Period pain: A brief look at ‘binge gambling’

Most of you reading this will have probably heard of ‘binge drinking’ and ‘binge eating’. These behaviours are well known in the psychological literature. However, there has been very little research into the phenomenon of binge gambling. Binge gambling shares many similarities with other binge behaviours including loss of control, salience, mood modification, conflict, withdrawal symptoms, denial, etc. However, there are also clear differences between some binge behaviours. For instance, amounts of alcohol and food can be quantified and measured in terms of physical factors (e.g., organ capacity, weight, metabolic rate), and are therefore subject to physical limitation. The amount of money spent gambling can be highly individual, related to the gambler’s income and access to money, and is limited by few external controls aside from time, fatigue, and lack of funds.

In 2003, Dr. Lia Nower and Dr. Alex Blaszczynski published a case study of a binge gambler in the journal International Gambling Studies. They hypothesized the existence of a unique typology of adult gamblers that are distinctly different from traditional pathological gamblers. They hypothesized that gambling binges are characterized by six factors including:

• Sudden onset of irregular or intermittent periods of sustained gambling
• Excessive expenditures relative to income
• Rapidly spent money over a discrete interval of time
• Sense of urgency and impaired control
• Marked intra-and inter-personal distress
• Absence between bouts of any rumination, preoccupation or cravings to resume gambling participation.

More recently I also published a case study of a binge gambler in the International Journal of Mental Health and Addiction – a male slot machine addict that I called ‘Trevor’ (and aged 31 years when I published my study). I met Trevor in my capacity as an expert witness in a court trial. Trevor was charged with criminal offences related to his gambling behaviour.

Trevor’s initial gambling involvement started in the summer of 1990 when he was 16 years of age. At the time, Trevor had just begun working on a Youth Training Scheme in a West Midland town in the UK. His place of work was situated right next to an amusement arcade that housed many slot machines. Trevor’s normal routine was to go to the arcade every Friday (on his ‘pay day’). At this stage, Trevor rarely spent more than £3 at any one time on the machines and they were clearly unproblematic at that point.

Over the following years (1993–1996), Trevor’s slot machine gambling became progressively worse (at least in the amount he was spending on them) although not necessarily problematic. From 1995 onwards, Trevor had a good job as a support worker for people with disabilities. He was 21-years old and “making good money” (£250 a week), but about half of his salary was used to fund his slot machine gambling. Trevor recalled very vividly one Friday evening at the end of 1995 when he lost £200 of his weekly wage playing a slot machine. This he said was “devastating” to him. It was after this single incident that Trevor admitted to himself that he may have a problem with his gambling. Trevor is what would best be described as a binge gambler and did not gamble daily. His typical pattern would be to gamble only once or twice a week (most Fridays and the occasional Sunday). However, these binges often resulted in the losing of substantial sums of money — at least substantial to Trevor.

The real “crunch” in Trevor’s life came in the latter half of 1997 (aged 23 years) when because of his excessive gambling he failed to pay any rent or bills and was evicted from the flat he was living in at the time. In February 1998, Trevor started attending Gamblers Anonymous (GA) even though there was not a local group to attend. This meant he had to travel to Birmingham, which was three-quarters of an hour away from where he lived. Trevor attended GA for just over a year and eventually left in March 1999. While drop out rates for GA tend to be high (over 90% in the first few weeks of attendance), Trevor gained immense benefit from this group by the fact he attended for a significant period of his life. The weekly GA meeting provided a supportive network that helped Trevor’s gambling problem subside. He also knew he wasn’t alone in experiencing these types of problem.

During the following five-year period (early 1999 to early 2004), Trevor didn’t gamble at all, took control of his own earnings, and appeared to have his slot machine gambling under control. During this period, his gambling problem almost totally subsided. He began a relationship in 2000, and in 2002, they had a baby son. Trevor gambled small amounts (approximately £2 to £3) very occasionally on slot machines and always in the company of his partner who would be “keeping an eye on him” to make sure he didn’t overspend. During this period of over three years, Trevor claimed he was in control of his gambling and that because his life had some stability.

In February 2004, Trevor and his partner split up and Trevor’s gambling once again “spiralled out of control”. Most of the time Trevor would be gambling on his favourite slot machine in his local pub because it served as an escape from the breakdown of his relationship. Trevor claimed that only a quarter of his wages at this point was spent on gambling because he needed to keep money back to buy things for when he got periodic access to his young son (such as nappies, food, etc.).

On the surface, this type of behaviour does not appear to be indicative of someone totally out of control with their gambling, as most problem gamblers do not think about the consequences of their actions before they gamble. It could be the case that Trevor was either lying about how much money he spent or — like many gamblers — was not accurately recalling how much money he was spending during this period. Alternatively, and perhaps more likely, he only gambled excessively when there was nothing else to focus on his life. If Trevor’s self-report is to be believed, his son appeared to act as a barrier to the worst excesses of his gambling as his son came first when he had access to him. On the occasions where Trevor was totally responsible for his son, it forced Trevor’s problem gambling into the background somewhat.

The research literature (including my own work) certainly shows that major life events often cause spontaneous remission in gambling addictions (e.g., getting married, birth of first child, getting a job etc.). During this period in 1994, Trevor didn’t feel he had enough to support his gambling from his wages as he resorted to criminal acts, (i.e., opening mail at the postal depot where he worked in an attempt to get money to gamble on slot machines). Being caught stealing money to feed his gambling habit clearly indicated to Trevor that he needed help with his gambling again. He once again attended GA in the latter half of 2004.

Trevor believed his gambling problems were related to low self-esteem coupled with feeling depressed and having nothing else to do. Such feelings are typically found in problem gamblers who use gambling as a way of modifying their mood. Trevor claimed that his excessive gambling was integrally linked with his mood state and that when he was feeling down and/or agitated he sought solace in gambling that made him (temporarily) feel better. However, when he lost money, he would feel even worse. Trevor’s gambling problems were usually linked to other underlying problems. When these were dealt with, his problem gambling all but disappeared. It became obvious that Trevor’s gambling binges were typically caused by very specific ‘trigger’ incidents and that Trevor used gambling as a way of making himself feel better. The break-up of his last relationship was such a clear trigger incident.

Compared to other problem gamblers I have known, Trevor’s gambling was much less problematic. The gambling was usually symptomatic of other problems in Trevor’s life. In short, problem gambling only occurred at two very specific periods in Trevor’s life (1997 and 2004) and that these binges were triggered by very specific incidents. It is also worth noting that Trevor’s gambling problem was very specific (i.e., slot machines) and that no other types of gambling caused him any problems. Trevor’s case appears to adhere to the six characteristics of binge gambling outlined above by Dr. Nower and Dr. Blaszczynski in that there was irregular or intermittent periods of sustained gambling, excessive expenditures relative to income, rapidly spent money over a discrete interval of time, a sense of urgency and impaired control (at least at the times of problem gambling), marked intra- and inter-personal distress, and absence between bouts of any rumination, preoccupation or cravings to resume gambling participation.

It is not uncommon for problem gamblers to gamble excessively on ‘pay days’, lose their money, and wait for the next cycle. What really distinguishes Trevor as a binge gambler is that there is clear evidence that Trevor has had long periods of trouble-free gambling in his life (e.g., 1990 to 1995; 2000 to 2004). When things were going well for Trevor, gambling was simply not an issue. When given access and responsibility for his son, Trevor clearly puts him before anything else. Being totally responsible for his son appears be a major protective barrier in preventing him gamble.

It is also interesting to note that between his two major binges of problem gambling (1997 and 2004), Trevor appeared to have phases of both abstinent and controlled gambling. This shares some similarities with the literature on controlled drinking (particularly the pioneering research of Dr. Linda Sobell and Dr. Mark Sobell) which suggests that alcoholics who had sustained periods of non-problematic social drinking may be more likely to be able return to controlled drinking. Trevor’s case also supports other case studies in the gambling literature showing that controlled gambling after periods of problem gambling is possible.

The concept of problem binge gambling is still a much overlooked area. It appears to be less serious than chronic problem gambling but can still cause significant problems in the lives of people it affects. More research should be carried out along the lines of the types of research that are currently being carried out into binge drinking.

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

Further reading

Dickerson, M. G., & Weeks, D. (1979). Controlled gambling as a therapeutic technique for compulsive gamblers. Journal of Behavioural Therapy and Experimental Psychiatry, 10, 139–141.

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

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

Griffiths, M.D. (2002). Gambling and gaming addictions in adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055–1056.

Griffiths, M.D. (2006). A case study of binge problem gambling. International Journal of Mental Health and Addiction, 4, 369-376.

Nower, L., & Blaszczynski, A. (2003). Binge gambling: A neglected concept. International Gambling Studies, 3, 23–35.

Rankin, H. (1982). Control rather than abstinence as a goal in the treatment of excessive gambling. Behavioural Research Therapy, 20, 185–187.

Sobell, L. C., Sobell, M. B., & Ward, E. (Eds.) (1980). Evaluating alcohol and drug abuse treatment effectiveness. Elmsford, New York: Pergamon.

Eat to the beat: What is the relationship between exercise addiction and eating disorders?

In previous blogs I briefly examined both exercise addiction and eating addiction. However, there is some research that these two disorders sometimes co-occur. In some of the papers I have co-written we have reviewed the evidence as to whether exaggerated exercise behaviour is a primary problem in the affected person’s life or whether it emerges as a secondary problem in consequence of another psychological dysfunction. In the former case, the dysfunction is usually classified as primary exercise addiction because it manifests itself as a form of behavioural addiction. In the latter case, it is usually termed as secondary exercise addiction because it co-occurs with another dysfunction, typically with eating disorders, such as anorexia nervosa or bulimia nervosa.

In primary exercise addiction, the motive for over-exercising is typically geared toward avoiding something negative, although the affected individual may be totally unaware of their motivation. It is a form of escape response to a source of disturbing, persistent, and uncontrollable stress. However, in the case of a secondary exercise addiction, the excessive exercise is used as a means of weight loss (in addition to very strict dieting). Thus, secondary exercise addiction has a different etiology than primary exercise addiction. Nevertheless, it should be highlighted that many symptoms and consequences of exercise addiction are similar whether it is a primary or a secondary exercise addiction. The distinguishing feature between the two is that in primary exercise addiction, the exercise is the main objective, whereas in secondary exercise addiction, weight loss is the main objective, while exaggerated exercise is one of the primary means in achieving the objective.

In a qualitative study published by Dr Diane Bamber (University of Cambridge), she and her team interviewed 56 regularly exercising adult women. On the basis of the analysis of the results, the authors identified three factors in the diagnostic criteria of secondary exercise addiction. Among these factors, only the presence of eating disorder symptoms differentiated secondary from primary exercise addiction. The other two factors (i.e., dysfunctional psychological, physical, or social behaviour, and the presence of withdrawal symptoms) were nonspecific to secondary exercise addiction.

However, Dr Michelle Blaydon (formerly of the University of Hong Kong) and colleagues attempted to further sub-classify secondary exercise addiction based on the primary source of the problem, which in their view was related to either a form of eating disorder or to an exaggerated preoccupation with body image. Although this appears to have face validity, to date, there is no empirical evidence for such speculation. Furthermore, a different research study by Dr Diane Bamber found no evidence for primary exercise addiction. In fact, they believe that all problematic exercise behaviours are linked to eating disorders. However, this view remains critically challenged in the literature and there are documented case studies – including one that I published myself back in 1997 where no eating disorders were present at all.

In addition to several studies that have reported disordered eating behaviour often (if not always) accompanied by exaggerated levels of physical exercise, the reverse relationship has also been established. Individuals affected by exercise addiction often (but not always) show an excessive concern about their body image, weight, and control over their diet. This co-morbidity makes it difficult to establish which is the primary disorder. This dilemma has been investigated using trait and personality-oriented investigations. In an early but widely cited controversial study led by Dr Alayne Yates (University of Hawaii) concluded that addicted male long-distance runners resembled anorexic patients on a number of personality dispositions (e.g., introversion, inhibition of anger, high expectations, depression, and excessive use of denial) and labelled the similarity as the “anorexia analogue” hypothesis.

To further test the hypothesis, Yates and colleagues examined the personality characteristics of 60 male obligatory exercisers and then compared their profiles with those of clinical patients diagnosed with anorexia nervosa. While the study did not lend support to the hypothesis, the authors claimed that running and extreme dieting were both dangerous attempts to establish an identity, as either addicted to exercise or anorexic. The study has been criticized for a number of shortcomings, including the lack of supporting data, poor methodology, lack of relevance to the average runner, over-reliance on extreme cases or individuals, and exaggerating the similarities between the groups.

Indeed, later investigations also failed to reveal similarities between the personality characteristics of people affected by exercise addiction and those suffering from eating disorders. Therefore, the anorexia analogue hypothesis has failed to secure empirical support. Numerous studies have further examined the relationship between exercise addiction and eating disorders but no consensus has emerged. One reason for the inconsistent findings may be attributed to the fact that the extent of co-morbidity could vary from case to case depending on personality predispositions, the underlying psychological problem that has led to exercise addiction, and/or the interaction of the two, as well as the form and severity of the eating disorder.

A French study led by Professor Michel Lejoyeaux (Bichat and Maison Blanche Hospital) on 125 Parisian male and female current exercise addicts reported that 70% of their sample were bulimic. In another US study by Dr Patricia Estok and Dr Ellen Rudy among 265 young American adult women runners and non-runners, 25% of those who ran more than 30 miles per week showed a high risk for anorexia nervosa. In studies of people with eating disorders, a study by Peter Lewinsohn (Oregon Research Institute, US) found excessive exercise activity among males with binge eating disorders, but not females. However, the percentage overlap was not reported. Finally, in a review by Marilyn Freimuth (Fielding Graduate University, US), she and her colleagues reported that among people with eating disorders, 39% to 48% also experienced an exercise addiction.

Basically, the major weakness of the literature is the complete lack of large-scale studies. In a recent review of the addiction co-morbidity literature that I did with Dr Steve Sussman and Nadra Lisha (University of Southern California), we didn’t locate a single study on the co-occurrence of exercise addiction with other disorders with a sample size of more than 500 participants.

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

Further reading

Bamber, D.J., Cockerill, I.M., Rodgers, S., & Carroll, D. (2003). Diagnostic criteria for exercise dependence in women. British Journal of Sports Medicine, 37(5), 393–400.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, DOI: 10.3109/10826084.2011.639120.

Blaydon, M.J., & Lindner, K. J. (2002). Eating disorders and exercise dependence in triathletes. Eating Disorders, 10(1), 49-60.

Blaydon, M.J., Lindner, K. J., & Kerr, J. H. (2004). Metamotivational characteristics of exercise dependence and eating disorders in highly active amateur sport participants. Personality and Individual Differences, 36(6), 1419-1432.

Estok, P.J., & Rudy, E.B. (1996). The relationship between eating disorders and running in women. Research in Nursing & Health, 19, 377-387.

Freimuth, M., Waddell, M., Stannard, J., Kelley, S., Kipper, A., Richardson, A., & Szuromi, I. (2008). Expanding the scope of dual diagnosis and co-addictions: Behavioral addictions. Journal of Groups in Addiction & Recovery, 3, 137-160.

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

Lejoyeux, M., Avril, M., Richoux, C., Embouazza, H., & Nivoli, F. (2008). Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room. Comprehensive Psychiatry, 49, 353-358.

Lewinsohn, P.M., Seeley, J.R., Moerk, K.C., & Striegel-Moore, R.H. (2002). Gender differences in eating disorder symptoms in young adults. International Journal of Eating Disorders, 32, 426-440.

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.

Szabo, A. (2010). Addiction to exercise: A symptom or a disorder? New York, NY: Nova Science Publishers.

Yates, A., Leehey, K., & Shisslak, C. M. (1983). Running – an analogue of anorexia? New England Journal of Medicine, 308(5), 251-255.