My Strange Addiction: The wonderful world of the weird

In a previous blog, I examined a case of so-called ‘hair dryer dependence’. The source material for this blog came from one of the people who had appeared on the TLC (The Learning Channel) documentary television series My Strange Addiction. Immediately after I had written the blog I was emailed by one of the researchers on the show asking if I could help getting people on the show for the next series (Season 4).

For those who have no idea what I am talking about, My Strange Addiction is a US TV documentary show that features stories about people with unusual behaviours. Very few of the behaviours they have featured so far would be classed as addictions in the way that I define them. However, some of the behaviours are genuine obsessions and/or compulsions while others have not been the focus of any kind of medical and/or psychiatric diagnosis.

So far, the show has featured people with various obsessive-compulsive disorders (some of which I have examined in my blog) including body dysmorphic disorder, pica (the eating of non-food such as paper, mud, glass, metal), exercise bulimia, trichotillomania (compulsive hair pulling), dermatillomania (compulsive skin picking), thumb-sucking, furry fandom, excessive laxative use, urine drinking, paraphilic infantilism (being an adult baby), and dating cars.

MY STRANGE ADDICTION: A CALL FOR PARTICIPANTS

If anyone out there thinks they have an interesting story that My Strange Addiction might like to hear about, the show’s producers would really appreciate any help they can get in reaching people who may be good potential candidates for their TV show.

• Are you currently struggling to overcome a strange obsession, addiction or compulsive behavior that is taking over your life?
• Do you spend countless hours obsessing about something or engaging in behavior that others would say is strange?
• Have you drained all of your finances into this obsession?
• Are your friends and family members concerned about your wellbeing?
• Would you like to regain control of your life and your health?

If you found yourself answering yes to any of these questions, you may qualify to be a participant in a major documentary series that offers professional assistance for those struggling with a strange obsession, compulsion, or addiction.

For consideration, please reply to this advert with your name, age, contact information, and brief explanation of how a strange addiction is taking over your life. You can also contact us directly at 312-467-8145 or 20westcastingteam@gmail.com. All submissions will remain confidential. Thank you for sharing your story.

Postscript: Alternatively, if you would like to tell me your story as part of my own academic research, then feel free to contact me at my academic email address: mark.griffiths@ntu.ac.uk.

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

Further reading and viewing

Griffiths, J. (2011). Review: My Strange Addiction. US Weekly January 25. http://www.usmagazine.com/entertainment/news/review–my-strange-addiction-2011251#ixzz1tYHsItPh

Internet Movie Database. My Strange Addiction. Located at: http://www.imdb.com/title/tt1809014/

My Strange Addiction Official Website. Located at: http://tlc.howstuffworks.com/tv/my-strange-addiction

TV.com. My Strange Addiction. Located at: http://www.tv.com/shows/my-strange-addiction/

Warming Glow. The 10 strangest addictions from  ‘My Strange Addiction’. http://warmingglow.uproxx.com/2012/02/10-strangest-my-strange-addictions#page/1

Wikipedia. My Strange Addiction. Located at: http://en.wikipedia.org/wiki/My_Strange_Addiction

Wikipedia. List of My Strange Addiction episodes. Located at: http://en.wikipedia.org/wiki/List_of_My_Strange_Addiction_episodes

Starstruck: Is fame addictive?

Back in the mid-1990s, I started doing some research on the psychology of fame with Dr. Adam Joinson (then at the University of Glamorgan but now at the Open University). One of the first things we did after setting up our website (the not-so-originally titled ‘The Psychology of Fame Project’) was go and interview PR guru and ‘fame-maker’ Max Clifford. We enjoyed our interview and published it in a 1998 issue of Psychology Post. One of the more interesting claims made by Max Clifford was his assertion that fame is addictive. Below is an extended extract from our interview with him. He said that:

“The sad part about [fame] is people that desperately need to become famous. It’s like a drug, it’s like a drug addict, and there’s so many people that come up and then they go, and when you meet them they are desperate, desperate for it. I mean, they are living ten, fifteen, twenty years ago when they were famous, they can’t accept they are no longer famous. It is an addiction. It’s a craving. It varies from individual to individual but it’s the same as drugs or alcohol or anything else. At it’s worst – and I’ve known a lot of the worst – it totally takes over your life, your philosophy, your outlook on everyday life. It’s tragic. The way it normally works is that somebody becomes famous so they follow the natural path. In other words, the bigger house, the bigger car, the bigger everything. They tend to isolate themselves from people that actually know them and possibly care about them because they aren’t there any more.

They then become surrounded by people who live off them, pick off them – PR’s, managers, PA’s – who say what the person wants to hear all the time. They become wrapped up in fame and get a totally jaundiced picture of life and reality. Life becomes emptier and emptier and then when the fame’s gone, they can’t handle it. There’s so many people who would do anything. Anything to be famous. It’s more important almost than life itself. It’s sad, it’s shocking, and it’s frightening. Not everybody, but there seems to be more and more and more. Maybe just more and more of them are making their way to my door. I don’t know. Fame is becoming a bigger drug than ever”.

So can fame really be an addiction? There are certainly those in both the academic and medical community who think that it can although empirical evidence is hard to come by.

In a 2011 interview with the US newspaper Palm Beach Post about his conference paper ‘Power, fame, and recovery’, the US psychiatrist Dr. Reef Karim said “Little kids today don’t want to be doctors or lawyers. They just want to be famous”. He is concerned about what happens when fame is the actual addiction. As I have noted in my own research, fame used to only be a by-product of a person’s talent in another field (acting, singing, sport, politics, etc.). However, we now live n a culture where some people are just “famous for being famous”.

Dr. Karim said he has been treating people for “fame addiction” for a number of years and claims it is inextricably linked to the rise of television and the internet. (And I have also commented a number of times in the media that the rise of reality TV shows also play a role in fuelling the desire to become famous). Karim says there is a need to be validated and be adored externally.

In an interview with MSNBC News website, Beverly Hills psychologist Dr. Bethany Marshall appears to agree with Karim as she was quoted as saying: “a lot of our youth, their parents don’t love them unconditionally for who they are. The fantasy of being loved just for who you are without having to do anything”. In the same article, the anthropologist Dr. David Sloan Wilson (SUNY-Binghamton, USA) said: “Our minds are adapted for a small-scale society and what’s happening today is an out of control version of that. The lust for fame has taken on this pathological form that is much like our eating habits making us obese.” Dr. Robi Ludwig (again in the MSNBC story) commented that:

“Fame is so fleeting. People who achieve it, there’s no guarantee that they’ll maintain it. So, therein lies sort of the addictive loop. One of the concerns with celebrities who have made it is that they will lose it. There is this need for more and more. And just like with any addiction, it has less to do with actually the item that you’re seeing, so the fame is actually used as a mood enhancer. Fame helps a person to feel important, invaluable –  that they matter.”

As noted above, empirical evidence on fame being addictive is lacking. Jake Halpern (author of the book Fame Junkies) carried out a study with Syracuse University’s Newhouse School of Public Communications and surveyed 650 children from New York about their attitudes toward fame and pop culture. When given the option to become stronger, smarter, famous, or more beautiful, boys chose fame almost as often as they chose intelligence, and girls chose it more often.

Psychologists Dr Donna Rockwell (Michegan School of Professional Psychology, USA) and Dr David Giles (Winchester University, UK) carried out a qualitative interview study with 15 well-known American celebrities (from the fields of politics, law, business, writing, sports, music, film, television news and entertainment). The study found that those interviewed felt that being famous had (for the people themselves) led to a loss of privacy, demanding expectations, gratification of ego needs, and symbolic immortality. Areas of psychological concern for celebrity mental health included isolation, and an unwillingness to give up fame. Based on their data, Rockwell and Giles argued that celebrity is a process involving four temporal phases – (i) a period of love/hate towards the experience; (ii) an addiction phase where behavior is directed solely towards the goal of remaining famous; (iii) an acceptance phase, requiring a permanent change in everyday life routines; and (iv) an adaptation phase, where new behaviors are developed in response to life changes involved in being famous. In relation to addiction, the authors noted:

“The lure of adoration is attractive, and it becomes difficult for the person to imagine living without fame. One participant said, ‘It is somewhat of a high,’ and another, ‘I kind of get off on it.’ One said, ‘I’ve been addicted to almost every substance known to man at one point or another, and the most addicting of them all is fame.’ Where does the celebrity go when fame passes; having become dependent on fame, how does one adjust to being less famous over time? ‘As the sun sets on my fame,’ one celebrity said, ‘I’m going to have to learn how to put it in its proper place.’ The adjustment can be a difficult one”.

There are also addiction links in relation to whether those who are famous are more susceptible to developing other types of addiction. I have appeared on a number of television shows (such as Channel 4’s Celebrity Rehab) and the film Starsuckers talking about this issue.

In a recent article on the magazine The Fix, Dr. Dale Archer (Lake Charles Memorial Hospital, USA) made some observations that I have noted myself. He said:

“Fame and addiction are definitely related. Those who are prone to addiction get a much higher high from things – whether it’s food, shopping, gambling or fame – which means [the behavior or situation] will trigger cravings. When we get an addictive rush, we are getting a dopamine spike. If you talk to anyone who performs at all, they will talk about the ‘high’ of performing. And many people who experience that high report that when they’re not performing, they don’t feel as well. All of which is a good setup for addiction. People also get high from all the trappings that come with fame,” he says. “The special treatment, the publicity, the ego. Fame has the potential to be incredibly addicting”.

I suspect it will be a long time – if ever – that fame is described as a genuine addiction, mainly because there is the question of what such people are actually addicted to (a point that I have made in other papers of mine in relation to ‘internet addiction’). Are they addicted to the adoration and praise of their fans? Greater access to sexual partners and sexual conquests? The money they earn? The buzz of performing? All of the above? The bottom line is that “fame” is not an activity like gambling, sex or exercise that have definitional boundaries. Therefore, in the case of “fame” the object of addiction and the rewards gained may come from many different forms of reinforcement.

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

Further reading

Griffiths, M.D. & Joinson, A. (1998). Max-imum impact: The psychology of fame. Psychology Post, 6, 8-9.

Halpern, J. (2007). Fame Junkies. New York: Houghton Mifflin Harcourt

McGuinness, K. (2012). Are Celebrities More Prone to Addiction? The Fix, January, 18. Located at: http://www.thefix.com/content/fame-and-drug-addiction-celebrity-addicts100001

Rockwell, D. & Giles, D.C. (2009). Being a Celebrity: A Phenomenology of Fame. Journal of Phenomenological Psychology, 40, 178-210.

Streeter, L.G. (2011), Doctor helps people beat their fame addiction. Palm Beach Post, October 3. Located at:  http://www.palmbeachpost.com/health/doctor-helps-people-beat-their-fame-addiction-1892781.html

Turner, M. (2007). Addicted to fame: Stars and fans share affliction. MSNBC Entertainment News, August 9. Located at: http://today.msnbc.msn.com/id/20199608/ns/today-entertainment/t/addicted-fame-stars-fans-share-affliction/

Driving force: Can people become addicted to joyriding?

In the UK, car theft is a big criminal problem, with thousands of cars stolen every week. Much of this car crime is theft by young males in their late adolescence or early twenties who simply steal the car for one evening and go joyriding for fun. Joyriding typically involves the person stealing the car so that they can drive them at the fastest speeds possible and impress their friends who may be either in the car with them or watching them from afar. Much of the excitement surrounding the activity is that it is risky, illegal and dangerous. As Jack Katz (University of California, USA) in a chapter on ‘Sneaky Thrills’ notes: “joyriding captures a from of auto theft in which getting away with something in celebratory style is more important than keeping anything or getting anywhere particular”

Back in 1980, Dr Joseph Reser (Griffith University, Australia), discussed the psychological relationship between people and cars. He argued that cars (and driving in cars) served five functions: (i) transportation, (ii) providing a sense of freedom and allowing escape from an inherently stressful urban environment, (iii) identification and self-presentation, a sign of socioeconomic status, (iv) privacy, security, and familiarity, and (v) providing a responsive micro-environment that allows a feeling of competence and mastery. In relation to joyriding, the second, third and fifth functions appear to be the most important in terms of motivation. However, these functions focus on the more positive sides and presumably from the perspective of car driver as owner (rather than car driver as stealer).

For joyriders, such behaviour can result in social costs (e.g., getting arrested, being imprisoned) and/or health costs (e.g., getting injured, being killed). The fact that joyriding behaviour by those taking part is often something that they engage in repetitively (in spite of the many risks involved) has led some to suggest that the activity may have an addictive potential to a small minority. Although there is a growing literature on joyriders by both criminologists and psychologists, there are very few empirical studies that have examined ‘joyriding addiction’.

Believe it or not – and I’m not making this up – the first peer reviewed academic paper published on addiction to joyriding was by Dr Andrew McBride who provided a case study of the fictional character Toad (from Kenneth Grahame’s novel Wind in the Willows). Dr McBride, who at the time was working for the Community Addiction Unit in Cardiff, published an interesting paper in a 2000 issue of the journal Addiction Research, and argued that the adventures of Toad “can be read as an embodiment of late twentieth century ideas of dependence. Toad’s seemingly reckless driving, car theft, related problems, and his friends’ treatment of him are described” (p.129). Using various criteria of dependence, McBride argued that Toad fulfilled many of these criteria in relation to his driving and car theft. This included:

• Salience and persistence: “When Toad’s preoccupation is at its height, he neglects all alternative pleasures and persists with his driving despite the catalogue of harmful consequences listed by his friends and a period of imprisonment. Grahame’s description of Toad’s driving clothes suggests he also recognized the importance of ritual to the process of addiction”
• Subjective compulsion: “Toad clearly experiences a strong desire and a sense of compulsion to drive and steal cars”
• Tolerance: “Toad’s first exposure to cars, as a pedestrian casualty of a road traffic accident, is sufficient to leave him in an intoxicated state for days. Latterly his appetite for cars and driving appears to have been temporarily sated only after extreme recklessness and the destruction of the vehicle”
• Loss of control: “Toad is unable to hold back from initiating driving and literally, as well as metaphorically, loses control of the cars that he drives”
• Desire or efforts to control use: “Toad generally contemplates change only under conditions of extreme coercion. A healthy corrective for those who imagine addicts continuously bloodied and bowed”
• Withdrawal symptoms: “Upon forced withdrawal from cars Toad displays hostility and the intriguing amateur theatricals, akin to occupational delirium, complete with marked autonomic changes, followed by depression, despair and anorexia”
• Relapse after abstinence: “In the description of Toad’s car theft I would argue that we have the clearest most elegant account of any relapse in literature: cue exposure, akrasia, lapse, and immediate loss of control”

McBride says that in Wind in the Willows, Kenneth Grahame described Toad’s physiological responses to behavioural addiction long before experts in the addiction field had even thought about the possibility of non-chemical dependencies. (Interestingly, McBride notes that following the death of Grahame’s mother in early childhood, Grahame’s father developed a serious addiction to alcohol and eventually abandoned the family, and wondered whether the fact he witnessed addiction first hand influenced his characters).

Previous (but unpublished) academic questionnaire studies have hinted that joyriding may be addictive. For instance, in an unpublished postgraduate study of youth car crime by Reeves in 1993, it was reported that her survey data supported the idea that for some offenders the behaviour appeared to be “a compulsion or addiction in its own right”. Another unpublished postgraduate study by McCorry in 1992 surveying persistent joyriders claimed that the sample included individuals who showed signs of tolerance, salience, conflict, withdrawal, craving and relapse with regards to their joyriding. Both of these unpublished studies used surveys and neither study examined the ‘addictiveness’ of joyriding in any great depth. A German study of 84 delinquents by Dr Thomas Kneckt (1996) also claimed that “in several cases [joyriders] can show addiction-like traits”.

The first published empirical study was a qualitative study comprising interviews of 15 juvenile offenders who were also joyriders (aged 14 to 17 years of age) published in 1997. The research was carried out in Northern Ireland by Dr Rosemary Kilpatrick (Queen’s University Belfast) and published as a chapter in the book ‘Addicted To Crime?’ Kilpatrick concluded that joyriding contained addictive elements. More specifically, it was reported that in relation to the juvenile joyriders interviewed that all 15 of them displayed characteristics of tolerance, salience, and conflict. She also reported that nine of the joyriders in the sample could be described as having four characteristics of addiction (i.e., tolerance, salience, conflict, and relapse), while at least seven of the sample displayed five of the six characteristics (including withdrawal and/or craving). Kilpatrick also noted the strong resistance amongst people who work with young offenders to the concept of addiction as applied to joyriding, due to perception that it may ‘‘bolster the joyriders’ glamorous image of themselves’’.

Arguably the most well known study on ‘joyriding addiction’ was carried out by Sue Kellett (as part of her PhD at Loughborough University [UK] in 2000). A paper from the PhD (co-written with Dr Harriet Gross) was eventually published in a 2006 issue of Psychology, Crime and Law. Kellett and Gross further explored the notion of joyriding addiction in another qualitative study but with a larger and more diverse sample than Rosemary Kilpatrick’s study. The study comprised semi-structured interviews with 54 joyriders (aged 15 to 21 years of age) all of whom were convicted car thieves (“mainly in custodial care”).

Although the study’s main aim was to examine the notion of joyriding addiction, the authors were keen to stress that the study was “not an attempt to pathologize the activity by looking for causes or predispositions to ‘’joyriding addiction’’, such as the identification of certain personality types, nor was it an attempt to compare groups of joyriders with different demographic characteristics”.

The interviews aimed to examine the “joyriding career’’ by exploring (but not restricted to) (i) the initial involvement in joyriding activities, (ii) regular patterns of behaviour, including excessiveness, (iii) the importance, or salience of the behaviour, (iv) the consequences of joyriding, including negative experiences, and (v) experiences of stopping – or attempts to stop – joyriding.

With regards to addiction, the interviews also looked for signs of salience, tolerance, withdrawal symptoms, conflict, and relapse. The results of the study indicated that all of the “dependency criteria” used by Kellett and Gross occurred within the joyriders’ accounts of their behaviour particularly ‘‘persistence despite knowledge and concern about the harmful consequences’’, ‘‘tolerance’’, ‘‘persistent desire and/or unsuccessful attempts to stop’’, “large amounts of time being spent thinking about and/or recovering from the behaviour’’ and “loss of control”. Kellett and Gross also cited examples of ‘withdrawal’ symptoms when not joyriding, the giving up of other important activities so that they could go joyriding instead, and spending more time participating in joyriding than they had originally intended. Overall, the findings appeared to confirm the earlier study by Kilpatrick.

Addiction to joyriding (and criminal behaviour more generally is evidently a highly controversial issue. As an interesting aside, Kellett and Gross also debated the issue around what behaviours should be even considered as potentially addictive. (I have a vested interest as I have been accused by some in the addiction field as “watering down the concept of addiction” by researching into such behaviours as internet addiction, video game addiction, exercise addition, mobile phone addiction, and sex addiction).

They noted that the book in which Kilpatrick’s earlier study had appeared (‘Addicted to Crime?’) was attacked in a review by David Crighton in a 1998 issue of The Psychologist (the ‘house’ journal of the British Psychological Society). Crighton asserted that some of the book’s authors had resorted to ‘‘worryingly trite definitions of addiction’’ and that the use of the addiction model to explain many of these criminal behaviours had been ‘‘stretched beyond all logical credibility’’. Despite such harsh criticism, I agree with Kellet and Gross that the debate regarding the addictive potential of criminal behaviours should continue to be encouraged and that further empirical research within an addiction framework should continue – particularly as such a framework might at least partly explain why some individuals feel compelled to engage in criminal behaviour such as joyriding.

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

Further reading

Crighton, D. A. (1998). Addicted to addictions? The Psychologist; Bulletin of the British Psychological Society, 11, 349.

Hodge, J., McMurran, M & Hollin, C. (1997). Addicted to crime? Chichester: John Wiley & Sons.

Katz, J. (2004). Sneaky thrills. In M. Pogrebin (Ed.), About criminals: A view of the offender’s world (pp. 25-32). Thousand Oaks, CA: Sage.

Kellett, S. (2000). An investigation into joyriding as an addictive behaviour. Unpublished Ph.D. thesis in Psychology (Loughborough University).

Kellett, S.  & Gross, H. (2006). Addicted to joyriding? An exploration of young offenders’ accounts of their car crime. Psychology, Crime & Law, 12, 39-59.

Kilpatrick, R. (1997). Joyriding: An addictive behaviour? In J. Hodge, M. McMurran, & C. Hollin (Eds.), Addicted to crime? (pp. 165-190). Chichester: John Wiley & Sons.

Kneckt, T. (1996). Joy riding und dissozialität. Eine vergleichsstudie anhand einer 84köpfigen straffälligengruppe [Joy riding and dissocial behavior. A comparative study based on 84 members of a delinquent group]. Archiv für Kriminologie, 198(3-4), 110-116.

McBride, A. (2000). Toad’s syndrome: Addiction to joy riding. Addiction Research, 8, 129-139.

McCorry, H.  (1992). Joyriding and its addictive aspects. Unpublished M.Sc. thesis in Developmental and Educational Psychology (Queen’s University of Belfast).

Reeves, S. (1993). The addicted joyrider: Fact, fiction or fad? Unpublished M.Sc. thesis in Applied Criminological Psychology (Birkbeck College, University of London).

Reser, J.P. (1980). Automobile addiction: Real or imagined? Man-Environment Systems, 10, 279-287.

24-carrot hold: Can you have a compulsive craving for carrots?

“Eating raw carrots may be as addictive as cigarette smoking and every bit as difficult to give up” said The Independent newspaper back in 1992. The paper was reporting on a study by Czech researchers Ludek Cerný and Karel Cerný who published a paper in the British Journal of Addiction (BJA) concerning three case studies of people allegedly addicted to carrots. So can carrots really be addictive?

When I started to research this a little further, I was surprised to discover that there are many reports in the medical literature dating back almost 100 years of the consequences of excessive carrot eating. The most commonly reported consequence is that excessive carrot eating can cause people’s skin pigmentation to turn yellow (a condition that has since been given the name hypercarotenemia). In 1975, there was an infamous case that received widespread news coverage concerning the death of a 48-year old man who drank excessive amounts of carrot juice. The coroner actually attributed the man’s death as addiction to carrot juice although Dr Ivan Sharman (writing in an article in a 1985 issue of the British Medical Journal on hypercarotenemia) speculated that the person’s addiction to carrots may have reduced the patient’s intake of more nourishing food. Cases of hypercarotenemia have also been reported amongst people with anorexia, hypothyroidism, and Down’s Syndrome.

The 1992 BJA paper described three cases (one male and two females) who the authors claimed had developed a psychological dependence on carrots. The dependence was – in part – caused by the ‘active ingredients’ (including carotine) found in carrots. When unable to eat carrots, these people displayed symptoms of irritability and nervousness, and were said to have an inability to simply discontinue. All three people were cigarette smokers and the two women described their dependence on carrots as stronger than that of nicotine (whereas the man described it as slightly weaker). The man was eating “five bunches” of carrots daily and had – somewhat ironically – started eating carrots as a way of trying to reduce the amount of cigarettes that he smoked. When he gave up carrots, he resumed smoking. One of the women ate a kilogram of raw carrots a day, and was treated for ‘neurological disturbance’. The other woman – pregnant with her first child – started eating large quantities of carrots. She managed to stop eating carrots excessively for 15 years after the baby was born. However, following a stomach upset she relapsed. According to the authors, there was a happy outcome when the woman switched to radishes and developed a diet totally free of carrots!

In 1996, another paper was published in the Australian and New Zealand Journal of Psychiatry by Dr. Robert Kaplan (a consultant psychiatrist at the Liaison Clinic in Wollongong, Australia). The paper concerned the case of a 49-year-old female compulsive carrot eater who after a period of depression (caused by the breakdown of her marriage) started to eat 2-3kg of carrots every day, and lost interest in eating any other food. As in the cases outlined above, she was also a heavy smoker. As Dr Kaplan wrote:

“She rapidly lost interest in eating any other foods. Attempts to resist the craving were useless and she would get out of bed at night to eat more carrots. Her activities began to revolve around this activity, particularly the almost- daily visits to the supermarket. She became an expert in assessing the carrots, selecting them on size and shape: features which would determine the woodiness and succulence when eaten. As she put it: ‘I just wanted to eat a nice juicy carrot and couldn’t stop munching after that’…[She then developed a] noticeable orange/yellow discolouration of her face and hands. She explained that the carrot eating had overtaken her life and she had been too embarrassed to tell me about it at earlier visits. However, the skin discoloration was now quite visible and she felt self-conscious in public. In an attempt to overcome the problem she had stayed with her parents for several weeks, where they had encouraged her to eat normal meals. However, the craving continued and she became concerned about her appearance and the loss of control” (p.699).

The carrot eating continued and she was unable to stop eating carrots (she couldn’t last more than half a day before she gave in to the craving. Any attempt to stop eating carrots led to intense withdrawal symptoms (including anxiety, restlessness, shaking, craving, irritability, and insomnia). During a hysterectomy, the surgeon discovered that the woman’s internal organs were a bright yellow colour. Dr. Kaplan then noted:

“Losing her appetite, she stopped smoking cigarettes and eating carrots. The first few days lead to intense cravings for both substances, which settled, followed by cigarette cravings for a few more weeks. She felt that the postoperative distress and nicotine withdrawal symptoms had a combined effect which helped her overcome her carrot craving. Within 4 weeks, she felt she had overcome the carrot addiction, with cessation of both psychological and physical symptoms” (p.699).

The woman maintained her cessation of carrot eating although still occasionally craved cigarettes. Dr Kaplan reported that the thought of eating carrots now repulsed her. Interestingly, the woman believed that she couldn’t have stopped eating carrots without the discomfort produced by the nicotine withdrawal. It was concluded that compulsive carrot eating is a rare condition and that the basis for the addiction is most likely beta carotene (found in carrots). Although the woman was administered sertraline for her depression, it had no effect on the amount of carrots that she ate.

The idea that food can be addictive is not new and there are certainly reports of specific foodstuffs being addictive (chocolate perhaps being an obvious case in point). However, based on these few published case studies (particularly the one reported by Kaplan), it would appear that in extreme and very unusual circumstances, that carrots may indeed be addictive to some people.

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

Further reading

al-Jubouri, M.A., Coombes, E.J., Young, R.M. & McLaughlin, N.P. (1994). Xanthoderma: an unusual presentation of hypothyroidism. Journal of Clinical Pathology, 47, 850-851.

černý, L. & černý, K. (1992). Can carrots be addictive? An extraordinary form of drug dependence. British Journal of Addiction, 87, 1195-1197.

Corwin, R.L. & Grigson, P.S. (2009). Overview – food addiction: Fact or fiction? Journal of Nutrition, 139: 617–619.

Hess, A.F. & Myers, V.C. (1919) Carotenaemia: A new clinical picture. Journal of the American Medical Association, 73, 1743.

Kaplan, R. (1996), Carrot addiction. Australian and New Zealand Journal of Psychiatry, 30, 698-700.

Leitner, Z.A., Moore, T., & Sharman, I.M. (1975). Fatal self-medication with retinol and carrot juice. Proceedings of the Nutrition Society, 34, 44A.

Pelchat, M.L. (2009). Food addiction in humans. Journal of Nutrition, 139, 620-622.

Schoenfeld, Y., Shaklai, M., Ben-Baruch, N., Hirschorn, M. & Pinkhaus, J. (1982). Neutropenia induced by hypercarotenemia. The Lancet, i, 1245.

Sharman, I.M. (1985). Hypercarotenaemia. British Medical Journal, 290, 95-96.

Sherman, P., Leslie, K., Goldberg, E., Rybczynski, J. & St-Louis, P. (1994). Hypercarotenemia and transaminitis in female adolescents with eating disorders: A prospective, controlled study. Journal of Adolescent Health, 15, 205-209.

Storm W. (1990). Hypercarotenemia in children with Down’s syndrome. Journal of Mental Deficiency Research, 34, 283-286.

Tanorexia: Can excessive tanning be an addiction?

Back in June 1997, I appeared as the obligatory “addiction expert” on the BBC television programme ‘Esther’ talking about people who said they were addicted to tanning (and was dubbed by the researchers on the programme as ‘tanorexia’ – a term that – at the time – I had not come across and is still considered slang even by academics researching in the area). I have to admit that none of the case studies on the programme appeared to be addicted to tanning (at least based on my own addiction criteria) but it did at least alert me to the fact that some people at least claimed to be addicted to tanning.

There certainly appeared to be some similarities between the people interviewed and nicotine addiction in the sense that the ‘tanorexics’ knew they were significantly increasing their chances of getting skin cancer as a direct result of their risky behaviour but felt they were unable to stop doing it (similar to nicotine addicts who know they are increasing the probability of various cancers but also feel unable to stop despite knowing the health risks).

Since my appearance on the programme, tanning addiction – typically involving the repeated daily use of sun beds by women – appears to have become a topic for scientific investigation. If memory serves me correctly, most of the people who appeared on the show appeared to be using tanning as a way of raising their self-esteem and to feel better about themselves. Given that when we are exposed to ultraviolet rays from the sun or tanning bed, our bodies produce it’s own mood-inducing morphine-like substances (i.e., endorphins), the idea that someone could become addicted to tanning is not as far-fetched as it could be.

In fact, in a 2006 study published in the Journal of the American Academy of Dermatology by researchers at Wake Forest University Baptist Medical Center (USA) reported that frequent tanners (those who tanned 8-15 times a month; n=8) who took an endorphin blocker (naltrexone) similar to what a person undergoing alcohol or drug withdrawal suffers), whereas infrequent tanners (n=8) experienced no withdrawal symptoms under identical conditions. However, with only 16 participants in total, the results must be treated with some caution.

Symptoms and consequences of tanorexia are alleged to include (i) intense anxiety if sun bed sessions are missed by the tanorexic, (ii) competition among other tanorexics to see who can get the darkest tan, (iii) chronic frustration by the tanorexic that their skin colour is too light, and (iv), the belief by tanoexics that their skin colour is lighter than it actually is (similar to anorexics believing that they are much heavier than they actually are). Some academics claim that tanorexia is not actually the same as tanning addiction, and argue that tanorexics primary motivation is to get a deep coloured tan. However, there is little empirical research to show whether these tanning behaviours are different or part of the same syndrome.

A 2005 study conducted by researchers at the University of Texas (USA) and published in the US journal Archives of Dermatology claimed that more than half of beach lovers could be considered tanning addicts. They then went on to further claim that just over a quarter of the sample (26%) of “sun worshippers” would qualify as having a substance-related disorder if UV light was classed as the substance they crave. Their paper also reported that frequent tanners experienced a “loss of control” over their tanning schedule, and displayed a pattern of addiction similar to smokers and alcoholics.

Another study carried out in 2008 on 400 students and published in the American Journal of Health Behavior reported that 27% of the students were classified as “tanning dependent”. The authors claimed that those classed as being tanning dependent had a number of similarities to substance use, including (i) higher prevalence among youth, (ii) an initial perception that the behavior is image enhancing, (iii) high health risks and disregard for warnings about those risks, and (iv) the activity being mood enhancing. Independent predictors of tanning dependence included ethnicity (i.e., Caucasians more likely than African Americans to be tanning dependent), lack of skin protective behaviours (i.e., those sunbathing without sun cream and experiencing sunburn more likely to be tanning dependent), smoking (smokers more likely to be tanning dependent), and body mass index (obese people less likely to be tanning dependent).

There is also some interesting empirical evidence that in extreme cases, excessive tanning may be an indication of body dysmorphic disorder (BDD), a mental psychological condition where people are obsessively critical of their physique or self-image. A short article published in the Journal of the American Academy of Dermatology reported the case of 11 patients with BDD who used tanning in an attempt to conceal or improve the appearance of a perceived physical defect.

Overall, the evidence as to whether tanorexia and/or tanning addiction exists is limited with the vast majority of empirical data collected by dermatologists rather than psychologists and biologists. As I noted in a previous blog, I am not convinced – yet – that tanorexics experience a real dependence and/or addiction based on the published empirical evidence. However, at least there are research teams (particularly in the US) empirically investigating its existence.

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

Further reading

Heckman, C.J., Egleston, B.L., Wilson, D.B. & Ingersoll, K.S. (2008). A preliminary investigation of the predictors of tanning dependence. American Journal of Health Behavior, 32, 451-464.

Hunter-Yates J., Dufresne, R.G. & Phillips, K.A. (2007). Tanning in body dysmorphic disorder. Journal of the American Academy of Dermatology, 56(5 Supplement), S107-S109.

Kaur, M., Liguori, A., Lang, W., Rapp, S., Fleischer, A., Feldman, S. (2006). Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. Journal of the American Academy of Dermatology, 54, 709-711.

Warthan, M., Uchida, T. & Wagner, R. (2005). UV light tanning as a type of substance-related disorder. Archives of Dermatology, 141, 963-966.

Internet addiction: How big a problem is it?

Yesterday, a study was reported in the British media that Chinese scientists had observed differences in the brains of people who obsessively use the internet similar to those found in people who have substance addiction. This led to the question of whether this was “proof that internet addiction exists”. I was asked for my comments by both the Guardian and the Daily Telegraph and I thought I would use my blog to put forward my own view on the topic.

There is currently a debate among psychologists and psychiatrists as to whether ‘Internet addiction’ constitutes a true addiction and should therefore be recognized as a psychiatric disorder in the American Psychiatric Association’s fifth edition of the forthcoming Diagnostic and Statistical Manual. The past 15 years have produced many empirical studies demonstrating that a significant number of individuals appear to report psychological problems associated with excessive Internet use. The extent and severity of these problems may be somewhat overestimated because of the relatively low methodological quality of many studies in this area. Most studies have utilized inconsistent criteria to identify Internet addicts and/or have applied recruitment methods that may have caused serious sampling bias. More specifically in relation to Internet addiction criteria used in most studies, I have asserted in a number of my publications that the main problems with the measures used is that they tend to (i) have no measure of severity, (ii) have no temporal dimension, (iii) overestimate the prevalence of problems, and (iv) take no account of the context of Internet use.

In a number of published literature reviews, I have also argued that those working in the Internet addiction field need to distinguish between addictions on the Internet, and addictions to the Internet. My view is that most ‘Internet addicts’ are not addicted to the Internet itself, but use it as a medium to fuel other addictions. I have also used case study evidence to argue that some very excessive Internet users may not have any negative detrimental effects as a consequence of their behavior and therefore cannot even be classed as addicted. In short, a gambling addict who uses the Internet to gamble is a gambling addict not an Internet addict. The Internet is just the place where they conduct their chosen (addictive) behavior. However, I am the first to concede that I have also observed that some behaviors engaged on the Internet (e.g., cybersex, cyberstalking etc.) may be behaviors that the person would only carry out on the Internet because the medium is anonymous, non face-to-face, and disinhibiting.

For these reasons, it is often argued that problematic Internet behaviors may be more appropriately conceptualised within existing known psychopathologies such as depression or anxiety. Nevertheless, a number of researchers (including myself) have argued that Internet addictions do exist and can arise from unhealthy involvement in a range of online activities. These activities may include browsing websites, online information gathering, downloading or trading files online, online social networking, online video gaming, online shopping, online gambling, and various online sexual activities such as viewing pornography or engaging in simulated sexual acts.

While there is no consensus regarding the clinical status of Internet addiction, there appears to be significant demand for treatment for Internet-related problems, particularly in China, Taiwan and South Korea, where the estimated prevalence of Internet addiction problems among adolescents ranges from 1.6% to 11.3%. The South Korean government has reportedly established a network of over 140 counselling centres for treatment of Internet addiction, and have introduced treatment programs at almost 100 hospitals. In addition, numerous ‘boot camp’-style programs for Internet-addicted adolescents have emerged in both China and Korea. In Western countries, clinics specializing in the psychological treatment of computer-based addictions have also emerged, including: the Center for Online and Internet Addiction located in Bradford, Pennsylvania, United States; the Computer Addiction Study Center, McLean Hospital, Belmont, Massachusetts, United States; the Broadway Lodge residential rehabilitation unit located in Somerset, England; and the Smith & Jones 12-step (Minnesota Model) clinic located in Amsterdam, Holland. Additionally, there are some online providers of treatment services for Internet addiction (e.g., www.netaddiction.com; www.netaddictionrecovery.com; www.onlineaddiction.com.au), many of which are modelled on 12-step self-help treatment philosophies including specific types of groups such as Online Gamers Anonymous.

Available evidence suggests that, internationally, a large number of individuals with Internet-related problems have received some form of treatment from a mental health or medical service provider. However, very few studies have examined the effectiveness of any such treatments, including counselling, psychotherapy, or pharmacological interventions. The number of studies in this area is not as large as the number of studies examining the general features and correlates of Internet addiction, or as the number of studies of psychological treatment for other behavioral addictions, such as pathological gambling.

Very recently, I – along with colleagues from the University of Adelaide (Dr Daniel King and Professor Paul Delfabbro) – published a systematic review of the Internet addiction treatment literature. Our review investigated the reporting quality of treatment studies according to the 2010 Consolidating Standards of Reporting Trials (CONSORT) statement. Our evaluation of the studies we reviewed highlighted several key limitations, including (a) inconsistencies in the definition and diagnosis of Internet addiction, (b) a lack of randomization and blinding techniques, (c) a lack of adequate controls or other comparison groups, and (d) insufficient information concerning recruitment dates, sample characteristics, and treatment effect sizes.

There were also wider issues as to whether the people being treated in the studies evaluated were actually bona fide ‘Internet addicts’ as some of the people treated may have been addicted to a specific application or activity on the Internet (e.g., gaming, gambling, social networking) rather than being addicted to the Internet itself. We also stressed that research is also needed into whether addicts who use a particular medium to engage in their activity require different types of intervention and/or treatment. For instance, do Internet gambling addicts need or require different treatment interventions than gambling addicts who do not use the Internet to gamble?

Finally, there appears to be a significant need for consensus concerning the clinical definition of Internet addiction and possible sub-forms relating to particular Internet applications and/or activities. This theoretical obstacle, which has existed for over 15 years, has hindered progress in all areas of this field, including the development and validation of a recognised diagnostic tool. Our evaluation of the literature using the CONSORT criteria identified many areas of study design and reporting in need of improvement. In particular, there is a need for more randomized, controlled trials, in both the pharmacological and non-pharmacological intervention literature.

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

I would also like to thank Dr Daniel King and Professor Paul Delfabbro (University of Adelaide) for their additional input

Further reading

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

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

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

Griffiths, M.D. (2010). Internet abuse and internet addiction in the workplace. Journal of Worplace Learning, 7, 463-472.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: Does it really exist? (Revisited). In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (2^nd Edition), pp.141-163. New York: Academic Press.

Widyanto, L. & Griffiths, M.D. (2009). Unravelling the Web: Adolescents and Internet Addiction. In R. Zheng, J. Burrow-Sanchez & C. Drew (Eds.), Adolescent Online Social Communication and Behavior: Relationship Formation on the Internet. pp. 29-49. Hershey, Pennsylvania: Idea Publishing.

Widyanto, L., Griffiths, M.D. & Brunsden, V. (2011). A psychometric comparison of the Internet Addiction Test, the Internet Related Problem Scale, and Self-Diagnosis. Cyberpsychology, Behavior, and Social Networking, 14, 141-149.

Shop until you drop! Can shopping really be addictive?

So far in my articles in this blog, I have tried to argue that behaviours such as gambling, sex, and video game playing can all be viewed as potentially addictive. Empirical research also suggests that the form of addictive behaviour someone develops may depend upon their gender. For instance, men are more likely to be addicted to drugs, gambling and sex whereas women are more likely to suffer from the so-called “mall disorders” such as eating and shopping. For instance, the vast majority of compulsive shoppers (up to 80%) are female.

Compulsive buying has been reported as a way to alter a verity of negative feelings, by achieving short-term gratification through shopping. As with other addictive behaviours, this reward gives shopping its addictive potential, reinforcing the behaviour through pleasure, attention and praise, thereby driving the repetitive and compulsive processes. Compulsive buyers do not buy so much to acquire or gain use from their purchases. Instead they do so to achieve this reward, through the buying process itself. Such repetitive behaviour can – in extreme cases – be problematic. However, those affected may not initially see the behaviour as a problem. In fact, at an early stage it may be seen as providing a quick, perhaps impulsive, relief from anxiety or emotional distress. Consequently, individuals may be unaware of the negative consequences to follow

Compulsive buying disorder was first described clinically in 1915 by the German psychiatrist Emil Kraepelin in terms of what he called “buying maniacs”. More recently compulsive buying has been described as an example of ‘reactive impulse’. For most people, buying behaviour is a normal routine part of everyday life. However, for compulsive buyers, it is an inability to control an overpowering impulse to buy. This impulse can take over lives, resulting in negative consequences – similar to pathological gambling – such as debt, despite repeated attempts to stop. This can create further economic and emotional problems, such as stress and anxiety, for themselves and their families, which can drive the behaviour to continue by using shopping as a form of relief.

Compulsive buyers have been found to frequently have reactions of anxiety to both external and internal stimuli. Empirical research has highlighted that shopping binges are used as a reaction to such feelings. These binges have been found to be a quick relief from anxiety and stress. However, a compulsive buyer may eventually come to view their behaviour as a “loss of control,” creating additional anxiety and frustration. This can increase the ‘need’ to shop as to relive such feelings.

Prevalence rates of shopping have been highly variable and few studies have been carried out on nationally representative samples. A number of reports place it between 12% to 22% among younger people (including college and university students) though most estimates place it as ranging from 1% to 6% among adults with higher figures being reported in places such as the United States. Perhaps somewhat predictably, low levels of self-esteem have also been reported in compulsive buying populations. It is suggested that compulsive behaviours, particularly compulsive buying, are an attempt to temporarily relieve these feelings of low self-esteem by using the reward gained from buying as validation. Alternatively, low self-esteem may be a negative outcome of engaging in these behaviours, which creates the need for validation.

The direction of the relationship is still debated, causing increasing interest in research. Many compulsive buyers display a clear desire to please through their spending habits, portraying a sense of social desirability. This is often done through buying gifts for others, often with the belief that such gifts will make their recipients happy. Pleasing others is seen as a way of getting positive attention or being liked, possibly to boost low self-esteem and receive further rewarding properties. Therefore, the product being bought has no direct effect on the individual. It is the process of buying that creates reward, resulting in a boosting of self-esteem and relief from anxiety that may have increased if the impulse to buy had not been met.

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

Further reading

Black, D. W. (2007) A review of compulsive buying disorder. World Psychiatry, 6, 14-18.

Davenport, K., Houston, J. & Griffiths, M.D. (2012). Excessive eating and compulsive buying behaviours in women: An empirical pilot study examining reward sensitivity, anxiety, impulsivity, self-esteem and social desirability. International Journal of Mental Health and Addiction, DOI 10.1007/s11469-011-9332-7.

Dittmar, H. (2005). Compulsive buying-a growing concern? An examination of gender, age, and endorsement of materialistic values as predictors. British Journal of Psychology, 96, 467-491.

Hodgson R.J., Budd R. & Griffiths M. (2001). Compulsive behaviours (Chapter 15). In H. Helmchen, F.A. Henn, H. Lauter & N. Sartorious (Eds) Contemporary Psychiatry. Vol. 3 (Specific Psychiatric Disorders). pp.240-250. London: Springer.

Koran, L.M., Faber, R.J., Aboujaoude, E., Large, M.D., & Serpe, R.T. (2006). Estimated prevalence of compulsive buying behavior in the United States. American Journal of Psychiatry, 163, 1806-1812.

Kukar-Kinney, M., Ridgway. N.M & Monroe, K.B (2009) The relationship between consumers’ tendencies to buy compulsively and their motivations to shop and buy on the internet, Journal of Retailing, 85, 298–307.

MacLaren, V.V., & Best, L.A. (2010). Multiple addictive behaviors in young adults: Student norms for the Shorter PROMIS Questionnaire. Addictive Behaviors, 35, 252-255.

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

Workaholism: Healthy enthusiasm or an addiction?

As someone who is often called a ‘workaholic’ by both my friends and colleagues, I have always been interested in whether people can be genuinely addicted to their jobs. The term ‘workaholism’ has been around for over 40 years since the publication of Wayne Oates’ 1971 book Confessions of a Workaholic, and has now passed into the public mainstream. Despite four decades of research into workaholism, no single definition or conceptualization of this phenomenon has emerged. Much of the work into the area has used operational definitions that do not conceptualize workaholism as an addiction or if they do conceptualize it as an addiction, the criteria used are somewhat dissimilar to the criteria used when examining other behavioural addictions such as gambling addiction, Internet addiction, sex addiction, exercise addiction, video game addiction, etc.

Reliable statistics on the prevalence of workaholism are hard to come by, although some researchers claim that one in four employed people are workaholics. It has also been claimed that amongst professional groups, the rate of workaholism is high especially in occupations such as medicine. As a result they work long hours, rarely delegate, expend high effort, and may not necessarily be more productive.

Workaholics have been conceptualized in different ways. For instance, workaholics are typically viewed as one (or a combination) of the following:

• Those viewed as hyper-performers
• Those viewed as unhappy and obsessive individuals who do not perform well in their jobs
• Those who work as a way of stopping themselves thinking about their emotional and personal lives
• Those who are over concerned with their work and neglect other areas of their lives.

Some authors note that there is a behavioural component and a psychological component to workaholism. The behavioural component comprises working excessively hard (i.e., a high number of hours per day and/or week), whereas the psychological (dispositional) component comprises being obsessed with work (i.e., working compulsively and being unable to detach from work. This may sometimes be accompanied by other characteristics such as low work enjoyment.

There are those scholars who differentiate between positive and negative forms of workaholism. For instance, some view workaholism as both a negative and complex process that eventually affects the person’s ability to function properly. In contrast, others highlight the workaholics who are totally achievement oriented and have perfectionist and compulsive-dependent traits. Workaholics appear to have a compulsive drive to gain approval and success but it can result in impaired judgment and personality breakdowns.

In relation to studies of workaholism, the most widely employed empirical approach proposes three underlying dimensions. These are (i) work involvement, (ii) drive, and (iii) work enjoyment. I have noted in my own writings on the topic that what starts out as love of work can often end up with the person developing perfectionist and obsessional traits. Some have argued that workaholism can be deadly and dangerous with an onset (e.g., busyness), a progression (e.g., loss of productivity, relationships etc.), and a conclusion (e.g., hospitalization or death from a heart attack). Others have argued that the final stage of workaholism is narcissism, often characterised by a complete loss of compassion and empathy. Furthermore, psychological research has shown links between workaholism and personality types including those with Type A Behaviour Patterns (i.e., competitive, achievement-oriented individuals) and those with obsessive-compulsive traits.

Research appears to indicate there are three central characteristics of workaholics. In short, they typically:

• Spend a great deal of time in work activities
• Are preoccupied with work even when they are not working
• Work beyond what is reasonably expected from them to meet their job requirements.
• Spend more time working because of an inner compulsion, rather than because of any external factors.

Workaholism as a syndrome is characterized by the number of hours spent on work, and the inability to detach psychologically from work. Although these features of workaholism appear to have good face validity, I have argued in a number of my papers that the amount of activity engaged in is not necessarily a core feature of addiction.

Some in the field view workaholism as much a ‘system addiction’ as an individual one. Although the manifestations of workaholism are at the level of the individual, workaholic behaviour is socially acceptable and even encouraged by major organizations. Organizations can potentially facilitate addictive work in a number of ways. For employees, an organization can provide the structure and/or the mechanisms and dynamics for both the addictive substance (e.g., adrenalin) and/or the process (i.e., work itself). I have argued that for someone working too much, it makes little practical difference if they are dependent or addicted. In relation to excessive work, the public understands notions of ‘addiction’ and ‘workaholism’ and these are therefore still very useful constructs for both academic (research) and educational purposes.

Dr Mark Griffiths, Professor of Gambling Studies, 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.

Matuska, K.M. (2010). Workaholism, life balance, and well-being: A comparative analysis. Journal of Occupational Science, 17, 104-111.

Schaufeli, W.B., Taris, T.W., & Bakker, A.B. (2006). Doctor Jekyll or Mr Hyde? On the differences between work engagement and workaholism. In R. Burke (Ed.), Workaholism and long working hours (pp. 193-217). Cheltenham: Edward Elgar.

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

van Beek, I., T.W., Taris, & Schaufeli, W.B. (2011). Workaholic and work engaged employees: Dead ringers or worlds apart? Journal of Occupational Health Psychology, 16, 468-482.

To what extent can cybersex be addictive?

For many years I have been writing about sexual addictions – particularly those online. Online sexual behaviours can be classified as either cybersexual consumption (i.e., downloading and watching sexual content online such as pornography or reading sexual content in forums/chat sites without actively participating), or cybersexual interaction with others in real-time (e.g., synchronous participation in the form of text-based chat and/or video-linked conversations) or delayed (e.g., asynchronous interaction in the form of exchanging sexual content via email text, pictures and/or video). Either of these behaviours may be accompanied by concurrent masturbation. Furthermore, Internet activities with a sexual component can be problematic because (a) they manifest sexual desires that the person (or their corporeal sexual partner) disapprove of or feel guilty about, (b) they divert sexual energy from corporeal sex, or greatly distort it, and (c) because the search for the ideal online sexual material takes a great deal of time.

My research on this topic in the early 2000s also highlighted other potential usages the Internet can be put to with regards to engaging in sexual activities. These include sexual behaviours related to criminal activities, namely displaying, downloading or distributing illegal material such as paedophilic images and movies, and sexual menace online, that includes harassment and cyberstalking. Therefore, it appears necessary not only to distinguish between consumptive and interactive cybersex, but also between “normal” and deviant online sexual behaviours. Here, “deviant” refers to any behaviour that can potentially result in criminal prosecution. Therefore, it would appear that there is a wide variety of sexual activities that the Internet can be used for – some of which may take on addictive qualities as individuals begin to compulsively engage in them.

Sex on the Internet is particularly viable because of the inherent qualities of the Internet that the late Al Cooper has referred to as the Triple A Engine (Access, Affordability and Anonymity). The online world including explicit sexual material as well as potential online and offline sexual partners can be accessed anytime and anywhere, as long as there is an Internet connection in place. Most of the time, sexual activities can be pursued at virtually no cost online, clearly demarcating online sex from offline sex, considering the expenditures involved in buying sex tapes or paying for sex workers. In comparison, the costs for bandwidth access are relatively low. The internet liberates individuals from the imminent fear of engaging in something that is charged with a variety of taboos in offline life and provides the option to freely explore their (sexual) selves.

Other things that might make online activities more (or less) dangerous might be perceived safety and a lack of consequences for the behaviour.  Perhaps some individuals are more inclined to think of their activities as relatively harmless (and in some ways, they might be), until they (or their partner) see themselves as “out of control”.  Perhaps the perceived physical or social danger attached to offline sexual compulsivity encourages avoidance of behaviours that would contribute to these compulsions.  Accordingly, the Internet could be used by those who already see themselves as “sex addicts” as a way to avoid the perceived consequences of offline behaviour.

As an adaptation to Al Cooper’s initial concept, Dr Kimberley Young and colleagues developed their own ACE model, incorporating Anonymity, Convenience and Escape as factors salient to the Internet. These factors facilitate the engagement in sex by decreasing the inhibition thresholds present in offline sexual relations. Not only is a person anonymous online, but the Internet is ubiquitous and it can be accessed conveniently from a safe base, such as the person’s home. Furthermore, the Internet can serve as a space of refuge, somewhere to escape to when faced with daily hassles.

This clearly resonates with the idea of any addiction, including technological addictions, originating in a need to cope with everyday stressors via escaping into alternative mood states induced by substances, activities, or alternative worlds provided by virtual environments. With regards to pornography use, Al Cooper’s and Kimberley Young’s salient factors can be extended even further by integrating sophistication and monitoring, factors that may further limit actual usage. Both sophistication, operationalized as occupational prestige and education, and external monitoring, for instance by the spouse, contribute to a reduction of the probability to use pornography and/or engage in other types of online sexual behaviour.

To date, only a relatively small number of studies have empirically assessed Internet sex addiction. My colleague (Daria Kuss) and I have an upcoming review to be published in the next issue of the journal Addiction Research and Theory. The purpose of our review was to present and critically evaluate the current scientific knowledge about online sex addiction. Upon careful review of the current scientific literature, only fourteen scientific studies of online sex addiction in adults were identified. Overall, the studies we reviewed highlighted that the essential feature that distinguishes people who engage in cybersex in a healthy and complementary way to their offline sexuality was not excessive use per se, but the presence of a variety of negative consequences.

From a diagnostic viewpoint, the excessive engagement in sex may be viewed as genuinely pathological once it causes significant impairment in a person’s life. Such impairment may relate to different areas of the affected person’s life, including their professional, social/romantic, and/or leisure life. Similarly, if cybersex users experience clinically significant distress and/or impairment because of their engagement in online sexual behaviours, it appears relatively safe to claim that they suffer from Internet sex addiction.

We also concluded that the gender dissimilarities found in most of the studies to date, indicate that the prevalence of online sex addiction (as well as the preference for particular Internet applications) differs between men and women. This is related to the finding that the Internet seems to be a particularly fertile ground for marginalized groups, such as homosexuals and bisexuals, as well as females, who may feel liberated from real life constraints with regards to exploring their sexuality and finding offline sex partners online.

The reasons that females may compulsively seek sex online appear to be similar to those of bisexuals and homosexuals, namely the liberating potential of the Internet that enables the almost infinite exploration of sexuality without the latent taboos imposed by societal and cultural environments. Pathological use of Internet sex not only requires future research, but the current studies indicate specific areas that may be further explored empirically.

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

My sincere thanks to Daria Kuss (Nottingham Trent University) for providing her expertise and input into this blog

Further reading

Griffiths, M. (2000). Excessive Internet use: Implications for sexual behavior. CyberPsychology & Behavior, 3(4), 536-552.

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

Griffiths, M. (2001). Sex on the Internet: Observations and implications for Internet sex addiction. Journal of Sex Research, 38(4), 333-342.

Griffiths, M.D. (2004). Sex addiction on the Internet. Janus Head: Journal of Interdisciplinary Studies in Literature, Continental Philosophy, Phenomenological Psychology and the Arts, 7(2), 188-217.

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

Kuss, D.J. & Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Theory and Research, DOI: 10.3109/16066359.2011.588351.

Young, K.  & Nabuco de Abreu, C. (Eds.), Internet Addiction: A Handbook for Evaluation and Treatment. New York: Wiley.

Running on empty: Can excessive exercise really be an addiction?

Back in 1997, I published my first academic paper on exercise addiction – a case study of a young women addicted to martial arts – at least according to the definition of exercise I was using. However, at present, exercise addiction is not officially recognised in any medical or psychological diagnostic frameworks such as the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) or the World Health Association’s International Classification of Diseases. However, there has been a lot of research into whether exercise can be classed as a bona fide addiction.

In spite of the widespread usage of the term ‘exercise addiction’ there are many different terminologies that describe excessive exercise syndrome. Such terms include (i) exercise dependence, (ii) obligatory exercising, (iii) exercise abuse, and (iv) compulsive exercise. In a recent review that I co-wrote with Dr Zsolt Demetrovics and colleagues at Eotvos Lorand University (Budapest), we believe the term ‘addiction’ is the most appropriate because it incorporates both dependence and compulsion. Based on research carried out internationally, we believe that exercise addiction should be classified within the category of behavioural addictions. The resemblance is evidenced not only in several common symptoms, but also in demographic characteristics, the prognosis of the disorder, co-morbidity, response to treatment, prevalence in the family, and etiology.

But how is exercise addiction assessed? Several instruments have been developed and adopted for the assessment of exercise addiction. Two relatively early scales, the ‘Commitment to Running Scale’ and the ‘Negative Addiction Scale’ are no longer used because of theoretical and methodological shortcomings. Among the psychometrically tested instruments, the ‘Obligatory Exercise Questionnaire’ (OEQ), the ‘Exercise Dependence Scale’ (EDS), and the ‘Exercise Dependence Questionnaire’ (EDQ) have proved to be both psychometrically valid and reliable instruments for assessing the symptoms and the extent of exercise addiction.

The OEQ is a 20-item self-report questionnaire that assesses the urge for undertaking exercise. The questionnaire has three subscales comprising (i) the emotional element of exercise, (ii) exercise frequency and intensity, and (iii) exercise preoccupation. The EDS conceptualizes compulsive exercise on the basis of the DSM criteria for substance abuse or addiction, and empirical research shows that it is able to differentiate between at-risk, dependent and non-dependent athletes, and also between physiological and non-physiological addiction. The EDS comprises seven subscales including (i) tolerance, (ii) withdrawal, (iii) intention effect, (iv) lack of control, (v) time, (vi) reduction of other activities, and (vii) continuance. In contrast to the EDS, the EDQ is aimed to measure compulsive exercise behaviour as a multidimensional construct. Furthermore, it can be used in assessing compulsion in many different forms of physical activities.

To generate a quick and easily administrable tool for surface screening of exercise addiction, I, and my colleagues (Annabel Terry and Attila Szabo), developed the ‘Exercise Addiction Inventory’ (EAI), a short 6-item instrument aimed at identifying the risk of exercise addiction. The EAI assesses the six common symptoms of addictive behaviours, namely (i) salience, (ii) mood modification, (iii) tolerance, (iv) withdrawal symptoms, (v) social conflict, and (vi) relapse. The EAI has been psychometrically investigated and has relatively high internal consistency and convergent validity with the EDS.

There are several other instruments available for assessing exercise addiction. However, they are either rarely adopted in research or are aimed at a specific form of physical activity such as body building (such as the ‘Bodybuilding Dependency Scale’). A more general but seldom adopted instrument is the ‘Exercise Beliefs Questionnaire’ (EBQ) that assesses individual thoughts and beliefs about exercise and it is based on four factors comprising (i) social desirability, (ii) physical appearance, (iii) mental and emotional functioning, and (iv) vulnerability to disease and aging. Empirical testing shows the instrument to have acceptable psychometric properties. There is also the ‘Exercise Dependence Interview’ (EXDI) that not only assesses compulsive exercising, but also eating disorders. However, one of the major limitations of this measure is that no psychometric properties have been reported.

Another scale is the ‘Commitment to Exercise Scale’ (CES) that examines the pathological aspects of exercising (e.g., continued training despite injuries) and compulsory activities (e.g., feeling guilty when exercise is not fulfilled). The CES has a satisfactory level of reliability. Finally the ‘Exercise Orientation Questionnaire’ (EOQ) measures attitudes towards exercise and related behaviours. The EOQ comprises six factors including (i) self-control, (ii) orientation to exercise, (iii) self-loathing, (iv) weight reduction, (v) competition, and (vi) identity.

Of these instruments outlined, the most popular currently are the EDS and the EAI (due to its brevity and easy scoring). Research has shown that when employed together, these two instruments yield comparable results. Despite the development of all these different scales and screening tools, their existence does not guarantee that exercise addiction will ever be officially recognised by the medical and/or psychiatric community.

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

Further reading

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2011). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, DOI: 10.3109/10826084.2011.639120

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial Validity and Psychometric Examination of the Exercise Dependence Scale-Revised. Measurement in Physical Education and Exercise Science, 8(4), 183-201.

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial Validity and Psychometric Examination of the Exercise Dependence Scale-Revised. Measurement in Physical Education and Exercise Science, 8(4), 183-201.

Freimuth M., Moniz S., & Kim S.R. (2011). Clarifying exercise addiction: Differential diagnosis, co-occurring disorders, and phases of addiction. International Journal of Environmental Research and Public Health, 8, 4069-4081.

Griffiths, M. D. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39(6), e30.

Ogden, J., Veale, D. M., & Summers, Z. (1997). The development and validation of the Exercise Dependence Questionnaire. Addiction Research, 5(4), 343-355.

Pasman, L. N., & Thompson, J. K. (1988). Body image and eating disturbance in obligatory runners, obligatory weightlifters, and sedentary individuals. International Journal of Eating Disorders, 7(6), 759-769.

Terry, A., Szabo, A., & Griffiths, M. D. (2004). The exercise addiction inventory: A new brief screening tool. Addiction Research and Theory, 12(5), 489-499.

Yates, A., Edman, J. D., Crago, M., & Crowell, D. (2001). Using an exercise-based instrument to detect signs of an eating disorder. Psychiatry Research, 105(3), 231-241.