Category Archives: Psychological disorders

Blocking out the pain: Tetris, trauma, and Game Transfer Phenomena

Unwanted visual intrusions are characteristic of Post-Traumatic Stress Disorder (PTSD). According to Dr. Emily Holmes and her colleagues in a 2009 paper in the journal PLoS ONE, one innovative intervention for inhibiting unwanted intrusions is playing the Tetris videogame, described as a ‘cognitive vaccine’ in preventing intrusions after traumatic events. Playing Tetris consumes heavy visuospatial working memory resources that potentially compete with cognitive resources required for elaboration of visual imagery. Since Holmes and colleagues’ study, other studies have used Tetris to inhibit intrusive imagery including more studies by Holmes and her colleagues and others by Ella James’ research group, as well as some innovative studies using Tetris to reduce drug cravings by Jessica Storka-Brown and her colleagues (see ‘Further reading’ below). However, none of these studies assessed the role of videogame content after playing in relation to Game Transfer Phenomena (GTP), an area that we have carried out a lot of research into (see ‘Further reading’ below).

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GTP research has investigated non-volitional experiences (e.g., altered sensorial perceptions and automatic mental processes/behaviours) mostly experienced after gaming. Gamers often report sensorial (visual/auditory) intrusions after playing (e.g., visual and auditory imagery, hallucinations). In a survey of 2,362 gamers that we published in a 2016 issue of the International Journal of Human-Computer Interaction, most (77%) had visualized images from a variety of videogames (including tile-puzzle games) with closed-eyes, and one-third (31%) had visualized images with open-eyes. Other studies have experimentally induced videogame-related visualizations at sleep onset (including studies by Stickgold and colleagues [2000], Wamsley and colleagues [2010], Kusse and colleagues [2012] – see ‘Further reading’).

James and colleagues’ 2015 study in the journal Psychological Science was the first to make explicit reference to GTP (referred to as the ‘Tetris effect’ [TE]). In 2012, we argued the TE term is misleading as it suggests repetition is the core of transfer effects. However, other factors are involved. Research concerning GTP makes the distinction between sensorial modalities facilitating non-volitional phenomena with videogame content that occur along the continuum from mild to severe. Moreover, the descriptive constructs of GTP are empirically based on our analysis of 3,500+ gamers and have been examined via confirmatory factor analysis demonstrating good reliability and validity.

James and her colleagues tested if playing Tetris offered a protective mechanism against re-experiencing traumatic events. Healthy participants (n=56) were randomly assigned to either playing Tetris for 11 minutes, or doing nothing before exposure to a 12-minute traumatic film. Image-base memories about the film were then registered in a one-week dairy. However, playing Tetris as a proactive interference task before watching the film did not show significant results. James and colleagues offered different explanations including: (i) duration of the task in relation to film length, (ii) temporal contingencies between the tasks, (iii) differences between the task types, (iv) videogame types used, and (v) reactivation of gameplay during the film for aided interference. In a commentary paper published in a 2016 issue of Frontiers in Psychology, we discussed these findings and some of its shortcomings in relation to GTP literature.

  • Duration of task in relation to film length: Playing Tetris for 11 minutes may not have been long enough to compete with the consolidation of memory of the 12-minute film. GTP are significantly more likely to occur when playing 3-6 hours. Our research reported only 4% of gamers reported GTP when playing sessions shorter than one-hour. Laboratory experiments have taken days of playing to induce game-related visualizations at sleep onset.
  • Temporal contingencies between gaming and film watching: The tasks were performed minutes apart from each other. GTP mostly occur soon after stopping playing but our research has found that gamers have also reported GTP days after playing. In most cases, duration of experience is very short (seconds/minutes) but in some cases hours or longer.
  • Differences between the tasks: Previous studies have demonstrated that similar tasks aid interference. However, watching a film is a passive activity while gaming is interactive requiring additional perceptual/motor skills. Therefore, it may be expected that gaming is more potent as interference task, particularly because inducing the subjective sense of presence in the virtual world may strengthen the interference.
  • Type of videogame used as interference task and emotional content of film: The unrealistic (geometric) Tetris content may have been overwritten by the film’s traumatic images. Visualization of stereotypical games induced at sleep onset are characterized by lack of emotion, assuming that the amygdala and the reward system are not involved. In GTP research, emotions in tile-matching puzzle-games are incomparable to emotions in realistic videogames.
  • Reactivation of gameplay during the film for aided interference: The use of cue reminders may have potential in reviving videogame content. In many cases, thoughts and altered perceptions are triggered by game-related cues. Selective attention toward game-related cues has been demonstrated in experiments. GTP have been reported in variety of videogame genres particularly those that have very realistic graphics and settings. Therefore, more realistic games may aid associations between real life stimuli and videogame content, and may be more effective in competing with memories of traumatic events.

In our Frontiers paper, we noted that playing Tetris is not only an effective visuospatial task (overloading working memory resources needed for imagery-formation while playing), but as demonstrated in our GTP studies, videogame content stays active after playing (e.g., mental imagery, sensory perceptions), and may offer additional benefits for managing unwanted intrusions. GTP may potentially strengthen effects of interference tasks but should be used cautiously, because videogame content not only targets unwanted intrusions, but also influences individual cognitions, perceptions, and behaviours in day-to-day contexts (e.g., attention bias, lack of task awareness, control inhibition failures). Moreover, our studies have shown distress and dysfunction have been reported with GTP.

Consequently, further research needs conducting to identify: (i) videogames that are most effective, (ii) playing duration, (iii) factors that reduce intervention efficacy and strategies to control them, and (iv) individuals that may benefit the most from such intervention. While using videogames as intervention tools for preventing unwanted imagery from traumatic experiences has potential, therapeutically it is still at an early stage.

  • (Please note: This blog was co-written with Dr. Angelica Ortiz de Gortari and is based on an article we published in Frontiers in Psychology: Ortiz de Gortari, A.B. & Griffiths, M.D. (2016). Playing the computer game Tetris prior to viewing traumatic film material and subsequent intrusive memories: Examining proactive interference. Frontiers in Psychology, 7, 260. doi: 10.3389/fpsyg.2016.00260)

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

Further reading

Holmes, E. A., James, E. L., Kilford, E. J., & Deeprose, C. (2010). Key steps in developing a cognitive vaccine against traumatic flashbacks: Visuospatial Tetris versus Verbal Pub Quiz. PloS ONE, 5(11), e13706.

James, E. L., Bonsall, M. B., Hoppitt, L., Tunbridge, E. M., Geddes, J. R., Milton, A. L., & Holmes, E. A. (2015a). Computer game play reduces intrusive memories of experimental trauma via reconsolidation-update mechanisms. Psychological Science. doi: 10.1177/0956797615583071

James, E. L., Zhu, A. L., Tickle, H., Horsch, A., & Holmes, E. A. (2015b). Playing the computer game Tetris prior to viewing traumatic film material and subsequent intrusive memories: Examining proactive interference. Journal of Behavior Therapy and Experimental Psychiatry. doi: 10.1016/j.jbtep.2015.11.004

Kusse, C., Shaffii-Le Bourdiec, A., Schrouff, J., Matarazzo, L., & Maquet, P. (2012). Experience-dependent induction of hypnagogic images during daytime naps: A combined behavioural and EEG study. Journal of Sleep Research, 21(1), 10-20.

Ortiz de Gortari, A. B., Aronsson, K., & Griffiths, M. D. (2011). Game Transfer Phenomena in video game playing: A qualitative interview study. International Journal of Cyber Behavior, Psychology and Learning 1(3), 15-33.

Ortiz de Gortari, A. B., & Griffiths, M. D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. I. Gackenbach (Ed.), Video Game Play and Consciousness (pp. 223-250). Hauppauge, NY: Nova Publisher.

Ortiz de Gortari, A. B., & Griffiths, M. D. (2014a). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30(2), 95-105.

Ortiz de Gortari, A. B., & Griffiths, M. D. (2014b). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning 4(1), 59-75.

Ortiz de Gortari, A. B., & Griffiths, M. D. (2014c). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12(4), 1-21.

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

Ortiz de Gortari, A.B. & Griffiths, M.D. (2016). Prevalence and characteristics of Game Transfer Phenomena: A descriptive survey study. International Journal of Human-Computer Interaction, 32, 470-480.

Ortiz de Gortari, A.B., Oldfield, B. & Griffiths, M.D. (2016). An empirical examination of factors associated with Game Transfer Phenomena severity. Computers in Human Behavior, 64, 274-284.

Ortiz de Gortari, A. B., Pontes, H. M. & Griffiths, M. D.  (2015). The Game Transfer Phenomena Scale: An instrument for investigating the nonvolitional effects of video game playing. Cyberpsychology, Behavior, and Social Networking 10, 588-594

Skorka-Brown, J., Andrade, J., & May, J. (2014). Playing ‘Tetris’ reduces the strength, frequency and vividness of naturally occurring cravings. Appetite, 76 , 161-165.

Skorka-Brown, J., Andrade, J., Whalley, B., & May, J. (2015). Playing Tetris decreases drug and other cravings in real world settings. Addictive Behaviors, 51, 165-170.

Stickgold, R., Malia, A., Maguire, D., Roddenberry, D., & O’Connor, M. (2000). Replaying the Game: Hypnagogic images in normals and amnesics. Science, 290(5490), 350-353.

Wamsley, E. J., Perry, K., Djonlagic, I., Reaven, L. B., & Stickgold, R. (2010). Cognitive replay of visuomotor learning at sleep onset: Temporal dynamics and relationship to task performance. Sleep, 1(33), 59-68.

 

Learning, yearning, but not earning: A brief look at student gambling

Last week, the UK Gambling Commission put out a press release relating to student gambling. Having been in the university sector for as long as I have been researching gambling (i.e., 30 years), student gambling is an area that has always been close to my professional heart. I have published dozens of papers on youth gambling and student gambling over the last three decades (see ‘Further reading’ below for a few examples).

With my daughter leaving home to go to university this week there are lots I could potentially worry about and gambling isn’t necessarily my main concern where my daughter is concerned, but gambling is still of concern to me especially because a study I published back in 2012 with Luke Benson and Dr. Christine Norman (in the International Journal of Mental Health and Addiction) found that first year university students gambled more than final year students and were more susceptible to problem gambling compared to final year students.

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The Gambling Commission have just published their own research into the topic. They hired Youth Sight who conducted 1,000 online interviews with undergraduate students in August 2017 (the students were part of an online panel recruited from applicants through Universities and Colleges Admission Service). The quotas chosen reflected the UK student population in terms of gender, course year and university group. Here are some of their key findings:

  • Two-thirds of students had gambled in the previous month
  • Over half of student gamblers (54%) engaged in gambling to make money
  • Two-fifths of students said they felt guilty after they had gambled
  • One in eight student gamblers had missed lectures due to gambling
  • One in four student gamblers (25%) had spent more money gambling than they could afford
  • One in 25 student gamblers (4%) were in debt because of their gambling
  • One in four students that had a gambling debt, had a debt of over £10,000

The Gambling Commission noted there were are number of limitations with the study. They specifically noted that gambling participation rates may have been higher than if the data had been collected using other methodologies (telephone, face-to-face interviews) due to the self-selecting nature of online surveys. However, online surveys were chosen due to students’ access to technology and the availability of a representative panel via this method. 

On the back of their survey, the Gambling Commission also provided their top ten tips to help students avoid getting into trouble with gambling. I have reproduced them here verbatim.

  • Ask yourself why you are gambling: Are you gambling to escape debt or as a way to make quick money? Think carefully about your motivations to gamble. Gambling shouldn’t be seen as the answer to improving your personal finances. If you have concerns about money, speak to a financial adviser or student support services.
  • Monitor how often you’re gambling online: Websites must give you access to historic account activity. This means you can see exactly when, how much and what you’ve been gambling on over time and make well-informed choices about what to do next.
  • Keep track of how much time you’ve spent gambling: With a reality check, you can set alerts to pop up on screen, which help you to monitor the time spent gambling either online or on gaming machines in a betting shop.
  • Limit how much you can spend: If you’re concerned about how much money you’re gambling, you can set a limit on how much you spend across individual gambling products online. You can also set a limit on how much you spend on gaming machines in a betting shop.
  • Give yourself a timeout: During a timeout, you can block yourself from gambling online for a set amount of time, of up to 6 weeks, and even bar yourself from gambling during a specific time of day.
  • Need a longer break? Self-exclude from gambling firms for a minimum of 6 months: If you think you are spending too much time or money gambling – whether online or in gambling premises – you can ask to be self-excluded. This is when you ask the company to stop you from gambling with them for a period of time. The exclusion will last for a minimum of least six months. Self-exclusion can be used if you think you have a problem with gambling and want help to stop. [The Gambling Commission] are also working with industry representatives to develop a national online self-exclusion scheme.
  • Read the terms and conditions: Did you know almost 80% of gamblers haven’t read the terms and conditions on the websites they are gambling on? By taking the time to read the T&Cs, you can ensure you understand exactly what you are gambling on, and what restrictions are attached to promotions and bonus offers (such as a minimum spend level before the bonus is paid) – this will help you make an informed decision.
  • Make sure the website you’re gambling with is licensed: Make sure you’re gambling with a Gambling Commission licensed business. This means you’ll be protected by gambling and consumer protection rules in Great Britain. Licensed gambling businesses must display that they are licensed and provide a link to our licence register where you can see what type of activities they are allowed to offer and also if we have taken any regulatory action against them.
  • Check how your money is protected: Any gambling business that holds customer funds must explain in their T&Cs how customer funds are protected if the business goes bust – this should help you decide who you want to gamble with.
  • Feel it’s getting too much? Talk to someone: There are a number of gambling support groups available if you feel your gambling is getting out of control or too much. More information about the signs of problem gambling can be found on the Gambleaware and Gamcare websites [You can call the National Gambling Helpline on Freephone 0808 8020 133]. They also provide general information about gambling, including how to gamble safely and where to get help if you or someone you know has problems with their gambling.

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

Further reading

Benson, L., Norman, C. & Griffiths, M.D. (2012). The role of impulsivity, sensation seeking, coping, and year of study in student gambling: A pilot study. International Journal of Mental Health and Addiction, 10, 461-473.

Canale, N., Griffiths, M.D., Vieno, A., Siciliano, V. & Molinaro, S. (2016). Impact of internet gambling on problem gambling among adolescents in Italy: Findings from a large-scale nationally representative survey. Computers in Human Behavior, 57, 99-106.

Canale, N., Vieno, A., Lenzi, M., Griffiths, M.D., Borraccino, A., Lazzeri, G., Lemma, P., Scacchi, L., Santinello, M. (2017). Income inequality and adolescent gambling severity: Findings from a large-scale Italian representative survey. Frontiers in Psychology, 8, 1318. doi: 10.3389/fpsyg.2017.01318

Gambling Commision (2017). Commission raises awareness of potential risks for students who gamble. September 12. Located at: http://www.gamblingcommission.gov.uk/news-action-and-statistics/news/2017/Commission-raises-awareness-of-potential-risks-for-students-who-gamble.aspx

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

Griffiths, M.D. (2002). Adolescent gambling: What should teachers and parents know? Education and Health, 20, 31-35.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2008). Adolescent gambling in Great Britain. Education Today: Quarterly Journal of the College of Teachers. 58(1), 7-11.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. (2015). Adolescent gambling and gambling-type games on social networking sites: Issues, concerns, and recommendations. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 33(2), 31-37.

Griffiths, M.D. & Calado, F. (2017). Adolescent gambling. Reference Module in Neuroscience and Biobehavioral Psychology (pp. 1-12). Oxford: Elsevier.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Serial delights: Killing as an addiction

A couple of days ago I watched the 2007 US psychological thriller Mr. Brooks. The film is about a celebrated businessman (Mr. Earl Brooks played by Kevin Costner) who also happens to be serial killer (known as the ‘thumbprint killer’). The reason I mention all this is that the explanation given in the film by Earl for the serial killing is that it was an addiction. A number of times in the film he is seem attending Alcoholics Anonymous and quoting from the 12-step recovery program to help him ‘beat his addiction’. With the help of the AA Fellowship, he had managed not to kill anyone for two years but at the start of the film, Earl’s psychological alter-ego (‘Marshall’ played by William Hurt) manages to coerce Earl into killing once again. I won’t spoil the plot for people who have not seen the film but the underlying theme that serial killing is an addiction that Earl is constantly fighting against, is embedded in an implicit narrative that addiction somehow ‘explains’ his behaviour and that he is not really responsible for it. This is not a view I hold myself as all addicts have to take some responsibility for their behaviour.

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The idea of serial killing being conceptualized as an addiction in popular culture is not new. For instance, Brian Masters book about British serial killer Dennis Nilsen (who killed at least 12 young men and was also a necrophile) was entitled Killing for Company: The Story of a Man Addicted to Murder, and Mikaela Sitford’s book about Harold Shipman, the British GP (aka ‘Dr. Death’) who killed over 200 people, was entitled Addicted to Murder: The True Story of Dr. Harold Shipman.

One of the things that I have always argued throughout my career, is that someone cannot become addicted to an activity or a substance unless they are constantly being rewarded (either by continual positive and/or negative reinforcement). Given that serial killing is a discontinuous activity (i.e., it happens relatively infrequently rather than every hour or day) how could killing be an addiction? One answer is that the act of killing is part of the wider behaviour in that the preoccupation with killing can also include the re-enacting of past kills and the keeping of ‘trophies’ from the victims (which I overviewed in a previous blog). As the author of the book Freud, Profiled: Serial Killer noted:

“The serial killer is most often described as a kind of addict. Murder is his addiction, the thrill achieved in murder his ‘kick.’ This addiction requires a maintenance ‘fix.’ At first, the experience is wonderfully exhilarating, later the fix is needed to just feel normal again. It is a hard habit to break, the hungering sensation to consume another life returns. Between murders, they often play back video or sound recordings or look at photos made of their previous murders. This voyeurism provides a surrogate death-meal until their next feeding”.

In Eric Hickey’s 2010 book Serial Murderers and Their Victims, Dr. Hickey makes reference to an unpublished 1990 monograph by Dr. Victor Cline who outlined a four-factor addiction syndrome in relation to sexual serial killers who (so-called ‘lust murderers’ that I also examined in a previous blog). More specifically:

“The offender first experiences ‘addiction’ similar to the physiological/psychological addiction to drugs, which then generates stress in his or her everyday activities. The person then enters a stage of ‘escalation’, in which the appetite for more deviant, bizarre, and explicit sexual material is fostered. Third, the person gradually becomes ‘desensitized’ to that which was once revolting and taboo-breaking. Finally, the person begins to ‘act out’ the things that he or she has seen”.

This four-stage model is arguably applicable to serial killing more generally. It also appears to be backed up by one of the most notorious serial killers, Ted Bundy. In an interview with psychologist Dr. James Dobson (found in Harold Schecter’s 2003 book The Serial Killer Files: The Who, What, Where, How, and Why of the World’s Most Terrifying Murderers), Bundy claimed:

“Once you become addicted to [pornography], and I look at this as a kind of addiction, you look for more potent, more explicit, more graphic kinds of material. Like an addiction, you keep craving something which is harder and gives you a greater sense of excitement, until you reach the point where the pornography only goes so far – that jumping-off point where you begin to think maybe actually doing it will give you that which is just beyond reading about it and looking at it”.

Dr. Hickey claims that such urges to kill are fuelled by fantasies that have become well-developed and killers to vicariously gain control of other individual. He also believes that fantasies for lust killers are far greater than an escape, and becomes the focal point of all behaviour. He concludes by saying that “even though the killer is able to maintain contact with reality, the world of fantasy becomes as addictive as an escape into drugs”. In the book The Serial Killer Files, Harold Schechter notes that:

“For homicidal psychopaths, lust-killing often becomes an addiction. Like heroin users, they not only become dependent on the thrilling sensation – the rush – of torture, rape, and murder; they come to require ever greater and more frequent fixes. After a while, merely stabbing a co-ed to death every few months isn’t enough. They have to kill every few weeks, then every few days. And to achieve the highest pitch of arousal, they have to torture the victim before putting her to death. This kind of escalation can easily lead to the killer’s own destruction. Like a junkie who ODs in his urgent quest to satisfy his cravings, serial killers are often undone by their increasingly unbridled sadism, which drives them to such reckless extremes that they are finally caught. Monsters tend to be sadists, deriving sexual gratification from imposing pain on others. Their secret perversions, at first sporadic, often trap them in a pattern as the intervals between indulgences become briefer: it is a pattern whose repetitions develop into a hysterical crescendo, as if from one outrage to another the monster were seeking as a climax his own annihilation”.

Schecter uses the ‘addiction’ explanation for serial killing throughout his writings even for serial killers from the past including American nurse Jane Toppan (the ‘Angel of Death’) who confessed to 33 murders in 1901 and died in 1938 (“she became addicted to murder”), cannibalistic child serial killers Gilles Garnier (died in 1573) and Peter Stubbe (died 1589) (“both became addicted to murder and cannibalism, both preferred to prey upon children”), and Lydia Sherman (died 1878) who killed 8 children including six of her own (“confirmed predator, addicted to cruelty and death”).

In a recent 2012 paper on mental disorders in serial killers in the Iranian Journal of Medical Law, Dr. N. Mehra and A.S. Pirouz quoted the literary academic Akira Lippit who argued that in films, the “completion of each serial murder lays the foundation for the next act which in turn precipitates future acts, leaving the serial subject always wanting more, always hungry, addicted”. They then go on to conclude that:

“Once a killer has tasted the success of a kill, and is not apprehended, it will ultimately mean he will strike again. He put it simply, that once something good has happened, something that made the killer feel good, and powerful, and then they will not hesitate to try it again. The first attempt may leave them with a feeling of fear but at the same time, it is like an addictive drug. Some killers revisit the crime scene or take trophies, such as jewelry or body parts, or video tape the scenario so as to be able to re-live the actual feeling of power at a later date”.

Although I haven’t done an extensive review of the literature, I do think it’s possible – even on the slimmest of empirical bases presented here – to conceptualize serial killing as a potential behavioural addiction for some individuals. However, it will always depend upon how addiction is defined in the first place.

Dr. Mark Griffiths, Professor of Behavioural Addiction, 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.

Brophy, J. (1967). The Meaning of Murder. London: Crowell.

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

Lippit, A.M. (1996). The infinite series: Fathers, cannibals, chemists. Criticism, Summer, 1-18.

Masters, B. (1986). Killing for Company: The Story of a Man Addicted to Murder. New York: Stein and Day.

Mehra, N., & Pirouz, A. S. (2012). A study on mental disorder in serial killers. Iranian Journal of Medical Law, 1(1), 38-51.

Miller, E. (2014). Freud, Profiled: Serial Killer. San Diego: New Directions Publishing.

Schecter, H. (2003). The Serial Killer Files: The Who, What, Where, How, and Why of the World’s Most Terrifying Murderers. New York: Ballantine Books

Sitford, M. (2000). Addicted to Murder: The True Story of Dr. Harold Shipman. London: Virgin Publishing.

Taylor, T. (2014). Is serial killing an addiction? IOL, April 9. Located at: http://www.iol.co.za/news/crime-courts/is-serial-killing-an-addiction-1673542

Art in the right place: Cosey Fanni Tutti’s ‘Art Sex Music’

Five years ago I wrote a blog about one of my favourite bands, Throbbing Gristle (TG; Yorkshire slang for a penile erection). In that article, I noted that TG were arguably one of “the most extreme bands of all time” and “highly confrontational”. They were also the pioneers of ‘industrial music’ and in terms of their ‘songs’, no topic was seen as taboo or off-limits. In short, they explored the dark and obsessive side of the human condition. Their ‘music’ featured highly provocative and disturbing imagery including hard-core pornography, sexual manipulation, school bullying, ultra-violence, sado-masochism, masturbation, ejaculation, castration, cannibalism, Nazism, burns victims, suicide, and serial killers (Myra Hindley and Ian Brady).

I mention all this because I have just spent the last few days reading the autobiography (‘Art Sex Music‘) of Cosey Fanni Tutti (born Christine Newbie), one of the four founding members of TG. It was a fascinating (and in places a harrowing) read. As someone who is a record-collecting completist and having amassed almost everything that TG ever recorded, I found Cosey’s book gripping and read the last 350 pages (out of 500) in a single eight-hour sitting into the small hours of Sunday morning earlier today.

cosey_fanni_tutti_paperback_signed

TG grew out of the ‘performance art’ group COUM Transmissions in the mid-1970s comprising Genesis P-Orridge (‘Gen’, born Neil Megson in 1950) and Cosey. At the time, Cosey and Gen were a ‘couple’ (although after reading Cosey’s book, it was an unconventional relationship to say the least). TG officially formed in 1975 when Chris Carter (born 1953) and Peter ‘Sleazy’ Christopherson (1955-2010). Conservative MP Sir Nicholas Fairburn famously called the group “wreckers of civilisation” (which eventually became the title of their 1999 biography by Simon Ford).

As I noted in my previous article, TG are – psychologically – one of the most interesting groups I have ever come across and Cosey’s book pulled no punches. To some extent, Cosey’s book attempted to put the record straight in response to Simon Ford’s book which was arguably a more Gen-oriented account of TG. Anyone reading Cosey’s book will know within a few pages who she sees as the villain of the TG story. Gen is portrayed as an egomaniacal tyrant who manipulated her. Furthermore, she was psychologically and physically abused by Gen throughout their long relationship in the 1970s. Thankfully, Cosey fell in love with fellow band member Chris Carter and he is still the “heartbeat” of the relationship and to who her book is dedicated.

Like many of my favourite groups (The Beatles, The Smiths, The Velvet Underground, Depeche Mode), TG were (in Gestaltian terms) more than the sum of their parts and all four members were critical in them becoming a cult phenomenon. The story of their break up in the early 1980s and their reformation years later had many parallels with that of the Velvet Underground’s split and reformation – particularly the similarities between Gen and Lou Reed who both believed they were leaders of “their” band and who both walked out during their second incarnations.

Cosey is clearly a woman of many talents and after reading her book I would describe her as an artist (and not just a ‘performance artist’), musician (or maybe ‘anti-musician in the Brian Eno sense of the word), writer, and lecturer, as well as former pornographic actress, model, and stripper. It is perhaps her vivid descriptions of her life in the porn industry and as a stripper that (in addition to her accounts of physical and psychological abuse by Gen) were the most difficult to read. For someone as intelligent as Cosey (after leaving school with few academic qualifications but eventually gaining a first-class degree via the Open University), I wasn’t overly convinced by her arguments that her time working in the porn industry both as a model and actress was little more than an art project that she engaged in on her own terms. But that was Cosey’s justification and I have no right to challenge her on it.

What I found even more interesting was how she little connection between her ‘pornographic’ acting and modelling work and her time as a stripper (the latter she did purely for money and to help make ends meet during the 1980s). Her work as a porn model and actress was covert, private, seemingly enjoyable, and done behind closed doors without knowing who the paying end-users were seeing her naked. Her work as a stripper was overt, public, not so enjoyable, and played out on stage directly in front of those paying to see her naked. Two very different types of work and two very different psychologies (at least in the way that Cosey described it).

Obviously both jobs involved getting naked but for Cosey, that appeared to be the only similarity. She never ever had sex for money with any of the clientele that paid to see her strip yet she willingly made money for sex within the porn industry. For Cosey, there was a moral sexual code that she worked within, and that sex as a stripper was a complete no-no. The relationship with Gen was (as I said above) ‘unconventional’ and Gen often urged her and wanted her to have sex with other men (and although she never mentioned it in her book, I could speculate that Gen had some kind of ‘cuckold fetish’ that I examined in a previous blog as well as some kind of voyeur). There were a number of times in the book when Cosey appeared to see herself as some kind of magnet for unwanted attention (particularly exhibitionists – so-called ‘flashers’ – who would non-consensually expose their genitalia in front of Cosey from a young age through to adulthood). Other parts of the book describe emotionally painful experiences (and not just those caused by Gen) including both her parents disowning her and a heartfelt account of a miscarriage (and the hospital that kept her foetus without her knowledge or consent). There are other sections in the book that some readers may find troubling including her menstruation art projects (something that I perhaps should have mentioned in my blog  on artists who use their bodily fluids for artistic purposes).

Cosey’s book is a real ‘warts and all’ account of her life including her many health problems, many of which surprisingly matched my own (arrhythmic heart condition, herniated spinal discs, repeated breaking of feet across the lifespan). Another unexpected connection was that her son with Chris Carter (Nick) studied (and almost died of peritonitis) as an undergraduate studying at art at Nottingham University or Nottingham Trent University. I say ‘or’ because at one stage in the book it says that Nick studied at Nottingham University and in another extract it says they were proud parents attending his final degree art show at Nottingham Trent University. I hope it was the latter.

Anyone reading the book would be interested in many of the psychological topics that make an appearance in the book including alcoholism, depression, claustrophobia, egomania, and suicide to name just a few. In previous blogs I’ve looked at whether celebrities are more prone to some psychological conditions including addictions and egomania and the book provides some interesting case study evidence. As a psychologist and a TG fan I loved reading the book.

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

Further reading

Cooper, D. (2012). Sypha presents … Music from the Death Factory: A Throbbing Gristle primer. Located at: http://denniscooper-theweaklings.blogspot.co.uk/2012/02/sypha-presents-music-from-death-factory.html?zx=c19a3a826c3170a7

Fanni Tutti, C. (2017). Art Sex Music. Faber & Faber: London.

Ford, S. (1999). Wreckers of Civilization: The Story of Coum Transmissions and Throbbing Gristle. London: Black Dog Publishing.

Kirby, D. (2011). Transgressive representations: Satanic ritual abuse, Thee Temple ov Psychick Youth, and First Transmission. Literature and Aesthetics, 21, 134-149.

Kromhout, M. (2007). ‘The Impossible Real Transpires’ – The Concept of Noise in the Twentieth Century: a Kittlerian Analysis. Located at: http://www.mellekromhout.nl/wp-content/uploads/The-Impossible-Real-Transpires.pdf

Reynolds, S. (2006). Rip It Up and Start Again: Postpunk, 1978–1984. New York: Penguin.

Sarig, R. (1998). The Secret History of Rock: The Most Influential Bands You’ve Never Heard Of. New York: Watson-Guptill Publications.

Walker, J.A. (2009). Cosey Fanni Tutti & Genesis P-Orridge in 1976: Media frenzy, Prostitution-style, Art Design Café, August 10. Located at: http://www.artdesigncafe.com/cosey-fanni-tutti-genesis-p-orridge-1-2009

Wells, S. (2007). A Throbbing Gristle primer. The Guardian, May 27. Located at: http://www.guardian.co.uk/music/musicblog/2007/may/29/athrobbinggristleprimer

Search of the poisoned mind? A brief look at ‘internet search dependence’

Despite being a controversial topic, research into a wide variety of online addictions has grown substantially over the last decade. My own research into online addictions has been wide ranging and has included online social networking, online sex addiction, online gaming addiction, online shopping addiction, and online gambling addiction. As early as the late 1990s/early 2000s, I constantly argued that when it came to online addictions, most of those displaying problematic behaviour had addictions on the internet rather than addictions to the internet (i.e., they were not addicted to the medium of the internet but addicted to applications and activities that could be engaged in via the internet).

A recent 2016 paper by Dr. Yifan Wang and colleagues in the journal Frontiers in Public Health described the development of the Questionnaire of Internet Search Dependence (QISD), a tool developed to assess individuals who may be displaying a dependence on using online search engines (such as Google and Baidu). The notion of individuals being addicted to using search engines is not new and was one of five types of internet addiction outlined in a 1999 typology in a paper in the Student British Medical Journal by Dr. Kimberley Young (and what she termed ‘information overload’ and referred to compulsive database searching). Although I criticized the typology on the grounds that most of the types of online addict were not actually internet addicts but were individuals using the medium of the internet to fuel other addictive behaviours (e.g., gambling, gaming, day trading, etc.), I did implicitly acknowledge that activities such as internet database searching could theoretically exist, even if I did not think it was a type of internet addiction.

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As far as I am aware, the new scale developed by Wang et al. (2016) is the first to create and psychometrically evaluate an instrument to assess ‘internet search dependence’. As noted by the authors:

Subsequently, we compiled 16 items to represent psychological characteristics associated with Internet search dependence, based on the literature review and a follow-up interview with 50 randomly selected university students…We adopted the six criteria for behavioral addiction formulated by Griffiths (i.e., salience, mood modification, tolerance, withdrawal, conflict, and relapse) [Griffiths, 1999b]”.

Given the authors claimed they used an early version of my addiction components model (i.e., one from 1999 rather than my most recent 2005 formulation) to help inform item construction, I was obviously interested to see the scale’s formulated items. I have to admit that I had a lot of misgivings about the paper so I wrote a commentary on it that has just been published in the same journal (Frontiers in Public Health). More specifically, I noted in my paper that if an individual was genuinely addicted to searching online databases I would have expected to see all of my six criteria applied as follows:

  • Salience – This occurs when searching internet databases 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 searching the internet they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with internet database searching).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of internet database searching 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’ when searching internet databases).
  • Tolerance – This is the process whereby increasing amounts of time searching internet databases are required to achieve the former mood modifying effects. This basically means that for someone engaged in internet database searching, they gradually build up the amount of the time they spend searching internet databases every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.), that occur when an individual is unable to search internet databases because they are ill, the internet is unavailable, or there is no Wi-Fi on holiday, etc.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time searching internet databases.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive internet database searching to recur and for even the most extreme patterns typical of the height of excessive internet database searching to be quickly restored after periods of control.

Of the 12 QISD items constructed in the new scale, very few appeared to have anything to do with addiction and/or dependence but this is most likely due to the fact that the authors also used data collected from 50 participants to inform their items and not just the criteria in the addiction components model. However, relying heavily on input from their participants resulted in a number of key features in addiction/dependence not even being assessed (i.e., no assessment of salience, mood modification, conflict, relapse or tolerance). A couple of items may peripherally assess withdrawal symptoms (e.g., ‘I will be upset if I cannot find an answer to a complex question through Internet search’) but not in any way that is directly associated with addiction or dependence. This may be because the authors’ conceptualization of ‘dependence’ was more akin to ‘over-reliance’ rather than traditional definitions of dependence.

While the QISD may be psychometrically robust I argued that it appears to have little face validity and does not appear to assess problematic engagement in internet database searching (irrespective of how addiction or dependence is defined). Based on the addiction components model, I concluded my paper by creating my own scale to assess internet search dependence based directly on the addiction components model and which I argued would have much greater face validity than any item currently found in the QISD:

  • Internet database searching is the most important thing in my life.
  • Conflicts have arisen between me and my family and/or my partner about the amount of time I spend searching internet databases.
  • I engage in internet database searching as a way of changing my mood.
  • Over time I have increased the amount of internet database searching I do in a day.
  • If I am unable to engage in internet database searching I feel moody and irritable.
  • If I cut down the amount of internet database searching I do, and then start again, I always end up searching internet databases as often as I did before.

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

Further reading

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

Andreassen, C.S., Pallesen, S., Griffiths, M.D. (2017). The relationship between excessive online social networking, narcissism, and self-esteem: Findings from a large national survey. Addictive Behaviors, 64, 287-293.

Canale, N., Griffiths, M.D., Vieno, A., Siciliano, V. & Molinaro, S. (2016). Impact of internet gambling on problem gambling among adolescents in Italy: Findings from a large-scale nationally representative survey. Computers in Human Behavior, 57, 99-106.

Griffiths, M.D. (1998). Internet addiction: Does it really exist? In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (pp. 61-75). New York: Academic Press.

Griffiths, M.D. (1999a). Internet addiction: Internet fuels other addictions. Student British Medical Journal, 7, 428-429.

Griffiths, M.D. (1999b). Internet addiction: Fact or fiction? The Psychologist: Bulletin of the British Psychological Society, 12, 246-250.

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

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

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

Griffiths, M.D. (2017). Commentary: Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, in press.

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

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.

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

Wang, Y., Wu, L., Zhou, H., Xu, J. & Dong, G. (2016). Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 4, 274. doi: 10.3389/fpubh.2016.00274

Young, K. S. (1999). Internet addiction: evaluation and treatment. Student British Medical Journal, 7, 351-352.

A diction for addiction: A brief overview of our papers at the 2017 International Conference on Behavioral Addictions

This week I attended (and gave one of the keynote papers at) the fourth International Conference on Behavioral Addictions in Haifa (Israel). It was a great conference and I was accompanied by five of my colleagues from Nottingham Trent University all of who were also giving papers. All of the conference abstracts have just been published in the latest issue of the Journal of Behavioral Addictions (reprinted below in today’s blog) and if you would like copies of the presentations then do get in touch with me.

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Griffiths, M.D. (2017). Behavioural tracking in gambling: Implications for responsible gambling, player protection, and harm minimization. Journal of Behavioral Addictions, 6 (Supplement 1), 2.

  • Social responsibility, responsible gambling, player protection, and harm minimization in gambling have become major issues for both researchers in the gambling studies field and the gaming industry. This has been coupled with the rise of behavioural tracking technologies that allow companies to track every behavioural decision and action made by gamblers on online gambling sites, slot machines, and/or any type of gambling that utilizes player cards. This paper has a number of distinct but related aims including: (i) a brief overview of behavioural tracking technologies accompanied by a critique of both advantages and disadvantages of such technologies for both the gaming industry and researchers; (ii) results from a series of studies carried out using behavioural tracking (particularly in relation to data concerning the use of social responsibility initiatives such as limit setting, pop-up messaging, and behavioural feedback); and (c) a brief overview of the behavioural tracking tool mentor that provides detailed help and feedback to players based on their actual gambling behaviour.

Calado, F., Alexandre, J. & Griffiths, M.D. (2017). Youth problem gambling: A cross-cultural study between Portuguese and English youth. Journal of Behavioral Addictions, 6 (Supplement 1), 7.

  • Background and aims: In spite of age prohibitions, most re- search suggests that a large proportion of adolescents engage in gambling, with a rate of problem gambling significantly higher than adults. There is some evidence suggesting that there are some cultural variables that might explain the development of gambling behaviours among this age group. However, cross­cultural studies on this field are generally lacking. This study aimed to test a model in which individual and family variables are integrated into a single perspective as predictors of youth gambling behaviour, in two different contexts (i.e., Portugal and England). Methods: A total of 1,137 adolescents and young adults (552 Portuguese and 585 English) were surveyed on the measures of problem gambling, gambling frequency, sensation seeking, parental attachment, and cognitive distortions. Results: The results of this study revealed that in both Portuguese and English youth, the most played gambling activities were scratch cards, sports betting, and lotteries. With regard to problem gambling prevalence, English youth showed a higher prevalence of problem gambling. The findings of this study also revealed that sensation seeking was a common predictor in both samples. However, there were some differences on the other predictors be- tween the two samples. Conclusions: The findings of this study suggest that youth problem gambling and its risk factors appear to be influenced by the cultural context and highlights the need to conduct more cross-cultural studies on this field.

Demetrovics, Z., Richman, M., Hende, B., Blum, K., Griffiths,
M.D, Magi, A., Király, O., Barta, C. & Urbán, R. (2017). Reward Deficiency Syndrome Questionnaire (RDSQ):
A new tool to assess the psychological features of reward deficiency. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

  • ‘Reward Deficiency Syndrome’ (RDS) is a theory assuming that specific individuals do not reach a satisfactory state of reward due to the functioning of their hypodopaminergic reward system. For this reason, these people search for further rewarding stimuli in order to stimulate their central reward system (i.e., extreme sports, hypersexuality, substance use and/or other addictive behaviors such as gambling, gaming, etc.). Beside the growing genetic and neurobiological evidence regarding the existence of RDS little re- search has been done over the past two decades on the psychological processes behind this phenomenon. The aim of the present paper is to provide a psychological description of RDS as well as to present the development of the Reward Deficiency Syndrome Questionnaire (developed using a sample of 1,726 participants), a new four-factor instrument assessing the different aspects of reward deficiency. The results indicate that four specific factors contribute to RDS comprise “lack of satisfaction”, “risk seeking behaviors”, “need for being in action”, and “search for overstimulation”. The paper also provides psychological evidence of the association between reward deficiency and addictive disorders. The findings demonstrate that the concept of RDS provides a meaningful and theoretical useful context to the understanding of behavioral addictions.

Demetrovics, Z., Bothe, B., Diaz, J.R., Rahimi­Movaghar, A., Lukavska, K., Hrabec, O., Miovsky, M., Billieux, J., Deleuze,
J., Nuyens, P. Karila, L., Nagygyörgy, K., Griffiths, M.D. & Király, O. (2017). Ten-Item Internet Gaming Disorder Test (IGDT-10): Psychometric properties across seven language-based samples. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

  • Background and aims: The Ten-Item Internet Gaming Disorder Test (IGDT-10) is a brief instrument developed to assess Internet Gaming Disorder as proposed in the DSM­5. The first psychometric analyses carried out among a large sample of Hungarian online gamers demonstrated that the IGDT-10 is a valid and reliable instrument. The present study aimed to test the psychometric properties in a large cross-cultural sample. Methods: Data were collected among Hungarian (n = 5222), Iranian (n = 791), Norwegian (n = 195), Czech (n = 503), Peruvian (n = 804), French­speaking (n = 425) and English­ speaking (n = 769) online gamers through gaming­related websites and gaming-related social networking site groups. Results: Confirmatory factor analysis was applied to test the dimensionality of the IGDT-10. Results showed that the theoretically chosen one-factor structure yielded appropriate to the data in all language­based subsamples. In addition, results indicated measurement invariance across all language-based subgroups and across gen- der in the total sample. Reliability indicators (i.e., Cronbach’s alpha, Guttman’s Lambda-2, and composite reliability) were acceptable in all subgroups. The IGDT- 10 had a strong positive association with the Problematic Online Gaming Questionnaire and was positively and moderately related to psychopathological symptoms, impulsivity and weekly game time supporting the construct validity of the instrument. Conclusions: Due to its satisfactory psychometric characteristics, the IGDT-10 appears to be an adequate tool for the assessment of internet gam- ing disorder as proposed in the DSM-5.

Throuvala, M.A., Kuss, D.J., Rennoldson, M. & Griffiths, M.D. (2017). Delivering school-based prevention regarding digital use for adolescents: A systematic review in the UK. Journal of Behavioral Addictions, 6 (Supplement 1), 54.

  • Background: To date, the evidence base for school-delivered prevention programs for positive digital citizenship for adolescents is limited to internet safety programs. Despite the inclusion of Internet Gaming Disorder (IGD) as a pro- visional disorder in the DSM-5, with arguable worrying prevalence rates for problematic gaming across countries, and a growing societal concern over adolescents’ digital use, no scientifically designed digital citizenship programs have been delivered yet, addressing positive internet use among adolescents. Methods: A systematic database search of quantitative and qualitative research evidence followed by a search for governmental initiatives and policies, as well as, non­profit organizations’ websites and reports was conducted to evaluate if any systematic needs assessment and/or evidence-based, school delivered prevention or intervention programs have been conducted in the UK, targeting positive internet use in adolescent populations. Results: Limited evidence was found for school-based digital citizenship awareness programs and those that were identified mainly focused on the areas of internet safety and cyber bullying. To the authors’ knowledge, no systematic needs assessment has been conducted to assess the needs of relevant stakeholders (e.g., students, parents, schools), and no prevention program has taken place within UK school context to address mindful and positive digital consumption, with the exception of few nascent efforts by non­profit organizations that require systematic evaluation. Conclusions: There is a lack of systematic research in the design and delivery of school-delivered, evidence-based prevention and intervention programs in the UK that endorse more mindful, reflective attitudes that will aid adolescents in adopting healthier internet use habits across their lifetime. Research suggests that adolescence is the highest risk group for the development of internet addictions, with the highest internet usage rates of all age groups. Additionally, the inclusion of IGD in the DSM-5 as provisional disorder, the debatable alarming prevalence rates for problematic gaming and the growing societal focus on adolescents’ internet misuse, renders the review of relevant grey and published research timely, contributing to the development of digital citizenship programs that might effectively promote healthy internet use amongst adolescents.

Bányai, F., Zsila, A., Király, O., Maraz, A., Elekes, Z., Griffiths, M.D., Andreassen, C.S. & Demetrovics, Z. (2017). Problematic social networking sites use among adolescents: A national representative study. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

  • Despite being one of the most popular activities among adolescents nowadays, robust measures of Social Media use and representative prevalence estimates are lacking in the field. N = 5961 adolescents (49.2% male; mean age 16.6 years) completed our survey. Results showed that the one-factor Bergen Social Media Addiction Scale (BSMAS) has appropriate psychometric properties. Based on latent pro le analysis, 4.5% of the adolescents belonged to the at-risk group, who reported low self-esteem, high level of depression and the elevated social media use (34+ hours a week). Conclusively, BSMAS is an adequate measure to identify those adolescents who are at risk of problematic Social Media use and should therefore be targeted by school-based prevention and intervention programs.

Bothe, B., Toth-Király, I. Zsila, A., Griffiths, M.D., Demetrovics, Z. & Orosz, G. (2017). The six-component problematic pornography consumption scale. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

  • Background and aims: To our best knowledge, no scale ex- ists with strong psychometric properties assessing problematic pornography consumption which is based on an over- arching theoretical background. The goal of the present study was to develop a short scale (Problematic Pornography Consumption Scale; PPCS) on the basis of Griffiths` (2005) six-component addiction model that can assess problematic pornography consumption. Methods: The sample comprised 772 respondents (390 females; Mage = 22.56, SD = 4.98 years). Items creation was based on the definitions of the components of Griffiths’ model. Results: A confirmatory factor analysis was carried out leading to an 18­item second­order factor structure. The reliability of the PPCS was good and measurement invariance was established. Considering the sensitivity and specificity values, we identified an optimal cut­off to distinguish between problematic and non-problematic pornography users. In the present sample, 3.6% of the pornography consumers be- longed to the at-risk group. Discussion and Conclusion: The PPCS is a multidimensional scale of problematic pornography consumption with strong theoretical background that also has strong psychometric properties.

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

Surprise, surprise: A brief overview of our recent papers on strange addictions and behaviours

Following my recent blogs where I outlined some of the papers that my colleagues and I have published on mindfulness, Internet addiction, gaming addiction, youth gambling, workaholism, exercise addiction, and sex addiction, here is a round-up of recent papers that my colleagues and I have published on strange and/or surprising addictions and behaviours.

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

  • Background: Muscle dysmorphia (MD) describes a condition characterised by a misconstrued body image in which individuals who interpret their body size as both small or weak even though they may look normal or highly muscular. MD has been conceptualized as a type of body dysmorphic disorder, an eating disorder, and obsessive–compulsive disorder symptomatology. Method and aim: Through a review of the most salient literature on MD, this paper proposes an alternative classification of MD – the ‘Addiction to Body Image’ (ABI) model – using Griffiths (2005) addiction components model as the framework in which to define MD as an addiction. Results: It is argued the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and the use or purchase of physical exercise accessories). In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition (rather than addiction to exercise or certain types of eating disorder). Conclusions: Based on empirical evidence to date, it is proposed that MD could be re-classified as an addiction due to the individual continuing to engage in maintenance behaviours that may cause long-term harm.

Griffiths, M.D., Foster, A.C. & Shorter, G.W. (2015). Muscle dysmorphia as an addiction: A response to Nieuwoudt (2015) and Grant (2015). Journal of Behavioral Addictions, 4, 11-13.

  • Background: Following the publication of our paper ‘Muscle Dysmorphia: Could it be classified as an addiction to body image?’ in the Journal of Behavioral Addictions, two commentaries by Jon Grant and Johanna Nieuwoudt were published in response to our paper. Method: Using the ‘addiction components model’, our main contention is that muscle dysmorphia (MD) actually comprises a number of different actions and behaviors and that the actual addictive activity is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and purchase or use of physical exercise accessories. This paper briefly responds to these two commentaries. Results: While our hypothesized specifics relating to each addiction component sometimes lack empirical support (as noted explicitly by both Nieuwoudt and Grant), we still believe that our main thesis (that almost all the thoughts and behaviors of those with MD revolve around the maintenance of body image) is something that could be empirically tested in future research by those who already work in the area. Conclusions: We hope that the ‘Addiction to Body Image’ model we proposed provides a new framework for carrying out work in both empirical and clinical settings. The idea that MD could potentially be classed as an addiction cannot be negated on theoretical grounds as many people in the addiction field are turning their attention to research in new areas of behavioral addiction.

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

  • Dancing is a popular form of physical exercise and studies have show that dancing can decrease anxiety, increase self-esteem, and improve psychological wellbeing. The aim of the current study was to explore the motivational basis of recreational social dancing and develop a new psychometric instrument to assess dancing motivation. The sample comprised 447 salsa and/or ballroom dancers (68% female; mean age 32.8 years) who completed an online survey. Eight motivational factors were identified via exploratory factor analysis and comprise a new Dance Motivation Inventory: Fitness, Mood Enhancement, Intimacy, Socialising, Trance, Mastery, Self-confidence and Escapism. Mood Enhancement was the strongest motivational factor for both males and females, although motives differed according to gender. Dancing intensity was predicted by three motivational factors: Mood Enhancement, Socialising, and Escapism. The eight dimensions identified cover possible motives for social recreational dancing, and the DMI proved to be a suitable measurement tool to assess these motives. The explored motives such as Mood Enhancement, Socialising and Escapism appear to be similar to those identified in other forms of behaviour such as drinking alcohol, exercise, gambling, and gaming.

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

  • Although recreational dancing is associated with increased physical and psychological well-being, little is known about the harmful effects of excessive dancing. The aim of the present study was to explore the psychopathological factors associated with dance addiction. The sample comprised 447 salsa and ballroom dancers (68% female, mean age: 32.8 years) who danced recreationally at least once a week. The Exercise Addiction Inventory (Terry, Szabo, & Griffiths, 2004) was adapted for dance (Dance Addiction Inventory, DAI). Motivation, general mental health (BSI-GSI, and Mental Health Continuum), borderline personality disorder, eating disorder symptoms, and dance motives were also assessed. Five latent classes were explored based on addiction symptoms with 11% of participants belonging to the most problematic class. DAI was positively associated with psychiatric distress, borderline personality and eating disorder symptoms. Hierarchical linear regression model indicated that Intensity (ß=0.22), borderline (ß=0.08), eating disorder (ß=0.11) symptoms, as well as Escapism (ß=0.47) and Mood Enhancement (ß=0.15) (as motivational factors) together explained 42% of DAI scores. Dance addiction as assessed with the Dance Addiction Inventory is associated with indicators of mild psychopathology and therefore warrants further research.

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

  • Objectives: Dacryphilia is a non-normative sexual interest that involves enjoyment or arousal from tears and crying, and to date has never been researched empirically. The present study set out to discover the different interests within dacryphilia and explore the range of dacryphilic experience. Methods: A set of online interviews were carried out with individuals with dacryphilic preferences and interests (six females and two males) from four countries. The data were analyzed for semantic and latent themes using thematic analysis. Results: The respondents’ statements focused attention on three distinct areas that may be relevant to the experience of dacryphilia: (i) compassion; (ii) dominance/submission; and (iii) curled-lips. The data provided detailed descriptions of features within all three interests, which are discussed in relation to previous quantitative and qualitative research within emotional crying and tears, and the general area of non-normative sexual interests. Conclusions: The study suggests new directions for potential research both within dacryphilia and with regard to other non-normative sexual interests.

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

  • Aims: Recent research has suggested that for some individuals, educational studying may become compulsive and excessive and lead to ‘study addiction’. The present study conceptualized and assessed study addiction within the framework of workaholism, defining it as compulsive over-involvement in studying that interferes with functioning in other domains and that is detrimental for individuals and/or their environment. Methods: The Bergen Study Addiction Scale (BStAS) was tested — reflecting seven core addiction symptoms (salience, mood modification, tolerance, withdrawal, conflict, relapse, and problems) — related to studying. The scale was administered via a cross-sectional survey distributed to Norwegian (n = 218) and Polish (n = 993) students with additional questions concerning demographic variables, study-related variables, health, and personality. Results: A one-factor solution had acceptable fit with the data in both samples and the scale demonstrated good reliability. Scores on BStAS converged with scores on learning engagement. Study addiction (BStAS) was significantly related to specific aspects of studying (longer learning time, lower academic performance), personality traits (higher neuroticism and conscientiousness, lower extroversion), and negative health-related factors (impaired general health, decreased quality of life and sleep quality, higher perceived stress). Conclusions: It is concluded that BStAS has good psychometric properties, making it a promising tool in the assessment of study addiction. Study addiction is related in predictable ways to personality and health variables, as predicted from contemporary workaholism theory and research.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2016). Study addiction: A cross-cultural longitudinal study examining temporal stability and predictors of its changes. Journal of Behavioral Addictions, 5, 357–362.

  • Background and aims: ‘Study addiction’ has recently been conceptualized as a behavioral addiction and defined within the framework of work addiction.  Using a newly developed measure to assess this construct, the Bergen Study Addiction Scale (BStAS), the present study examined the one-year stability of study addiction and factors related to changes in this construct over time, and is the first longitudinal investigation of study addiction thus far. Methods: The BStAS and the Ten Item Personality Inventory (TIPI) were administered online together with questions concerning demographics and study-related variables in two waves. In Wave 1, a total of 2,559 students in Norway and 2,177 students in Poland participated. A year later, in Wave 2, 1,133 Norwegians and 794 Polish who were still students completed the survey. Results: The test-retest reliability coefficients for the BStAS revealed that the scores were relatively stable over time. In Norway scores on the BStAS were higher in Wave 2 than in Wave 1, while in Poland the reverse pattern was observed. Learning time outside classes at Wave 1 was positively related to escalation of study addiction symptoms over time in both samples. Being female and scoring higher on neuroticism were related to an increase in study addiction in the Norwegian sample only. Conclusion: Study addiction appears to be temporally stable, and the amount of learning time spent outside classes predicts changes in study addiction one year later.

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

Further reading

Greenhill, R. & Griffiths, M.D. (2014). The use of online asynchronous interviews in the study of paraphilias. SAGE Research Methods Cases. Located at: http://dx.doi.org/10.4135/978144627305013508526

Greenhill, R. & Griffiths, M.D. (2016). Sexual interest as performance, intellect and pathological dilemma: A critical discursive case study of dacryphilia. Psychology and Sexuality, 7, 265-278.

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

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

Griffiths, M.D. (2001). Stumped! Amputee fetishes. Bizarre, 44, 70-74.

Griffiths, M.D. (2001). Heaven can wait: The psychology of near death experiences. Bizarre, December, 63-66.

Griffiths, M.D. (2012). The use of online methodologies in studying paraphilia: A review. Journal of Behavioral Addictions, 1, 143-150.

Griffiths, M.D. (2013). Bizarre sex. New Turn Magazine, 3, 49-51.

Griffiths, M.D. (2013). Eproctophilia in a young adult male: A case study. Archives of Sexual Behavior, 42, 1383-1386.

Stars in their eyes: Another look at Celebrity Worship Syndrome

Last week I did a number of media interviews about Celebrity Worship Syndrome (CWS) including the Metro newspaper (‘From Beyonce to Elvis, here’s the ugly truth about why we worship celebrities’) and the International Business Times (‘Crazy about Kylie Jenner? Professor of Behavioural Addiction explains celebrity obsession’). I also wrote an article for the Huffington Post. The ‘hook’ for all these stories was the DVD release of the film Kill The King (also known by the title Shangri La Suite) which tells the story of two 20-year old damaged lovers – Jack and Karen (played by Luke Grimes and Emily Browning) – who head to Los Angeles to kill rock ‘n’ roll legend Elvis Presley in the summer of 1974. While Jack’s obsession with Elvis is somewhat extreme, over the last two decades there has been an increasing amount of research into CWS.

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CWS has been described as an obsessiveaddictive disorder where an individual becomes overly involved and interested (in short, completely obsessed) with the details of the personal life of a celebrity. Any person who is ‘in the public eye’ can be the object of a person’s obsession (e.g., authors, politicians, journalists), but research and criminal prosecutions suggest they are more likely to be someone from the world of television, film and/or pop music. Research suggests that CWS exists and that according to Dr. John Maltby and his colleagues (see ‘Further reading’ below) there are three independent dimensions of celebrity worship. These are on a continuum and named (i) entertainment-social, (ii) intense-personal, and (iii) borderline pathological.

  • The entertainment-social dimension relates to attitudes where individuals are attracted to a celebrity because of their perceived ability to entertain and to become a social focus of conversation with likeminded others.
  • The intense-personal dimension relates to individuals that have intensive and compulsive feelings about a celebrity.
  • The borderline-pathological dimension relates to individuals who display uncontrollable behaviours and fantasies relating to a celebrity.

Among adults, their research has shown that there is a correlation between the pathological aspects of CWS and poor mental health such as high anxiety, more depression, high stress levels, increased illness, and poorer body image. Among teenage females there is a relationship between intense-personal celebrity worship and body image (basically, teenage girls who identify with celebrities have much poorer body image compared to other groups). In addition, most celebrity-obsessed individuals often suffer high levels of dissociation and fantasy-proneness. Maltby’s research suggests about 1% of his participants have obsessional tendencies towards celebrities.

Research has also shown that worshipping celebrities can have both positive and negative consequences. People who worship celebrities for entertainment and social reasons have been found to be more optimistic, outgoing, and happy. Those who worship celebrities for personal reasons have been found to be more obsessive, more depressed, more anxious, more solitary, more impulsive, more anti-social and more troublesome. My own thoughts on CWS and celebrity culture are provided below and are from the interviews I did with the Metro and the International Business Times (IBT).

IBT: In a world filled with Kardashians, social media and vast consumerism, why do you think people are more obsessed with celebrities than ever?

MG: The first thing I would say is that most people are not obsessed with celebrities but there are probably a lot more people who are obsessed compared to a couple of decades ago (although this is speculation on my part as no research has ever examined the prevalence of celebrity obsession among a nationally representative sample). One study did estimate about 1% of their sample being obsessed with celebrities but there is no comparative study prior to that. However, I do think that the numbers of people who have celebrity obsessions has increased over the last 20 years and much of this is most likely due to the rise of celebrities using social media (and the fact that celebrities can now interact – if they want – hour by hour with their fan base) and the increase in general media coverage surrounding celebrity and celebrity lives (including a large increase in reality TV starring celebrities and an increase in the number of celebrity gossip magazines). These types of media and social media can give rise to what we psychologists call parasocial relationships. With respect to celebrities, parasocial relationships are one-sided relationships, where fans express interest, time, money, and/or emotion in and/or on the celebrity (while the celebrity is totally unaware of the fan in any singular or specific sense).

IBT: Do you know what happens in the mind when we form an obsession or infatuation with some things? 

MG: Celebrity infatuations are nothing to particularly worry about because they tend to be intense but relatively short-lived admiration for the person. Celebrity obsessions can be of a lot more concern. At their simplest level, a celebrity obsession is when someone constantly thinks about a particular celebrity in a way that most people would describe as abnormal. This can be to the point where the obsession conflicts with most other things in the individual’s life including job or education, other relationships, and other hobbies. A person’s whole life can revolve around the celebrity and such individuals can end up spending way beyond their disposable income by buying their merchandise (CDs, DVDs, books, perfumes, clothing lines, etc.) and/or seeing them live on stage (singing, acting, etc.). There is no single explanation as to why someone might develop a celebrity obsession but many appear to start with a sexual attraction to the celebrity in question and have fantasies of what they would do if they met the object of their desire. Research has shown that there is a correlation between the pathological aspects of celebrity worship and poor mental health such as high anxiety, more depression, high stress levels, increased illness, and poorer body image. Among teenage females there is a relationship between intense-personal celebrity worship and body image (basically, teenage girls who identify with celebrities have much poorer body image compared to other groups). In addition, most celebrity-obsessed individuals often suffer high levels of dissociation and fantasy-proneness.

IBT: What does it have to take about a ‘celebrity’ for people to become obsessed?

MG: At a micro-level, any person who is ‘in the public eye’ can be the object of a person’s obsession (e.g., authors, politicians, journalists), but research and criminal prosecutions suggest they are more likely to be someone from the world of television, film and/or pop music. This is most likely because such celebrities tend to be more popular and have bigger followings in the public eye in media and on social media. At a micro-level, we are all individuals it could be something very idiosyncratic but given that the little research carried out tends to report that celebrity worshippers are sexually attracted to their celebrity of choice, then being good looking (at least in the eyes of the beholder) appears to be a common denominator.

IBT: How do you think today’s modern obsession with celebrity influenced and resounded throughout Kill the King?

MG: One of Jack’s reasons for being sent to a rehab centre – in addition to a drug addiction problem – is because of his “increasingly abnormal obsession” with Elvis Presley. While Jack’s obsession with Elvis is somewhat extreme and arguably a type of ‘Celebrity Worship Syndrome’, his character doesn’t seem to overlap too much with modern day celebrity worshippers. Jack’s character is more akin to celebrity stalkers or celebrity assassins (like John Lennon’s killer Mark Chapman) than the archetypal young female totally obsessed and besotted with their favourite pop star or actor. Given that Kill The King was set in 1974 and celebrity obsession (and Celebrity Worship Syndrome) is a more modern day phenomenon, I wouldn’t have expected that much overlap anyway.

Metro: Should we be worried about this kind of social media ‘bond’, seeing as icons like John Lennon were assassinated by fans who became obsessed with them?

MG: The chances of those things happening are few and far between. If someone is absolutely hooked on the idea of killing a celebrity, they’ll go and do it. I don’t think it’s to do with the rise of the mass media or anything like that. Most research says fandom is actually good for people. It gives them a hobby. Fans talk to other fans. It brings us together, and it can be life-affirming. I’m a massive, massive David Bowie fan. I’m a record collector, too and I’m probably more on the obsessive side than most people. But I don’t think I’m a worse person for that.

Metro: So what’s the difference between you and someone who spends thousands and thousands of pounds on plastic surgery to look more like their idol?

MG: Those are the real extreme cases. The good news is that recent research has shown that less than one per cent of people are really unhealthily obsessed with stars. And of those people, most are not going to do things that have negative effects on their life. In my opinion, the difference between a healthy enthusiasm and an unhealthy obsession is that enthusiasm adds to life, and addictions or obsessions take away from it. For most people, even those who have a compulsive element to their fandom like myself, it doesn’t have a negative effect on their quality of life. It’s probably better to buy records and memorabilia than designer handbags. Sometimes it’s not just about money, it’s about the time you spend as well. For one person, an obsession can be fine, and for another it can be very problematic. If a fan works in Tesco and they’re following their hero around the country, watching them night after night on tour and buying merchandise, they just don’t have the disposable income to do it. I could do that, thanks to my salary, but I can’t afford the time.

Metro: Is there a link between someone’s social background and their preference for celebrity culture?

MG: I don’t know the scientific link there, but I wouldn’t be surprised if the lower the socio-economic class you’re in the more likely you are to be involved and like celebrity culture. ‘Gogglebox’ stars, for instance. The middle class, well-to-do people like current affairs, news and politics and those who are less well-off are probably more interested in EastEnders and things like that.

Metro: Are there any psychological issues that lead to celebrity worship?

MG: Those with celebrity worship syndrome tend to have worse mental health. They’re more likely to be anxious, depressed, to have high stress levels, increased bouts of illness and a poor body image. But it’s a case of the chicken or the egg, because these people might self-medicate through these parasocial relationships with celebs they’ll never even meet. 

Metro: What are the effects of celebrity culture? Particularly for young people?

MG: We know that young people are not as engaged with politics. They just don’t trust politicians, and it’s linked to the rise of social media. Celebrities have more pull, and followers, than [British Prime Minister] Theresa May or [leader of the Labour Party] Jeremy Corbyn will ever have. I’m not in a position to say whether people should be more interested in X or Y. Certain things in life make people feel good. As humans we seek out things that get us high, aroused, excited –  or we seek out things which tranquilise and numb us. Celebrities tend to give us a thrill. 

Metro: Are celebrities vulnerable themselves?

MG: I certainly wouldn’t like to be in a position where cameras are waiting outside my house. Stardom can bring positive things, but also a lot of unexpected negatives too. We have to remember at the end of the day that celebrities are just human beings, with all the same emotional foibles and weaknesses we have – and sometimes they’re magnified times a hundred because of the pressure and stress of the spotlight. And the internet, too. It’s no wonder some of them fall prey to serious addictions. 

Metro: People like Amy Winehouse? She’s the most recent example I can think of.

MG: Before she died, Amy Winehouse had got to that stage where she was very famous, and she was earning a lot of money. And that meant she was surrounded by sycophants and ‘yes’ people. Those kinds of people say things they think you want to hear, and they’re not necessarily looking out for you. Amy was surrounded by people thinking about their own wages and careers. No, it’s not a surprise when these things happen, and people could see it coming. Like with Kurt Cobain’s death. Amy didn’t get the help she needed. We can say that in hindsight.’

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

Further reading

BBC News (2003). Worshipping celebrities ‘brings success. August 13. Located at: http://news.bbc.co.uk/1/hi/health/3147343.stm

Chapman, J. (2003). Do you worship the celebs? Located at: http://www.dailymail.co.uk/tvshowbiz/article-176598/Do-worship-celebs.html

Griffiths, M.D. (2016). Does ‘Celebrity Worship Syndrome’ really exist? Huffington Post, November 18. Located at: http://www.huffingtonpost.co.uk/dr-mark-griffiths/does-celebrity-worship-sy_b_13012170.html

McCutcheon, L.E., Lange, R., & Houran, J. (2002). Conceptualization and measurement of celebrity worship. British Journal of Psychology, 93, 67-87.

Maltby, J., Houran, M.A., & McCutcheon, L.E. (2003). A Clinical Interpretation of Attitudes and Behaviors Associated with Celebrity Worship. Journal of Nervous and Mental Disease, 191, 25-29.

Maltby, J., Houran, J., Ashe, D., & McCutcheon, L.E. (2001). The self-reported psychological well-being of celebrity worshippers. North American Journal of Psychology, 3, 441-452.

Maltby, J., Day, L., McCutcheon, L.E., Gillett, R., Houran, J., & Ashe, D. (2004). Celebrity Worship using an adaptational-continuum model of personality and coping. British Journal of Psychology. 95, 411-428.

Maltby, J., Giles, D., Barber, L. & McCutcheon, L.E. (2005). Intense-personal Celebrity Worship and Body Image: Evidence of a link among female adolescents. British Journal of Health Psychology, 10, 17-32.

Maltby, J., Day, L., McCutcheon, L.E,. Gilett, R., Houran, J. & Ashe, D.D. (2004), ‘Personality and Coping: A Context for Examining Celebrity Worship and Mental Health. British Journal of Psychology, 95, 411-428.

Maltby, J., Day, L., McCutcheon, L.E., Houran, J. & Ashe, D. (2006). Extreme celebrity worship, fantasy proneness and dissociation: Developing the measurement and understanding of celebrity worship within a clinical personality context. Personality and Individual Differences, 40, 273-283.

Wikipedia (2012). Celebrity Worship Syndrome. Located at: http://en.wikipedia.org/wiki/Celebrity_Worship_Syndrome

Stitches brew: A brief look at self-harm lip sewing

In previous blogs I have examined both self-harming behaviour (such as cutting off one’s own genitals, removing one’s own eye, removing one’s own ear, self-asphyxial risk taking in adolescence, and religious self-flagellation) and extreme body modification. One area where these two areas intersect is lip sewing. According to the Wikipedia entry on lip sewing:

“Lip sewing or mouth sewing, the operation of stitching together human lips, is a form of body modification. It may be carried out for aesthetic or religious reasons; as a play piercing practice; or as a form of protest. Sutures are often used to stitch the lips together, though sometimes piercings are made with needle blades or cannulas and monofilament is threaded through the holes. There is usually a fair amount of swelling, but permanent scarring is rare. Lip sewing may be done for aesthetic reasons, or to aid meditation by helping the mind to focus by removing the temptation to speak. BMEzine, an online magazine for body modification culture, published an article about a 23-year-old film student Inza, whose quest for body modifications was very varied. She spoke about her experiences with lip sewing as a form of play piercing”.

My reason for writing this blog was prompted by a case study published by Dr. Safak Taktak and his colleagues in the journal Health Care Current Reviews. (I ought to add that I have read a number of papers by Taktak and his colleagues as they have reported some interesting other interesting case studies including those on shoe fetishism, semen fetishism, and fetishes more generally – see ‘Further reading’ below). In this particular paper, they reported the case of a male prisoner who had continually sewed his lips together. Although they were aware of cases of sewing lips together as a form of protest, they claimed that there had never been any case reported in the medical literature.

lip-sewing

The case report involved a male 37-year old Turkish (imprisoned) farmer, father of two children, with only basic education. After sewing his lips together, the man was brought into the hospital by the police, along with a handwritten note that read: “My jinns imposed speech ban to me and they made me sew my lips unwillingly. Otherwise, they threaten me with my children. I want to meet a psychiatrist urgently”. (Jinns I later learned are – in Arabian and Muslim mythology – intelligent spirits of lower rank than the angels, able to appear in human and animal forms and are able to possess humans). Not only were his lips sown together with black thread but he had also sewn both of his ears to the side of his head (these are also photographed in the paper and you can download the report free from here). This was actually the fourth time the man had sewed his lips together (but the first that he had sewn his ears). Each time, the doctors took out the stitches and dressed the wounds. The authors examined previous documentation about the man and reported that the man had been in prison for four years after injuring someone (no details were provided) and had been diagnosed with both anxiety disorder and anti-social personality disorder. On a prison ward comprising ten other prisoners, he had attempted suicide when trying to hang himself (in fact, you can clearly see the marks on his neck in the paper’s photographs). The authors reported that:

[The man] had blunted affect. He wasn’t able to stay in the [prison] ward because of the directive voices in his head. He declared he needed to stay in the ward alone. He heard all the words as swearing and he was punished by some people as well as some entities. He also said that some jinns in the form of animals threatened him not to speak and listen to anyone; otherwise they were going to kill his kids. He wanted to protect his children [and] he stitched his lips not to speak anyone and stitched his ears not to hear anyone. In his family history, he stated that his uncle committed suicide by hanging himself and saying ‘the birds are calling me’; his father was schizophrenia-diagnosed”.

The authors then reported:

“The patient stated that he sewed his lips with any colour of thread he could find. He had approximately fifteen pinholes on his upper and lower lips. He tended to suicide with directive auditory and visual hallucination (sic) and reference paranoid delirium. As he was imprisoned, he wasn’t able to use drugs. The patient who was thought to have a psychotic disorder was injected [with] 10 mg haloperidol intramuscularly and he was sent to a safe psychiatry hospital”.

As I have noted in my previous blogs on self-harming behaviour (and as noted in this particular paper), there are many different definitions of what constitutes self-destructive behaviour. This particular case was said to be suited to the psychotic behaviours characterised by Dr. Armando Favazza’s three self-destructive behaviours (i.e., compulsive, typical, and psychotic) outlined in his 1992 paper ‘Repetitive self-mutilation’ (published in the journal Psychiatry Annals). In their discussion of the case, the authors noted:

“The cases like sewing one’s own lips which we observe as a different type of destructing oneself in our case are mostly regarded as intercultural expression of feelings. The ones, who sew their lips in order to protest something, show their reactions by blocking the nutrition intake organ to the ones who want to continue their superiority. It can be expected in psychotic cases that the patients or his beloved ones might be harmed, damaged or affected emotionally. Thus, the patient who is furious and anxious might react by [attempting] violence as a reaction to these repetitive threats. Auditory hallucinations giving orders can cause the aggressive behaviours to start…In our psychotic case, this kind of behaviour is a way to prevent the voices coming from his inner world, not to answer them and hence making passive defending to world which he does not want to interact. By this means, he may harmonise with the secret natural powers which affect him and he may protect himself his children…[also] there can be a relief through sewing lips and ears or strangulation against the oppression created by the person not being able to adapt the prison…It should not be forgotten that the prison is a stressful environment and stressful living [increases] the disposition to psychopathologic behaviour that the living difficulties in prisons can affect the way of thinking and the capacity of coping and it may cause different psychiatric incidences”.

As noted at the start of this article, lip sewing is typically attributed to religious reasons, reasons of protest or aesthetic reasons. In this particular case, none of these reasons was apparent (and therefore notable – in the medical and psychiatric literature at the very least). The addition of sewing his ears appears to be even more rare, and thus warrants further research.

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

Further reading

Favazza, A.R. (1992). Repetitive self-mutilation. Psychiatric Annals, 22(2), 60-63.

Taktak, S., Ersoy, S., Ünsal, A., & Yetkiner, M. (2014). The man who sewed his mouth and ears: A case report. Health Care Current Reviews, 2(121), 2.

Taktak, S., Karakus, M., & Eke, S. M. (2015). The man whose fetish object is ejaculate: A case report. Journal of Psychiatry, 18(276), 2.

Taktak, S., Karakuş, M., Kaplan, A., & Eke, S. M. (2015). Shoe fetishism and kleptomania comorbidity: A case report. European Journal of Pharmaceutical and Medical Research, 2, 14-19.

Taktak, S., Yılmaz, E., Karamustafalıoglu, O., & Ünsal, A. (2016). Characteristics of paraphilics in Turkey: A retrospective study – 20years. International Journal of Law and Psychiatry, in press.

Wikipedia (2016). Lip sewing. Located at: https://en.wikipedia.org/wiki/Lip_sewing