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.

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.

CWS has been described as an obsessive–addictive 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.

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

Higher and higher: Can psychoactive substance use enhance creativity?

In a previous blog I examined whether celebrities are more prone to addictions. In that article I argued that many high profile celebrities have the financial means to afford a drug habit like cocaine or heroin. For many in the entertainment business such as being the lead singer in a famous rock band, taking drugs may also be viewed as one of the defining behaviours of the stereotypical ‘rock ‘n’ roll’ lifestyle. In short, it’s almost expected. There is also another way of looking at the relationship between celebrities and drugs and this is in relation to creativity, particularly as to whether the use of drugs can inspire creative writing or music. For instance, did drugs like cannabis and LSD help The Beatles create some of the best music ever such as Revolver? Did the Beach Boys’ Brian Wilson’s use of drugs play a major role in why the album Pet Sounds is often voted the best album of all time? Did the use of opium by Edgar Allen Poe create great fiction? Did William S. Burroughs’ use of heroin enhance his novel writing?

To investigate the question of whether drug use enhances creativity, I and my research colleagues Fruzsina Iszáj and Zsolt Demetrovics have just published a review paper in the International Journal of Mental Health and Addiction examining this issue. We carried out a systematic review of the psychological literature and reviewed any study that provided empirical data on the relationship between psychoactive substance use and creativity/artistic creative process that had been published in English in peer-reviewed journals or scientific books. Following a rigorous filtering process, we were surprised to find only 19 studies that had empirically examined the relationship between drug use and creativity (14 empirical studies and five case studies).

Six of the 19 studies (four empirical papers and two case reports) were published during the 1960s and 1970s. However, following the peak of psychedelia, only three papers (all of them empirical) were published in the following 20 years. Since 2003, a further 10 studies were published (seven empirical papers and three case studies). The majority of the studies (58%) were published in the USA. This dominance is especially true for the early studies in which six of the seven empirical papers and both case studies that were published before mid-1990s were written by US researchers. However, over the past 14 years, this has changed. The seven empirical papers published post-2000 were shared between six different countries (USA, UK, Italy, Wales, Hungary, Austria), and the three case studies came from three countries (USA, UK, Germany).

Seven empirical papers and two case studies dealt with the relationship between various psychoactive substances and artistic creation/creativity. Among the studies that examined a specific substance, six (three empirical papers and three case studies) focused on the effects of either LSD or psilocybin. One empirical study focused on cannabis, and one concerned ayahuasca.

With the exception of one study where the sample focused on adolescents, all the studies comprised adults. More non-clinical samples (15 studies, including case studies) were found than clinical ones (four studies). Three different methodological approaches were identified. Among the empirical studies, seven used questionnaires comprising psychological assessment measures such as the Torrance Test of Creative Thinking (TTCT).

According to the types of psychoactive substance effect on creativity, we identified three groups. These were studies that examined the effect of psychedelic substances (n=5), the effect of cannabis (n=1), and those that did not make a distinction between substances used because of the diverse substances used by participants in the samples (n=7). In one study, the substances studied were not explicitly identified.

The most notable observation of our review was that the findings of these studies show only limited convergence. The main reason for this is likely to be found in the extreme heterogeneity concerning the objectives, methodology, samples, applied measures, and psychoactive substances examined among the small number of studies. Consequently, it is hard to draw a clear conclusion about the effect of psychoactive substance use on creativity based on the reviewed material.

Despite the limited agreement, most of the studies confirmed some sort of association between creativity and psychoactive substance use, but the nature of this relationship was not clearly established. The frequently discussed view that the use of psychoactive substances leads to enhanced creativity was by no means confirmed. What the review of relevant studies suggests is that: (i) substance use is more characteristic in those with higher creativity than in other populations, and (ii) it is probable that this association is based on the inter-relationship of these two phenomena. At the same time, it is probable that there is no evidence of a direct contribution of psychoactive substances to enhanced creativity of artists.

It is more likely that substances act indirectly by enhancing experiences and sensitivity, and loosening conscious processes that might have an influence on the creative process. This means the artist will not be more creative but the quality of the artistic product will be altered due to substance use. On the other hand, it appears that psychoactive substances may have another role concerning artists, namely that they stabilize and/or compensate a more unstable functioning.

Beyond the artistic product, we also noted that (iii) specific functions associated with creativity appear to be modified and enhanced in the case of ordinary individuals due to psychoactive substance use. However, it needs to be emphasized that these studies examined specific functions while creativity is a complex process. In light of these studies, it is clear that psychoactive substances might contribute to a change of aesthetic experience, or enhanced creative problem solving. One study (a case study of the cartoonist Robert Crumb) showed that LSD changed his cartoon illustrating style. Similarly, a case study of Brian Wilson argued that the modification of musical style was connected to substance use. However, these changes in themselves will not result in creative production (although they may contribute to the change of production style or to the modification of certain aspects of pieces of arts). What was also shown is that (iv) in certain cases, substances may strengthen already existing personality traits.

In connection with the findings reviewed, one should not overlook that studies focused on two basically different areas of creative processes. Some studies examined the actual effects of a psychoactive substance or substances in a controlled setting, while others examined the association between creativity and chronic substance users. These two facets differ fundamentally. While the former might explain the acute changes in specific functions, the latter may highlight the role of chronic substance use and artistic production.

It should also be noted that the studies we reviewed differed not only regarding their objectives and methodology, but also showed great heterogeneity in quality. Basic methodological problems were identified in many of these studies (small sample sizes, unrepresentative samples, reliance on self-report and/or non-standardized assessment methods, speculative research questions, etc.). Furthermore, the total number of empirical studies was very few. At the same time, the topic is highly relevant both in order to understand the high level of substance use in artists and in order to clarify the validity of the association present in public opinion. However, it is important that future studies put specific emphasis on adequate methodology and clear research questions.

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

Further reading

Belli, S. (2009). A psychobiographical analysis of Brian Douglas Wilson: Creativity, drugs, and models of schizophrenic and affective disorders. Personality and Individual Differences, 46, 809-819.

Dobkin de Rios, M. & Janiger, O. (2003). LSD, spirituality, and the creative process. Rochester, VT: Park Street Press.

Edwards, J. (1993). Creative abilities of adolescent substance abusers. Journal of Group         Psychotherapy, Psychodrama & Sociometry, 46, 52-60.

Fink, A., Slamar-Halbedl, M., Unterrainer, H.F. & Weiss, E.M. (2012). Creativity: Genius, madness, or a combination of both? Psychology of Aesthetics, Creativity, and the Arts, 6(1), 11–18.

Forgeard, M.J.C. & Elstein, J.G. (2014). Advancing the clinical science of creativity. Frontiers in Psychology, 5, 613.

Frecska, E., Móré Cs. E., Vargha, A. & Luna, L.E. (2012). Enhancement of creative expression and entoptic phenomena as after-effects of repeated ayahuasca ceremonies. Journal of Psychoactive Drugs, 44, 191-199

Holm-Hadulla, R.M. & Bertolino, A. (2014). Creativity, alcohol and drug abuse: The pop icon Jim Morrison. Psychopathology, 47,167-73

Iszáj, F. & Demetrovics, Z. (2011). Balancing between sensitization and repression: The role of opium in the life and art of Edgar Allan Poe and Samuel Taylor Coleridge. Substance Use and Misuse, 46, 1613-1618

Iszaj, F., Griffiths, M.D. & Demetrovics, Z. (2016). Creativity and psychoactive substance use: A systematic review. International Journal of Mental Health and Addiction. doi: 10.1007/s11469-016-9709-8

Jones, M.T. (2007). The creativity of crumb: Research on the effects of psychedelic drugs on the comic art of Robert Crumb. Journal of Psychoactive Drugs, 39, 283-291.

Jones, K.A., Blagrove, M. & Parrott, A.C. (2009). Cannabis and ecstasy/ MDMA: Empirical measures of creativity in recreational users. Journal of Psychoactive Drugs. 41(4), 323-329

Kerr, B. & Shaffer, J. & Chambers, C., & Hallowell, K. (1991). Substance use of creatively talented adults. Journal of Creative Behavior, 25(2), 145-153.

Knafo, D. (2008). The senses grow skilled in their craving: Thoughts on creativity and addiction. Psychoanalytic Review, 95, 571-595.

Lowe, G. (1995). Judgements of substance use and creativity in ’ordinary’ people’s everyday lifestyles. Psychological Reports. 76, 1147-1154.

Oleynick, V.C., Thrash, T. M., LeFew, M. C., Moldovan, E. G. & Kieffaber, P. D. (2014). The scientific study of inspiration in the creative process: challenges and opportunities. Frontiers in Human Neuroscience, 8, 436.

Plucker, J.A., McNeely, A. & Morgan, C. (2009). Controlled substance-related beliefs and use: Relationships to undergraduates’ creative personality traits. Journal of Creative Behavior, 43(2), 94-101

Preti, A. & Vellante, M. (2007). Creativity and psychopathology. Higher rates of psychosis proneness and nonright-handedness among creative artists compared to same age and gender peers. Journal of Nervous and Mental Disease, 195(10), 837-845.

Schafer, G. & Feilding, A. & Morgan, C. J. A. & Agathangelou, M. & Freeman, T. P. &      Curran, H.V. (2012). Investigating the interaction between schizotypy, divergent thinking and cannabis use. Consciousness and Cognition, 21, 292–298

Thrash, T.M., Maruskin, L.A., Cassidy, S. E., Fryer, J.W. & Ryan, R.M. (2010). Mediating between the muse and the masses: inspiration and the actualization of creative ideas. Journal of Personality and Social Psychology, 98, 469–487.

Go sober this October: How to lower your alcohol intake this month

Last week I was interviewed by the Daily Telegraph about this year’s  ‘Go Sober For October‘ (“Octsober”) campaign. In addition to wanting some tips on how to cut down alcohol intake (see below), they wanted to know why people are so reliant on alcohol to relieve stress, socialise and escape. On a very simple level, alcohol is a pharmacological depressant that enhances disinhibition (i.e., a disregard for social conventions) and which is both physiologically and psychologically rewarding. Like most addictive behaviours it is a mood modifier that can either get individuals high, excited, buzzed up and aroused or (somewhat paradoxically) do the exact opposite and help them escape, numb, relax and de-stress. The fact that it’s socially condoned and widely available make it a perfect substance for individuals to use and misuse.

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

Don’t go it alone: If you really want to cut down your alcohol intake, try do it with your friends and family together. Doing it with others rather than on your own means you will have others around you going through the same thing as yourself as well as having a ready made support group.

Don’t buy rounds of drinks in pubs and clubs: If you’ve ever been out on a pub crawl with friends, you will know that you tend to drink at the pace of the quickest drinker in the group (and this may be at a quicker rate than you would ideally prefer). If you do want to drink in rounds, then try opting out every other round and/or try to drink with a smaller group of friends (as larger groups typically lead to more alcohol being drunk over the course of an evening).

Spread out your drinking and drink more slowly: Sounds obvious but it’s true. (As I noted above, in places where alcohol is very expensive this becomes a natural option). A related option is to have one alcoholic drink followed by one non-alcoholic drink throughout the evening.

Don’t buy pints, doubles or large glass drinks: When you do drink in pubs and clubs, order smaller measures (wine in a small glass rather than a large one, halves instead of pints, a bottle of lager rather than a pint of lager). All of these smaller options mean a reduced ‘alcohol by volume’ ratio (i.e., less alcohol actually consumed). If you are the kind of person who says to yourself ‘I never have more than two glasses of wine a night’, then changing to a smaller glass will have an immediate and appreciable effect in lowering overall alcohol intake.

Where possible choose non–alcoholic drinks: When you eat out or dine at home, have a soft drink, juice or water rather than wine or beer with your meal.

Dilute alcoholic drinks: If the option of a non-alcoholic drink isn’t always possible or simple doesn’t appeal, then dilute your drinks. Have a lager shandy or a white wine spritzer.

Have ‘alcohol-free’ days: If you drink every day, start by trying to drink alcohol every other day. If you drink alcohol a few times a week, try to drink just once a week. Just cutting down on your normal weekly pattern will help you to realise that you can go without alcohol.

Avoid cocktails: Cocktails often contains a lot more alcohol than people think.

Drink alcohol free beers and lagers: If you love the taste of lager or beer, there are alcohol free options. There are also an increasing number of fake cocktails (‘mocktails’).

Reward yourself for not drinking alcohol: Many people drink as a way to alleviate the stresses and strains of every day life (or to do the exact opposite – to celebrate the fact that you’ve done something well or because it is a special occasion). The money not spent on alcohol could go towards giving yourself another kind of treat or reward (a massage, the new CD you wanted, watching a film at the cinema, etc.).

Tell everyone in your social circle you’re cutting down alcohol intake: By telling everyone you know including family, friends and work colleagues, you will be more committed to not drinking alcohol than if you told no-one.

Avoid temptation: One of the key factors in any potentially addictive activity is knowing what the ‘triggers’ are (e.g., walking past a pub, watching television, having an argument with your loved one, etc.). Knowing what the triggers are can be a strategy for avoiding temptation (e.g., changing the routes on your way back home to avoid walking past your favourite pub, doing something else instead of watching television, etc.).

Get a new hobby: Changing one aspect of your routine life can also help change other aspects. Sometimes, changing one aspect of your life (such as introducing daily exercise) goes hand-in-hand with other areas of your life (drinking less alcohol, eating more healthily).

Think of the benefits of not drinking alcohol: Not drinking alcohol can bring lots of positives. In six months without alcohol I’ve lost about 6.35kg in weight because alcohol is high in calories (and that’s without exercise!). Other benefits include more money for other things, better quality sleep, less stress (because alcohol is a depressant), and better health.

Use alcohol tracking tools: Many apps are now available to help you keep track of your alcohol intake. For instance, the MyDrinkaware tool allows you to see how alcohol is affecting you on a number of different dimensions including your health (how many units you are consuming over time), weight (how many calories you are consuming over time), and finances (how much money you are spending on alcohol over time).

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

Further reading

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

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

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

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

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

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

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

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

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

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

Confession session: The psychology of apology

(Please note: The following blog is an extended version of an article that was first published earlier this year in the Nottingham Post).

Back in March 2016, Nottingham Labour Councillor Alan Rhodes made a public apology after the former social worker Andris Logins was jailed for 20 years for rape and abuse of children at a Nottinghamshire care home. Mr Rhodes said: “It was our role to keep children safe and we clearly didn’t” and that “we failed in our duty of care”. Although most of us apologise for all sorts of things each day, it’s becoming increasingly common for a ‘non-celebrities’ to say sorry in a public way – particularly for historical events that the person giving the apology had no part in.

There are three main ways of saying sorry. The first is the apology with no excuse, when we don’t try to justify what we’ve done. We simply take full responsibility and promise it will never happen again. Secondly, there’s the excuse apology when we say we’re sorry but also add it wasn’t our fault. For instance, we might blame someone else, an accident, human error, or a lapse of judgement. With the third type of apology, we don’t feel we’ve done wrong, but offer some sort of justification. If we’ve wronged someone, we might say they deserved it. We might even feel what we’ve done is so trivial it’s not even worth bothering about. Dr. Aaron Lazare, author of the 2005 book On Apology, says that an apology is one of the most profound interactions that two human beings can have between one another

But why do we apologise? Psychologist Dr. Guy Winch views apologies as linguistic tools that help us acknowledge violations of social expectations and norms. He also says that apologies help us take direct responsibility for the impact of our actions on other individuals and provide a way of asking for forgiveness. Consequently, we are able to repair our relationships with those individuals, restore our own social standing, and help ease guilt and/or shame. Confessing and saying sorry is a simple way to get rid of all those negative feelings. The guilt created by transgressions, such as lying on a CV, or cheating in an exam, can eat away at some people for years.

There also appear to be gender differences. Research studies have tended to find that women appear to say sorry far more than men, because men feel they’re ‘one down’ to someone if they offer an apology. In contrast, women will say sorry for things they haven’t done because they prefer to smooth things over quickly and keep relationships going. However, the differences may be more nuanced. One study found no differences between men and women in the number of the proportion of offenses that prompted apologies but men apologized less frequently than women because they had a higher threshold for what constitutes offensive behaviour. Another study found that men apologized more frequently to women than they did to other men.

We also appear to have developed a ‘confessional culture’ over recent years in which celebrities and politicians are keener than ever to publicly admit to their private indiscretions. It could be that we’re more forgiving of public figures and that because we know more about the pressures of fame, we empathise with them. Another reason might be we no longer care because we don’t think what someone does in the private life affects their job. One thing we do expect from public figures is for their apologies to be sincere.

Arguably one of the most high profile examples was former US president Bill Clinton and his sexual relationship with Monica Lewinsky. Although Clinton continually denied for seven months any such relationship, when he eventually said sorry in August 1998, it was seen as sincere and many people sympathised with him. By apologising sincerely, or appearing to, public figures demonstrate they’re human, with weaknesses just like the rest of us.

These days, celebrities are quick to admit to what they’ve done. Lots of actors, comedians, singers and sports people have confessed to their addictions to drugs, alcohol and gambling before checking into high profile clinics like The Priory. For some, it’s no doubt a cynical move to help their public image. By apologising promptly, they’re seen as being brave, and any bad publicity will die down more quickly. Those who offer belated, grudging apologies see their image suffer.

Apologies can also help those who receive them. Police forces up and down the country have piloted schemes where criminals are confronted by their victims and offered a chance to apologies (known as ‘restorative justice’). Many victims say the one thing they’d really appreciate is an apology, and they’re often grateful to receive on. As the saying goes, “sorry seems to be the hardest word” but it has the potential to mean so much to so many.

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

Further reading

Bachman, G. F., & Guerrero, L. K. (2006). Forgiveness, apology, and communicative responses to hurtful events. Communication Reports, 19(1), 45-56.

Griffiths, M.D. (2000). Saying sorry can make you feel so much better. The Sunday Post, January 23, p. 30-31.

Griffiths, M.D. (2016). Sorry may be the hardest word but more people than ever are saying it. Nottingham Post, April 11, p.14.

Fehr, R., & Gelfand, M.J. (2010). When apologies work: How matching apology components to victims’ self-construals facilitates forgiveness. Organizational Behavior and Human Decision Processes, 113(1), 37-50.

Frantz, C.M., & Bennigson, C. (2005). Better late than early: The influence of timing on apology effectiveness. Journal of Experimental Social Psychology, 41(2), 201-207.

Lazare, A. (2005). On Apology. Oxford: Oxford University Press.

Scher, S. J., & Darley, J. M. (1997). How effective are the things people say to apologize? Effects of the realization of the apology speech act. Journal of Psycholinguistic Research, 26(1), 127-140.

Struthers, C. W., Eaton, J., Santelli, A. G., Uchiyama, M., & Shirvani, N. (2008). The effects of attributions of intent and apology on forgiveness: When saying sorry may not help the story. Journal of Experimental Social Psychology, 44(4), 983-992.

Takaku, S. (2001). The effects of apology and perspective taking on interpersonal forgiveness: A dissonance-attribution model of interpersonal forgiveness. Journal of Social Psychology, 141(4), 494-508.

Takaku, S., Weiner, B., & Ohbuchi, K.I. (2001). A cross-cultural examination of the effects of apology and perspective taking on forgiveness. Journal of Language and Social Psychology, 20(1-2), 144-166.

Winch, G. (2013). Emotional First Aid: Healing Rejection, Guilt, Failure, and Other Everyday Hurts. London: Penguin.

Bog standard: A brief look at toilet tissue eating

In previous blogs I have looked at pica (i.e., the eating of non-nutritive items or substances) and subtypes of pica such as geophagia (eating of soil, mud, clay, etc.), pagophagia (eating of ice), acuphagia (eating of metal), and coprophagia (eating of faeces). It wasn’t until I started to research on specific sub-types of pica, that I discovered how many different types of non-food substances had been identified in the academic and clinical literature. For instance, Dr. V.J. Louw and colleagues provided a long list in a 2007 issue of the South African Medical Journal including cravings for the heads of burnt matches (cautopyreiophagia), cigarettes and cigarette ashes, paper, starch (amylophagia), crayons, cardboard, stones (lithophagia), mothballs, hair (trichophagia), egg shells, foam rubber, aspirin, coins, vinyl gloves, popcorn (arabositophagia), and baking powder. Most of these are generally thought to be harmless but as Louw and colleagues note, a wide range of medical problems have been documented:

“These include abdominal problems (sometimes necessitating surgery), hypokalaemia, hyperkalaemia, dental injury, napthalene poisoning (in pica for toilet air-freshener blocks), phosphorus poisoning (in pica for burnt matches), peritoneal mesothelioma (geophagia of asbestos-rich soil), mercury poisoning (in paper pica), lead poisoning (in dried paint pica and geophagia), and a pre-eclampsia-like syndrome (baking powder pica)”.

In the clinical literature, the eating of paper has been occasionally documented (although anecdotal evidence suggests this is fairly common and I remember doing it myself as a child). A review paper on pica by Dr. Silvestre Frenk and colleagues in the Mexican journal Boletín Médico del Hospital Infantil de México highlighted dozens of pica-subtypes and created many new names for various pica sub-types. They proposed that people who eat paper display ‘papirophagia’ (in fact if you type ‘papirphagia’ into Google, you only get one hit – the paper by Silvestre and colleagues – although this blog may make it two!). Eating paper is not thought to be particularly harmful although I did find a case of mercury poisoning because of ‘paper pica’ (as the authors – Dr. F. Olynk and Dr. D. Sharpe – called it) in a 1982 issue of the New England Journal of Medicine.

One sub-type of papirophagia is the eating of toilet paper. As far as I am aware, there is only one case study in the literature and this was published back in 1981, Dr. J. Chisholm Jr. and Dr. H. Martín in the Journal of the National Medical Association. They described the case of a 37-year old black woman with an “unusually bizarre craving” for toilet tissue paper. The authors reported that:

“[The] woman was referred for evaluation of disturbed smell and loss of taste for over one year. These were associated with chronic fatigue and listlessness. During this same period of time, she rather embarrassedly admitted to an overwhelming desire to eat toilet tissue. Frequently, she would awaken at night and dash to her bathroom to eat toilet tissue. No other type(s) of pica were admitted. In addition, she gave a long history of menorrhagia and frequently passed vaginal blood clots during her menses. Her libido was normal and there was no history of poor wound healing, skin or mucous membrane lesions, or intestinal symptoms. Her dietary history suggested a high carbohydrate diet, and due to a mild exogenous obesity she intermittently resorted to a vegan-like diet that included beans and various seeds”

A variety of medical tests were carried out and she was diagnosed with combined iron and zinc deficiency. She was treated with iron and zinc tablets and within a week, both her taste and smell had returned, and her energy levels greatly improved. Zinc deficiencies can lead to a wide variety of clinical disorders including loss of small and taste, anorexia, dwarfism (i.e., growth retardation), impaired wound healing, and geophagia. The woman’s (sometimes) vegan diet may have been to blame for her zinc deficiency as the authors noted that:

“Although vegetables contain zinc, vegans should be made aware that zinc from plant sources is not readily absorbed because naturally occurring phytates, particularly high in beans and seeds, reduce zinc gastrointestinal absorption. Carbohydrates are very poor sources of zinc. Chronic iron deficiency secondary to chronic menorrhagia accounts well for the anemia, fatigue, and unusual pica for toilet tissue noted in this patient”.

Paper pica has occasionally been mentioned in other academic papers although details have typically been limited. For instance, a 1995 paper in the journal Birth by Dr. N.R. Cooksey on three cases of pica in pregnancy reported that one of the women chewed non-perfumed blue toilet paper during the first trimester of her pregnancy (and was forced by her mother to stop). There was also a 2003 paper published by Dr. Dumaguing in the Journal of Geriatric Psychiatry and Neurology examining pica in mentally ill geriatrics. One of the cases mentioned was a 76-year old patient that not only ingested their medication (an emollient cream for arthritis) but was also recorded eating toilet paper, napkins, Styrofoam cups, crayons, and other patients’ medications.

A more recent 2008 paper by Dr. Sera Young and her colleagues in the journal PLoS ONE, critically reviewed procedures and guidelines for interviews and sample collection in relation to pica substances. In describing the protocols involved, they referred to paper pica in the questions that should be asked:

“What is the local name, brand name, or type of pica substance desired or consumed? This will help others to know if this substance has already been studied and assist interested researchers in obtaining subsequent samples at a later date. Furthermore, different manufactured products may contain different materials, e.g. Crayola chalkboard chalk contains slightly different ingredients from other brands. Similarly, the consequences of toilet tissue paper consumption are different from those of eating pages of a novel; information would be lost if the substance was simply described as paper. For these reasons, the substance consumed should be described in as much detail and as accurately as possible”.

Personally (and based on anecdotal evidence), I think that papirophagia is not overly rare (especially among children – although I admit this may be more out of curiosity that craving) but the clinical literature suggests that it is a fairly rare disorder found amongst distinct sub-groups (pregnant women, the mentally ill). Given the fact that for most people eating paper would not cause any problems, this would provide the main reason why so few cases end up seeking medical, clinical, and/or psychological help.

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

Further reading

Chisholm Jr, J. C., & Martín, H. I. (1981). Hypozincemia, ageusia, dysosmia, and toilet tissue pica. Journal of the National Medical Association, 73(2), 163-164.

Cooksey, N.R. (1995). Pica and olfactory craving of pregnancy: How deep are the secrets? Birth, 22, 129-137.

Dumaguing, N.I., Singh, I., Sethi, M., & Devanand, D.P. (2003). Pica in the geriatric mentally ill: unrelenting and potentially fatal. Journal of Geriatric Psychiatry and Neurology, 16, 189-191.

Frenk, S., Faure, M.A., Nieto, S. & Olivares, Z. (2013). Pica. Boletín Médico del Hospital Infantil de México, 70(1), 55-61

Louw, V.J., Du Preez, P., Malan, A., Van Deventer, L., Van Wyk, D., & Joubert, G. (2007). Pica and food craving in adults with iron deficiency in Bloemfontein, South Africa. South African Medical Journal, 97, 1069-1071.

Olynyk, F., & Sharpe, D. H. (1982). Mercury poisoning in paper pica. The New England Journal of Medicine, 306, 1056 -1057.

Young, S.L., Wilson, M.J., Miller, D., Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS ONE, 3(9), e3147. doi:10.1371/journal.pone.0003147

Imitate modern: Why do people commit copycat killings?

The nine people murdered in Munich a couple of days ago by 18-year-old German-Iranian gunman David Ali Sonboly made headlines around the world. It has been claimed that Sonboly (who subsequently killed himself) was “obsessed with mass shootings” and that the police found lots of material in his room about mass killings including the massacre by Norway’s Anders Behring Breivik. Whether the murders by Sonboly are ‘copycat’ killings remains to be determined but there are dozens of other cases where copycat killings have been proven.

Back in 2014, the gruesome killing of two prostitutes in Hong King by British banking trader Rurik Jutting drew comparisons with the fictional character Patrick Bateman, the Wall Street investment banker and serial killer in the film American Psycho (based on the Bret Easton Ellis book of the same name).

As you might expect, a copycat murder is defined as a murder that has been modelled, motivated and/or inspired either by a real life murderer that has been reported by the print or broadcast media, or is based on a murderer portrayed in books, television or film. The term ‘copycat killer’ has been in use for almost 100 years and was first used in relation to murders that mimicked those of Jack the Ripper. Early research by criminologists began to speculate that the sensationalist publicity in the print media about the Ripper murders was the inspiration for Ripper-like copycat killings.

In addition to murder, copycat crimes have been shown to occur in many other equally destructive acts including suicides, murder-suicides, familicides, and rampage killings. Arguably the most well known writing on the topic was Loren Coleman’s 2004 book The Copycat Effect. Coleman believes that because shocking crimes receive widespread media publicity it makes the perpetrators infamous. He argues that the notoriety and ‘fame’ that serial killers receive is one of the main reasons why copycats commit similar crimes. Put more simply, copycats may believe that by committing heinous crimes, they may end up being the subject of a book or film themselves. The Copycat Effect is so well known that it was even the subject of a Hollywood film – the 1995 psychological thriller Copycat starring Sigourney Weaver as a criminal psychologist involved in a case where each murder in the film is made by a serial killer meticulously copying previous high profile murderers such as Ted Bundy, Jeffrey Dahmer (the ‘Milwaukie Cannibal’), David Berkowitz (the ‘Son of Sam’), and the Hillside Strangler (actually two men, Kenneth Bianchi and Angelo Buono).

But is the media to blame for copycat murders? Well, partly – but not totally. Research has shown that although most people convicted of copycat murders admit to being motivated by something they had seen on the news or in a film, they already had a criminal record (often violent crime) and/or were mentally ill before they began killing. What this suggests is that media coverage and fictionalized accounts of serial killers tend to affect those that already have a criminal predisposition and/or mental health issues rather than have a more widespread effect on people more generally. In such extreme and minority cases, it does appear that watching or reading about high profile murderers (e.g., Jeffrey Dahmer, Ed Gein) or infamous fictionalised killers (e.g., Dexter Morgan in Dexter or Patrick Batemen in American Psycho) does at the very least give emotionally undeveloped people ideas on how they could kill someone.

Copycat murderers do appear to realise that the more shocking and heinous the killing, the more newsworthy it will be. This also appears to have had an impact on films too. It appears some cinema-going audience want to see more depraved, deranged and twisted ways in which people can be killed (as evidenced by the so-called ‘torture porn’ franchises of Saw and Hostel). The more blood and pain, the better. Methods to kill in such films may be the inspiration of copycat killers to come.

Although there is a relationship between copycat killers and what they have seen or read about in the media, there are many other risk factors that have been associated with (and have an interplay with) copycat killings. Men are more likely to be copycat killers than females, and many copycat killers are young adults (below the age of 30 years). Copycat killers are more likely to suffer from personality (and other mental health) disorders, come from socially dysfunctional and alienating family backgrounds, be emotionally vulnerable, be trusting of the media, and – as noted above – a previous criminal history (as well as self-identifying with criminals they have watched or seen in fact and/or fiction).

Psychologists have also noted there appears to be a natural human inhibition against killing (even in acts of lawful killing such as fighting in a war). However, if individuals adopt some kind of a persona, such inhibitions can be reduced (often referred to by psychologists as ‘depersonalization’). If copycat killers temporarily take on the persona of the person they are copying in addition to the act of killing, this may also play a contributory role in some of their actions. American evolutionary psychologist Dr.Nigel Barber has also noted in relation to rampage killing that: “Most copycats have their private agenda in a rampage killing but seek to tie it in to other events that received a lot of publicity. In this way, they bask in the reflected publicity, so to speak. In many cases, the rampage killer wants to commit suicide but opts to take others with him”.

Although there are many reasons as to how and why an individual becomes a copycat killer, the evidence does seem to suggest that the media perhaps need to take a more cautionary approach when reporting the details of murders, and also suggests that the police and other criminal agencies should not go into every detail about how the murders were committed. Such actions alone will not stop copycat killings, but it may help reduce the overall number occurring in the first place.

(Material in this blog first appeared in an article I wrote for The Independent in November 2014 – see ‘Further reading’ below)

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

Further reading

Barber, N. (2012). Copycat killings: Making sense of the senseless. Psychology Today, July 27. Located at: https://www.psychologytoday.com/blog/the-human-beast/201207/copycat-killings

Boyle, K. (2001). What’s natural about killing? Gender, copycat violence and Natural Born Killers. Journal of Gender Studies, 10(3), 311-321.

Coleman, L. (2004). The copycat effect: How the media and popular culture trigger the mayhem in tomorrow’s headlines. New York: Simon and Schuster.

Fox, J.A., & Levin, J. (2014). Extreme killing: Understanding serial and mass murder. London: Sage.

Griffiths, M.D. (2014). Hong Kong murder: Why do people commit copycat killings? The Independent, November 4. Located at: http://www.independent.co.uk/life-style/health-and-families/features/hong-kong-murder-why-do-people-commit-copycat-killings-9838892.html

Kunich, J.C. (2000). Natural born copycat killers and the law of shock torts. Washington University Law Quarterly, 78(4), 1157-1270.

Surette, R. (2002). Self-reported copycat crime among a population of serious and violent juvenile offenders. Crime and Delinquency, 48(1), 46-69.

Wikipedia (2016). Copycat crime. Located at: https://en.wikipedia.org/wiki/Copycat_crime

More term warfare: Is the concept of ‘internet addiction’ a misnomer?

A recent study by Professor Phil Reed and his colleagues published in the Journal of Clinical Psychiatry provided some experimental evidence that internet addicts may be conditioned by what they view on the screen. Given that I was the first person in the world to publish an academic paper on internet addiction back in November 1996 it’s good to see that the number of studies into internet addiction has grown substantially over the last 20 years and that there are now hundreds of studies that have investigated the disorder worldwide in many different ways.

This newly published study is one of the few in the field that has investigated internet addiction from an experimental perspective (as opposed the majority that use self-report survey methods and the increasing number of neuroimaging studies examining what happens inside the brains of those who spend excessive amounts of time online).

Professor Reed’s study involved 100 adult volunteers who were deprived of internet access for four hours. The research team then asked the participants to name a colour (the first one that they could think of) and then gave them 15 minutes to access any websites that they wanted to on the internet. The research team monitored all the sites that the participants visited and after the 15-minute period they were again asked to think of the first colour that came to mind. The participants were also asked to complete various psychometric questionnaires including the Internet Addiction Test (IAT). The IAT is a 20-item test where each item is scored from 0 [not applicable] or 1 [rarely] up to 5 [always]. An example item is “How often do you check your e-mail before something else that you need to do?” Those scoring 80 or above (out of 100) are typically defined as having a probable addiction to the internet by those who have used the IAT in previous studies.

Those classed as “high problem [internet] users” on the basis of IAT scores (and who were deprived internet access) were more likely to choose a colour that was prominent on the websites they visited during the 15-minute period after internet deprivation. This wasn’t found in those not classed as internet addicts. Professor Reed said:

“The internet addicts chose a colour associated with the websites they had just visited [and] suggests that aspects of the websites viewed after a period without the net became positively valued. Similar findings have been seen with people who misuse substances, with previous studies showing that a cue associated with any drug that relieves withdrawal becomes positively valued itself. This is the first time though that such an effect has been seen for a behavioural addiction like problematic internet usage”.

While this is an interesting finding there are some major shortcomings both from a methodological standpoint and from a more conceptual angle. Firstly, the number of high problem internet users that were deprived internet access for four hours comprised just 12 individuals so the sample size was incredibly low. Secondly, the individuals classed as high problem internet users had IAT scores ranging from 40 to 72. In short, it is highly unlikely that any of the participants were actually addicted to the internet. Thirdly, although the IAT is arguably the most used screen in the field, it has questionable reliability and validity and is now very out-dated (having been devised in 1998) and does not use the criteria suggested for Internet Disorder in the latest (fifth) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Using more recently developed instruments such as our own Internet Disorder Scale would have perhaps overcome some of these problems.

There are also much wider problems with the use of the term ‘internet addiction’ as most studies in the field have really investigated addictions on the internet rather than to the internet. For instance, individuals addicted to online gaming, online gambling or online shopping are not internet addicts. They are gambling addicts, gaming addicts or shopping addicts that are using the medium of the internet to engage in their addictive behaviour. There are of course some activities – such as social networking – that could be argued to be a genuine type of internet addiction as such activities only take place online. However, the addiction is to an application rather than the internet itself and this should be termed social networking addiction rather than internet addiction. In short, the overwhelming majority of so-called internet addicts are no more addicted to the internet than alcoholics are addicted to the bottle.

A shorter version of this article was first published in The Conversation

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

Further reading

Griffiths, M.D. & Kuss, D.J. (2015). Online addictions: The case of gambling, video gaming, and social networking. In Sundar, S.S. (Ed.), Handbook of the Psychology of Communication Technology (pp.384-403). Chichester: Wiley-Blackwell.

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

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

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

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.

Osborne, L. A., Romano, M., Re, F., Roaro, A., Truzoli, R., & Reed, P. (2016). Evidence for an internet addiction disorder: internet exposure reinforces color preference in withdrawn problem users. Journal of Clinical Psychiatry, 77(2), 269-274.

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

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

Career to the ground: A brief overview of our recent papers on workaholism

Following my recent blogs where I outlined some of the papers that my colleagues and I have published on mindfulness, Internet addiction, gaming addiction, sex addiction, responsible gambling, shopping addiction, exercise addiction, and youth gambling, here is a round-up of papers that my colleagues and I have published on workaholism and work addiction over the last few years.

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

• Research into excessive work has gained increasing attention over the last 20 years. Terms such as “workaholism,””work addiction” and “excessive work” have been used interchangeably. Given the increase in empirical research, this study presents the development of the Bergen Work Addiction Scale (BWAS), a new psychometrically validated scale for the assessment of work addiction. A pool of 14 items, with two reflecting each of seven core elements of addiction (i.e., salience, mood modification, tolerance, withdrawal, conflict, relapse, and problems) was initially constructed. The items were then administered to two samples, one recruited by a web survey following a television broadcast about workaholism (n=11,769) and one comprising participants in the second wave of a longitudinal internet-based survey about working life (n=368). The items with the highest corrected item-total correlation from within each of the seven addiction elements were retained in the final scale. The assumed one-factor solution of the refined seven-item scale was acceptable (root mean square error of approximation=0.077, Comparative Fit Index=0.96, Tucker-Lewis Index=0.95) and the internal reliability of the two samples were 0.84 and 0.80, respectively. The scores of the BWAS converged with scores on other workaholism scales, except for a Work Enjoyment subscale. A suggested cut-off for categorization of workaholics showed good discriminative ability in terms of working hours, leadership position, and subjective health complaints. It is concluded that the BWAS has good psychometric properties.

Andreassen, C.S., Griffiths, M.D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: A survey study in a nationally representative sample of Norwegian employees. PLoS ONE, 9(8): e102446. doi:10.1371/journal.pone.0102446.

• Workaholism has become an increasingly popular area for empirical study. However, most studies examining the prevalence of workaholism have used non-representative samples and measures with poorly defined cut-off scores. To overcome these methodological limitations, a nationally representative survey among employees in Norway (N = 1,124) was conducted. Questions relating to gender, age, marital status, caretaker responsibility for children, percentage of full-time equivalent, and educational level were asked. Workaholism was assessed by the use of a psychometrically validated instrument (i.e., Bergen Work Addiction Scale). Personality was assessed using the Mini-International Personality Item Pool. Results showed that the prevalence of workaholism was 8.3% (95% CI= 6.7–9.9%). An adjusted logistic regression analysis showed that workaholism was negatively related to age and positively related to the personality dimensions agreeableness, neuroticism, and intellect/imagination. Implications for these findings are discussed.

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

• Workaholism was first conceptualized in the early 1970s as a behavioral addiction, featuring compulsive use and interpersonal conflict. The current article briefly examines the empirical and theoretical literature over the past four decades. In relation to conceptualization and measurement, how the concept of workaholism has worsened from using dimensions based on anecdotal evidence, ad-hoc measures with weak theoretical foundation, and poor factorial validity of multidimensional conceptualizations is highlighted. Benefits of building on the addiction literature to conceptualize workaholism are presented (including the only instrument that has used core addiction criteria: the Bergen Work Addiction Scale). Problems estimating accurate prevalence estimates of work addiction are also presented. Individual and sociocultural risk factors, and the negative consequences of workaholism from the addiction perspective (e.g., depression, burnout, poor health, life dissatisfaction, family/relationship problems) are discussed. The current article summarizes how current research can be used to evaluate workaholism by psychiatric–mental health nurses in clinical practice, including primary care and mental health settings.

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

• Introduction: Research on the consequences of sickness presenteeism, or the phenomenon of attending work whilst ill, has focused predominantly on identifying its economic, health, and absenteeism outcomes, in the process neglecting important attitudinal-motivational outcomes. Purpose: A mediation model of sickness presenteeism as a determinant of job satisfaction via affective-motivational states (specifically engagement with work and addiction to work) is proposed. This model adds to the current literature, by focussing on (i) job satisfaction as an outcome of presenteeism, and (ii) the psychological processes associated with this. It posits sickness presenteeism as psychological absence and work engagement and work addiction as motivational states that originate in that. Methods: An online survey on sickness presenteeism, work engagement, work addiction, and job satisfaction was completed by 158 office workers. Results: The results of bootstrapped mediation analysis with observable variables supported the model. Sickness presenteeism was negatively associated with job satisfaction. This relationship was fully mediated by both engagement with work and addiction to work, explaining a total of 48.07% of the variance in job satisfaction. Despite the small sample, the data provide preliminary support for the model. Conclusions: Given that there is currently no available research on the attitudinal consequences of sickness presenteeism, these findings offer promise for advancing theorising in this area.

Quinones, C., Griffiths, M.D. & Kakabadse, N. (2016). Compulsive Internet use and workaholism: An exploratory two-wave longitudinal study. Computers in Human Behavior, 60, 492-499.

• Workaholism refers to the uncontrollable need to work and comprises working compulsively (WC) and working excessively (WE). Compulsive Internet Use (CIU), involves a similar behavioural pattern although in specific relation to Internet use. Since many occupations rely upon use of the Internet, and the lines between home and the workplace have become increasingly blurred, a self-reinforcing pattern of workaholism and CIU could develop from those vulnerable to one or the other. The present study explored the relationship between these compulsive behaviours utilizing a two-wave longitudinal study over six months. A total of 244 participants who used the Internet as part of their occupational role and were in full-time employment completed the online survey at each wave. This survey contained previously validated measures of each variable. Data were analysed using cross-lagged analysis. Results indicated that Internet usage and CIU were reciprocally related, supporting the existence of tolerance in CIU. It was also found that CIU at Time 1 predicted WC at Time 2 and that WE was unrelated to CIU. It is concluded that a masking mechanism appears a sensible explanation for the findings. Although further studies are needed, these findings encourage a more holistic evaluation and treatment of compulsive behaviours.

Orosz, G., Dombi, E., Andreassen, C.S., Griffiths, M.D. & Demetrovics, Z. (2016). Analyzing models of work addiction: Single factor and bi-factor models of the Bergen Work Addiction Scale. International Journal of Mental Health and Addiction, in press.

• Work addiction (‘workaholism’) has become an increasingly studied topic in the behavioral addictions literature and had led to the development of a number of instruments to assess it. One such instrument is the Bergen Work Addiction Scale (BWAS). However, the BWAS has never been investigated in Eastern-European countries. The goal of the present study was to examine the factor structure, the reliability and cut-off scores of the BWAS in a comprehensive Hungarian sample. This study is a direct extension of the original validation of BWAS by providing results on the basis of representative data and the development of appropriate cut-off scores. The study utilized an online questionnaire with a Hungarian representative sample including 500 respondents (F = 251; Mage = 35.05 years) who completed the BWAS. A series of confirmatory factor analyses were carried out leading to a short, 7-item first-order factor structure and a longer 14-item seven-factor nested structure. Despite the good validity of the longer version, its reliability was not as high as it could have been. One-fifth (20.6 %) of the Hungarians who used the internet at least weekly were categorized as work addicts using the BWAS. It is recommended that researchers use the original seven items from the Norwegian scale in order to facilitate and stimulate cross-national research on addiction to work.

Andreassen, C.S., Griffiths, M.D., Sinha, R., Hetland, J. & Pallesen, S. (2016). The relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PLoS ONE, 11(5): e0152978. doi:10.1371/journal. pone.0152978.

• Despite the many number of workaholism studies, large-scale studies have been lacking. The present study utilized an open web-based cross-sectional survey assessing symptoms of psychiatric disorders and workaholism among 16,426 workers (M_age=37.3 years, SD₌11.4, range=16-75 years). Participants were administered the Adult ADHD Self-Report Scale, the Obsession-Compulsive Inventory-Revised, the Hospital Anxiety and Depression Scale, and the Bergen Work Addiction Scale, along with additional questions examining demographic and work-related variables. Analyses of variance revealed significant workaholism group differences in terms of age, marital status, education, professional position, work sector, occupation, and annual income. No gender differences were found, except in a logistic regression analysis, indicating that women had a greater risk than men of being categorized as workaholics. Correlations between all psychiatric symptoms and workaholism were significant and positively correlated. Workaholism comprised the dependent variable in a four-step linear multiple hierarchical regression analysis as well as in a logistic regression analysis. In the linear regression analysis demographics (age, gender, and marital status) explained 0.8% of the variance in workaholism. The mental health variables (ADHD, OCD, anxiety, and depression) explained between 1.9% and 11.9% of the variance. In an adjusted logistic regression analysis, all psychiatric symptoms were positively associated with workaholism. Although most effect sizes were relatively small, the study’s findings expand our understanding of possible mental health predictors of workaholism, and sheds new light on the reality of adult ADHD in work life. The study’s implications, strengths, and shortcomings are also discussed.

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

Further reading

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

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

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

Karanika-Murray, M., Duncan, N., Pontes, H. & Griffiths, M.D. (2015). Organizational identification, work engagement, and job satisfaction. Journal of Managerial Psychology, 30, 1019-1033.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.