Category Archives: Compulsion

Sound conclusions: The psychology of musical preferences

Last week I was invited to give a keynote talk at an Italian conference on community psychology in Padova. The reason I mention this is because it was at this conference I met another academic – Dr. Tom Ter Bogt – that has a job that I would love to have. Dr. Ter Bogt is a Professor in Popular Music and Youth Culture at the Department of Interdisciplinary Social Sciences of Utrecht University. Regular readers of my blog will know that I have an obsessive love of music and have written about the psychology many of my musical heroes in previous blogs.

It all started when Dr. Ter Bogt innocently asked me what I thought of Noel Gallagher’s latest album (Chasing Yesterday). When I told him that I thought it was great, it sparked a long conversation where we discussed our eclectic love of music taking in a shared appreciation of Oasis, The Beatles, Throbbing Gristle, The Velvet UndergroundLou Reed, Iggy Pop, David Bowie, Roxy Music, Brian Eno, Grace Jones, Johnny Cash, and Chic (to name but a few). I also learned that he used to be a club DJ and that he had authored a best selling book on the history of pop music in his home country. In further email conversations, he also shared with me that his most played artists were Television and the Comsat Angels (something I would never have predicted based on out initial conversation but something that I found endearing).

In the nicest way possible, I am envious of Dr. Ter Bogt’s job. He has managed to become a professor through his love of music, and now carries out scientific research on the topic. Our respective research backgrounds – while very different – occasionally intersect. For instance, Dr. Ter Bogt and his colleagues published a paper in a 2002 issue of Contemporary Drug Problems on ‘Dancestasy’ (dance and MDMA use) in Dutch youth culture and I have published papers on both dance as an addiction, and young people’s use of ecstasy as a ‘risky but rewarding behaviour’ (see ‘Further reading below).

As an avid music fan I was interested to read Dr. Ter Bogt’s typology of music listeners in a 2010 paper in the journal Psychology of Music. In this study, Dr. Ter Bogt and his colleagues constructed a typology of music listeners based on the of importance attributed to music and four types of music use (among a sample of nearly a thousand Dutch participants): (i) mood enhancement (e.g., “Music helps me to relax and stop thinking about things”), (ii) coping with problems (e.g., “I always play music when I feel sad”), (iii) defining personal identity (e.g., “Lyrics of my music often express how I feel”), and (iv) social identity (e.g., “I can’t be friends with someone who dislikes my music”).

Using latent class analysis, the study’s participants were classed into three listener groups – High-Involved Listeners (HILs; 19.7% of the sample), Medium-Involved Listeners (MILs; 74.2%), and Low-Involved Listeners (LILs; 6.1%). HILs listened to music most often for mood enhancement, coping with distress, identity construction and social identity formation. MILs and LILs formed predictably attached less importance to music in their lives. HILs liked a wide range of musical genres (e.g., pop, rock, urban, dance, etc.) and experienced the most positive affects when listening to music. Interestingly, both HILs and MILs (when compared to LILs) reported more negative affects (such as anger and sadness) when listening to music. The study also reported that even LILs listened to music frequently and used it as a mood enhancer.

In a 2010 study in the Journal of Adolescence, Dr. Ter Bogt and his colleagues examined the association between music preferences and adolescent substance use. In a nationally representative sample of 7324 Dutch adolescents (aged 12–16 years), the study collected data concerning music preferences, substance use behaviors, and the perceived number of peers using substances. Adolescent music preferences for eight different music genres clustered into four distinct styles labeled as pop (chart music, Dutch pop), adult (classical music, jazz), urban (rap/hip-hop, soul/R&B) and hard (punk/hardcore, techno/hard-house). Adolescent substance use among the participants comprised smoking, drinking, and cannabis use. The results showed that music preference and substance use was either wholly or partially mediated by perceived peer use.

Using the same dataset, a study published in a 2009 issue of Substance Use and Misuse reported that when all other factors were controlled for, higher levels of substance use was more likely among those who liked punk/hardcore, techno/hard-house, and reggae while lower levels of substance use was more likely among those who preferred pop and classical music. According to Ter Bogt and his colleagues, prior empirical research had demonstrated that liking heavy metal and rap predicted substance use. The Dutch data in this study found that “a preference for rap/hip-hop only indicated elevated smoking among girls, whereas heavy metal was associated with less smoking among boys and less drinking among girls”. Consequently, it was concluded that the music genres associated with increased substance use “may vary historically and cross-culturally, but, in general, preferences for nonmainstream music are associated positively with substance use, and preferences for mainstream pop and types of music preferred by adults (classical music) mark less substance use among adolescents”. The authors also noted that the data were correlational therefore the direction of causation of the music–substance use link cannot be drawn.

In a more recent (2013) study published in the journal Pediatrics, Dr. Ter Bogt and colleagues examined the relationship between early adolescents’ musical preferences and minor delinquency. Following 309 adolescents (149 boys, 160 girls) from the age of 12 years over a four-year period, the study found that that early fans of different types of rock (e.g., rock, heavy metal, gothic, punk), African American music (rhythm and blues, hip-hop), and electronic dance music (trance, techno/hard-house) showed elevated minor delinquency both concurrently and longitudinally. Conversely, preferring conventional pop (chart pop) or highbrow music (classic music, jazz) was negatively related to minor delinquency. The study concluded that “early music preferences emerged as more powerful indicators of later delinquency rather than early delinquency, indicating that music choice is a strong marker of later problem behavior”.

On a personal level, I know how important music is in my on life and as a source of my own identity. The many studies carried out by Dr. Ter Bogt and his research colleagues further our understanding of music across the lifespan (particularly its role in adolescence) and I look forward to reading their future work.

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

Further reading

Delsing, M. J., Ter Bogt, T. F., Engels, R. C., & Meeus, W. H. (2008). Adolescents’ music preferences and personality characteristics. European Journal of Personality, 22(2), 109-130.

Larkin, M. & Griffiths, M.D. (2004). Dangerous sports and recreational drug-use: Rationalising and contextualising risk. Journal of Community and Applied Social Psychology, 14, 215-232.

Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

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.

Mulder, J., Ter Bogt, T. F., Raaijmakers, Q. A., Gabhainn, S. N., Monshouwer, K., & Vollebergh, W. A. (2009). The soundtrack of substance use: music preference and adolescent smoking and drinking. Substance Use and Misuse, 44(4), 514-531.

Mulder, J., Ter Bogt, T. F., Raaijmakers, Q. A., Gabhainn, S. N., Monshouwer, K., & Vollebergh, W. A. (2010). Is it the music? Peer substance use as a mediator of the link between music preferences and adolescent substance use. Journal of Adolescence, 33, 387-394.

Mulder, J., Ter Bogt, T., Raaijmakers, Q., & Vollebergh, W. (2007). Music taste groups and problem behavior. Journal of Youth and Adolescence, 36(3), 313-324.

Selfhout, M. H., Branje, S. J., ter Bogt, T. F., & Meeus, W. H. (2009). The role of music preferences in early adolescents’ friendship formation and stability. Journal of Adolescence, 32(1), 95-107.

Ter Bogt, T., Engels, R., Hibbel, B., Van Wel, F., & Verhagen, S. (2002). ‘Dancestasy’: Dance and MDMA use in Dutch youth culture. Contemporary Drug Problems, 29, 157–181.

Ter Bogt, T. F., Keijsers, L., & Meeus, W. H. (2013). Early adolescent music preferences and minor delinquency. Pediatrics, 131(2), e380-e389.

Ter Bogt, T.F., Mulder, J., Raaijmakers, Q.A., & Gabhainn, S.N. (2010). Moved by music: A typology of music listeners. Psychology of Music, 39, 147-163.

Cheesy does it: An unusual case of sitophilia

In a previous blog I looked at sitophilia, a sexual paraphilia in which individuals have an erotic attraction to (and derive sexual arousal from) food. One of the strangest sitophile stories I have read concerns the case of the ‘Swiss Cheese Pervert’.  In the run up to Christmas 2013, a chubby man estimated to be in his 40s was driving around the Mayfair district of Philadelphia (USA) and exposing his genitals to a number of women while seated in his Sedan. However, this was no ordinary case of exhibitionism. As the Fortean Times reported:

“He would then dangle a large slice of Swiss cheese over his penis and offers to pay the women to perform sexual acts on him using the snack. At least two other women received messages on [the] OKCupid [online dating website] they believe were from the same man, describing how being unpopular with women drove him to have sex with cheese. He offered to pay $50 for a woman to pleasure him with a slice. The city’s police suspect 41-year-old Chris Pagano, since he was arrested in 2006 and 2009 for allegedly propositioning women with Swiss cheese on the streets of Norristown, Philadelphia. Pagano claimed that the latest incidents had nothing to do with him – but the picture he used on Facebook was the same as the one on the OKCupid profile message sent to a woman asking her to indulge his cheese craving”.

Pagano’s previous arrests were well documented in the local Philadelphia press and one journalist (Victor Fiorello) has written a number of stories about Pagano’s sexual exploits. In one of his stories he obtained the court documents in relation to the 2006 and 2009 arrests and one extract (with the woman’s name removed to protect her identity) read that:

“[The woman] told police that at approximately 0030 hours she was walking home from a store the male approached her from behind and asked her a question. The male removed a large block of cheese from his pocket and told [the woman] that he would pay her $20 to rub the Swiss cheese on his penis. [The woman] became alarmed and fled on foot toward her residence. The male offered [the woman] more money as she fled the area. [The woman] described the male as white, balding, and weighing over 300 pounds”

Following the late 2013 reports in the local press, one woman (Gabby Chest) telephoned the police saying that she had got an email on the OKCupid website from a “really strange guy” fitting the description of Pagano and who in his message wrote that he was “looking for someone to perform masturbation on him with cheese”. In the online message to Ms. Chest, the man admitted that he had great difficulty in initiating relationships with women because of his weight problem. This (he claimed) led to his cheese fetish and helped him to deal with his sexual urges. The whole message was reprinted on the PhillyMag website and I have reprinted it verbatim as I think it provides a good insight into the behaviour:

“Hello, my name is Chris. I am sure you are seeking a relationship, and I am sort of seeking the same, well sort of. You see I am currently content with my life. I enjoy meeting new people and making friends, but I also enjoy looking for women who are just looking for fun, opportunities, and or sex. I am kind of hoping you may be one of those women, who are open to certain activities of a suggestive nature. I realize talking and or requesting anything sexual with a someone you don’t know can be a turn off for most, but would you be interested in getting to know me, and perhaps being involved in a sexual encounter together? I know it’s a bit much to take in, since you really don’t know me. Still I am open to get to know you at first before anything would happen. I want to be up-front with you and tell you what exactly I am looking for. This way you have an idea of what I am into. You see it’s not sex in the traditional sense, it’s more a fetish. Don’t get me wrong I do enjoy traditional sex, but I grown to prefer this more. This fetish is a Sitophilia type fetish. I will give you a short explanation that lead me to discover why I like this type of fetish.

You see, when I was young and even now I seemed to be judged on my looks and not on my personality. So finding women and starting relationships was harder for me then most. Couple that with a strong sex drive, and you get the picture. So I developed this fetish to help me deal with my sexual urges. I found that women tend to like dairy products, and settled on cheese to represent the girl. Thus I started having sex with cheese. I like to use Swiss cheese and would wrap slices of the cheese around penis, then masturbate. Now tho [sic], after finding several girls to do it for me, I prefer having girls do it for me, instead of myself. Still I suppose I was lucky in finding those women, and our relationships did not last long, since our relationship based more on my fetish and me helping them out money wise. When they became comfortable again, we stayed friends, but they seemed to move on with their lives or I moved on because of the drama that sometimes followed some of them. The other problem I encounter is that women tend to be more freaked out over my fetish, then they would be over other questionable activities that are far more disgusting then mine. I don’t understand why using cheese in the way I use it is so disturbing to women, the ones who have done my fetish for me say it’s quite vanilla compared to so things they have encountered, and say I am quite harmless given my kind personality. So my request is, is there any way you would be willing to strike up an arraignment with me to do my fetish for me, if of course you would be open to this sort of activity? 

Lastly if I have offended you, I am sorry as it was not my intention to do so. I just hope my fetish with cheese does not disturb you in any way, sorry if it has. Also when I mention arrangement, please don’t think it just has to be money either, I know you are not a prostitute, in fact I don’t want women like that at all. It can be anything you feel is a fair trade. Please if you could please let me know if you might be interested or not, and what you think of my request, I would appreciate it, thanks”.

In another online message, it is alleged that he said: “I am lucky I never became a rapist”. This latter admission suggesting that his cheese infatuation was a less palatable alternative to his cheese infatuation. In an email on the OKCupid website, he wrote to another woman and added:

“I tried many different kinds of cheese, like American, Provolone, chez whiz, jack, and cheddar, but settled on Swiss as the best…because of its eye patterns, texture, and the way it feels against my penis. When I was younger I had far more stamina for cheese sex. I was able to wrap and wear a good 1½ pounds of Swiss cheese against my penis, and wear it for hours at a time before I would climax…One last note, I do not like cheese, except for mozzarella, and that is the one cheese I have never used on myself. So no I do not eat the cheese after I am done using it for pleasure, it is discarded. I am always asked that question”.

I found the online message sent to Ms. Chest of great psychological interest. Pagano obviously knew that his preferred sexual behaviour was sitophilia and that he himself conceptualized his own behaviour as fetishistic. He also provided what I believe to be a plausible explanation as to how cheese became a symbolic female substitute for sex. Using cheese in his early masturbatory experiences would almost certainly created an associative pairing between sex and cheese (to the point where cheese on its own may have caused a classically conditioned response resulting in sexual arousal). Pagano’s own realistic assessment of his sexual attractiveness appears to have led to sexual displacement in which cheese represented an outlet for his sexual urges and desires. He was fully aware that his desires would seem strange to most people and that he was prepared to pay for the activity if that helped women participate. From the newspaper reports I read, it would appear that the criminal exhibitionism (i.e., flashing his genitalia at women he approached in his car) was peripheral to his real desire of soliciting women to engage in ‘cheesy’ sex.

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

Further reading

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

Daily Mail (2014). ‘Swiss Cheese Pervert’ terrorizes Philadelphia asking women to perform sexual acts on him using a slice of fromage. Daily Mail. January 13. Located at: http://www.dailymail.co.uk/news/article-2538687/Swiss-Cheese-Pervert-terrorizing-Philadelphia.html

Fiorello, V. (2014). Is this guy the Swiss Cheese Pervert? PhillyMag, January 11. Located at: www.phillymag.com/news/2014/01/11/norristowns-swiss-cheese-pervert/

Fiorello, V. (2014). Here are mugshots of alleged Swiss Cheese Pervert Chris Pagano. PhillyMag, January 11. Located at: http://www.phillymag.com/news/2014/01/13/mugshots-swiss-cheese-pervert-chris-pagano/

Fortean Times (2014). Please cheese me…Fortean Times, March 1, p.10

Gas roots: A beginner’s guide to anaesthesiophilia

“I love the idea of being wheeled in my bed along the hospital corridors before bursting through the swing doors of the Anaesthetic Room. The lady anaethetist then smiles and tells me that she has decided to put me to sleep with the Gas. ‘NO! Not the Gas!’ The lady then insists by saying that it is her treat and that she has been looking forward to this moment! She smiles as she lowers the black rubbery mask and whispers, ‘Now just relax. IT’S TIME! Breathe in the Gas nice and deep. I look forward to seeing you struggle to keep your eyes open; but very soon you will succumb to the lovely Gas and you will have to close your eyes! Sleep well!’ She leans closer to me and laughs as I take deep breaths of the lovely Gas!!” (Participant at Sleep Peeps website).

In a previous blog, I examined medical fetishism that refers to an umbrella group of related sexual fetishes in which individuals derive sexual pleasure and arousal from medical and/or clinical practices and procedures (e.g., undergoing a rectal examination or urethral swab, having temperature taken), objects (e.g., stethoscope, hypodermic needle), situations (e.g., waiting to see a nurse), and environments (e.g., being in a hospital waiting room). One form of medical fetishism is anaesthesia fetishism in which individuals derive sexual pleasure and arousal from either administering and/or receiving some kind of anaesthetic such as chloroform, ether, butane, etc. As an entry in Wikipedia notes:

This may include the sexual attraction to the equipment, processes, substances, effects, environments or situations. Sexual arousal from the desire to administer anesthesia, or the sexual desire for oneself to be anaesthetized are two forms in which an individual may exist as an arbiter of the fetish. Older-style anesthesia masks of black rubber, still in occasional use today, are one of the more common elements fetishized, and have earned the nickname Black Beauty by many fetishists…The Internet has enabled people with this relatively rare paraphilia to discuss the subject and exchange anesthesia-related multimedia”.

Back in 1999, I had my first ever article published on sexually paraphilic behaviour in the magazine Bizarre. It was an article on autoerotic deaths and it featured the cases of ten people who had died in strange sexual circumstances. One of the cases I featured was originally published in a 1988 issue of the American Journal of Forensic Medicine and Pathology (by Dr. J.J. McLennan and colleagues). The case involved a single 59-year old white US male antiques dealer. The man was found dead in his locked apartment. He was seated in front of a dental anaesthetic machine with the anaesthetic face-mask over his face. He was sucking on a rubber teat similar (but much bigger) than a baby’s feeding bottle. There were other anaesthetic machines around the apartment as well as a lot of sexual literature (magazines, photographs, paintings, manuscripts all concerned with his elaborate fetish some of which included photographs of himself in these situations). He was wearing a rubber type apron, three woolen cardigans, a woman’s blouse and two pairs of women’s trousers and a pair of women’s bloomers. This appeared to be a genuine case of anaesthesiophilia. (A similar case was also reported in 1988 the same journal by Dr. S. Leadbeatter. Here, the method of induction of cerebral hypoxia was inhalation of nitrous oxide [i.e., ‘laughing gas’] from a dental anesthetic machine).

In the same article I featured the case of a single 32-year old white US male computer programmer that was published in a 1983 issue of Medicine, Science and the Law (by Dr. S.M. Cordner). Here, the man was found dead in bed with cassette recorder next to him and covered in dry semen stains. He was wearing headphones which playing “snorting” horse sounds. There was also a can of aerosol propellant. At the end of the bed was a large painting of a male strapped to the hind legs of a horse who was being anally penetrating by the horse. The horse was ridden by a leather-clad woman. He was also wearing some kind if homemade masturbatory device. His death was recorded as cardio-respiratory failure consistent with aerosol propellant abuse (death by misadventure).

Although this case wasn’t technically anaesthesiophilia, it did involve self-administration of a chemical agent to modify the sensations of masturbation. However, in a 2009 book chapter on ‘adult sexual offences’ by Dr. Deborah Rogers (in the book Clinical Forensic Medicine), she seems to suggest that the case I have just described would be classed as anaesthesiophilia as she defines such a paraphilia as it involves the person using a volatile substance (e.g., chloroform, ether, butane) as a source of sexual arousal. She also points out the commonalities between anaesthesiophilia, hypoxyphilia (sexual arousal and pleasure from oxygen deprivation), and electrophilia (sexual arousal and pleasure from electricity and electric stimuli). More specifically she notes:

“Some sexual variations involve inherently life-threatening practices. These include autoerotic asphyxia (using strangulation, hanging, gagging, plastic bag asphyxia, inverted suspension), electrophilia and anaesthesiophilia. When accidental deaths do occur in these circumstances associated paraphernalia may be present at the scene, such as evidence of transvestism, bondage, pornographic material or mirrors. Family members or friends who discover the body in these situations may, in an attempt to preserve the reputation of the deceased, remove certain articles. In doing so they may create a scene erroneously considered a suicide or homicide. When the truth is divulged sympathetic explanations are necessary for reassurance that these deaths are usually accidental”.

Many of the same points were made by Dr. Stephen Hucker writing in a 2011 issue of the Archives of Sexual Behavior. Hucker compared electrophilia and hypoxyphilia and electrophilia with anaesthesiophilia. He also stated that all these behaviours have potential “to result in a well-recognized mode of accidental death” and come “under the general rubric of sexual masochism.

Using Dr. Rogers’ wider definition of anaesthesiophilia indicates that the practice – while rare – is well known in the forensic literature where a number of autoerotic deaths have been reported as arising from the sexual use of volatile substances. One of the first such deaths reported in the literature dates back to a 1933 German report (by Dr. F. Schwarz). He recounted the case of a man who had used a complex system of valves, tubes, and balloons to get sexually aroused from nitrous oxide (stolen from his dad’s medical practice).

Another lethal German case from 1997 was reported by Dr. M. Rothschild and Dr. V. Schneider. Again, the source of sexual arousal was nitrous oxide (this time dispensed from cream dispenser cartridges via a homemade system of anesthetic tubes, plastic bags, and an anesthetic face mask. A paper by Dr. D. Breitmeier and colleagues in a 2002 issue of the Journal of Legal Medicine reported an autoerotic death of a man due to a bizarre combination of asphyxia by suffocation and intoxication with (the drug) ketamine that was self-administered by an intravenous catheter.

Dr. R.W. Byard and his colleagues also reported an unusual autoerotic death in a 2000 issue of the Journal of Clinical Forensic Medicine. They reported the case of a 38-year-old man who was “found dead in bed dressed in female clothing with a mouth gag, handcuffs and bindings around the genitals and limbs”. A gas mask respirator was also covering the mouth and nose and death was attributed to a combination of chloroform toxicity and upper-airway obstruction. Another autoerotic death involving chloroform was reported by Dr. Peter Singer and Dr. Graham Jones in a 2006 issue of the Journal of Analytical Toxicology.

“He was found lying on the floor of his apartment, prone on a piece of foam and a towel. His eyes were bound with a towel, his lower face and nose were almost entirely covered with duct tape surrounding a rubber hose in his mouth. The other end of the hose was loosely sitting inside an open bottle which was in a box beside him. He was bound-up by an intricate system of ropes, handles, and rods, ending with a noose around his neck”

Clearly, much of what we know about anaesthesiophilia appears to be based on case reports where the use of an anaesthetizing agent during the sexual act has gone horribly wrong. Most of the deaths occurred because the person appears to have been on their own and was presumably a masturbatory act. Engaging in the act where more than one person is present significantly reduces the chances of anything unwanted happening for the anaesthesiophile.

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

Further reading

Breitmeier D., Passie, T., Mansouri, F., Albrecht, K, Kleemann, W.J. (2002) Autoerotic accident associated with self-applied ketamine. Journal of Legal Medicine, 116, 113-116.

Bungardt, N. & L. Pötsch, (2003). [Report on a methemoglobinemia associated death]. Archiv fur Kriminologie, 212, 176-183.

Byard, R.W., Kostakis, C., Pigou, P.E. & Gilbert, J.D. (2000). Volatile substance use in sexual asphyxia. Journal of Clinical Forensic Medicine, 7, 26-28.

Cordner, S.M. (1983). An unusual case of sudden death associated with masturbation. Medicine, Science and Law, 23, 54-56.

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

Hucker, S. (2011). Hypoxyphilia. Archives of Sexual Behavior, 40, 1323-1326.

Leadbeatter, S., (1988). Dental anesthetic death: An unusual autoerotic episode. American Journal of Forensic Medicine and Pathology, 9, 60-63.

McLennan, J.J., Sekula-Perlman, A., Lippstone, M.B. & Callery, R.T. (1998). Propane-associated autoerotic fatalities. American Journal of Forensic Medicine and Pathology, 19, 381-386.

Musshoff, F., Padosch, S.A., Kroener, L.A, et al., (2006). Accidental autoerotic death by volatile substance abuse or nonsexually motivated accidents? American Journal of Forensic Medicine and Pathology, 27, 188-192.

Rogers, D.J. (2009). Adult sexual offences. In McLay, W.D.S. (Ed.). Clinical Forensic Medicine (3rd Edition, pp. 137-154). Cambridge: Cambridge University Press.

Rothschild, M.A. & Schneider, V. (1997). Uber zwei autoerotische Unf T Lachgasnarkose und Thoraxkompression. Archiv fur Kriminologie, 200, 65-72.

Schwarz, F. (1933). T Lachgasvergiftung bei Selbstnarkose. Archiv fur Kriminologie, 93, 215-217.

Singer, P.P. & Jones, G.R. (2006). An unusual autoerotic fatality associated with chloroform inhalation. Journal of Analytical Toxicology, 30, 216-218.

Stemberga, V., Bralić, M., Bosnar, A. & Coklo M. (2007). Propane-associated autoerotic asphyxiation: accident or suicide? Collegium Antropologicum, 31, 625-627.

Thibault R, Spencer JD, Bishop JW, Hibler NS (1984) An unusual autoerotic death: asphyxia with an abdominal ligature. Journal of Forensic Science, 29, 679-684.

Wikipedia (2012). Medical fetishism. Located at: http://en.wikipedia.org/wiki/Medical_fetishism

Whirled piece: Dancing as an addiction

In previous blogs I have examined various (admittedly extreme) aspects of dancing including people that are sexually aroused by dancing (choreophilia), dancing as a form of frottuerism, people that are addicted to dancing (in this case, the Argentine tango), and people who have developed medical complaints as a result of dancing (‘breaker’s neck’ caused by break dancing). However, over the last few months I have been a co-author on two dance-related research papers with my research colleagues in Hungary (led by Aniko Maraz). The first one (published in the journal PLoS ONE) was about the development and psychometric validation of the ‘Dancing Motives Inventory’ (DMI). The second one (also published in PLoS ONE) was a study of dance addiction (and which I will describe in more detail below).

I’m sure many of you reading this will think that dancing is a somewhat trivial area to be carrying out scientific research. However, research has shown that dancing can have substantial benefits for physical and mental health such as decreased depression and anxiety, and increased physical and psychological wellbeing. After we developed the DMI, we realised that very little known about the psychological underpinnings of excessive dancing, and whether in extreme cases, dancing could be classed as an addictive behaviour. Given the lack of empirical research in dance addiction, we conceptualized dance addiction to be akin to exercise addiction. For example, a study published in the journal Perceptual and Motor Skills led by Dr. Edgar Pierce reported that dancers scored higher on the Exercise Addiction Scale compared to endurance and non-endurance athletes. Added to this, both exercise and dancing require stamina and physical fitness, and for this reason, dance is often classified as a form of exercise.

Over the last 20 years I have published many papers on exercise addiction (see ‘Further reading’ below) so there is no reason why dance addiction couldn’t theoretically exist (in fact, it could be argued that dance addiction – if it exists – is a sub-type of exercise addiction). There are also a handful of studies that have examined excessive dancing and whether it can be addictive to a small minority. A study by Edgar Pierce and Myra Daleng (again in Perceptual and Motor Skills) conducted a study with 10 elite ballet dancers and found that dancers rated thinner bodies as ideal and significantly more desirable than their actual body image despite being in the ‘ideal’ BMI range. The study also found that dancers often continue to dance despite discomfort, “because of the embedded subculture in dance that embraces injury, pain, and tolerance”. In a more recent study in the Journal of Behavioral Addictions (and which I reported at length in a previous blog), Dr. Remi Targhetta and colleagues assessed addiction to the Argentine tango. They found that almost half of their participants (45%) met the DSM-IV criteria of abuse, although a substantially lower prevalence rate (7%) was found when using more conservative criteria.

In our recently published study, we proposed that excessive social dancing would be associated with detriments to mental health. More specifically, we aimed to (i) identify subgroups of dancers regarding addiction tendencies, (ii) explore which factors account for the elevated risk of dance addiction, and (iii) explore the motivations underlying excessive dancing.

Our sample included 447 salsa and ballroom dancers (32% male and 68% female, with an average age of 33 years) who danced recreationally at least once a week. To assess ‘dance addiction’ we created the ‘Dance Addiction Inventory’ modified from the Exercise Addiction Inventory (that I co-developed back in 2004) in which we simply replaced the word ‘exercise’ with the word ‘dance’. We also assessed the dancers’ general mental health, borderline personality disorder, eating disorder symptoms, and dance motives.

As far as we are aware, our study is the first to explore the psychopathology and motivation behind dance addiction. Based on my criteria of addiction, five distinct types of dancers were identified. Only two of these types danced excessively. About one-quarter of our sample reported high values on all criteria of addiction but they reported no conflict with the social environment. However, 11% of dancers (and what we termed the ‘high risk’ group) scored high on all addiction symptoms and experienced conflict in their life as a consequence of their excessive dancing.

Our study also found that dance addiction was associated with mild psychopathology, especially with elevated number of eating disorder symptoms and (to a lesser extent) borderline personality traits (something which has also been found in research examining exercise addiction). Perhaps unsurprisingly, escapism (and to a lesser extent mood enhancement) was an especially strong indicator of dance addiction. I say ‘unsurprisingly’ because escapism has already been much reported in other types of behavioural addiction such as gambling and video gaming (including a lot of my own research). Here, escapism as a motivational factor refers to dancing in order to avoid feeling empty or as a mechanism to deal with everyday problems. Based on our findings, we believe that to a minority of individuals appear to be addicted to dancing and that it may be being used be a maladaptive coping mechanism.

Based on what we know in the exercise addiction literature, we proposed that future studies should also assess whether eating disorder is primary or secondary to dance addiction (i.e., whether the purpose of excessive dancing is weight-control and/or the motivation to perform leads to disturbances in eating patterns). I should also point out that although we found that distress was correlated with dance addiction, the association disappeared when other measures were added to the regression model. This may indicate that distress is not directly associated with problematic dancing and that it may arise from other problematic factors such as having an eating disorder.

Given the lack of research in the field, other studies are needed to confirm or refute the findings of our study. Given that dancing is a social activity, social conflicts may not arise when the person has only fellow dancers as partners or friends – therefore, the risky behaviour may remain somewhat hidden. Another question that could be examined is whether there is any difference between amateur and professional dancers in terms of addiction tendency (although among professional dancers there may be a debate about whether their behaviour is dancing addiction or ‘workaholism’). Also, we don’t know whether our findings can be extended to other dance genres (as we only surveyed ballroom and salsa dancers)

I would just like to end by saying that dancing is very clearly a healthy activity for the majority of individuals. However, our study does seem to suggest that excessive dancing may have problematic and/or harmful effects for a small minority. Although we couldn’t establish causality, dance addiction appears to have the potential to be associated with mild psychopathology.

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

Additional input: Aniko Maraz, Róbert Urbán and Zsolt Demetrovics.

Further reading

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory,14, 631-646

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Griffiths, M.D., Szabo, A. & Terry, A. (2005). The Exercise Addiction Inventory: A quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, 30-31.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.

Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

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.

Pierce, E.F. & Daleng, M.L. (1998) Distortion of body image among elite female dancers. Perceptual and Motor Skills, 87, 769-770.

Pierce, E.F., Daleng, M.L. & McGowan, R.W. (1993) Scores on exercise dependence among dancers. Perceptual and Motor Skills, 76, 531-535.

Ramirez, B., Masella, P.A., Fiscina, B., Lala, V.R., & Edwards, M. D. (1984). Breaker’s neck. Journal of the American Medical Association, 252(24), 3366-3367.

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

Meditate to medicate: Mindfulness as a treatment for behavioural addiction

Please note: A version of the following article was first published on addiction.com and was co-written with my research colleagues Edo Shonin and William Van Gordon

Mindfulness is a form of meditation that derives from Buddhist practice and is one of the fastest growing areas of psychological research. We have defined mindfulness as the process of engaging a full, direct, and active awareness of experienced phenomena that is spiritual in aspect and that is maintained from one moment to the next. As part of the practice of mindfulness, a ‘meditative anchor’, such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present moment sensory and cognitive-affective experience.

Throughout the last two decades, Buddhist principles have increasingly been employed in the treatment of a wide range of psychological disorders including mood and anxiety disorders, substance use disorders, bipolar disorder, and schizophrenia-spectrum disorders. The emerging role of Buddhism in clinical settings appears to mirror a growth in research examining the potential effects of Buddhist meditation on brain neurophysiology. Such research forms part of a wider dialogue concerned with the evidence-based applications of specific forms of spiritual practice for improved psychological health.

Within mental health and addiction treatment settings, mindfulness-based interventions (MBIs) are generally delivered in a secular eight-week format and often comprise the following: (i) weekly sessions of 90-180 minutes duration, (ii) a taught psycho-education component, (iii) guided mindfulness exercises, (iv) a CD of guided meditation to facilitate daily self-practice, and (v) varying degrees of one-to-one discussion-based therapy with the program instructor. Examples of MBIs used in behavioural addiction treatment studies include Mindfulness-Based Cognitive Therapy, Mindfulness-Enhanced Cognitive Behaviour Therapy, Mindfulness-Based Relapse Prevention, Mindfulness-Based Stress Reduction, and Meditation Awareness Training.

Studies investigating the role of mindfulness in the treatment of behavioural addictions have – to date – primarily focused on problem and/or pathological gambling. These studies have shown that levels of dispositional mindfulness in problem gamblers are inversely associated with gambling severity, thought suppression, and psychological distress. Recent clinical case studies have demonstrated that weekly mindfulness therapy sessions can lead to clinically significant change in problem gambling individuals. Published case studies include: (i) a male in his sixties addicted to offline roulette playing, (ii) a 61-year old female (with comorbid anxiety and depression) addicted to slot machine gambling (treated with a modified version of Mindfulness-Based Cognitive Therapy), and (iii) a 32-year old female (with co-occurring schizophrenia) addicted to online slot-machine playing (treated with a modified version of Meditation Awareness Training). Also, a recent study showed that problem gamblers that received Mindfulness-Enhanced Cognitive Behaviour Therapy demonstrated significant improvements compared to a control group in levels of gambling severity, gambling urges, and emotional distress.

Outside of gambling addiction, case studies have investigated the applications of mindfulness for treating addiction to work (i.e., workaholism) and sex. In the case of the workaholic, a director of a blue-chip technology company in his late thirties was successfully treated for his workaholism utilizing Meditation Awareness Training. Significant pre-post improvements were also observed for sleep quality, psychological distress, work duration, work involvement during non-work hours, and employer-rated job performance. However, as with any case study, the single-participant nature of the study significantly restricts the generalizability of such findings.

Key treatment mechanisms that have been identified and/or proposed in this respect (several of which overlap with mechanisms identified as part of the mindfulness-based treatment of chemical addictions) include:

  • A perceptual shift in the mode of responding and relating to sensory and cognitive-affective stimuli that permits individuals to objectify their cognitive processes and to apprehend them as passing phenomena.
  • Reductions in relapse and withdrawal symptoms via substituting maladaptive addictive behaviours with a ‘positive addiction’ to mindfulness/meditation (particularly the ‘blissful’ and/or tranquil states associated with certain meditative practices).
  • Transferring the locus of control for stress from external conditions to internal metacognitive and attentional resources.
  • The modulation of dysphoric mood states and addiction-related shameful and self-disparaging schemas via the cultivation of compassion and self-compassion.
  • Reductions in salience and myopic focus on reward (i.e., by undermining the intrinsic value and ‘authenticity’ that individuals assign to the object of addiction) due to a better understanding of the ‘impermanent’ nature of existence (e.g., all that is won must ultimately be lost, an attractive body will age and wither, a senior/lucrative occupational role must one day be relinquished, etc.).
  • Growth in spiritual awareness that broadens perspective and induces a re-evaluation of life priorities.
  • ‘Urge surfing’ (the meditative process of adopting an observatory, non-judgemental, and non-reactive attentional-set towards mental urges) that aids in the regulation of habitual compulsive responses.
  • Reduced autonomic and psychological arousal via conscious-breathing-induced increases in prefrontal functioning and vagal nerve output (breath awareness is a central feature of mindfulness practice).
  • Increased capacity to defer gratitude due to improvements in levels of patience.
  • A greater ability to label and therefore modulate mental urges and faulty thinking patterns.

Although preliminary findings indicate that there are applications for MBIs in the treatment of behavioural addictions, further empirical and clinical research utilizing larger-sample controlled study designs is clearly needed. Despite this, both the classical Buddhist meditation literature and recent scientific findings appear to agree that when correctly practised and administered, mindfulness meditation is a safe, non-invasive, and cost-effective tool for treating behavioural addictions and for improving psychological health more generally.

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

Further reading

Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, in press.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 194, doi: 10.3389/fpsyg.2013.00194.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Mindfulness as a treatment for behavioural addiction. Journal of Addiction Research and Therapy, 5: e122. doi: 10.4172/2155-6105.1000e122.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Current trends in mindfulness and mental health. International Journal of Mental Health and Addiction, 12, 113-115.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2014). Practical tips for using mindfulness in general practice. British Journal of General Practice, 624 368-369.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Mindfulness in psychology: A breath of fresh air? The Psychologist: Bulletin of the British Psychological Society, 28, 28-31.

Shonin, E., Van Gordon W., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.

Disfigure it out: A brief look at post-mortem mutilation in murder cases

A body of an adult female of about 25 years old was found dead in a naked condition in a reserved forest area in South Delhi in June, 2006 by police. There was information to [the] police via public call as 2-3 people had killed one lady after [having] sex [with her] and [then running] away. Further enquiry, revealed that they all had consumed alcohol along with the lady. They also had sexual intercourse with her using condom…Following the quarrel they killed her by hitting her head with a heavy stone. After killing her, they also tried to destroy her identity by burning her face with wooden stick and twigs and her clothes. One of them also introduced a wine bottle inside [her] vagina. There were multiple postmortem injuries in particular pattern over left side lower part of chest, abdomen and inguinal regions including upper part of left thigh. All [the] accused were subsequently arrested by the police”.

This shocking account of a brutal murder was the opening paragraph in a paper by Dr. B.L. Chaudhary and his colleagues in a 2007 issue of the Journal of Indian Academy of Forensic Medicine (JIAFM). Although an increasingly common theme in television and film homicides, post-mortem mutilation of a dead person’s body by perpetrators is arguably much rarer than the incidence in fictionalized drama. The JIAFM paper noted that the majority of such cases typically involve body “dismemberment for the purpose of disposing or hiding a body or of preventing identification”.

A national study carried out in Sweden by Dr. Jovan Rajs and colleagues in the Journal of Forensic Sciences found that only 22 deaths over a 30-year period (1961-1990) had been criminally mutilated and/or dismembered. These were then classified into one of three types: (i) defensive, (ii) offensive (i.e., lust murder) and (iii) necromanic mutilation. They reported that the perpetrators of the defensive and aggressive post-mortem mutilation were typically “disorganized” (i.e., alcoholics, drug abusers, mentally disordered) whereas the lust murderers were typically “organized” with a long history of violent crimes. The JIAFM paper summarized the findings of Raus and colleagues:

“The characteristics of the mutilations were diverse. In cases of murder committed in association with sexual deviation, wounding is usually limited to the breasts and sexual organs. Corpse mutilation can also be of a symbolic nature as in cases of mafia murders (revenge punishment) and then it is associated with torturing the victim and with the motive of destruction of identify of victim”.

In the case of the female victim reported by Chaudhary and colleagues, they reported that it was the victim’s head, face, and chest that were burned, destroyed, and mutilated post-mortem. They speculated that this was done to either (i) to prevent identification of the victim, (ii) to make it difficult to determine the cause of death, or (iii) as an act of depersonalization as it is often seen “when the murder is disorganized and has a close relation to his victim or offensive mutilation as general act of frustration”. Why the men had inserted a foreign object into the woman’s vagina was less clear. The authors speculated that it may have been because of (i) frustration of a non-performing sexual partner because of heavy intoxication, (ii) an extortion demand by victim, (iii) blackmail by the victim, or (iv) psychopathic tendencies of the perpetrators can carried out for sadistic pleasure. However, they also added that:

“In this case as there was alleged history of consensual sexual activity which could be or could not be as body had injuries so it could be non-consensual activity also. Apparently there was no smell in the [gastric] contents but samples were sent for alcohol screening/concentration estimation. In [the medical] literature, various materials and objects like chilly powder, corrosives, metal or wooden sticks are introduced into genitalia as a part of punishment for unfaithfulness or infidelity. Males suffering from depression due to erectile dysfunctions, premature ejaculation and impotency may indulge in extreme frustration cases. In this psychological profiling of the accused can also be helpful in knowing for such abnormal instincts. At times, provocative words by female partner about their malehood could trigger such impulsive murder and mutilation”

Post-mortem mutilation while extreme can sometimes border on the almost unbelievable. For instance, Dr. J. Kunz and Dr. A. Gross published a paper in a 2001 issue of the American Journal of Forensic and Medical Pathology which as Ronseal would claim “does exactly what it says on the tin” as it was entitled Victim’s scalp on the killer’s head: An unusual case of criminal postmortem mutilation”. The paper reported that:

“After killing his father, the son decapitated his body and dissected the scalp free, forming a mask of the father’s head and neck. The young man wore the scalp-mask over his own head to imitate the father. The motive of the murder was revenge, and the postmortem mutilation was the realization of the perpetrator’s fantasies, symbolically representing a penalty for the reprehensible past life of his father”.

Another extreme case of postmortem mutilation following murder was reported by Dr. Tomasz Konopka and his colleagues in a 2006 issue of the Journal of Forensic Medicine and Pathology. In this instance, a Polish man cut up the corpse and dismembered the body into 850 fragments. He “employed various tools to divide the body into fragments and subsequently boiled the pieces to reduce their volume”. This reduced the body volume by 30kg. The murderer then placed all the body fragments into two large pots in a space under his stairwell and then plastered over the wall to hide the body. Another paper by Dr. Konopka and colleagues in a 2007 issue of Legal Medicine examined 23 cases of dismembered bodies in the 1968-2005 period at the Cracow Department of Forensic Medicine. Of these, 17 were cases of defensive mutilation, three were offensive mutilation and two were dismemberment (decapitation, and direct cause of death). One case remained unclassified where the murderer dissected free skin from the whole torso. They concluded that:

“Apart from rare cases of necrophilia, the victim of dismemberment is always a victim of homicide. Homicides ending with corpse dismemberment are most commonly committed by a person close to, or at least acquainted with the victim and they are performed at the site of homicide, generally in the place inhabited by the victim, the perpetrator or shared by both. Such instances are generally not planned by the perpetrator and rarely serial in character”.

Finally, I came across an interesting 2009 paper by a Finnish team led by Dr. Häkkänen-Nyholm in the Journal of Forensic Sciences. The authors noted that research relating to mutilation of bodies by murderers was “sparse”. They estimated the rate of mutilation of the victim’s body in Finnish homicides. To do this they examined all crime and forensic reports of homicide offenders from 1995–2004 (n = 676). Only 13 murders (2.2%) involved postmortem mutilation. They concluded that:

“Educational and mental health problems in childhood, inpatient mental health contacts, self-destructiveness, and schizophrenia were significantly more frequent in offenders guilty of mutilation. Mutilation bore no significant association with psychopathy or substance abuse. The higher than usual prevalence of developmental difficulties and mental disorder of this subsample of offenders needs to be recognized”.

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

Further reading

Chaudhary, B.L., Murty, O.P. & Singh, D. (2007). Foreign objects in genitalia: Homicide with destruction of identity – A case report. Journal of Indian Academy of Forensic Medicine, 29(4), 135-137.

Häkkänen-Nyholm, H., Weizmann‐Henelius, G., Salenius, S., Lindberg, N., & Repo-Tiihonen, E. (2009). Homicides with mutilation of the victim’s body. Journal of Forensic Sciences, 54(4), 933-937.

Hladík, J., Štefan, J., Srch, M., & Pilin, A. (2000). A rare case of evisceration. International Journal of Legal Medicine, 113(2), 107-109.

Konopka, T., Bolechala, F., & Strona, M. (2006). An unusual case of corpse dismemberment. The American Journal of Forensic Medicine and Pathology, 27(2), 163-165.

Konopka, T., Strona, M., Bolechała, F., & Kunz, J. (2007). Corpse dismemberment in the material collected by the Department of Forensic Medicine, Cracow, Poland. Legal Medicine, 9(1), 1-13.

Kunz, J. & Gross, A. (2001). Victim’s scalp on the killer’s head: An unusual case of criminal postmortem mutilation. American Journal of Forensic and Medical Pathology, 22(3), 327-31.

Rajs, J., Lundstrom, M., Broberg, M., Lidberg, L., & Lindquist, O. (1998). Criminal mutilation of the human body in Sweden: A thirty year medico-legal and forensic psychiatric study. Journal of Forensic Sciences, 43(3), 563-80.

Simonsen, J. (1989). A sadistic homicide. The American Journal of Forensic Medicine and Pathology, 10(2), 159-163.

Türk, E. E., Püschel, K., & Tsokos, M. (2004). Features characteristic of homicide in cases of complete decapitation. The American Journal of Forensic Medicine and Pathology, 25(1), 83-86.

Net losses: Another look at problematic online gaming

I have examined problematic and/or addictive video gaming in a number of my previous blogs. Despite the increasing amount of empirical research into problematic online gaming, the phenomenon still sadly lacks a consensual definition. Some researchers (including myself, and others such as John Charlton and Ian Danforth) consider video games as the starting point for examining the characteristics of this specific pathology, while other researchers consider the internet as the main platform that unites different addictive internet activities including online games (such as my friends and colleagues Tony Van Rooij and Kimberley Young). There are also recent studies that have made an effort to integrate both approaches (such as some work I carried out with Zsolt Demetrovics and his team of Hungarian researchers in the journal PLoS ONE).

I have noted in a number of my papers on addiction (particularly in a paper I had published in a 2005 issue of the Journal of Substance Use) that although each addiction has several particular and idiosyncratic characteristics, they have more commonalities than differences that may reflect a common etiology of addictive behaviour. Using the ‘components’ model of addiction, within a biopsychosocial framework, I consider online game addiction a specific type of video game addiction that can be categorized as a nonfinancial type of pathological gambling. I developed the components of video game addiction theory by modifying Iain Brown’s earlier addiction criteria. These are:

(1) Salience: This is when video gaming becomes the most important activity in the person’s life and dominates his/her thinking (i.e., preoccupations and cognitive distortions), feelings (i.e., cravings) and behaviour (i.e., deterioration of socialized behaviour);

(2) Mood modification: This is the subjective experience that people report as a consequence of engaging in video game play (i.e. they experience an arousing ‘buzz’ or a ‘high’ or, paradoxically, a tranquillizing and/or distressing feel of ‘escape’ or ‘numbing’).

(3) Tolerance: This is the process whereby increasing amounts of video game play are required to achieve the former effects, meaning that for persons engaged in video game playing, they gradually build up the amount of the time they spend online engaged in the behaviour.

(4) Withdrawal symptoms: These are the unpleasant feeling states or physical effects that occur when video gaming is discontinued or suddenly reduced, for example, the shakes, moodiness, irritability, etc.

(5) Conflict: This refers to the conflicts between the video game player and those around them (i.e., interpersonal conflict), conflicts with other activities (e.g., job, schoolwork, social life, hobbies and interests) or from within the individual themselves (i.e., intrapsychic conflict and/or subjective feelings of loss of control) which are concerned with spending too much time engaged in video game play.

(6) Relapse: This is the tendency for repeated reversions to earlier patterns of video game play to recur and for even the most extreme patterns typical at the height of excessive video game play to be quickly restored after periods of abstinence or control.

John Charlton and Ian Danforth analyzed these six criteria and found that tolerance, mood modification and cognitive salience were indicators of high engagement, while the other components – withdrawal symptoms, conflict, relapse and behavioural salience – played a central role in the development of addiction.

Researchers such as Guy Porter and Vladan Starcevic don’t differentiate between problematic video game use and problematic online game use. They conceptualized problematic video game use as excessive use of one or more video games resulting in a preoccupation with and a loss of control over playing video games, and various negative psychosocial and/or physical consequences. Their criteria for problematic video game use didn’t include other features usually associated with dependence or addiction, such as tolerance and physical symptoms of withdrawal, because in their opinion there is no clear evidence that problem video game use is associated with these phenomena.

Arguably the most well known representative of the internet-based approach is Kimberley Young who developed her theoretical framework for problematic online gaming based on her internet addiction criteria which were based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – (Fourth Edition, DSM-IV) criteria for pathological gambling. Her theory states that online game addicts gradually lose control over their game play, that is, they are unable to decrease the amount of time spent playing while immersing themselves increasingly in this particular recreational activity, and eventually develop problems in their real life. The idea that internet/online video game addiction can be assessed by the combination of an internet addiction score and the amount of time spent gaming are also reflective of the internet-based approach.

Integrative approaches try to take into consideration both aforementioned approaches. For instance, a 2010 paper by M.G. Kim and J. Kim in Computers in Human Behavior claimed that neither the first nor the second approach can adequately capture the unique features of online games such as Massively Multiplayer Online Role-Playing Games (MMORPGs), therefore it’s absolutely necessary to create an integrated approach. They argued that “internet users are no more addicted to the internet than alcoholics are addicted to bottles” which means that the internet is just one channel through which people may access whatever content they want (e.g., gambling, shopping, chatting, sex, etc.) and therefore users of the internet may be addicted to the particular content or services that the Internet provides, rather than the channel itself. On the other hand, online games differ from traditional stand-alone games, such as offline video games, in important aspects such as the social dimension or the role-playing dimension that allow interaction with other real players.

Their multidimensional Problematic Online Game Use (POGU) model reflects this integrated approach fairly well. It was theoretically developed on the basis of several studies and theories (such as those by Iain Brown, John Charlton, Ian Danforth, Kimberley Young and myself), and resulted in five underlying dimensions: euphoria, health problems, conflict, failure of self-control, and preference of virtual relationship. A 2012 study I carried out with Zsolt Demetrovics and his team also support the integrative approach and stresses the need to include all types of online games in addiction models in order to make comparisons between genres and gamer populations possible (such as those who play online Real-Time Strategy (RTS) games and online First Person Shooter (FPS) games in addition to the widely researched MMORPG players). According to this model, six dimensions cover the phenomenon of problematic online gaming – preoccupation, overuse, immersion, social isolation, interpersonal conflicts, and withdrawal. Personally, I believe that online game addiction can be defined as one type of behavioural addiction. In fact ‘internet gaming disorder’ has just been included in the appendices of the new DSM-5 in order to encourage research to determine whether this particular condition should be added to the manual as a disorder in the future.

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

Additional input: Orsolya Pápay, Katalin Nagygyörgy and Zsolt Demetrovics

Further reading

Charlton, J. P., & Danforth, I.D.W. (2007). Distinguishing addiction and high engagement in the context of online game playing. Computers in Human Behavior, 23(3), 1531-1548.

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M.D., Pápay, O. & Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5): e36417. doi:10.1371/journal.pone.0036417.

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

Han, D. H., Hwang, J. W., & Renshaw, P. F. (2010). Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. Experimental and Clinical Psychopharmacology, 18, 297-304.

Kim, M.G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.

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

Peters, C. S., & Malesky, L. A. (2008). Problematic usage among highly-engaged players of massively multiplayer online role playing games. Cyberpsychology & Behavior, 11(4), 480-483.

Pontes, H. & Griffiths, M.D. (2014). The assessment of internet gaming disorder in clinical research. Clinical Research and Regulatory Affairs, 31(2-4), 35-48.

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

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

Porter, G., Starcevic, V., Berle, D., & Fenech, P. (2010). Recognizing problem video game use. The Australian and New Zealand Journal of Psychiatry, 44, 120-128.

Van Rooij, A. J., Schoenmakers, T. M., Vermulst, A. A., Van den Eijnden, R. J., & Van de Mheen, D. (2011). Online video game addiction: identification of addicted adolescent gamers. Addiction, 106(1), 205-212.

Young, K. S. (1998a). Caught in the Net: How to recognize the signs of Internet addiction and a winning strategy for recovery. New York: Wiley.

Young, K. S. (1999). Internet addiction: Symptoms, evaluation, and treatment. In L. Vande Creek & T. Jackson (Eds.), Innovations in clinical practice: A source book (pp. 17, 19–31). Sarasota, FL: Professional Resource Press.

Water feature: A brief look at psychogenic polydipsia, hyponatraemia, and ‘aquaholism’

Over the weekend I went to the cinema with my oldest son to watch Mad Max: Fury Road. The reason I mention this is because King Immortan Joe in the film (who live in a world where water is a scarce commodity) tells his thirsty subjects “Do not become addicted to water, it will take hold of you”. As soon as I got home after the film, I was straight onto Google and Google Scholar to see whether there had been anything written on ‘water addiction’. Unsurprisingly, there were lots of newspaper reports of individuals being ‘addicted’ to water but little in the academic literature. For instance, one American online article told the story of Sasha Kennedy:

“[Sasha] is addicted to water, drinking 25 liters of the stuff a day, far exceeding the USDA Recommended Daily Water Intake of 2.7 liters…What surprised me most was that the condition had a name: Psychogenic polydipsia. It is ‘an uncommon clinical disorder characterized by excessive water-drinking in the absence of a physiologic stimulus to drink’ and is typically found among mental patients on phenothiazine medications. Kennedy appears to be completely sane, although she does experience the dry mouth sensation characteristic of the condition…You’d think drinking so much water would do something to her health, but medical experts confirmed that there is nothing wrong with her. She doesn’t even have hypoatremia, where cells swell due to too much water in the blood. She’s perfectly healthy and her blood isn’t diluted. Then again, her habit started when she was two years old, so maybe her body acclimatized. Her lifestyle, however, is drastically affected by her addiction. She has to go to the toilet 40 times a day and can only get about an hour of sleep every night before having to wake up to drink some water or go to the loo. She carries large bottles of water with her everywhere she goes, and once quit her job because the tap water quality wasn’t up to par”.

Another case was reported by the UK’s Daily Mail who recounted the story of 22-year old “aquaholic” Sarah Schapira who (at the time the article was written) drank seven litres of water every day, and like Sasha above spent a lot of time in the toilet. Schapira stated:

“My argument has always been that water is good for you and helps you to detox. We’ve all been told about the benefits of water, so I drink lots and lots of it, from the minute I wake up to the minute I go to bed. If I don’t have my bottle of water I feel paranoid. And if I try not to drink for an hour, I start to feel dehydrated and I get throbbing headaches. But it has got to the stage where I don’t know how to give it up. It used to make me feel really good and healthy but not any more. I know I ought to cut down but I’m not sure how I can”.

Polydipsia (which in practical terms means drinking more than three litres of water a day) 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. The low levels of sodium causes the brain to swell which in turn constricts the blood supply to the brain when the brain compresses against the skull’s inner surface. Another person interviewed for the Daily Mail story was 26-year-old Rachel Bennett, a marketing agent from North London who drank also drank seven litres of water a day which led to headaches and dizziness. She said:

“My friends used to tease me about the amount I drank, but I dismissed their fears because I always thought it was so good for me. It got to the stage where I felt I couldn’t function without it. If I woke without a bottle of water by my bed, I would feel really paranoid. I couldn’t drink tap water – that tasted awful – instead I drank Evian by the gallon. It’s expensive, too – I could spend over £30 a week on water – but I had got to the stage where I got a huge buzz from drinking so much”.

In researching this article, I was surprised to find dozens and dozens of academic papers on psychogenic polydipsia (PPD). For instance, 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. They also noted that:

“The underlying pathophysiology of this syndrome is unclear, and multiple factors have been implicated, including a hypothalamic defect and adverse medication effects. Hyponatremia in PPD can progress to water intoxication and is characterized by symptoms of confusion, lethargy, and psychosis, and seizures or death. Evaluation of psychiatric patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria, hyponatremia”.

A 2000 study in European Psychiatry by Dr. E. Mercier-Guidez and Dr. 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. The study reported that 38 of the psychiatric patients (11%) suffered from polydipsia with one-third of them at risk of water intoxication. They also reported that being polydipsic was significantly associated with being male, a cigarette smoker and celibate. Those with polydipsia were highly prevalent among those with schizophrenia, mental retardation, pervasive developmental disorders and somatic disorders.

A comprehensive review by Dr. Victor Vieweg and Dr. Robert Leadbetter in the journal CNS Drugs examined the polydipsia-hyponatraemia syndrome (PHS). They reported that PHS occurs in approximately 5%-10% of institutionalised, chronically psychotic patients, of which four-fifths have schizophrenia. Major clinical features are polydipsia and dilutional hyponatraemia. Patents with PHS can experience delirium, generalised seizures, coma and death. The main ways to treat such individuals are fluid restriction, daily bodyweight monitoring, behavioural approaches, and supplemental oral sodium chloride administration. However, these interventions can be expensive as they require experienced and dedicated multidisciplinary staff. They also report that:

“A number of pharmacological treatments have been assessed for PHS including the combination of lithium and phenytoin, demeclocycline, propranolol, ACE inhibitors, selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors, typical antipsychotic drugs, clozapine and risperidone. Of these agents, the most promising are the combination of lithium and phenytoin, and clozapine…Long term strategies include behavioural interventions and the combination of lithium and phenytoin, and clozapine”.

Unsurprisingly, I found almost nothing on being addicted to water. A 2010 review article on PPD by Dr. D. Hutcheon and Dr. M. Bevilacqua in the Annals of the American Psychotherapy Association claimed:

“One way to assess a patient’s ability to limit polydipsia is to examine their objective reasons why polydipsia is so important in their lives. This can be initiated during psychosocial rehabilitation group meetings held semi-weekly (e.g., two 15-minute sessions per week). In these meetings, many patients have described a euphoric quality associated with polydipsia, although others have admitted to increased irritability. Most patients have noted a desire for stimulation, similar to other substances of abuse such as alcohol or street drugs. Developing an understanding of what influences a patient to develop an addiction for polydipsia can improve management of this dysregulation of fluid intake…During the treatment period in a structured inpatient setting, many patients diagnosed with psychogenic polydipsia, whether falling in the range of mild, moderate, or severe addiction, are unable to sustain a comfortable discharge to an open ward…psychogenic polydipsia can become an addiction with no demonstrable cure if left untreated… Due to the nature of the addiction and potential for self-injurious behavior, treatment requires a milieu that balances maximizing the patients’ dignity with their safety, which demands close scrutiny by the multidisciplinary team”.

I also found an old case study from a 1973 issue of the British Journal of Addiction on ‘water dependence’. This paper reported that the excessive drinking of water can dilute electrolytes in an individual’s brain and cause intoxication. A couple of papers by Dr. Bennett Foddy and Dr. Julian Savulescu have cited this case study in their own writings on addiction. In a 2010 issue of Philosophy, Psychiatry and Psychology, they noted:

“Of course, it can be claimed that a person who is addicted to sugar or water is diseased, and that their brain has changed in such a way as to make their sugar- or water-seeking behavior involuntary. Yet we know how sugar interacts with the brain to form a sensitization effect, and it is identical to how drugs – and sugar – interact with the brain of a non-addicted person. If addictions are formed through a pharmacological process, it is the exact same process that forms a person’s likes and dislikes of any pleasurable stimulus. Terms like ‘addiction’ and ‘dependence’ can reasonably be employed when a person’s likes become particularly strong, but it should be understood that these terms denote a difference in degree, not a difference in kind…The only relevant difference between drugs and sugar is that drugs produce a higher level of brain reward relative to the volume of the dose. It is easier to get addicted to heroin than to sugar, because you can do it by taking a quarter gram at a time. It is very hard to get addicted to water, because you must force down liters of it every day”.

This interesting extract argues that it is theoretically possible for someone to become addicted to water and that there is no real difference to drug addictions in terms of conceptualization and mechanism – just that the sheer amount of water that needs to be drunk to have a negative effect is large and highly unlikely.

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

Further reading

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.

Foddy, B., & Savulescu, J. (2007). Addiction is not an affliction: Addictive desires are merely pleasure-oriented desires. American Journal of Bioethics, 7(1), 29-32

Foddy, B., & Savulescu, J. (2010). A liberal account of addiction. Philosophy, Psychiatry, and Psychology, 17(1), 1-22.

Hutcheon, D., & Bevilacqua, M. (2010). Psychogenic polydipsia: A review of past and current interventions for treating psychiatric inpatients diagnosed with psychogenic polydipsia (PPD). Annals of the American Psychotherapy Association, 13(1). Located at: http://www.biomedsearch.com/article/Psychogenic-polydipsia-review-past-current/222558218.html

Teoh, S.Y. (2012). Woman addicted to water drinks 100 glasses a day. The Mary Sue, July 12. Located at: http://www.themarysue.com/woman-addicted-to-water/#geekosystem

Vieweg, W.V.R., & Leadbetter, R.A. (1997). Polydipsia-Hyponatraemia Syndrome. CNS Drugs, 7(2), 121-138.

Verghese, C., de Leon, J., & Josiassen, R. C. (1996). Problems and progress in the diagnosis and treatment of polydipsia and hyponatremia. Schizophrenia Bulletin, 22(3), 455-464.

Hirsute yourself: A brief look at female body hair fetishism

In previous blogs I have examined a number of fetishes and sexual paraphilias related to human body hair including trichophilia/hirsutophilia (sexual arousal for hair, usually head hair), pogonophilia (sexual arousal from beards), and haircut fetishism (sexual arousal from seeing someone get their haircut either voluntary or through coercion). Another sub-type of trichophilia is men that get sexual pleasure and arousal from women that are abnormally hairy (including but not limited to overly hairy pubic hair, underarm hair, hairy arms, hairy legs, and hair around nipples). As far as I am aware, there is no academic research on this topic although a quick Google search with the term ‘hairy women’ reveals dozens of websites catering for (presumably) men that get their sexual kicks from hirsute women.

Other required viewing would no doubt include the television documentary F*** Off, I’m A Hairy Woman (first screened in 2007). The programme was hosted by female stand-up comic and Guardian newspaper columnist Shazia Mirza, and its focus was body image and stereotypes about women’s androgenic hair. The programme followed Shazia Mirza over a six-month period in which she let all her body hair grow for six months. As the Wikipedia entry on the show noted:

Her introduction posed the question, ‘what would it be like if we lived in a world where beautiful women were allowed to be hairy?’ To find out, [Mirza] decided to take the plunge and grow out [her] body hair. Can [she] learn to love it, and can [she] convince the rest of the world to love it too? After six months, she advertised for other hairy women to put on a catwalk show, wearing lingerie made of body hair designed and made by artist Tracey Moberly”.

There are a few online articles about some men’s love of hairy women including a 2010 Ezine Article on ‘Men looking for a hairy woman – tips on how to find them’ (and is actually about how hairy women can date men rather than vice-versa). The author – Angelina Andrews – claims that on most internet polls ‘hirsute fetishes’ are among the top ten most popular male fetishes. While I don’t dispute this, most of this relates to general ‘hair on head’ fetishism rather than hirsute female fetishism more specifically. The article claims:

“Most [hairy] women like yourself will be tempted to join a ‘hairy dating’ website. I would strongly advise against it. These sites actually have very few members right now. Most people with a fetish for female hair tend to just join conventional dating sites. You will also find that these sites for hirsute lady lovers are overly pricey. Most men have no idea about hairy dating sites. They tend to join huge dating communities. This is where you should join too…These popular sites have advanced profile matching technology. What this means is they tend to match your profile with people who might be interested in it. All you have to do is write down that you have body hair and you would love to meet a male hirsute fetishist. On most sites this will be enough to send your profile to relevant men”.

In the name of academic research I went searching on the internet for evidence (outside of pornographic videos) to see if there were individuals that claimed to be sexually aroused by female body hair. Below are typical extracts various online forums from both men that claim to have a fetish for female body hair and from women that have dated men with a fetish for female body hair:

  • Extract 1: “My boyfriend has a fetish for hairy women? Is this normal? He is also trying to convince me to let all my body hair grow. Should I do it?”
  • Extract 2: “I am a 31-year-old male with a fetish for very hairy women”
  • Extract 3: “I always had a fetish for hairy women. [I] was wondering if any other guys out there like me. I would really like to meet and perhaps date a girl who’s hairy or hirsute. It’s just really hard to find someone like that – especially since everyone today is smooth like a little girl. If you’re out there, then message me please. I am 20 [years old]”
  • Extract 4: “I have had guys tell me about some crazy fetishes in my life. I even had a few guys – American and European mainly – tell me they don’t mind their girl being hairy. Some find it sexy! I have some comfort in knowing that men still find me beautiful even in knowing about my flaws! But it is still an odd fetish but different strokes for different folks, I guess! I even Googled the term and found a LOT of fetish/porn photos of hairy women. Not sure how I feel about it yet”
  • Extract 5: “Any fetish makes me feel objectified…I’ve met a couple of guys who i suspect had a hair fetish, my arms were all they could look at, talk about and lust after, wanting to touch them when I had just met them, I had to slap their hands away to keep them from touching my arms. I normally feel whatever floats your boat as long as everybody is happy, but they make me feel so uncomfortable to be objectifying something that is part of a medical condition I have been fighting so long [i.e., polycystic ovary syndrome that results in high levels of male hormones in the body]. I’m self-conscious about my extra hair…[and] I don’t want somebody worshiping the very things I would change about my body. But if two people enjoy somebodies fetish together that’s ok, it’s just not for me. When guys show up here to talk about their fetish it really ticks me off”
  • Extract 6: “I love hair on women. Not necessarily on the legs, but I love a hairy crotch and hairy armpits. I know hairy is a fetish in porn a lot, but it doesn’t seem any other people I know share this ‘fetish’. I actually made one of my ex-girlfriends grow hers out because it was shaven. Then she shaved it back and I got really pissed off”

Although there is little detail in these extracts (and I can’t ensure the veracity of such claims), they suggest that (i) there are males out there that are sexually aroused by hairy women, (ii) that such males appear to be in young adulthood (in their twenties and thirties), (iii) that women that are the subject of such desires may not like to be objectified in such a way, and (iv) that it may be culturally determined (such as coming from Europe or America). All of this is (of course) highly speculative and given that there is unlikely to be a great surge of interest academically to research the topic, I can’t see ‘the facts’ becoming any clearer anytime soon.

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

Further reading

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

Andrews, A. (2010). Men looking for a hairy woman – tips on how to find them. Ezine Articles, November 16. Located at: http://ezinearticles.com/?Men-Looking-For-A-Hairy-Woman—Tips-To-Find-Them!&id=5393555

Bindel, J. (2010). Women: Embrace your facial hair. The Guardian, August 20. http://www.theguardian.com/lifeandstyle/2010/aug/20/women-facial-hair

Goulian, J-J. (2014). In defense of hairy women: Searching for a fair standard of beauty. Vice, February 11. http://www.vice.com/read/in-defense-of-hairy-women-0000222-v21n2

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

Wikipedia (2014). F*** Off, I’m A Hairy Woman. Located at: http://en.wikipedia.org/wiki/F***_Off,_I’m_a_Hairy_Woman

Viagra falls: Is there a relationship between sex and nosebleeds?

In previous blogs I have covered a number of different topics relating to various human behaviours involving blood including haematophagia (the eating and/or drinking of blood products), haemolacria (the crying of blood), clinical vampirism as a sexual paraphilia, and menophilia (sexual arousal from women menstruating). Today’s blog adds to the list by taking a brief look at sex and nosebleeds (medically known as epistaxis).

There are many causes of nosebleeds. The two most common are nose picking and being exposed to dry air for long periods. Other reasons include having high blood pressure, having a cold or flu, allergic rhinitis (nose allergies), acute sinusitis, heavy alcohol use, being exposed to chemical irritants, being on certain medications (such as blood thinners and non-steroidal anti-inflammatory drugs), nose trauma, cocaine use, and haemophilia. Added to this, there is plenty of anecdotal evidence of people claiming to get nosebleeds during vigorous sex.

However, an article in Culture Smash by Brian Ashcroft quoted an otolaryngologist, Dr. Kouichirou Kanaya (an ear, nose, and throat specialist) who was quoted as saying:

“The notion that sexual arousal causes the heart rate and blood pressure to rise is something that’s a well documented fact; however, in actuality, sexual arousal and bloody noses have no direct connection”

However, while researching this article I came across a number of medical papers showing that there is one area where nosebleeds have been related to sexual activity. More specifically, there have been a number of cases in the literature where men taking sildenafil (Viagra) and/or tadalafil (Cialis) have had nosebleeds during sex. For instance, Dr. L.A. Hicklin and colleagues reported two cases in a 2002 issue of the Journal of the Royal Society of Medicine. These are reported verbatim below followed by a 2006 case by Dr. G. Pomara and colleagues in the International Journal of Impotence Research, and a 2005 case by Dr. H. Ismail and Dr. P.G. Harries in the journal Acta oto-laryngologica:

  • Case 1: “A man in his late 50s was admitted from the emergency department with heavy prolonged epistaxis…During the admission the patient volunteered that, in the hours before his first nose-bleed, he had been engaging in energetic sexual activity. To enhance his sexual performance he had taken 50 mg sildenafil. Over the subsequent few days he had had several short but heavy epistaxes, and on the day of admission bleeding had continued for 6 hours without stopping. With packing and bed rest the bleeding gradually settled and he was discharged after six days”.
  • Case 2: “A man in his early 70s was admitted from the emergency department after 5 hours of epistaxis. He had taken sildenafil to enhance his sexual performance in the morning before his epistaxis…This was his first nose-bleed requiring medical attention…[After] two days and he was discharged home with no further epistaxis”.
  • Case 3: “A 32-year-old male presented to our department for recurrent epistaxis during sexual intercourses…During the consultation, he volunteered that the trigger for the epistaxis appeared to have been misuse of phosphodiesterase (PDE)-5 inhibitors, Viagra and Cialis. This first report of epistaxis after PDE-5 inhibitors in a young patient underline the possibility that in the next years the number of similar cases might increase due to the diffusion of PDE-5 inhibitor misuse in recreational settings”.
  • Case 4: A 66-year-old male presented to our department with recurrent epistaxis. On examination it was not possible to identify the source of the bleeding, despite various measures…During a consultation the patient volunteered that the trigger for the epistaxis appeared to have been energetic sexual activity. To enhance his sexual performance he had taken Viagra; however, on stopping the Viagra and changing to the newer drug Cialis, the episodes of epistaxis continued. We document what we believe to be the first case of epistaxis caused by Cialis”.

So why would Viagra and Cialis cause nosebleeds? Given that these medications help engorge erectile tissue, the nose also contains erectile tissue and the authors of these case reports believe that nasal engorgement also took place and lead to the nosebleeds. The phenomenon may be under-reported because individuals that use Viagra to enhance their sex lives may be too embarrassed to discuss this with doctors if it relates to sexual dysfunction. (I also came across a case report in a 2009 issue of the Indian Journal of Chest Diseases and Allied Sciences by Dr. R. Dixit and colleagues of a 38-year old man persistently coughing up of blood [haemoptysis] whenever he used Viagra during sex).

Another interesting angle on sexual nosebleeds comes from Japanese cartoon animation (and more specifically Manga comics). In an online article entitled ‘Nosebleeds: Manga just wouldn’t be the same without them’, the author argues that Manga cartoons contain a number of specific tropes (i.e., a significant or recurrent theme). These tropes (amongst others) included nosebleeds, sweat drops, snot bubbles, and popping veins. Sexual nosebleeds were the number one trope in the article. The article noted that:

“A nosebleed, in the wonderful world of manga, equates to sexual arousal. I saw this trope for the first time in Dragonball, when Bulma lifts her dress and the lecherous Master Roshi spurts blood from his nose. Although Bulma was commando at the time, nosebleeds can be triggered by seeing something as mild as a pair of panties. In the case of the boy in the following image, it seems his bloody nose was triggered more by a fetish for swimsuits rather than the girl wearing them: Clearly, horn dogs don’t spontaneously get nosebleeds in real life. So why is it so in manga? I think it’s generally accepted that a rush of blood to the head and the resulting nosebleed is a visual metaphor for blood rushing to, er, somewhere else – which probably explains why I’ve only ever seen guys get nosebleeds, although I could be wrong about that”.

I’ve never watched a full Manga cartoon in my life but from everything I’ve read, male nosebleeds are common cliché in anime cartoons and are known as ‘hanaji’. According to the online Urban Dictionary, hanaji is “when you see a boy get a nosebleed in anime, [and] usually means his blood pressure has suddenly severely increased from seeing a really cute girl”. In an article by Brian Ashcroft for Culture Smash, he also noted the nosebleed trope in Manga cartoons:

A character, male or female, gets excited—often sexually excited. Blood dribbles, or squirts, out of the character’s nose. The notion that arousal or excitement induces bloody noses…isn’t just part of anime or manga iconography. It’s also become an old wives’ tale of sorts…The trope is very much a Japanese one, appearing throughout the country’s popular culture and with various nuances in anime and manga. It is not a new trope and has existed for years…Manga artist Yasuji Tanioka is believed to be the first one to introduce the motif with his early 1970s manga Yasuji no Mettameta Gaki Dou Kouza. Other manga artists liked the expression and began replicating it in their own work”.

In relation to the nosebleed trope in anime cartoons, Dr. Kouichirou Kanaya (the ear, nose, and throat specialist quoted above) speculated that:

“Bloody noses are probably used to show in a powerful way just how excessively large the change induced by sexual arousal is. It’s a climax, and in manga, it often seems to be code for ejaculation”.

There are also anecdotal cases of nosebleed fetishes (called epistaxiophilia). However, the love of nosebleeds appears to have been created by using the name of nosebleed phobia (epistaxiophobia) and changing the suffix ‘phobia’ for ‘philia’. To my knowledge, there has never been an academic paper or clinical case study published on epistaxiophilia. However, I did come across a number of online confessions of individuals that admitted (if they are true) that they were sexually aroused by nosebleeds. Here are some extracts that I found in various online forums:

  • Extract 1: “Was just reading a thread on r/Askmen about men who get nosebleeds during sex. My brain processed SEX and NOSEBLEEDS and I immediately imagined myself riding a guy home when he suddenly got a nose bleed. I was strangely turned on by that idea. I don’t think I’d be comfortable sharing this newly discovered turn on with any of my friends because I feel like it’s so damn weird” (Female, Reddit, AskWomen forum)
  • Extract 2: “Nosebleed fetish? Does anyone have it? I normally don’t like blood but I find nosebleeds really hot. I wouldn’t ever hurt my loved one, but I have to admit that I’m quite aggressive towards normal people because of it” (Inwealorwoe [Male], Yahoo! Answers)
  • Extract 3: “I’ll completely understand and I won’t take offense if you run from this post flailing and gagging…For the longest time, I’ve had a nosebleed Maybe that links to the fact that I’ve also got haematophilia and a vampire fetish. But you know what I really like? When someone sneezes while they have a nosebleed” (Proclaimer, Female, 21 years old)
  • Extract 4: “I think it’s incredibly sexy when a guy has a nosebleed. Sneezing while having a nosebleed. I would agree that nosebleeds are probably a turn-on for me because of the whole vulnerability/loss of control factor. Same as with sneezing and colds and things like that” (Helter Skelter, female, 19 years old)
  • Extract 5: “I actually do have a blood/vampire fetish. I often find myself getting very thirsty as well as aroused when watching vampires feed in movies. However I don’t really find nosebleeds all that appealing. I’m not disgusted by it or anything, but it just wouldn’t really do anything for me. I guess it’s just not the type of bleeding that I’m attracted to. I can see how it might be appealing to others though” (Shayla, female 31 years)

Obviously I cannot vouch for the veracity of these claims but I have no reason to doubt them (and the final extract liked other blood fetishes but not a nosebleed fetish). There is no detail in any of these extracts to speculate as to why anyone develops a fetish to nosebleeds. However I’ll leave you with a reply to the person in Extract 2 above:

“[Nose bleed fetishes] makes sense. A sexual therapist said that our sexual fantasies are derived from non-sexual things in our life. So your fetish for nosebleeds could actually stem from something non-sexual in your life. For example, it probably turns you on because it makes you feel empowered and aggressive, since if the person you are with has a nosebleed it means you must have been rough with them. So I would say that your fetish is probably normal, because many people are turned on by feeling empowered and aggressive. Sounds normal to me” (The Way It Is, Yahoo! Answers)”.

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

Further reading

Ashcroft, B. (2012). Sexual arousal doesn’t cause bloody noses, says medical science! Culture Smash, October 19. Located at: http://kotaku.com/5953124/sexual-arousal-doesnt-cause-bloody-noses-says-medical-science

Dixit, R., Jakhmola, P., Sharma, S., Arya, M., & Parmej, A. R. (2009). Recurrent haemoptysis following sildenafil administration. Indian Journal of Chest Diseases and Allied Sciences, 15, 119-120.

Hicklin, L.A., Ryan, C., Wong, D.K.K., & Hinton, A.E. (2002). Nose-bleeds after sildenafil (Viagra). Journal of the Royal Society of Medicine, 95(8), 402-403.

Ismail, H., & Harries, P. G. (2005). Recurrent epistaxis after treatment with tadalafil (Cialis). Acta oto-laryngologica, 125(3), 334-335.

Pomara, G., Morelli, G., Menchini-Fabris, F., Dinelli, N., Campo, G., LiGuori, G., & Selli, C. (2006). Epistaxis after PDE-5 inhibitors misuse. International Journal of Impotence Research, 18(2), 213-214.

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