr. Lam then went on to report” 

“Every morning after he woke up, he would feel the urge to go out to find his ‘targets’. Although he knew it was very risky to take upskirt [photos] on MRT escalators, he felt compelled to satiate his urges and gratification, and was oblivious to his surroundings (e.g. passers-by security staff and CCTV) and the risk of being arrested. He could still feel the thrill and excitement, but he no longer enjoyed the act. It had become more like a compulsion…He was prescribed medication to manage his mood and urges to act out, and attended psychotherapy to work on his voyeuristic behaviour and learn more effective coping skills. He has since graduated from university, and has not breached the law with [upskirting] behaviour again”.

Dr. Lam, like other practitioners who treat sex offenders, often view extreme cases of voyeurism as a compulsion, obsession and/or an addiction. If extreme voyeurism (in general) can be seen as an addiction, there is no theoretical reason why upskirting couldn’t be viewed similarly. As far as I am aware, the case described by Dr. Lam is the only one in the academic literature of outlining and treating an individual with an upskirting disorder. As with other sexually non-normative behaviours I went online to see if there were any anecdotal accounts of addiction to upskirting and came across a few self-confessed accounts (particularly on The Candid Forum website):

  • Extract 1: “I’m not sure if you could help me. I suppose it’s an addiction. I am obsessed with women’s knickers and constantly try to look up women’s skirts, even schoolgirls. I know it’s wrong but I love to see the secrets. One day I will be caught and arrested. Am I a pervert?” (‘Andy’).
  • Extract 2: “I’m really starting to feel overwhelmed by this ‘addiction’ I have to upskirt videos…I just can’t seem to get enough, even when in the big picture, most of them are all the same. I have well over 3000 videos on my computer of just upskirts (not including other types of videos)…It’s also stressful to know that I may very well not get through them all, at least for a very long time (I still have yet to watch 1800 of them). There’s a lot of time involved in downloading them (waiting due to file hosting sites telling you [that] you have reached your daily limit etc., entering captcha codes). But all these videos actually amaze me at the same time, due to just how many times guys have gotten away with it…There’s a certain ‘wow’ factor I guess, but that also derives from the entire voyeur aspect of it to begin with, where a guy is able to creep up on a woman and she doesn’t even realize it…Do any of you share the same addiction as me, and do you want to get rid of it? (‘GD102’).
  • Extract 3: I used to be really addicted [to upskirting] until I made myself understand something you already know – once you’ve seen 200 asses, you’ve pretty much seen them all. There’s no point in wasting your time overindulging in the same thrill over and over again. Yeah, the excitement of seeing something you’re not supposed to see is hot as hell, but you have to set limits for yourself, and not try to fantasize too much about the upskirts you haven’t seen, and spend more time enjoying, and maybe sorting, the upskirts you already have. That’s what I’ve been doing lately” (‘Agent Ika’).
  • Extract 4: “[Upskirting] really does get repetitive. For me the thrill now comes from pretending I’m a director of a film – getting new angles, upskirts from the front, whole body shots with the upskirt still showing, and always including faceshots” (‘Stimulus’).

Obviously I have no way of knowing whether these online forum confessions are true (but they seem to be). Based on these extracts, there is certainly the possibility raised that upskirting may be addictive to a very small minority of individuals. Extract 2 was particularly interesting in that the individual had never engaged in upskirting himself but his ‘addiction’ to watching upskirting videos takes up so much time in his life.

Another source suggesting that upskirting may be an addictive activity comes from the details of those arrested and prosecuted. For instance, one infamous example in the UK (in 2015) was the case of Paul Appleby who managed to take 9000 upskirting photos in the space of just five weeks (suggesting that he was doing it all day every day to have taken so many photos). Appleby was finally caught when he was caught bending over to take a photo up a woman’s skirt in a Poundland shop. The Daily Mirror reported that:

“The tubby pervert, who was ‘addicted’ to snapping upskirts, fled the store after he was spotted…when [police] officers found his camera and iPhone a staggering 9,000 ‘upskirt’ images were discovered. The photos had been taken between November 1 and December 4 last year. [Appleby] admitted two counts of committing an act of outraging public decency…and was given a three-year community order…[Appleby] had been prosecuted for a ‘similar matter’ of outraging public decency in London in 2010. Alistair Evans, defending claimed Appleby had committed the crime for ‘sexual gratification’ and his behaviour was a ‘compulsion and an addiction’ he needed treatment for”.

Here, the mitigating factor for Appleby’s behaviour was that he was addicted to upskirting. The fact that Appleby did not receive a custodial sentence suggests the excuse of being ‘addicted’ to the behaviour led to the judge being more lenient. Another individual who avoided a custodial sentence for upskirting offences was Andrew MacRae who claimed he was addicted to sex. MacRae had amassed 49,000 upskirt photos and videos using hidden cameras at his workplace, on trains, and at the beach. He pled guilty to three counts of outraging public decency and seven counts of voyeurism. The judge said he would spare him jail if he was treated for his “compulsive voyeurism”. A report in the Daily Mail recounted what that Judge Jeremy Donne said:

“This was undoubtedly a sophisticated, organised, planned and long-running campaign of voyeurism – again with a significant degree of planning – and members of the general public, female commuters in the main, were caught by your voyeuristic activities. Your activities were undoubtedly despicable and will cause deep revulsion in all who hear them.  Women will undoubtedly feel a need to be protected from such behaviour by the knowledge that the courts will deal with offenders severely, and men will thereby be deterred from committing such offences. On the other hand, you suffer from an illness that can be treated and you have submitted to that treatment. You have features of sexual addiction disorder with disorders of sexual preference, namely voyeurism and fetishistic transvestism – all defined in the international classification of diseases. You continue to receive treatment from psychiatrists who consider you to be at low risk of re-offending”.

Another recent British case highlighted the ingenious methods used to aid upskirting. Here, Stafford Cant used spy cameras hidden inside one of his trainers, his key fob, and his wrist watch to engage in upskirting women (as well as filming the backs of their legs) who were shopping in a Cheshire village. Acting on a tip-off, his house was raided and the police found 222,000 videos and pictures dating back seven years. ‘Addiction’ was again used as a mitigating factor in the crimes (along with depression and anxiety disorders) but this time it was not addiction to voyeurism but an addiction to collecting things. However, unlike the two cases above, Cant was jailed for three years after pleading guilty to outraging public decency, voyeurism and possessing and distributing indecent images.

Although there is little psychological literature on upskirting, there appears to be anecdotal evidence that the behaviour (in the extreme) could perhaps be conceptualized as an addiction and/or compulsion among a minority of individuals. The cases of those that have been arrested and prosecuted demonstrate that upskirting behaviour was time-consuming given the sheer number of photos and videos amassed, and that the behaviour was ultimately problem-inducing and undesirable. Given that the relatively recent rise of upskirting appears to mirror the rise in the use of smartphones and spy equipment available at affordable prices, I expect to see more such cases to be written about in psychological and criminological journals in the years to come.

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

Further reading

Fight The New Drug (2018). What’s “upskirting”, and how does porn culture feed this twisted trend? July 5. Located at: https://fightthenewdrug.org/whats-upskirting-and-how-does-porn-culture-feed-this-twisted-trend/

Jolly, B. (2015). Upskirt pervert who took 9,000 secret photos in just five weeks avoids jail. Daily Mirror, January 28. Located at: https://www.mirror.co.uk/news/uk-news/upskirt-pervert-who-took-9000-5058048

Keay, L. (2018). Live Nation executive who built-up sordid library of 49,000 upskirt pictures by filming women on trains, the beach and at work is spared jail as his wife stands by him. Daily Mail, January 5. Located at: http://www.dailymail.co.uk/news/article-5239815/LiveNation-executive-Andrew-MacRae-avoids-jail-upskirt.html

Lam, J. (2017). Fifty shades of sexual offending – Part 1. The Law Gazette, July. Located at: http://v1.lawgazette.com.sg/2017-07/1910.htm

Martin, G. (2018). What happened to me was wrong. Time to make it illegal, too. World Economic Forum, April 9. Located at: https://www.weforum.org/agenda/2018/04/what-happened-to-me-was-wrong-time-to-make-it-illegal-too/

Petter, O. (2018). Upskirting: What is it and why are people trying to make it illegal” The Independent, June 18. Located at: https://www.independent.co.uk/life-style/upskirting-explained-law-rules-criminal-offence-photos-skirt-consent-women-gina-martin-a8401011.html

Shepherd, R. & Smithers, D. (2018). The public school pervert who spent years secretly filming up women’s skirts in one of Britain’s wealthiest villages. Manchester Evening News, March 29. Located at: https://www.manchestereveningnews.co.uk/news/greater-manchester-news/alderley-edge-upskirt-film-pervert-14470375

The Strait Times (2016). Taking upskirt photos may be symptomatic of voyeuristic disorder. July 30. Located at: https://adelphipsych.sg/straits-times-taking-upskirt-photos-may-be-symptomatic-of-voyeuristic-disorder/

Wilson, H. (2004). Peeping Tom’s secret weapon. The Independent, July 8. Located at: https://www.independent.co.uk/news/science/peeping-toms-secret-weapon-552402.html

Odds on: Ten ways to help prevent problem gambling

[Please note: The following article was written with Dr. Michael Auer]

Problem gambling has become a major issue in many countries worldwide. In this short article we provide ten ways to help prevent problem gambling.

Raise the minimum age of all forms of commercial gambling to 18 years – Research has consistently shown that the younger a person starts to gamble, the more likely they are to develop gambling problems. Stopping problem gambling in adolescence is a key step in preventing problem gambling in the first place. Any venue or website that hosts gambling games should have effective age verification procedures.

Restrict the most harmful types of gambling – Most research shows that gambling activities which can be gambled on continuously such as slot machines tend to be far more problematic than discontinuous games such as weekly lotteries. More harmful forms of gambling should be restricted to dedicated gambling venues rather than housed in non-dedicated gambling premises (such as supermarkets, cafes, and restaurants).

Educate players to pre-commit when engaging in the most harmful types of gambling – Ideally, the most harmful forms of gambling should have mandatory limit-setting options for players to set their own voluntary time and money limits when playing the games. Gambling operators can also use mandatory loss limits to keep gambling expenditure to a minimum.

Take responsibility for where problem gambling lies – While all individuals are ultimately responsible for their own gambling behaviour, other stakeholders – including the gambling industry – have control over the structural and situational characteristics of gambling products. Government policymakers and legislators have a responsibility to ensure that gambling products are tightly regulated and to ensure that any given jurisdiction has the infrastructure to keep gambling problems to a minimum. Gambling operators are responsible for all advertising and marketing and need to ensure that the content is socially responsible and promotes responsible gambling. Within gambling venues, all practices and procedures should be socially responsible (such as not giving free alcohol while gambling, and no ATM machines on the gaming floor).

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Put social responsibility at the heart of gambling operating practice – The most socially responsible gambling operators always puts player protection and harm minimisation at the heart of their business. They need to provide all information about their products so that individuals can make an informed choice about whether to gamble in the first place. They should advertise their products responsibly and provide their clientele with tools to aid responsible gambling, and provide help and guidance for those who think they are developing a gambling problem or have one.

Raise awareness about gambling among health practitioners and the general public – Problem gambling may be perceived as a somewhat ‘grey’ area in the field of health. However, there is an urgent need to enhance awareness about gambling-related problems within the general public and the medical and health professions.

Identify at-risk players Big Data and Artificial Intelligence are common approaches applied in behavioural analysis across many industries. Online gambling and personalized land-based gambling operators can detect harmful behavioural patterns such as chasing losses or binge gambling. Such players can be excluded from direct marketing, specific types of games, and/or contacted to prevent the development of problem gambling.

Use personalized feedbackResearch across many areas such as sports, health behaviour, as well as gambling has shown that personalized feedback can effectively change behaviour. Using behavioural data available in online gambling and personalized land-based venues, gamblers can be informed in real-time about behavioural changes in order to make them more aware and use pre-commitment tools such as limit-setting and/or self-exclusion.   

Set up both general and targeted gambling prevention initiatives The goals of gambling intervention are to (i) prevent gambling-related problems, (ii) promote informed, balanced attitudes, and choices, and (iii) protect vulnerable groups. The guiding principles for action on gambling are therefore prevention, health promotion, harm reduction, and personal and social responsibility. This includes:

  • General awareness raising (e.g. public education campaigns through advertisements on television, radio, newspapers).
  • Targeted prevention (e.g. education programs and campaigns for particularly vulnerable populations such as senior citizens, adolescents, ethnic minorities).
  • Awareness raising within gambling establishments (e.g. brochures and leaflets describing problem gambling, indicative warning signs, where help for problems can be sought such as problem gambling helplines, referral service, telephone counselling web-based chatrooms for problem gamblers, and outpatient treatment).
  • Training materials (e.g. training videos about problem gambling shown in schools, job centres).

Educate and training those working in the gambling industry about problem gambling – All gaming personnel in any gambling establishments from shop retailers to croupiers should receive ongoing training regarding responsible gambling and problem gambling.

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

Further reading

Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.

Auer, M. & Griffiths, M.D. (2013). Voluntary limit setting and player choice in most intense online gamblers: An empirical study of gambling behaviour. Journal of Gambling Studies, 29, 647-660.

Auer, M. & Griffiths, M.D. (2014). Personalised feedback in the promotion of responsible gambling: A brief overview. Responsible Gambling Review, 1, 27-36.

Auer, M., Malischnig, D. & Griffiths, M.D. (2014). Is ‘pop-up’ messaging in online slot machine gambling effective? An empirical research note. Journal of Gambling Issues, 29, 1-10.

Auer, M. & Griffiths, M.D. (2015). Testing normative and self-appraisal feedback in an online slot-machine pop-up message in a real-world setting. Frontiers in Psychology, 6, 339. doi: 10.3389/fpsyg.2015.00339.

Auer, M. & Griffiths, M.D. (2015). The use of personalized behavioral feedback for problematic online gamblers: An empirical study. Frontiers in Psychology, 6, 1406. doi: 10.3389/fpsyg.2015.01406.

Auer, M. & Griffiths, M.D. (2016). Personalized behavioral feedback for online gamblers: A real world empirical study. Frontiers in Psychology, 7, 1875. doi: 10.3389/fpsyg.2016.01875.

Griffiths, M.D. (2017). Evaluating responsible gambling tools using behavioural tracking data. Casino and Gaming International, 31, 41-45.

Griffiths, M.D. (2016). Gambling advertising, responsible gambling, and problem gambling: A brief overview. Casino and Gaming International, 27, 57-60.

Griffiths, M.D. & Auer, M. (2016). Should voluntary self-exclusion by gamblers be used as a proxy measure for problem gambling? Journal of Addiction Medicine and Therapy, 2(2), 00019.

Griffiths, M.D., Harris, A. & Auer, M. (2016). A brief overview of behavioural feedback in promoting responsible gambling. Casino and Gaming International, 26, 65-70.

Harris, A. & Griffiths, M.D. (2017). A critical review of the harm-minimisation tools available for electronic gambling. Journal of Gambling Studies, 33, 187–221.

Oehler, S., Banzer, R., Gruenerbl, A., Malischnig, D., Griffiths, M.D. & Haring, C. (2017). Principles for developing benchmark criteria for staff training in responsible gambling. Journal of Gambling Studies, 33, 167-186.

Wood, R.T.A. & Griffiths, M.D. (2015). Understanding positive play: An exploration of playing experiences and responsible gambling practices. Journal of Gambling Studies, 31, 1715-1734.

Wood, R.T.A., Shorter, G.W. & Griffiths, M.D. (2014). Rating the suitability of responsible gambling features for specific game types: A resource for optimizing responsible gambling strategy. International Journal of Mental Health and Addiction, 12, 94–112.

Every little ring: Another look at excessive smartphone use

Last week I did seven back-to-back BBC radio interviews concerning my thoughts on a new study on smartphone use carried out by Opinium Research for Virgin Mobile and reported in a number of papers including the Daily Mail. The company surveyed 2,004 British adults (aged 18 years and over) who own a smartphone as well 200 British teenagers and tweenagers aged between 10 and 17 years. The main findings were that:

  • British adults receive an average of 33,800 mobile phone messages and alerts annually
  • British adults spend the equivalent of 22 days a year checking messages on their smartphones (an average of 26 minutes a day)
  • An average smartphone user gets 93 buzzes a day
  • Those aged between 18 and 24 years have almost three times more messages receiving 239 messages and alerts a day on average (approximately 87,300 a year).
  • On average, Britons are members of six chat groups, although a small minority (2%) are members of 50 groups or more, rising to 7% among those aged 18 to 24 years.
  • One in four adults say they check a WhatsApp message instantly, with this increasing to almost one in three among 18 to 24-year-olds.
  • Smartphone users receive 427% more messages and notifications than they did a decade ago
  • Smartphone users sent 278% more messages than they did a decade ago

The survey found a contributing factor behind the surge in the number of messages received was the rise of group chats on platforms like WhatsApp and Facebook. In the press release, Dr Dimitrios Tsivrikos (consumer and business psychologist at University College London) said:

“The boom in smartphone use was a positive trend and allowed consumers greater control over their lives. In an age where we are constantly surrounded by endless tasks, always flooded with a sea of data, smartphones allow us to manage our lives in a way that suits us. From calendars and reminders, to emails and instantaneous access to an encyclopaedia of human knowledge, smartphones give us total control, right at our fingertips.”

FRANCE-ECONOMY-TELECOMMUNICATION-SMARTPHONES

There was nothing in the study that I found particularly surprising but I was hoping to see what survey had found from those under 18 years of age (but nothing was reported in the national newspapers and I’ve been unable to track down anything beyond the press release).

In my radio interviews, most of the presenters wanted to know the extent to which individuals are now ‘addicted’ to their mobile phones. I then trotted out my usual response that ‘people are no more addicted to their smartphones than alcoholics are addicted to a bottle’ and said if there was anything addicting then it was the application (e.g., gaming, gambling, shopping, social networking, etc.) rather than the smartphone itself. I also went through the addiction components model and hypothesized what the behaviour of a smartphone addict would look like if they were genuinely addicted to their smartphone applications:

  • Salience – This occurs when using a smartphone 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 on their smartphone they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with smartphone use).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of using their smartphone 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’ whenever they use their smartphone).
  • Tolerance – This is the process whereby increasing amounts of time on a smartphone are required to achieve the former mood modifying effects. This basically means that for someone engaged on a smartphone, they gradually build up the amount of the time they spend using a smartphone 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 access their smartphone because they have mislaid or lost it, are too ill to use it, in a place with no reception, 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 on a smartphone.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive smartphone use to recur and for even the most extreme patterns typical of the height of excessive smartphone use to be quickly restored after periods of control.

Using these criteria, I then went on to say that very few people would be classed as addicted to their smartphones. However, I did point out that such behaviour is on a continuum and that there may be a growing number of people that experience problematic smartphone use rather than being addicted. The examples I used included those individuals who would rather spend time on their smartphone than spending it with their partner and/or children, or individuals who spend so much time on their smartphone that it impacts on their job or their education (depending upon how old they are). Neither of these on their own (or together) necessarily indicate addictive use of smartphones but could be a sign that such individuals are at risk for developing an addiction to the applications on their smartphone. However, I would still argue that someone that spends all their time on social networking sites and social media (via their mobile phone) are a social media addict rather than a smartphone addict although others might see this as a semantic difference rather than a difference of substance. Whatever we call the behaviour, there does seem to be growing evidence that smartphones play a major role in people’s lives and that a small minority appear to have problematic use (as outlined in a number of studies that I have co-authored – see ‘Further reading’ below).

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

Further reading

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. Oberst, U., Cladellas, R. & Talarn, A. (2012). Problematic Internet and cell phone use in Spanish teenagers and young students. Anales de Psicologia, 28, 789-796.

Csibi, S., Griffiths, M.D., Cook, B., Demetrovics, Z., & Szabo, A. (2018). The psychometric properties of the Smartphone: Applications-Based Addiction Scale (SABAS). International Journal of Mental Health and Addiction. doi: 10.1007/s11469-017-9787-2

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

Hussain, Z., Griffiths, M.D. & Sheffield, D. (2017). An investigation in to problematic smartphone use: The role of narcissism, anxiety, and personality factors. Journal of Behavioral Addictions, 6, 378–386.

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.

Lopez-Fernandez, O., Kuss, D.J., Romo, L. Morvan, Y., Kern, L., … Griffiths, M.D., … Billieux, J. (2017). Self-reported dependence on mobile phones in young adults: A European cross-cultural empirical survey. Journal of Behavioral Addictions, 6, 168-177.

Lopez-Fernandez, O., Männikkö, N., Kääriäinen, M., Griffiths, M.D., & Kuss, D.J. (2018). Mobile gaming does not predict smartphone dependence: A cross-cultural study between Belgium and Finland. Journal of Behavioral Addictions. doi: 10.1556/2006.6.2017.080

Richardson, M., Hussain, Z. & Griffiths, M.D. (2018). Problematic smartphone use, nature connectedness, and anxiety. Journal of Behavioral Addictions. doi: 10.1556/2006.7.2018.10

 

Screenage rampage: What should parents know about videogame playing for children?

Last month, the World Health Organisation (WHO) announced that it was planning to include ‘Gaming Disorder’ (GD) in the latest edition of the International Classification of Diseases. This followed the American Psychiatric Association’s decision to include ‘Internet Gaming Disorder’ in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders in 2013. According to the WHO, an individual with GD is a person who lets playing video games “take precedence over other life interests and daily activities,” resulting in “negative consequences” such as “significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

I have been researching videogame addiction for nearly 30 years, and during that time I have received many letters, emails, and telephone calls from parents wanting advice concerning videogames. Typical examples include ‘Is my child playing too much?’, ‘Will playing videogames spoil my pupils’ education?’, ‘Are videogames bad for children’s health? and ‘How do I know if a child is spending too long playing videogames?’ To answer these and other questions in a simple and helpful way, I have written this article as a way of disseminating this information quickly and easily.

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To begin with parents should begin by finding out what videogames their children are actually playing! Parents might find that some of them contain material that they would prefer them not to be having exposure to. If they have objections to the content of the games they should facilitate discussion with children about this, and if appropriate, have a few rules. A few aims with children should be:

  • To help them choose suitable games which are still fun
  • To talk with them about the content of the games so that they understand the difference between make-believe and reality
  • To discourage solitary game playing
  • To guard against obsessive playing
  • To follow recommendations on the possible risks outlined by videogame manufacturers
  • To ensure that they have plenty of other activities to pursue in their free time besides the playing of videogames

Parents need to remember that in the right context videogames can be educational (helping children to think and learn more quickly), can help raise a child’s self-esteem, and can increase the speed of their reaction times. Parents can also use videogames as a starting point for other activities like painting, drawing, acting or storytelling. All of these things will help a child at school. It needs to be remembered that videogame playing is just one of many activities that a child can do alongside sporting activities, school clubs, reading and watching the television. These can all contribute to a balanced recreational diet.

The most asked question a parent wants answering is ‘How much videogame playing is too much? To help answer this question I devised the following checklist. It is designed to check if a child’s videogame playing is getting out of hand. Ask these simple questions. Does your child:

  • Play videogames every day?
  • Often play videogames for long periods (e.g., 3 to 6 hours at a time)?
  • Play videogames for excitement or ‘buzz’ or as a way of forgetting about other things in their life?
  • Get restless, irritable, and moody if they can’t play videogames?
  • Sacrifice social and sporting activities to play videogames?
  • Play videogames instead of doing their homework?
  • Try to cut down the amount of videogame playing but can’t?

If the answer is ‘yes’ to more than four of these questions, then your child may be playing too much. But what can you do if your child is playing videogames too much?

  • First of all, check the content of the games. Try and give children games that are educational rather than the violent ones. Parents usually have control over what their child watches on television – videogames should not be any different.
  • Secondly, try to encourage video game playing in groups rather than as a solitary activity. This will lead to children talking and working together.
  • Thirdly, set time limits on children’s playing time. Tell them that they can play for a couple of hours after they have done their homework or their chores – not before.
  • Fourthly, parents should always get their children to follow the recommendations by the videogame manufacturers (e.g., sit at least two feet from the screen, play in a well-lit room, never have the screen at maximum brightness, and never play videogames when feeling tired).

I have spent many years examining both the possible dangers and the potential benefits of videogame playing. Evidence suggests that in the right context videogames can have positive health and educational benefits to a large range of different sub-groups. What is also clear from the case studies displaying the more negative consequences of playing is that they all involved children who were excessive users of videogames. From prevalence studies in this area, there is little evidence of serious acute adverse effects on health from moderate play. In fact, in some of my studies, I found that moderate videogame players were more likely to have friends, do homework, and engage in sporting activities, than those who played no videogames at all.

For excessive videogame players, adverse effects are likely to be relatively minor, and temporary, resolving spontaneously with decreased frequency of play, or to affect only a small subgroup of players. Excessive players are the most at-risk from developing health problems although more research is needed. If care is taken in the design, and if they are put into the right context, videogames have the potential to be used as training aids in classrooms and therapeutic settings, and to provide skills in psychomotor coordination, and in simulations of real life events (e.g., training recruits for the armed forces).

Every week I receive emails from parents claiming that their sons are addicted to playing online games or that their daughters are addicted to social media. When I ask them why they think this is the case, they almost all reply “because they spend most of their leisure time in front of a screen.” This is simply a case of parents pathologising their children’s behaviour because they think what they are doing is “a waste of time.” I always ask parents the same three things in relation to their child’s screen use. Does it affect their schoolwork? Does it affect their physical education? Does it affect their peer development and interaction? Usually parents say that none of these things are affected so if that is the case, there is little to worry about when it comes to screen time. Parents also have to bear in mind that this is how today’s children live their lives. Parents need to realise that excessive screen time doesn’t always have negative consequences and that the content and context of their child’s screen use is more important than the amount of screen time.

(N.B. This article is an extended version of an article that was originally published by Parent Zone)

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

Further reading

Griffiths, M.D. (2003).  Videogames: Advice for teachers and parents. Education and Health, 21, 48-49.

Griffiths, M.D. (2009). Online computer gaming: Advice for parents and teachers. Education and Health, 27, 3-6.

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., Kuss, D.J. & Pontes, H. (2016). A brief overview of Internet Gaming Disorder and its treatment. Australian Clinical Psychologist, 2(1), 20108.

Griffiths, M.D. & Meredith, A. (2009). Videogame addiction and treatment. Journal of Contemporary Psychotherapy, 39(4), 47-53.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2012). Clinical interventions for technology-based problems: Excessive Internet and video game use. Journal of Cognitive Psychotherapy: An International Quarterly, 26, 43-56.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.

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.

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

Learning, yearning, but not earning: A brief look at student gambling

Last week, the UK Gambling Commission put out a press release relating to student gambling. Having been in the university sector for as long as I have been researching gambling (i.e., 30 years), student gambling is an area that has always been close to my professional heart. I have published dozens of papers on youth gambling and student gambling over the last three decades (see ‘Further reading’ below for a few examples).

With my daughter leaving home to go to university this week there are lots I could potentially worry about and gambling isn’t necessarily my main concern where my daughter is concerned, but gambling is still of concern to me especially because a study I published back in 2012 with Luke Benson and Dr. Christine Norman (in the International Journal of Mental Health and Addiction) found that first year university students gambled more than final year students and were more susceptible to problem gambling compared to final year students.

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The Gambling Commission have just published their own research into the topic. They hired Youth Sight who conducted 1,000 online interviews with undergraduate students in August 2017 (the students were part of an online panel recruited from applicants through Universities and Colleges Admission Service). The quotas chosen reflected the UK student population in terms of gender, course year and university group. Here are some of their key findings:

  • Two-thirds of students had gambled in the previous month
  • Over half of student gamblers (54%) engaged in gambling to make money
  • Two-fifths of students said they felt guilty after they had gambled
  • One in eight student gamblers had missed lectures due to gambling
  • One in four student gamblers (25%) had spent more money gambling than they could afford
  • One in 25 student gamblers (4%) were in debt because of their gambling
  • One in four students that had a gambling debt, had a debt of over £10,000

The Gambling Commission noted there were are number of limitations with the study. They specifically noted that gambling participation rates may have been higher than if the data had been collected using other methodologies (telephone, face-to-face interviews) due to the self-selecting nature of online surveys. However, online surveys were chosen due to students’ access to technology and the availability of a representative panel via this method. 

On the back of their survey, the Gambling Commission also provided their top ten tips to help students avoid getting into trouble with gambling. I have reproduced them here verbatim.

  • Ask yourself why you are gambling: Are you gambling to escape debt or as a way to make quick money? Think carefully about your motivations to gamble. Gambling shouldn’t be seen as the answer to improving your personal finances. If you have concerns about money, speak to a financial adviser or student support services.
  • Monitor how often you’re gambling online: Websites must give you access to historic account activity. This means you can see exactly when, how much and what you’ve been gambling on over time and make well-informed choices about what to do next.
  • Keep track of how much time you’ve spent gambling: With a reality check, you can set alerts to pop up on screen, which help you to monitor the time spent gambling either online or on gaming machines in a betting shop.
  • Limit how much you can spend: If you’re concerned about how much money you’re gambling, you can set a limit on how much you spend across individual gambling products online. You can also set a limit on how much you spend on gaming machines in a betting shop.
  • Give yourself a timeout: During a timeout, you can block yourself from gambling online for a set amount of time, of up to 6 weeks, and even bar yourself from gambling during a specific time of day.
  • Need a longer break? Self-exclude from gambling firms for a minimum of 6 months: If you think you are spending too much time or money gambling – whether online or in gambling premises – you can ask to be self-excluded. This is when you ask the company to stop you from gambling with them for a period of time. The exclusion will last for a minimum of least six months. Self-exclusion can be used if you think you have a problem with gambling and want help to stop. [The Gambling Commission] are also working with industry representatives to develop a national online self-exclusion scheme.
  • Read the terms and conditions: Did you know almost 80% of gamblers haven’t read the terms and conditions on the websites they are gambling on? By taking the time to read the T&Cs, you can ensure you understand exactly what you are gambling on, and what restrictions are attached to promotions and bonus offers (such as a minimum spend level before the bonus is paid) – this will help you make an informed decision.
  • Make sure the website you’re gambling with is licensed: Make sure you’re gambling with a Gambling Commission licensed business. This means you’ll be protected by gambling and consumer protection rules in Great Britain. Licensed gambling businesses must display that they are licensed and provide a link to our licence register where you can see what type of activities they are allowed to offer and also if we have taken any regulatory action against them.
  • Check how your money is protected: Any gambling business that holds customer funds must explain in their T&Cs how customer funds are protected if the business goes bust – this should help you decide who you want to gamble with.
  • Feel it’s getting too much? Talk to someone: There are a number of gambling support groups available if you feel your gambling is getting out of control or too much. More information about the signs of problem gambling can be found on the Gambleaware and Gamcare websites [You can call the National Gambling Helpline on Freephone 0808 8020 133]. They also provide general information about gambling, including how to gamble safely and where to get help if you or someone you know has problems with their gambling.

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

Further reading

Benson, L., Norman, C. & Griffiths, M.D. (2012). The role of impulsivity, sensation seeking, coping, and year of study in student gambling: A pilot study. International Journal of Mental Health and Addiction, 10, 461-473.

Canale, N., Griffiths, M.D., Vieno, A., Siciliano, V. & Molinaro, S. (2016). Impact of internet gambling on problem gambling among adolescents in Italy: Findings from a large-scale nationally representative survey. Computers in Human Behavior, 57, 99-106.

Canale, N., Vieno, A., Lenzi, M., Griffiths, M.D., Borraccino, A., Lazzeri, G., Lemma, P., Scacchi, L., Santinello, M. (2017). Income inequality and adolescent gambling severity: Findings from a large-scale Italian representative survey. Frontiers in Psychology, 8, 1318. doi: 10.3389/fpsyg.2017.01318

Gambling Commision (2017). Commission raises awareness of potential risks for students who gamble. September 12. Located at: http://www.gamblingcommission.gov.uk/news-action-and-statistics/news/2017/Commission-raises-awareness-of-potential-risks-for-students-who-gamble.aspx

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

Griffiths, M.D. (2002). Adolescent gambling: What should teachers and parents know? Education and Health, 20, 31-35.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2008). Adolescent gambling in Great Britain. Education Today: Quarterly Journal of the College of Teachers. 58(1), 7-11.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. (2015). Adolescent gambling and gambling-type games on social networking sites: Issues, concerns, and recommendations. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 33(2), 31-37.

Griffiths, M.D. & Calado, F. (2017). Adolescent gambling. Reference Module in Neuroscience and Biobehavioral Psychology (pp. 1-12). Oxford: Elsevier.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Screenagers in love: Adolescent screen time, content, and context

In 1999, the American Academy of Pediatrics (AAP) advocated the ‘2×2’ screen time guidelines to parents that their children should be restricted to no more than 2 hours of screen time a day and that children under 2 years of age should not be exposed to any screen time at all. Not only is this unworkable in today’s multi-media world but the guidelines are not based on scientific evidence. Thankfully, the AAP have revised their guidelines in the light of how today’s children actually engage with screen-based interactive technologies. For me, the issue is not about the amount of screen time but is about the content and the context of screen use. I have three ‘screenagers’ (i.e., children often referred to as ‘digital natives’ who have never known a world without the internet, mobile phones and interactive television) who all – like me – spend a disproportionate amount of their everyday lives on front of a screen for both work/educational and leisure purposes. Engaging in a lot of screen-based activities is not inherently negative – it’s simply a case of doing things differently than we did 20 years ago.

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One online activity that has received a lot of criticism in the media is the playing of online videogames. However there is now a wealth of research which shows that video games can be put to educational and therapeutic uses, as well as many studies which reveal how playing video games can improve reaction times and hand-eye co-ordination. Their interactivity can stimulate learning, allowing individuals to experience novelty, curiosity and challenge that stimulates learning. Although I have published many studies concerning online gaming addiction, there is little empirical evidence that moderate gaming has any negative effects whatsoever. In fact, many excessive players experience detrimental effects.

Over the past 15 years I have spent time researching the excessive playing of online videogames like Everquest and World of Warcraft (WoW). Online gaming involves multiple reinforcements in that different features might be differently rewarding to different people. In video games more generally, the rewards might be intrinsic (e.g. improving your highest score, beating your friend’s high score, getting your name on the “hall of fame”, mastering the game) or extrinsic (e.g. peer admiration).

In online gaming, there is no end to the game and there is the potential for gamers to play endlessly. This can be immensely rewarding and psychologically engrossing. For a small minority of people, this may lead to addiction where online gaming compromises everything else in their lives. However, playing excessively doesn’t necessarily make someone an addict. A few years ago in the International Journal of Mental Health and Addiction, I published two case study accounts of two males who claimed that they were gaming for up to 80 hours a week. They were behaviourally identical in terms of their game playing, but very different in terms of their psychological motivation to play.

The first case was an unemployed single 21-year old male. His favourite online game was World of Warcraft and that since leaving university he had spent an average of 10 to 14 hours a day playing WoW. He claimed that WoW had a positive influence in his life and that most of his social life was online and that it increased his self-esteem. He also argued that he had no other commitments and that he had the time and the flexibility to play WoW for long stretches. Gaming provided a daily routine when there was little else going on. There were no negative detrimental effects in his life. When he got a job and a girlfriend, his playing all but stopped.

The second case was 38-year old male, a financial accountant, married and had two children. He told me that over the previous 18 months, his online playing of Everquest had gone from about 3-4 hours of playing every evening to playing up to 14 hours a day. He claimed that his relationship was breaking down, that he was spending little time with his children, and that he constantly rang in sick to work so that he could spend the day playing online games. He had tried to quit playing on a number of occasions but could not go more than a few days before he experienced “an irresistible urge” to play again – even when his wife threatened to leave him.

Giving up online gaming was worse than giving up smoking and that he was “extremely moody, anxious, depressed and irritable” if he was unable to play online. Things got even worse. He was fired from his job for being unreliable and unproductive (although his employers were totally unaware of his gaming behaviour). As a result of losing his job, his wife also left him. This led to him “playing all day, every day”. It was a vicious circle in that his excessive online gaming was causing all his problems yet the only way he felt he could alleviate his mood state and forget about all of life’s stresses was to play online games even more.

I argued that only the second man appeared to be genuinely addicted to online gaming but that the first man wasn’t. I based this on the context and consequences of his excessive play. Online gaming addiction should be characterized by the extent to which excessive gaming impacts negatively on other areas of the gamers’ lives rather than the amount of time spent playing. For me, an activity cannot be described as an addiction if there are few (or no) negative consequences in the player’s life even if the gamer is playing up to 14 hours a day. The difference between a healthy enthusiasm and an addiction is that healthy enthusiasms add to life, addictions take away from it.

Every week I receive emails from parents claiming that their sons are addicted to playing online games and that their daughters are addicted to social media. When I ask them why they think this is the case, they almost all reply “because they spend most of their leisure time in front of a screen”. This is simply a case of parents pathologising their children’s behaviour because they think what they are doing is “a waste of time”. I always ask parents the same three things in relation to their child’s screen use. Does it affect their schoolwork? Does it affect their physical education? Does it affect their peer development and interaction? Usually parents say that none of these things are affected so if that is the case, there is little to worry about when it comes to screen time. Parents also have to bear in mind that this is how today’s children live their lives. Parents need to realise that excessive screen time doesn’t always have negative consequences and that the content and context of their child’s screen use is more important than the amount of screen time.

(Please note: This article is an extended version of an article that was originally published by the London School of Economics’ Media Policy Project)

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

Further reading

Griffiths, M.D. (2010). Online video gaming: What should educational psychologists know? Educational Psychology in Practice, 26(1), 35-40.

Griffiths, M.D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. (2013) Social networking addiction: Emerging themes and issues. Journal of Addiction Research and Therapy, 4: e118. doi: 10.4172/2155-6105.1000e118.

Griffiths, M.D. (2014). Child and adolescent social gaming: What are the issues of concern? Education and Health, 32, 9-12.

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

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., Kuss, D.J. & Demetrovics, Z. (2014). Social networking addiction: An overview of preliminary findings. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.119-141). New York: Elsevier.

Kuss, D.J. & Griffiths, M.D. (2011). Online social networking and addiction: A literature review of empirical research. International Journal of Environmental and Public Health, 8, 3528-3552.

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.

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

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.

Pápay, O., Urbán, R., Griffiths, M.D., Nagygyörgy, K., Farkas, J. Kökönyei, G., Felvinczi, K., Oláh, A., Elekes, Z., Demetrovics, Z. (2013). Psychometric properties of the Problematic Online Gaming Questionnaire Short-Form (POGQ-SF) and prevalence of problematic online gaming in a national sample of adolescents. Cyberpsychology, Behavior, and Social Networking, 16, 340-348.

Tub zero: A brief look at bath-related illnesses and fatalities

Regular readers of my blog will know that I have an interest in all things bizarre and out of the ordinary. In previous blogs I have examined coital cephalagia (people that get headaches from having sex) and masturbatory cephalagia (people that get headaches from masturbation). It was while researching those articles that I came across a 2005 paper on ‘bath-related headaches’ (BRHs) by Dr. Mak and colleagues in the journal Cephalagia.

BRH is rare headache syndrome. They reported 13 case studies (six from their own case files collected over a seven-year period and seven from other reports in the medical literature). They reported that all the cases involved “Oriental women” aged 32 to 67 years (with an average age of 51 years). The cases were reported in females from Hong Kong (n=6), Taiwan (n=4) and Japan (n=3). All of the women reported severe headaches (lasting from 30 minutes to 30 hours) that were triggered by bathing or other activities involving contact with water. Typically, the onset of the headaches were “hyperacute” and were like ‘thunderclap’ headaches (a severe headache that takes seconds to minutes to reach maximum intensity). The paper reported that no underlying secondary causes were identified and that drug treatment was generally unsatisfactory (although use of the drug Nimodipine was reported to shorten the length of the headache in some cases). Unfortunately, the only way that such headaches could be prevented was to avoid bathing.

After reading this paper I looked for other papers relating to bath-related illnesses. A 2000 paper by Dr. S. Cerovac and Dr. A. Roberts reported on 57 cases of burns sustained by hot bath and shower water (in the journal Burns) over an eight-year period. None of the 57 cases died as a result of the burns. The authors worked at Stoke Mandeville Hospital (in the UK) and they divided the cases into child (below the age of 16 years) and adult groups. Most of the children (n=39) were under the age of three years (83%), with two-fifths having superficial burns (41%). Most of these cases occurred due to what the authors described as “inadequate supervision” by the child’s parents (85%). Among the adult group, 83% of the adults were over 60 years of age with around 65% of them having “some form of psycho-motor disorder that predisposed to an accident which should have been anticipated”. The adult group had more extensive burns which resulted in eight deaths (out of 18 cases; 44%). They reported that the number of cases had been declining over the eight-year period but the study highlighted that fatal incidents could be caused by something as simple as bathing.

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A 1995 study by Dr. J. Lavelle in the Annals of Emergency Medicine evaluated the risk factors associated with bathtub submersion injury and their relationship to child abuse and neglect over a 10-year period (1982-1992). They reported that there had been 21 patients treated for bathtub near-drownings (nine of which had subsequently died). Of these, two-thirds of the children (67%) had “historic and/or physical findings suspicious for abuse or neglect, including incompatible history for the injury, other physical injuries, previous child abuse reports, psychiatric history of the caretaker, and/or psychosocial concerns noted in the chart”. The mortality rate of 42% was significant. However, findings showed that no demographic characteristics identified at-risk children.

Perhaps the most common form of bathtub deaths are infant drownings. A paper by Dr. John Pearn and Dr. James Nixon examined the socio-demographic factors surrounding drowning accidents among children aged 0-15 years in a 1978 issue of Social Science & Medicine. Obviously this paper examined all drownings but did note that those that involved bathtub drownings occur “almost exclusively in lower social class homes” In a follow-up study specifically on bathtub drownings, Dr. Pearn and his colleagues reported the cases of seven bathtub drownings in the journal Pediatrics. All of the seven cases were infants in the US state of Hawaii. As with the previous paper, the authors reported that the families of the infant were typically of lower socioeconomic status but also added that the deaths had occurred when the father “had immediate care of the infant at the time of the accident”. In five of the cases, the drowned infant was being looked after by older sibling.

In 1985, Dr. Lawrence Budnick and Dr. D. Ross published a study on bathtub-related drownings in the USA in the American Journal of Public Health. They analysed information (1979-1981) on such deaths using data from the (i) National Center for Health Statistics and (ii) Consumer Product Safety Commission data. They reported 710 individuals had drowned in the bath during this period with an estimated mortality rate of 1.6 per million individuals per year. They reported an excess of deaths in the spring but this was not statistically significant. However, they did note that individuals “at the extremes of age were at greatest risk of death, with mortality rates of 5-6 per million per year”. Unsurprisingly, there was a frequent history of children below the age of five years being left unattended by parents. Amongst young to middle-aged adults, there was a frequent history of seizures or history of alcohol or drug use. Among more elderly individuals there was frequent evidence of having fallen in the bath.

Similarly, in 2006, Dr. G. Somers and colleagues carried out a 20-year review of bathtub drownings published in the American Journal of Forensic Medicine and Pathology. The authors retrospectively retrospective reviewed US autopsy records over a 20-year period (1984–2003). They identified 18 cases of bathtub drownings (8 boys and 10 girls) aged 6 months to 70 months (average of 17 months) almost three-quarters aged under one year (72%). The factors leading to the death were reported as inadequate adult supervision (89%), cobathing (39%), the use of infant bath seats (17%), and coexistent medical disorders predisposing the child to the drowning episode (17%).

A paper by Dr. R. Rauchschwalbe and colleagues in a 1997 issue of Pediatrics examined the role of bathtub seats and rings as a primary cause of death in US infant drowning deaths (1983-1995). The paper reported 32 deaths by drowning involving bath seats/rings with the victims’ ages at the time of the death ranging from 5 to 15 months (average 8 months old). Nine in ten deaths was due to a “reported lapse in adult supervision”. The authors concluded that infant drownings associated with bath seats/rings are increasing in the US and that very young children “should never be left in the bathtub unsupervised, even for brief moments”.

A more recent 2004 study by Dr. R. Byard and Dr. T. Donald in the Journal of Paediatrics and Child Health examined the possible role of infant bathtub seats in drowning and near-drowning (1998-2003). The authors used files from the Forensic Science Centre and Child Protection Unit, Women’s and Children’s Hospital in Adelaide (Australia). In the six-year period, there were six cases of drowning in children aged under two years. They noted:

“One of these cases, a 7-month-old boy, had been left unattended for some time in an adult bath in a bathtub seat. He was found drowned, having submerged after slipping down and becoming trapped in the seat. Three near-drowning episodes occurred in children under the age of 2 years, including two boys aged 7 and 8 months, both of whom had been left for some time in adult baths in bath seats. Both were successfully resuscitated and treated in hospital…These cases demonstrate the vulnerability of infants to immersion incidents when left unattended in bathtubs”.

In a 1984 paper in the Journal of the American Medical Association, Dr. Lawrence Budnick examined bathtub-related electrocutions in the USA (1979 to 1982). He reported that at least 95 Americans had been electrocuted in the bath and that the use of hair dryers in the bathroom had caused 60% of the deaths. It was also noted that two-thirds of the deaths had occurred during spring and winter, and that those under five years of age had the highest mortality rate.

A 2003 paper by Dr. N. Yoshioka and his colleagues in the journal Legal Medicine examined bathtub deaths in Japan. The authors claimed that approximately 100–120 cases of “sudden death in bathroom” are reported there every year and accounts for around “8–10% of the total number of what is considered unnatural deaths”. Most of the deaths occur in winter and 80% of cases involve the elderly and the authors described the deaths as “baffling” as the autopsies rarely locate the exact cause of death. By testing physiological changes 54 volunteers in both winter and summer, the authors reported that many heart conditions occurred during the winter months in their volunteers (e.g., cardiac arrhythmia including ventricular tachycardia, ventricular extrasystole, supraventricular extrasystole, and bradycardia) and that these conditions might lead to an increased risk for cardiac arrest while bathing.

Another possible reason for bathtub-related drownings is epileptic seizures while bathing. A paper by Dr. C. Ryan and Dr. G. examined drowning deaths among epileptics in a 1993 issue of the Canadian Medical Association Journal. The authors retrospectively reviewed deaths from drowning in Alberta (Canada) from 1981 to 1990. Of these drownings in Alberta (n=482), 5% (n=25) were directly related to epileptic seizures of which 60% (n=15) occurred while the individual was taking an unsupervised bath. The authors advised that all people with epilepsy should take showers (while sitting) instead of baths.

While most of these bath-related health issues and fatalities are rare, they do highlight the issue that accidents can happen anywhere and that in the bath can be a vulnerable location for infants left unattended or those with medical conditions that cause immobility.

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

Further reading

Budnick, L.D. (1984). Bathtub-related electrocutions in the United States, 1979 to 1982. JAMA, 252(7), 918-920.

Budnick, L.D., & Ross, D.A. (1985). Bathtub-related drownings in the United States, 1979-81. American Journal of Public Health, 75(6), 630-633.

Byard, R. W., & Donald, T. (2004). Infant bath seats, drowning and near‐drowning. Journal of Paediatrics and Child Health, 40(5‐6), 305-307.

Cerovac, S., & Roberts, A.H. (2000). Burns sustained by hot bath and shower water. Burns, 26(3), 251-259.

Lavelle, J. M., Shaw, K. N., Seidl, T., & Ludwig, S. (1995). Ten-year review of pediatric bathtub near-drownings: evaluation for child abuse and neglect. Annals of Emergency Medicine, 25(3), 344-348.

Mak, W., Tsang, K.L., Tsoi, T.H., Au Yeung, K.M., Chan, K.H., Cheng, T. S., … & Ho, S.L. (2005). Bath‐related headache. Cephalalgia, 25(3), 191-198.

Pearn, J. H., Brown, J., Wong, R., & Bart, R. (1979). Bathtub drownings: Report of seven cases. Pediatrics, 64(1), 68-70.

Nixon, J., & Pearn, J. (1978). An investigation of socio-demographic factors surrounding childhood drowning accidents. Social Science & Medicine. Part A: Medical Psychology & Medical Sociology, 12, 387-390.

Rauchschwalbe, R., Brenner, R.A., & Smith, G.S. (1997). The role of bathtub seats and rings in infant drowning deaths. Pediatrics, 100(4), e1.

Ryan, C. A., & Dowling, G. (1993). Drowning deaths in people with epilepsy. CMAJ: Canadian Medical Association Journal, 148(5), 781-784.

Somers, G. R., Chiasson, D. A., & Smith, C. R. (2006). Pediatric drowning: A 20-year review of autopsied cases: III. Bathtub drownings. American Journal of Forensic Medicine and Pathology, 27(2), 113-116.

Yoshioka, N., Chiba, T., Yamauchi, M., Monma, T., & Yoshizaki, K. (2003). Forensic consideration of death in the bathtub. Legal Medicine, 5, S375-S381.