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Bog standard: A brief look at toilet tissue eating

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

Bog standard: A brief look at toilet tissue eating

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

Muddy daughters: A beginner’s guide to geophagia

In previous blogs I have looked at pica and some of the pica sub-variants including pagophagia (the eating of ice) and coprophagia (the eating of faeces). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Today’s blog takes a look at geophagia (the eating of earth, soil and/or clay). In a literature review published in the Journal of the Royal Society of Medicine by Dr Alexander Woywodt and Dr. Akos Kiss that geophagia has been regarded as a psychiatric disease, a culturally sanctioned practice and/or a sequel to poverty and famine. Geophagia is also a culturally sanctioned practice in some parts of the world. Woywodt and Kiss also stated that:

“[Geophagia] is not uncommon in southern parts of the United States5 as well as urban Africa. Fine red clay is often preferred. In particular, geophagia is observed during pregnancy or as a feature of iron-deficiency anaemia. Where poverty and famine are implicated, earth may serve as an appetite suppressant and filler; similarly, geophagia has been observed in anorexia nervosa. However, geophagia is often observed in the absence of hunger, and environmental and cultural contexts of the habit have been emphasized. Finally, geophagia is encountered in people with learning disability, particularly in the context of long-term institutionalization”.

The relationship between anaemia and pica (including geophagia) has been well documented. However, Woywodt and Kiss assert that it is still unclear whether anaemia prompts geophagia to compensate for iron deficiency or whether geophagia is the cause of anaemia. Prevalence rates of pica have range anywhere between 0.02% and 74% depending on the study and population studied although there are few reliable prevalence estimates of geophagia. One study of pregnant Tanzanian women found a prevalence rate of 26.5% (but this is – of course – a totally unrepresentative sample).

A recent review on pica led by Dr Sera Young (University of California, USA) noted that geophagia is the most common type of pica described in the psychological and medical literature although it did also report that geophagics frequently eat other non-food stuffs (particularly if the desired soil is unavailable or socially unacceptable). For many people, pica is not dangerous but for geophagia there may be complications including parasitic infections (from eating soil). Although eating soil and clay may be regarded as unappetizing (and perhaps bizarre) by most people, some authors have argued that eating soil can be nutritionally beneficial (which if that was the case, it wouldn’t technically be a form of pica).

While not being considered a social norm in Western society, eating soil or clay is said to be quite common among primitive or economically depressed peoples a way of augmenting a scanty and/or mineral-deficient diet. Having said that, the geophagia is most often confined to people suffering from chronic mental illness. Clay (as opposed to soil) consumption has been reported in India, Haiti, various parts of Africa (Cameroon, Gabon, Guinea), and even rural areas of the USA. Like soil consumption, clay consumption has also been associated with pregnant women and some women claim they eat it to eliminate nausea. The Wikipedia entry on geophagia noted:

“In Haiti, the poorest economy in the Western Hemisphere, geophagy is widespread. The clay mud is worked into what looks like pancakes or cookies, called ‘bon bons de terres’…The cookies have little or no nutritional value and are associated with various health problems”.

A study led by Dr. L.T. Glickman and colleagues, and published in a 1999 issue of the International Journal of Epidemiology, provided some data on geophagia by carrying out a study examining intestinal parasitism among children from three rural villages in Guinea (Africa). More specifically they examined the faecal stools of 266 randomly selected children (aged 1-18 years). The researchers found that 53% of children were infected by at least one type of soil-transmitted parasite. They also surveyed parents and reported that geophagia was reported by parents to occur in 57% of children aged 1-5 years, 53% of children aged 6-10 years, and 43%, of children aged 11-18 years. It was concluded that geophagia is an important risk factor for orally acquired parasitic infections in African children.

A small study carried out by Turkish researchers and published in a 1978 issue of Acta Haematologica carried out oral iron and zinc tolerance tests on 12 patients from Turkey and Iran aged between 8 and 21 years with iron deficiency anemia and geophagia. The research team reported decreased iron and zinc absorption in patients compared to control patients. They concluded that iron and zinc malabsorption may be an additional feature of the syndrome characterized by geophagia among those from Turkey and Iran. Finally, in their literature review on geophagia, Dr Woywodt and Dr Kiss concluded that:

“The causation is certainly multifactorial; and clearly the practice of earth-eating has existed since the first medical texts were written. The descriptions do not allow simple categorization as a psychiatric disease. Finally, geophagia is not confined to a particular cultural environment and is observed in the absence of hunger”

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

Further reading

Arcasoy, A., Cavdar, A.O. & Babacan, E. (1978). Decreased iron and zinc absorption in Turkish children with iron deficiency and geophagia. Acta Haematologica, 60, 76-84.

Ashworth, M., Hirdes, J.P. & Martin, L. (2008). The social and recreational characteristics of adults with intellectual disability and pica living in institutions. Research in Developmental Disabilities, 30, 512-520.

Danford, D.E. & Huber, A.M. (1982). Pica among mentally retarded adults. American Journal of Mental Deficiency, 87, 141-146.

Glickman, L.T., Camara, A.O., Glickman, N.W. & McCabe, G.P. (1999). Nematode intestinal parasites of children in rural Guinea, Africa: Prevalence and relationship to geophagia. International Journal of Epidemiology, 28, 169-174.

Kettaneh, A., Eclache, V., Fain, O., Sontag, C., Uzan, M. Carbillon, Stirnemann, J. & Thomas, M. (2005). Pica and food craving in patients with iron-deficiency anemia: A case-control study in France. American Journal of Medicine, 118, 185-188

Lacey, E. (1990). Broadening the perspective of pica: Literature review. Public Health Reports, 105, 29-35.

López, L.B., Ortega Soler, C.R. & de Portela, M.L. (2004). Pica during pregnancy: A frequently underestimated problem. Archivos latinoamericanos de nutricion, 54, 17-24.

Nyaruhucha, C.N. (2009). Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 11(1), 29–34.

Rose, E.A., Porcerelli, J.H, & Anne Neale, A.V. (2000). Pica: Common but commonly missed. Journal of the American Board of Family Practice, 13, 353-358.

Stein, D.J., Bouwer, C. & van Heerden, B. (1996). Pica and the obsessive- compulsive spectrum disorders. South African Medical Journal, 86, 1586-1592.

Woywodt, A. & Kiss, A. (2002). Geophagia: the history of earth-eating. Journal of the Royal Society of Medicine, 95:143-146.

Young, S.L., Wilson, M.J., Miller, D., & Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS One, 3(9), e3147.

Wikipedia (2012). Geophagy. Located at: http://en.wikipedia.org/wiki/Geophagy

Herd in-stink-t: A brief look at cow dung and cow urine therapy

“Hindu nationalists in India have launched a marketing exercise to promote cow’s urine as a health cure. They say the urine, being sold for 30p a bottle, can be used for ailments ranging from liver disease to obesity and even cancer. The urine is being sold under the label ‘Gift of the Cow’, and is being enthusiastically promoted by the government of Gujarat. The urine is collected every day from almost 600 shelters for rescued and wounded cattle, and is available in about 50 centres in Gujarat. It also comes in tablets or a cream mixed with other traditional medicinal herbs and demand is currently outstripping supply…The healing properties of cow dung and cow’s urine are mentioned in ancient Hindu texts and authorities claim research conducted by doctors at the cow-protection commission indicates the urine can cure anything from skin diseases, kidney and liver ailments to obesity and heart ailments. Although most Indian doctors view the medicines as eccentric, several advocates of the treatment have come forward in Gujarat to support the claims…They include Vidhyaben Mehta, a 65-year-old woman with a cancerous tumour on her chest who has been taking cow’s urine for the past three years. She says she is no longer in pain and has survived in spite of medical predictions that she would die two years ago” (News report, India Divine website, February 17, 2002).

As regular readers of my blog will know, I’m not averse to writing about matters concerning bodily waste products (i.e., urine and faeces) in that I have covered urophilia (sexual arousal to urine), coprophilia (sexual arousal to faeces), zoocoprophilia (sexual arousal to animal faeces), copraphagia (eating human and/or animal faeces), and the making of jenkem (fermenting human urine and faeces as a way of getting high and intoxicated). Today’s blog takes a brief look at the use of cow urine and cow dung for allegedly medicinal purposes.

As far as I am aware, the only country in the world that uses cow dung and cow urine to treat disease and illness is India. Much of the reasoning behind the use of cow waste products to treat illness is rooted in Hindu beliefs about the cow. Many of you reading this will be aware of the ‘sacred cow’ in Hindu religion. However, as a number of articles I have read on Hindu culture point out, Hindus don’t actually worship cows (in the sense that they worship a deity), but ‘respect, honour and adore’ them because cows give more than they take, and for Hindus, cows symbolize all other animals. In Hindu religion, the cow also symbolizes dignity, strength, endurance, maternity and selfless service. As one article I read noted:

“To the Hindu, the cow symbolizes all other creatures. The cow is a symbol of the Earth, the nourisher, the ever-giving, undemanding provider. The cow represents life and the sustenance of life. The cow is so generous, taking nothing but water, grass and grain. It gives and gives and gives of its milk, as does the liberated soul give of his spiritual knowledge. The cow is so vital to life, the virtual sustainer of life, for many humans. The cow is a symbol of grace and abundance. Veneration of the cow instils in Hindus the virtues of gentleness, receptivity and connectedness with nature…The generous cow gives milk and cream, yogurt and cheese, butter and ice cream, ghee and buttermilk. It gives entirely of itself through sirloin, ribs, rump, porterhouse and beef stew. Its bones are the base for soup broths and glues. It gives the world leather belts, leather seats, leather coats and shoes, beef jerky, cowboy hats – you name it”.

All over India, the cow is honoured, garlanded and given special feedings at festivals (including the Gopashtama annual festival). But where does the use of cow urine and cow dung come in? Basically, the five products (pancagavya) of the cow – milk, curds, ghee butter, urine and dung — are all used in Hindu worship (puja), in addition to extreme penance rites. As another article I read explains:

“The milk of the family cow nourishes children as they grow up, and cow dung (gobar) is a major source of energy for households throughout India. Cow dung is sometimes among the materials used for a tilak – a ritual mark on the forehead. Most Indians do not share the western revulsion at cow excrement, but instead consider it an earthy and useful natural product…[Over time] Hindus stopped eating beef. This was mostly like for practical reasons as well as spiritual. It was expensive to slaughter an animal for religious rituals or for a guest, and the cow provided an abundance of important products, including milk, browned butter for lamps, and fuel from dried dung”.

As a result of Hinduism’s reverence of the cow, cow urine and cow dung has become big business in India’s Nagpur region. Scientific research into the health benefits of cattle waste products is being carried out by Go-vigyan, a research and development organization. Some of the products that Go-vigyan makes (and I’m not making this up) include cow urine shampoo and cow dung toothpaste.

Cow dung and urine are used in the treatment of several disorders including renal disorders, leucoderma, arthritis, and hyperlipidemia. It’s also been claimed that panchagavya products show excellent agricultural applications. For instance, cow urine and neem leaves have been combined to make pesticides and insect repellent. The best selling medicine in the Nagpur region is Gomutra Ark, which is nothing more than distilled cow urine (Go=Cow, Mutra=Urine, Ark=medicine). Those who take it believe it can prevent and/or cure anything from the common cold to cancer, tuberculosis, and AIDS.

If you go onto YouTube, there are quite a few short video clips showing urine being massaged from cows and dung being collected in cattle sheds. Skilled cow handlers massage and encourage the cows to urinate. There are also clips of Indian women making cow dung soap. I wouldn’t have believed it myself if I hadn’t watched it with my own eyes. You can also check out photos of Indian women undergoing cow dung therapy at the Science Photo Library.

It’s difficult to assess the extent to which there is a placebo effect operating here but there’s no doubting some people’s beliefs that cow dung and urine are miracle cures for a wide range of illnesses and diseases. There’s even a dedicated webpage of testimonials from people who claim they have been cured of their diseases (e.g., AIDS, cancer, heart problems, etc.) by cow urine. I did come across a 2009 academic paper by Dr. R.S. Chauhan and colleagues in The Indian Cow: The Scientific and Economic Journal. They reported that cow urine had been granted U.S. Patents (No. 6896907 and 6,410,059) for its medicinal properties “particularly for its use along with antibiotics for the control of bacterial infection and fight against cancers. Through extensive research studies a cow urine distillate fraction, popularly known as ‘ark’, has been identified as a bioenhancer of the activities of commonly used antibiotics, anti-fungal and anti-cancer drugs”.

The authors reviewed the literature on the use of cow urine for medicinal purposes and reported that cow urine therapy provides promising results for the treatment of cancer. They noted that the anti-cancer potential of cow urine therapy was “reflected by several case reports, success stories and practical feedback of patients for the treatment of cancer”. They claimed that cow urine “enhances the immunocompetence and improves general health of an individual; prevent the free radicals formation and act as anti-aging factor; reduces apoptosis in lymphocytes and helps them to survive; and efficiently repairs the damaged DNA, thus is effective for the cancer therapy”. They also claimed experiments (presumably done in India) proved that cow urine above all other urine was the most medically effective as “scientific validation of cow urine therapy is required for its worldwide acceptance and popularity”. I remain open to the idea that cow urine may be of medical benefit, but remain to be convinced on what I have read to date.

http://www.cowurine.com/testimonials.html

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

Further reading

Chauhan, R.S., Dhama, K. & Lokesh, S. (2009). Anti-cancer property of cow urine. The Indian Cow: The Scientific and Economic Journal, 5(19), 22-58.

Joseph, M. (2004). Cattle, the research catalyst. Wired, November 16. Located at: http://www.wired.com/culture/lifestyle/news/2004/11/65717

Go-Vigyan Anusandhan Kendra (undated). Medical products development. Located at: http://www.govigyan.com/medicalproducts.htm

India Yogi (undated). Why is the cow ‘sacred’? Located at: http://www.indiayogi.com/content/symbolism/answer.aspx?id=3

Nair, R.J. (2010). Cow dung, urine as medicine? Discovery News, March 2. http://news.discovery.com/human/health/cow-dung-medicine-spiritual-india.htm

National Hindu Students Forum (2004). Why do Hindus worship the cow? Located at: http://www.nhsf.org.uk/index.php?option=com_content&view=article&id=526 (reprinted from an article in Hinduism Today)

Religion Facts (2012). The cow in Hinduism. December 21. Located at: http://www.religionfacts.com/hinduism/things/cow.htm

This farming man: An unusual case of zoocoprophilia?

One of the most bizarre sex-related stories I have come across in the last few years concerns an Englishman called David Truscott from Pengegon Parc, Camborne (in Cornwall). Truscott, was 41-years-old when he was put in prison for two years after he had harassed and terrorized one particular family for a six-year period near Redruth (Cornwall). He repeatedly covered his naked (or scantily-clad) body in cow manure and would roll around on the floor masturbating on the family’s farm (if he wasn’t completely naked he either wore just underpants although on one occasion he was apprehended by police wearing shiny red sorts and latex gloves). He had already received a court order preventing him from going anywhere near the family but breached his restraining order on February 26 [2011] when he was caught by the farmer Clive Roth’s 16-year old son pleasuring himself while covered in cow manure.

Jill Wilson, the crown prosecutor in the case at Truro Court told the court that there was “a history of [Truscott] visiting this particular farm seeking sexual gratification while immersed in cow dung and mud”. Mark Charnley, the lawyer defending Truscott told the court that his client was a “sad, vulnerable, socially inadequate man…He does show remorse for what he did and a realization of the harm he was doing to the family and pleased for leniency because his client had no close family and had learning difficulties. Charnley also suggested that Truscott was suffering from a form of autism that led him to engage in his sexual behaviour while under stress. However, Judge Christopher Elwen said Truscott had to be jailed for his “perverted activities [and because he’d] made the home life of the Roth family absolute hell through your bizarre fetish and disgusting behaviour”. The Judge concluded: “The family members live in fear of what you might get up to from time to time. They have constantly to look over their shoulders. Any untoward activity on the farm brings your disgusting behaviour to mind”.

It was back in 2004 that Truscott was first spotted by the family when he was found masturbating in the faeces of the farm’s muck spreader. As the behaviour was not an isolated incident, the family tried to keep their manure spreading equipment clean but Truscott still found ways to make himself a nuisance to the family. When the manure became harder to come by, Truscott took his revenge on the family by setting fire to an animal pen containing the family’s cows and calves in which one of the cows died. The family’s three-year old son was traumatized by the incident and lived in fear that the house where he lived was going to be burned to the ground. Mr Roth’s mother also lived in fear that the farmhouse was going to be the subject of an arson attack. As a consequence, Truscott pleaded guilty and received a three-year prison sentence.

When he was released from prison in 2009, Truscott returned to the family’s farmhouse and was found naked in a pile of manure. He received yet another prison sentence (of 20 weeks) and a restraining order preventing him from stepping foot on the family’s farm. However, this proved ineffective and was broken on a number of subsequent occasions (including one where he immersed himself almost naked inside a large vat of manure inside the farm’s milking parlour. It was also revealed in court that Trsucott owned 360 pairs of women’s knickers and usually slept in ladies’ pyjamas.

Although I only have the various news reports to go on (all the ones I read are listed in the ‘Further reading’ section at the end of this blog), I would make a number of observations. Firstly, the primary sexual attraction appears to be towards animal faeces, therefore he could possibly be classed as a coprophile. Although I have never come across a case of anyone in the academic and clinical literature deriving sexual pleasure from anything other than human faeces, definitions of coprophilia never specify that the faecal matter has to be human. Maybe Truscott’s behaviour could therefore be classed as “zoocoprophilia” (my own word to describe those individuals who derive sexual pleasure and arousal from animal faeces).

Secondly, (and I admit this is highly speculative), it could perhaps be argued that Truscott would classify as a ‘Class V zoosexual’ in Dr. Anil Aggrawal’s recently published new classification of zoophiles. The Class V zoosexual type comprises what Aggrawal calls fetishistic zoophiles. These individuals keep various animal parts (especially fur) that they then use as an erotic stimulus as a crucial part of their sexual activity. Such individuals have been reported in the clinical literature including the case of a woman (reported in a 1990 issue of the American Journal of Forensic Medical Pathology) who used the tongue of a deer as her primary masturbatory aid. Given that the animal manure appeared to be a critical component in Truscott’s masturbatory activity, maybe he could arguably be classed as a Class V zoosexual.

Thirdly, there is some empirical evidence of an overlap in coprophilia and zoophilia. An earlier study on a sample of paraphiliacs reported that zoophiles appear to engage in many paraphilic behaviours including coprophilia. In a survey of 561 non-incarcerated paraphiliacs seeking treatment, Dr Gene Abel and colleagues reported in an issue of the Bulletin of the American Academy of Psychiatry and the Law, that all of the 14 zoophiles in their sample reported more than one paraphilia and seven of them reported at least five other paraphilas including coprophilia, urophilia, pedophilia, exhibitionism, voyeurism, frotteurism, telephone scatophilia, transvestic fetishism, fetishism, sexual sadism, and/or sexual masochism. This also supports the observation that if a person has one paraphilia, they often have others. In the case of Truscott, there was some evidence that he engaged in transvestite sexual behaviour in the fact that he often wore women’s knickers and slept in female nightwear.

Finally, fact that Truscott’s lawyer suggested his client had a form of autism may be an important factor in the behaviour displayed. In a previous blog I wrote on coprophagia (i.e., people that eat faeces, and a behaviour that sometimes overlaps with coprophilia), I noted that various medical and psychological disorders have been identified that are associated with coprophagia including mental retardation and autism.

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

Further reading

Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M. S., & Rouleau, J. L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.

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

Beck D.A. & Frohberg, N.R. (2005). Coprophagia in an elderly man: a case report and review of the literature. International Journal of Psychiatry Medicine, 35, 417-427.

Crazy News (2011). The pervert who got sexual thrills in cow manure. March 24. Located at: http://weirdcrazynews.blogspot.co.uk/2011/03/pervert-who-got-sexual-thrills-in-cow.html

Daily Mirror (2011). Pervert who got sexual thrills in cow manure sent to prison. Daily Mirror, March 24. Located at: http://www.mirror.co.uk/news/weird-news/pervert-who-got-sexual-thrills-in-cow-117998

Evening Standard (2011). Pervert with fetish for cow manure is locked up, March 23. Located at: http://www.standard.co.uk/news/pervert-with-fetish-for-cow-manure-is-locked-up-6384125.html

Ghaziuddin, N. & McDonald, C. (1989). A clinical study of adult coprophagics. British Journal of Psychiatry, 4, 53-54.

Omasiali (2011). Sick white devil repeatedly has sex with cow manure back in jail, May 15. http://omasiali.wordpress.com/2011/05/15/sick-white-devil-repeatedly-has-sex-with-cow-manure-back-in-jail/

Randall, M.B., Vance, R.P., McCalmont, T.H. (1990). Xenolingual autoeroticism. American Journal of Forensic and Medical Pathology, 11, 89-92.

Skruff, J. (2012). Britain’s filthiest sex fiend strikes again, July 18. Located at: http://skrufff.com/2012/07/britains-filthiest-sex-fiend-strikes-again/

White Watch (2011). White man who repeatedly has sex with cow manure back in jail. March 27. Located at: http://whitewatch.info/2011/03/27/white-man-who-repeatedly-has-sex-with-cow-manure-back-in-jail.aspx

High performer to hyper former: A brief overview of Klüver–Bucy syndrome‬

While I was researching a previous blog on coprophagia (eating faeces), I came across a finding that coprophagia was prevalent in those with Klüver-Bucy Syndrome (KBS). I have to be honest and say I had never heard of KBS until that point so I thought I would investigate a little further. Back in 1937, Dr. Heinrich Klüver and Dr. Paul Bucy described an unreported behavioural syndrome in rhesus monkeys following removal of the bilateral temporal lobe in the brain, and described by Klüver himself as “the most striking and apparent alteration ever observed in consequence of surgical experiments performed on animal brains”. The surgical procedure resulted in (i) psychic blindness or visual agnosia (i.e., a deficiency in the ability to recognize visual objects), (ii) strong oral tendencies, (iii) hypermetamorphosis (i.e., an irresistible impulse to notice and react to everything within sight), (iv) decrease in aggressive behaviour, and fear reaction, and (v) hypersexuality.

The first human case was reported in 1955 by Dr. H. Terzian and Dr. G. Ore (in the journal Neurology). They carried out a bilateral removal of the temporal lobes in an adult male that resulted in KBS. The second case (although many papers I have read claim this was the first human case) – a 22-year-old man – was reported by Marlowe and colleagues in a 1975 issue of the journal Cortex. In this individual, KBS occurred following bilateral temporal lobe damage due to herpes simplex meningoencephalitis.

Since those two early cases, KBS has been associated with numerous disorders of the central nervous system. For instance, a treatment study of six KBS cases in a 2004 issue of Neurology India, Dr. Jha and Dr. Patel noted that the range of conditions associated with KBS included Alzheimer’s disease, juvenile neuronal lipofuscinosis, Huntington’s disease, herpes simplex encephalitis, toxoplasmosis, traumatic brain injury, hypoglycemia, acute intermittent porphyria, traumatic head/brain injury, tuberculous meningitis, heat stroke and Shigellosis. Other conditions may also contribute to a diagnosis of KBS including ischaemia, anoxia, progressive subcortical gliosis, Rett Syndrome, Pick’s Disease, porphyria, and carbon monoxide poisoning.

In humans, KBS is a rare behavioural impairment resulting from damage to both of the anterior temporal lobes of the brain. The disorder is not life threatening, but health practitioners can find KBS sufferers difficult to manage. The condition can be caused by either (i) bilateral temporal lobectomy, or (ii) bilateral temporal lobe damage from degenerative disorders, trauma, and encephalitis. At present, there is no known cure for KBS. Research carried out on human case studies have recorded a variety of symptoms including:

  • Hyperorality: Typified by KBS sufferers compulsively examining everything by mouth
  • Hypersexuality: Typified by KBS sufferers experiencing a heightened sex drive and/or seeking sexual stimulation from unusual or inappropriate items.
  • Docility: Typified by KBS sufferers exhibiting low aggressive tendencies and diminished fear responses.
  • Dietary changes and/or hyperphagia: Typified by KBS sufferers eating non-nutritive items or substances (i.e., pica) and/or overeating.
  • Visual agnosia: Typified by KBS sufferers as the inability to recognize normally familiar objects or people.

Other types of behaviour reported in KBS sufferers include (i) amnesia (i.e., memory loss), (ii) hypermetamorphosis (as noted in rhesus monkeys above), (iii) lack of emotional response and diminished emotional affect amnesia, (iv) dementia, (v) dysphasia (i.e., inability to communicate following brain injury), and (vi) seizures. In humans, the three most common symptoms are docility, hyperorality and dietary changes.

The natural history of KBS is still unknown, but in the case of trauma, a recent paper by Dr. Amaresh Deginal and Dr. Siddling Changty in the Indian Journal of Neurotrauma (2011) reported that the course is temporary, ranging from seven days to one year. They also noted there is no specific treatment apart from oral Carbamazepine (CBZ). CBZ and leuprolides have been used to decrease the hypersexuality in KBS sufferers. Other medications (e.g., anti-cholinergics and haloperidol) have also been used in treating other behavioural consequences associated with KBS as highlighted in the paper by Jha and Patel above. However, as Dr. John Anson and Dr. Donald Kuhlman concluded:

“Klüver-Bucy syndrome remains a fascinating syndrome whose exact neuroanatomicalbasis is unclear. As neurosurgical treatment of seizure disorders increases, the consequences of mesial temporal lobectomy must be considered. Although most patients with intractable seizures improve after surgical intervention, they may develop neuro-behavioural complications such as the Kluver-Bucy syndrome. A more limited surgical resection, particularly one that spares more of the amygdala, may minimize the chance of this type-of complication”.

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

Further reading

Anson, J.A. & Kuhlman, D.T. (1993). Post-ictal Kliuver-Bucy syndrome after temporal lobectomy. Journal of Neurology, Neurosurgery and Psychiatry, 56, 311-313.

Deginal, A. & Changty, S. (2011). Post traumatic Klüver-Bucy syndrome: A case report. Indian Journal of Neurotrauma, 8, 41-42.

Jha, S. & Patel, R. (2004). Klüver-Bucy syndrome – an experience with six cases. Neurology India, 52, 369-71.

Klüver, H. &  Bucy, P.C. (1937). Psychic blindness and other symptoms following bilateral temporal lobectomy in rhesus monkeys. American Journal of Physiology, 119, 352-353.

Kwiatkowski, S., Starowicz, A., Milczarek, O. & Kawecki, Z. (2011). Neuropsychological characteristic of post-traumatic Klüver-Bucy Syndrome. Archives of Psychiatry and Psychotherapy, 4, 59-65

Lilly, R., Cummings, J.L., Benson, F. & Frankel, M. (1983). The human Klüver‐Bucy syndrome, Neurology, 33, 1141.

Marlowe, W.B., Mancall, E.L. & Thomas J.J. (1975). Complete Klüver-Bucy syndrome in man. Cortex, 11, 53-59.

Ozawa, H., Sasaki, M., Sugai, K., et al. (1997). Single-Photon Emission CT and MR findings in Klüver-Bucy syndrome after Reye syndrome. American Journal of Neuroradiology, 18, 540-42.

Stewart, J.T. (1985). Carbamazepine treatment of patient with Klüver-Bucy syndrome. Journal of Clinical Psychiatry, 46, 496-497.

Terzian, H. & Ore, G.D. (1955) Syndrome of Kluver and Bucy. Reproduced in man by bilateral removal of the temporal lobes. Neurology, 5, 373-80.

Waste not, want not: A brief overview of coprophagia

One of the most stomach churning behaviours among humans is coprophagia (i.e., the eating of faeces), and has the capacity to generate intense emotional reactions among those witnessing such behaviour. I don’t know about you, but my first visual exposure to human copraphagia was in the 1972 John Waters film Pink Flamingos when the leading “actress” Divine (a transvestite male) ate the freshly produced (and real) excrement from a dog that had just defecated on the pavement. As the narrator states immediately this as happened, Divine is “not only the filthiest person in the world, but is also the world’s filthiest actress”. The arts world is littered with coprophagic references and acts ranging from the detailed descriptions in the Marquis de Sade’s infamous novel The 120 Days of Sodom through to recent films such as The Human Centipede.

Hundreds of years ago, medical doctors used to taste their patients’ faeces as a way to assess their patients health and condition. Such historical actions, while seemingly gross, at least had a functional goal. In contemporary society, coprophagia often occurs among individuals with severe developmental disabilities although for a very small minority, coprophagic acts may occur as part of the sexual paraphilia coprophilia (i.e., sexual arousal and pleasure from faeces).

Copraphagia is a complex behavioural disorder and is commonly regarded as a variant form of pica (i.e., the eating of non-nutritive items or substances), even though there are many health risks associated with it (e.g., intestinal parasites, diarrhea, blood-borne pathogens). Other problems include poor oral hygiene, chronic gingival infection, and salivary gland infections.

A number of medical disorders have been identified that are associated with coprophagia including seizure disorders, cerebral atrophy, and tumours. There are also many psychological and psychiatric disorders associated with coprophagia including mental retardation, alcoholism, severe depression, autism, obsessive-compulsive disorder, Klüver-Bucy syndrome, schizophrenia, fetishes, delirium, and dementia. The psychopathological roots and etiology of coprophagia still remain little known, and much of what has been published academically involves case studies. Furthermore, the prevalence of copraphagia is also unknown but thought to be very rare.

In a 1989 study of 14 elderly coprophagic patients (average age of 71 years) in psychiatric hospitals published in the British Journal of Psychiatry, Ghaziuddin and McDonald reported that nine had senile dementia, two were severely depressed, and one had cerebral atrophy. Three of the 14 were reported has having no cognitive deficits. Although comprising only 14 patients, this is actually one of the largest studies in the area as most published papers consist of case studies.

As mentioned above, copraphagia can on occasion be seen as part of a sexual fetish where the eating of faeces is associated with sexual arousal. In a 1995 issue of the Journal of Sex and Marital Therapy, Dr. T. Wise and Dr. R. Goldberg reported the case of a non-psychotic 47-year old man of normal intelligence who had a fetish for faecal smearing that escalated into coprophagia when combined with alcohol abuse and depression.

In researching this blog, I came across a form of culture bound syndrome called Arctic Hysteria (also known as Piblokto and Pibloktoq) where one of the common symptoms is coprophagia. Culture bound syndromes comprise a combination of psychiatric and/or somatic symptoms viewed as a recognizable disease within specific cultures or societies. Arctic Hysteria only manifests itself in winter among Inuhuit societies living (unsurprisingly) within the Arctic Circle. The condition is characterized by “an abrupt dissociative episode of intense hysteria, frequently followed by convulsive seizures and coma lasting up to 12 hours. Symptoms can include intense screaming, uncontrolled wild behaviour, depression, coprophagia, and insensitivity to extreme cold”. Some scholars have cast doubt on its existence as a bona fide medical entity, but the association with copraphagia occurs repeatedly.

There is a wide variety of treatments that have been used for coprophagia including behavioural therapy, dietary changes, pharmacotherapy (e.g., tricyclic antidepressants, haloperidol, perospirone), and electro-convulsive therapy. All of these have reported at least partial success.

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

Further reading

Beck D.A. & Frohberg, N.R. (2005). Coprophagia in an elderly man: a case report and review of the literature. International Journal of Psychiatry Medicine, 35, 417-427.

Donnellan, C.A. & Playfer, J.R. (1999). A case of coprophagia presenting with sialadenitis. Age and Ageing, 28, 233-234.

Foxx, R. M., & Martin, E. D. (1975). Treatment of scavenging behavior (coprophagy and pica) by overcorrection. Behavior Research and Therapy, 13, 153–162.

Friedin, B.D., & Johnson, H.K. (1979). Treatment of a retarded child’s feces smearing and coprophagic behavior. Journal of Mental Deficiency Research, 23, 55–61.

Ghaziuddin, N. & McDonald, C. (1989). A clinical study of adult coprophagics. British Journal of Psychiatry, 4, 53-54.

Harada, K.I., Yamamoto, K. & Saito, T. (2006). Effective treatment of coprophagia in a patient with schizophrenia with the novel atypical antipsychotic drug perospirone. Pharmacopsychiatry, 39, 113.

Ing, A.D., Roane, H.S. & Veenstra, R.A. (2011). Functional analysis and treatment of coprophagia. Journal of Applied Behavior Analysis. 44, 151–155

Pardini, M., Guida, S. & Gialloreti, L.E. (2010). Aripiprazole Treatment for Coprophagia in Autistic Disorder. Journal Neuropsychiatry and Clinical Neuroscience, 22(4), E33

Wise, T.N. & Goldberg, R.L. (1995). Escalation of a fetish: coprophagia in a nonpsychotic adult of normal intelligence. Journal of Sex and Marital Therapy, 21, 272-275.

Waste not, want not: A brief overview of coprophagia

One of the most stomach churning behaviours among humans is coprophagia (i.e., the eating of faeces), and has the capacity to generate intense emotional reactions among those witnessing such behaviour. I don’t know about you, but my first visual exposure to human copraphagia was in the 1972 John Waters film Pink Flamingos when the leading “actress” Divine (a transvestite male) ate the freshly produced (and real) excrement from a dog that had just defecated on the pavement. As the narrator states immediately this as happened, Divine is “not only the filthiest person in the world, but is also the world’s filthiest actress”. The arts world is littered with coprophagic references and acts ranging from the detailed descriptions in the Marquis de Sade’s infamous novel The 120 Days of Sodom through to recent films such as The Human Centipede.

Hundreds of years ago, medical doctors used to taste their patients’ faeces as a way to assess their patients health and condition. Such historical actions, while seemingly gross, at least had a functional goal. In contemporary society, coprophagia often occurs among individuals with severe developmental disabilities although for a very small minority, coprophagic acts may occur as part of the sexual paraphilia coprophilia (i.e., sexual arousal and pleasure from faeces).

Copraphagia is a complex behavioural disorder and is commonly regarded as a variant form of pica (i.e., the eating of non-nutritive items or substances), even though there are many health risks associated with it (e.g., intestinal parasites, diarrhea, blood-borne pathogens). Other problems include poor oral hygiene, chronic gingival infection, and salivary gland infections.

A number of medical disorders have been identified that are associated with coprophagia including seizure disorders, cerebral atrophy, and tumours. There are also many psychological and psychiatric disorders associated with coprophagia including mental retardation, alcoholism, severe depression, autism, obsessive-compulsive disorder, Klüver-Bucy syndrome, schizophrenia, fetishes, delirium, and dementia. The psychopathological roots and etiology of coprophagia still remain little known, and much of what has been published academically involves case studies. Furthermore, the prevalence of copraphagia is also unknown but thought to be very rare.

In a 1989 study of 14 elderly coprophagic patients (average age of 71 years) in psychiatric hospitals published in the British Journal of Psychiatry, Ghaziuddin and McDonald reported that nine had senile dementia, two were severely depressed, and one had cerebral atrophy. Three of the 14 were reported has having no cognitive deficits. Although comprising only 14 patients, this is actually one of the largest studies in the area as most published papers consist of case studies.

As mentioned above, copraphagia can on occasion be seen as part of a sexual fetish where the eating of faeces is associated with sexual arousal. In a 1995 issue of the Journal of Sex and Marital Therapy, Dr. T. Wise and Dr. R. Goldberg reported the case of a non-psychotic 47-year old man of normal intelligence who had a fetish for faecal smearing that escalated into coprophagia when combined with alcohol abuse and depression.

In researching this blog, I came across a form of culture bound syndrome called Arctic Hysteria (also known as Piblokto and Pibloktoq) where one of the common symptoms is coprophagia. Culture bound syndromes comprise a combination of psychiatric and/or somatic symptoms viewed as a recognizable disease within specific cultures or societies. Arctic Hysteria only manifests itself in winter among Inuhuit societies living (unsurprisingly) within the Arctic Circle. The condition is characterized by “an abrupt dissociative episode of intense hysteria, frequently followed by convulsive seizures and coma lasting up to 12 hours”. Symptoms can include intense screaming, uncontrolled wild behaviour, depression, coprophagia, and insensitivity to extreme cold”. Some scholars have cast doubt on its existence as a bona fide medical entity, but the association with copraphagia occurs repeatedly.

There is a wide variety of treatments that have been used for coprophagia including behavioural therapy, dietary changes, pharmacotherapy (e.g., tricyclic antidepressants, haloperidol, perospirone), and electro-convulsive therapy. All of these have reported at least partial success but as with research on coprophagia more generally, most treatment papers are based on case studies.

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

Further reading

Beck D.A. & Frohberg, N.R. (2005). Coprophagia in an elderly man: a case report and review of the literature. International Journal of Psychiatry Medicine, 35, 417-427.

Donnellan, C.A. & Playfer, J.R. (1999). A case of coprophagia presenting with sialadenitis. Age and Ageing, 28, 233-234.

Foxx, R. M., & Martin, E. D. (1975). Treatment of scavenging behavior (coprophagy and pica) by overcorrection. Behavior Research and Therapy, 13, 153–162.

Friedin, B.D., & Johnson, H.K. (1979). Treatment of a retarded child’s feces smearing and coprophagic behavior. Journal of Mental Deficiency Research, 23, 55–61.

Ghaziuddin, N. & McDonald, C. (1989). A clinical study of adult coprophagics. British Journal of Psychiatry, 4, 53-54.

Harada, K.I., Yamamoto, K. & Saito, T. (2006). Effective treatment of coprophagia in a patient with schizophrenia with the novel atypical antipsychotic drug perospirone. Pharmacopsychiatry, 39, 113.

Ing, A.D., Roane, H.S. & Veenstra, R.A. (2011). Functional analysis and treatment of coprophagia. Journal of Applied Behavior Analysis. 44, 151–155

Pardini, M., Guida, S. & Gialloreti, L.E. (2010). Aripiprazole Treatment for Coprophagia in Autistic Disorder. Journal Neuropsychiatry and Clinical Neuroscience, 22(4), E33

Wise, T.N. & Goldberg, R.L. (1995). Escalation of a fetish: coprophagia in a nonpsychotic adult of normal intelligence. Journal of Sex and Marital Therapy, 21, 272-275.

Pica boom? A beginner’s guide to pica

Pica is an eating disorder that has been documented in the psychological literature for hundreds of years and refers to a behaviour in which individuals eat non-nutritive items or substances (such as coal, hair and wood). The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines pica as “the persistent eating of nonnutritive substances for a period of at least one month, without an association with an aversion to food”. Therefore, one-off instances of eating non-nutritious items would not constitute pica. Children who occasionally eat items like crayons are rarely diagnosed as having pica. Pica comes from a Latin word for the magpie bird (known for its strange eating behaviours).

The prevalence rates of pica depend on which patient populations have been studied. Prevalence estimates are also skewed by the fact that many people suffering from pica are embarrassed about the behaviour and may not tell anyone and/or seek medial treatment. However, it is well established that pica is more prevalent in children, pregnant women, adults from lower socioeconomic classes, and children with developmental disabilities (such as autism). The incidence of pica is also higher amongst those suffering from family-related stress. Although pica can be a symptom of anaemia (i.e., iron deficiency) and other chemical imbalances, research has shown it is actually more common among those who have normal iron levels.

Prevalence rates of pica have range anywhere between 0.02% and 74% depending on the study and population studied. For instance, studies have reported pica prevalence rates of:

  • 0.02% in Danish pregnant women
  • 8% in US black pregnant women (pagophagia)
  • 9% in Saudi Arabian pregnant women
  • 26.5% in Tanzanian pregnant women (geophagia)
  • 31% of Californian Mexican pregnant women
  • 44% of Mexican pregnant women
  • 50% of Nigerian pregnant women
  • 74% in Kenyan pregnant women
  • 44% in French anaemic patients (vs. 9% matched controls)
  • 64% in Turkish anaemic patients (vs. 17% controls)
  • 22%-26% in mentally retarded adults
  • 34% in sickle cell disease patients

The Danish figure from a study led by Dr Tina Mikkelsen (University of Southern Denmark) is likely to be the most accurate as it was carried out on a sample of 100,000 pregnant Danish women and only 14 of the total sample reported that they had pica. The authors concluded that in privileged populations, pica is more a myth than a reality.

Despite increased research in the area, there has been no definitive explanation as to why some people consume such substances as hair (trichophagia), ice (pagophagia – which I briefly examined in a previous blog), soil/clay (geophagia), wood (xylophagia), stones (lithophagia), glass (hyalophagia), plumbophagia (lead paint chips), or laundry (uncooked) starch (amylophagia). Dr. Ella Lacey (Southern Illinois University) also listed many other non-food substances that pica sufferers may eat that don’t have specific names such as those people who eat paper, balloons, grass, soap, cotton wool, and cigarette butts. Pica is a widespread practice throughout Africa and India. It has also been reported in Australia, Canada, Israel, Iran, Uganda, Jamaica and various European countries. A recent review on pica led by Dr Sera Young (University of California, USA) noted that geophagia is the most common type of pica described in the psychological and medical literature. They also noted that:

  • Geophagics frequently eat other non-food stuffs.
  • Those who eat more manufactured substances say they use them as a replacement for earth, either because the desired soil is unavailable or socially unacceptable
  • Bar the eating of ice, most pica substances are absorptive in the dry state and all easily absorb moisture.
  • Pica substances are typically craved with great intensity or ‘‘devouring passion’’

A variety of conditions are known to cause some types of pica including mineral deficiencies, hookworm infection (parasitic infection in the small intestine), coeliac disease (an autoimmune disorder of the small intestine) and Kleine-Levin Syndrome (also known as Sleeping Beauty Syndrome, a neurological disorder characterized by recurring periods of excessive amounts of sleeping and eating). Interestingly, there are culture-specific cases where pica is not related to psychopathological disorders or deficiencies. For instance, black women in Georgia (USA) are known to eat kaolin (white dirt that is actually a clay mineral) – a so-called “culture-bound syndrome” (i.e., a recognizable combination of psychiatric and somatic symptoms that are only within a specific culture or society).

Some pica type disorders may be part of a wider psychiatric condition (such as schizophrenia) and/or may be part of a sexual paraphilia such as the small numbers of people who engage in coprophagia (eating faces) as part of coprophilia and people who engage in urophagia (drinking urine) as part of urophilia. If the primary focus for eating the item or substance was sexual, it would be more likely diagnosed as a sexual paraphila rather than pica. However, many of those with pica claim to love the taste, texture and/or smell of the things they eat. Some studies have suggested an association between pica and addictive behaviors. Others suggest pica is on the obsessive-compulsive disorder (OCD) spectrum of diseases. For instance, a study based on pica case studies by Dr Dan Stein and colleagues (a the University of Stellenbosch, South Africa) came to the conclusion that (based on their case studies), pica may be a symptom of OCD, and that pica may be phenomenologically reminiscent of an impulse control disorder.

For many people, pica is not dangerous but for some there may be complications including (i) parasitic infections (such as geophagics eating soil or copraphagics eating faeces), (ii) internal bodily obstruction (e.g., such as tricophagics getting hair stuck in their intestines), (iii) toxic reactions (e.g., such as autistic children getting lead poisoning from eating painted plaster), (iv) excessive caloric intake (such as that occurring with starch cravings), (v) dental injuries and infections, and (vi) nutritional deficiencies.

As Dr. Lacey concluded: Pica appears to be a complex behavior that requires deliberate study rather than application of ex post facto single cause theories. Although such theories may motivate any given study of pica, it should be apparent that any single cause model will likely offer only a limited explanation of such diverse practices as have been described in the literature through case reports,’ research studies, and literature ‘reviews of various clinical and applied disciplines”

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

Further reading

al-Kanhal, M.A., & Bani, I.A. (1995). Food habits during pregnancy among Saudi women. International Journal for Vitamin and Nutrition Research, 65, 206-210.

Ashworth, M., Hirdes, J.P. & Martin, L. (2008). The social and recreational characteristics of adults with intellectual disability and pica living in institutions. Research in Developmental Disabilities, 30, 512-520.

Danford, D.E. & Huber, A.M. (1982). Pica among mentally retarded adults. American Journal of Mental Deficiency, 87, 141-146.

Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemade, U.J. et al (1994). Pica in an urban environment. Journal of Nutrition, 124(6 Suppl): 954S-962S.

Kettaneh, A., Eclache, V., Fain, O., Sontag, C., Uzan, M. Carbillon, Stirnemann, J. & Thomas, M. (2005). Pica and food craving in patients with iron-deficiency anemia: A case-control study in France. American Journal of Medicine, 118, 185-188

Lacey, E. (1990). Broadening the perspective of pica: Literature review. Public Health Reports, 105, 29-35.

López, L.B., Ortega Soler, C.R. & de Portela, M.L. (2004). Pica during pregnancy: A frequently underestimated problem. Archivos latinoamericanos de nutricion, 54, 17-24.

Mikkelson, T.B., Andersen, A.M. & Olsen, S.F. (2006). Pica in pregnancy in a privileged population: myth or reality. Acta Obstetricia et Gynecologica Scandinavica, 85, 1265-1266.

Ngozi, P.O. (2008). Pica practices of pregnant women in Nairobi, Kenya. East African Medical Journal, 85(2), 72-79.

Nyaruhucha, C.N. (2009). Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 11(1), 29–34.

Rose, E.A., Porcerelli, J.H, & Anne Neale, A.V. (2000). Pica: Common but commonly missed. Journal of the American Board of Family Practice, 13, 353-358.

Simpson, E., Mull, J.D., Longley, E., & East, J. (2000). Pica during pregnancy in low-income women born in Mexico. Western Journal of Medicine, 173, 20-24.

Smulian, J.C., Motiwala, S. & Sigman, R.K. (1995). Pica in a rural obstetric population. Southern Medical Journal, 88, 1236–1240.

Stein, D.J., Bouwer, C. & van Heerden, B. (1996). Pica and the obsessive- compulsive spectrum disorders. South African Medical Journal, 86, 1586-1592.

Young, S.L., Wilson, M.J., Miller, D., & Hillier, S. (2008). Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS One, 3(9), e3147.

Faecal attraction: A beginner’s guide to coprophilia

Coprophilia (also known as coprolagnia) is a paraphilia where people get sexual pleasure from faeces. Sexual excitement typically comes from either (i) watching somebody defecate on somebody else or (ii) they themselves defecating on somebody else. In rare instances, some people may become sexually aroused when they are defecated upon by somebody else. As Dr Judith Milner and colleagues wrote in the 2008 book ’Sexual Deviance: Theory, Assessment and Treatment’:

“Although some authors have defined the focus of coprophilia as the act of elimination (McCary, 1967), others have defined it as the act of consumption of excrement (Allen, 1969). To complicate the definition further, it appears that some individuals may have an interest in eliminating on one’s partner or in playing with the fecal matter. According to Smith (1976), a common analytic interpretation is that the excrement symbolically represents the penis and that the presence of the fecal matter serves as a defense against castration anxiety”

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it is classified under ‘Paraphilia Not Otherwise Specified’ (PNOS) along with other paraphilias such as necrophilia, zoophilia, klismaphilia, and telephone scatophilia. As with all paraphilias in the PNOS category, diagnosis is only made “if the behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning…Fantasies, behaviors, or objects are paraphilic only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of non-consenting individuals, lead to legal complications, interfere with social relationships)”. The psychologist Dr Tamara Penix (Eastern Michigan University, USA) says there are no data indicating successful treatment of coprophilia.

Surprisingly little scientific research has been carried out on coprophilia, probably because it is so rare. There are certainly pornographic films that include sexual defecation acts (notably some Japanese pornography). Some of these films include coprophiliacs engage in coprophagia (i.e., the eating of faeces and typically referred to more commonly as ‘scat’) which can provides a significant health risk in the form of hepatitis (perhaps another reason as to why the act is so rare). The psychiatrist, Dr Charles Lake (University of Kansa Medical Center, USA) notes that both coprophilia and coprophagia are traditionally considered characteristics of schizophrenia. However, there are case reports in the literature of non-psychotic coprophiliacs with normal intelligence such as one published in the Journal of Sex and Marital Therapy in 1995.

The most infamous copraphiliac was allegedly Adolf Hitler. This was alluded to in a recent 2011 biography of Hitler’s lover Eva Braun by Heike B. Gortemaker. However, other books on Hitler have been more explicit. For instance, Greg Hallet in his chapter ‘Hitler’s Sexuality’ (from his 2008 book ‘Hitler was a British Agent’) wrote:

“Hitler’s close boyhood friend from Linz, August Kubizek, wrote Adolf Hitler, Mein Jugendfreund (My Youth Friend), ‘Adolf did not engage in love affairs or flirtations. He always rejected the coquettish advances of girls or women. Women and girls took an interest in him but he always evaded their endeavours’…During deconstruction, it is customary that the person is sexually abused in the manner which is most embarrassing to that person. In Hitler’s case, he was sodomised, creating a submissive distant respect for homosexuals like his bodyguards and some of his highest-placed leaders. His natural bent was developed into coprophilia (being shat on)…With each deconstruction an embarrassing addiction is developed and filmed. With Hitler it was sadomasochism, coprophilia and homosexuality. That is, he liked to be verbally abused and slapped around, to have his head urinated on, his chest shat on, and to have sex with men”

The few studies that have been carried out have tended to be done on sadomasochist individuals (although even for sadomasochists this appears to be a rare activity for them to engage in). A study led by psychologist Dr Kenneth Sandnabba (Åbo Akademi University, Turku, Finland) and published in the Journal of Sex Research surveyed 164 Finnish male sadomasochists and reported that that 18% of them had engaged in at least one coprophilic act (6% as a masochist, 3% as a sadist, and 9% as both). There was no difference in sexual orientation with 18% of heterosexual sadomasochists and 17% of homosexual sadomasochists having engaged in at least one coprophilic act. The results also showed that the sadomasochists were socially well-adjusted and that their SM behavior was mainly a facilitative aspect of their sexual lives.

In a follow-up study published in the journal Deviant Behavior, Sandnabba and colleagues analysed data from a subset of twelve men from their study of sadomasochists who had also engaged in zoophilic activities. This group was then compared with a control group of sadomasochists from the same data set but who had not engaged in zoophilic activities. Results showed seven out of twelve zoophilic sadomasochists had engaged in coprophilic acts whereas only one in twelve non-zoophilic sadomasochists had engaged in coprophilic acts. In fact, the zoophilic sadomasochists were more likely to engage in a wide range of sexual behaviours including spanking, gagging, biting, urophilia (urinating on or being urinated on for sexual pleasure), fisting, coprophilia, skin branding, and transvestism (i.e., cross-dressing). The authors concluded that zoophilic sadomasochists were more sexually experimental than the non-zoophilic sadomasochistic controls.

An earlier study on a much bigger sample of paraphiliacs also reported that zoophiles appear to engage in many paraphilic behaviours including coprophilia. In their survey of 561 non-incarcerated paraphiliacs seeking treatment, Dr Gene Abel and colleagues found that all of the 14 zoophiles in their sample reported more than one paraphilia and seven of them reported at least five other paraphilas including coprophilia, urophilia, pedophilia, exhibitionism, voyeurism, frotteurism, telephone scatophilia, transvestic fetishism, fetishism, sexual sadism, and/or sexual masochism.

There doesn’t appear to be any consensus as to the origins of these highly unusual paraphilias although (as with most paraphilic behaviour) operant and classical conditioning would appear to play a major role. The following example is a self-report that I found in an online discussion group:

“It all started when I was young. I hated white underwear for some reason and when I wore them I’d be turned on. Eventually it felt odd and good that I urinated in them. I wet my bed for days when I was a young boy and stopped when my parents found out about it. When I was young, I hated bowel movements. It felt gross and stuff. After discovering masturbation, I eased my bowel movements by masturbating. It felt good, and my bowel movements weren’t so gross. I don’t know how it happened but the two finally caught up to each other and I became accustomed to the smell when I masturbated. Everything escalated as time went on, I’ve been in this fetish for a while now – since I was 12 years old. I am 18 now”

The origins of the coprophilic behaviour certainly appear (in this case) to be as a result of both classical and operant conditioning. However, other people suggest different etiological factors may contribute in the development of coprophilia. For instance, in Canada, Dave Hingsburger published a case study of an institutionalized and mentally handicapped man who engaged in coprophilic acts approximately three times a week. It was argued that the cause of the coprophilia was the patient’s maladaptive response to a severely limited institutional environment rather than any behavioural conditioning.

Whatever the origins, it is evident that compared to many other paraphilic behaviours, there is a dearth of empirical and clinical data relating to the acquisition, development, and maintenance of coprophilia.

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

Further reading

Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M. S., & Rouleau, J. L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.

Allen, C. (1969). A textbook of psychosexual disorders (2nd ed.). London: Oxford University Press.

Denson, R. (1982). Undinism: The fetishizaton of urine. Canadian Journal of Psychiatry, 27, 336–338.

Hallett, G. (2008). Hitler was a British agent. London: Progressive Books.

Hingsburger, D. (1989). Motives for coprophilia: Working with individuals who had been institutionalized with developmental handicaps. Journal of Sex Research, 26,139-140.

Karpman, B. (1948). Coprophilia: A collective review. Psychoanalytic Review, 35, 253–272.

Karpman, B. (1949). A modern Gulliver: A study in coprophilia. Psychoanalytic Review, 36, 260-282.

Lake, C.R. (2008). Hypothesis: Grandiosity and guilt cause paranoia; Paranoid schizophrenia is a psychotic mood disorder; a review. Schizophrenia Bulletin, 34, 1151-1162.

McCary, J. L. (1967). Human sexuality. New York: Van Nostrand Reinhold.

Milner, J.S., Dopke, C.A. & Crouch, J.L.  (2008). Paraphilia not Otherwise Specified: Psychopathology and theory. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp.384-418). New York: Guildford Press.

Penix, T.M. (2008). Paraphilia not Otherwise Specified: Assessment and treatment. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp.419-438). New York: Guildford Press.

Sandnabba, N.K., Santtila, P. & Nordling, N. (1999). Sexual behavior and social adaptation among sadomasochistically-oriented males. Journal of Sex Research, 36, 273-282.

Sandnabba, N.K. Santtila, P., Nordling, N. Beetz, A.M., Alison, L. (2002). Characteristics of a sample of sadomasochistically-oriented males with recent experience of sexual contact with animals. Deviant Behavior, 23, 511-529.

Smith, R. S. (1976). Voyeurism: A review of the literature. Archives of Sexual Behavior, 5, 585–608.

Wise, T.N. & Goldberg, R.L. (1995). Escalation of a fetish: Coprophagia in a nonpsychotic adult of normal intelligence. Journal of Sex and Marital Therapy, 21, 272-275.