Called up for navel duty: A beginner’s guide to alvinophilia

Alvinophilia – according to Dr. Anil Aggrawal in his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices – is a sexual paraphilia in which individuals derive sexual pleasure and sexual arousal from the navel and bellies (although he refers to it as ‘alvinolagnia’). He also notes that:

“[Navel fetishism is] a strong attraction to the human navel (often called the belly button). Navel fetishists are sexually aroused by viewing, licking, tickling, sucking, sniffing, or kissing the navel of another person, or by having any of this activity done to their own navel by partner or to a lesser extent, by themselves. Some navel fetishists engage in outercourse (non-penetrative or dry sex as opposed to intercourse) involving the navel. Navel fetishism often co-exists with stomach fetishism”.

I have yet to come across a proper definition so for the purposes of this blog but some sources say it includes any sexual pleasure or arousal from any aspect of a belly or a navel (but this particular blog will just examine bellies as including navels will take me into the whole world of body piercing which I will leave for another blog).

I have only come across one academic paper that makes a specific reference to ‘alvinophilia’ and that was a study led by Dr G. Scorolli (University of Bologna, Italy) on the relative prevalence of different fetishes using online fetish forum data. I have made reference to this study in previous blogs on paraphilias such as lactophilia, mysophilia, and stigmatophilia. It was estimated (very conservatively in the authors’ opinion), that their sample size comprised at least 5000 fetishists (but was likely to be a lot more). They reported that some of the sites featured references to belly and/or navel fetishes (3%). However, there was no further information as to whether the belly/navel fetish was connected to piercing, pregnancy, and/or belly inflation.

In a previous blog, I looked at fat fetishism. Obviously belly size is one of the most important aspects of a fat fetishist’s sexual focus. Many fat admirers are ‘feeders’ who deliberately over-feed their sexual partners (i.e., ‘feedees’) on their way to becoming a ‘big beautiful woman’ (BBW). Within the context of their sexual relationship, feeders obtain sexual gratification from the encouraging and gaining of body fat through excessive food eating. For many, it is the increasing stomach size that becomes the primary sexual focus. The bigger the stomach, the more sexually aroused the feeder becomes.

There are also fat fetishists who are turned on my ‘gut-flopping’. This involves masochistic elements involving female domination (“femdom”) and has to be seen to be believed. In an article on the world’s strangest fetishes, the Pop Crunch website reported:

“Femdom + masochism + BBW = gut flopping. A heavily obese woman comes up to you, usually on all fours, and drops her belly on you with full force. It combines the pain and control of your run of the mill dominatrix with the obsession and fetishization of fat that accompanies chubby chasers and feeders. The scariest thing about this fetish in particular, is the potential for damage. These ladies are large. Their stomachs are large. They’re hitting your back with a significant amount of speed and force, and you’re in a position where there’s not much support. Imagine someone dropping a bag of oranges on your back, while you’re in that position. Yeah…that’s all kinds of screwed up”.

It would also appear that another behaviour related to alvinophilia is pregnancy fetishism (i.e., maieusiophilia). In a previous blog I outlined the various attractions of maieusiophilia including belly size. Some maieusiophiles prefer an abdominal bump that is “just showing” whereas others – seemingly the majority of maieusiophiles – prefer “the bigger the better”). As I also noted in that article, for a small minority, the belly is so big that all thoughts are fantasy-based as the source of sexual arousal can become “a belly with a girl attached”. In fact, one online website (Bastion Works) claims that some maieusiophiles “have been known to enjoy the concept of stomachs grown to the size of vehicles, buildings, or even planets”. This would seem to indicate that there is a crossover with macrophilia (which I also examined in a previous blog).

There is also a related sexual fetish that involves belly inflation which I would argue is subsumed within alvinophilia. Belly inflation is also part of the wider practice of body inflation, and involves the practice of inflating (or sometimes pretending to inflate) a part of one’s body (in this case the belly), typically for sexual gratification. For some, this may be connected with sexual arousal from the receiving of enemas (i.e., klismaphilia). There are a number of websites dedicated to this practice such as the Body Inflation website. Here are a few online accounts I came across:

Extract 1: “Somewhere in my pre-teen years I became captivated with the look of full, pregnant-like bellies and began “experimenting” with large balloons under my shirt and pants. Then after noticing the female profile of very pregnant models wearing girdles and pantyhose in mail order catalogs, I got a girdle. One night I placed a large punching type balloon between it and my belly and started pumping up the balloon until it was incredibly huge. Needless to say I was really hooked now! Then I became curious about actually trying to inflate my belly; and so one night inserted the pump hose and soon I had my abdomen pumped up rock hard. Now I was even more hooked. Over the years I experimented with using water until today – some 40+ years later – I now regularly ‘fill-up’ with 2+ gallons of saline water, creating an incredible very pregnant looking profile. Why do I do it, well I guess it’s the incredible rush that I get every time!”

Extract 2: “I have an inflation fetish myself. Every now and then – which is starting to become daily – I usually inflate my stomach with air or water. I occasionally chug [almost] a gallon of milk or water with salt in it – chugging too much water can be poisonous, so always put some salt in it to balance your electrolytes. I find it very arousing to get a rock-hard stomach and I want to continue to make my stomach bloat bigger and rounder, yet maintain my abs. It’s a fun challenge”.

This next one makes a connection between fat fetishism, feeders, and belly inflation:

Extract 3: “I have the same fetish. I’m a gay guy, and I prefer belly expansion in particular. I think this fetish is somehow tied to the weight gain fetish that the internet and media has exposed in recent years. I, too, have a weight gain fetish. However, I enjoy helping or watching a partner partake in weight gain, but not myself. Getting back on the subject, though I do enjoy inflating myself. Whether it be through bloating with water, air enemas, or water enemas. Water enemas have become my personal favorite method, plus they’re actually healthy and cleanse your colon. I have noticed a lot of people with similar fetishes though. Everyone has their own niche of what turns them on”.

Given the lack of research into alvinophilia, online accounts such as the ones above are about all that academic theorizing has to go on. This is definitely an area that the research community would benefit from knowing more about.

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.

Bastion Works (2012). Maieusiophilia. Located at: http://bastionworks.com/Mikipedia/index.php?title=Maieusiophilia

Gates, K. (1999). Deviant Desires: Incredibly Strange Sex. Juno Books.

Pop Crunch (2010). The 17 Most WTF Fetishes Imaginable. May 11. Located at: http://www.popcrunch.com/the-17-most-wtf-fetishes-imaginable/

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

Swami, V. & Tovee, M.J. (2009). Big beautiful women: the body size preferences of male fat admirers. Journal of Sex Research, 46, 89-96.

Terry, L.L. & Vasey, P.L. (2011). Feederism in a woman. Archives of Sexial Behavior, 40, 639-645.

Wikipedia (2012). Body inflation. Located at: http://en.wikipedia.org/wiki/Body_inflation

Wikipedia (2012). Pregnancy fetishism. Located at: http://en.wikipedia.org/wiki/Pregnancy_fetishism

Rude food? A beginner’s guide to sitophilia

There has long been an association between eating and sexual behaviour on many different levels. Eating and sex are both basic human needs and sometimes interact more directly. Many would also agree that eating (in and of itself) can be a sensual activity. There are also some foods that are considered to be aphrodisiacs. For example, foodstuffs such as oysters and chocolate are considered to have aphrodisiac properties (even if there is a lack of empirical evidence). The important factor is that if people believe the food in question has such arousing properties then there is likely to be some kind of a placebo effect.

In previous blogs I have looked at both feederism (in which sexual arousal and gratification is stimulated through a person gaining body fat) and vorarephilia (in which people are sexually aroused by the idea of being eaten, eating another person, or observing this process for sexual gratification). Another eating-related sexual behaviour is sitophilia. This is a sexual paraphilia in which the individual has an erotic attraction to (and derives sexual arousal from) food. Sitophilia can also include sexual arousal caused by erotic situations involving food. This may comprise many different types of activity including those who:

• Eat one particular foodstuff from the body of another (e.g., licking chocolate mousse off the breasts of a naked partner).
• Eat a variety of foods or a whole meal off somebody’s naked body (such as the Japanese practice of nyotaimori – see below).
• Use a foodstuff to enhance a particular sexual act (e.g., sucking on a lime before engaging in oral sex to swell the taste buds and create more sensitivity when licking genital tissue). This could also technically involve the use of a foodstuff to enhance genital lubrication (e.g., use of olive oil).
• Use food as a method of control and/or flagellation in sadomasochistic activity (e.g., the throwing of oranges at the buttocks as a from of sexual humiliation or punishment). Dominant partners can also choose to control their submissive partner’s eating habits and food intake as a regular part of their sex play. Some dominant individuals will restrain their submissive partner’s hands, and order them to eat from a dish on the floor. This can be a highly sexually charged situation for those into erotic humiliation.
• Use food as a masturbatory aid. This may include males hollowing out foodstuffs (such as a pumpkin) into which they simulate intercourse, and females using phallic shaped foods as a penis substitute (e.g., cucumbers).
• Drink bodily fluids (such as semen) after it has been blended into other foods (e.g., mashed potato) following masturbation.
• Drink bodily fluids as part of another drink (e.g., adding ice cubes made of semen to a pina colada where the saltiness of the semen counteracts the sweetness of pineapple).
• Use food as an enhancement to sexual intercourse (e.g., the use of a slitted plum placed over an erect penis and then inserted into a partner’s vagina to add volume and pressure to the sexual act for both partners.
• Use food to aid sexual stimulation and erotic pleasure (e.g., the insertion of grapes into the rectum). This latter type of act also includes particular foodstuffs such as the insertion of ginger into the rectum (called ‘figging’ – check it out on Wikipedia if you find this hard to believe). The use of ginger has also been documented as being inserted into the vagina and urethral opening.

There are also various sub-types of sitophilia (such as botulinonia that involves the sexual use of sausages). Similarly, as mentioned in the list above, those who use various foods as dildo substitute masturbatory aids (e.g., cucumbers, aubergines, carved out melons, butternet squash, etc.) may also be sitophiles.

Sitophilic acts have appeared in popular films and books. The most infamous are probably (i) the lead character Jim Levenstein (Jason Biggs) in the film American Pie is caught masturbating into a pie after being told that third base (i.e., fellatio) feels like “warm apple pie”, (ii) the sex scene in the film 9½ Weeks where John Gray (Micky Rourke) spoon feeds Elizabeth McGraw (Kim Basinger) various kinds of food while blindfolded, and (iii) the Philip Roth book Portnoy’s Complaint that features detailed depictions of masturbation – the most infamous being the use of a piece of liver steak by the male protagonist (Alexander Portnoy) to masturbate into and which is later served at a family dinner. However, one of the weirdest sitophilic acts I have come across is in Seijun Suzuki’s film Branded to Kill (1967) where the leading man Goro Hanada (Joe Shishido) has a food fetish where he has to sniff boiling rice in order to become sexually excited.

I have also come across descriptions of food orgy parties. These are:

“Organized by individuals where friends bring either an erotic arrangement of food on a dish to share, or food that feels sensuous when rubbed onto a partner and licked off. Afterwards, everyone soaks in a hot tub. There are also all-male games such as ‘Shoot the Cookie’ and ‘Soggy Biscuit’ where males stand in a circle around a cookie and masturbate. The rule dictates that the last one who ejaculates on the cookie has to eat it”.

There are also those who use foodstuffs to make the sexual act messier (i.e., “sploshing” – a form of salirophilia) that I briefly examined in a previous blog on salirophilia (in which individuals experience sexual arousal from soiling or disheveling the object of their desire). Sitophilia can also play a part in the activity of ‘food play’ (which doesn’t always have sexual connotations so should not be used synonymously). For instance, nyotaimori and nantaimori (the obscure Japanese practice of ‘female body presentation’ and ‘male body presentation’ respectively) is not usually seen as either fetishistic or paraphilic for those who participate. This practice is also known as “body sushi” and involves people eating food from the body of a naked person). Some websites (such as Muki’s Kitchen) have turned such behaviour into an art form.

Some reports claim that the person covered in food has to learn to withstand the coldness of the food and is trained to lie and keep still for hours while those around eat off their body. However, the Guardian journalist Julie Bindel who attended a nyotaimori platter in London says that the women she ate off were models with no prior training.

I have yet to read a single academic or clinical paper that has been published on the topic although there is a lot of online activity surrounding those who get sexually aroused by food (check out the links in the ‘Further reading’ section). For instance, here is one story I found from a homosexual man into both feederism and sitophilia.

“I love to eat. I am a chubby guy, 5’4″ and currently 200 lbs. I attempt to maintain around 200 lbs if I can manage it. Along with sitophilia I am also attracted to other chubby guys. Well I get extremely turned on by food. I love the look of food, the smell of food, the taste of food. The act of eating food also is such a turn on. Feeling food in my mouth, chewing it and the act of swallowing food and feeling it slide down to my stomach gets me totally aroused. I love to indulge in buffets. Going to a buffet is better than any porn I could ever watch. Usually there are lots of chubby men there for me to watch and satisfy my chubby guy fetish too. I have spent several hours at a buffet indulging. I usually walk around half hard the whole time. In private I love to include food in sex. Just earlier I had a piece of chocolate cheescake. It was a very rich, dense and decadent cheescake. I took it out of the fridge and took it into my bedroom. I got naked and laid on the bed. My cock was instantly hard. I took the slice of cheesecake in one hand and my cock in the other hand. I started to masturbate while slowly tasting the cake. I became so aroused that I began to furiously pound my cock and I just stuffed the whole piece of cheesecake into my mouth. It was a huge piece and I could almost not fit it all in. My mouth was stuffed and my cheeks puffed out totally filled with the cheesecake. As I chewed and felt the creamy chocolate cheesecake in my mouth, I felt my arousal build and that familiar sensation of being close to an orgasm. I pounded my cock even harder and then I took one swallow…feeling the bit of cheesecake sliding down my throat brought me just to the edge of orgasm. I could not stand it any longer. I began to chew and swallow all of the cheesecake and I erupted in a very powerful and intense orgasm”

Here are two confessions from female sitophiles. They wrote:

Extract 1: “Something about watching a man eat turns me on like crazy. I like to cook for men just so I can watch them eat my food. When men eat, they attack, and I find it incredibly sexy. If any professional might know the reason for this, I would greatly appreciate your insight. It is not getting in the way of my everyday life, it is just something that gets me going”.

Extract 2: “I used to be bulimic in high school (that’s when I realized I like sticking my fingers in food) and now I’m on a strict diet and my sitophilia is worse than ever! I love watching people eat fatty foods and I want to know what sploshing is like. I lay awake at night fantasizing about being covered in cake batter or spaghetti-o’s and rubbing it onto my skin. I’ve been weird about food since my eating disorder, but sitophilia was not in my vocabulary until very recently”.

Despite such online confessions, sitophilia appears to be one of many paraphilias that have passed the academic and clinical world by. This may be because food play is quite common among ‘normal’ and ‘experimental’ sex, and/or may be seen as academically and/or clinically trivial.

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

Further reading

Bindel, J. (2009). ‘I am about to eat sushi off a naked woman’s body’. The Guardian, February 12. Located at: http://www.guardian.co.uk/lifeandstyle/2010/feb/12/nyotaimori-eating-sushi-naked-woman

Sense and Sensuality Website (Education and Discussion website). Located at: http://sensesensuality.blogspot.co.uk/2009/06/sex-ed-paraphilia-sitophilia.html?zx=879c2fb6531ed60d

Spiritual BDSM (2011). What is sitophilia? December 6, Located at: http://www.spiritualbdsm.com/2011/12/what-is-sitophilia.html?zx=69b8151a4d2896e3

My Strange Addiction: The wonderful world of the weird

In a previous blog, I examined a case of so-called ‘hair dryer dependence’. The source material for this blog came from one of the people who had appeared on the TLC (The Learning Channel) documentary television series My Strange Addiction. Immediately after I had written the blog I was emailed by one of the researchers on the show asking if I could help getting people on the show for the next series (Season 4).

For those who have no idea what I am talking about, My Strange Addiction is a US TV documentary show that features stories about people with unusual behaviours. Very few of the behaviours they have featured so far would be classed as addictions in the way that I define them. However, some of the behaviours are genuine obsessions and/or compulsions while others have not been the focus of any kind of medical and/or psychiatric diagnosis.

So far, the show has featured people with various obsessive-compulsive disorders (some of which I have examined in my blog) including body dysmorphic disorder, pica (the eating of non-food such as paper, mud, glass, metal), exercise bulimia, trichotillomania (compulsive hair pulling), dermatillomania (compulsive skin picking), thumb-sucking, furry fandom, excessive laxative use, urine drinking, paraphilic infantilism (being an adult baby), and dating cars.

MY STRANGE ADDICTION: A CALL FOR PARTICIPANTS

If anyone out there thinks they have an interesting story that My Strange Addiction might like to hear about, the show’s producers would really appreciate any help they can get in reaching people who may be good potential candidates for their TV show.

• Are you currently struggling to overcome a strange obsession, addiction or compulsive behavior that is taking over your life?
• Do you spend countless hours obsessing about something or engaging in behavior that others would say is strange?
• Have you drained all of your finances into this obsession?
• Are your friends and family members concerned about your wellbeing?
• Would you like to regain control of your life and your health?

If you found yourself answering yes to any of these questions, you may qualify to be a participant in a major documentary series that offers professional assistance for those struggling with a strange obsession, compulsion, or addiction.

For consideration, please reply to this advert with your name, age, contact information, and brief explanation of how a strange addiction is taking over your life. You can also contact us directly at 312-467-8145 or 20westcastingteam@gmail.com. All submissions will remain confidential. Thank you for sharing your story.

Postscript: Alternatively, if you would like to tell me your story as part of my own academic research, then feel free to contact me at my academic email address: mark.griffiths@ntu.ac.uk.

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

Further reading and viewing

Griffiths, J. (2011). Review: My Strange Addiction. US Weekly January 25. http://www.usmagazine.com/entertainment/news/review–my-strange-addiction-2011251#ixzz1tYHsItPh

Internet Movie Database. My Strange Addiction. Located at: http://www.imdb.com/title/tt1809014/

My Strange Addiction Official Website. Located at: http://tlc.howstuffworks.com/tv/my-strange-addiction

TV.com. My Strange Addiction. Located at: http://www.tv.com/shows/my-strange-addiction/

Warming Glow. The 10 strangest addictions from  ‘My Strange Addiction’. http://warmingglow.uproxx.com/2012/02/10-strangest-my-strange-addictions#page/1

Wikipedia. My Strange Addiction. Located at: http://en.wikipedia.org/wiki/My_Strange_Addiction

Wikipedia. List of My Strange Addiction episodes. Located at: http://en.wikipedia.org/wiki/List_of_My_Strange_Addiction_episodes

Turn the eater on: Fat fetishes and feederism

Many years ago when I was just entering my teens (well, 1979 since you ask), I heard a song by Adam and the Ants called ‘Fat Fun’ which at the time completely passed me by that it was all about fat fetishes. I should have guessed given that so many songs written by Adam Ant at the time were about fetishes and paraphilias (something that I have written about in an essays at length elsewhere (you can check them out in various places here and there).

Over the last few years, fat fetishism and fat admiration have come into more into the public domain through national press and television documentaries (I was interviewed by The Times on the topic back in June 2010)

Fat fetishists – mostly heterosexual and sometimes colloquially referred to as ‘chubby chasers’ – have an overwhelming (and often exclusive) sexual attraction towards very obese individuals of the opposite sex. (As a number of researchers point out, there is no widely held consensus in defining a fat admirer (FA), but the term is typically used in relation to individuals who find attractive someone considered clinically overweight). However, a recent paper by Dr Lee Monaghan (University of Limerick, Ireland) also noted and described aspects of the small gay fat admiration community through the use of qualitative data he collected online.

Fat fetishism also includes both ‘feederism’ and ‘gaining’ in which sexual arousal and gratification is stimulated through the person (referred to as the ‘feedee’) gaining body fat. Feederism is a practice carried out by many fat admirers within the context of their sexual relationships and is where the individuals concerned obtain sexual gratification from the encouraging and gaining of body fat through excessive food eating. Sexual gratification may also be facilitated and/or enhanced the eating behaviour itself, and/or from the feedee becoming fatter – known as ‘gaining’ – where either one or both individuals in the sexual relationship participate in activities that result in the gaining of excess body fat. This may not only involve eating more food but also engaging in sedentary activities that leave the feedee immobile. Some fat admirers may also derive pleasure from very specific parts of the body becoming fatter. A recent paper by Dr Lesley Terry and Dr Paul Vasey (both at the University of Lethbridge, Canada) in the Archives of Sexual Behavior, also claim that feedees are individuals who become sexually aroused by eating, being fed, and the idea or act of gaining weight.

Even if a fat admirer does not have direct sexual access to someone grossly overweight, there are other activities that fat admirers can encourage their sexual partners to engage in such as ‘padding’ (where individuals wear padded or layered clothing in a way that the person appears to have a distended abdomen) and inflation (where individuals inflate their abdomen with air or liquid so their abdomen is distended).

There has been a lot of psychological research showing that attractiveness of women is related to both low body mass index (BMI) and low waist-to-hip ratio (WHR). However, there has been a great deal of debate the universality of the findings and there is a lot of research that body shape attractiveness is determined by other factors including cross-cultural differences and gender-role stereotyping. There has also been research on physical attractiveness among ‘subcultures’ such as those people with eating disorders or in relation to sexual orientation. For instance, a study by Dr Viren Swami (University of Westminster, UK) and Dr Martin Tovee (University of Newcastle, UK) found that lesbians appear to idealize a heavier body weight in a potential partner than do heterosexual women or men.

One of these relatively unexplored ‘subcultures’ is the FA community. A study by Dr Viren Swami (by this time at the University of Liverpool, UK) and Professor Adrian Furnham (University College London, UK) and published in the Archives of Sexual Behavior (2009), examined the body weight WHR preferences of 56 heterosexual ‘fat admirers’. They claimed that the “relative scarcity of studies on the preferences of FAs can probably be traced back to the misperception that it is inconceivable that an individual could be attracted to obese others or that such a preference is somehow ‘’deviant’”. Unsurprisingly, their study – which was the first published on notions of attractiveness within the FA community – reported that FAs preferred heavyweight individuals and rated those individuals with high WHRs as the most attractive. The results predictably suggest that heterosexual male FAs hold very different ideals relating to attractiveness when compared with heterosexual men from the general population. Although some of the participants were fat themselves, there was no difference between these individuals and those FAs who were not overweight. The authors conclude that:

“It seems plausible that male FA is paraphilic in the sense of it being a non-mainstream sexual practice without necessarily implying dysfunction or deviance. For instance, it may be that hunger or food was involved in the behavioral imprinting of a fat fetish in early childhood, a hypothesis favored by some psychoanalysts…A related theory also based on the principles of behavioral imprinting argues that when young men masturbate, the objects that are frequently nearby at the time of masturbation become objects of arousal in the future. The individual is thus associating the object with sexual orgasm, and this may include either eroticized images of overweight individuals, food, and so on” (p.206).

It is also worth noting that in the Journal of Sex Research, Dr Swami repeated the study comparing FAs with a control group of non-FAs and found the same results. Despite these studies, there is still little empirical research on fat admirers and feederism. The recent paper by Dr Terry and Dr Vasey reported the case study of a 30-year old female feedee (‘Lisa’).

At the time of the study, Lisa was 30 years of age, married and Caucasian. She was recruited by the researchers from a feederism website (FantasyFeeder.com). By age 13 years (at 5 feet 11 inches tall) she was mildly preoccupied with her weight. She weighed 120-130 lbs and had BMI of 16-18 (i.e., underweight). However. Like many girls, she viewed herself as fat and became self-conscious about her hips, thighs, and belly. She claimed to experience sexual thoughts about weight gain and fat from a very young age. Because of her sexual fantasies about fat women during adolescence, she experienced some confusion about her sexual orientation (but deemed herself heterosexual).

As an adult, Lisa said she was still sexually aroused in response to fat women but that it was limited to visual images found on the internet. Her ideal website would be where there were several pictures of the same woman getting fatter over time (and which she would masturbate over). Lisa also fantasized about being forced to gain weight by a dominant male who would became sexually aroused by making her gain weight. She also reported that all of her orgasms involve fantasizing about some form of feederism and that sometimes all she needs to reach orgasm is to fantasize about being a little bit heavier. Although she has actively engaged in weight gain for a four-month period in 2008, she has never been in a feedee/feeder relationship (as she doesn’t want the negative health consequences of becoming extremely overweight). She also reported her sexual arousal had significantly declined after the weight gain period.

In their discussion of Lisa’s case, Terry and Vasey made the point that as with many paraphilias, her pattern of sexual arousal was characterized by intense and repetitive sexual urges, fantasies, and behaviours involving unusual activities (i.e., the intense focus on eroticizing body fat). Terry and Vasey also questioned whether Lisa’s behaviour represented a form of morphophilia (i.e., peak erotic focus on a particular body characteristic – in this case body fat). They also speculated that some of the behaviour was sexually masochistic and that this supported their view that feederism had paraphilic elements (although Lisa reported that masochistic behaviours generally repulsed her). As with any case study, it may not be representative of the entire feederism community. Terry and Vasey also assert that more research needs to consider if, and how, feederism is taxonomically distinct from the various forms of morphophilia.

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

Further reading

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

Monaghan, L. (2005). Big handsome men, bears, and others: Virtual constructions of ‘fat male embodiment’. Body and Society, 11, 81-111.

Murray, S. (2004). Locating aesthetics: Sexing the fat woman. Social Semiotics, 14, 237-247.

Swami, V. & Furnham, A. (2009). Big and beautiful: Attractiveness and health ratings of the female body by male ‘‘fat admirers’’. Archives of Sexual Behavior, 38, 201-208.

Swami, V., & Tovee, M.J. (2006). The influence of body weight on the physical attractiveness preferences of feminist and non-feminist heterosexual women and lesbians. Psychology of Women Quarterly, 30, 252-257.

Swami, V. & Tovee, M.J. (2009). Big beautiful women: the body size preferences of male fat admirers. Journal of Sex Research, 46, 89-96.

Terry, L.L. & Vasey, P.L. (2011). Feederism in a woman. Archives of Sexial Behavior, 40, 639-645.

Pica boom? A beginner’s guide to pica

Pica is an eating disorder that has been documented in the psychological literature for hundreds of years and refers to a behaviour in which individuals eat non-nutritive items or substances (such as coal, hair and wood). The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines pica as “the persistent eating of nonnutritive substances for a period of at least one month, without an association with an aversion to food”. Therefore, one-off instances of eating non-nutritious items would not constitute pica. Children who occasionally eat items like crayons are rarely diagnosed as having pica. Pica comes from a Latin word for the magpie bird (known for its strange eating behaviours).

The prevalence rates of pica depend on which patient populations have been studied. Prevalence estimates are also skewed by the fact that many people suffering from pica are embarrassed about the behaviour and may not tell anyone and/or seek medial treatment. However, it is well established that pica is more prevalent in children, pregnant women, adults from lower socioeconomic classes, and children with developmental disabilities (such as autism). The incidence of pica is also higher amongst those suffering from family-related stress. Although pica can be a symptom of anaemia (i.e., iron deficiency) and other chemical imbalances, research has shown it is actually more common among those who have normal iron levels.

Prevalence rates of pica have range anywhere between 0.02% and 74% depending on the study and population studied. For instance, studies have reported pica prevalence rates of:

• 0.02% in Danish pregnant women
• 8% in US black pregnant women (pagophagia)
• 9% in Saudi Arabian pregnant women
• 26.5% in Tanzanian pregnant women (geophagia)
• 31% of Californian Mexican pregnant women
• 44% of Mexican pregnant women
• 50% of Nigerian pregnant women
• 74% in Kenyan pregnant women
• 44% in French anaemic patients (vs. 9% matched controls)
• 64% in Turkish anaemic patients (vs. 17% controls)
• 22%-26% in mentally retarded adults
• 34% in sickle cell disease patients

The Danish figure from a study led by Dr Tina Mikkelsen (University of Southern Denmark) is likely to be the most accurate as it was carried out on a sample of 100,000 pregnant Danish women and only 14 of the total sample reported that they had pica. The authors concluded that in privileged populations, pica is more a myth than a reality.

Despite increased research in the area, there has been no definitive explanation as to why some people consume such substances as hair (trichophagia), ice (pagophagia – which I briefly examined in a previous blog), soil/clay (geophagia), wood (xylophagia), stones (lithophagia), glass (hyalophagia), plumbophagia (lead paint chips), or laundry (uncooked) starch (amylophagia). Dr. Ella Lacey (Southern Illinois University) also listed many other non-food substances that pica sufferers may eat that don’t have specific names such as those people who eat paper, balloons, grass, soap, cotton wool, and cigarette butts. Pica is a widespread practice throughout Africa and India. It has also been reported in Australia, Canada, Israel, Iran, Uganda, Jamaica and various European countries. A recent review on pica led by Dr Sera Young (University of California, USA) noted that geophagia is the most common type of pica described in the psychological and medical literature. They also noted that:

• Geophagics frequently eat other non-food stuffs.
• Those who eat more manufactured substances say they use them as a replacement for earth, either because the desired soil is unavailable or socially unacceptable
• Bar the eating of ice, most pica substances are absorptive in the dry state and all easily absorb moisture.
• Pica substances are typically craved with great intensity or ‘‘devouring passion’’

A variety of conditions are known to cause some types of pica including mineral deficiencies, hookworm infection (parasitic infection in the small intestine), coeliac disease (an autoimmune disorder of the small intestine) and Kleine-Levin Syndrome (also known as Sleeping Beauty Syndrome, a neurological disorder characterized by recurring periods of excessive amounts of sleeping and eating). Interestingly, there are culture-specific cases where pica is not related to psychopathological disorders or deficiencies. For instance, black women in Georgia (USA) are known to eat kaolin (white dirt that is actually a clay mineral) – a so-called “culture-bound syndrome” (i.e., a recognizable combination of psychiatric and somatic symptoms that are only within a specific culture or society).

Some pica type disorders may be part of a wider psychiatric condition (such as schizophrenia) and/or may be part of a sexual paraphilia such as the small numbers of people who engage in coprophagia (eating faces) as part of coprophilia and people who engage in urophagia (drinking urine) as part of urophilia. If the primary focus for eating the item or substance was sexual, it would be more likely diagnosed as a sexual paraphila rather than pica. However, many of those with pica claim to love the taste, texture and/or smell of the things they eat. Some studies have suggested an association between pica and addictive behaviors. Others suggest pica is on the obsessive-compulsive disorder (OCD) spectrum of diseases. For instance, a study based on pica case studies by Dr Dan Stein and colleagues (a the University of Stellenbosch, South Africa) came to the conclusion that (based on their case studies), pica may be a symptom of OCD, and that pica may be phenomenologically reminiscent of an impulse control disorder.

For many people, pica is not dangerous but for some there may be complications including (i) parasitic infections (such as geophagics eating soil or copraphagics eating faeces), (ii) internal bodily obstruction (e.g., such as tricophagics getting hair stuck in their intestines), (iii) toxic reactions (e.g., such as autistic children getting lead poisoning from eating painted plaster), (iv) excessive caloric intake (such as that occurring with starch cravings), (v) dental injuries and infections, and (vi) nutritional deficiencies.

As Dr. Lacey concluded: “Pica appears to be a complex behavior that requires deliberate study rather than application of ex post facto single cause theories. Although such theories may motivate any given study of pica, it should be apparent that any single cause model will likely offer only a limited explanation of such diverse practices as have been described in the literature through case reports,’ research studies, and literature ‘reviews of various clinical and applied disciplines”

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

Further reading

al-Kanhal, M.A., & Bani, I.A. (1995). Food habits during pregnancy among Saudi women. International Journal for Vitamin and Nutrition Research, 65, 206-210.

Ashworth, M., Hirdes, J.P. & Martin, L. (2008). The social and recreational characteristics of adults with intellectual disability and pica living in institutions. Research in Developmental Disabilities, 30, 512-520.

Danford, D.E. & Huber, A.M. (1982). Pica among mentally retarded adults. American Journal of Mental Deficiency, 87, 141-146.

Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemade, U.J. et al (1994). Pica in an urban environment. Journal of Nutrition, 124(6 Suppl): 954S-962S.

Kettaneh, A., Eclache, V., Fain, O., Sontag, C., Uzan, M. Carbillon, Stirnemann, J. & Thomas, M. (2005). Pica and food craving in patients with iron-deficiency anemia: A case-control study in France. American Journal of Medicine, 118, 185-188

Lacey, E. (1990). Broadening the perspective of pica: Literature review. Public Health Reports, 105, 29-35.

López, L.B., Ortega Soler, C.R. & de Portela, M.L. (2004). Pica during pregnancy: A frequently underestimated problem. Archivos latinoamericanos de nutricion, 54, 17-24.

Mikkelson, T.B., Andersen, A.M. & Olsen, S.F. (2006). Pica in pregnancy in a privileged population: myth or reality. Acta Obstetricia et Gynecologica Scandinavica, 85, 1265-1266.

Ngozi, P.O. (2008). Pica practices of pregnant women in Nairobi, Kenya. East African Medical Journal, 85(2), 72-79.

Nyaruhucha, C.N. (2009). Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 11(1), 29–34.

Rose, E.A., Porcerelli, J.H, & Anne Neale, A.V. (2000). Pica: Common but commonly missed. Journal of the American Board of Family Practice, 13, 353-358.

Simpson, E., Mull, J.D., Longley, E., & East, J. (2000). Pica during pregnancy in low-income women born in Mexico. Western Journal of Medicine, 173, 20-24.

Smulian, J.C., Motiwala, S. & Sigman, R.K. (1995). Pica in a rural obstetric population. Southern Medical Journal, 88, 1236–1240.

Stein, D.J., Bouwer, C. & van Heerden, B. (1996). Pica and the obsessive- compulsive spectrum disorders. South African Medical Journal, 86, 1586-1592.

Young, S.L., Wilson, M.J., Miller, D., & Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS One, 3(9), e3147.

24-carrot hold: Can you have a compulsive craving for carrots?

“Eating raw carrots may be as addictive as cigarette smoking and every bit as difficult to give up” said The Independent newspaper back in 1992. The paper was reporting on a study by Czech researchers Ludek Cerný and Karel Cerný who published a paper in the British Journal of Addiction (BJA) concerning three case studies of people allegedly addicted to carrots. So can carrots really be addictive?

When I started to research this a little further, I was surprised to discover that there are many reports in the medical literature dating back almost 100 years of the consequences of excessive carrot eating. The most commonly reported consequence is that excessive carrot eating can cause people’s skin pigmentation to turn yellow (a condition that has since been given the name hypercarotenemia). In 1975, there was an infamous case that received widespread news coverage concerning the death of a 48-year old man who drank excessive amounts of carrot juice. The coroner actually attributed the man’s death as addiction to carrot juice although Dr Ivan Sharman (writing in an article in a 1985 issue of the British Medical Journal on hypercarotenemia) speculated that the person’s addiction to carrots may have reduced the patient’s intake of more nourishing food. Cases of hypercarotenemia have also been reported amongst people with anorexia, hypothyroidism, and Down’s Syndrome.

The 1992 BJA paper described three cases (one male and two females) who the authors claimed had developed a psychological dependence on carrots. The dependence was – in part – caused by the ‘active ingredients’ (including carotine) found in carrots. When unable to eat carrots, these people displayed symptoms of irritability and nervousness, and were said to have an inability to simply discontinue. All three people were cigarette smokers and the two women described their dependence on carrots as stronger than that of nicotine (whereas the man described it as slightly weaker). The man was eating “five bunches” of carrots daily and had – somewhat ironically – started eating carrots as a way of trying to reduce the amount of cigarettes that he smoked. When he gave up carrots, he resumed smoking. One of the women ate a kilogram of raw carrots a day, and was treated for ‘neurological disturbance’. The other woman – pregnant with her first child – started eating large quantities of carrots. She managed to stop eating carrots excessively for 15 years after the baby was born. However, following a stomach upset she relapsed. According to the authors, there was a happy outcome when the woman switched to radishes and developed a diet totally free of carrots!

In 1996, another paper was published in the Australian and New Zealand Journal of Psychiatry by Dr. Robert Kaplan (a consultant psychiatrist at the Liaison Clinic in Wollongong, Australia). The paper concerned the case of a 49-year-old female compulsive carrot eater who after a period of depression (caused by the breakdown of her marriage) started to eat 2-3kg of carrots every day, and lost interest in eating any other food. As in the cases outlined above, she was also a heavy smoker. As Dr Kaplan wrote:

“She rapidly lost interest in eating any other foods. Attempts to resist the craving were useless and she would get out of bed at night to eat more carrots. Her activities began to revolve around this activity, particularly the almost- daily visits to the supermarket. She became an expert in assessing the carrots, selecting them on size and shape: features which would determine the woodiness and succulence when eaten. As she put it: ‘I just wanted to eat a nice juicy carrot and couldn’t stop munching after that’…[She then developed a] noticeable orange/yellow discolouration of her face and hands. She explained that the carrot eating had overtaken her life and she had been too embarrassed to tell me about it at earlier visits. However, the skin discoloration was now quite visible and she felt self-conscious in public. In an attempt to overcome the problem she had stayed with her parents for several weeks, where they had encouraged her to eat normal meals. However, the craving continued and she became concerned about her appearance and the loss of control” (p.699).

The carrot eating continued and she was unable to stop eating carrots (she couldn’t last more than half a day before she gave in to the craving. Any attempt to stop eating carrots led to intense withdrawal symptoms (including anxiety, restlessness, shaking, craving, irritability, and insomnia). During a hysterectomy, the surgeon discovered that the woman’s internal organs were a bright yellow colour. Dr. Kaplan then noted:

“Losing her appetite, she stopped smoking cigarettes and eating carrots. The first few days lead to intense cravings for both substances, which settled, followed by cigarette cravings for a few more weeks. She felt that the postoperative distress and nicotine withdrawal symptoms had a combined effect which helped her overcome her carrot craving. Within 4 weeks, she felt she had overcome the carrot addiction, with cessation of both psychological and physical symptoms” (p.699).

The woman maintained her cessation of carrot eating although still occasionally craved cigarettes. Dr Kaplan reported that the thought of eating carrots now repulsed her. Interestingly, the woman believed that she couldn’t have stopped eating carrots without the discomfort produced by the nicotine withdrawal. It was concluded that compulsive carrot eating is a rare condition and that the basis for the addiction is most likely beta carotene (found in carrots). Although the woman was administered sertraline for her depression, it had no effect on the amount of carrots that she ate.

The idea that food can be addictive is not new and there are certainly reports of specific foodstuffs being addictive (chocolate perhaps being an obvious case in point). However, based on these few published case studies (particularly the one reported by Kaplan), it would appear that in extreme and very unusual circumstances, that carrots may indeed be addictive to some people.

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

Further reading

al-Jubouri, M.A., Coombes, E.J., Young, R.M. & McLaughlin, N.P. (1994). Xanthoderma: an unusual presentation of hypothyroidism. Journal of Clinical Pathology, 47, 850-851.

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

Corwin, R.L. & Grigson, P.S. (2009). Overview – food addiction: Fact or fiction? Journal of Nutrition, 139: 617–619.

Hess, A.F. & Myers, V.C. (1919) Carotenaemia: A new clinical picture. Journal of the American Medical Association, 73, 1743.

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

Leitner, Z.A., Moore, T., & Sharman, I.M. (1975). Fatal self-medication with retinol and carrot juice. Proceedings of the Nutrition Society, 34, 44A.

Pelchat, M.L. (2009). Food addiction in humans. Journal of Nutrition, 139, 620-622.

Schoenfeld, Y., Shaklai, M., Ben-Baruch, N., Hirschorn, M. & Pinkhaus, J. (1982). Neutropenia induced by hypercarotenemia. The Lancet, i, 1245.

Sharman, I.M. (1985). Hypercarotenaemia. British Medical Journal, 290, 95-96.

Sherman, P., Leslie, K., Goldberg, E., Rybczynski, J. & St-Louis, P. (1994). Hypercarotenemia and transaminitis in female adolescents with eating disorders: A prospective, controlled study. Journal of Adolescent Health, 15, 205-209.

Storm W. (1990). Hypercarotenemia in children with Down’s syndrome. Journal of Mental Deficiency Research, 34, 283-286.

Eat to the beat: What is the relationship between exercise addiction and eating disorders?

In previous blogs I briefly examined both exercise addiction and eating addiction. However, there is some research that these two disorders sometimes co-occur. In some of the papers I have co-written we have reviewed the evidence as to whether exaggerated exercise behaviour is a primary problem in the affected person’s life or whether it emerges as a secondary problem in consequence of another psychological dysfunction. In the former case, the dysfunction is usually classified as primary exercise addiction because it manifests itself as a form of behavioural addiction. In the latter case, it is usually termed as secondary exercise addiction because it co-occurs with another dysfunction, typically with eating disorders, such as anorexia nervosa or bulimia nervosa.

In primary exercise addiction, the motive for over-exercising is typically geared toward avoiding something negative, although the affected individual may be totally unaware of their motivation. It is a form of escape response to a source of disturbing, persistent, and uncontrollable stress. However, in the case of a secondary exercise addiction, the excessive exercise is used as a means of weight loss (in addition to very strict dieting). Thus, secondary exercise addiction has a different etiology than primary exercise addiction. Nevertheless, it should be highlighted that many symptoms and consequences of exercise addiction are similar whether it is a primary or a secondary exercise addiction. The distinguishing feature between the two is that in primary exercise addiction, the exercise is the main objective, whereas in secondary exercise addiction, weight loss is the main objective, while exaggerated exercise is one of the primary means in achieving the objective.

In a qualitative study published by Dr Diane Bamber (University of Cambridge), she and her team interviewed 56 regularly exercising adult women. On the basis of the analysis of the results, the authors identified three factors in the diagnostic criteria of secondary exercise addiction. Among these factors, only the presence of eating disorder symptoms differentiated secondary from primary exercise addiction. The other two factors (i.e., dysfunctional psychological, physical, or social behaviour, and the presence of withdrawal symptoms) were nonspecific to secondary exercise addiction.

However, Dr Michelle Blaydon (formerly of the University of Hong Kong) and colleagues attempted to further sub-classify secondary exercise addiction based on the primary source of the problem, which in their view was related to either a form of eating disorder or to an exaggerated preoccupation with body image. Although this appears to have face validity, to date, there is no empirical evidence for such speculation. Furthermore, a different research study by Dr Diane Bamber found no evidence for primary exercise addiction. In fact, they believe that all problematic exercise behaviours are linked to eating disorders. However, this view remains critically challenged in the literature and there are documented case studies – including one that I published myself back in 1997 where no eating disorders were present at all.

In addition to several studies that have reported disordered eating behaviour often (if not always) accompanied by exaggerated levels of physical exercise, the reverse relationship has also been established. Individuals affected by exercise addiction often (but not always) show an excessive concern about their body image, weight, and control over their diet. This co-morbidity makes it difficult to establish which is the primary disorder. This dilemma has been investigated using trait and personality-oriented investigations. In an early but widely cited controversial study led by Dr Alayne Yates (University of Hawaii) concluded that addicted male long-distance runners resembled anorexic patients on a number of personality dispositions (e.g., introversion, inhibition of anger, high expectations, depression, and excessive use of denial) and labelled the similarity as the “anorexia analogue” hypothesis.

To further test the hypothesis, Yates and colleagues examined the personality characteristics of 60 male obligatory exercisers and then compared their profiles with those of clinical patients diagnosed with anorexia nervosa. While the study did not lend support to the hypothesis, the authors claimed that running and extreme dieting were both dangerous attempts to establish an identity, as either addicted to exercise or anorexic. The study has been criticized for a number of shortcomings, including the lack of supporting data, poor methodology, lack of relevance to the average runner, over-reliance on extreme cases or individuals, and exaggerating the similarities between the groups.

Indeed, later investigations also failed to reveal similarities between the personality characteristics of people affected by exercise addiction and those suffering from eating disorders. Therefore, the anorexia analogue hypothesis has failed to secure empirical support. Numerous studies have further examined the relationship between exercise addiction and eating disorders but no consensus has emerged. One reason for the inconsistent findings may be attributed to the fact that the extent of co-morbidity could vary from case to case depending on personality predispositions, the underlying psychological problem that has led to exercise addiction, and/or the interaction of the two, as well as the form and severity of the eating disorder.

A French study led by Professor Michel Lejoyeaux (Bichat and Maison Blanche Hospital) on 125 Parisian male and female current exercise addicts reported that 70% of their sample were bulimic. In another US study by Dr Patricia Estok and Dr Ellen Rudy among 265 young American adult women runners and non-runners, 25% of those who ran more than 30 miles per week showed a high risk for anorexia nervosa. In studies of people with eating disorders, a study by Peter Lewinsohn (Oregon Research Institute, US) found excessive exercise activity among males with binge eating disorders, but not females. However, the percentage overlap was not reported. Finally, in a review by Marilyn Freimuth (Fielding Graduate University, US), she and her colleagues reported that among people with eating disorders, 39% to 48% also experienced an exercise addiction.

Basically, the major weakness of the literature is the complete lack of large-scale studies. In a recent review of the addiction co-morbidity literature that I did with Dr Steve Sussman and Nadra Lisha (University of Southern California), we didn’t locate a single study on the co-occurrence of exercise addiction with other disorders with a sample size of more than 500 participants.

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

Further reading

Bamber, D.J., Cockerill, I.M., Rodgers, S., & Carroll, D. (2003). Diagnostic criteria for exercise dependence in women. British Journal of Sports Medicine, 37(5), 393–400.

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, DOI: 10.3109/10826084.2011.639120.

Blaydon, M.J., & Lindner, K. J. (2002). Eating disorders and exercise dependence in triathletes. Eating Disorders, 10(1), 49-60.

Blaydon, M.J., Lindner, K. J., & Kerr, J. H. (2004). Metamotivational characteristics of exercise dependence and eating disorders in highly active amateur sport participants. Personality and Individual Differences, 36(6), 1419-1432.

Estok, P.J., & Rudy, E.B. (1996). The relationship between eating disorders and running in women. Research in Nursing & Health, 19, 377-387.

Freimuth, M., Waddell, M., Stannard, J., Kelley, S., Kipper, A., Richardson, A., & Szuromi, I. (2008). Expanding the scope of dual diagnosis and co-addictions: Behavioral addictions. Journal of Groups in Addiction & Recovery, 3, 137-160.

Griffiths, M. D. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Lejoyeux, M., Avril, M., Richoux, C., Embouazza, H., & Nivoli, F. (2008). Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room. Comprehensive Psychiatry, 49, 353-358.

Lewinsohn, P.M., Seeley, J.R., Moerk, K.C., & Striegel-Moore, R.H. (2002). Gender differences in eating disorder symptoms in young adults. International Journal of Eating Disorders, 32, 426-440.

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

Szabo, A. (2010). Addiction to exercise: A symptom or a disorder? New York, NY: Nova Science Publishers.

Yates, A., Leehey, K., & Shisslak, C. M. (1983). Running – an analogue of anorexia? New England Journal of Medicine, 308(5), 251-255.

A glutton for reward (rather than punishment)? A brief psychological overview of excessive and addictive eating

In a previous article in this blog on shopping addictions, it was highlighted that the form of excessive or addictive behaviour someone develops may depend upon gender. As I noted in that article, men are more likely to be addicted to drugs, gambling and sex whereas women are more likely to suffer from ‘mall disorders’ such as eating and shopping. Food is – of course – a primary reward as it is necessary for our survival. However, it is this reward that gives highly palatable food (such as sugar) its addictive potential, leading to excessive eating as an addictive behaviour. Possible reasons behind such excessive eating in today’s society are many, including the increasing availability of food, a more inactive lifestyle, and financial considerations. Furthermore, as a means of mood enhancement, food is highly rewarding, easily available, low-cost and most of all it is legal!

Such justifications demonstrate some degree of explanatory power, contributing to research into the topic of excessive eating as an area of increasing interest. However, no such explanations address the critical question of why certain people seem to overeat, despite repeated efforts not to. The majority of obese cases tend to result from an over-consumption of energy, independent from a lack of physical activity. Therefore it may be people, rather than food, that need to be of focus here.

Prevalence rates for excessive and addictive eating are highly variable. Past year prevalence rates of eating disorders (particularly binge eating disorder, among older teens and adults typically varies between 1 to 2% but much higher figures have been reported in a variety of studies in a number of different countries (between 6% and 15% depending upon the sample). Based on these many studies that included samples of at least 500 participants, Professor Steve Sussman, Nadra Lisha (both at the University of Southern California) and myself estimated a past year prevalence rate of 2% for eating addiction among general population U.S. adults.

Reward sensitivity is a personality construct of Jeffrey Gray’s Reinforcement Sensitivity Theory, and is thought to control approach behaviour, by means of the dopamine reward centre. Individuals that are highly sensitive to reward are more prone to detect signals of reward in their environment (such as food) resulting in approaching these rewards more frequently, along with responding quicker and more strongly. Research demonstrates associations between reward sensitivity and increased food cravings, body weight, binge eating, and a preference for high fat food. Such findings offer a possible explanation for why only some individuals eat excessively when reward, particularly that produced by food, is a process available to all.

An excessive appetite for food has long been linked to emotional eating with research demonstrating that refined food addicts specifically report eating when they feel anxious. For instance, this is demonstrated in the eating habits of overweight Americans, revealing that women tend to binge eat when they feel lonely or depressed, while men overeat in positive social situations. Research dating back to the early 1990s found that women being treated for eating disorders described feeling less anxious as an episode of binge eating went on. Such research suggests that highly anxious people are more likely to turn to food for comfort, leading to excessive eating, yet in turn cause themselves more anxiety when this comfort is unavailable. For instance, this is demonstrated in the eating habits of overweight Americans, revealing that women tend to binge eat when they feel lonely or depressed, while men overeat in positive social situations.

Research has shown that obese people score higher on impulsiveness personality scales. Impulsivity is a tendency to ‘act on the spur of the moment’, often associated with a failure to learn from negative experience, wherein individuals know the appropriate way to behave but fail to act accordingly. Refined food addicts eat for a ‘pick-me-up’, although they are aware that they are not hungry, suggesting a correlation between reward sensitivity and impulsive reactions to such reward cues. Impulsive individuals have a tendency to react to stress and anxiety, with a craving for immediate satisfaction as a form of relief. Although eating may deliver this reward or relief, it may then condition impulsive individuals to react quickly, with this inapt response, to such feelings in the future; such as with feelings of hunger when feeling anxious. This could explain why repeated attempts to restrict food intake and lose weight, so often results in relapse in obese people.

Associations have also been observed between self-esteem and a variety of excessive eating behaviour populations, such as restrained eaters, bulimic patients, and binge eaters. One explanation for this suggests that individuals with low self-esteem have lower expectations for personal performance, resulting in less effort being made to resist challenges and temptations to their diets. This offers another explanation that individuals with low self-esteem depend more on external cues to control eating, such as how food looks, rather than internal cues, such as hunger, indicating reward sensitivity and resulting in dieters with low self-esteem overeating. Here, low self-esteem combined with reward sensitivity and its further correlations to impulsivity and anxiety, seem to demonstrate a destructive model of influence on behaviour, one trait further amplifying the next leading to continuous eating to excess.

In relation to low self-esteem, low social desirability has been seen to correlate significantly with restrained eating in obese people. High social desirability is most commonly associated with a desire for thinness. Therefore, although an association with eating behaviour exists, high social desirability is more likely to correlate with anorexic behaviours as opposed to excessive eating. Low social desirability, combined with low self-esteem as a cause or effect, could contribute to explaining excessive eating in some individuals, which in turn could be reasoned by contributions of all traits previously mentioned.

Finally, Professor Elizabeth Hirschman at Rutgers University has proposed a general model of addictive consumption that interrelates excessive and compulsive consumption behaviour. This model suggests similar characteristics people exhibit, along with common causes, patterns of development, and the similar functions such behaviours serve for individuals. Many of these have been previously associated with excessive eating in particular, further suggesting a general consumption personality principle.

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

Further reading

Davenport, K., Houston, J. & Griffiths, M.D. (2012). Excessive eating and compulsive buying behaviours in women: An empirical pilot study examining reward sensitivity, anxiety, impulsivity, self-esteem and social desirability. International Journal of Mental Health and Addiction, DOI 10.1007/s11469-011-9332-7.

Davis, C., Levitan, R. D., Smith, M., Tweed, S. & Curtis, C. (2006) Associations among overeating, overweight, and attention deficit/hyperactivity disorder: A structural equation modelling approach. Eating Behaviors, 7, 266–274.

Hirschman, E.C. (1991) Recovering from drug addiction: A phenomenological account. In Sherry, J.F and Sternthal, B (Eds.), Advances in Consumer Research. Association for Consumer Research, 18, 541-549.

Hodgson R.J., Budd R. & Griffiths M. (2001). Compulsive behaviours (Chapter 15). In H. Helmchen, F.A. Henn, H. Lauter & N. Sartorious (Eds) Contemporary Psychiatry. Vol. 3 (Specific Psychiatric Disorders). pp.240-250. London: Springer.

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

Trinko, R., Sears, R. M., Guarnieri, D. J. & DiLeone, R. J. (2007) Neural mechanisms underlying obesity and drug addiction. Physiology & Behavior, 91, 499–505.