Category Archives: Obsessive-Compulsive Disorder

Naming desire: A personal look at my new job title

Back in 2002, I was incredibly proud when I became one of the youngest full Professors in the UK when I was bestowed the title of Professor of Gambling Studies based on my research contribitions to the gambling studies field. Anyone that has followed my career over the last decade (or this blog over the last four years) will no doubt have realised that my research interests and expertise include a lot more than gambling.

Although I still publish a lot of papers on gambling (12 to 17 papers per calendar year; see Appendix 1 below) I have carried out more and more research into non-gambling addictions and over the last six years (2010-2015) my refereed journal outputs on gambling have only constituted one-third of all my refereed journal outputs (32%) (see Appendix 1 and Figure 1).

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The overwhelming majority of my published refereed papers since January 2010 (n=246; 88%) concern behavioural addictions (i.e., gambling addiction, videogame addiction, internet addiction, work addiction, sex addiction, exercise addiction, shopping addiction, dancing addiction, etc.). If gambling addiction is removed from these papers, this still leaves 56% of all my papers during the 2010-2015 period concerning other behavioural addictions (n=158). The remainder of my refereed journal papers (34 papers; 12%) mainly concern the topic of mindfulness carried out with my colleagues Edo Shonin and William Van Gordon. Even my three books in the 2010-2105 timeframe have been on three totally separate topics (i.e., problem gambling, internet addiction and mindfulness). Of my 71 book chapters in this 2010-2015 period, 22 have been on gambling addiction, 41 have been on other behavioural addictions, and 8 have concerned other topics (see Figure 2). In the ‘Further reading’ section below is some of the papers that I have published this year and even a quick glance will highlight that gambling papers are in the minority.

It is also worth noting that I am one of the most highly cited academics in the UK (soemthig else that I am very proud of) and a quick look at my Google Scholar citations profile (currently over 24,500 citations as of October 31, 2015) that of my top ten most highly cited papers, only one is on gambling adiction and the other nine concern my papers on videogame addiction and internet addiction.

Basically, my job title didn’t reflect what I was actually doing on the research front. And this is the very argument I put to my employer (Nottingham Trent University) a number of weeks ago. As far as I am aware, I am the first professor at NTU to ever ask for my title to be changed but last week I was informed by my line manager that the university was convinced by the case I put forward and from now on I will be Professor of Behavioural Addiction.

This new title change has pleased me greatly and of course subsumes the vast majority of the research that I am doing (including my research into gambling addiction). I don’t think I will ever stop carrying out research in the gambling field but my new job title will stop me feeling guilty about working in non-gambling areas. It may also stop some of few abusive emails I get regarding my blogs (saying in very colourful language that I should stop writing about other behavioural addictions and sexual paraphilias and “write about what I get paid to do”). Firstly, I would point out to these individuals that I don’t get paid to write my personal blog and even if I did, I write all my blogs in my spare time.

If you’ve read this far, then thank you. I promise normal service will be resumed in my next blog when it will be about something other than myself.

Appendix 1: Summary statistics of my refereed journal papers (January 1, 2010 to October 20, 2015)

  • 2010: Gambling papers (n=17); Behavioural addiction papers (n=19); Other papers (n=1)
  • 2011: Gambling papers (n=15); Behavioural addiction papers (n=15); Other papers (n=2)
  • 2012: Gambling papers (n=10); Behavioural addiction papers (n=28); Other papers (n=3)
  • 2013: Gambling papers (n=12); Behavioural addiction papers (n=23); Other papers (n=4)
  • 2014: Gambling papers (n=13); Behavioural addiction papers (n=33); Other papers (n=13)
  • 2015: Gambling papers (n=13); Behavioural addiction papers (n=27); Other papers (n=7)
  • In press: Gambling papers (n=8); Behavioural addiction papers (n=13); Other papers (n=4)


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

Further reading (some recent papers)

Andreassen, C.S., Griffiths, M.D., Pallesen, S., Bilder, R.M., Torsheim, T. Aboujaoude, E.N. (2015). The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test. Frontiers in Psychology, 6:1374. doi: 10.3389/fpsyg.2015.01374.

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

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

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

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

Canale, N. Santinello, M. & Griffiths, M.D. (2015). Validation of the Reasons for Gambling Questionnaire (RGQ) in a British population survey. Addictive Behaviors, 45, 276-280.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). Trait urgency and gambling problems in young people: the role of decision-making processes. Addictive Behaviors, 46, 39-44.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). How do impulsivity traits influence problem gambling through gambling motives? The role of perceived gambling risk/benefits. Psychology of Addictive Behaviors, 29, 813–823.

Cleghorn, J. & Griffiths, M.D. (2015). Why do gamers buy ‘virtual assets’? An insight in to the psychology behind purchase behaviour. Digital Education Review, 27, 98-117.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.

Dhuffar, M. & Pontes, H.M. & Griffiths, M.D. (2015). Dysphoric mood states and consequences of sexual behaviours as predictors of hypersexual behaviours in university students: An exploratory study. Journal of Behavioural Addictions, 4, 181–188.

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

Greenhill, R. & Griffiths, M.D. (2015). Compassion, dominance/submission, and curled lips: A thematic analysis of dacryphilic experience. International Journal of Sexual Health, 27, 337-350.

Griffiths, M.D. (2015). Problematic technology use during adolescence: Why don’t teenagers seek treatment? Education and Health, 33, 6-9.

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

Hanss, D., Mentzoni, R.A., Griffiths, M.D., & Pallesen, S. (2015). The impact of gambling advertising: Problem gamblers report stronger impacts on involvement, knowledge, and awareness than recreational gamblers. Psychology of Addictive Behaviors, 29, 483-491.

Hussain, Z., Williams, G. & Griffiths, M.D. (2015). An exploratory study of the association between online gaming addiction and enjoyment motivations for playing massively multiplayer online role-playing games. Computers in Human Behavior, 50, 221–230.

Karanika-Murray, M., Pontes, H.M., Griffiths, M.D. & Biron, C. (2015). Sickness presenteeism determines job satisfaction via affective-motivational states. Social Science and Medicine, 139, 100-106.

Király, O., Griffiths, M.D. & Demetrovics Z. (2015). Internet gaming disorder and the DSM-5: Conceptualization, debates, and controversies, Current Addiction Reports, 2, 254–262.

Király, O., Urbán, R., Griffiths, M.D., Ágoston, C., Nagygyörgy, K., Kökönyei, G. & Demetrovics, Z. (2015). Psychiatric symptoms and problematic online gaming: The mediating effect of gaming motivation. Journal of Medical Internet Research, 17(4) :e88.

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

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

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

Ortiz de Gortari, A.B. & Griffiths, M.D. (2015). Game Transfer Phenomena and its associated factors: An exploratory empirical online survey study. Computers in Human Behavior, 51, 195-202.

Ortiz de Gortari, A.B., Pontes, H.M. & Griffiths, M.D. (2015). The Game Transfer Phenomena Scale: An instrument for investigating the non-volitional effects of video game playing. Cyberpsychology, Behavior and Social Networking, 18, 588-594.

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

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

Quinones, C. & Mark D. Griffiths (2015). Addiction to work: recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48-59.

Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

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

Penned in: How to become an excessive (and productive) writer

Many people that I know would probably describe me as a ‘writaholic’ based on the number of articles and papers that I have had published. When it comes to addictions in academia, ‘writing addiction’ is just about the best one you can have. I don’t believe I have an addiction to writing but it is a very salient activity in my life and I am a habitual writer and I write every day. In previous blogs I examined diary writing and psychological wellbeing as well as an article on graphomania (obsessive writing). Today’s blog briefly examines some of the things that make people more productive writers (and by definition a more excessive writer). During my career I’ve published many articles on the writing process (see ‘Further reading’ below) and today’s blog looks at some of my beliefs and practices.

Before outlining some general advice, it’s also worth exploring many of the false beliefs that many of us have about writing – beliefs which may explain why many of us don’t like writing. For instance:

  • Writing is inherently difficult: Like speaking, writing doesn’t need to be perfect to be effective and satisfying.
  • Good writing must be original: Little, if any, of what we write is truly original. What makes our ideas worthwhile communicating is the way we present them.
  • Good writing must be perfect preferably in a single draft: In general, the more successful writers are more likely to revise manuscripts.
  • Good writing must be spontaneous: There appears to be a belief that writing should await inspiration. However, the most productive and satisfying way to write is habitually, regardless of mood or inspiration. Writers who overvalue spontaneity tend to postpone writing, and if they write at all, they write in binges that they associate with fatigue.
  • Good writing must proceed quickly: Procrastination goes hand in hand with impatience. Those writers who often delay writing suppose that writing must proceed quickly and effortlessly. However, good writing can often proceed at a slow pace over a lengthy period of time.
  • Good writing is delayed until the right mood with big blocks of undisrupted time available: Good writing can take place in any mood at any time. It is better to write habitually in short periods every day rather than in binges.
  • Good writers are born not made: Good writing is a process that can be learned like any other behaviour.
  • Good writers do not share their writing until it is finished and perfect: Although some writers are independent, many writers share their ideas and plans at an early stage and then get colleagues to read over their early drafts for comments and ideas.

Even when these false beliefs about writing are dispelled, many of us can still have problems putting pen to paper or finger to keypad. Insights about writing only slowly translate into actions. For most professionals, writing is only done out of necessity (i.e., a report that they have to hand in). This produces a feeling of ‘having to write’ rather than ‘wanting to write’ and can lead to boredom and/or anxiety. Furthermore, most people appear to view writing as a private act in which their problems are unique and embarrassing. Strategies for overcoming this include getting colleagues to criticize their own work before going ‘public’, sharing initial plans and ideas with others, and practising reviewing other people’s work.

It is generally acknowledged that there is no one proven effective method above all others for teaching people to become better writers. It is also a process that can be learned and can aid learning (i.e., a skill learned through opportunities to write and from instructional feedback). Although there are no ‘quick fixes’ to becoming a better writer, here are some general tips on how to make your writing more productive. I would advise you to:

  • Establish a regular place where all serious writing is done
  • Remove distracting temptations from the writing site (e.g., magazines, television)
  • Leave other activities (e.g., washing up, making the dinner) until after writing
  • Limit potential interruptions (e.g., put a “Do not disturb” sign on the door, unplug the telephone)
  • Make the writing site as comfortable as possible
  • Make recurrent activities (e.g., telephone calls, coffee making) dependent upon minimum periods of writing first
  • Write while ‘feeling fresh’ and leave mentally untaxing activities until later in the day
  • Plan beyond daily goals and be realistic about what can be written in the time available
  • Plan and schedule writing tasks into manageable units
  • Complete one section of writing at a time if the writing is in sections
  • Use a word processor to make drafting easier
  • Revise and redraft at least twice
  • Write daily rather than ‘bingeing’ all in one go
  • Share writing with peers as people are more helpful, judgmental and critical on ‘unfinished’ drafts

Obviously, the problem with such a prescriptive list such as this is that not every suggestion will work for everyone. Many of us know our own limitations and create the right conditions to help get the creative juices going. Some people can’t write in silence or with others in the room. By reading this short blog I cannot make you become a more productive and excessive writer overnight. However, it has hopefully equipped my blog readers with some tips and discussion points that may help in facilitating better writing amongst yourselves and colleagues.

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

Further reading

Griffiths, M.D. (1994). Productive writing in the education system. The Psychologist: Bulletin of the British Psychological Society, 7, 460-462.

Griffiths, M.D. (2001). How to…get students to write with confidence. Times Higher Education Supplement, June 8, p.24.

Griffiths, M.D. (2004). Tips on…Report writing. British Medical Journal (Careers), 328, 28.

Griffiths, M.D. (1998). Writing for non-refereed outlets (Part 1 – Professional journals and newsletters). Psy-PAG Quarterly, 29, 41-42.

Griffiths, M.D. (1999). Writing for non-refereed outlets (Part 2 – Newspapers and magazines). Psy-PAG Quarterly, 30, 5-6.

Griffiths, M.D. (2000). Writing and getting published – My top 10 tips. Psy-PAG Quarterly, 34, 2-4.

Griffiths, M.D. (2005). Addiction, fiction and media depiction: A light-hearted look at scientific writing and the media. Null Hypothesis: The Journal of Unlikely Science, 2(2), 16-17.

Griffiths, M.D. (2010). Top tips on…Writing with confidence. Psy-PAG Quarterly, 76, 33-34.

Griffiths, M.D. (2013). How writing blogs can help your academic career. Psy-PAG Quarterly, 87, 39-40.

Griffiths, M.D. (2014). Top tips on…Writing blogs. Psy-PAG Quarterly, 90, 13-14.

Good buy to love: Introducing the Bergen Shopping Addiction Scale

(Please note that the following article was co-written using material provided by my research colleague Dr. Cecilie Schou Andreassen and our fellow researchers).

In two of my previous blogs I took a brief look at the area of shopping addiction (that you can read here and here). Since writing those blogs I’ve co-written a few papers on compulsive buying and shopping addiction (see ‘Further reading’ below), the latest of which was published in the journal Frontiers in Psychology (FiP) and led by my friend and research colleague Dr. Cecilie Schou Andreassen at the University of Bergen in Norway. In the FiP paper we reported on the development of a newly created instrument to assess this disorder called the Bergen Shopping Addiction Scale (BSAS).

Whether compulsive and excessive shopping represents an impulse-control, obsessive-compulsive or addictive disorder has been debated for several years This fact is reflected in the many names that have been given to this disorder including ‘oniomania’, ‘shopaholism’, ‘compulsive shopping’, ‘compulsive consumption’, ‘impulsive buying’, “compulsive buying’ and ‘compulsive spending’. In a review by Dr. Andreasson in the Journal of Norwegian Psychological Association, she argued that shopping disorder is best understood from an addiction perspective, and defined it as “being overly concerned about shopping, driven by an uncontrollable shopping motivation, and to investing so much time and effort into shopping that it impairs other important life areas”. Several authors (including myself) share this view as a growing body of research shows that those with problematic shopping behaviour report specific addiction symptoms such as craving, withdrawal, loss of control, and tolerance.

Research also suggests that the typical shopping addict is young, female, and of lower educational background. Some personality factors have also been shown to be associated with shopping addiction including extroversion and neuroticism. It has been suggested that neurotic individuals (typically being anxious, depressive, and self-conscious) may use shopping as means of reducing their negative emotional feelings. Other personality factors may actually protect individuals from developing shopping addictions (e.g., conscientiousness). Empirical research (including some research I carried out with Kate Davenport and James Houston published in a 2012 issue of the International Journal of Mental Health and Addiction) has consistently reported significantly lower levels of self-esteem among shopping addicts. Such findings suggest that irrational beliefs such as “buying a product will make life better” and “shopping this item will enhance my self-image” may trigger excessive shopping behaviour in people with low self-esteem. However, this may be related to depression, which has been shown to be highly comorbid with problematic shopping.

Other factors, such as anxiety have also often been associated with shopping, and it has also been suggested that self-critical people shop in order to escape, or cope with, negative feelings. In addition, shopping addiction has also been explained (by such people as Dr. Marc Potenza and Dr. Eric Hollander) as a way of regulating neurochemical (e.g., serotonergic, dopaminergic, opioid) abnormalities and has been successfully treated with pharmacological agents, including selective serotonin reuptake inhibitors (SSRIs) and opioid antagonists.

One of the key problems that we outlined in our new FiP paper is that in prior research there is a lack of a common understanding about how problematic shopping should be defined, conceptualized, and measured. Consequently, there are huge disparities and unreliable prevalence estimates of shopping addiction ranging from 1% to 20% and beyond (depending upon the criteria used to assess the disorder). Although several scales for assessing shopping addiction have been developed (mainly in the late 1980s and early 1990s) many of them have poor theoretical anchoring and/or are primarily rooted within the impulse-control paradigm. We also argued that several items of existing scales are outdated with regards to modern consumer patterns (such as people using cheques or no reference to online shopping). Newer scales that have been developed don’t view problematic shopping behaviour as an addiction in terms of core addiction criteria (i.e., salience, mood modification, tolerance, withdrawal, conflict, relapse and resulting problems).

This is why we decided to develop a new shopping addiction scale (i.e., the BSAS) containing a small number of items that reflect the core elements of addiction (and if you want to take the test yourself, it’s at the end of this article). We examined the psychometric properties of the new scale among a large sample of Norwegian individuals (n=23,537), and the testing phase began with 28 items (four statements for each of the seven components of addiction outlined above). The BSAS was constructed simply by taking the highest scoring item from each of seven 4-item clusters. We found that scores on the BSAS were significantly higher among females, as well as being inversely related to age (and therefore in line with previous research). We also found that scores on the BSAS were positively associated with extroversion and neuroticism.

The association of shopping addiction with extroversion may reflect that, in general, extroverts need more stimulation than non-extroverted individuals, a notion that is in line with studies showing that extroversion is associated with addictions more generally. It may also reflect the notion that extroverts purchase specific types of products excessively as a means to express their individuality, enhance personal attractiveness, or as a way to belong to a certain privileged group a (e.g., the buying of high end luxury goods). The association of shopping addiction with neuroticism may be because neuroticism is a general vulnerability factor for the development of psychopathology and that people scoring high on neuroticism engage excessively in different behaviours in order to escape from dysphoric feelings.

We also found that shopping addiction was inversely related to self-esteem. This is also in line with the findings of previous studies and implies that some individuals shop excessively in order to obtain higher self-esteem (e.g., associated “rub-off” effects from high status items such as popularity, compliments, in-group ‘likes’, omnipotent feelings while buying items, attention during the shopping process from helping retail personnel), to escape from feelings of low self-esteem, or that shopping addiction lowers self-esteem. Obviously our new scale needs to be further evaluated in future studies (as it has only been investigated in this one study) and it also requires validation in other cultures.

Overall, we concluded that the BSAS has good psychometrics – basically the scale is quick to administer, reliable and valid. With the advent of new technology and modern consumer patterns we may be witnessing an increase in problematic shopping behaviour. It is likely that new Internet-related technologies can greatly facilitate the emergence of problematic shopping behaviour because of factors such as accessibility, affordability, anonymity, convenience, and disinhibition. Therefore, we encourage other researchers to consider using the BSAS in epidemiological studies and treatment settings.

Want to take the test?  

Answer each of the following questions with one of the following five responses: ‘completely disagree’, ‘disagree’, ‘neither disagree nor agree’, ‘agree’, and ‘completely agree’.

  • You think about shopping/buying things all the time
  • You shop/buy things in order to change your mood
  • You shop/buy so much that it negatively affects your daily obligations (e.g., school and work)
  • You feel you have to shop/buy more and more to obtain the same satisfaction as before.
  • You have decided to shop/buy less, but have not been able to do so
  • You feel bad if you for some reason are prevented from shopping/buying things
  • You shop/buy so much that it has impaired your well-being

If you answer “agree” or “completely agree” on at least four of the seven items, you may be a shopping addict.

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

Further reading

Aboujaoude, E. (2014). Compulsive buying disorder: A review and update. Current Pharmaceutical Design, 20, 4021-4025.

Andreassen, C. S. (2014). Shopping addiction: An overview. Journal of Norwegian Psychological Association, 51, 194–209.

Andreassen, C.S., Griffiths, M.D., Pallesen, S., Bilder, R.M., Torsheim, T. Aboujaoude, E.N. (2015). The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test. Frontiers in Psychology, 6:1374. doi: 10.3389/fpsyg.2015.01374.

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, 10, 474-489.

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

McQueen, P., Moulding, R., & Kyrios, M. (2014). Experimental evidence for the influence of cognitions on compulsive buying. Journal of Behavior Therapy and Experimental Psychiatry, 45, 496–501.

Workman, L., & Paper, D. (2010). Compulsive buying: A theoretical framework. Journal of Business Inquiry, 9, 89–126.

Hoard focus: A brief overview of Diogenes Syndrome

In a previous blog on animal hoarding I made a passing reference to Diogenes Syndrome (DS) that is sometimes referred to as ‘senile squalor syndrome’ (as it typically occurs in elderly individuals – although it has occasionally been reported in young adults). According to a paper by Alberto Pertusa and colleagues in a 2010 issue of Clinical Psychology Review:

“Squalor has been defined in various ways including, ‘social breakdown of the elderly’, ‘Diogenes syndrome’ and ‘severe domestic squalor’…These definitions have usually encompassed both domestic neglect and a lack of personal hygiene…The majority of case observations and studies on squalor have focused on elderly populations recruited from nursing or disability services…These studies initially suggested that those living in squalor were likely to be over the age of 60, primarily female, living alone and unmarried…Hypotheses on the etiology of squalor have moved from the phenomenon possibly being uni-dimensional to having heterogeneous causes such as physical disabilities, brain damage, psychiatric conditions, and personality disorders…A study on squalor reported the prevalence to be 0.005% in the United Kingdom”.

Hoarding is often a consequence of having DS but is associated with self-neglect and much of the items excessively hoarded are typically items of trash with little or no value. Like animal hoarders, those with DS often live on their own in severe domestic squalor and unsanitary conditions. As I noted in my previous blog, DS is characterized by extreme self-neglect, apathy, domestic squalor, social withdrawal, compulsive hoarding of rubbish, and lack of shame. Most sufferers refuse help of others and the onset of DS may sometimes be initiated by a stressful event in their lives (such as death of a loved one). According to a 2013 paper on DS by Dr. Projna Biswas and colleagues in the journal Case Reports in Dermatological Medicine:

“DS is named after the Greek Philosopher “Diogenes of Sinope” (4th century BC) who taught about cynicism philosophy. He kept his need for clothing and food to a minimum by begging. He used to follow some ideas like ‘life according to nature’, ‘self-sufficiency’, ‘freedom from emotion’, ‘lack of shame’, ‘outspokenness’, and ‘contempt for social organization’…The approximate annual incidence of Diogenes is 0.05% in people over the age of 60 [years]. Affected individuals come from any socioeconomic status, but are usually of average or above-average intelligence…It is often associated with other mental illnesses, such as schizophrenia, mania, and frontotemporal dementia…While no clear etiology exists, it is hypothesized that it may be due to a stress reaction in people with certain pre-morbid personality traits, such as being aloof, or certain personality disorders, such as schizotypal or obsessive compulsive personality disorder. There are suggestions that an orbitofrontal brain lesion may lead to such behaviours…while others state that chronic mania symptoms, such as poor insight, can lead to such a condition”.

DS was not included separately in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) although hoarding (syllogomania) is included as a genuine psychiatric diagnosis. Because of deliberate self-isolation, physical neglect and poor eating, DS mortality rates are high with close to half of sufferers dying within five years of DS onset. Biswas and colleagues also note:

“Diogenes syndrome is also known as dermatitis passivata. The term Diogenes syndrome was coined in 1975 by [Clark and colleagues]…DS has been classified as primary or pure which is not associated with mental illness and secondary or symptomatic. Secondary DS is related to mental illness like schizophrenia, depression, and dementia…Alcohol abuse has been identified as a cofactor…Multiple deficiency states have been associated with DS including iron, folate, vitamin B12, vitamin C, calcium and vitamin D, serum proteins and albumin, water, and potassium…Skin lesions are mainly due to uncleanliness which may result in various infestations and infections. These are ignored by the patient. Dirt, dust, bacterial, fungal, and parasitic debris conglomerate to form thick crusts and scales over various parts of the body”.

The paper by Biswas and colleagues’ asserted that four symptoms have been reported as being in almost all DS sufferers. These are that they: (i) never ask for any help despite possessing nothing; (ii) are unusually fond of certain objects (including rubbish); (iii) display unusual behavior with other people (misanthropy) and (iv) display extreme self-neglect. Although hoarding is often present in those with DS, there have been some cases reported where no hoarding was present. In their 2010 review paper, Dr. Pertusa and colleagues noted:

“Research on hoarding has rarely included assessments of severe domestic squalor. Winsberg et al. (1999) noted that clutter inhibited normal activities of daily living – including personal hygiene. A few studies have provided more direct indications of squalor in hoarding. [one study in 2000] surveyed health department officers in Massachusetts who reported that 38% of their hoarding cases were ‘heavily cluttered with filthy environment, overwhelming’. [Another study] focused on cleanliness ratings of the personal appearance and the homes of 62 elderly hoarding individuals. In their sample, 17% of individuals were described as ‘extremely filthy’ and 33% of residences were rated as ‘extremely filthy and dirty’. For 32% of the residences, there was an overpowering odor from rotten food or animal or human feces. Many subjects could not use their refrigerator (45%), kitchen sink (42%), bathtub (42%), or toilet (10%). Lack of standardized instruments to measure squalor have prevented researchers from understanding squalor in compulsive hoarding”.

Dr. Pertusa and his colleagues claim the data on DS is scarce and that the clinical picture between hoarding and DS needs more clinical research. They do conclude that hoarding within a DS diagnosis is clinically different from other types of hoarding (for instance, compulsive hoarders do not display the same core features as those with DS such as squalor and self-neglect). Like many other clinical conditions, Pertusa’s team assert that longitudinal studies will best help uncovering the natural history and link (if any) between both DS and compulsive hoarding.

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

Further reading

Biswas, P., Ganguly, A., Bala, S., Nag, F., Choudhary, N., & Sen, S. (2013). Diogenes syndrome: a case report. Case reports in dermatological medicine,

Clark, A. N., Mankikar, G. D., & Gray, I. (1975). Diogenes syndrome. A clinical study of gross neglect in old age. Lancet, 1(7903), 366−368.

Drummond, L.M., Turner, J., Reid, S. (1996). Diogenes’ syndrome – a load of old rubbish? Irish Journal of Psychiatric Medicine, 14(3), 99–102.

Greve, K.W., Curtis, K.L., & Bianchini, K.J. (2004). Personality disorder masquerading as dementia: A case of apparent Diogenes syndrome. International Journal of Geriatric Psychiatry, 19, 703–705

Irvine, J. D., & Nwachukwu, K. (2014). Recognizing Diogenes syndrome: a case report. BMC Research Notes, 7(1), 276.

Pertusa, A., Frost, R.O., Fullana, M.A., Samuels, J., Steketee, G., Tolin, D., Saxena, S., Leckman, J.F., Mataix-Cols, D. (2010). Refining the diagnostic boundaries of compulsive hoarding: A critical review. Clinical Psychology Review, 30, 371-386.

Rosenthal, M., Stelian, J., & Wagner, J. (1999). Diogenes syndrome and hoarding in the elderly: Case reports. Israel Journal of Psychiatry and Related Sciences, 36, 29–34.

Coming to a different view: The Masturbation Fantasy Paradox

While researching an article on compulsive masturbation, I quite by chance came across a recent paper published by Wolter Seuntjens in the Journal of Unsolved Questions entitled ‘The Masturbation Fantasy Paradox: An Overlooked Phenomenon?’ (And yes, I too was amazed that there was a journal with such a name, although it colloquially calls itself JUNQ).

Seuntjens noted in his paper that masturbation is an activity that is often accompanied by fantasizing. However, he uses anecdotal evidence and material found in biographic and literary works to suggest some people are completely unable to fantasize about the person they are in love with during masturbation. This he describes as the ‘Masturbation Fantasy Paradox’ (MFP), a “putative phenomenon” that “may be a particular case of a more general principle put forward by Sigmund Freud”. Freud wrote an essay in 1912 concerning the paradoxes of love and desire. More specifically, in ‘On the universal tendency to debasement in the sphere of love’ Freud noted that “where such men love they have no desire and where they desire they cannot love”.

The whole thesis of the paper appears to rests on a few choice selections from autobiographical material supplied by comic actor and broadcaster (and all-round polymath) Stephen Fry, journalist and columnist Dermod Moore, and French writer and poet (and founder of the Surrealist movement) André Breton. More specifically, the extracts chosen by Seuntjens were:

  • Extract 1: “Although I was to develop, like every male, into an enthusiastic, ardent and committed masturbator, he was never once, nor ever has been, the subject of a masturbatory fantasy. Many times I tried to cast him in some scene. I was directing for the erotic XXX cinema in my head, but it always happened that some part of me banished him from the set, or else the very sight of him on screen in the coarse porn flick running in my mind had the effect of a gallon of cold water. Sex was to enter our lives, but he was never wank fodder, never” (Stephen Fry in Moab is My Washpot).
  • Extract 2: “I have no racy stories about shady events after lights-out in the tent. In fact, having recently discovered masturbation, I found camp frustrating for the lack of opportunity for relief. The fly-infested latrines were the only possible venues, but, unaccountably, self-abuse lost its allure there. However, I was in love with a boy in my patrol. I never really thought about sex with him, but we would roll around on the damp grass in mock combat, laughing and shouting “Help! Homo! Rape!” loudly enough, supposedly, to disguise our covert desire from the others. And from each other” (Dermod Moore in Diary of a Man [about his experience as a Boy Scout]).
  • Extract 3: “In 1930, André Breton, while discussing sexuality in the loosely formed group of surrealists, remarked comparably: What do you think about when you masturbate? André Breton: It is accompanied by a series of fleeting images of different women (dream women) or I knew or know but never a woman I have loved”.

These three selections are presented as “direct observations” and then followed by an extract from a book The Ultimate Aphrodisiac by John Hole. In the novel, the book’s main protagonist Norman Ranburn says:

  • Extract 4: “It didn’t matter that he might be in love with her. Love meant nothing at his age. Except, he discovered with some fascination, that he didn’t want to besmirch and overlay his vision of her with a dirty wanker’s fantasy”.

Unsurprisingly, Seuntjens notes there is no scientific research into the MFP and also claims there is little research on masturbatory fantasizing more generally. His first port of call are Nancy Friday’s books My Secret Garden (the best selling book on female sexual fantasies) and Men in Love, Men’s Sexual Fantasies: The Triumph of Love Over Rage. Two of Friday’s respondents arguably describe the MFP when they are reported as saying:

  • Extract 5: “The funny thing is, when I’m dating someone I really care for, I never fantasize about them…Usually my thoughts center around a man I find fantastically attractive and very nice, i.e., a customer, a stranger on the street, someone I don’t know too well” (‘Beth Anne’).
  • Extract 6: “By age twenty, still a virgin, I had had a succession of enchanting teen-age affairs – but since nice girls didn’t have sexual organs and certainly didn’t fuck, I didn’t even attempt to fondle a breast or introduce ‘French’ kissing. I didn’t even feel free to fantasize my latest love for masturbation purposes, usually resorting to her sister or one of her less attractive girl friends instead. One’s love had to be kept on a special Pedestal” (‘Don’).

Friday then goes onto speculate (in her book Forbidden Flowers: More Women’s Sexual Fantasies) that:

“One of the ironies of fantasy is that the hero of our erotic reveries is rarely the man we love. Perhaps it is the very fulfillment and satisfaction we get from him that leaves nothing to the imagination, and so we need these strangers in the night to people our imaginary sexual worlds. They bring us the excitement of the unknown”.

In an arguably more scientific piece of research, Seuntjens made reference to Dr. Brett Kahr’s 2007 book Sex and the Psyche that included reference to his British Sexual Fantasy Research Project comprising 13,553 participants and additional and in-depth face-to-face interviews with a further 122 people. Dr. Kahr made no direct reference to MFP but did note a more negative reason as to why some people do not fantasize about people they love:

“Many of the people whom I interviewed told me that they did not want to fantasize about the partner with whom they had had a row only hours before, the same partner who had spent all their money and had bored them with endless stories about their tedious work colleagues”.

Although the evidence presented by Seuntjens for the MFP was (at best) arguably anecdotal, it doesn’t mean that it doesn’t exist. If it does exist, the obvious question to ask why some people may ‘suffer’ from the MFP while others don’t. As Seuntjens concluded:

“If Freud intended the paradox primarily for the physical act of sex, the Masturbation Fantasy Paradox describes the phenomenon for the mental process of fantasizing. The Masturbation Fantasy Paradox, if it is a genuine phenomenon, may prove to be a special case of the more general paradox of love and desire so pointedly expressed in Freud’s dictum”.

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

Further reading

Freud, S. (1912). On the universal tendency to debasement in the sphere of love’. ‘Contributions to the psychology of love II’ in The Standard Edition of the Complete Psychological Works of Sigmund Freud (1957), Vol. XI, London: Hogarth Press.

Friday, N. (1973). My Secret Garden: Women’s Sexual Fantasies. New York: Pocket Books.

Friday, N. (1975). Forbidden Flowers: More Women’s Sexual Fantasies. London: Arrow Books.

Friday, N. (1980). Men in Love, Men’s Sexual Fantasies: The Triumph of Love Over Rage. London: Arrow Books.

Fry, S. (1997). Moab is My Washpot. London: Hutchinson.

Hole, J. (1996). The Ultimate Aphrodisiac. London: Hodder & Stoughton.

Kahr, B. (2007). Sex and the Psyche. London: Allen Lane

Moore, D. (2005). Diary of a Man. Dublin: Hot Press Books.

Pierre, J. (1992). Investigating Sex – Surrealist Discussions 1928-1932 (translated by Malcom Imrie). New York: Verso.

Seuntjens, W. (2013). The Masturbation Fantasy Paradox: An overlooked phenomenon? Journal of Unsolved Questions, 3(1), 9-12

Horticulture clash: Can gardening be addictive?

Back in November 2000, I appeared in numerous tabloid newspapers around the world in a story about ‘gardening addiction’ (such as one in the Daily Mail – ‘Professor says gardening is addictive’). It all began after I was interviewed by a journalist from the New Scientist magazine (Andy Coghlan). Coghlan wanted my reaction to a study published in the journal Biological Psychology led by my friend and colleague, Dr. Gerhard Meyer (with who I later co-edited the book Problem Gambling in Europe in 2009). Meyer and his colleagues had carried out a study on blackjack players and showed that they increased their heart rates while gambling (something that I also found in an earlier study I published on arousal in slot machine gamblers in a 1993 issue of the journal Addictive Behaviors). Meyer’s study also found that blackjack gamblers playing for money also had increased levels of salivary cortisol compared to blackjack gamblers playing for points.

I was asked by Coghlan whether I thought gambling could be a genuine addiction, even though it didn’t involve the ingestion of a psychoactive substance. I systematically went through my addiction components model (salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse) and spent about 15 minutes talking about my research on various behavioural addictions. When the New Scientist article was published, the only quote attributed to me was the following:

“Some people say you can’t have addiction unless you take a substance, but I would argue that gambling taken to excess is an addiction. If you accept that, you then accept that sex, computer games, even gardening, can be addictive. It opens up the floodgates to everything else”.

I had quite deliberately used the example of gardening to make the point that addiction should be assessed by standard addiction criteria and that if any behaviour fulfils all the criteria for addiction it should be classed as such irrespective of what the behaviour is. I also said in my interview with the New Scientist that I had never come across a case of gardening addiction but that it was theoretically possible. The New Scientist story was re-written by many different news outlets around the world. My comments were included in all of these stories. Some of these stories were reported with the focus being on the gambling study (such as the one reported by the BBC which you can read here). Others such as the Daily Mail and the New York Post (NYP) made my comments as the focus of the story. Here is what the NYP reported under the headline ‘Garden-variety junkies hooked on hobby’:

“Before you stop to smell the roses, you might want to think twice. People who enjoy gardening are as physically addicted as junkies and alcoholics, researchers claim. The findings by scientists at Bremen University in Germany are controversial because many experts refuse to believe that behavior can be addictive…The scientists also found the same is true of sex and gambling. They studied gamblers and measured the amounts of a stress hormone linked to addiction. Dr. Gerhard Meyer asked 10 gamblers in a casino to play blackjack, staking their own money. While the volunteers played, Meyer measured changes in their heart rates and levels of the stress hormone cortisol in their saliva. He then asked them to play for points rather than money, as a ‘control’ situation. Both heart rates and cortisol concentrations were markedly higher when the gamblers played for money…People who use addictive narcotics also have increased cortisol levels, which, in turn, can trigger the ‘addiction chemicals’ dopamine and seretonin in the brain. ‘Some people say you can’t have addiction unless you take a substance, but I would argue that gambling taken to excess is an addiction’, psychologist Mark Griffiths said. ‘If you accept that, you then accept that sex, computer games, even gardening, can be addictive. It opens up the floodgates to everything else’. If the new research is correct, gardening, gambling and sex, which involve pleasurable rewards for effort expended, could set up an addictive chemical pathway in the brain…Meyer says his findings might reduce the culpability of people who have committed crimes. If lawyers can attribute their clients’ crimes to physiological cravings rather than acts of free will, they may receive lighter sentences, he says”.

I spent much of the week in the media trying to get what I had actually said into context (and even appeared on Channel 4’s Big Breakfast television show defending what I had said). The Daily Mail article had sought comment from TV’s most high profile gardening expert Alan Titchmarsh who said: “[Gardening] is a very addictive pursuit. Once you’ve discovered the thrill of making things grow, you can’t stop. I get very twitchy if I can’t get outside and garden for a few days. It is an addiction – but a positive, useful addiction”. While I have no doubt Titchmarsh believed gardening to be a positive addiction (and would fulfil Dr. Bill Glasser’s criteria for positive addiction that I examined in a previous blog), it wouldn’t be an addiction using my own criteria. I wrote a letter to the New Scientist that they published on November 22 (2000) under the title ‘All kinds of addiction’. In that letter I wrote:

“My alleged comments about gardening addiction have been taken totally out of context and I would like to set the record straight, particularly as many of the national media appeared to have had a laugh at my expense following your press release on this story. My comments were made in reaction to the research by Meyer on gambling addiction, and whether I thought gambling was a true addiction because it didn’t involve a drug. I replied that any behaviour, be it gambling, sex, eating, Internet use, playing computer games or even, theoretically, gardening, that features all the core components of addiction, that is to say, mood-modifying effects, withdrawal symptoms, build-up of tolerance, total preoccupation with the activity, loss of control, neglect of everything else in their lives and relapse can be classed as an addiction. This was not reported in your article, leaving me wide open to misinterpretation. For the record, I have never said that gardening is addictive. What I have said is that any behaviour that fulfils the criteria for addiction can be operationally defined as addiction”.

On the same day (November 22), the Daily Mail also published an edited version of the letter I sent to the New Scientist buried away on page 73 (which you can read here) under the title ‘Eh, not quite’. In retrospect, I can smile about the whole incident, but I wasn’t smiling at the time. In a 2005 paper in the Journal of Substance Use, I subtly included a reference to the ‘gardening addiction’ story (or rather the lack of it) in a paper examining the nature of addiction:

It is also important to acknowledge that the meanings of ‘addiction’, as the word is understood in both daily and academic usage, are contextual, and socially constructed (Howitt, 1991; Irvine, 1995; Truan, 1993). We must ask whether the term ‘addiction’ actually identifies a distinct phenomenon – something beyond problematic behaviour – whether socially constructed or physiologically based. If so, what are the principal features of this phenomenon? If we argue that it is hypothetically possible to be addicted to anything, it is still necessary to account for the fact that many people become addicted to alcohol but very few to gardening. Implicit within our understanding of the term ‘addiction’ is some measure of the negative consequences that must be experienced in order to justify the use of this word in its academic or clinical context. It seems reasonable at this stage to suggest that a combination of the kinds of rewards (physiological and psychological) and environment (physical, social and cultural) associated with any particular behaviour will have a major effect on determining the likelihood of an excessive level of involvement in any particular activity”.

I have still to come across anyone that I would say is genuinely addicted to gardening. However, I did come across an interesting paper on unusual compulsive behaviours caused by individuals receiving medication for Parkinson’s disease. The paper was published in a 2007 issue of the journal Parkinsonism and Related Disorders by Dr. Andrew McKeon and his colleagues. They reported seven case studies of unusual compulsive behaviours after treating their patients with dopamine agonist therapy (i.e., treatment that activates dopamine receptors in the body). One of the cases involved a man who developed a gardening compulsion:

“A 53-year-old male with [Parkinson’s disease] for 13 years became intensely interested in lawn care. He would use a machine to blow leaves for 6 [hours] without rest, finding it difficult to disengage from the activity, as he found the repetitive behavior soothing. He also developed compulsive gambling”.

This case study at least suggests that someone can develop addictive and/or compulsive like behaviour towards gardening but is obviously isolated and very rare (and in this case brought on by the medication taken). I am not aware of any empirical research on gardening addiction since my comments on the topic back in 2000. However, I still stick to my assertion that if the rewards are present (i.e., psychological, social, physiological, and/or financial), it is theoretically possible for people to become addicted to almost anything – even gardening.

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

Further reading

Glasser, W. (1976). Positive Addictions. New York, NY: Harper & Row.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (1993). Tolerance in gambling: An objective measure using the psychophysiological analysis of male fruit machine gamblers. Addictive Behaviors, 18, 365-372.

Griffiths, M.D. (2000). All kinds of addiction New Scientist, November 22, p 58.

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

Hoffmann, B. (2000). Garden-variety junkies ‘hooked’ on hobby: Study. New York Post, November 10. Located at:

Howitt, D. (1991). Concerning Psychology. Milton Keynes: Open University Press.

Irvine, J. M. (1995). Reinventing perversion: Sex addiction and cultural anxieties. Journal of the History of Sexuality, 5, 429–450.

Meyer, G., Hauffa, B. P., Schedlowski, M., Pawlak, C., Stadler, M. A., & Exton, M. S. (2000). Casino gambling increases heart rate and salivary cortisol in regular gamblers. Biological Psychiatry, 48(9), 948-953.

Meyer, G., Hayer, T. & Griffiths, M.D. (2009). Problem Gaming in Europe: Challenges, Prevention, and Interventions. New York: Springer.

McKeon, A., Josephs, K. A., Klos, K. J., Hecksel, K., Bower, J. H., Michael Bostwick, J., & Eric Ahlskog, J. (2007). Unusual compulsive behaviors primarily related to dopamine agonist therapy in Parkinson’s disease and multiple system atrophy. Parkinsonism & Related Disorders, 13(8), 516-519.

Truan, F. (1993). Addiction as a social construction: A postempirical view. Journal of Psychology, 127, 489-499.

Strange fascinations: A brief look at unusual compulsive and addictive behaviours

In previous blogs, I have examined lots of strange types of addictive and compulsive behaviours including compulsive singing, compulsive hoarding, carrot eating addiction, Argentine tango addiction, compulsive nose-picking, compulsive punning, compulsive helping, obsessive teeth whitening, compulsive list-making, chewing gum addiction, hair dryer addictionwealth addiction, and Google Glass addiction (to name just a few).

However, while doing some research for a paper I am writing on ‘fishing addiction’ (yes, honestly), I came across an interesting paper on unusual compulsive behaviours caused by individuals receiving medication for Parkinson’s disease ([PD] a degenerative disorder of the central nervous system) and multiple system atrophy ([MSA] a degenerative neurological disorder in which nerve cells inside the brain start to degenerate and with symptoms similar to Parkinson’s disease).

In the gambling studies field there are now numerous papers that have been published showing that some Parkinson’s patients develop compulsive gambling after being treated for PD. According to the website, those undergoing PD treatment can have many side effects including addictive gambling, obsessive shopping, binge eating, and hypersexuality. The website also notes other types of compulsive behaviour that have been associated with PD medication including “punding or compulsive hobbyism [when someone does things such as collecting, sorting or continually handling objects]. It may also be experienced as (i) a deep fascination with taking technical equipment apart without always knowing how to put it back together again, (ii) hoarding things, (iii) pointless driving or walking, and (iv) talking in long monologues without any real content”.

The paper that caught my eye was published in a 2007 issue of the journal Parkinsonism and Related Disorders by Dr. Andrew McKeon and his colleagues. They reported seven case studies of unusual compulsive behaviours after treating their patients with dopamine agonist therapy (i.e., treatment that activates dopamine receptors in the body). The paper described some compulsive behaviours that most people would not necessarily associate with being problematic. Below is a brief description of the seven cases that I have taken verbatim from the paper.

  • Patient 1: “A 65-year-old female with PD for 9 years developed compulsive eating, and also felt compelled to repetitively weigh herself at frequent intervals during the day and at night. She found her behavior both purposeless and repetitive. Obsessive thoughts were also a feature, as the patient ‘had to’ weigh herself three times each occasion she used the weighing scales”.
  • Patient 2: “A 67-year-old female with PD for 8 years played computer games and solitaire card games for hours on end, often continuing to do so through the night. She did not enjoy the experience and found it purposeless, but did so as she felt she had ‘to be doing something’. She also developed compulsive eating and gambling”.
  • Patient 3: “A 48-year-old male with PD for 5 years, with little prior interest, developed an intense interest and fascination with fishing. His wife was concerned that he fished incessantly for days on end, and his interest did not abate despite never catching anything. This patient also developed compulsive shopping, spending large amounts of time and money in thrift stores”.
  • Patient 4: “A 53-year-old male with PD for 13 years became intensely interested in lawn care. He would use a machine to blow leaves for 6h without rest, finding it difficult to disengage from the activity, as he found the repetitive behavior soothing. He also developed compulsive gambling”.
  • Patient 5: “The wife of a 52-year-old male with an 11-year history of PD complained that her husband now spent all of his time on his hobbies, to the detriment of their marriage. The patient made small stained glass windows, day and night. In addition, he would frequently stay awake arranging rocks into piles in their yard, intending to build a wall, but never doing so. He would start multiple projects but complete nothing. He was also noted to have become hypersexual, demanding sexual intercourse from his wife several times daily”.
  • Patient 6: “This 60-year-old male, with a history of alcohol abuse and ultimately diagnosed with MSA, relentlessly watched the clock, locked and unlocked doors and continually arranged and lined up small objects on his desk. He also became hyperphagic and hypersexual, developing an intense fascination with pornographic films”.
  • Patient 7: “The wife of a 59-year-old male with PD for 1 year described how her husband dressed and undressed several times daily. On one occasion, while guests were at their house for dinner, he spent most of his time in his bedroom repeatedly changing from one pair of trousers into another. This behavior deteriorated considerably on increasing levodopa dose to 1100mg/day, and on a subsequent occasion after reducing quetiapine from 100 to 75 mg/day”.

These cases highlight that the compulsive behaviours that develop following dopamine agonist therapy often co-occur with one or more other compulsive behaviour and that much of these behaviours are repetitive and unwanted. As the authors noted:

“The temporal association between medication initiation and the onset of these behaviors led to our suspicion that medications were causative. In the aggregate, these patients illustrate that the behaviors provoked by drug therapy in parkinsonism cover a broad spectrum, ranging from purposeless and repetitive to complex, reward-oriented behaviors. Punding is the term typically applied to the former, and was seen in Patient 5 (arranging rocks into piles) and Patient 6 (lining up small objects on a desk)…Previous descriptions of pathological behaviors occur- ring with dopaminergic therapy in PD have been notable for the absence of obsessive thoughts accompanying compulsive behaviors, unlike Patient 1 who was remark- able for a counting ritual accompanying repetitive use of a weighing scale. In six of the seven cases, other reward- seeking behaviors (gambling, shopping, hypersexuality or overeating) were present and contemporaneous with these other unusual compulsive behaviors. This suggests that all of these behaviors, while phenomenologically distinct, are all part of the range of psychopathology encapsulated by obsessive-compulsive spectrum disorders”.

According to the website, PD sufferers are more likely to experience impulsive and compulsive behaviour if the person is (i) diagnosed with Parkinson’s at a young age, (ii) male, (iii) single and live alone, (iv) a smoker, and (v) someone with a personal or family history of addictive behaviour. The same article also notes that if the PD sufferer has a history of ‘risk-taking’, such as gambling, drug abuse or alcoholism, [they] may be more likely to develop dopamine addiction”. This is where the PD sufferer takes more of their medication than is needed to control their Parkinson’s symptoms (and known as dopamine dysregulation syndrome). Similarly, Dr. McKeon and colleagues concluded:

“Previously described associated clinical features include a prior history of depressed mood (four patients in this series), disinhibition, irritability and appetite disturbance…A history of problems with impulse control prior to the diagnosis of PD may be a risk factor for developing compulsive behaviors with dopaminergic therapies…although this only pertained to Patient 6…The compulsions were not found to be troublesome by three patients, with complaints regarding behavioral change coming from the patient’s spouse. Our observations affirm the need to check with both patient and family at follow-up visits for the emergence of a variety of troublesome pathological behaviors that may result from dopaminergic therapy, particularly dopamine agonists”.

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

Further reading

Dodd, M. L., Klos, K. J., Bower, J. H., Geda, Y. E., Josephs, K. A., & Ahlskog, J. E. (2005). Pathological gambling caused by drugs used to treat Parkinson disease. Archives of Neurology, 62, 1377-1381.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

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

Klos, K. J., Bower, J. H., Josephs, K. A., Matsumoto, J. Y., & Ahlskog, J. E. (2005). Pathological hypersexuality predominantly linked to adjuvant dopamine agonist therapy in Parkinson’s disease and multiple system atrophy. Parkinsonism and Related Disorders, 11, 381-386.

McKeon, A., Josephs, K. A., Klos, K. J., Hecksel, K., Bower, J. H., Michael Bostwick, J., & Eric Ahlskog, J. (2007). Unusual compulsive behaviors primarily related to dopamine agonist therapy in Parkinson’s disease and multiple system atrophy. Parkinsonism and Related Disorders, 13(8), 516-519.

Nirenberg, M. J., & Waters, C. (2006). Compulsive eating and weight gain related to dopamine agonist use. Movement Disorders, 21, 524-529.

Pontone, G., Williams, J. R., Bassett, S. S., & Marsh, L. (2006). Clinical features associated with impulse control disorders in Parkinson disease. Neurology, 67, 1258-1261.

Voon, V., Hassan, K., Zurowski, M., De Souza, M., Thomsen, T., Fox, S.,…& Miyasaki, J. (2006). Prevalence of repetitive and reward-seeking behaviors in Parkinson disease. Neurology, 67, 1254-1257.

Token gestures: A brief look at ‘sexual trophy collecting’

Back in 2002, I had a little piece published on excessive collecting behaviour in the Guardian newspaper (‘Addicted to hoarding’). In it I wrote:

“I have always been interested in why we have what seems like an innate ability to collect. I would almost go as far as to say that we are ‘natural born hoarders’. Furthermore, there has been surprisingly little research in this area and Freud’s theories on the topic are unfortunately almost empirically untestable. I would also add that for some people, collecting is at the pathological end of the behavioural continuum. There are some that are (for want of a better word) ‘addicted’ to collecting and there are some with obsessive-compulsive disorders who simply cannot throw away anything”.

Since then I’ve published a few articles on the psychology of collecting in this blog and is probably one of the reasons that I have had a few approaches over the last couple months from journalists asking me about the psychology behind various forms of collecting. (In fact, I’ve also been approached to write an academic chapter on the phenomenon too). Two of the most recent media requests included journalists writing articles on why people collect retro video games (which I hope to write about in a future blog) and another on why people collect ‘sexual trophies’.

I have to admit that I am no expert on sexual trophies so I did a little reading on the topic. According to one definition I came across, a sexual trophy is “any item or piece of clothing gained from a sexual encounter as proof of a successful sexual conquest”. To tie in with the release of US comedy I Just Want My Pants Back, MTV conducted a [non-academic] survey and reported that one in three young British people (aged between 18 and 34 years) admitted to owning some sort of sex trophy with one in six of them (16%) claiming they had two or more sex-based trophies (a group that MTV termed ‘Sexual Magpies’).

However, when it comes to the collecting ‘sexual trophies’, I would argue that most academic research that I have come across on the topic relates to more criminal sexual deviance rather than day-to-day sexual encounters. For instance, in the 2010 book Serial Murderers and Their Victims, Dr. Eric Hickey described the case of man – who was a voyeur – from Georgia (US) that used to break into houses and steal women’s underwear. On his eventual arrest they found over 400 pairs of knickers that he had stolen. More disturbing are cases such as this excerpt from a story in the Daily Telegraph. This is arguably more typical of what I perceive to be sexual trophy hunters:

“A company manager and ‘pillar of the community’ has been exposed after 20 years as a serial sex attacker known as the Shoe Rapist. James Lloyd, 49, a long-standing Freemason who took the footwear of his victims as trophies, was finally caught through advances in DNA techniques. Police later found more than 100 pairs of stiletto shoes hidden behind a trap door at the printing works where he was employed… As well as taking their shoes, he often stole jewellery from the women, mainly in their teens and early 20s, between 1983 and 1986” (Daily Telegraph, July 18, 2006).

However, Dr. Hickey’s book describes even worse acts of sexual trophy collecting. He noted that many serial killers are “known for their habits of collecting trophies or souvenirs. Others have collected lingerie, shoes, hats, and other apparel”. A sizeable section of the book concentrates on the types of serial killers that are popular in the media (such as those that commit ‘lust murders‘) and are the subject of many Hollywood films such as the series of films with (my favourite fictional psychopath) Hannibal Lecter. As Hickey notes:

“These are the rapists who enjoy killing and, often, indulging in acts of sadism and perversion. These are the men who have engaged in necrophilia, cannibalism, and the drinking of victims’ blood. Some like to bite their victims; others enjoy trophy collecting – shoes, underwear, and body parts, such as hair clippings, feet, heads, fingers, breasts, and sexual organs…[and] evoke our disgust, horror, and fascination”.

One of the cases discussed is 1950s US serial killer Harvey Glatman (known in the media as ‘The Lonely Hearts Killer’) who used to take photographs of the women he murdered. Citing the work of Dr. Robert Keppel (another expert in serial murder cases and author of Serial Murder: Future Implications for Police Investigations), Dr. Hickey wrote:

“His photos were more than souvenirs, because in Glatman’s mind, they actually carried the power of his need for bondage and control. They showed the women in various poses: sitting up or lying down, hands always bound behind their backs, innocent looks on their faces, but with eyes wide with terror because they had guessed what was to come”.

Other murderers described by Dr. Hickey included a man that liked to surgically remove (and keep) the eyeballs from his sexual victims (most probably 1990s’ serial killer Charles Allbright) and another that skinned his victims and made lampshades, eating utensils, and clothing. In his overview of necrophilic homicide (i.e., those individuals that kill others in order to engage in sexual activity), Hickey also mentions that such necrosadistic murderers often engage in other paraphilias related to necrophilia “including partialism or the desire to collect specific body parts that the offenders finds sexually arousing. This may include feet, hands, hair, and heads, among others”. Hickey also noted that:

“Another important characteristic of these lust killers was the ‘perversion factor’. This subgroup was often prone to carry out bizarre sexual acts. These acts most commonly included necrophilia and trophy collection. Jerry Brudos severed the breasts of some of his victims and made epoxy molds. Brudos, like others, also photographed his victims in various poses, dressed and disrobed. The photos served as trophies and a stimulus to act out again”.

Later in the book, Dr. Hickey examines the case of Jerry Brudos in more detail (please be warned that some of the things written here may offend those of a sensitive nature):

“At an early age, Jerry Brudos developed a particular interest in women’s shoes, especially black, spike-heeled shoes. As he matured, his shoe fetish increasingly provided sexual arousal. At 17, he used a knife to assault a girl and force her to disrobe while he took pictures of her. For his crime he was incarcerated in a mental hospital for 9 months. His therapy uncovered his sexual fantasy for revenge against women, fantasies that included placing kidnapped girls into freezers so he could later arrange their stiff bodies in sexually explicit poses. He was evaluated as possessing a personality disorder but was not considered to be psychotic…He continued to collect women’s undergarments and shoes. Prior to his first murder, he had already assaulted four women and raped one of them. At age 28, Jerry was ready to start killing…He took [his first victim] to his garage, where he smashed her skull with a two-by-four. Before disposing of the body in a nearby river, he severed her left foot and placed it in his freezer. He often would amuse himself by dressing the foot in a spiked-heel shoe. His fantasy for greater sexual pleasure led him…to strangle [another victim] with a postal strap. After killing her, he had sexual intercourse with the corpse, then cut off the right breast and made an epoxy mold of the organ. Before dumping her body in the river, he took pictures of the corpse. Unable to satisfy his sexual fantasies and still in the grasp of violent urges, he found his third victim…After sexually assaulting her, he strangled her in his garage, amputated both breasts, again took pictures, and tossed her body into the river”.

Arguably the most infamous ‘sexual trophy collector’ was 1980s US serial killer Jeffrey Dahmer, the so-called ‘Milwaukee Cannibal’. In Dr. Hickey’s account he noted that:

“Restraining Dahmer, the officers looked around the apartment and counted at least 11 skulls (7 of them carefully boiled and cleaned) and a collection of bones, decomposed hands, and genitals. Three of the cleaned skulls had been spray-painted black and silver. These were to be part of the shrine fantasized by Dahmer. A complete skeleton suspended from a shower spigot and three skulls with holes drilled into them were found throughout the apartment…Chemicals, including muriatic acid, ethyl alcohol, chloroform, and formaldehyde, were also discovered, along with several Polaroid photographs of recently dismembered young men. A complete human head sat in the refrigerator”.

Another infamous case from the early 1970s (that I admit I had never heard of until I read Dr. Hickey’s book) was Ed Kemper, a cannibalistic killer who also collected human trophies and keepsakes of his victims. Citing the book Hunting Humans by Dr. Elliot Leyton, it was reported that:

“At the age of 23, Ed started killing again, a task that would last nearly a year and entail eight more victims. He shot, stabbed, and strangled them. All were strangers to him, and all were hitchhikers. He cannibalized at least two of his victims, slicing off parts of their legs and cooking the flesh in a macaroni casserole. He decapitated all of his victims and dissected most of them, saving body parts for sexual pleasure, sometimes storing heads in the refrigerator. Ed collected ‘keepsakes’ including teeth, skin, and hair from the victims. After killing a victim, he often engaged in sex with the corpse, even after it had been decapitated. In his confession Kemper stated five different reasons for his crimes. His themes centered on sexual urges, wanting to possess his victims, trophy hunting, a hatred for his mother, and revenge against an unjust society (Leyton, 1986)”.

The most obvious question related to these depraved acts is why such people do it in the first place. Writing in the Encyclopedia of Murder and Violent Crime, Nicole Mott provides an answer:

“A trophy is in essence a souvenir. In the context of violent behavior or murder, keeping a part of the victim as a trophy represents power over that individual. When the offender keeps this kind of souvenir, it serves as a way to preserve the memory of the victim and the experience of his or her death. The most common trophies for violent offenders are body parts but also include photographs of the crime scene and jewelry or clothing from the victim. Offenders use the trophies as memorabilia, but also to reenact their fantasies. They often masturbate or use the trophies as props in sexual acts. Their exaggerated fear of rejection is quelled in front of inanimate trophies. Ritualistic trophy taking, as is found with serial offenders, acts as a signature. A signature is similar to a modus operandi (a similar act ritualistically performed in virtually all crimes of one offender), yet it is an act that is not necessary to complete the crime”

In one of my previous blogs on the psychology of collecting more generally, I referred to a paper by Dr. Ruth Formanek in the Journal of Social Behavior and Personality. She suggested five common motivations for collecting: (i) extension of the self (e.g., acquiring knowledge, or in controlling one’s collection); (ii) social (finding, relating to, and sharing with, like-minded others); (iii) preserving history and creating a sense of continuity; (iv) financial investment; and (v), an addiction or compulsion. She also claimed that the commonality to all motivations to collect was a passion for the particular things collected. Personally, I think that the acquisition of sexual trophies – even in the most deranged individuals – can be placed within this motivational typology in that such individuals clearly have a passion for what they do and I would argue that the behaviour is an extension of the self that to some individuals may be a compulsion or addiction.

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

Further reading

Branagh, N. (2012). Third of UK owns sex trophy. March 26. Located at:

Du Clos, B. (1993). Fair Game. New York: St. Martin’s Paperbacks.

Griffiths, M.D. (2002). Addicted to hoarding. The Guardian (Review Section), August 10, p.19.

Formanek, R. (1991). Why they collect: Collectors reveal their motivations. Journal of Social Behavior and Personality, 6(6), 275-286.

Hickey, E. W. (Ed.). (2003). Encyclopedia of Murder and Violent Crime. London: Sage Publications

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

Keppel, R. D. (1989). Serial Murder: Future Implications for Police Investigations. Cincinnati, OH: Anderson.

Leyton, E. (1986a). Hunting Humans. Toronto: McClelland and Stewart.

Leyton, E. (1986b). Compulsive Killers: The Story of Modern Multiple Murder. New York: New York University Press.

Blog-nitive psychology: 500 articles and counting

It’s hard for me to believe that this is the 500th article that I have published on my personal blog. It’s also the shortest. I apologise that it is not about any particular topic but a brief look back at what my readers access when they come across my site. (Regular readers might recall I did the same thing back in October 2012 in an article I wrote called ‘Google surf: What does the search for sex online say about someone?’). As of August 26 (2014), my blog had 1,788,932 visitors and is something I am very proud of (as I am now averaging around 3,500 visitors a day). As I write this blog, my most looked at page is my blog’s home page (256,262 visitors) but as that changes every few days this doesn’t really tell me anything about people like to access on my site.

Below is a list of all the blogs that I have written that have had over 10,000 visitors (and just happens to be 25 articles exactly).

The first thing that struck me about my most read about articles is that they all concern sexual fetishes and paraphilias (in fact the top 30 all concern sexual fetishes and paraphilias – the 31st most read article is one on coprophagia [7,250 views] with my article on excessive nose picking being the 33rd most read [6,745 views]). This obviously reflects either (a) what people want to read about, and/or (b) reflect issues that people have in their own lives.

I’ve had at least five emails from readers who have written me saying (words to the effect of) “Why can’t you write what you are supposed to write about (i.e., gambling)?” to which I reply that although I am a Professor of Gambling Studies, I widely research in other areas of addictive behaviour. I simply write about the extremes of human behaviour and things that I find of interest. (In fact, only one article on gambling that I have written is in the top 100 most read articles and that was on gambling personality [3,050 views]). If other people find them of interest, that’s even better. However, I am sometimes guided by my readers, and a small but significant minority of the blogs I have written have actually been suggested by emails I have received (my blogs on extreme couponing, IVF addiction, loom bandsornithophilia, condom snorting, and haircut fetishes come to mind).

Given this is my 500th article in my personal blog, it won’t come as any surprise to know that I take my blogging seriously (in fact I have written academic articles on the benefits of blogging and using blogs to collect research data [see ‘Further reading’ below] and also written an article on ‘addictive blogging’!). Additionally (if you didn’t already know), I also have a regular blog column on the Psychology Today website (‘In Excess’), as well as regular blogging for The Independent newspaper, The Conversation, GamaSutra, and If there was a 12-step ‘Blogaholics Anonymous’ I might even be the first member.

“My name is Mark and I am a compulsive blogger”

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

Further reading

Griffiths, M.D. (2012). Blog eat blog: Can blogging be addictive? April 23. Located at:

Griffiths, M.D. (2012). Stats entertainment: A review of my 2012 blogs. December 31. Located at:

Griffiths, M.D. (2013). How writing blogs can help your academic career. Psy-PAG Quarterly, 87, 39-40.

Griffiths, M.D. (2013). Stats entertainment (Part 2): A 2013 review of my personal blog. December 31. Located at:

Griffiths, M.D. (2014). Top tips on…Writing blogs. Psy-PAG Quarterly, 90, 13-14.

Griffiths, M.D. (2014). Blogging the limelight: A personal account of the benefit of excessive blogging. May 8. Located at:

Griffiths, M.D., Lewis, A., Ortiz de Gortari, A.B. & Kuss, D.J. (2014). Online forums and blogs: A new and innovative methodology for data collection. Studia Psychologica, in press.

Arcade fire: A brief look at pinball addiction

“I guess what started my pinball addiction was how it has become the perfect distraction. I like to drink beer. And go out. And recreate. Pinball is often found in bars here in the San Francisco Bay Area, so grabbing a beer and dropping a few quarters and playing a game with a friend is a great way to kick it. That’s kind of how it started, as something I might do here and there, but it’s grown into a full blown addiction as I’ve discovered more about pinball. It’s a hobby, a sport, and a pastime, but for me, it’s all consuming” (Gene X, December 18, 2013). is a periodic hobby-blog operated by one guy with over 20 years of unbridled collector’s obsession over anything having to do with the Art, Science, History and Culture of Pinball. Armed with an arsenal of over 30 Pins, our Moderator has built, rebuilt, repaired, restored, demolished and labored with an OCD level of passion over 100’s of pinball machines from the 70’s, 80’s and 90’s era. While he has experimented with various EM pins over the years, The Junky is particularly passionate about the SS games of the 90s and present” (from the Pinball Junky website).

As far as I am aware, only one academic paper has ever been published on pinball addiction, and that was a case study that I published in 1992 issue of Psychological Reports. My paper featured the case of a young man (aged 25 years) that I interviewed as part of another study on slot machine gambling (that I published in a 1994 issue of the British Journal of Psychology about the role of cognitive bias and skill in slot machine gambling). During the post-experimental interview, I asked all my participants to complete a questionnaire that included the (1987 revised third edition) Diagnostic and Statistical Manual of Mental Disorders criteria for pathological gambling. None of the nine items was endorsed but after completing my questionnaire, my participant spontaneously added that if he’d been asked the same questions about his pinball playing and videogame playing he would have answered ‘yes’ to a majority of the questions. On the spur of the moment I changed the word ‘gamble’ in the DSM-III-R criteria to the word ‘play’ and asked him to take that part of the survey again. In short, I asked him if he endorsed any of the following

  • Frequent preoccupation with playing or obtaining money to play
  • Often plays with larger amounts of money or over a longer period than intended
  • Need to play more to achieve the desired excitement
  • Restlessness or irritability if unable to play
  • Repeatedly returns to win back losses
  • Repeated efforts to cut down or stop playing
  • Often plays when expected to fulfill social, educational or occupational obligations.
  • Has given up some important social, occupational or recreational activity in order to play
  • Continues to play despite inability to pay mounting debts, or despite other significant social, occupational, or legal problems that the individual knows to be exacerbated by playing

If a person answers ‘yes’ to four of the above questions, the person was deemed to be an amusement machine ‘addict’. This time, my participant answered ‘yes’ to six out the nine questions, that I interpreted as showing signs of pinball pathology. It was at this point he was interviewed further.

The participant began playing pinball machines (and arcade videogame machines) at school when he was around 14 or 15 years of age. This he did with many of his male peers at the start of the ‘videogame explosion’ (as he put it) in around 1979 to 1980. He became “very good” at pinball playing and felt particularly good when lots of people, both male and female, were watching him and he was playing well. This implied he played mainly for social reasons. However, he also enjoyed playing on his own and, at the time of my study, he predominantly played alone. While playing, he reported that he experienced a ‘high’ – a continuous high (as opposed to an immediate high or ‘rush’ reported by some addicted slot machine gamblers (that I had reported throughout my published studies on adolescent slot machine players in 1990 and 1991) which was especially notable when he “started off with a good ball”, got free replay”, or experienced something intrinsically motivating to him (e.g., someone watching him play).

Back in 1983, Dr. Sidney Kaplan and Dr. Shirley Kaplan reported in the Journal of Popular Culture, that male pinball players may be attracted by the machine’s sexual graphics. However, my participant reported that he was more attracted by the features within the game and liked the idea that he could master a game, something that attracted him to videogames as well. He went on to say that both pinball machines and videogame machines were very similar because they both (i) score through points, (ii) have no financial reward – unlike a fruit machine, (iii) give the players pleasure from gaining a high score, i.e., an intrinsic reward, (iv) have the chance to gain free replays, and (v) require skill to play well. The reasons he didn’t play slot machines were because (i) its financial rewards were too infrequent, (ii) they are mostly chance-oriented, (iii) there are no points to score, and (iv) there is no free replay feature (except of course if the player won and decided to play again).

At the time I published the paper, it had been argued at various gambling conferences that I attended that “videogames are not as bad as slot machines because the better the player gets, the less money the player spends”. At face value this was correct as some adolescents could make 10 pence last over an hour on a videogame. However, the participant explained to me that he (and others) used to spend “hundreds of pounds” learning to play videogames and pinball machines, and then, when they were proficient at them, they would get bored with the game and spend their money learning how to play a new game on another machine. For this participant, pinball machines were different from videogame playing. Although he had played many different pinball machines, he had a personal favourite which he always returned to because it was the one on which he had his first “major success” (i.e., a very high score).

Back in 1992 I argued that it would be beneficial to adapt the criteria for pathological gambling for use in the monitoring of gaming machine addictions. By using such checklists (which can be administered quickly and easily), I argued it would be possible to record objective measures of incidence of probable amusement-machine addicts (including pinball addiction) and possibly show whether these types of addictions are implicated or act as precursors to more established addictions (e.g., pathological gambling). In 2013, criteria for Internet Gaming Disorder were included in Section 3 of the latest DSM-5 (using many of the criteria outlined above). However, given the complete lack of any other academic paper on pinball addiction, it doesn’t look as though pinball addiction will be appearing in any psychiatric diagnostic manual anytime soon. However, this case and other papers that I wrote on slot machine and video game addiction at the time led to my 1995 paper on technological addictions (that has now become one of my most highly cited papers).

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

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd Edition -Revised). Washington D.C. : Author

Griffiths, M.D. (1990). Addiction to fruit machines: A preliminary study among males. Journal of Gambling Studies, 6, 113-126.

Griffiths, M.D. (1991). Fruit machine addiction: Two brief case studies. British Journal of Addiction, 85, 465.

Griffiths, M.D. (1991). Amusement machine playing in childhood and adolescence: A comparative analysis of video games and fruit machines. Journal of Adolescence, 14, 53-73.

Griffiths, M.D. (1991). The psychobiology of the near miss in fruit machine gambling. Journal of Psychology, 125, 347-357.

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

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

Griffiths, M.D. (1993). Tolerance in gambling: An objective measure using the psychophysiological analysis of male fruit machine gamblers. Addictive Behaviors, 18, 365-372.

Griffiths, M.D. (1993). Fruit machine addiction in adolescence: A case study. Journal of Gambling Studies, 9, 387-399.

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

Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Kaplan, S. J. (1983). The image of amusement arcades and differences in male and female video game playing. Journal of Popular Culture, 17(1), 93-98.

Kaplan, S., & Kaplan, S. (1981). A research note: Video games, sex, and sex differences. Social Science, 208-212

Kaplan, S., & Kaplan, S. (1983). Video games, sex and sex differences. The Journal of Popular Culture, 17(2), 61-66.


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