Category Archives: Psychiatry

Place your bets: Has problem gambling in Great Britain decreased?

In the summer of 2014 I was commissioned to review problem gambling in Great Britain (the fall out of which I wrote about in detail in a previous blog). Earlier last year, a detailed report by Heather Wardle and her colleagues examined gambling behaviour in England and Scotland by combining the 2012 data from the Health Survey for England (HSE; n=8,291 aged 16 years and over) and the 2012 Scottish Health Survey (SHeS; n=4,815). To be included in the final data analysis, participants had to have completed at least one of the gambling participation questions. This resulted in a total sample of 11,774 participants. So what did the research find? Here is a brief summary of the main results:

  • Two-thirds of the sample (65%) had gambled in the past year, with men (68%) gambling more than women (62%). As with the British Gambling Prevalence Survey (BGPS), past year participation was greatly influenced by the playing of the bi-weekly National Lottery (lotto) game. Removal of those individuals that only played the National Lottery meant that 43% had gambled during the past year (46% males and 40% females).
  • Gambling was more likely to be carried out by younger people (50% among those aged 16-24 years and 52% among those aged 25-34 years).
  • The findings were similar to the previous BGPS reports and showed that the most popular forms of gambling were playing the National Lottery (52%; 56% males and 49% females), scratchcards (19%; 19% males and 20% females), other lottery games (14%; 14% both males and females), horse race betting (10%; 12% males and 8% females), machines in a bookmaker (3%; 5% males and 1% females), slot machines (7%; 10% males and 4% females), online betting with a bookmaker (5%; 8% males and 2% females), offline sports betting (5%; 8% males and 1% females), private betting (5%; 8% males and 2% females), casino table games (3%; 5% males and 1% females), offline dog race betting (3%; 4% males and 2% females), online casino, slots and/or bing (3%; 4% males and 2% females), betting exchanges (1%; males 2% and females 0%), poker in pubs and clubs (1%; 2% males and 0% females), spread betting (1%; 1% males and 0% females).
  • The only form of gambling (excluding lottery games) where females were more likely to gamble was playing bingo (5%; 7% females and 3% males).
  • Most participants gambled on one or two different activities a year (1.7 mean average across the total sample).
  • Problem gambling assessed using the Problem Gambling Severity (PGSI) criteria was reported to be 0.4%, with males (0.7%) being significantly more likely to be problem gamblers than females (0.1%). This equates to approximately 180,200 British adults aged 16 years and over.
  • Problem gambling assessed using the criteria of the fourth Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was reported to be 0.5%, with males (0.8%) being significantly more likely to be problem gamblers than females (0.1%). This equates to approximately 224,100 British adults aged 16 years and over.
  • Using the PGSI screen, problem gambling rates were highest among young men aged 16-24 years (1.7%) and lowest among men aged 65-74 years (0.4%). Using the DSM-IV screen, problem gambling rates were highest among young men aged 16-24 years (2.1%) and lowest among men aged over 74 years (0.4%).
  • Problem gambling rates were also examined by type of gambling activity. Results showed that among past year gamblers, problem gambling was highest among spread betting (20.9%), played poker in pubs or clubs (13.2%), bet on other events with a bookmaker (12.9%), bet with a betting exchange (10.6%) and played machines in bookmakers (7.2%).
  • The activities with the lowest rates of problem gambling were playing the National Lottery (0.9%) and scratchcards (1.7%).
  • Problem gambling rates were highest among individuals that had participated in seven or more activities in the past year (8.6%) and lowest among those that had participated in a single activity (0.1%).

The authors also carried out a latent class analysis and identified seven different types of gambler among both males and females. The male groups comprised:

  • Cluster A: non-gamblers (33%)
  • Cluster B: National Lottery only gamblers (22%)
  • Cluster C: National Lottery and scratchcard gamblers only (20%)
  • Cluster D: Minimal, no National Lottery [gambling on 1-2 activities] (9%)
  • Cluster E: Moderate [gambling on 3-6 activities] (12%)
  • Cluster F: Multiple [gambling on 6-10 activities] (3%)
  • Cluster G: multiple, high [gambling on at least 11 activities] (1%).

The female groups comprised:

  • Cluster A: non-gamblers (40%)
  • Cluster B: National Lottery only gamblers (21%)
  • Cluster C: National Lottery and scratchcard gamblers only (7%)
  • Cluster D: Minimal, no National Lottery (8%)
  • Cluster E: moderate, less varied [2-3 gambling activities, mainly lottery-related] (8%)
  • Cluster F: moderate, more varied [2-3 gambling activities but wider range of activities] (6%)
  • Cluster G: multiple [gambling on at least four activities] (6%)

Using these groupings, the prevalence of male problem gambling was highest among those in Cluster G: multiple high group (25.0%) followed by Cluster F: multiple group (3.3%) and Cluster E: moderate group (2.6%). The prevalence of problem gambling was lowest among those in the Cluster B; National Lottery Draw only group (0.1%) followed by Cluster C: minimal – lotteries and scratchcards group (0.7%). The prevalence of female problem gambling was highest among those in the Cluster G: multiple group (1.8%) followed by those in Cluster F: moderate – more varied group (0.6%). The number of female gamblers was too low to carry out any further analysis. The report also examined problem gambling (either DSM-IV or PGSI) by gambling activity type.

  • The prevalence of problem gambling was highest among spread-bettors (20.9%), poker players in pubs or clubs (13.2%), bettors on events other than sports or horse/dog races (12.9%), betting exchange users (10.6%) and those that played machines in bookmakers (7.2%).
  • The lowest problem gambling prevalence rates were among those that played the National Lottery (0.9%) and scratchcards (1.7%).
  • These figures are very similar to those found in the 2010 BGPS study although problem gambling among those that played machines in bookmakers was lower (7.2%) than in the 2010 BGPS study (8.8%).
  • As with the BGPS 2010 study, the prevalence of problem gambling was highest among those who had participated in seven or more activities in the past year (8.6%) and lowest among those who had taken part in just one activity (0.1%). Furthermore, problem gamblers participated in an average 6.6 activities in the past year.

Given that the same instruments were used to assess problem gambling, the results of the most recent surveys using data combined from the Health Survey for England (HSE) and Scottish Health Survey (SHeS) compared with the most recent British Gambling Prevalence Survey (BGPS) do seem to suggest that problem gambling in Great Britain has decreased over the last few years (from 0.9% to 0.5%). However, Seabury and Wardle again urged caution and noted:

“Comparisons of the combined HSE/SHeS data with the BGPS estimates should be made with caution. While the methods and questions used in each survey were the same, the survey vehicle was not. HSE and SHeS are general population health surveys, whereas the BGPS series was specifically designed to understand gambling behaviour and attitudes to gambling in greater detail. It is widely acknowledged that different survey vehicles can generate different estimates using the same measures because they can appeal to different types of people, with varying patterns of behaviour…Overall, problem gambling rates in Britain appear to be relatively stable, though we caution readers against viewing the combined health survey results as a continuation of the BGPS time series”.

There are other important caveats to take into account including the differences between the two screen tools used in the BGPS, HSE and SHeS studies. Although highly correlated, evidence from all the British surveys suggests that the PGSI and DSM-IV screens capture slightly different groups of problem gamblers. For instance, a 2010 study that I co-authored with Jim Orford, Heather Wardle, and others (in the journal International Gambling Studies) using data from the 2007 BGPS showed that the PGSI may under-estimate certain forms of gambling-related harm (particularly by women) that are more likely to be picked up by some of the DSM-IV items. Our analysis also suggested that the DSM-IV appears to measure two different factors (i.e., gambling-related harm and gambling dependence) rather than a single one. Another important distinction is that the two screens were developed for very different purposes (even though they are attempting to assess the same construct). The PGSI was specifically developed for use in population surveys whereas the DSM-IV was developed with clinical populations in mind. Given these differences, it is therefore unsurprising that national surveys that utilize the screens end up with slightly different results comprising slightly different groups of people.

It also needs stressing (as noted by the authors of most of the national gambling surveys in Great Britain) that the absolute number of problem gamblers identified in any of the surveys published to date has equated to approximately 60 people. To detect any significant differences statistically between any of the studies carried out to date requires very large sample sizes. Given the very low numbers of problem gamblers and the tiny number of pathological gamblers, it is hard to assess with complete accuracy whether there have been any significant changes in problem and pathological gambling between all the published studies over time. Wardle and her colleagues concluded that:

“Overall, based on this evidence, it appears that problem gambling rates in England and Scotland are broadly stable. Whilst problem gambling rates according to either the DSM-IV or the PGSI were higher in 2010, the estimate between 2007 and the health surveys data were similar. Likewise, problem gambling rates according to the DSM-IV and the PGSI individually did not vary statistically between surveys, meaning that they were relatively similar” (p.130).

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

Further reading

Griffiths, M.D. (2014). Problem gambling in Great Britain: A brief review. London: Association of British Bookmakers.

Orford, J., Wardle, H., Griffiths, M.D., Sproston, K. & Erens, B. (2010). PGSI and DSM-IV in the 2007 British Gambling Prevalence Survey: Reliability, item response, factor structure and inter-scale agreement. International Gambling Studies, 10, 31-44.

Seabury, C. & Wardle, H. (2014). Gambling behaviour in England and Scotland. Birmingham: Gambling Commission.

Wardle, H. (2013). Gambling Behaviour. In Rutherford, L., Hinchliffe S., Sharp, C. (Eds.), The Scottish Health Survey: Vol 1: Main report. Edinburgh.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., & Seabury, C. (2013). Gambling Behaviour. In Craig, R., Mindell, J. (Eds.) Health Survey for England 2012 [Vol 1]. Health, social care and lifestyles. Leeds: Health and Social Care Information Centre.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M. D., Constantine, R., & Pigott, S. (2007). The British Gambling Prevalence Survey 2007. London: National Centre for Social Research.

Wardle, H., Sutton, R., Philo, D., Hussey, D. & Nass, L. (2013). Examining Machine Gambling in the British Gambling Prevalence Survey. Report by NatCen to the Gambling Commission, Birmingham.

Animal passions: Why would anyone want to have sex with an animal?

Note: A shortened version of this article was first published in The Independent.

Last month, Denmark passed a law making bestiality a criminal offence from July 1st in a move to tackle animal-sex tourism. Bestiality (also known as zoophilia) is typically defined as relating to recurrent intense sexual fantasies, urges, and sexual activities with non-human animals. At present, there are still a number of countries where zoophilia is legal including Brazil, Mexico, Thailand, Finland, Hungary, and Romania. In the US there is no federal law against zoophilia although most states class it as a felony and/or misdemeanour although in some states it is technically legal (for example, Texas, Kentucky, Nevada, New Jersey, New Hampshire, Wyoming, West Virginia, and New Mexico).

Over the last few years I have written articles on the psychology of many different types of zoophilia including those who have engaged in sexual activities with dogs (cynophilia), cats (aelurophilia), horses (equinophilia), pigs (porcinophilia), birds (ornithophilia), dolphins (delphinophilia), lizards (herpetophilia), worms (vermiphilia), and insects (formicophilia). Dr. Alfred Kinsey shocked the US back in the 1950s when his infamous ‘Kinsey Reports’ claimed that 8% of males and 4% females had at least one sexual experience with an animal. Perhaps unsurprisingly, there was a much higher prevalence for zoophilic acts among people that who worked on farms (for instance, 17% males had experienced an orgasmic episode involving animals). According to Kinsey, the most frequent sexual acts that humans engaged in with animals comprised calves, sheep, donkeys, large fowl (ducks, geese), dogs and cats.

In the 1970s, world renowned sexologist Professor John Money claimed that zoophilic behaviours were usually transitory occurring when there is no other sexual outlet available. However, research carried out in the 2000s shows this not be the case. Up until the advent of the internet, almost every scientific or clinical study reported on zoophilia were case reports of individuals that has sought treatment for their unusual sexual preference. However, the internet brought many like-minded people together and there are dozens of websites where zoophiles chat to each other online and share their videos including the Beast Forum, the largest online zoophile community in the world with tens of thousands of members.

Almost all of the recently published studies have collected their data online from non-clinical samples. All of these studies report that the overwhelming majority of self-identified male and female zoophiles do not have sex with animals because there is no other sexual outlet but do so because it is their sexual preference. The most common reasons for engaging in zoophilic relationships were attraction to animals out of either a desire for affection, and a sexual attraction toward and/or a love for animals.

For instance, a study by Dr. Hani Miletski surveyed 93 zoophiles (82 males and 11 females). Only 12% of her sample said they engaged in sex with animals because there were no human partners available, and only 7% said it was because they were too shy to have sex with humans. For the females, the main reasons for having sex with animals was because they were sexually attracted to the animal (100%), had love and affection for the animal (67%) and/or because they said the animal wanted sex with them (67%). Most of Miletski’s sample preferred sex with dogs (87% males; 100% females) and/or horses (81% males; 73% females). Only 8% of males wanted to stop having sex with animals and none of the females. Unlike case study reports of zoophilia published prior to 2000, the studies published over the last 15 years using non-clinical samples report the vast majority of zoophiles do not appear to be suffering any significant clinical significant distress or impairment as a consequence of their behaviour.

In 2011, Dr Anil Aggrawal published a comprehensive typology of zoophilia in the Journal of Forensic and Legal Medicine. Dr. Aggrawal’s claimed there were ten different types of zoophile based on both the scientific and clinical literature, as well as some theoretical speculation. For instance:

  • Humananimal role-players – those who never have sex with animals but become sexually aroused through wanting to have sex with humans who pretend to be animals.
  • Romantic zoophiles – those who keeps animals as pets as a way to get psychosexually stimulated without actually having any kind of sexual contact with them.
  • Zoophilic fantasizers – those who fantasize about having sexual intercourse with animals but never actually do.
  • Tactile zoophiles – those who get sexual excitement from touching, stroking or fondling animals or their genitals but do not actually have sexual intercourse with animals.
  • Fetishistic zoophiles – those who keep various animal parts (especially fur) that are used as erotic stimuli as a crucial part of their sexual activity (typically masturbation). (See my previous blog on the use of an animal part as a masturbatory aid)
  • Sadistic bestials – those who derive sexual arousal from the torturing of animals (known as zoosadismhttps://drmarkgriffiths.wordpress.com/2012/08/06/stuff-love-a-beginners-guide-to-plushophilia/) but does not involve sexual intercourse with the animal.
  • Opportunistic zoosexuals – those who have normal sexual encounters but would have sexual intercourse with animals if the opportunity arose.
  • Regular zoosexuals – those who prefer sex with animals than sex with humans (but are capable of having sex with both). Such zoophiles will engage in a wide range of sexual activities with animals and love animals on an emotional level.
  • Homicidal bestials – those who need to kill animals in order to have sex with them. Although capable of having sex with living animals, there is an insatiable desire to have sex with dead animals.
  • Exclusive zoosexuals – those who only have sex with animals to the exclusion of human sexual partners.

Personally, I don’t view human-animal role players as zoophiles as this would include those in the Furry Fandom (individuals that dress up and interact socially as animals). There is no official definition of what a ‘furry’ actually is although most furries would agree that they share an interest in fictional anthromorphic animal characters that have human characteristics and personalities and/or mythological or imaginary creatures that possess human and/or superhuman capabilities. The furry fandom has also developed its own vocabulary including words such as ‘fursona’ (furry persona), ‘plushie’ (person who has sex with cuddly toys), and ‘yiff’ (furry pornography). A study by David J. Rust of 360 members of the furry community suggested less than 1% were plushophiles and that 2% were zoophiles.

Many zoophiles believe that in years to come, their sexual preference will be seen as no different to being gay or straight. This is not a view I adhere to especially because animals cannot give consent (although many zoophiles claim the animals they have sexual relationships with do give ‘consent’). The one thing we do know is that the internet has revolutionised the way we carry out our research and get access to ‘hard to reach’ groups. Thanks to online research, zoophilia is just one of many sexually atypical behaviours that we now know more about both behaviourally and psychologically.

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

Further reading

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

Beetz, Andrea (2002). Love, Violence, and Sexuality in Relationships between Humans and Animals. Germany: Shaker Verlag.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., Gebhard, P.H. (1953). Sexual Behavior in the Human Female. Philadelphia, PA: W.B. Saunders Company.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., (1948). Sexual Behavior in the Human Male. Philadelphia, PA: W.B. Saunders Company.

R.J. Maratea (2011). Screwing the pooch: Legitimizing accounts in a zoophilia on-line community. Deviant Behavior, 32, 918-943.

Miletski, H. (2000). Bestiality and zoophilia: An exploratory study. Scandinavian Journal of Sexology, 3, 149–150.

Miletski, H. (2001). Zoophilia – implications for therapy. Journal of Sex Education and Therapy, 26, 85–89.

Miletski, H. (2002). Understanding bestiality and zoophilia. Germantown, MD: Ima Tek Inc.

Williams, C. J., & Weinberg, M. S. (2003). Zoophilia in men: A study of sexual interest in animals. Archives of Sexual Behavior, 32, 523–535.

The must of lust discussed: Why isn’t sex addiction in the DSM-5?

Please note: A shorter and slightly different version of this blog first appeared on addiction.com

Sex addiction appears to be a highly controversial area among both the general public and those who work in the addiction field. Some psychologists adhere to the position that unless the behaviour involves the ingestion of a psychoactive substance (e.g., alcohol, nicotine, cocaine heroin), then it can’t really be considered an addiction. But I’m not one of them. If it were up to me, I would have given serious consideration to including sex addiction in the latest (fifth) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Given that ‘gambling disorder’ was reclassified from a disorder of impulse control to a behavioural addiction in the DSM-5, there is now no theoretical reason why other behavioural addictions can’t be added in the years to come. So why wasn’t sex addiction included in the latest DSM-5? Here are some possible reasons.

Some researchers think that sex addiction just doesn’t exist (for moral and theoretical reasons): Many scholars have attacked the whole concept of sex addiction saying it is a complete myth. It’s not hard to see why, as many of the claims appear to have good face validity. Many sociologists would argue that ‘sex addiction’ is little more than a label for sexual behaviour that significantly deviates from society’s norms. The most conventional attack on sex addiction is a variation on the position outlined in my introduction (i.e., that ‘addiction’ is a physiological condition caused by ingestion of physiological substances, and must therefore be defined physiologically). There are also attacks on more moral grounds with people saying that if excessive sexual behaviour is classed as an addiction it undermines individuals’ responsibility for their behaviour (although this argument could be said of almost any addiction).

The word ‘addiction’ has become meaningless: There are also those researchers within the social sciences who claim that the every day use of the word ‘addiction’ has rendered the term meaningless (such as people saying that their favorite television show is ‘addictive viewing’ or that certain books are ‘addictive reading’). Related to this is that those that work in the field don’t agree on what the disorder (e.g. ‘sex addiction’, ‘sexual addiction’, ‘hypersexuality disorder’, ‘compulsive sexual behaviour’, ‘pornography addiction’, etc.) should be called and whether it is a syndrome (i.e., a group of symptoms that consistently occur together, or a condition characterized by a set of associated symptoms) or whether there are many different sub-types (pathological promiscuity, compulsive masturbation, etc.). 

There is a lack of empirical evidence about sex addiction: One of the main reasons that sex addiction is not yet included in the DSM-5 is that the empirical research in the area is relatively weak. Although there has been a lot of research, there has never been any nationally representative prevalence surveys of sex addiction using validated addiction criteria, and a lot of research studies are based upon those people who turn up for treatment. Like Internet Gaming Disorder (which is now in the appendix of the DSM-5), sex addiction (or more likely ‘Hypersexual Disorder’) will not be included as a separate mental disorder until the (i) defining features of sex addiction have been identified, (ii) reliability and validity of specific sex addiction criteria have been obtained cross-culturally, (iii) prevalence rates of sex addiction have been determined in representative epidemiological samples across the world, and (iv) etiology and associated biological features of sex addiction have been evaluated.

The term ‘sex addiction’ is used an excuse to justify infidelity: One of the reasons why sex addiction may not be taken seriously is that the term is often used by high profile celebrities as an excuse by those individuals who have been sexually unfaithful to their partners (e.g., Tiger Woods, Michael Douglas, David Duchovny, Russell Brand). In some of these cases, sex addiction is used to justify the individual’s serial infidelity. This is what social psychologists refer to as a ‘functional attribution’. For instance, the golfer Tiger Woods claimed an addiction to sex after his wife found out that he had many sexual relationships during their marriage. If his wife had never found out, I doubt whether Woods would have claimed he was addicted to sex. I would argue that many celebrities are in a position where they were bombarded with sexual advances from other individuals and succumbed. But how many people wouldn’t do the same thing if they had the opportunity? It becomes a problem only when you’re discovered, when it’s in danger of harming the celebrity’s brand image.

The evidence for sex addiction is inflated by those with a vested interest: One of the real issues in the field of sex addiction is that we really have no idea of how many people genuinely experience sex addiction. Sex addiction specialists like Patrick Carnes claims that up to 6% of all adults are addicted to sex. If this was really the case I would expect there to be sex addiction clinics and self-help support groups in every major city across the world – but that isn’t the case. However, that doesn’t mean sex addiction doesn’t exist, only that the size of the problem isn’t on the scale that Carnes suggests. Coupled with this is that those therapists that treat sex addiction have a vested interest. Out simply, there are many therapists worldwide who make a living out of treating the disorder. Getting the disorder recognized by leading psychological and psychiatric organizations (e.g., American Psychiatric Association, World Health Organization) legitimizes the work of sex addiction counselors and therapists so it is not surprising when such individuals claim how widespread the disorder is.

There may of course be other reasons why sex addiction is not considered a genuine disorder. Compared to behavioural addictions like gambling disorder, the empirical evidence base is weak. There is little in the way of neurobiological research (increasingly seen as ‘gold standard’ research when it comes to legitimizing addictions as genuine). But carrying out research on those who claim to have sex addiction can face ethical problems. For instance, is it ethical to show hardcore pornography to a self-admitted pornography addict while participating in a brain neuroimaging experiment? Is the viewing of such material likely to stimulate and enhance the individual’s sexual urges and result in a relapse following the experiment? There are also issues surrounding cultural norms. The normality and abnormality of sexual behaviour lies on a continuum but what is considered normal and appropriate in one culture may not be viewed similarly in another (what is often referred to by sociologists as ‘normative ambiguity’). Personally, I believe that sex addiction is a reality but that it affects a small minority of individuals. However, many sex therapists claim it is on the increase, particularly because the Internet has made sexual material so easy to access. Maybe if sex addiction does eventually make it into future editions of the DSM, it will be one of the sub-categories of Internet Addiction Disorder rather than a standalone category.

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

Further reading

Dhuffar, M. & Griffiths, M.D. (2014). Understanding the role of shame and its consequences in female hypersexual behaviours: A pilot study. Journal of Behavioural Addictions, 3, 231–237.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, DOI 10.1007/s40429-015-0055-x

Goodman, A. (1992). Sexual addiction: Designation and treatment. Journal of Sex and Marital Therapy, 18, 303-314.

Griffiths, M.D. (2000). Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.

Griffiths, M.D. (2001). Sex on the internet: Observations and implications for sex addiction. Journal of Sex Research, 38, 333-342.

Griffiths, M.D. (2001). Addicted to love: The psychology of sex addiction. Psychology Review, 8, 20-23.

Griffiths, M.D. (2010). Addicted to sex? Psychology Review, 16(1), 27-29.

Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Research and Theory, 20, 111-124.

Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.

Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400.

Orford, J. (2001). Excessive sexuality. In J. Orford, Excessive Appetites: A Psychological View of the Addictions. Chichester: Wiley.

In dependence days: A brief overview of behavioural addictions

Please note: A version of this blog first appeared on addiction.com

Conceptualizing addiction has been a matter of great debate for decades. For many people the concept of addiction involves the taking of drugs. Therefore it is perhaps unsurprising that most official definitions concentrate on drug ingestion. Despite such definitions, there is now a growing movement that views a number of behaviours as potentially addictive including those that do not involve the ingestion of a drug. These include behaviours diverse as gambling, eating, sex, exercise, videogame playing, love, shopping, Internet use, social networking, and work. I have argued in many of my papers that all addictions – irrespective of whether they are chemical or behavioural – comprise six components (i.e., salience, mood modification, tolerance, withdrawal, conflict and relapse). More specifically:

  • Salience – This occurs when the activity becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialized behaviour). For instance, even if the person is not actually engaged in the activity they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with the activity).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of engaging in the activity and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’).
  • Tolerance – This is the process whereby increasing amounts of the activity are required to achieve the former mood modifying effects. This basically means that for someone engaged in the activity, they gradually build up the amount of the time they spend engaging in the activity every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to engage in the activity.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (e.g., work, social life, hobbies and interests) or from within the individual (e.g., intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time engaging in the activity.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive engagement in the activity to recur, and for even the most extreme patterns typical of the height of excessive engagement in the activity to be quickly restored after periods of control.

In May 2013, the new criteria for problem gambling (now called ‘Gambling Disorder’) were published in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), and for the very first time, problem gambling was included in the section ‘Substance-related and Addiction Disorders’ (rather than in the section on impulse control disorders as had been the case since 1980 when it was first included in the DSM-III). Although most of us in the field had been conceptualizing extreme problem gambling as an addiction for many years, this was arguably the first time that an established medical body had described it as such.

There had also been debates about whether or not ‘Internet Addiction Disorder’ should have been included in the DSM-5. As a result of these debates, the Substance Use Disorder Work Group recommended that the DSM-5 include ‘Internet Gaming Disorder’ [IGD] in Section III (“Emerging Measures and Models”) as an area that required further research before possible inclusion in future editions of the DSM. To be included in its own right in the next edition, research will have to establish the defining features of IGD, obtain cross-cultural data on reliability and validity of specific diagnostic criteria, determine prevalence rates in representative epidemiological samples in countries around the world, and examine its associated biological features. Other than gambling and gaming, no other behaviour (e.g., sex, work, exercise, etc.) has yet to be classified as a genuine addiction by established medical and/or psychiatric organizations.

In one of the most comprehensive reviews of chemical and behavioural addictions, Dr. Steve Sussman, Nadra Lisha and myself examined all the prevalence literature relating to 11 different potentially addictive behaviours. We reported overall prevalence rates of addictions to cigarette smoking (15%), drinking alcohol (10%), illicit drug taking (5%), eating (2%), gambling (2%), internet use (2%), love (3%), sex (3%), exercise (3%), work (10%), and shopping (6%). However, most of the prevalence data relating to behavioural addictions (with the exception of gambling) did not have prevalence data from nationally representative samples and therefore relied on small and/or self-selected samples.

Addiction is an incredibly complex behaviour and always result from an interaction and interplay between many factors including the person’s biological and/or genetic predisposition, their psychological constitution (personality factors, unconscious motivations, attitudes, expectations, beliefs, etc.), their social environment (i.e. situational characteristics such as accessibility and availability of the activity, the advertising of the activity) and the nature of the activity itself (i.e. structural characteristics such as the size of the stake or jackpot in gambling). This ‘global’ view of addiction highlights the interconnected processes and integration between individual differences (i.e. personal vulnerability factors), situational characteristics, structural characteristics, and the resulting addictive behaviour.

There are many individual (personal vulnerability) factors that may be involved in the acquisition, development and maintenance of behavioural addictions (e.g. personality traits, biological and genetic predispositions, unconscious motivations, learning and conditioning effects, thoughts, beliefs, and attitudes), although some factors are more personal (e.g. financial motivation and economic pressures in the case of gambling addiction). However, there are also some key risk factors that are highly associated with developing almost any (chemical or behavioural) addiction such as having a family history of addiction, having co-morbid psychological problems, and having a lack of family involvement and supervision. Psychosocial factors such as low self-esteem, loneliness, depression, high anxiety, and stress all appear to be common among those with behavioural addictions.

This article briefly demonstrates that behavioural addictions are a part of a biopsychosocial process and not just restricted to drug-ingested (chemical) behaviours. Evidence is growing that excessive behaviours of all types do seem to have many commonalities and this may reflect a common etiology of addictive behaviour. Such commonalities may have implications not only for treatment of such behaviours but also for how the general public perceive such behaviours.

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

Further reading

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

Demetrovics, Z. & Griffiths, M.D. (2012). Behavioral addictions: Past, present and future. Journal of Behavioral Addictions, 1, 1-2.

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

Griffiths, M.D. (2009). Gambling addictions. In A. Browne-Miller (Ed.), The Praeger International Collection on Addictions: Behavioral Addictions from Concept to Compulsion (pp. 235-257). Westport, CT: Praeger.

Griffiths, M.D. (2010). Addicted to sex? Psychology Review, 16(1), 27-29

Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Transgressive Culture, 1(1), 7-28.

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

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

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

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

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

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

Displeasures of the flesh: A brief look at anthropophagolagnia and paraphilic behaviour in serial killers

In previous blogs I have examined the psychology of sexual cannibalism and erotophonophilia (aka ‘lust murder’) as well as an article that I wrote on serial killers that collect their victims’ body parts as ‘trophies’. One very rare sub-type of both sexual cannibalism and erotophonophilia is anthropophagolagnia. This particular type of sexual paraphilia has been defined by Dr Anil Aggrawal as the paraphilia of “rape with cannibalism” and by the Right Diagnosis website as sexual urges, preferences or fantasies involving raping and then cannibalizing the victim”.

The Listaholic website goes as far to say that anthropophagolagnia is one of the ten “most bizarre sexual fetishes on earth” claiming that serial killer is the “poster boy” for these “twisted” individuals. Other serial killers that might be classed as anthropophagolagniacs include Albert Fish, Peter Kirsten, Ottis Toole and Ed Gein. However, there also appear to be cases of what I would call ‘systematic anthropophagolagnia’ if the extract I found online is true:

“While it is easy to dismiss one case as stemming from some sort of neurological aberrations in the participants, we also see sexualized cannibalism in modern day Africa. In the early 2000s in Congo, rape and cannibalism were reported to coincide sporadically across the region. The claims are backed by a UN investigation into the phenomena…Rebels would go into villages and rape the women and children, then dismember them alive while eating their flesh. There are many reports of family members being forced to eat the flesh of other murdered family members after being raped…The men committing these atrocities do not have any neurological aberrations, they simply have the power to exercise this behavior. While cannibalism has been practiced in Africa as part of spiritual traditions for centuries, sadistic sexualized torture is not part of that tradition. So why add it in? Presumably the rebels didn’t all happen to be born child rapists either, yet raping children is part of their terror campaign and they must be able to achieve an erection to carry out the task, and so it must be assumed they learned to like it”.

Last year, I also read about 40-year old preacher Stephen Tari, the leader of a 6,000-strong cannibal rape cult in Papua New Guinea. He was in prison following his conviction for a brutal rape but escaped (only to be killed by people from his village in retaliation for the cannibalistic rape murders he had committed). As a report in The Independent noted:

“[Tari] had previously been accused of raping, murdering and eating three girls in front of their traumatised mothers…The charismatic cult leader, who wore white robes and is said to have regularly drunk the blood of his ‘flower girls’, quickly returned to his home village of Gal after [a prison] escape, but could only manage six months before killing yet again…It has not yet been established if the murdered woman was killed as part of a blood sacrifice, but it is considered likely as Tari was said to have been attempting to resurrect his cult following the spell in prison”.

Dr. Eric Hickey (in his book Serial Murderers and Their Victims) notes that paraphilic behaviour is very common among those that commit sexual crimes (and that more than one is often present) but that the two activities (sex offending and paraphilias) may be two independent constructs and that one does not necessarily affect the other. In fact he notes that:

“Rather than paraphilia being caused by sexual pathology, they may be better understood as one of many forms of general social deviance…For the male serial killer, the paraphilia engaged in usually has escalated from softer forms to those that are considered not only criminal but violent as well. They range from unusual to incredibly bizarre and disgusting. As paraphilia develop, men affected by them often engage in several over a period of time. Most men who engage in paraphilia often exhibit three or four different forms, some of them simultaneously. For those with violent tendencies, soft paraphilia can quickly lead to experimentation with hardcore paraphilia that often involves the harming of others in sexual ways. For example, some paraphilic offenders prefer to stalk and sexually assault their victims in stores and other public places without getting caught. The thrill of hunting an unsuspecting victim contributes to sexually arousing the offender”.

Hickey asserts that anthropophagolagnia is one of the so-called ‘attack paraphilias’ (as opposed to the ‘preparatory paraphilias’). Attack paraphilias are described by Hickey as being sexually violent (towards other individuals including children in extreme circumstances). Preparatory paraphilias are defined by Hickey as those “that have been found as part of the lust killer’s sexual fantasies and activities” (including those that display anthropophagolagnia). However, Hickey notes that individuals that engage in preparatory paraphilias do not necessarily go on to become serial killers. He then goes on to say:

“The process of sexual fantasy development may include stealing items from victims. Burglary, although generally considered to be a property crime, also is sometimes a property crime for sexual purposes. Stealing underwear, toiletries, hair clippings, photographs, and other personal items provides the offender with souvenirs for him to fantasize over”.

Some of the examples Hickey cites are both revealing and psychologically interesting:

“One offender noted how he would climax each time he entered a victim’s home through a window. The thought of being alone with people sleeping in the house had become deeply eroticized. Another offender likes to break into homes and watch victims sleep. He eventually will touch the victim and will only leave when she begins to scream. He ‘began’ his sexual acting out as a voyeur. This paraphilic process was also examined by Purcell and Arrigo (2001), who note that the process consists of mutually interactive elements: paraphilic stimuli and fantasy; orgasmic conditioning process; and facilitators (drugs, alcohol, and pornography). The probability of the offender harming a victim is extremely high given the progressive nature of his sexual fantasies”.

Along with anthropophagolagnia, other ‘attack paraphilias’ that have been associated with serial killers include amokoscisia (sexual arousal or sexual frenzy from a desire to slash or mutilate other individuals [typically women]), anophelorastia (sexual arousal from defiling or ravaging another individual), biastophilia (sexual arousal from violently raping other individuals; also called raptophilia), dippoldism (sexual arousal from abusing children, typically in the form of spanking and corporal punishment), necrophilia (sexual arousal from having sex with acts with dead individuals), paedophilia (sexual arousal from having sex with minors typically via manipulation and grooming), and sexual sadism (empowerment and sexual arousal derived from inflicting pain and/or injuring other individuals).

The ‘preparatory paraphilias’ that typically precede serial killing and attack paraphilias such as anthropophagolagnia include agonophilia (sexual arousal caused by a sexual partner pretending to struggle), altocalciphilia (sexual arousal from high-heeled shoes), autonecrophilia (sexual arousal by imagining oneself as a dead person), exhibitionism (exposing genitals to inappropriate and/or non-consenting people for sexual arousal), frottage (sexual arousal from rubbing up against the body against a sexual partner or object), gerontophilia (sexual arousal from someone whose age is older and that of a different generation), hebephilia (men that are sexually aroused by aroused by teenagers), kleptolagnia (sexual arousal from stealing), retifism (sexual arousal from shoes), scatophilia (sexual arousal via making telephone calls, using vulgar language, and/or trying to elicit a reaction from the other party), scoptophilia (sexual arousal by watching others [typically engaged in sexual behaviour] without their consent, and more usually referred to as voyeurism), and somnophilia (sexual arousal from fondling strangers in their sleep). The multiplicity of co-existent paraphilias (including anthropophagolagnia) is highlighted by the Wikipedia entry on Jeffrey Dahmer:

“Dahmer readily admitted to having engaged in a number of paraphilic behaviors, including necrophilia, exhibitionism, hebephilia, fetishism, pygmalionism, and erotophonophilia. He is also known to have several partialisms, including anthropophagy (also known as cannibalism). One particular focus of Dahmer’s partialism was the victim’s chest area. By his own admission, what caught his attention to Steven Hicks hitchhiking in 1978 was the fact the youth was bare-chested; he also conceded it was possible that his viewing the exposed chest of Steven Tuomi in 1987 while in a drunken stupor may have led him to unsuccessfully attempt to tear Tuomi’s heart from his chest. Moreover, almost all the murders Dahmer committed from 1990 onwards involved a ritual of posing the victims’ bodies in suggestive positions – many pictures taken prior to dismemberment depict the victims’ bodies with the chest thrust outwards. Dahmer also derived sexual pleasure from the viscera of his victims; he would often masturbate and ejaculate into the body cavity and at other times, literally used the internal organs as a masturbatory aid”.

Almost nothing is known empirically about anthropophagolagnia except that it is very rare and that almost all information about it comes from serial killers that have been caught. Explanations for the development of anthropophagolagnia can only be speculated but are likely to be no different from the development of other paraphilic behaviour. Hickey (citing Irwin Sarason and Barbara Sarason’s Abnormal Psychology textbook) notes five key explanations for the development of paraphilias (reproduced below verbatim):

  • Psychodynamic – paraphilic behavior as a manifestation of unresolved conflicts during psychosexual development;
  • Behavioral – paraphilia is developed through conditioning, modeling, reinforcement, punishment, and rewards, the same process that normal sexual activity is learned;
  • Cognitive – paraphilia become substitutes for appropriate social and sexual functioning or the inability to develop satisfying marital relationships;
  • Biological – heredity, prenatal hormone environment, and factors contributing to gender identity can facilitate paraphilic interests. Other explanations are linked to brain malfunctioning and chromosomal abnormalities;
  • Interactional – that development of paraphilia is a process that results from psychodynamic, behavioral, cognitive, and biological factors.

As an eclectic, I favour the interactional explanation for the existence of anthropophagolagnia but also believe that the most important influences are the behavioural aspects via classical and operant conditioning processes.

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.

Hall, J. (2013). ‘Black Jesus’ murder: Leader of 6,000-strong cannibal rape cult hacked to death by villagers in Papua New Guinea jungle after killing yet again. The Independent, August 30. Located at: http://www.independent.co.uk/news/world/asia/black-jesus-murder-leader-of-6000strong-cannibal-rape-cult-hacked-to-death-by-villagers-in-papua-new-guinea-jungle-after-killing-yet-again-8791967.html

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.

Purcell, C., and B. Arrigo. (2001). Explaining paraphilias and lust murder: Toward an integrated model. International Journal of Offender Therapy and Comparative Criminology, 45(1), 6–31.

Sarason, I. G. and B. R. Sarason. (2004). Abnormal Psychology, 11th Edition. Upper Saddle River, N.J.: Prentice Hall.

Wikipedia (2014). Jeffrey Dahmer. Located at: http://en.wikipedia.org/wiki/Jeffrey_Dahmer

Booze news: What are the simplest ways to reduce your alcohol intake?

Last week I did an interview with the Daily Mail about how to cut down alcohol intake. The hook of the story was from a 2012 Finnish study published in the journal Addiction. The longitudinal study examined whether how close a person lives to a pub or bar and whether it had any effect on risky drinking behaviour (‘Living in proximity of a bar and risky alcohol behaviours: a longitudinal study’). The study was briefly summarized in Medical News Today:

“People who live close to an on-site alcohol outlet, such as a bar, are more likely to engage in risky alcohol behavior, while people who live further away have a lower chance of dangerous drinking. The researchers analyzed data consisting of the locations of licensed on-site alcohol outlets between 2000 and 2008, which was taken from the alcohol licence register, maintained by Valvira (National Supervisory Authority for Welfare and Health). They then reviewed data on alcohol consumption from surveys taken from the Finnish Institute of Occupational Health’s (FIOH) Public Sector study from 2000 to 2009. More than 78,000 people filled out at least one survey and over 55,000 took at least two surveys. The team found that people who lived less than a kilometer away from a bar or other on-site alcohol outlet had a 13% higher chance of heavy alcohol use compared to those who lived more than a kilometer away. When a people changed the location of their house between the two study surveys, the likelihood changed. [More specifically] (i) a shorter distance raised the likelihood of risky drinking by 17%, [and] (ii) a longer distance decreased the likelihood by 17%The authors concluded that people have a higher chance of consuming alcohol if they live close to an on-site alcohol outlet”.

This is an example of the ‘availability hypothesis’ that is well known in most areas of addictive behaviour. In my own field of gambling studies, there is a general rule of thumb that where the opportunities and access to gambling are increased, more people engage in gambling (although this is not necessarily proportional to the level of problem gambling). The relationship between accessibility and engagement in addictive behaviour is complex as many other factors come into play. However, the Finnish study on risky drinking and proximity to alcohol outlets provides empirical support for the availability hypothesis.

There are also likely to be cultural differences. A lot of my consultancy work is for Scandinavian companies and I have been fortunate to visit Finland, Norway, Sweden and Denmark many times. One thing that is very noticeable in these countries is that alcohol is highly taxed and it is very expensive to drink alcohol in bars. On one of my first visits to Norway in the mid-1990s, I insisted on buying a round of drinks for the six people I was with (even though they were pleading with me not to). When I was charged 350 Krone (about £35) I began to understand why. My experience is that buying rounds of drinks appears to be very rare and I noticed that many people would make their pint of lager last hours in the bar.

Moving to countries like Norway as a way of cutting down on alcohol intake is a drastic option as there are many other simple ways that we can cut down on drinking alcohol. Unfortunately, as a result of a chronic medical condition I was told to stop drinking alcohol last September (2014). In the last six months I have drank only 8 units of alcohol (and 6 of those units were on New Year’s Eve). My own reduction in alcohol intake was forced upon me. I can obviously choose to ignore my doctor’s advice but I decided not to. Any woman has to make a similar decision about whether they consume alcohol and/or nicotine during pregnancy.

The remainder of today’s blog provides some tips on the simplest ways to cut down on alcohol intake. They are not aimed at problem drinkers as they require extra external support and interventions from family, friends, doctors and/or therapists. The tips below come from a variety of sources (listed in ‘Further reading’). I don’t claim to be an expert on alcohol addiction (although I have published more than a few papers on alcohol problems over the years – again, see some of these in ‘Further reading’ below) but most of these tips are practical and common sense:

  • Don’t go it alone: If you really want to cut down your alcohol intake, try do it with your friends and family together. Doing it with others rather than on your own means you will have others around you going through the same thing as yourself as well as having a ready made support group.
  • Don’t buy rounds of drinks in pubs and clubs: If you’ve ever been out on a pub crawl with friends, you will know that you tend to drink at the pace of the quickest drinker in the group (and this may be at a quicker rate than you would ideally prefer). If you do want to drink in rounds, then try opting out every other round and/or try to drink with a smaller group of friends (as larger groups typically lead to more alcohol being drunk over the course of an evening).
  • Spread out your drinking and drink more slowly: Sounds obvious but it’s true. (As I noted above, in places where alcohol is very expensive this becomes a natural option). A related option is to have one alcoholic drink followed by one non-alcoholic drink throughout the evening.
  • Don’t buy pints, doubles or large glass drinks: When you do drink in pubs and clubs, order smaller measures (wine in a small glass rather than a large one, halves instead of pints, a bottle of lager rather than a pint of lager). All of these smaller options mean a reduced ‘alcohol by volume’ ratio (i.e., less alcohol actually consumed). If you are the kind of person who says to yourself ‘I never have more than two glasses of wine a night’, then changing to a smaller glass will have an immediate and appreciable effect in lowering overall alcohol intake.
  • Where possible choose nonalcoholic drinks: When you eat out or dine at home, have a soft drink, juice or water rather than wine or beer with your meal.
  • Dilute alcoholic drinks: If the option of a non-alcoholic drink isn’t always possible or simple doesn’t appeal, then dilute your drinks. Have a lager shandy or a white wine spritzer.
  • Have ‘alcohol-free’ days: If you drink every day, start by trying to drink alcohol every other day. If you drink alcohol a few times a week, try to drink just once a week. Just cutting down on your normal weekly pattern will help you to realise that you can go without alcohol.
  • Avoid cocktails: Cocktails often contains a lot more alcohol than people think.
  • Drink alcohol free beers and lagers: If you love the taste of lager or beer, there are alcohol free options. There are also an increasing number of fake cocktails (‘mocktails’).
  • Reward yourself for not drinking alcohol: Many people drink as a way to alleviate the stresses and strains of every day life (or to do the exact opposite – to celebrate the fact that you’ve done something well or because it is a special occasion). The money not spent on alcohol could go towards giving yourself another kind of treat or reward (a massage, the new CD you wanted, watching a film at the cinema, etc.).
  • Tell everyone in your social circle you’re cutting down alcohol intake: By telling everyone you know including family, friends and work colleagues, you will be more committed to not drinking alcohol than if you told no-one.
  • Avoid temptation: One of the key factors in any potentially addictive activity is knowing what the ‘triggers’ are (e.g., walking past a pub, watching television, having an argument with your loved one, etc.). Knowing what the triggers are can be a strategy for avoiding temptation (e.g., changing the routes on your way back home to avoid walking past your favourite pub, doing something else instead of watching television, etc.).
  • Get a new hobby: Changing one aspect of your routine life can also help change other aspects. Sometimes, changing one aspect of your life (such as introducing daily exercise) goes hand-in-hand with other areas of your life (drinking less alcohol, eating more healthily).
  • Think of the benefits of not drinking alcohol: Not drinking alcohol can bring lots of positives. In six months without alcohol I’ve lost about 6.35kg in weight because alcohol is high in calories (and that’s without exercise!). Other benefits include more money for other things, better quality sleep, less stress (because alcohol is a depressant), and better health.
  • Use alcohol tracking tools: Many apps are now available to help you keep track of your alcohol intake. For instance, the MyDrinkaware tool allows you to see how alcohol is affecting you on a number of different dimensions including your health (how many units you are consuming over time), weight (how many calories you are consuming over time), and finances (how much money you are spending on alcohol over time).

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

Further reading

Drinkaware (2015). Tips for cutting down when out. Located at: https://www.drinkaware.co.uk/make-a-change/how-to-cut-down/cutting-down-when-out-and-about/tips-for-cutting-down-when-out

Drinkaware (2015). Track your drinking. Located at: https://www.drinkaware.co.uk/unitcalculator#unitcalculator

Griffiths, M.D. (2014). I drink, therefore I am: The UK’s alcohol dependence. Intervene, April, 20-23.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Halonen, J. I., Kivimäki, M., Virtanen, M., Pentti, J., Subramanian, S. V., Kawachi, I., & Vahtera, J. (2013). Living in proximity of a bar and risky alcohol behaviours: a longitudinal study. Addiction, 108(2), 320-328.

Glynn, S. (2012). Living close to a bar increases chance of risky drinking. Medical News Today, November 7. Located at: http://www.medicalnewstoday.com/articles/252462.php

NHS Choices (2015). Tips on cutting down [alcohol]. Located at: http://www.nhs.uk/Livewell/alcohol/Pages/Tipsoncuttingdown.aspx

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

Disarray of light: A brief look at ‘chaos addiction’

A few weeks ago, three independent things happened that has led me to writing this article. Firstly, I received an email from one of my blog readers who wrote:

“I’m a recovering addict. I still find that hard to admit even after time in therapy and the support of my loved ones, but to say it out loud can sometimes be a help. One part of my therapy, which really did strike a chord was something called ‘Chaos Addiction’. It was suggested to me that my addictive behaviors were fueled by a need to constantly have things in my life that were ‘in flux’ – to experience the ‘predictably unpredictable’. Looking back over my life, it hit home…I’d love it if you might think about sharing this with your site’s readership”.

Secondly, a couple of days later I was given a CD-R by one of my friends that included the song ‘Addicted to Chaos’ by the group Megadeth (from their 1994 album Youthanasia). Thirdly, a couple of days after that I was watching the film Chasing Lanes where the lead character in the film Doyle Gipson (played by Samuel L Jackson) is told by his Alcoholics Anonymous sponsor (played by William Hurt) that he was ‘addicted to chaos’ rather than alcohol.

I have never come across the term ‘chaos addiction’ prior to the email I was sent. As far as I am aware, there has never been any empirical research on the topic although Dr. Keith Lee did write a 2007 book (Addicted to chaos: The journey from extreme to serene) of his own experiences on the topic. Using case studies, the book examines individuals that have become “addicted to intensity out of the chaos and toward mind/body harmony, higher consciousness, and a deeply spiritual transformation”. More specifically:

“In a culture where the ‘extreme theme’ has become the norm, people are increasingly seduced into believing that intensity equals being alive. When that happens, the mind becomes wired for drama and the soul is starved of meaningful purpose. This type of life may produce heart-pounding excitement, but the absence of this addictive energy can bring about withdrawal, fear, and restlessness that is unbearable”.

In researching this article I came across a number of online articles dealing with ‘addiction to chaos’. The term has been applied to the actress Lindsay Lohan following a television interview with Oprah Winfrey (and the many articles that followed that honed in on her ‘addiction to chaos).

A short piece in Business Week by Clate Mask claimed that it is entrepreneurs that are frequently addicted to chaos (based on his “experiences and observations working with thousands and thousands of entrepreneurs over the years” along with his top three signs he sees as being addicted to chaos: (i) their business life revolves around the in-box, (ii) they can’t step away from the business, (ii) they are strangely proud they have so little free time. Clate then goes on to claim that:

“If you find yourself experiencing these symptoms, you are probably addicted to chaos. Get help. Business ownership should bring you more time, money, and control. If you’re not getting that, make some changes to your mindset and your business systems so you can find the freedom you were looking for when you started your business in the first place”.

However, to me, this appears to be more like addiction to work rather than addiction to chaos (see ‘Further reading’ below for my papers on workaholism).

An online article by Silvia Mordini discussed about her personal experiences and how she now uses yoga to provide grounding and stability in her life. (In fact, there are quite a few papers on treating addictions with yoga including a recent systematic review of randomized control trials by Paul Posadski and his colleagues in the journal Focus on Alternative and Complementary Therapies – see ‘Further reading’ below). As Mordini confessed:

“My past addiction to chaos simply hurt me too much. I got sick of the constant mental tug-o-war with myself.  I’m not interested in feeling impatient with one thought and having to pull or push at the next one. Impatience promotes chaos and doesn’t feel good. The antidote to this is patience. Patience feels good. It feels like a return to mental stability no matter the chaos around us or what other people are thinking or doing…[The grounding that yoga brings] serves us as a simplifying force in order to stabilize our minds. When grounded, we plug back into our best selves and become fully present and balanced. Our energy stabilizes. Once centered, we are able to clearly see the circumstances of our lives. We no longer over-respond or over-worry because the static noise of chaos doesn’t pull us apart”.

She then goes on to provide her readers with five practical ways to promote stability and overcome addiction to chaos: (i) practice yoga, (ii) meditate, (iii) use a mantra (she suggests “I will let go of the need to be needed/I will let go of the need to be accepted/I will let go of the need to be accomplished), unplug from technology, and (v) get your hands and feet dirty (do some gardening, go for a walk on the beach, etc.). Obviously there is no clinical research confirming that these strategies would help overcome ‘chaos addiction’ but engaging in them certainly won’t do anyone any harm.

Another online article (‘Addicted to Chaos’) by addiction counselor Rita Barsky notes that many addicts grew up within dysfunctional families and noted:

“We never felt safe in our family of origin and the only thing we knew for sure was that nothing was for sure. Life was totally unpredictable and we became conditioned to living in chaos. When I talk about chaos in our lives, it was often not the kind that can be seen. In fact, many alcoholic/addict mothers were also super controllers and on the surface, our lives appeared to be perfect. The unsafe and chaotic living conditions of our lives were not visible or obvious to the outside world. Despite the appearance of everything being under control, we experienced continued chaos, developed a tolerance for chaos and I believe became addicted to chaos. I think it is important to say I have never done a scientific experiment to investigate this theory. It is based on observation of numerous alcoholic/addicts and their behavior”.

This was clearly written from experience and appears to have some face validity. Interestingly, Barsky then goes on to say:

“During the recovery process life becomes more manageable and less chaotic. The alcoholic/addict begins to feel a sense of autonomy and safety. A feeling of calm settles over their life. The paradox for the alcoholic/addict is that feeling calm is so unfamiliar it induces anxiety. There is a sense of waiting for the other shoe to drop. When there is a crisis, whether real or perceived, we actually experience a physical exhilaration and it feels remarkably like being active. From there it can be a very short distance to a relapse. Even if we don’t pick up we are not in a sober frame of mind. Addiction to chaos can be very damaging. Once engaged in someone else’s crisis we abandon ourselves and often develop resentments, especially if it is someone we love or are close to. Family chaos is the ‘best’ because it’s so familiar and we can really get off on it. When there is a crisis with family or friends we feel compelled to listen to every sordid detail and/or take action. We are unable to let go, we need to be in the mix even though it is painful and upsetting. It requires tremendous effort to detach and not jump in with both feet to the detriment to our well being”.

I find this account compelling because it’s written by someone that appears to have gone through this herself, and has now applied her therapeutic expertise retrospectively to understand the underlying psychology of what was occurring at the height of the addiction. Another compelling account is at Molly Field’s Yoga Blog.

“My object of desire is Chaos. My therapist told me at the end of my first session ever that I have a Chaos addiction…I’m not kidding: this stuff’s insidious. If it weren’t for my awareness of my ability to lose my temper over little-seeming things (aka scars from my past), I’d never know about the Addiction to Chaos. It’s because I grew up with it, was surrounded by it and trained by some of the world’s finest Chaos foments that I became one myself…My relationship with Chaos had become so much a part of my fabric of being that if I didn’t sense it, I would make it”.

Finally, I’ll leave you with the only tool that I have come across that claims to provide a diagnostic indication of whether someone is addicted to chaos. I need to point out that this came from the website of former psychologist Phil McGraw, the US television host of Dr. Phil. I have reproduced everything below verbatim (so when it says that “you are addicted to chaos” if you endorsed five or more of the ten items, that is the view of Dr. Phil – whenever I have co-developed a scale, I at least add the words “You may have a problem” rather than “You have got a problem”).

“While most people try to avoid drama, research shows that others have figured out how to trigger the body’s stress response, just for the rush. Take the test and find out if you’re creating chaos in your everyday life!

Directions: Answer the following questions ‘True’ or ‘False’

  • Do you usually yell and scream to make your point?
  • Do you ramp things up to win every argument? 

  • If you get sick, do you feel that EVERYONE should know about it?
  • 
When you argue, do you ever break things or knock them over? 

  • Does being calm or bored sound like the worst thing to you? 

  • Do you ever yell at strangers if you feel that they are in your way? 

  • Do you hate it when you are not the center of attention? 

  • Is there usually a crisis to solve in your life? 

  • Do you break up or threaten a break up with a mate often? 

  • Are you usually the one who starts fights?

Results: If you answered ‘True’ to five or more of the questions above, you are addicted to chaos”

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

Further reading

Barsky, R. (2007). Addicted to Chaos. A Sober Mind, December 2. Located at: http://asobermind.blogspot.co.uk/2007/12/addicted-to-chaos.html

Field, M. (2012). Recovering from an addiction to chaos. The Yoga Blog, April 7. Located at: http://www.theyogablog.com/recovering-from-addiction/

Griffiths, M.D. (2005). Workaholism is still a useful construct Addiction Research and Theory, 13, 97-100.

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.

Jakub, L. Addicted to chaos: Oprah’s interview with Lindsay Lohan. Hello Giggles, August 19. Located at: http://hellogiggles.com/addicted-to-chaos-oprahs-interview-with-lindsay-lohan

Kramer, L. (2015). Are you addicted to chaos? Recovery.org, January, 15. Located at: http://www.recovery.org/pro/articles/are-you-addicted-to-chaos/

Lee, J.K. (2007). Addicted to chaos: The journey from extreme to serene. Transformational Life Coaching and Consultancy.

Mask, C. (2011). Three signs you’re addicted to chaos. Business Week, March 18. Located at: http://www.businessweek.com/smallbiz/tips/archives/2011/03/three_signs_you_are_addicted_to_chaos.html

Posadzki, P., Choi, J., Lee, M. S., & Ernst, E. (2014). Yoga for addictions: a systematic review of randomised clinical trials. Focus on Alternative and Complementary Therapies, 19(1), 1-8.

Mordini, S. (2013). Are you addicted to chaos and drama? Mind Body Green, January 15. Located at: http://www.mindbodygreen.com/0-7395/are-you-addicted-to-chaos-and-drama.html

Blood discussed: A brief look at haematophagia

Haematophagia usually refers to the practice of animals feeding on the blood of another species. However, the term has also been applied to humans that consume blood (something that I have referred to in previous blogs on clinical vampirism and menophilia). Most writings on human haematophagia usually refer to the practice in some sexual and/or vampiric capacity (e.g., some individuals in China and Vietnam believe certain types of snake blood are aphrodisiacs and are drunk with rice wine) but haematophagia can also occur for other reasons.

While I working was in Spain, I was taken to one of the best Castilian restaurants, and as part of the starter I was served morcilla sausage. Morcilla sausage is basically a Spanish version of black pudding (aka ‘blood pudding’) and made from pig’s blood. I absolutely loved it. It did make me wonder what other ‘blood’ foods I might enjoy. I did a bit of research into the making of blood sausages and found out that variations of this dish exist in cultures all over the world (e.g., Europe, Asia, and the Americas), and that all kinds of different animals’ blood can be used (including pigs, sheep, cattle, goats, and ducks). According to the Wikipedia entry on human haematophagia:

“Drinking blood and manufacturing foodstuffs and delicacies with animal blood is also a feeding behavior in many societies. Cow blood mixed with milk, for example, is a mainstay food of the African Massai. Some sources say that Mongols would drink blood from one of their horses if it became a necessity. Black pudding is eaten in many places around the world. Some societies, such as the Moche, had ritual hematophagy, as well as the Scythians, a nomadic people of Russia, who had the habit of drinking the blood of the first enemy they would kill in battle…Psychiatric cases of patients performing hematophagy also exist. Sucking or licking one’s own blood from a wound is also a behavior commonly seen in humans, and in small enough quantities is not considered taboo. Finally, human vampirism has been a persistent object of literary and cultural attention”

There a numerous YouTube videos of the African Massai (in Tanzania) drinking blood directly from the necks of live cattle (such as here and here). Cattle blood drinking typically occurs after special celebrations (such as births, ritual circumcisions, etc.), but the special occasions are not compulsory for blood drinking to occur. The cattle are never killed and the cuts made to drink blood from appear to heal quickly. One report on the Environmental Graffiti website described the practice:

“Half a dozen Maasai warriors wrestle with the struggling cow. Another waits with his bow drawn, arrow at the ready. Finally, they have the straining animal in position. The warrior with the weapon shoots straight for the bovine’s jugular. Warm blood gushes into a waiting bucket, pumped out by the animal’s still-beating heart. The blood keeps flowing, almost filling the container, before the cow is released – its punctured neck sealed with a dab of cow dung. It will live to see another day. Its’ blood-donating job is done, at least for another month. The Maasai men who perform this blood-draining ritual do not intend to kill, or even harm, the animal. They merely want some of its nourishing crimson fluid to drink”.

Another Wikipedia entry focusing on blood as food notes that in addition to blood sausages, animal blood has also been used to thicken, colour, and/or flavour sauces and gravies, and for various types of blood soup (such as ‘czernina’ in Poland, ‘papas de sarrabulho’ in Portugal, and ‘svartsoppa’ made with goose blood in Sweden). Although blood is a taboo food in some cultures, in others it is perfectly acceptable – particularly in times when food has been scarce. Other cultures have other blood foods including blood pancakes (in Scandinavian and Baltic countries), blood tofu (China, Thailand, Vietnam), blood cake (Taiwan), blood potato dumplings (‘blodpalt’ made with reindeer blood in Sweden) and blood bread (‘paltbrod’ in Sweden). Additionally, Wikipedia noted that:

“Blood can also be used as a solid ingredient, either by allowing it to congeal before use, or by cooking it to accelerate the process. In Hungary when a pig is slaughtered in the morning the blood is fried with onions and is served for breakfast. In China, ‘blood tofu’ is most often made with pig’s or duck’s blood, although chicken’s or cow’s blood may also be used. The blood is allowed to congeal and simply cut into rectangular pieces and cooked. This dish is also known in Java as saren, made with chicken’s or pig’s blood. Blood tofu is found in curry mee as well as the Sichuan dish, maoxuewang. In Tibet, congealed yak’s blood is a traditional food”.

The Tanzanian Massai people are not the only culture to consume uncooked animal blood products. For instance, Inuits living in the Arctic Circle consume seal blood and believe it to have health and social benefits. According to a paper on consuming seal blood in a 1991 issue of Medical Anthropology Quarterly, seal blood is “seen as fortifying human blood by replacing depleted nutrients and rejuvenating the blood supply, [and] is considered a necessary part of the Inuit diet”. Another academic paper by Dr. Edmund Searles in a 2002 issue of the journal Food and Foodways reported that in relation to the drinking of seal blood: Inuit food generates a strong flow of blood, a condition considered to be healthy and indicative of a strong body”. Historically, there are accounts of Irish people bleeding cattle as a preventative measure against cattle diseases. The Wikipedia entry on blood as food claims that the Irish mixed the drawn blood with butter, herbs, oats or meal” to provide a “nutritious emergency food”.

During my research I also came across a story in The Atheist Times (with photographic evidence) of Hindus engaged in the practice of decapitating and drinking goat blood directly from its body (a blood sacrifice). The report claimed the practice was widely prevalent throughout India and Malaysia. These Hindus believe that the Hindu goddess Kali descends upon those drinking the goat’s blood.

Staying on the religious theme, there are (of course) many (arguably ‘mainstream’) simulated acts of haemotphagia – most notably in various religious ceremonies and rituals. The most obvious is in the transubstantiation of wine as the blood of Jesus Christ during Christian Eucharist (where religious followers believe they are drinking the blood of Christ). Various religions engage in such pseudo-haemotophagic practices including the Catholic Church, Eastern Orthodox, Oriental Orthodox, some Anglican, and Lutheran churches. (Other religions are the exact opposite and consider the drinking of blood taboo such as Jewish and Muslim cultures).

As this brief review demonstrates, non-sexual and non-vampiric human haematophagia and pseudo-haematophagia appear to be common and widespread in many cultures and countries. Academic research on the topic appears to be limited although it certainly warrants further investigation.

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

Further reading

Borré, K. (1991). Seal blood, Inuit blood, and diet: A biocultural model of physiology and cultural identity. Medical Anthropology Quarterly, 5, 48-62.

Davidson, A (2006). The Oxford Companion to Food. Oxford: Oxford University Press.

Searles, E. (2002). Food and the making of modern Inuit identities. Food and Foodways, 10(1-2), 55-78.

Wikipedia (2013). Blood as food. Located at: http://en.wikipedia.org/wiki/Blood_as_food

Wikipedia (2013). Hematophagy. Located at: http://en.wikipedia.org/wiki/Hematophagy

Acting up: A brief look at the ‘Hollywood Phenomenon’ delusion

In a previous blog I briefly examined Delusional Misidentification Syndromes (DMSs). These are arguably some of the strangest mental and neurological syndromes that exist. All DMSs involve a belief by the affected individual that the identity of something (i.e., a person, place, object, etc.) has altered or changed in some way. There are many variants of DMS, and in most cases the delusion is monothematic (i.e., it only concerns one particular topic). The DMSs that are most written about are:

  • The Fregoli delusion (individuals who have the belief that more than one person that they have met is the same person in more than one disguise).
  • The Capgras delusion (individuals who have the belief that someone (typically a spouse or close relative) has been replaced by an identical-looking imposter.
  • Subjective doubles (aka Christodoulou syndrome) (individuals who have the belief that there are (one or more) doubles of themselves [i.e., doppelgangers] that carry out actions and behaviours independently and lead a life of their own.
  • Intermetamorphosis: (individuals who have the belief that people in their immediate vicinity change identities with each other but keep the same appearance.

According to Dr. K.W. De Pauw and Dr. T.K. Szulecka in a 1988 issue of the British Journal of Psychiatry, those with DMSs are “more likely to commit violent crimes against persons than those with chronic, undifferentiated psychoses”. In their paper, De Pauw and Szulecka reviewed the literature concerning violence associated with DMSs and reported four case studies of individuals that were “either perpetrators or victims of assaults as a consequence of the syndromes of Fragoli, Intermetamorphosis, Subjective Doubles and Capgras”. After this paper was published, Dr. A.P. Shubsachs and Dr. A. Young responded to the paper (also in the British Journal of Psychiatry) with a short account of two case studies with a variant of delusional misidentification environment”.

The two cases had a delusion that was described as the ‘Hollywood Phenomenon’ and comprised the belief “that the patient’s environment has been changed to a film or theatre set peopled by actors and in which the patient has a role to play”. (This also appears to be similar to the ‘Truman Show’ Delusion that I described in a previous blog and is “a novel delusion, primarily persecutory in form, in which the patient believes that he is being filmed, and that the films are being broadcast for the entertainment of others”).

Shubsachs and Young asserted that the ‘Hollywood Phenomenon’ (HP) was a symptom rather than a syndrome. They also reported that based on their tow case studies, HP can occur along with atypical Capgras phenomenon, and may result in violence, verbal hostility, and non co-operation. Here are the two case studies in the authors’ own words (taken verbatim from the British Journal of Psychiatry):

  • Case 1: “Mr. A, a 22-year-old single Australian man with a history of two admissions for bipolar affective disorder, left Australia in the early stages of a manic episode. On arrival in the UK his condition deteriorated, with elevated mood, decreased sleep, excess energy, and accelerated thoughts. He recognised that he was relapsing and consulted a GP, who arranged an urgent out-patient appointment. Before that appointment he became convinced he was ‘an actor and that everything that was going on was a film’ in which he was the main player. He stole a car which he deliberately crashed because ‘it was a stunt car and I was a stunt man who was supposed to crash it…it was rigged so I wouldn’t get hurt’. He was arrested and later assaulted the police surgeon with what he erroneously believed was a bottle of ‘harmless sugar glass’ causing severe injuries. Mr A. claimed that he, the surgeon, and the police were all play actors and that his actions would have ‘no real consequence’. Remanded in prison for psychiatric reports, he was intermittently violent in response to similar misidentifications until he became euthymic following medication. He was transferred Hospital Order, and on admission had insight into his previous delusions”.
  • Case 2: “Miss B. exhibited both a Capgras phenomenon and a ‘Hollywood phenomenon’. She was a single retired midwife in late middle age, living alone. She had had several admissions with a diagnosis of depressive psychosis or schizophrenia. On this occasion she was depressed with early morning wakening, psychomotor retardation, appetite and weight loss, and felt hopeless and worthless. She believed relatives were impostors and was verbally aggressive towards them. She believed that the hospital was a film set peopled by actors, the admitting doctor a film director, and that the purpose of the interview was to obtain a script for the film. While she struggled and was verbally hostile at attempts to detain her, there was no serious violence. She recovered fully after ECT”.

Shubsachs and Young claimed that the HP delusion was both uncommon and under-reported, and that both of the cases that they described involved “affective illness without organic impairment”. They then went on to claim that they didn’t think that the ‘Hollywood Phenomenon’ was “specific for affective disorders” (and asked if other psychiatrists reading their case studies could provide other examples). They concluded that the HP “differs from the superficially similar transient experience in derealisation in that it has a real, not an ‘as if’ quality, is enduring, and has all the features of a delusion including the tendency to be acted upon”.

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

Further reading

Christodoulou G.N. (1986). Delusional Misidentification Syndromes. Basel: Karger.

De Pauw, K. W., & Szulecka, T. K. (1988). Dangerous delusions. Violence and the misidentification syndromes. British Journal of Psychiatry, 152(1), 91-96.

Ellis, H.D., Luauté, J.P. & Retterstøl, N. (1994). Delusional misidentification syndromes. Psychopathology, 27(3-5), 117-120.

Enoch, M.D. & Trethowan, W. (1979). Uncommon Psychiatric Syndromes. Oxford: Butterworth-Heinemann; 1979.

Fusar-Poli, P., Howes, O., Valmaggia, L., & McGuire, P. (2008). ’’Truman’’ signs and vulnerability to psychosis. British Journal of Psychiatry, 193, 168.

Gold, J. & Gold, I. (2012). The “Truman Show” delusion: Psychosis in the global village. Cognitive Neuropsychiatry, 17, 455.

Shubsachs, A.P., & Young, A. (1988). Dangerous delusions: The ‘Hollywood phenomenon’. British Journal of Psychiatry, 152(5), 722-722.

Gamblers anonymous: The psychology of live online casino gambling

Over the last decade, my research unit has carried out an increasing amount of research into the psychology of online gambling. In some of our recent research interviewing online gamblers, offline gamblers and non-gamblers, we found that people who gambled online did so because of its (i) convenience, (ii) greater value for money, (iii) the greater variety of games, and (iv) anonymity. Perhaps more interestingly, were the inhibiting reasons that stopped people from wanting to gamble online in the first place. The main inhibiting reason that stopped people gambling online was that offline gamblers and non-gamblers said the authenticity of gambling was significantly reduced when gambling online. We also found a number of other inhibitors of online gambling including (i) the reduced realism, (ii) the asocial nature of the internet, (iii) the use of electronic money, and (iv) concerns about the safety of online gambling websites. The reduced authenticity and realism may help to explain why online live action casino games are seen as increasingly popular among some types of gamblers.

This empirical research also chimes with my own personal psychology of online gambling. One of the main reasons I don’t like gambling at Internet casinos is that I believe the majority of game outcome are likely to be pre-programmed and/or predetermined. To me, this is somewhat akin to playing with imaginary dice! Our empirical research findings also help explain the rise of live online casino gambling. Players not only want increased realism and authenticity, but still have the added advantages of online anonymity while playing.

In online live casino gaming, the anonymity of the Internet allows players to privately engage in gambling without the fear of stigma. This anonymity may also provide the gambler with a greater sense of perceived control over the content, tone, and nature of the online experience. Anonymity may also increase feelings of comfort since there is a decreased ability to look for, and thus detect, signs of insincerity, disapproval, or judgment in facial expression, as would be typical in face-to-face interactions. For activities such as gambling, this may be a positive benefit particularly when losing as no-one will actually see the face of the loser. Anonymity may reduce social barriers to engaging in gambling, particularly those activities thought to be more skill-based gambling activities (such as poker or blackjack) that are relatively complex and often possess tacit social etiquette. The potential discomfort of committing a structural or social faux-pas in the gambling environment because of inexperience is minimized because the player’s identity remains concealed.

Furthermore, one of the main reasons why behaviour online is very different from offline is because it provides a ‘disinhibiting’ experience. One of the main consequences of disinhibition is that on the internet people lower their emotional guard and become much less restricted and inhibited in their actions.

The increase in online live casino gambling has happened alongside the rise of online betting exchanges – the type of online gambling where it could be argued that skill can – to some extent – be exercised. For gamblers, having a punt on live sporting events via betting exchanges is a psychologically safer option because punters know (or can check) who won a particular football or horse race. The playing of live action casino games via the Internet shares some of the psychological similarities of online betting exchanges.

The rise of live online gambling has been coupled with increasingly sophisticated gaming software, integrated e-cash systems, and increased realism (in the shape of “real” gambling via webcams, live remote wagering, and/or player and dealer avatars). These are all inter-linked facilitating factors. Another factor that I feel is really important in the rise of online gambling (including online live action casino games) is the inter-gambler competition. Obviously there is an overlap between competitiveness and skill but they are certainly not the same. What’s more recent research has suggested that being highly competitive may not necessarily be good for the gambler. For instance, Professor Howard Shaffer, a psychologist at Harvard University, claims that men are more likely to develop problematic gambling behaviour because of their conventionally high levels of aggression, impulsivity and competitiveness. Clearly, the idea of the competitiveness of the activity being one of the primary motivations to gamble is well supported.

Based on the fact that so little research has systematically examined the links between gambling and competitiveness, our research unit did some research into this area. We speculated that a gambler who is highly competitive will experience more arousal and stimulation, and be drawn to gambling as an outlet to release competitive instincts and drives. This is likely to occur more in activities like online poker and online live action casino games. Our research did indeed show that problem gamblers were significantly more likely than non-problem gamblers to be competitive.

Being highly competitive may help in explaining why in the face of sometimes negative and damaging financial consequences, gamblers persist in their habit. Psychological research in other areas has consistently shown that highly competitive individuals are more sensitive to social comparison with peers regarding their task performance. Applying this to a gambling situation, it is reasonable to suggest that competitive gamblers may be reluctant to stop gambling until they are in a positive state in relation to opposing gamblers, perhaps explaining why excessive gambling can sometimes occur.

Sociologists have speculated that factors of the human instinctual expressive needs, such as competition, can be temporarily satisfied when engaging in gambling activities. Evidence exists supporting gambling as an instrumental outlet for expressing competitive instinctual urges. The US sociologist Erving Goffman developed what he called the ‘deprivation-compensation’ theory to explain the relationship between gambling and competitiveness. He suggested that the stability of modern society no longer creates situations where competitive instincts are tested. Therefore, gambling is an artificial, self-imposed situation of instability that can be instrumental in creating an opportunity to test competitive capabilities. Again, online live action casino gambling is another gambling form that can facilitate such instinctive needs.

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

Further reading

Goffman, I. (1972). Where the action is. In: Interaction Ritual (pp. 149–270). Allen Lane, London.

Griffiths, M.D. (2010). Gambling addiction on the Internet. In K. Young & C. Nabuco de Abreu (Eds.), Internet Addiction: A Handbook for Evaluation and Treatment. pp. 91-111. New York: Wiley.

Griffiths, M.D. & Parke, J. (2003). The environmental psychology of gambling. In G. Reith (Ed.), Gambling: Who wins? Who Loses? pp. 277-292. New York: Prometheus Books.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2009). Socio-demographic correlates of internet gambling: findings from the 2007 British Gambling Prevalence Survey. CyberPsychology and Behavior, 12, 199-202.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Kuss, D. & Griffiths, M.D. (2012).  Internet gambling behavior. In Z. Yan (Ed.), Encyclopedia of Cyber Behavior (pp.735-753). Pennsylvania: IGI Global.

McCormack. A. & Griffiths, M.D. (2012). Motivating and inhibiting factors in online gambling behaviour: A grounded theory study. International Journal of Mental Health and Addiction, 10, 39-53.

McCormack, A. & Griffiths, M.D. (2013). A scoping study of the structural and situational characteristics of internet gambling. International Journal of Cyber Behavior, Psychology and Learning, 3(1), 29-49.

McCormack, A., Shorter, G. & Griffiths, M.D. (2013). An examination of participation in online gambling activities and the relationship with problem gambling. Journal of Behavioral Addictions, 2(1), 31-41.

McCormack, A., Shorter, G. & Griffiths, M.D. (2013). Characteristics and predictors of problem gambling on the internet. International Journal of Mental Health and Addiction, 11, 634-657.

Wardle, H. & Griffiths, M.D. (2011). Defining the ‘online gambler’: The British perspective. World Online Gambling Law Report, 10(2), 12-13.

Wardle, H., Moody, A., Griffiths, M.D., Orford, J. & and Volberg, R. (2011). Defining the online gambler and patterns of behaviour integration: Evidence from the British Gambling Prevalence Survey 2010. International Gambling Studies, 11, 339-356.

Follow

Get every new post delivered to your Inbox.

Join 1,907 other followers