Category Archives: Eating disorders

Stats entertainment (Part 2): A 2013 review of my personal blog

My last blog of 2013 was not written by me but was prepared by the WordPress.com stats helper. I thought a few of you might be interested in the kind of person that reads my blogs. I also wanted to wish all my readers a happy new year and thank you for taking the time to read my posts.

Here’s an excerpt:

The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 860,000 times in 2013. If it were an exhibit at the Louvre Museum, it would take about 37 days for that many people to see it.

Click here to see the complete report.

My fiction ‘addiction’: The psychology of Hannibal Lecter

If I ever went on the BBC television show Mastermind, one of my potential specialist subjects would be the fictional serial killing psychiatrist Hannibal ‘The Cannibal’ Lecter (in print and on screen). I have devoured all four of Thomas Harris’ original books and all the DVDs (all five films and the TV series). In short, I am an obsessive Lecterite. While I was at university in the 1980s doing my undergraduate psychology degree, I was also the Entertainment Editor of the University of Bradford’s newspaper (Fleece). One of the perks of my part-time (unpaid) job was that I got to watch all the latest cinema releases for free and review them for Fleece. In 1986, one of the films that I watched (and loved) was Manhunter directed by Michael Mann. At the time, I didn’t realize that the film was based on Thomas Harris’ second book Red Dragon (first published in 1981 following his 1975 non-Lecter novel Black Sunday). However, I do remember the great (and understated) performance by Scottish actor Brian Cox playing the serial killing psychiatrist (spelled ‘Lecktor’ rather than Lecter in that particular film).

It was in 1991 that my real fascination with Lecter began after seeing The Silence of the Lambs directed by Jonathan Demme (and starring Anthony Hopkins as Lecter). I went to see it in the first week it was out as I was a big fan of Demme’s work particularly his musical documentary of Talking Heads in Stop Making Sense (1984), and films such as Melvin and Howard (1980), Swing Shift (1984), and Something Wild (1986). I came out of the cinema and within the space of a few weeks I had seen the film three times (and I was delighted when the film won all five of the main Oscar categories in 1992 – only the third film ever to have done so). At the time, I was a psychology lecturer at the University of Plymouth, and was teaching a weekly criminal psychology module to police inspectors on the university’s BA in Social and Organizational Studies. I was enthralled by the film’s use of behavioural profiling of criminals and the fact that the star of the film was a strange and bizarre paradox – a highly intelligent and highly cultured psychiatrist that also happened to be a serial killing cannibal.

It was at this point that I bought the two Thomas Harris novels that featured Lecter (i.e., Red Dragon and the 1988 sequel The Silence of the Lambs). I was gripped. Harris had clearly done his psychological and criminological research well (and I found the two books even better than the films). From then on I sought out anything Lecter-related and bought Harris’ further sequel (Hannibal, 1999) and prequel (Hannibal Rising, 2006), and watched and bought the big-budget Hollywood films Hannibal (2001, directed by Ridley Scott), Red Dragon (2002, directed by Brett Ratner) and Hannibal Rising (2007, directed by Peter Webber and starring Gaspard Ulliel as the young Hannibal), and most recently the US television series Hannibal (2013, starring Mads Mikkelsen as Lecter). My good friends also started buying me Lecter-related gifts (such as Daniel O’Brien’s excellent 2001 book The Hannibal Files).

So why am I – and millions of others worldwide – so fascinated, and – for want of a better word – ‘hooked’ on Hannibal the Cannibal’s fictional exploits? In 2005, the American Film Institute voted Hannibal Lecter the No.1 villain of all time (and who would argue against?). I suppose one of the scariest things about Lecter is that he’s the composite of real serial killers. People like Lecter actually exist and Harris clearly did his homework in writing his novels. In July 2013, Harris gave a rare interview and claimed that his inspiration for Lecter was a real-life Mexican murdering doctor (that he gave a pseudonym ‘Dr. Salazar’) and that he met in the 1960s while he was a newspaper crime reporter. Harris claimed that ‘Salazar’ had a “certain elegance”. It has also been noted that Harris attended the trial of Pietro Pacciani, a suspected serial killer nicknamed the ‘Monster of Florence’. The Wikipedia entry on Lecter claims that Pacciani’s serial killing modus operandi was used in his Hannibal novel. The Wikipedia entry also went on to say:

“According to David Sexton, author of The Strange World of Thomas Harris: Inside the Mind of the Creator of Hannibal Lecter, Harris once told a librarian in Cleveland, Mississippi, that Lecter was inspired by William Coyne, a local murderer who had escaped from prison in 1934 and gone on a rampage that included acts of murder and cannibalism. In her book Evil Serial Killers, Charlotte Greig asserts that the serial killer Albert Fish was the inspiration, at least in part, for Lecter. Greig also states that to explain Lecter’s pathology, Harris borrowed the story of serial killer and cannibal Andrei Chikatilo’s brother Stepan being kidnapped and eaten by starving neighbours (though she states that it is unclear whether the story was true or whether Stepan Chikatilo even existed)”.

I was surprised to find that there are dozens of academic papers written from many perspectives including psychology, psychiatry, criminology, media/film studies, and literary criticism (and I may well come back and write further blogs on Lecter using some of these). However, the rest of today’s blog concentrates on a really interesting trilogy of papers about Lecter written by Professor James Oleson in the Journal of Criminal Justice and Popular Culture (during 2005-2006). Oleson did a thorough review of various academic literatures and noted (in his 2005 paper) the following in relation to (i) the appeal of serial killers, and (ii) the appeal of Lecter more specifically:

“Apter (1992) suggests that serial killers transfix people because dangerous things – like serial killers – tend to create a state of invigorating psychological arousal. To neutralize the feelings of anxiety that accompany dangerous threats – like serial killers – we use protective frames such as narrative explanations or criminological theories. In explaining the serial killer’s behavior, we allow ourselves to succumb to the exciting magnetism of evil (Kloer, 2002) and can thereby ‘experience the excitement of arousal without being overwhelmed by anxiety’ (Ramsland, 2005)…Why do we love Lecter? Perhaps because he is the ‘perfect gothic hero’ (Dunant, 1999) or because he is the perfect gothic antihero (Dery, 1999). Perhaps it is because the heroic and the villainous co-exist within him. Because he is Obi Wan Kenobi and Darth Vader rolled into one (Hawker, 2001), because he is Darth Vader and Superman rolled into one (Cagle, 2002), or because he is Sherlock Holmes and Professor Moriarty rolled into one (Sexton, 2001)”.

Professor Oleson spends a lot of the first paper examining whether Lecter fits any of the serial killer typologies that various criminologists have formulated over the last three or four decades. According to Oleson, various researchers have identified two key precursors that have a high association with serial homicide – a pathological fantasy life and childhood trauma. Oleson argues that Lecter fits “this basic etiological model” because “he enjoys a rich and detailed fantasy life” and “he suffered serious childhood trauma”. Oleson also recounted the FBI’s research into ‘organized’ and ‘disorganized’ serial killers, and argued that there was evidence across all Harris’ books that Lecter displayed all 14 profile characteristics of an organized serial killer: (i) average to above-average intelligence, (ii) socially competent, (iii) skilled work preferred, (iv) sexually competent, (v) high birth order status, (vi) father’s work stable, (vii) inconsistent childhood discipline, (viii) controlled mood during crime, (ix) use of alcohol with crime, (x) precipitating situational stress, (xi) living with partner, (xii) mobility with car in good condition, (xiii) follows crime in news media, and (xiv) may change jobs or leave town.

Oleson also notes there are some models of serial killing that Lecter does not fit at all. For instance, the ‘addiction model’ of killing argues that some serial killers have a compulsion to kill and that they become addicted to killing (as put forward in the 1988 book Serial Killers by Dr. Joel Norris, and the 1996 book The Psychopathology of Serial Murder by Dr. Stephen Giannangelo). Another psychological model associated with serial killers is the concept of ‘sociopathy’ and ‘psychopathy’ (now termed ‘antisocial personality disorder’). Throughout Harris’ novels there are various references to Lecter being a sociopath and in the films he is described as being a psychopath (most notably by the psychiatrist Dr. Frederick Chilton, Director of the Baltimore State Hospital for the Criminally Insane, where Lecter was sent after being caught by his former profiling partner at the FBI (Will Graham). Oleson uses Dr. Robert Hare’s commonly used Psychopathy Checklist (first published in a 1980 issue of the journal Personality and Individual Differences) and convincingly shows that there is little evidence that Lecter is a psychopath.

Another model that Lecter does not fit is the “homicidal triad” of warning-sign behaviours (i.e., bed-wetting, animal cruelty, and fire starting) outlined in the many books of the FBI’s Dr. John Douglas and Mark Olshaker. This FBI research asserts that these three warning behaviours (particularly when they co-occur in adolescence) signal an elevated risk of subsequent serial homicide. However, Oleson shows that Lecter does not fit this profile at all. In his second (2006) paper, Oleson also assesses to what extent Lecter is insane. According to the M’Naughten test for insanity:

“It must be clearly proved that, at the time of committing the act, the party accused was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing, or that [if] he did know it, that he did not know he was doing what was wrong (Finkel, 1988)”.

Oleson argues that Lecter “flunks the M’Naughten test on all counts”. In fact he goes on to say that:

“[Lecter] does not suffer from a defect of reason – if anything, as a genius with an infinitely rare IQ score, he may suffer from a superhuman perfection of the reason… Similarly, Lecter knows perfectly well the nature and quality of the crimes he commits, and he knows that they are denounced as wrong by society…The character of Hannibal Lecter would be deemed sane under more recently developed tests for insanity, as well. Lecter, in perfect command of his will, does not commit his crimes because he is compelled. Accordingly, he would not be insane under any formulation of the irresistible impulse test (Finkel, 1988). Nor would he be found insane under the American Law Institute test. ‘A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of law’ (Finkel, 1988). Lecter possesses both near-infallible cognitive ability and an iron will. He in no way fits the categories of insanity articulated under prevailing rules”.

Oleson’s papers also examine the idea that Lecter may be a non-human monster, a vampire, a superhuman, and/or the Devil. He also speculates that his crimes may be the product of his superhuman intellect (as Lecter’s IQ is so high that it cannot be assessed by any instruments that are currently used). As Oleson concludes in the second of his three papers:

“It has been suggested that the character of Hannibal Lecter is so memorable because he emerges from paradox…It could simply be the case, however, that Lecter is such a successful villain because we love monster stories…because we need monsters…and because the Lecter novels skillfully combine the police procedural with particularly resonant elements of the supernatural horror story”.

I (for one) love the paradox of Lecter’s personality and character. Both (super)man and monster. I admire some of his character traits but (of course) despise others. He is a highly flawed criminal genius and polymath. A serial killer and a cannibal. Victim and villain. In his third paper on Lecter, Oleson asserts something that I agree (and will leave you) with:

“By asking why Hannibal Lecter commits his crimes, criminologists may be able to use the Lecter novels and movies as a catalyst for the study of the etiology of serial homicide. The character of Hannibal Lecter is, after all, based on real life serial killers, and provides readers and viewers with an intimate (if hyperbolic) case study of an organized serial killer. Characters drawn from novels can serve as valuable heuristic devices…teaching us a great deal about the nature of crime and evil”.

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

Further reading

American Film Institute. (2005). Heroes and villains. Located at: http://www.afi.com/tvevents/100years/handv.aspx

Finkel, N. J. (1988). Insanity on Trial. New York: Plenum Press.

Hare, R.D. (1980). A research scale for the assessment of psychopathy in criminal populations. Personality and Individual Differences, 1, 111-119.

Hare, R.D. (1996). Psychopathy: A clinical construct whose time has come. Criminal Justice and Behavior, 23, 25-54.

Hare, R. D. (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems.

Hickey, E. W. (1991). Serial Murderers and Their Victims. Pacific Grove, CA: Brooks/Cole.

Oleson, J. C. (2003). The celebrity of infamy: A review essay of five autobiographies by three criminal geniuses. Crime, Law, and Social Change, 40, 409-16.

Oleson, J. C. (2005). King of killers: The criminological theories of Hannibal Lecter, part one. Journal of Criminal Justice and Popular Culture, 12, 186-210.

Oleson, J. C. (2006). Contemporary demonology: The criminological theories of Hannibal Lecter, part two. Journal of Criminal Justice and Popular Culture, 13, 29-49.

Oleson, J. C. (2006). The devil made me do it: the criminological theories of Hannibal Lecter, part three. Journal of Criminal Justice and Popular Culture, 13, 117-133.

Raine, A. (1993). The Psychopathology of Crime. New York: Academic Press.

Sexton, D. (2001). The Strange Mind of Thomas Harris. London: Faber and Faber.

Wikipedia (2013). Hannibal Lecter. Located at: http://en.wikipedia.org/wiki/Hannibal_Lecter

Sheathing troubles: The strange case of accidental condom inhalation

While researching a previous blog on condom snorting, I came across an interesting case study of ‘accidental condom inhalation’ (and no, I promise I am not making this up). The case dates back to 2004 and was published by Dr. C.L. Arya and colleagues in the Indian Journal of Chest Diseases and Allied Sciences (IJCDAS).

Anyone who has kids will know that (just out of curiosity) they commonly put things in their mouths. The IJCDAS paper made reference to a number of medical studies that have shown inhaled items include things that can be from the edible (nuts, seeds, beans, etc) to the non-edible (plastic objects, screws, needles, pins, etc). They also note that when inhaling such objects, it doesn’t always lead to immediate medical symptoms or complications (such as choking, wheezing, coughing, etc.). However, the case that Dr. Arya and colleagues reported on was a little out of the ordinary.

The case involved a 27-year-old woman who was a schoolteacher. For a six-month period she had been suffering from a persistent cough where she was coughing up mucus along with some pneumonia symptoms. Initial examination showed nothing of consequence. Further tests took place and the paper reported that:

“The chest radiographs carried out subsequently showed development of a non-homogeneous right upper lobe lesion, not resolving either with antibiotics or a four-month trial of an empirical anti-tuberculosis treatment instituted by various practitioners. No symptomatic relief was obtained with either therapy. [A later] chest radiograph demonstrated a right upper lobe collapse-consolidation of lung. The opacity led us to promptly carry out a video-bronchoscopy, which gave impression of a white membranous object protruding from the collapsed right upper lobe bronchus. On probing further, it was noticed to be an inverted bag-like structure ‘sitting’ in the bronchus and having a flap-like action. A rigid bronchoscopy was then performed and the object was easily removed with biopsy forceps, though, it tore into pieces during procedure”.

As you will have noted from the title of this blog, the pieces were identified as being from a condom. The woman and her husband eventually recalled to the medics (after much probing by the medics) that there was an incident that occurred where a condom had become loosened while the wife was performing oral sex on her husband. During this particular sexual act, the woman had experienced a bout of coughing and sneezing and without her knowing she had accidentally inhaled her husband’s condom.

One of the reasons that the accidental inhalation went unnoticed for so long was because the inhaled object was of “soft, elastic and rubbery consistency that [was] unlikely to cause a direct lung injury”. The authors noted that:

“The airway obstruction of the right upper lobe segments produced by [the condom], could have resulted in the retention of secretions and the infection of corresponding lung segments, which may have become radiologically visible as a non-homogeneous right upper lobe collapse-consolidation. Despite mechanical obstruction, the flap-like action of condom (as noticeable on video-bronchoscopy) probably continued to clear secretions from right upper lobe, contributing to the delay in radiologic presentation of case”.

The medics were unsure whether the woman had genuinely accidentally swallowed the condom or whether she was just too embarrassed to report the incident and/or didn’t relate the incident to her subsequent symptoms. The authors also claimed that the original physicians who examined the woman were responsible for the condition being prolonged as they had failed to suspect that a foreign object (i.e., a condom) was the cause of the non-resolved pneumonia. They then noted that:

“Perhaps, views of physicians were guided by the age of patient (that was less suited for a suspicion of an inhaled foreign body), and also the fact, that a disease like tuberculosis was so highly prevalent in this part of world that a preference for the institution of [anti-tuberculosis treatment] was quite natural”.

Together, all of these reasons are likely to have resulted in a delayed diagnosis. The authors also noted that:

“Even following the condom retrieval [both husband and wife] were understandably hesitant in disclosing it owing to the nature of affair concerned (involving one’s privacy), the unusual nature of coitus performed (via an oral route) and the inhalation of a discrete object (like condom). The possibility of seminal aspiration also taking place simultaneously may not be ruled out…The case has certain atypical features, of which, the foremost relates to the type of inhaled object, i.e., a condom, which has not been reported in the literature to the best of our knowledge…[Another] atypical feature was adult-age of patient, that by any means, would be least expected to be associated with any foreign body inhalation”.

The authors speculated as to whether this incident was a one-off or whether such incidents were more widespread and were being under-reported because the Indian sub-continent has “a traditional conservative culture” where “people tend to have religious attitudes and sex is largely considered to be a subject limited to a person’s private life”. The authors concluded that:

“Perhaps, the young lady in our case was also quite apprehensive about fellatio, a fact that could have played a part in the condom inhalation. It is much desirable that sex taboos prevalent on the sub-continent are curbed and greater sexual awareness created in the people’s minds”.

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

Further reading

Agarwal, R.K., Banerjee, G., Shembish, N., & Jamal, B.A., Kareemullah, C. & Swaleh, A. (1988). Foreign bodies in the tracheobronchial tree: A review of 102 cases in Benghazi, Libya. Annals of Tropical Paediatrics, 8, 213-16.

Arya, C.L., Gupta, R. & Arora, V.K. (2004). Accidental condom inhalation. Indian Journal of Chest Diseases and Allied Sciences, 46, 55-58.

Ben-Dov, I. & Aelony, Y. (1989). Foreign body aspiration in the adult: An occult cause of chronic pulmonary symptoms. Postgraduate Medical Journal, 65, 299-301.

Causey, A.L., Talton, D.S., Miller, R.C., Warren, E.T. (1997). Aspirated safety pin requiring thoracotomy: Report of a case and review. Pediatric Emergency Care, 13, 397-400.

Lyons, D.J., McClod, D., Prichard, J., Dowd, D., & Clancy L. (1993). Very long retention of bronchial foreign bodies: Two new cases and a review of the literature. Irish Medical Journal, 86, 74-75.

Murthy, P.S., Ingle, V.S., George, E., Ramakrishna S. & Shah, F.A. (2001). Sharp foreign bodies in the tracheobronchial tree. American Journal of Otolaryngology, 22, 154-56.

Muddy daughters: A beginner’s guide to geophagia

In previous blogs I have looked at pica and some of the pica sub-variants including pagophagia (the eating of ice) and coprophagia (the eating of faeces). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Today’s blog takes a look at geophagia (the eating of earth, soil and/or clay). In a literature review published in the Journal of the Royal Society of Medicine by Dr Alexander Woywodt and Dr. Akos Kiss that geophagia has been regarded as a psychiatric disease, a culturally sanctioned practice and/or a sequel to poverty and famine. Geophagia is also a culturally sanctioned practice in some parts of the world. Woywodt and Kiss also stated that:

“[Geophagia] is not uncommon in southern parts of the United States5 as well as urban Africa. Fine red clay is often preferred. In particular, geophagia is observed during pregnancy or as a feature of iron-deficiency anaemia. Where poverty and famine are implicated, earth may serve as an appetite suppressant and filler; similarly, geophagia has been observed in anorexia nervosa. However, geophagia is often observed in the absence of hunger, and environmental and cultural contexts of the habit have been emphasized. Finally, geophagia is encountered in people with learning disability, particularly in the context of long-term institutionalization”.

The relationship between anaemia and pica (including geophagia) has been well documented. However, Woywodt and Kiss assert that it is still unclear whether anaemia prompts geophagia to compensate for iron deficiency or whether geophagia is the cause of anaemia. Prevalence rates of pica have range anywhere between 0.02% and 74% depending on the study and population studied although there are few reliable prevalence estimates of geophagia. One study of pregnant Tanzanian women found a prevalence rate of 26.5% (but this is – of course – a totally unrepresentative sample).

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 although it did also report that geophagics frequently eat other non-food stuffs (particularly if the desired soil is unavailable or socially unacceptable). For many people, pica is not dangerous but for geophagia there may be complications including parasitic infections (from eating soil). Although eating soil and clay may be regarded as unappetizing (and perhaps bizarre) by most people, some authors have argued that eating soil can be nutritionally beneficial (which if that was the case, it wouldn’t technically be a form of pica).

While not being considered a social norm in Western society, eating soil or clay is said to be quite common among primitive or economically depressed peoples a way of augmenting a scanty and/or mineral-deficient diet. Having said that, the geophagia is most often confined to people suffering from chronic mental illness. Clay (as opposed to soil) consumption has been reported in India, Haiti, various parts of Africa (Cameroon, Gabon, Guinea), and even rural areas of the USA. Like soil consumption, clay consumption has also been associated with pregnant women and some women claim they eat it to eliminate nausea. The Wikipedia entry on geophagia noted:

“In Haiti, the poorest economy in the Western Hemisphere, geophagy is widespread. The clay mud is worked into what looks like pancakes or cookies, called ‘bon bons de terres’…The cookies have little or no nutritional value and are associated with various health problems”.

A study led by Dr. L.T. Glickman and colleagues, and published in a 1999 issue of the International Journal of Epidemiology, provided some data on geophagia by carrying out a study examining intestinal parasitism among children from three rural villages in Guinea (Africa). More specifically they examined the faecal stools of 266 randomly selected children (aged 1-18 years). The researchers found that 53% of children were infected by at least one type of soil-transmitted parasite. They also surveyed parents and reported that geophagia was reported by parents to occur in 57% of children aged 1-5 years, 53% of children aged 6-10 years, and 43%, of children aged 11-18 years. It was concluded that geophagia is an important risk factor for orally acquired parasitic infections in African children.

A small study carried out by Turkish researchers and published in a 1978 issue of Acta Haematologica carried out oral iron and zinc tolerance tests on 12 patients from Turkey and Iran aged between 8 and 21 years with iron deficiency anemia and geophagia. The research team reported decreased iron and zinc absorption in patients compared to control patients. They concluded that iron and zinc malabsorption may be an additional feature of the syndrome characterized by geophagia among those from Turkey and Iran. Finally, in their literature review on geophagia, Dr Woywodt and Dr Kiss concluded that:

“The causation is certainly multifactorial; and clearly the practice of earth-eating has existed since the first medical texts were written. The descriptions do not allow simple categorization as a psychiatric disease. Finally, geophagia is not confined to a particular cultural environment and is observed in the absence of hunger”

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

Further reading

Arcasoy, A., Cavdar, A.O. & Babacan, E. (1978). Decreased iron and zinc absorption in Turkish children with iron deficiency and geophagia. Acta Haematologica, 60, 76-84.

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.

Glickman, L.T., Camara, A.O., Glickman, N.W. & McCabe, G.P. (1999). Nematode intestinal parasites of children in rural Guinea, Africa: Prevalence and relationship to geophagia. International Journal of Epidemiology, 28, 169-174.

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.

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.

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

Woywodt, A. & Kiss, A. (2002). Geophagia: the history of earth-eating. Journal of the Royal Society of Medicine, 95:143-146.

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.

Wikipedia (2012). Geophagy. Located at: http://en.wikipedia.org/wiki/Geophagy

Fat chance: The British ‘obesity epidemic’

Obesity has become a major problem across the Western world including Great Britain. Some academic scholars claim that obesity is a natural consequence of ‘food addiction’. While I can share this viewpoint, there are many examples of obese people whose eating behaviour would not be classed as addicted using the addiction components model. However, that does not mean obesity is not a problem. Academically, I only became interested in obesity when I was appointed a member of the Department of Health’s Expert Working Group on Sedentary Behaviour, Screen Time and Obesity chaired by Professor Stuart Biddle and led to a major report that we published on obesity and sedentary behaviour in 2010 (see ‘Further reading).

Obesity is measured using a calculation based on a person’s Body Mass Index (BMI). BMI is calculated by dividing a person’s weight measurement [in kilograms] by the square of their height [in metres]. In adults, a BMI of 25kg/m2 to 29.9kg/m2 means that person is considered to be overweight, and a BMI of 30kg/m2 or above means that person is considered to be obese. A recent 2013 report by the Health and Social Care Information Centre presented a range of information on obesity in England drawn together from a variety of sources. The report noted that:

“NICE [National Institute for Health and Care Excellence] guidelines on prevention, identification, assessment and management of overweight and obesity highlight their impact on risk factors for developing long-term health problems. It states that the risk of these health problems should be identified using both BMI and waist circumference for those with a BMI less than 35kg/m2. For adults with a BMI of 35kg/m2 or more, risks are assumed to be very high with any waist circumference”.

The main source of the report’s data on the prevalence of overweight and obesity is taken from the annual Health Survey for England (HSE) that is written by NatCen Social Research, and published by the Health and Social Care Information Centre (HSCIC). Most of the information presented in the 2013 report is taken from the HSE 2011.The main findings were that:

  • The proportion of adults with a normal Body Mass Index (BMI) decreased from 41% to 34% among men and from 50% to 39% among women between 1993 and 2011.
  • The proportion that were overweight including obese increased from 58% to 65% in men and from 49% to 58% in women between 1993 and 2011.
  • There was a marked increase in the proportion of adults that were obese from 13% in 1993 to 24% in 2011 for men and from 16% to 26% for women.
  • The proportion of adults with a raised waist circumference increased from 20% to 34% among men and from 26% to 47% among women between 1993 and 2011.
  • In 2011, around three in ten boys and girls (aged 2 to 15) were classed as either overweight or obese (31% and 28% respectively), which is very similar to the 2010 findings (31% for boys and 29% for girls).
  • In 2011/12, around one in ten pupils in Reception class (aged 4-5 years) were classified as obese (9.5%) which compares to around a fifth of pupils in Year 6 (aged 10-11 years) (19.2%).
  • In 2011, obese adults (aged 16 and over) were more likely to have high blood pressure than those in the normal weight group. High blood pressure was recorded in 53% of men and 44% of women in the obese group and in 16% of men and 14% of women in the normal weight group.
  • Over the period 2001/02 to 2011/12 in almost every year more than twice as many females than males were admitted to hospital with a primary diagnosis of obesity.
  • In 2011, there were 0.9 million prescription items dispensed for the treatment of obesity, a 19% decrease on the previous year.

Using regression analysis, the HSE also examined the risk factors associated with being overweight and obese. For both men and women, being ‘most at risk’ was positively associated with: age; being an ex-cigarette smoker; self-perceptions of not eating healthily; not being physically active; and hypertension. Income was also associated with being ‘most at risk’, with a positive association for men and a negative association for women. It was also reported that among women only, moderate alcohol consumption was negatively associated with being ‘most at risk’.

Another summary report on adult weight published earlier this year by the National Obesity Observatory briefly reviewed the scientific data and concluded that in the UK: (i) an estimated 62% of adults (aged 16 and over) are overweight or obese, and that 2.5% have severe obesity; (ii) men and women have a similar prevalence of obesity, but men (41%) are more likely to be overweight than women (33%); (iii) the prevalence of obesity and overweight changes with age, and prevalence of overweight and obesity is lowest in the 16-24 years age group, and generally higher in the older age groups among both men and women; and (iv) women living in more deprived areas have the highest prevalence of obesity and those living in less deprived areas have the lowest, but there is no clear pattern for men.

The 2013 Health and Social Care Information Centre report also contextualized the obesity problem in the UK by comparing obesity rates with other European countries and worldwide using data published by the Organisation for Economic Co-operation and Development (OECD). In 2012, the OECD has published a number of ‘Health at a Glance’ reports including one on European health comparisons, and one on worldwide health comparisons (published in 2011). The data from these reports was summarised as follows:

“More than half (52%) of the adult population in the European Union reported that they were overweight or obese. The obesity rate has doubled over the last twenty years in many European countries and stands at between 7.9% in Romania and 10.3% in Italy to 26.1% in the UK and 28.5% in Hungary. The prevalence of overweight and obesity among adults exceeds 50% in 18 of 27 EU member states…[Worldwide] more than half (50.3%) of the adult population in the OECD reported that they were overweight or obese. The least obese countries were India (2.1%), Indonesia (2.4%) and China (2.9%) and the most obese countries were the US (33.8%), Mexico (30.0%) and New Zealand (26.5%). Obesity prevalence has more than doubled over the past 20 years in Australia and New Zealand. Some 20-24% of adults in Australia, Canada, the United Kingdom (UK) and Ireland are obese, about the same rate as in the United States in the early 1990s. Obesity rates in many western European countries have also increased substantially over the past decade. The rapid rise occurred regardless of where levels stood two decades ago. Obesity almost doubled in both the Netherlands and the UK, even though the current rate in the Netherlands is around half that of the UK”.

From an addiction perspective, there’s also some interesting data examining the co-relationship between obesity and drinking alcohol. For instance, a 2012 report by Gatineau and Mathrani examining the relationship between obesity and alcohol consumption reviewed the literature and made a number of conclusions. These were that (i) there is no clear causal relationship between alcohol consumption and obesity, although there are associations between alcohol and obesity and these are heavily influenced by lifestyle, genetic and social factors; (ii) many people are not aware of the calories contained in alcoholic drinks; (iii) the effects of alcohol on body weight may be more pronounced in overweight and obese people; (iv) alcohol consumption can lead to an increase in food intake; (v) heavy, but less frequent drinkers seem to be at higher risk of obesity than moderate, frequent drinkers; (vi) the relationships between obesity and alcohol consumption differ between men and women; (vii) excess body weight and alcohol consumption appear to act together to increase the risk of liver cirrhosis; and (viii) there is emerging evidence of a link between familial risk of alcohol dependency and obesity in women.

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

Further reading

Biddle, S., Cavill, N., Ekelund, U., Gorely, T., Griffiths, M.D., Jago, R., et al. (2010). Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health/Department For Children, Schools and Families.

Gatineau, M & Mathrani, S. (2012). Obesity and alcohol: An overview. Oxford: National Obesity Observatory.

Health and Social Care Information Centre (2013). Statistics on Obesity, Physical Activity and Diet: England, 2013. London: Health and Social Care Information Centre.

Organisation for Economic Co-operation and Development (2011). Health at a Glance 2011. Available at: http://www.oecd.org/dataoecd/6/28/491 05858.pdf

Organisation for Economic Co-operation and Development (2012). Health at a Glance: Europe 2012. Available at: http://www.oecd.org/health/healthatagla nceeurope.htm

National Obesity Observatory (2013). Adult weight. Oxford: National Obesity Observatory.

Bad blood: A brief look at zoophagia

In previous blogs on vampirism as a sexual paraphilia and tampon fetishes, I briefly mentioned zoophagia. In his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr Anil Aggrawal defines zoophagia as eating live animals for erotic arousal. The online Wiktionary provides the same definition but also adds that it is another name for Renfield’s Syndrome (which I also covered in my blog on vampirism as a sexual paraphilia). Renfield’s Syndrome (as yet) does not appear in the Diagnostic and Statistical Manual of Mental Disorders but has been described as consisting of three stages (of which only one stage comprises zoophagia). More specifically:

  • Stage 1 – Autovampirism (autohemophagia): In the first stage, RS sufferers drink their own blood and often bite or cut themselves to do so (although some pay just pick at their own scabs).
  • Stage 2 – Zoophagia: In the second stage, RS sufferers eat live animals and/or drink their blood. The sources animal blood may come from butchers and abbatoirs if they have no direct access.
  • Stage 3 – True vampirism: In the final stage, RS sufferers drink blood from other human beings. The sources of blood may be stolen from blood banks or hospitals or may be direct from other people. In the most extreme cases, RS sufferers may commit violent crimes including murder to feed their craving.

What is clear from the description of zoophagia as part of Renfield’s Syndrome is that sexual pleasure and sexual arousal do not appear to be part of the motivation to engage in the behaviour. Of all the sexual paraphlias I have ever written about, zoophagia is one of the few that I find it hard to imagine what the etiology of the behaviour involves. How does anybody end up developing sexual pleasure from eating animals while they are still alive?

There is very little written about zoophagia from an academic perspective. Most references to the behaviour are found in the forensic crime literature in relation to sexual homicides or as a behaviour associated with specific events such as satanic rituals (although this is more to do with haematophagy – the drinking of animal blood – than zoopahgia). As Dr. Eric Hickey notes in his 2010 book Serial Murderers and Their Victims, in most countries, drinking blood is not a crime. Zoophagia is arguably a sub-type of haematophilia (i.e., a sexual paraphilia in which individuals derive sexual pleasure and arousal from the tasting or drinking blood). Dr. Hickey also noted the relationship between zoophagia and haematophilia:

“[Haematophilia] is usually done in the presence of others. Most persons engaging in this form of paraphilia also have participated in or have co-occurring paraphilia often harmful to others. In addition, a true hematolagniacis a fantasy-driven psychopath and to be considered very dangerous. According to Noll (1992), such desires are founded in severe childhood abuse. The child may engage in auto-vampirism in tasting his own blood and during puberty. These acts are eventually sexualized and reinforced through masturbation. A progressive paraphilic stage during adolescence is the sexual arousal of eating animals and drinking their blood (zoophagia) while masturbating. The compulsive, fantasy driven, sexual nature of this paraphilia creates a very dangerous adult”.

One of the most infamous serial killers that engaged in zoophagic activity was the German Peter Kurten (1883-1931), a mass murderer nicknamed the ‘Vampire of Dusseldorf’ (a case study also written about by Dr. Louis Schlesinger in his 2004 book Sexual Murder). Citing the work of criminologist Herschel Prins published in a 1985 issue of the British Journal of Psychiatry, Dr. Hickey recalled that:

Kurten was raised in a very physically and sexually abusive home where he witnessed his alcoholic father raping his mother and sisters. He also engaged in sexually abusing his sisters…At age 11 he was taught by the local dog catcher how to torture dogs and sheep while masturbating. He developed multiple paraphilia including vampirism, hematolagnia, necrophilia, erotophonophilia, and zoophagia and was known to drink directly from the severed jugular of his victims. He raped, tortured, and killed at least nine known victims although he was believed to have murdered several others. He used hammers, knives, and scissors to kill both young girls and women and admitted that he was sexually aroused by the blood and violence. Some victims incurred many more stab wounds than others, and when asked about this variation he explained that with some victims his orgasm was achieved more quickly…Before his beheading he asked if he would be able to hear the blood gushing from his neck stump because “that would be the pleasure to end all pleasures”.

Most of the literature on the drinking of blood for sexual pleasure concerns humans and is found in the studies on clinical vampirism (that I reviewed in a previous blog). From the few case studies I have read where zoophagia was mentioned in passing, all of the people written about engage in other sexually paraphilic behaviours (similar to that of Kurten outlined above). There may also be links between zoophagia and sexual cannibalism (which I also covered in a previous blog). For instance, some zoophagic activity might be viewed as omophagic activity in which the act is a form of symbolic ritual where the person consuming the blood and/or flesh of a live animal believes they are incorporating the ‘life force’ of the animal in question. For instance, an entry in Murderpedia claims:

“Some killers have adopted a form of omophagia, which is called zoophagia, as a means of possessing their victims. Zoophagia is the consumption of life forms, as seen in the character of Renfield in Dracula, who progresses from spiders to flies to birds to cats. The idea is to ingest increasingly sophisticated life forms as a way to improve one’s own”

An online article on vampires and the fetish scene by the Occult and Violent Ritual Crime Research Center notes that some of the behaviours that vampires engage in are similar to behaviours engaged in by fetishists. In a section on ‘blood rituals and blood play’, the article notes that throughout history and across cultures, people have attributed sacred and magical qualities to blood, and that blood rituals include drinking and/or pouring blood on the body. It also noted that:

“In some cultures it was believed that drinking the blood of a victim would endow you with the victim’s strength. Similarly by drinking the blood of an animal you would acquire its qualities…The use of blood is commonly referred to as blood sports, blood play, blood lust and blood fetishism”.

Any information that we currently have on zoophagia comes from clinical and/or forensic case studies. It would appear that zoophagia is incredibly rare, usually occurs among males, often coincides with other sexually paraphilic behaviour, and is most likely to occur among those with psychopathic and/or serial killing tendencies (unless the behaviour is part of a satanic and/or other ritualistic event).

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.

Benezech, M., Bourgeois, M., Boukhabza, D. & Yesavage, J. (1981). Cannibalism and vampirism in paranoid schizophrenia. Journal of Clinical Psychiatry, 42(7), 290.

Gubb, K., Segal, J., Khota1, A, Dicks, A. (2006). Clinical Vampirism: a review and illustrative case report. South African Psychiatry Review, 9, 163-168.

Halevy, A., Levi, Y., Ahnaker, A. & Orda, R. (1989). Auto-vampirism: An unusual cause of anaemia. Journal of the Royal Society of Medicine, 82, 630-631.

Jaffe, P., & DiCataldo, F. (1994). Clinical vampirism: Blending myth and reality. Bulletin of the American Academy of Psychiatry and the Law, 22, 533-544.

Noll, R. (1992). Vampires, Werewolves and Demons: Twentieth Century Reports in the Psychiatric Literature. New York: Brunner/Mazel.

Occult and Violent Ritual Crime Research Center (2012). Renfield’s Syndrome. Located at: http://www.athenaresearchgroup.org/renfieldsyndrome.htm

Perlmutter, D. (2004). Investigating Religious Terrorism and Ritualistic Crimes.  Boca Raton, Florida: CRC Press LLC.

Prins, H. (1985). Vampirism: A clinical condition. British Journal of Psychiatry, 146, 666-668.

Wilson N. (2000) A psychoanalytic contribution to psychic vampirism: a case vignette. American Journal of Psychoanalysis, 60, 177-86.

The need in deed: Is ‘loss of control’ always a consequence of addiction?

I recently published a potentially controversial paper in the journal Frontiers in Psychiatry arguing that loss of control may not always be a natural consequence of addiction. Research into addiction has a long history although there has always been much debate as to what the key components of addiction are. Irrespective of the theory and model of addiction, most theorizing on addiction tends to assume (implicitly or explicitly) that ‘loss of control’ is central (if not fundamental) to addiction. My paper challenges such notions by arguing that there are a minority of individuals who appear to be addicted to a behaviour (i.e., work) but do not necessarily appear to display any loss of control.

Research into many different types of addiction has shown that addicts are not a homogeneous group, and this may also have implications surrounding control and loss of control. Many years ago, in my 1995 book Adolescent Gambling, I argued that in relation to problem gambling there appear to be at least two sub-types of addiction – primary addictions and secondary addictions. I defined primary addictions as those in which a person is addicted to the activity itself, and that individuals love engaging in the activity whether it is gambling, sex or playing video games. Here, the behaviour is primarily engaged in to get aroused, excited, and/or to get a ‘buzz’ or ‘high’. I defined secondary addictions as those in which the person engages in the behaviour as a way of dealing with other underlying problems (i.e., the addiction is symptomatic of other underlying problems). Here the behaviour is primarily engaged in to escape, to numb, to de-stress, and/or to relax.

Therapeutically, I argued that it is easier to treat secondary addictions. My argument was that if the underlying problem is addressed (e.g., depression), the addictive behaviour should diminish and/or disappear. Primary addicts appear to be more resistant to treatment because they genuinely love the behaviour (even though it may be causing major problems in their life). Furthermore, the very existence of primary addictions challenges the idea that loss of control is fundamental to definitions and concepts of addiction. Clearly, people with primary addictions have almost no desire to stop or cut down their behaviour of choice because it is something they believe is life affirming and central to the identity of who they are. But does lack of a desire to stop the behaviour they love prevent ‘loss of control’ from occurring? Arguably it does, particularly when examining the research on workaholism.

I have popularized the ‘addiction components model’, particularly in relation to behavioural addiction (i.e., non-chemical addictions that do not involve the ingestion of a psychoactive substance). The addiction components model operationally defines addictive activity as any behaviour that features what I believe are the six core components of addiction (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict and relapse, and which I outlined in my very first blog on this site)

One of the observations that can be made by examining these six criteria is that ‘loss of control’ is not one of the necessary components for an individual to be defined as addicted to an activity. Although I acknowledge that ‘loss of control’ can occur in many (if not most) addicts, loss of control is subsumed within the ‘conflict’ component rather than a core component in and of itself. The main reason for this is because I believe that there are some addictions – particularly behavioural addictions such as workaholism – where the person may be addicted without necessarily losing control. However, such a claim depends on how ‘loss of control’ is defined and the highlights the ambiguity in our standard understanding of addiction (i.e., the ambiguity of control as ability/means versus control as goal/end).

When theorists define and conceptualise ‘loss of control’ as applied to addictive behaviour, it typically refers to (i) the loss of the ability to regulate and control the behaviour, (ii) the loss of ability to choose between a range of behavioural options, and/or (iii) the lack of resistance to prevent engagement in the behaviour. In some behaviours such as workaholism and anorexia, the person arguably tries to achieve control in some way (i.e., over their work in the case of a workaholic, or over food in the case of an anorexic). However, this in itself is not a counter-example to the idea that addiction is a ‘loss of control’ if workaholics and anorexics have lost the ability to control other aspects of their day-to-day lives in their pursuit of control over work or food (i.e., there is a difference between control as the goal/end of behaviour, and control as an ability/means.

There is an abundance of research indicating that one of the key indicators of workaholism (alongside such behaviours as high performance standards, long working hours, working outside of work hours, and personal identification with the job) is that of control of work activities. In a recent paper I wrote with my colleague Dr. Maria Karanika-Murray in the Journal of Behavioral Addictions, we also noted that the need for control is high among workaholics, and as a consequence they have difficulty in disengaging from work leading to many other negative detrimental effects on their life such as relationship breakdowns. Even some of the instruments developed to assess workaholism utilize questions concerning the need to be in control.

There are also other studies that suggest some workaholics do not experience a ‘loss of control’ in the traditional sense that is used elsewhere in the addiction literature. For instance, in a 2004 issue of the Journal of Organizational Change Management, Dr. Peter Mudrack reported that two particular aspects of obsessive-compulsive personality (i.e., being stubborn and highly responsible) were predictive of workaholism. A very recent paper by Dr. Ayesha Tabassum and Dr. Tasnuva Rahman in the International Journal of Research Studies in Psychology noted that perfectionist workaholics experience an overbearing need for control and are very scrupulous and detail-oriented about their work. Unusually among addictions, workaholics usually have no desire to reduce or regulate their work behaviour (i.e., there is no ambivalence or conflicting desire for them). In this instance, there is no evidence of ‘loss of control’ as traditionally understood, because if they had ambivalent or conflicting desires, they would change their behaviour (i.e., reduce the amount of time they spend working). Although not an exhaustive list of studies, those mentioned here appear to indicate that some workaholics appear to be more in control than not in control.

When the addiction is primary, the goal/end of the behaviour is desired and/or endorsed without ambivalence by the addict. In these situations (as in some cases of workaholism), there is no evidence for loss of control, because no (failed) attempts are made by the addict to alter their behaviour. However, this could arguably still be compatible with the claim that there is loss of control in the sense of ability and/or means, because, if the workaholic tried to work less (or work in a less controlling way) because they started to recognize ill effects the addictive behaviour was having on their personal life, then they may fail to do so. Therefore, the lack of evidence is indicative rather than conclusive.

However, one of the reasons that workaholism raises interesting theoretical and conceptual issues concerning the loss of control is that it is an example of an addiction where the goal/end is itself a form of control (i.e., control over their productivity/outputs, control over others, control over time-keeping, etc.). Unlike many other addictions, such behaviour is not impulsive and/or chaotic but carefully planned and executed. So this raises the question, in what sense is workaholism a loss of control, understood in the typical way, as ability/means to the behaviour’s goal/end? In some cases of workaholism, there is no evidence that the workaholic lacks control over this goal/end, as they do not try to change their behaviour (and thus cannot fail to do so).

It could be argued – and this is admittedly speculative – that ‘loss of control’ as is traditionally understood appears to have a greater association with secondary addiction (i.e., where an individual’s addiction is symptomatic of other underlying problems) than primary (or ‘happy’ or ‘positive’) addiction (i.e., where an individual feels totally rewarded by the activity despite the negative consequences). Such a speculation has good face validity but needs empirical testing. However, a complicating factor is the fact that my studies on adolescent gambling addicts have demonstrated that some individuals start out as primary addicts but became secondary addicts over time. Again, this suggests that control (and loss of it) may be something that changes its nature over time.

In essence, workaholics appear to make poor choices and/or decisions that have wide-reaching detrimental consequences in their lives. However, at present we lack evidence that (should they decide otherwise) they would be unable to work in a more healthy way. Furthermore, and equally as important, the nature of workaholic behaviour is not impulsive and chaotic, but carefully planned and executed. This is particularly striking among some workaholics, because as I have noted, it is an addiction that for some individuals they continue to work happily despite objectively negative consequences (e.g., relationship breakdowns, neglect of parental duties, etc.). What the empirical research on workaholism suggests is that it is an example of an addiction in which the problem is better characterized as loss of prudence rather than loss of control, as traditionally understood.

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

Further reading

Andreassen, C.S., Griffiths, M.D., Hetland, J. & Pallesen, S. (2012). Development of a Work Addiction Scale. Scandinavian Journal of Psychology, 53, 265-272.

Andreassen, C. S., Torsheim, T., Brunborg, G. S., & Pallesen, S. (2012) Development of a Facebook addiction scale. Psychological Reports, 110, 501-517.

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

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

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

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

Mudrack, P.E. (2004). Job involvement, obsessive-compulsive personality traits, and workaholic behavioral tendencies. Journal of Organizational Change Management, 17, 490-508.

Mudrack, P.E. & Naughton, T.J. (2001) The assessment of workaholism as behavioral tendencies: Scale development and preliminary empirical testing. International Journal of Stress Management, 8, 93-111.

Tabassum, A. & Rahman, T. (2012). Gaining the insight of workaholism, its nature and its outcome: A literature review. International Journal of Research Studies in Psychology, 2, 81-92.

Sex starved: A beginner’s guide to sexual anorexia

In previous blogs I have looked at anorexia nervosa in the context of addictive eating disorders, ‘tanorexia’ (excessive tanning) and ‘fanorexia’ (excessive following of a celebrity or sports team). Today’s blog takes a brief look at ‘sexual anorexia’ that according to Dr. Douglas Weiss in his 1998 book Sexual Anorexia, Beyond Sexual, Emotional and Spiritual Withholding, typically refers to “the active, almost compulsive withholding of emotional, spiritual and sexual intimacy from the primary partner”. The 12-Step group Sex and Love Addicts Anonymous offers this definition and analogy:

“As an eating disorder, anorexia is defined as the compulsive avoidance of food. In the area of sex and love, anorexia has a similar definition: Anorexia is the compulsive avoidance of giving or receiving social, sexual, or emotional nourishment”

A paper by Dr. Randy Hardman and Dr. David Gardner in a 1986 issue of the Journal of Sex Education and Therapy compared anorexia nervosa and sexual anorexia. They highlighted the four most significant characteristic similarities of these self-perpetuating disorders from both an intrapsychic and interpersonal level. These were (i) control (i.e., overt personal control and covert relationship power), (ii) fear (i.e., fear of losing control and fear of personal sexuality), (iii) anger (i.e., passive and active expressions of anger based on devaluation), and (iv) justification (i.e., an elaborate system of denial, delusion, and misperception).

Along with Dr. Weiss, most of the key writings on the topic have been written by Dr. Patrick Carnes (the author of many articles and books on sex addiction). Dr. Carnes defines sexual anorexia as: “an obsessive state in which the physical, mental and emotional task of avoiding sex dominates one’s life. Like self-starvation with food, deprivation with sex can make one feel powerful and defended against all hurts.” In a 1998 paper in the journal Sexual Addiction and Compulsivity, he also notes that: “the term “sexual anorexia” has been used to describe sexual aversion disorder [in the Diagnostic and Statistical Manual of Mental Disorders], a state in which the patient has a profound disgust and horror at anything sexual in themselves and others”.

According to the Wikipedia entry on sexual anorexia, the term ‘sexual anorexia’ has been around for over 35 years, and the first use it the term is generally attributed to psychologist Nathan Hare, a psychologist who coined the term in his 1975 PhD thesis. (However, I have failed to track this down, and none of the academic papers I have read on sexual anorexia ever mention Hare).

Dr. Carnes claims to have identified three causative factors in the formation of sexual anorexia. These are (i) a probable history of sexual exploitation or severely traumatic sexual rejection, (ii) family history of extremes in thought or behavior (often very repressive/religious or it’s polar opposite of “anything-goes” permissiveness), and (iii) cultural, social or religious influences that view sex negatively and supports sexual oppression and repression. Dr. Weiss adds that there are three key criteria in the formation of anorexia: (i) sexual abuse, (ii) attachment disorder with the opposite sex parent and (iii) sex addiction.

In his 1997 book Sexual Anorexia: Overcoming Sexual Self-Hatred, Dr. Carnes views the symptom cluster of the sexual anorexic as primarily sexual and includes: (i) a dread of sexual pleasure, (ii) a morbid and persistent fear of sexual contact, (iii) obsession and hyper-vigilance around sexual matters, (iv) avoidance of anything connected with sex, (v) preoccupation with others being sexual, (vi) distortions of body appearance, (vii) extreme loathing of body functions, (viii) obsessional self-doubt about sexual adequacy, (ix) rigid, judgmental attitudes about sexual behaviour, (x) excessive fear and preoccupation with sexually transmitted diseases, (xi) obsessive concern or worry about the sexual intentions of others, (xii) shame and self-loathing over sexual experiences, (xiii) depression about sexual adequacy and functioning, (xiv) intimacy avoidance because of sexual fear, and (xv) self-destructive behavior to limit, stop, or avoid sex.

The 1998 paper published in the journal Sexual Addiction and Compulsivity by Dr. Carnes is one of the very few in the literature to collect empirical data. The data were collected from 144 patients at his treatment clinic that were diagnosed with sexual anorexia. Of these, 41% were male and 59% female aged between 19 and 58 years (all of whom were Caucasian). The main findings were that:

  • 67% reported a history of sexual abuse
  • 41% reported a history of physical abuse
  • 86% reported a history of emotional abuse
  • 65% reported members of the immediate family as some type of addict
  • 40% reported having a sex addict in the immediate family
  • 60% described their family as “rigid”
  • 67% described their family as “disengaged”

Carnes also reported that over two-thirds of the sexually anorexic population claimed to have other compulsive and/or addictive problems including alcoholism (33%), substance abuse (25%), compulsive eating (25%), caffeine abuse (26%), nicotine addiction (23%), compulsive spending (22%), and/or bulimia/anorexia with food (19%). Of most interest was the fact that Carnes compared his group of sexual anorexics with a group of sex addicts (also from his treatment centre). Carnes concluded that:

“By contrasting that profile with data from sex addicts who were in the same patient pool, some important contrasts can be made. The data for sex addicts and sexual anorexics were very parallel in terms of family system, abuse history, and related patterns of addiction, compulsion, and deprivation. Even the criteria for sex addiction and sexual anorexia have important parallels in terms of powerlessness, obsession, consequences, and distress…Such comparisons tend to confirm the proposition that extreme sexual disorders stem from many of the same factors and are variations of the same illness. Of equal importance is the possibility that extreme behaviors in various disorders (food, chemical, sexual, financial) whether in excess or in deprivation are for many patients interchangeable parts representing much deeper patterns of distress”

Finally, if you would like to know if you are sexually anorexic, you can take this simple test that I found at the Freedom In Grace website (and appears to be based on the world of Weiss and Carnes). If you endorse five or more of the following nine statements you or your partner are currently struggling with sexual anorexia”.

  • Withholding love from partner
  • Withholding praise or appreciation from partner
  • Controlling by silence or anger
  • Ongoing or ungrounded criticism causing isolation
  • Withholding sex from your partner
  • Unwillingness or inability to discuss feelings with partner
  • Staying so busy that they have no relational time for the partner
  • Making the problems or issues about your partner instead of owning their own issues
  • Controlling or shaming partner with money issues

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

Further reading

Carnes, P. (1997). Sexual Anorexia: Overcoming Sexual Self-Hatred. Center City, MN: Hazelden.

Carnes, P. (1998). The case for sexual anorexia: An interim report on 144 patients with sexual disorders. Sexual Addiction and Compulsivity, 5, 293–309.

Hardman, R.K. & Gardner, D.J. (1986). Sexual anorexia: A look at inhibited sexual desire. Journal of Sex Education and Therapy, 12, 55-59.

Nelson, Laura (2003). Sexual addiction versus sexual anorexia and the church’s impact. Sexual Addiction and Compulsivity, 10, 179–191.

Sex and Love Addicts Anonymous (undated). Sexual anorexia. Located at: http://www.slaauk.org/files/anorexia.pdf

Weiss, D. (1998). Sexual Anorexia, Beyond Sexual, Emotional and Spiritual Withholding. Fort Worth, TX: Discovery

Weiss, D. (2005). Sexual anorexia: A new paradigm for hyposexual desire disorder. Located at: http://www.sexaddict.com/eBooks/SAeBk.pdf

Wikipedia (2012). Sexual anorexia. Located at: http://en.wikipedia.org/wiki/Sexual_anorexia

Flat mates: A brief look at BBW squashing fetishes

While researching a previous blog on fat fetishes, I came across the practice of ‘gut flopping’. According to the online Urban Dictionary, gut flopping is “where a large bellied individual raises his or her stomach and allows it to drop upon his or her sexual partner in a way that creates a smack sound [and] is an act performed for sexual pleasure”. There is an infamous clip on the internet featuring gut flopping (which you can check out here if you are so inclined), but there is little written about it academically (or non-academically for that matter). However, one variant of this that appears to be very popular among a minority of men is ‘BBW squashing’ (i.e., men being squashed by one or more ‘big beautiful women’ for sexual pleasure) and also known as ‘crushing’ or ‘smashing’ by squashing enthusiasts. One such BBW (‘Massive Mocha’) appeared on Dr. Drew’s US television show in October 2011 talking about her experiences as someone who catered for men’s fetish to be sat on and squashed by very large women. ‘Massive Mocha’ revealed that men ask her to sit on them until they feel they are going to pass out from loss of breath.

According to the Squashing Fetish website, there are many variations of the fetish. Heterosexual squashing comprises very obese women squashing smaller (typically thin) men. Homosexual squashing comprises very obese men squashing much smaller men. For some, fantasizing about being squashed may satisfy the sexual fetish. This may include someone (weighing anything from 200 pounds to 600 pounds) sitting, standing, jumping, and/or crushing their face, belly and/or chest (resulting in the person being squashed squirming). The relationship (concerning control) is psychologically similar to the dominant and submissive in sexual sadism and sexual masochism. Being unable to breathe (or breathe properly) appears to be critical in the fetish and in that sense shares similarities with hypoxyphilia (i.e., autoerotic asphyxiation in which individuals derive sexual arousal and pleasure from the restriction of their oxygen supply).

Last year (May 22, 2012), Channel 4 (in the UK) screened Nick Betts’ documentary My Big Fat Fetish. One of the women interviewed at length in the show was BBW Reenaye Starr. She was interviewed by a British tabloid newspaper prior to the show being aired and was asked whether the physical contact associated with a squashing was seen as the ultimate prize by men who pay to be squashed by her. Starr was reported as saying:

“It depends. There are so many different kinds of ‘fat admirers’. Some men are not interested in squashing at all. Some men are just into big ladies looking cute. And then there are some into hardcore pornography who want to see big ladies having sex. It all depends on what your sub-fetish is – but to these men, being with a big woman in any capacity is their ultimate desire. [My] subscribers come from all over the world. But there is definitely a huge following in the UK…I personally – other than my husband – have two feeders who send me money for food online. They don’t physically feed me as they’re too far away but one is based in the US now so he does come in for squashings”

In an online article on BBW squashing (which looks as though it was written by BBW squashers themselves but I can’t be sure), it noted we may not be able to explain how being squashed can be sexy, but it is an important part of foreplay for those who have this kind of fetish”. The (anonymous) writer confirms my own view that BBW squashing is on the same spectrum as sexual behaviours such as sadomasochism, bondage, and domination “which means that in order to find sexual pleasure, one must feel pain from lack of oxygen, beating, among others”. The article also claims that BBW Squashing “is not as life-threatening as autoerotic asphyxiation since the man can tap the BBW anytime he feels that he’s close to passing out”. It claims that most BBWs engage in squashing for financial reasons and that their primary aim is “to concentrate on the sexual gratification of their clients…Others like Queen Raqui, it’s more like a sport in which she also earns money, without the pressure of having sex with her clients”. The article mainly concerns all the different types of ways that men can be squashed by BBWs.

  • Face-Sitting: This position involves the man lying diagonally across a bed with his head at the corner of the bed. The BBW squasher (BBWS) then sits on the man’s head with the man’s face in the BBWS’s crotch. Some BBWSs may move or shake about to enhance the man’s pleasure.
  • Sixty-Nine (69): This position involves the man lying flat on the bed while the BBWS lies on top of him so that her face is in the man’s crotch and is facing his legs (and vice-versa). Either partner may stimulate each other’s genitals while in the 69 position.
  • Back-Lying: This position involves a man lying on his back with the BBWS sitting on him and crushing his chest and/or face.
  • Leg-Captivity: This position involves the BBWS wrapping the man’s head between her legs with the man facing either her crotch or her buttocks. The BBWS may completely suffocate the man in this position (and has to rely on the man to signal to her to let her know when to let go).
  • Riding Horse Man: This position (as might be expected from the name) involves the BBWS riding the man like a horse while he is on his front. This is said to increase the man’s sexual arousal.
  • Double Trouble: This is not a position as such but involves two BBWSs sitting on a man in any variation of the positions outlined above.

In a previous blog I examined both macrophilia (i.e., sexual pleasure and arousal from giants) and crush fetishes (i.e., sexual pleasure and arousal from crushing or being crushed), and there seems to be some psychological similarity between BBW squashing and these other sexual paraphilias and fetishes. For instance, some macrophiles date extraordinarily tall women (so called ‘Amazons’) even if they have to pay for the privilege to do so. For instance, Mikayla Miles (who when wearing her fetish boots nearly 7 feet in her fetish boots, and 6 feet 4 inches without the boots) provides private sessions with macrophiles to engage in behaviours such as trampling. This has a lot of resonance with BBW squashing. Research has been carried out into both sadomasochistic sexual activity and fat fetishes, but little on where they intersect. This would certainly be a fruitful area for further empirical investigation.

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

Further reading

All Experts (2009). Fetishism/BBW. September 16. Located at: http://en.allexperts.com/q/Fetishism-2835/2009/9/BBW-1.htm

Call Escort Girls (2012). BBW squashing. February 28. Located at: http://callescortgirls.com/bbw-squashing

Leigh, R. (2012). “I work with attractive women who love themselves – what could be more empowering than that?” My Big Fat Fetish’s Reenaye Starr on squashings and whether she feels exploited. Daily Mirror, May 22. Located at: http://www.mirror.co.uk/news/world-news/my-big-fat-fetish-bbw-model-844022

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. & 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.

This farming man: An unusual case of zoocoprophilia?

One of the most bizarre sex-related stories I have come across in the last few years concerns an Englishman called David Truscott from Pengegon Parc, Camborne (in Cornwall). Truscott, was 41-years-old when he was put in prison for two years after he had harassed and terrorized one particular family for a six-year period near Redruth (Cornwall). He repeatedly covered his naked (or scantily-clad) body in cow manure and would roll around on the floor masturbating on the family’s farm (if he wasn’t completely naked he either wore just underpants although on one occasion he was apprehended by police wearing shiny red sorts and latex gloves). He had already received a court order preventing him from going anywhere near the family but breached his restraining order on February 26 [2011] when he was caught by the farmer Clive Roth’s 16-year old son pleasuring himself while covered in cow manure.

Jill Wilson, the crown prosecutor in the case at Truro Court told the court that there was “a history of [Truscott] visiting this particular farm seeking sexual gratification while immersed in cow dung and mud”. Mark Charnley, the lawyer defending Truscott told the court that his client was a “sad, vulnerable, socially inadequate man…He does show remorse for what he did and a realization of the harm he was doing to the family and pleased for leniency because his client had no close family and had learning difficulties. Charnley also suggested that Truscott was suffering from a form of autism that led him to engage in his sexual behaviour while under stress. However, Judge Christopher Elwen said Truscott had to be jailed for his “perverted activities [and because he’d] made the home life of the Roth family absolute hell through your bizarre fetish and disgusting behaviour”. The Judge concluded: “The family members live in fear of what you might get up to from time to time. They have constantly to look over their shoulders. Any untoward activity on the farm brings your disgusting behaviour to mind”.

It was back in 2004 that Truscott was first spotted by the family when he was found masturbating in the faeces of the farm’s muck spreader. As the behaviour was not an isolated incident, the family tried to keep their manure spreading equipment clean but Truscott still found ways to make himself a nuisance to the family. When the manure became harder to come by, Truscott took his revenge on the family by setting fire to an animal pen containing the family’s cows and calves in which one of the cows died. The family’s three-year old son was traumatized by the incident and lived in fear that the house where he lived was going to be burned to the ground. Mr Roth’s mother also lived in fear that the farmhouse was going to be the subject of an arson attack. As a consequence, Truscott pleaded guilty and received a three-year prison sentence.

When he was released from prison in 2009, Truscott returned to the family’s farmhouse and was found naked in a pile of manure. He received yet another prison sentence (of 20 weeks) and a restraining order preventing him from stepping foot on the family’s farm. However, this proved ineffective and was broken on a number of subsequent occasions (including one where he immersed himself almost naked inside a large vat of manure inside the farm’s milking parlour. It was also revealed in court that Trsucott owned 360 pairs of women’s knickers and usually slept in ladies’ pyjamas.

Although I only have the various news reports to go on (all the ones I read are listed in the ‘Further reading’ section at the end of this blog), I would make a number of observations. Firstly, the primary sexual attraction appears to be towards animal faeces, therefore he could possibly be classed as a coprophile. Although I have never come across a case of anyone in the academic and clinical literature deriving sexual pleasure from anything other than human faeces, definitions of coprophilia never specify that the faecal matter has to be human. Maybe Truscott’s behaviour could therefore be classed as “zoocoprophilia” (my own word to describe those individuals who derive sexual pleasure and arousal from animal faeces).

Secondly, (and I admit this is highly speculative), it could perhaps be argued that Truscott would classify as a ‘Class V zoosexual’ in Dr. Anil Aggrawal’s recently published new classification of zoophiles. The Class V zoosexual type comprises what Aggrawal calls fetishistic zoophiles. These individuals keep various animal parts (especially fur) that they then use as an erotic stimulus as a crucial part of their sexual activity. Such individuals have been reported in the clinical literature including the case of a woman (reported in a 1990 issue of the American Journal of Forensic Medical Pathology) who used the tongue of a deer as her primary masturbatory aid. Given that the animal manure appeared to be a critical component in Truscott’s masturbatory activity, maybe he could arguably be classed as a Class V zoosexual.

Thirdly, there is some empirical evidence of an overlap in coprophilia and zoophilia. An earlier study on a sample of paraphiliacs reported that zoophiles appear to engage in many paraphilic behaviours including coprophilia. In a survey of 561 non-incarcerated paraphiliacs seeking treatment, Dr Gene Abel and colleagues reported in an issue of the Bulletin of the American Academy of Psychiatry and the Law, that all of the 14 zoophiles in their sample reported more than one paraphilia and seven of them reported at least five other paraphilas including coprophilia, urophilia, pedophilia, exhibitionism, voyeurism, frotteurism, telephone scatophilia, transvestic fetishism, fetishism, sexual sadism, and/or sexual masochism. This also supports the observation that if a person has one paraphilia, they often have others. In the case of Truscott, there was some evidence that he engaged in transvestite sexual behaviour in the fact that he often wore women’s knickers and slept in female nightwear.

Finally, fact that Truscott’s lawyer suggested his client had a form of autism may be an important factor in the behaviour displayed. In a previous blog I wrote on coprophagia (i.e., people that eat faeces, and a behaviour that sometimes overlaps with coprophilia), I noted that various medical and psychological disorders have been identified that are associated with coprophagia including mental retardation and autism.

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

Further reading

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

Aggrawal, A. (2011). A new classification of zoophilia. Journal of Forensic and Legal Medicine, 18, 73-78.

Beck D.A. & Frohberg, N.R. (2005). Coprophagia in an elderly man: a case report and review of the literature. International Journal of Psychiatry Medicine, 35, 417-427.

Crazy News (2011). The pervert who got sexual thrills in cow manure. March 24. Located at: http://weirdcrazynews.blogspot.co.uk/2011/03/pervert-who-got-sexual-thrills-in-cow.html

Daily Mirror (2011). Pervert who got sexual thrills in cow manure sent to prison. Daily Mirror, March 24. Located at: http://www.mirror.co.uk/news/weird-news/pervert-who-got-sexual-thrills-in-cow-117998

Evening Standard (2011). Pervert with fetish for cow manure is locked up, March 23. Located at: http://www.standard.co.uk/news/pervert-with-fetish-for-cow-manure-is-locked-up-6384125.html

Ghaziuddin, N. & McDonald, C. (1989). A clinical study of adult coprophagics. British Journal of Psychiatry, 4, 53-54.

Omasiali (2011). Sick white devil repeatedly has sex with cow manure back in jail, May 15. http://omasiali.wordpress.com/2011/05/15/sick-white-devil-repeatedly-has-sex-with-cow-manure-back-in-jail/

Randall, M.B., Vance, R.P., McCalmont, T.H. (1990). Xenolingual autoeroticism. American Journal of Forensic and Medical Pathology, 11, 89-92.

Skruff, J. (2012). Britain’s filthiest sex fiend strikes again, July 18. Located at: http://skrufff.com/2012/07/britains-filthiest-sex-fiend-strikes-again/

White Watch (2011). White man who repeatedly has sex with cow manure back in jail. March 27. Located at: http://whitewatch.info/2011/03/27/white-man-who-repeatedly-has-sex-with-cow-manure-back-in-jail.aspx

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