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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

More mass debating: Compulsive sexual behaviour and the internet

The issue of sex addiction as a behavioural addiction has been hotly debated over the last decade. A recent contribution to this debate is a review by Shane Kraus and his colleagues in the latest issue of the journal Addiction that examined the empirical evidence base for classifying compulsive sexual behaviour (CSB) as a behavioural (i.e., non-substance) addiction. The review raised many important issues and highlighted many of the problems in the area including the problems in defining CSB, and the lack of robust data from many different perspectives (epidemiological, longitudinal, neuropsychological, neurobiological, genetic, etc.).

As my regular blog readers will know, I have carried out empirical research into a wide variety of different behavioural addictions (gambling, video gaming, internet use, exercise, sex, work, etc.) and have argued that some types of problematic sexual behaviour can be classed as sex addiction depending upon the definition of addiction used. I was invited by the editors of Addiction to write a commentary on the review and this has just been published in the same issue as the paper by Kraus and colleagues. This blog briefly looks at the issues in that review that I highlighted in my commentary.

For instance, there are a number of areas in Kraus et al.’s paper that were briefly mentioned without any critical evaluation. For instance, in the short section on co-occurring psychopathology and CSB, reference was made to studies claiming that 4%-20% of those with CSB also display disordered gambling behaviour. I pointed out that a very comprehensive review that I published with Dr. Steve Sussman and Nadra Lisha (in the journal Evaluation and the Health Professions) examining 11 different potentially addictive behaviours also highlighted studies claiming that sex addiction could co-occur with exercise addiction (8%-12%), work addiction (28%-34%), and shopping addiction (5%-31%). While it is entirely possible for an individual to be addicted to (say) cocaine and sex concurrently (because both behaviours can be carried out simultaneously), there is little face validity that an individual could have two or more co-occurring behavioural addictions because genuine behavioural addictions consume large amounts of time every single day. My own view is that it is almost impossible for someone to be genuinely addicted to (for example) both work and sex (unless the person’s work was as an actor/actress in the pornographic film industry).

The paper by Kraus et al also made a number of references to “excessive/problematic sexual behavior” and appeared to make the assumption that ‘excessive’ behaviour is bad (i.e., problematic).  While I agree that CSB is typically excessive, excessive sex in itself is not necessarily problematic. Preoccupation with any behaviour in relation to addiction obviously needs to take into account the context of the behaviour, as the context is far more important in defining addictive behaviour than the amount of the activity undertaken. As I have constantly argued, the fundamental difference between a healthy excessive enthusiasms and addictions is that healthy excessive enthusiasms add to life whereas addictions take away from them.

The paper also appeared to have an underlying assumption that empirical research from a neurobiological and genetic perspective should be treated more seriously than that from a psychological perspective. Whether problematic sexual behaviour is described as CSB, sex addiction and/or hypersexual disorder, there are thousands of psychological therapists around the world that treat such disorders. Consequently, clinical evidence from those that help and treat such individuals should be given greater credence by the psychiatric community.

shutterstock_cybersex

Arguably the most important development in the field of CSB and sex addiction is how the internet is changing and facilitating CSB. This was not even mentioned until the concluding paragraph yet research into online sex addiction (while comprising a small empirical base) has existed since the late 1990s including sample sizes of up to almost 10,000 individuals. In fact, there have been a number of recent reviews of the empirical data concerning online sex addiction including its treatment including ones by myself in journals such as Addiction Research and Theory (in 2012) and Current Addiction Reports (in 2015). My review papers specifically outlined the many specific features of the Internet that may facilitate and stimulate addictive tendencies in relation to sexual behaviour (accessibility, affordability, anonymity, convenience, escape, disinhibition, etc.). The internet may also be facilitating behaviours that an individual would never imagine doing offline such as cybersexual stalking.

Finally, there is also the issue of why Internet Gaming Disorder was included in the DSM-5 (in Section 3 – ‘Emerging measures and models’) but sex addiction/hypersexual disorder was not, even though the empirical base for sex addiction is arguably on a par with IGD. One of the reasons might be that the term ‘sex addiction’ is often used (and arguably misused) by high profile celebrities as an excuse to justify their infidelity (e.g., Tiger Woods, Michael Douglas, David Duchovny, Russell Brand), and is little more than a ‘functional attribution’. For instance, the golfer Tiger Woods claimed an addiction to sex after his wife found out that he had many sexual relationships during their marriage. If his wife had never found out, I doubt whether Woods would have claimed he was addicted to sex. I would argue that many celebrities are in a position where they are bombarded with sexual advances from other individuals and have succumbed. But how many people would not do the same thing if they had the opportunity? Sex only becomes a problem (and is pathologised) when the person is found to have been unfaithful. Such examples arguably give sex addiction a ‘bad name’, and provides a good reason for those not wanting to include such behaviour in diagnostic psychiatry texts.

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

Further reading

Bocij, P., Griffiths, M.D., McFarlane, L. (2002). Cyberstalking: A new challenge for criminal law. Criminal Lawyer, 122, 3-5.

Cooper, A., Delmonico, D.L., & Burg, R. (2000). Cybersex users, abusers, and compulsives: New findings and implications. Sexual Addiction and Compulsivity, 6, 79-104.

Cooper, A., Delmonico, D.L., Griffin-Shelley, E., & Mathy, R.M. (2004). Online sexual activity: An examination of potentially problematic behaviors. Sexual Addiction and Compulsivity, 11, 129-143.

Cooper, A., Galbreath, N., Becker, M.A. (2004). Sex on the Internet: Furthering our understanding of men with online sexual problems. Psychology of Addictive Behaviors, 18, 223-230.

Cooper, A., Griffin-Shelley, E., Delmonico, D.L., Mathy, R.M. (2001). Online sexual problems: Assessment and predictive variables. Sexual Addiction and Compulsivity, 8, 267-285.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.

Griffiths, M.D. (2000).  Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.

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

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

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

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

Griffiths, M.D. (2016). Compulsive sexual behaviour as a behavioural addiction: The impact of the Internet and other issues. Addiction, 111, 2107-2109.

Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.

Kraus, S., Voon, V., & Potenza, M. (2016). Should compulsive sexual behavior be considered an addiction? Addiction 111, 2097-2106.

Orzack M.H., & Ross C.J. (2000). Should virtual sex be treated like other sex addictions? Sexual Addiction and Compulsivity, 7, 113-125.

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

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addictions, 5, 363–372.

 

Ride on high: Another look at the psychology (and cycleology) of ‘cycling addiction’

Back in 2012, I wrote an article on cycling addiction for my blog and classed the behaviour as a sub-type of exercise addiction. Recently (June 2016), I was interviewed by Cycling Weekly magazine for an article on addiction to cycling, so I thought it opportune to look at the issue again. Over the last five years or so there has been an increase in the amount of research into exercise addiction (as I have outlined in a number of papers with my Hungarian colleagues Attila Szabo and Zsolt Demetrovics – see ‘Further reading’ below). However, there has still been no empirical research specifically into cycling addiction. In his 1997 book Motivation and Emotion in Sport, Dr. John Kerr speculated that endurance type exercise activities (e.g. running, cycling, swimming, aerobics and weight training) were most often associated with exercise addiction and dependence but this was based more on anecdotal as opposed to scientific evidence.

For the Cycling Weekly article, I was interviewed by Dr. Josephine Perry (who just happed to be both a psychologist and a cyclist). She noted in her article that:

“As a regular cyclist, it’s very likely you take a close interest in performance and have a strong drive to improve coupled with a willingness to push yourself hard in training and racing. Sometimes you probably feel under attack from family or colleagues who question or tease you about your ‘obsessive’ cycling habit. You no doubt retaliate by citing the many benefits of cycling: the brilliant friendships, massive health improvements, toned body and all the places you get to explore on your bike. But do your critics occasionally have a point? Does your relentless drive to improve sometimes go too far and place you in danger of crossing the thin line from dedication into addiction? Addiction to cycling is defined by an incessant internal need to train hard every day without taking the time off that you need to rest and recover — not to mention attend to other commitments in your life. In other words, addiction is defined by harm. You ignore the pleas from family or friends to cut back. Your priorities get rearranged, and nothing is allowed to come between you and your bike. Once this line is crossed, the benefits of cycling begin to diminish. The addicted cyclist feels more aches and pains, becomes prone to physical injuries, regular colds and hidden illnesses”.

In a recent (2016) book chapter, my colleagues and I noted that exercise addiction (irrespective of the sub-type) is a condition in which a regularly exercising person loses control over her or his exercise behaviour, while acting compulsively and exhibiting dependence, resulting in negative consequences in their day-to-day health and/or life. This maladaptive exercise behaviour is characterized by severe withdrawal symptoms when exercise is not possible, similar to both chemical addictions (e.g., alcohol addiction) and other behavioural addictions (e.g., gambling addiction). Based on the scientific evidence, exercise addiction is relatively rare, ranging from 0.3% to 0.5% as noted in the only study published using a representative national sample of the general population that we carried out in Hungary back in 2012 (published in the journal Psychology of Sport and Exercise). Given that exercise addiction (in general) is rare, the prevalence of cycling addiction would therefore be even lower. However, that doesn’t mean it doesn’t exist.

A recent study carried out by Dr. Bernd Zeulner and his colleagues among 1,031 endurance athletes (that included an unspecified number of cyclists) assessed the prevalence of exercise addiction using the Exercise Addiction Inventory (EAI; a scale that I co-developed with my colleagues Attila Szabo and Annabel Terry). The study (published in the journal Advances in Physical Education) found that 2.7% had the potential to develop an exercise addiction and that is higher than the prevalence among the general population.

Another study published in the Journal of Clinical Sport Psychology by Dr. Jason Youngman and Dr. Duncan Simpson examined exercise addiction among 1,285 triathletes (cycling, swimming and running) also using the EAI. The study found that approximately 20% of triathletes were at risk for exercise addiction, and that training for longer distance races puts triathletes at greater risk for exercise addiction than training for shorter races. They also found that as the number of weekly training hours increased, so did a triathlete’s risk for exercise addiction. Despite the lack of empirical evidence specifically on cycling addiction, Dr. Perry also noted in her article that:

“[Addicted cyclists] can also become susceptible to burnout and all that comes with it: decreased performance, low mood, changes in appetite, difficulty sleeping and generally a feeling that the outcomes are not matching the intensity of the effort being put in. For a cycling addict, this loss of form and the feelings of difficulty can be devastating…Other research has found the risks are highest in those exercising over five times a week. With the average amount of training for serious amateur cyclists being around 10 hours a week, they are certainly in the higher-risk category”.

I am not sure which study Dr. Perry is referring to in this quote, but in my interview with her, I noted that from my perspective, any behaviour can be potentially addictive if the reward mechanisms are in place but that we should be cautious about imposing the ‘addiction’ label. I told her that we can’t define whether someone is addicted just by the behaviour that they display. It is all to do with the context of that behaviour in their life. More importantly, it’s is not about the amount of time spent engaging in the behaviour but what impact the behaviour has on them. As I explained:

“A healthy enthusiasm adds to their life. An addiction takes away from it. If you have no dependants and both you and your partner enjoy the sport and there is no conflict, it would not be classed as an addiction. If family conflict becomes a factor, the exercise habit becomes fraught with complications.”

I noted in my previous blog on cycling addiction that one of the traits that appears to be associated with exercise addiction is perfectionism according to a 1990 paper by Dr. Caroline Davis that appeared in the journal Personality and Individual Differences. Research (by Dr. Heather Hasenblaus among others) has also found that extraversion, neuroticism, and agreeableness predict exercise addiction symptoms. I also noted in my interview with Dr. Perry that some people (such as those with Type A personalities) appear to have their risk for exercise addiction built into them. Some cyclists will be those Type-A achievers who are reward-orientated to do the best they can, in whatever they do. If they take up a sport, those personality traits previously used to be successful and focused in other areas such as work go into the new area.

I also noted in my Cycling Weekly interview that there are a number of signs that can help you spot if your attitude towards cycling is unhealthy. The most obvious one is when cycling becomes the most important activity in your life, dominating thinking, feelings and behaviour. If you need to cycle more to get the same mood benefit that you used to, your mood changes significantly and/or you feel physical effects when you can’t cycle, you may also be at risk. If you start to resent your family, job, social life, hobbies or other interests getting in the way of you cycling, you need to consider if you have crossed the line. Those addicted to cycling are more likely to get into debt to fund their habit, become excessively controlling over their eating to regulate weight and competitiveness, and find it hard to balance work, social and family commitments with training.

I was also asked for my views on the treatment of cycling addiction and said that cognitive-behavioural therapy would likely be the most effective (as the addict would be guided to identify goals that motivate them and be helped to find safe and reasonable ways to reach those goals) but that the type of treatment depends on whether the addiction to cycling was primary or secondary. Primary addicts, who are actually addicted because they love their sport, will find it is very hard to give up. Telling them they can’t continue will be stressful in itself. Secondary addicts may be trying to lose weight or to escape negative, unpleasant feelings or difficulties in their lives, using cycling to control their thoughts. These cyclists are using exercise as a coping mechanism. The key here is finding out why they are doing it to such an extent in the first place. Most will find their addiction is symptomatic of something else.

After interviewing me about whether cycling can be potentially addictive, Dr. Perry summed up my own views arguably better than I could have done it myself:

“[Cycling addiction] is not just about how many hours you are doing on the bike, how much you love your riding, or how many bikes you have; what matters is the impact on your life. If your work and family life allows it without conflict, and you’re not feeling over-stressed or over-tired, then your commitment to cycling is just that – a commitment. If you are suffering from continual injuries and not recovering fully, have found yourself feeling burnt out, dips in mood, feel obliged to miss family or social events for training, resulting in arguments, then you need to ask yourself seriously: am I addicted?”

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

Further reading

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

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Kökönyei, G., Urbán, R. and Demetrovics, Z. (2014). Exercise addiction – the emergence of a new disorder. Australasian Epidemiologist, 21(2), 36-40.

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2011). Exercise addiction: Symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Davis, C. (1990). Weight and diet preoccupation and addictiveness: The role of exercise. Personality and Individual Differences, 11, 823-827.

Freimuth, M., Moniz, S., & Kim, S.R. (2011). Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. International Journal of Environmental Research and Public Health, 8(10), 4069-4081.

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

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39(6), e30-31.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Hausenblas, H.A., & Giacobbi, P.R. (2004). Relationship between exercise dependence symptoms and personality. Personality and Individual differences, 36(6), 1265-1273.

Kerr, J. H. (1997) Motivation and Emotion in Sport: Reversal Theory. Hove: Psychology Press.

Kerr, J.H., Lindner, K.J. & Blaydon, M. (2007). Exercise Dependence. Oxford: Rutledge.

Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

Perry, J. (2016). Are you addicted to cycling? Cycling Weekly, July 21. Located at: http://www.cyclingweekly.co.uk/fitness/training/are-you-addicted-to-cycling-261852

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

Szabo, A., Griffiths, M.D. & Demetrovics, Z. (2016). Exercise addiction. In V. Preedy (Ed.), The Neuropathology Of Drug Addictions And Substance Misuse (Vol. 3) (pp. 984-992). London: Academic Press.

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

Youngman, J., & Simpson, D. (2014). Risk for exercise addiction: A comparison of triathletes training for sprint-, Olympic-, half-Ironman-, and Ironman-distance triathlons. Journal of Clinical Sport Psychology, 8, 19-37.

Zeulner, B., Ziemainz, H., Beyer, C., Hammon, M., & Janka, R. (2016). Disordered Eating and Exercise Dependence in Endurance Athletes. Advances in Physical Education, 6(2), 76.

Running up debt: A brief overview of our recent papers on exercise and shopping addictions

Following my recent blogs where I outlined some of the papers that my colleagues and I have published on mindfulness, Internet addiction, gaming addiction, youth gambling and other addictive behaviours, here is a round-up of recent papers that my colleagues and I have published on exercise addiction and shopping addictions (i.e., compulsive buying).

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

  • Research into the detrimental effects of excessive exercise has been conceptualized in a number of similar ways, including ‘exercise addiction’, ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Among the most currently used (and psychometrically valid and reliable) instruments is the Exercise Addiction Inventory (EAI). The present study aimed to further explore the psychometric properties of the EAI by combining the datasets of a number of surveys carried out in five different countries (Denmark, Hungary, Spain, UK, and US) that have used the EAI with a total sample size of 6,031 participants. A series of multigroup confirmatory factor analyses (CFAs) were carried out examining configural invariance, metric invariance, and scalar invariance. The CFAs using the combined dataset supported the configural invariance and metric invariance but not scalar invariance. Therefore, EAI factor scores from five countries are not comparable because the use or interpretation of the scale was different in the five nations. However, the covariates of exercise addiction can be studied from a cross-cultural perspective because of the metric invariance of the scale. Gender differences among exercisers in the interpretation of the scale also emerged. The implications of the results are discussed, and it is concluded that the study’s findings will facilitate a more robust and reliable use of the EAI in future research.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

  • Objectives: The existence of exercise addiction has been examined in numerous studies. However, none of the measures developed for exercise addiction assessment have been validated on representative samples. Furthermore, estimates of exercise addiction prevalence in the general population are not available. The objective of the present study was to validate the Exercise Addiction Inventory (EAI; Terry, Szabo, & Griffiths, 2004), and the Exercise Dependence Scale (EDS; Hausenblas & Downs, 2002b), and to estimate the prevalence of exercise addiction in general population. Design: Exercise addiction was assessed within the framework of the National Survey on Addiction Problems in Hungary (NSAPH), a national representative study for the population aged 18–64 years (N = 2710). Method: 474 people in the sample (57% males; mean age 33.2 years) who reported to exercise at least once a week were asked to complete the two questionnaires (EAI, EDS). Results: Confirmatory Factor Analysis (CFA) indicated good fit both in the case of EAI (CFI = 0.971; TLI = 0.952; RMSEA = 0.052) and EDS (CFI = 0.938; TLI = 0.922; RMSEA = 0.049); and confirmed the factor structure of the two scales. The correlation between the two measures was high (r = 0.79). Results showed that 6.2% (EDS) and 10.1% (EAI) of the population were characterized as nondependent-symptomatic exercisers, while the proportion of the at-risk exercisers were 0.3% and 0.5%, respectively. Conclusions: Both EAI and EDS proved to be a reliable assessment tool for exercise addiction, a phenomenon that is present in the 0.3–0.5% of the adult general population.

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

  • The aim of this brief analytical review is to highlight and disentangle research dilemmas in the field of exercise addiction. Research examining exercise addiction is primarily based on self-reports, obtained by questionnaires (incorporating psychometrically validated instruments), and interviews, which provide a range of risk scores rather than diagnosis. Survey methodology indicates that the prevalence of risk for exercise addiction is approximately 3 percent among the exercising population. Several studies have reported a substantially greater prevalence of risk for exercise addiction in elite athletes compared to those who exercise for leisure. However, elite athletes may assign a different interpretation to the assessment tools than leisure exercisers. The present paper examines the: 1) discrepancies in the classification of exercise addiction; 2) inconsistent reporting of exercise addiction prevalence; and 3) varied interpretation of exercise addiction diagnostic tools. It is concluded that there is the need for consistent terminology, to follow-up results derived from exercise addiction instruments with interviews, and to follow a theory-driven rationale in this area of research.

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

  • Although excessive and compulsive shopping has been increasingly placed within the behavioral addiction paradigm in recent years, items in existing screens arguably do not assess the core criteria and components of addiction. To date, assessment screens for shopping disorders have primarily been rooted within the impulse-control or obsessive-compulsive disorder paradigms. Furthermore, existing screens use the terms ‘shopping,’ ‘buying,’ and ‘spending’ interchangeably, and do not necessarily reflect contemporary shopping habits. Consequently, a new screening tool for assessing shopping addiction was developed. Initially, 28 items, four for each of seven addiction criteria (salience, mood modification, conflict, tolerance, withdrawal, relapse, and problems), were constructed. These items and validated scales (i.e., Compulsive Buying Measurement Scale, Mini-International Personality Item Pool, Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale) were then administered to 23,537 participants (Mage = 35.8 years, SDage = 13.3). The highest loading item from each set of four pooled items reflecting the seven addiction criteria were retained in the final scale, The Bergen Shopping Addiction Scale (BSAS). The factor structure of the BSAS was good (RMSEA=0.064, CFI=0.983, TLI=0.973) and coefficient alpha was 0.87. The scores on the BSAS converged with scores on the Compulsive Buying Measurement Scale (CBMS; 0.80), and were positively correlated with extroversion and neuroticism, and negatively with conscientiousness, agreeableness, and intellect/imagination. The scores of the BSAS were positively associated with anxiety, depression, and low self-esteem and inversely related to age. Females scored higher than males on the BSAS. The BSAS is the first scale to fully embed shopping addiction within an addiction paradigm. A recommended cutoff score for the new scale and future research directions are discussed.

Davenport, K., Houston, J. & Griffiths, M.D. (2012). Excessive eating and compulsive buying behaviours in women: An empirical pilot study examining reward sensitivity, anxiety, impulsivity, self-esteem and social desirability. International Journal of Mental Health and Addiction, 10, 474-489.

  • ‘Mall disorders’ such as excessive eating and compulsive buying appear to be increasing, particularly among women. A battery of questionnaires was used in an attempt to determine this association between specific personality traits (i.e., reward sensitivity, impulsivity, cognitive and somatic anxiety, self-esteem, and social desirability) and excessive eating and compulsive buying in 134 women. Reward sensitivity and cognitive anxiety were positively related to excessive eating and compulsive buying, as was impulsivity to compulsive buying. Somatic anxiety and social desirability were negatively related to compulsive buying. These preliminary findings indicate that excessive behaviours are not necessarily interrelated. The behaviours examined in this study appear to act as an outlet for anxiety via the behaviours’ reinforcing properties (e.g., pleasure, attention, praise, etc.). As a consequence, this may boost self-esteem. The findings also appear to indicate a number of risk factors that could be used as ‘warning signs’ that the behaviour may develop into an addiction.

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

  • Due to the problems of measurement and the lack of nationally representative data, the extent of compulsive buying behaviour (CBB) is relatively unknown. The validity of three different instruments was tested: Edwards Compulsive Buying Scale, Questionnaire About Buying Behavior and Richmond Compulsive Buying Scale using two independent samples. One was nationally representative of the Hungarian population (N=2710) while the other comprised shopping mall customers (N=1447). As a result, a new, four-factor solution for the ECBS was developed (Edwards Compulsive Buying Scale Revised (ECBS-R)), and confirmed the other two measures. Additionally, cut-off scores were defined for all measures. Results showed that the prevalence of CBB is 1.85% (with QABB) in the general population but significantly higher in shopping mall customers (8.7% with ECBS-R, 13.3% with QABB and 2.5% with RCBS-R). Conclusively, due to the diversity of content, each measure identifies a somewhat different CBB group.

Maraz, A., Griffiths, M.D., & Demetrovics, Z. (2016). The prevalence of compulsive buying in non-clinical populations: A systematic review and meta-analysis. Addiction, 111, 408-419.

  • Aims: To estimate the pooled prevalence of compulsive buying behaviour (CBB) in different populations and to determine the effect of age, gender, location and screening instrument on the reported heterogeneity in estimates of CBB and whether publication bias could be identified. Methods: Three databases were searched (Medline, PsychInfo, Web of Science) using the terms ‘compulsive buying’, ‘pathological buying’ and ‘compulsive shopping’ to estimate the pooled prevalence of CBB in different populations. Forty studies reporting 49 prevalence estimates from 16 countries were located (n = 32 000). To conduct the meta-analysis, data from non-clinical studies regarding mean age and gender proportion, geographical study location and screening instrument used to assess CBB were extracted by multiple independent observers and evaluated using a random-effects model. Four a priori subgroups were analysed using pooled estimation (Cohen’s Q) and covariate testing (moderator and meta-regression analysis). Results: The CBB pooled prevalence of adult representative studies was 4.9% (3.4–6.9%, eight estimates, 10 102 participants), although estimates were higher among university students: 8.3% (5.9–11.5%, 19 estimates, 14 947 participants) in adult non-representative samples: 12.3% (7.6–19.1%, 11 estimates, 3929 participants) and in shopping-specific samples: 16.2% (8.8–27.8%, 11 estimates, 4686 participants). Being young and female were associated with increased tendency, but not location (United States versus non-United States). Meta-regression revealed large heterogeneity within subgroups, due mainly to diverse measures and time-frames (current versus life-time) used to assess CBB. Conclusions: A pooled estimate of compulsive buying behaviour in the populations studied is approximately 5%, but there is large variation between samples accounted for largely by use of different time-frames and measures.

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

Further reading

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

Allegre, B., Therme, P. & Griffiths, M.D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of ‘ultra-marathoners’. International Journal of Mental Health and Addiction, 5, 233-243.

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, 47, 403-417.

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Kökönyei, G., Urbán, R. and Demetrovics, Z. (2014). Exercise addiction – the emergence of a new disorder. Australasian Epidemiologist, 21(2), 36-40.

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

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

Griffiths, M.D., Szabo, A. & Terry, A. (2005). The Exercise Addiction Inventory: A quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, 30-31.

Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.

Szabo, A. & Griffiths, M.D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

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

Warner, R. & Griffiths, M.D. (2006). A qualitative thematic analysis of exercise addiction: An exploratory study. International Journal of Mental Health and Addiction, 4, 13-26.

Naming desire: A personal look at my new job title

Back in 2002, I was incredibly proud when I became one of the youngest full Professors in the UK when I was bestowed the title of Professor of Gambling Studies based on my research contribitions to the gambling studies field. Anyone that has followed my career over the last decade (or this blog over the last four years) will no doubt have realised that my research interests and expertise include a lot more than gambling.

Although I still publish a lot of papers on gambling (12 to 17 papers per calendar year; see Appendix 1 below) I have carried out more and more research into non-gambling addictions and over the last six years (2010-2015) my refereed journal outputs on gambling have only constituted one-third of all my refereed journal outputs (32%) (see Appendix 1 and Figure 1).

Screen Shot 2015-10-31 at 13.15.27

The overwhelming majority of my published refereed papers since January 2010 (n=246; 88%) concern behavioural addictions (i.e., gambling addiction, videogame addiction, internet addiction, work addiction, sex addiction, exercise addiction, shopping addiction, dancing addiction, etc.). If gambling addiction is removed from these papers, this still leaves 56% of all my papers during the 2010-2015 period concerning other behavioural addictions (n=158). The remainder of my refereed journal papers (34 papers; 12%) mainly concern the topic of mindfulness carried out with my colleagues Edo Shonin and William Van Gordon. Even my three books in the 2010-2105 timeframe have been on three totally separate topics (i.e., problem gambling, internet addiction and mindfulness). Of my 71 book chapters in this 2010-2015 period, 22 have been on gambling addiction, 41 have been on other behavioural addictions, and 8 have concerned other topics (see Figure 2). In the ‘Further reading’ section below is some of the papers that I have published this year and even a quick glance will highlight that gambling papers are in the minority.

It is also worth noting that I am one of the most highly cited academics in the UK (soemthig else that I am very proud of) and a quick look at my Google Scholar citations profile (currently over 24,500 citations as of October 31, 2015) that of my top ten most highly cited papers, only one is on gambling adiction and the other nine concern my papers on videogame addiction and internet addiction.

Basically, my job title didn’t reflect what I was actually doing on the research front. And this is the very argument I put to my employer (Nottingham Trent University) a number of weeks ago. As far as I am aware, I am the first professor at NTU to ever ask for my title to be changed but last week I was informed by my line manager that the university was convinced by the case I put forward and from now on I will be Professor of Behavioural Addiction.

This new title change has pleased me greatly and of course subsumes the vast majority of the research that I am doing (including my research into gambling addiction). I don’t think I will ever stop carrying out research in the gambling field but my new job title will stop me feeling guilty about working in non-gambling areas. It may also stop some of few abusive emails I get regarding my blogs (saying in very colourful language that I should stop writing about other behavioural addictions and sexual paraphilias and “write about what I get paid to do”). Firstly, I would point out to these individuals that I don’t get paid to write my personal blog and even if I did, I write all my blogs in my spare time.

If you’ve read this far, then thank you. I promise normal service will be resumed in my next blog when it will be about something other than myself.

Appendix 1: Summary statistics of my refereed journal papers (January 1, 2010 to October 20, 2015)

  • 2010: Gambling papers (n=17); Behavioural addiction papers (n=19); Other papers (n=1)
  • 2011: Gambling papers (n=15); Behavioural addiction papers (n=15); Other papers (n=2)
  • 2012: Gambling papers (n=10); Behavioural addiction papers (n=28); Other papers (n=3)
  • 2013: Gambling papers (n=12); Behavioural addiction papers (n=23); Other papers (n=4)
  • 2014: Gambling papers (n=13); Behavioural addiction papers (n=33); Other papers (n=13)
  • 2015: Gambling papers (n=13); Behavioural addiction papers (n=27); Other papers (n=7)
  • In press: Gambling papers (n=8); Behavioural addiction papers (n=13); Other papers (n=4)

 

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

Further reading (some recent papers)

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

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

Auer, M. & Griffiths, M.D. (2015). Testing normative and self-appraisal feedback in an online slot-machine pop-up message in a real-world setting. Frontiers in Psychology, 6, 339. doi: 10.3389/fpsyg.2015.00339.

Auer, M. & Griffiths, M.D. (2015). The use of personalized behavioral feedback for problematic online gamblers: An empirical study. Frontiers in Psychology, 6, 1406. doi: 10.3389/fpsyg.2015.01406.

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2, 154-162.

Canale, N. Santinello, M. & Griffiths, M.D. (2015). Validation of the Reasons for Gambling Questionnaire (RGQ) in a British population survey. Addictive Behaviors, 45, 276-280.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). Trait urgency and gambling problems in young people: the role of decision-making processes. Addictive Behaviors, 46, 39-44.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). How do impulsivity traits influence problem gambling through gambling motives? The role of perceived gambling risk/benefits. Psychology of Addictive Behaviors, 29, 813–823.

Cleghorn, J. & Griffiths, M.D. (2015). Why do gamers buy ‘virtual assets’? An insight in to the psychology behind purchase behaviour. Digital Education Review, 27, 98-117.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.

Dhuffar, M. & Pontes, H.M. & Griffiths, M.D. (2015). Dysphoric mood states and consequences of sexual behaviours as predictors of hypersexual behaviours in university students: An exploratory study. Journal of Behavioural Addictions, 4, 181–188.

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

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

Griffiths, M.D. (2015). Problematic technology use during adolescence: Why don’t teenagers seek treatment? Education and Health, 33, 6-9.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Hanss, D., Mentzoni, R.A., Griffiths, M.D., & Pallesen, S. (2015). The impact of gambling advertising: Problem gamblers report stronger impacts on involvement, knowledge, and awareness than recreational gamblers. Psychology of Addictive Behaviors, 29, 483-491.

Hussain, Z., Williams, G. & Griffiths, M.D. (2015). An exploratory study of the association between online gaming addiction and enjoyment motivations for playing massively multiplayer online role-playing games. Computers in Human Behavior, 50, 221–230.

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

Király, O., Griffiths, M.D. & Demetrovics Z. (2015). Internet gaming disorder and the DSM-5: Conceptualization, debates, and controversies, Current Addiction Reports, 2, 254–262.

Király, O., Urbán, R., Griffiths, M.D., Ágoston, C., Nagygyörgy, K., Kökönyei, G. & Demetrovics, Z. (2015). Psychiatric symptoms and problematic online gaming: The mediating effect of gaming motivation. Journal of Medical Internet Research, 17(4) :e88.

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

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

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

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

Ortiz de Gortari, A.B., Pontes, H.M. & Griffiths, M.D. (2015). The Game Transfer Phenomena Scale: An instrument for investigating the non-volitional effects of video game playing. Cyberpsychology, Behavior and Social Networking, 18, 588-594.

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

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

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

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

Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

Van Gordon W., Shonin, E., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.

Rush hour: Can you be addicted to adrenaline?

(N.B. A shorter version of this article was first published in Hopes & Fears magazine).

Conceptualising addiction has been a matter of great debate for decades. For many people the concept of addiction involves the taking of drugs. However, there is now a growing movement that views a number of behaviors as potentially addictive including those that do not involve the ingestion of a drug. These include behaviors diverse as gambling, eating, sex, exercise, videogame playing, love, shopping, Internet use, social networking, and work. The term ‘adrenaline junkies’ has now passed into popular usage and usually refers to potentially dangerous activities such as bungee jumping, sky diving, BASE jumping, etc. My own view is that any activity that features continuous rewards (i.e., constant reinforcement) could be potentially addictive. I have argued in many of my papers that all addictions – irrespective of whether they are chemical or behavioral – comprise six components (i.e., salience, mood modification, tolerance, withdrawal, conflict and relapse). More specifically:

  • Salience – This occurs when the activity becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behavior (deterioration of socialized behavior). For instance, even if the person is not actually engaged in the activity they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with the activity).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of engaging in the activity and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’).
  • Tolerance – This is the process whereby increasing amounts of the activity are required to achieve the former mood modifying effects. This basically means that for someone engaged in the activity, they gradually build up the amount of the time they spend engaging in the activity every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to engage in the activity.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (e.g., work, social life, hobbies and interests) or from within the individual (e.g., intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time engaging in the activity.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive engagement in the activity to recur, and for even the most extreme patterns typical of the height of excessive engagement in the activity to be quickly restored after periods of control.

In short, if any ‘adrenaline junkies’ fulfilled all my six criteria I would class them as an addict. However, I have come across very few adrenaline junkies that endorse all of my six criteria. My position is that it is theoretically possible for individuals to become addicted to adrenaline producing activities but in reality, very few actually are.

Addiction is an incredibly complex behavior and always result from an interaction and interplay between many factors including the person’s biological and/or genetic predisposition, their psychological constitution (personality factors, unconscious motivations, attitudes, expectations, beliefs, etc.), their social environment (i.e. situational characteristics such as accessibility and availability of the activity, the advertising of the activity) and the nature of the activity itself (i.e. structural characteristics such as the size of the stake or jackpot in gambling). This ‘global’ view of addiction highlights the interconnected processes and integration between individual differences (i.e. personal vulnerability factors), situational characteristics, structural characteristics, and the resulting addictive behavior. In respect to ‘adrenaline addicts’ the most important factors are likely to be the individual’s personality and the potential of the reinforcing nature of the activity to produce mood modifying experiences.

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

Further reading

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

Demetrovics, Z. & Griffiths, M.D. (2012). Behavioral addictions: Past, present and future. Journal of Behavioral Addictions, 1, 1-2.

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

Griffiths, M.D. (2009). Gambling addictions. In A. Browne-Miller (Ed.), The Praeger International Collection on Addictions: Behavioral Addictions from Concept to Compulsion (pp. 235-257). Westport, CT: Praeger.

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

Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Transgressive Culture, 1(1), 7-28.

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

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

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

Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

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.

Let’s get physical: Exercise addiction (revisited)

At present, exercise addiction is not officially recognised in any medical or psychological diagnostic frameworks such as the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) or the World Health Association’s International Classification of Diseases. However, there has been a lot of research into whether exercise can be classed as a bona fide addiction. In spite of the widespread usage of the term ‘exercise addiction’ there are many different terminologies that describe excessive exercise syndrome. Such terms include ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Exercise addiction has been conceptualised as a behavioural addiction. The symptoms and consequences of exercise addiction have often been characterised by six common components of addiction: salience, mood modification, tolerance, withdrawal symptoms, personal conflict, and relapse.

For some people, exercise addiction is a primary problem in the person’s life whereas in others it can be a secondary problem as a consequence of other psychological dysfunctions (like eating disorders such as anorexia nervosa). In the former case, the dysfunction is considered as primary exercise addiction, while in the latter case it is termed as secondary exercise addiction because it co-occurs with another dysfunction. The differentiating feature between the two is that in primary exercise addiction the objective is the exercise itself, whereas in secondary exercise addiction the objective is weight loss, where excessive exercise is one of the primary means in achieving the desired objective.

The incentive or motive for fulfilling planned exercise is an important distinguishing characteristic between addicted and nonaddicted exercisers. The reason people exercise is often for an intangible reward such as feeling in shape, looking good, being with friends, staying healthy, building muscles, losing weight, etc. The personal experience of the anticipated reward reinforces and strengthens the exercise behaviour. Committed exercisers maintain their exercise for benefiting or gaining from their activity and thus, their behaviour is motivated via positive reinforcement. However, empirical research has demonstrated that addicted exercisers have to exercise in order to avoid negative feelings or withdrawal. The individual’s exercise may become a chore that has to be fulfilled, or otherwise an unwanted event would occur (such as the inability to cope with stress, or gaining weight, becoming moody, etc.). Every time a person undertakes behaviour to avoid something negative, bad, and/or unpleasant, the motive behind that behaviour acts as a negative reinforcement. In these situations, the person feels they have to do it rather than wanting to do it.

Mood modification is a key factor among the symptoms of exercise addiction and suggests there is a self-medication aspect of exercise that facilitates the distinction between normal and abnormal exercise. Addicts do not simply exercise to experience the joy of it, but rather to escape negative, unpleasant feelings and everyday difficulties.

The Exercise Addiction Inventory is one of the most recent and most widely used screening tools in the research area of exercise addiction, primarily because of its brevity and excellent psychometric properties (i.e., reliability and validity). The EAI comprises only six statements, each corresponding to one of the symptoms in the ’components’ model of addiction. Each statement is rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The EAI cut-off score for individuals considered at-risk of exercise addiction is 24 out of 30. To date, the only nationally representative study examining exercise addiction is a study that I co-authored with some Hungarian colleagues. We surveyed over 2,700 Hungarian adults aged 18–64 years and assessed exercise addiction using the EAI. Results showed that the proportion of the people at risk for exercise addiction was 0.5%.

There are numerous theories that deal with both the causes of exercise addiction and the process and mechanisms of its development and maintenance. A significant number of psychological theories are based on learning theory or the cognitive psychology approach. According to the theory of functioning, both positive reinforcers (e.g., a feeling of euphoria following exercise or muscle growth from exercise) and negative reinforcers (e.g. an end to unpleasant feelings through exercise or avoidance of the presumed negative effect of missed exercise) may lie behind the development and maintenance of exercise addiction which, according to the fundamental principles of learning theory, may contribute to the establishment of compulsive and addictive exercise that may be viewed as maladaptive.

One of my research colleagues, Dr. Attila Szabo stresses the role of cognitive appraisal mechanisms in the development of the vicious cycle that leads to excessive exercise. The process starts when the habitual exerciser uses exercise as a means of coping with stress, and the affected individual learns to depend on exercise at times of stress. The addicted exerciser is then trapped in a vicious cycle of needing increased amounts of exercise to deal with the consistently increasing life stress, part of which is caused by exercise itself.

It also appears that the issue of self-assessment represents a further significant factor among the psychological factors in the sense that during exercise, the physical strength experienced through exercise in a person dissatisfied with his or her body or body image contributes to the formation of a more positive self-image and self-assessment. It has also been shown that exercise activities (such as weightlifting) have a positive effect on body image and self-esteem both in men and in women. Perfectionism, obsessive-compulsive functioning, and heightened anxiety have also been claimed to be determining factors in exercise addiction.

The public promotion of healthy and appropriate exercise patterns may reduce the incidence of exercise addiction. It is important in public health programs and campaigns to (i) stress the healthy nature of regular exercise and (ii) communicate the message that exercise when taken to excess can be potentially harmful. It is important to raise awareness of potential harm within the population of regular exercisers. Some psychologists claim that individuals with exercise addiction have a poor understanding of the negative health consequences of excessive exercising, of the mechanism of exercise adaptation, and the need for rest between exercise sessions. The use of education may be an effective step in the prevention and treatment of exercise addiction.

As with other addictive disorders, the environment of regular exercisers also plays a significant role in recognising this condition early. In more severe cases psychotherapeutic interventions may be needed. When treating exercise addiction, abstinence from exercise may not be a required and/or realistic goal, because exercise has many benefits for health and no one would advocate doing no exercise. Therefore, the typical treatment goal would more likely be be to return to moderate and controlled exercise. In some cases, a different form of exercise may be recommended.

CASE STUDY

Joanna is a 25-year old student, well-educated female, from a stable family background, who realized that she had a problem surrounding exercise, and more specifically the martial art Jiu-Jitsu. Here, Joanna’s behavior is described in terms of the main components of addiction:

  • Salience: Jiu-Jitsu is the most important activity in Joanna’s life. Even when not actually engaged in the activity, she is thinking about the next training session or competition. She estimates that she spends approximately six hours a day (and sometimes much more) involved in training (e.g., weight training, jogging, general exercise, etc.).
  • Tolerance: Joanna started Jiu-Jitsu at an evening class once a week during her teenage years and built up slowly over a period of about five years. She now exercises every single day, and the lengths of the sessions have become longer and longer (suggesting tolerance).
  • Withdrawal: Joanna claims she becomes highly agitated and irritable if she is unable to exercise. She claims she also gets headaches and feels nauseous if she goes for more than a day without training or has to miss a scheduled session.
  • Mood modification: Joanna experiences mood changes in a number of ways. She feels very high and ‘buzzed up’ if she has done well in a Jiu-Jitsu competition (especially so if she wins). She also feels high if she has trained hard and for a long time.
  • Conflict: Joanna’s relationship with her long-term partner ended as a result of her exercise. She claimed she never spent much time with him and was not even bothered about their break-up. Her university work suffered because of the lack of time and concentration.
  • Loss of control: Joanna claims she cannot stop herself engaging in exercise when she “gets the urge”. Once she has started, she has to do a minimum of a few hours of exercise.
  • Relapse: Joanna has continually tried to stop and/or cut down but claims she cannot. She becomes highly anxious if she is unable to engage in exercise and then has to go out and train to make herself feel better. She is well aware that exercise has taken over her life but feels powerless to stop it.
  • Negative consequences: Joanna spends money beyond her means to maintain her exercising habit (e.g., on entrance fees for weight training, swimming, entrance fees enter Jiu-Jitsu tournaments across the country, etc.). She has resorted to socially unacceptable means (e.g., stealing) in order to get money to fund herself

In short, exercise is the most important thing in Joana’s life, and the number of hours engaged in physical activity per week has increased substantially over a five-year period. She displays withdrawal symptoms when she does not exercise, and experiences euphoric experiences related to various aspects of her exercising (e.g., training hard, winning competitions, etc.). She experiences conflict over exercise in many areas of her life and acknowledges she has a problem. Furthermore, she has lost friends, her relationship has broken down, her academic work has suffered, and she has considerable debt.

Note: An expanded version of this article was first published by Rehabs.com

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

Further reading

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

Allegre, B., Therme, P., & Griffiths, M. D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of ‘ultra-marathoners’. International Journal of Mental Health and Addiction, 5, 233-243.

Berczik, K., Szabó, A., Griffiths, M. D., Kurimay, T., Kun, B., Urbán, R., & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychomaetric examination of the Exercise Dependence Scale-Revised. Measurement in Phisical Education and Exercise Science, 8, 183-201.

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

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, e30-31.

Hausenblas H. A., & Downs, S. D. (2002a) Exercise dependence: a systematic review. Psychology of Sport Exercise, 3, 89-123.

Hausenblas, H. A., & Downs, S. D. (2002). How much is too much? The development and validation of the exercise dependence scale. Psychology and Health, 17, 387-404.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

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. (2000). Physical activity as a source of psychological dysfunction. In S. J. Biddle, K. R. Fox & S. H. Boutcher (Eds.), Physical Activity and Psychological Well-Being (pp. 130-153). London: Routledge.

Szabo, A., & Griffiths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

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

Winning runs? Another look at exercise addiction

Research appears to indicate that at times of psychological and/or emotional hardship, some habitual exercisers engage in such activity as a form of escape. The reliance on exercise as a means of coping with adversity has the potential become obsessive as well as compulsive. Associated with increased tolerance, over-exercising may lead to physical injuries, and (in extreme cases) irreversible health consequences, and mortality. Over-exercising to the point where a person loses control over the exercise routine has been termed ‘exercise addiction’ or ‘exercise dependence’. Due to the multidisciplinary nature of the literature regarding problematic exercise, different screening instruments have been formulated to assess the problem. In a 2013 issue of the journal Psychology of Sport and Exercise, I and a team of Hungarian researchers published the first ever national study of exercise addiction, and compared two different screening instruments (i.e., the Exercise Addiction Inventory [EAI] and the Exercise Dependence Scale [EDS]).

We made the assumption that these two instruments attempt to assess the same phenomenon. We also published a comprehensive review examining the literature on problematic exercise in a 2012 issue of Substance Use and Misuse and came to the conclusion that the most appropriate term to use is ‘exercise addiction’ because it incorporates both ‘dependence’ and ‘compulsion’. However, most researchers in the field use the terms ‘exercise addiction’, ‘exercise dependence’ and ‘compulsive exercise’ to mean the same thing.

These six core components of addictive behaviour that I outlined in my very first blog served the theoretical foundation for the Exercise Addiction Inventory (EAI). The EAI is a short, psychometrically validated questionnaire that comprises only six statements, each corresponding to one of the symptoms in the ‘components’ model of addiction. However, the cut-off points for exercise addiction were never tested psychometrically. The Exercise Dependence Scale (EDS) was based on the Diagnostic and Statistical Manual of Mental Disorder-IV criteria for substance dependence. The higher the score, the higher is the risk for addiction.

The EAI and the EDS are perhaps the most recent and most widely used screening tools in the research area of exercise addiction, primarily because of their superior psychometric properties in contrast to other instruments, and secondarily because of their theoretical underpinning. However, until our recently published study, these two tools had never been used in a nationally representative study. We assessed exercise addiction within the framework of the National Survey on Addiction Problems in Hungary (NSAPH).

The final sample comprised 2,170 people, stratified according to geographical location, degree of urbanization, and age. Those in this sample who engaged in regular exercise at least on a weekly basis (17.5%) were invited to complete the EAI and the EDS and comprised 474 participants (270 males and 204 females). In line with our assumptions, there was a high correlation between the two exercise addiction/dependence measures. On the basis of results we obtained, we reported that 0.3-0.5% of population is involved in addictive exercise (and equates to 1.9% to 3.2% of weekly regular exercisers).

As mentioned above, our study is the first national study ever to assess the prevalence of exercise addiction in a representative national sample and therefore there are no studies to compare our national findings of the study to. Our study provides primary benchmark data that subsequent national studies will need to be compared to. It is also the first ever study to compare the psychometric properties of (arguably) the two most widely used screening instruments that assess exercise dependence/addiction.

Based on the results of our study, it appears that both of the tools we examined (i.e., EAI and EDS) can reliably be applied in the future for both scientific research in the exercise addiction field, and as a screening instrument in non-research settings. For instance, the short, 6-item EAI could be used as a screening instrument in empirical surveys as a way of combating questionnaire fatigue. It could also be used as a ‘quick and easy’ tool that can be used by health practitioners (such as GPs with their patients) in screening for exercise addiction. The EDS also appears to be suitable for acquiring a more detailed and greater empirical insight to the problem in future studies.

However, there were also a number of limitations to our study. Owing to the sampling method, it was financially impractical to use observational data on physical activity and/or face-to-face clinical interviewing, and therefore we had to base our analysis solely on the basis of self-reports. Self-report data is also prone to the weaknesses of survey methodologies more generally including factors such as recall bias and social desirability. Another limitation was the cross-sectional nature of the dataset, therefore the causality inferences are limited, although further research may identify trends in exercise behaviours and provide models to determine the changes in exercise addiction. Another important question is the generalizability of these results to other countries. However, this question cannot be answered in a reliable way. Though the prevalence of regular exercise is lower in Hungary than in most of the other countries of the European Union, this result, in and of itself, does not necessarily mean that prevalence of excessive exercise is lower as well. It is also possible that though the prevalence of regular exercise is lower than in other countries, prevalence of exercise addiction among the exercisers is higher.

Our results indicate that while optimal regular exercising is a key component of preserving and improving physical and mental health, in case of a small proportion of the population, excessive exercise can generate significant problems. Both the EDS and EAI are adequate screening solutions to assessing exercise dependence/addiction within target populations. While the seven-factor EDS might give a more complex picture on the problem, the short, 6-item EAI has the added advantage of providing anyone who uses the instrument with an estimation of problems with exercise very quickly. Nevertheless, clinical validation of these assessment tools needs to be further targeted and scrutinized by future research.

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

Further reading

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

Allegre, B., Therme, P., & Griffiths, M. D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of ‘ultra-marathoners’. International Journal of Mental Health and Addiction, 5, 233-243.

Berczik, K., Szabó, A., Griffiths, M. D., Kurimay, T., Kun, B., Urbán, R., & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychomaetric examination of the Exercise Dependence Scale-Revised. Measurement in Phisical Education and Exercise Science, 8, 183-201.

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

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, e30-31.

Hausenblas H. A., & Downs, S. D. (2002a) Exercise dependence: a systematic review. Psychology of Sport Exercise, 3, 89-123.

Hausenblas, H. A., & Downs, S. D. (2002). How much is too much? The development and validation of the exercise dependence scale. Psychology and Health, 17, 387-404.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

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. (2000). Physical activity as a source of psychological dysfunction. In S. J. Biddle, K. R. Fox & S. H. Boutcher (Eds.), Physical Activity and Psychological Well-Being (pp. 130-153). London: Routledge.

Szabo, A., & Griffiths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

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

Give me strength: Muscle Dysmorphia as an addiction

Muscle Dysmorphia (MD) describes a condition characterised by a misconstrued body image in individuals interpret their body size as both small and weak even though they may look normal or even be highly muscular. Those experiencing the condition typically strive for maximum fat loss and maximum muscular build. MD can have potentially negative effects on thought processes including depressive states, suicidal thoughts, and in extreme cases, suicide attempts. These negative psychological states have also been linked with concurrent use of Appearance and Performance Enhancing Drugs (APED) including Anabolic Androgenic Steroids (AAS).

MD was originally categorised in 1993 by Dr. H.G. Pope and colleagues (in the journal Comprehensive Psychiatry) as Reverse Anorexia Nervosa, due to characteristic symptoms in relation to body size. It has been considered to be part of the spectrum of Body Dysmorphic Disorders (BDD) referring to a range of conditions that tap into issues surrounding body image and eating behaviours. Consequently, there is a lack of consensus amongst researchers whether MD is a form of BDD, Obsessive-Compulsive Disorder (OCD) or a type of eating disorder. Earlier this year, Andy Foster, Dr. Gillian Shorter and I published a paper in the Journal of Behavioral Addictions about the ‘Addiction to Body Image’ model, and arguing that MD could perhaps be conceptualized as an addiction.

Our ‘Addiction to Body Image’ (ABI) model attempts to provide an operational definition and to introduce a standard assessment across the research area. The ABI model uses my addiction components model (outlined is a previous blog) as the framework in which to define muscle dysmorphia as an addiction. For the purposes of our paper, body image was defined using Sarah Grogan’s definition (from her 2008 book Body image: Understanding body dissatisfaction in men, women, and children) who said it was a person’s “perceptions, thoughts and feelings about his or her body”. We argued that the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and/or physical exercise accessories, etc.).

In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition. The maintenance behaviours of those with ABI may include healthy changes to diet or increases in exercise. However, such behaviours can hide or mislead those with ABI away from the negative thought processes that are driving their addiction. It is in the cognitive dysfunction of MD where we believe there is a pathological issue, and why the field has encountered problems with the criteria for the condition. The attempt to explain MD in the same manner as other BDDs may not be adequate due to the cognitive dysfunction occurring in the context of the potentially positive physical effects via improvements in shape, tone, and/or health of the body.

We also argued that there is a difference in the cognitive dysfunction with a misconstrued self-body image compared to other BDDs. The cognitive dysfunction causes the individual with MD to have a misconstrued view of their own body image, and the person believes they are small and puny. This negative mindset has the potential to cause depression and other disorders, and may facilitate the addiction. Unlike other conceptualizations of MD in the BDD literature, we would argue that the agent of the addiction is the perceived body image that is maintained by engaging in secondary behaviours such as specific types of physical activity and food. The most important thing in the life of someone with MD is how their body looks (i.e., their body image). The behaviours that the person with MD engages in (such as excessive exercise or disordered eating) are merely the vehicles by which their addiction (i.e., their perceived body image) is maintained.

Based on empirical evidence to date, we proposed that Muscle Dysmorphia could be re-classed as an addiction due to the individual continuing to engage in maintenance behaviours that cause long-term psychological damage. More research is needed to explore the possibilities of MD as an addiction, and how this particular addiction is linked to substance use and/or other comorbid health conditions. Controversy about the conceptual measurement of the condition, has led to a number of different scales adapted from different criteria that may not fully measure the experience of MD.

However, a group of questions that might test the applicability of the ABI approach to measuring and conceptualising MD have not been asked. Questionnaires such as the Exercise Addiction Inventory and the Bergen Work Addiction Scale (two scales that I co-developed) could be adapted to fit MD characteristics. Adequate conceptualisation is key to explore the clinically relevant condition. This new ABI approach may also have implications for diagnostic systems around similar conditions such as other BDDs or eating disorders.

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

Additional input: Andy Foster and Dr. Gillian Shorter

Further reading

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

Foster, A.C., Shorter, G.W.& Griffiths, M.D. (2014). Muscle Dysmorphia: Could it be classified as an Addiction to Body Image? Journal of Behavioral Addictions, in press.

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

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

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The Exercise Addiction Inventory: A quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, 30-31.

Grogan, S. (2008). Body image: Understanding body dissatisfaction in men, women, and children. London: Routledge.

Mosley, P.E. (2009). Bigorexia: Bodybuilding and muscle dysmorphia. European Eating Disorders Review. 17, 191-198.

Murray, S. B., Rieger, E., Touyz, S. W., & De la Garza Garcia, Y. (2010). Muscle Dysmorphia and the DSM-V Conundrum: where does it belong? International Journal of Eating Disorders, 43, 483-491.

Nieuwoudt, J. E., Zhou, S., Coutts, R. A., & Booker, R. (2012). Muscle dysmorphia: Current research and potential classification as a disorder. Psychology of Sport and Exercise, 13, 569-577.

Olivardia, R. (2001). Mirror, mirror on the wall, who’s the largest of them all? The features and phenomenology of muscle dysmorphia. Harvard Review of Psychiatry, 9, 254–259.

Phillips, K. A. & Hollander, E. (1996). Body dysmorphic disorder.In T.A. Widige, A.J. Frances, H.A. Pincus, R. Ross, M.B. First, & W.W. Davis, Eds. DSM-IV Sourcebook, Volume 2. Washington DC: American Psychiatric Association.

Philips, K. A., Gunderson, C. G., Mallya, G., McElroy, S. L., & Carter, W. (1998). A comparison study of body dysmorphic disorder and obsessive-compulsive disorder. Journal of Clinical Psychiatry, 59, 568–575.

Pope, H. G., Jr., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A. (1997). Muscle dysmorphia. An underrecognised form of body dysmorphic disorder. Psychosomatics, 38, 548–557.

Pope, H. G., Jr., Katz, D. L., & Hudson, J. I. (1993). Anorexia nervosa and ‘‘reverse anorexia’’ among 108 male bodybuilders. Comprehensive Psychiatry, 34, 406–409.

Pope, C. G., Pope, H. G., Menard, W., Fay, C., Olivardia, R., & Phillips, K.A. (2005). Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body image, 2, 395-400.

Veale, D. (2004) Body dysmorphic disorder. Postgraduate Medical Journal. 80, 67-71.

Out of this whirled: Can dancing be addictive?

I don’t know about the rest of the world, but here in the UK, celebrity dancing television shows (such as Strictly Come Dancing and Dancing On Ice) have become highly popular as evidenced by the huge ratings successes over the last few years. As my family are big fans of these shows I’ve come to learn more about dance than I would care to admit. It’s also because of this that a recent paper published in the Journal of Behavioral Addictions caught my eye. It’s a paper by French researchers Remi Targhetta, Bertrand Nalpas, and Pascal Perney entitled Argentine tango: Another behavioral addiction?’ I’m sure many of you reading this will be sceptical about whether dancing can be addictive, but I have always argued that any behaviour can be addictive if there are constant rewards for the individual.

For those of you who know nothing about the Argentine tango (me included before I read this paper), the authors note that:

“Tango is a popular dance for two, which originated in Rio de la Plata, Argentina, in the mid-19th century. Although several styles exist, tango is mostly danced in either open or close embrace, with long elegant steps and complex figures often with sensual connotation. Dancers, men and women, wearing specific clothes and shoes, are perfumed and very elegant”.

The first author of this study (Dr. Targhetta) admits in the paper that he himself is an experienced tango dancer. He got the idea to investigate ‘tango addiction’ because of someone who had attended every night of a 10-day tango festival. Dr. Targhetta developed a friendly relationship with the dancer and suspected that the dancer might be “addicted” to tango. Dr. Targhetta then formally interviewed the dancer:

“He was a white collar in an insurance firm and has a very good income; he suddenly stopped working at 52 years of age in order to practice more and more tango as he wanted; then he moved to Argentina for 2 years to improve and intensify his practice; in Buenos Aires he danced every day from 11 PM to 4 AM and moreover spent 2 hours at least for preparation; he has never considered to reduce or stop dancing and, conversely, he started liking dancing more and more because he was feeling growing pleasure. He claimed that this practice presented no drawback, and on the contrary, there have been advantages such as well-being and self-confidence. Finally, the only time he did not dance was during a holiday week, he developed symptoms looking like those observed during withdrawal such as sadness, feeling uncomfortable and leg prickling”.

Following the interview, Dr. Targhetta concluded that the tango dancer might indeed be addicted but was substantially different from other similar behavioural addictions such as exercise dependence on sports such as running or body-building because “tango dancing requires usually smooth physical effort, it is always performed in an arousing senses environment, while embracing consecutively different partners”. (I’m not sure I follow this line of argument but it’s not critical for a appreciation of the study carried out).

Dr. Targhetta’s observations became the basis for carrying out a much bigger study to examine whether dancing can be addictive. The authors recruited their participants from subscribers to a monthly magazine called ToutTango devoted to tango dancing. Of the 15,000 subscribers, 1,129 tango dancers participated in the study (following an advertisement in the magazine asking for tango dancers to take part in an online survey entitled ‘Are you tango addicted?’). The survey included three measures of addiction: (i) the first measure was based on the DSM-IV criteria for substance dependence, (ii) the second measure comprised Dr. Aviel Goodman’s criteria of dependence, and (iii) the third measure was a self-evaluation of the degree of addiction to tango. More specifically, the authors wrote:

“We built a questionnaire based upon DSM-IV by re-writing each criterion to adapt them to tango, but without modifying their actual meaning; to complete our evaluation toolbox, we also adapted [Dr. Aviel Goodman’s 1990] diagnostic criteria for addictive disorders and, secondly, we added a Likert scale from 0 to 5 for self-evaluation of the degree of addiction to tango…To fit with the future DSM-V definition of substance use disorders, we added a question regarding craving for tango. On the basis of the information recorded from the dancer’s interview, we added some specific and hedonic questions related to the positive (physical or psychological) effects and some items related to the negative (physical or psychological) effects experienced”.

The authors reported that the “dependence rates” were 45% for the adapted DSM-IV criteria, 7% for Goodman’s criteria, and 36% self-rating scores. The difference in these prevalence rates is likely to be because of inadequate conceptualizations of the phenomenon to identify or from differences in the screening tools used. However, they also noted that physical withdrawal symptoms were reported one-fifth of the total sample and that a “strong craving” for dancing was reported by one-third of the total sample. Only 64 dancers (5.6%) were dependent according to all three addiction measures and it is this small percentage that is most likely to be the “hard core of dependent dancers”. Other interesting results included:

“Positive effects were high both in dependent and non-dependent groups and were markedly greater than negative effects. Long practice of tango dancing did not modify the dependence rate or reduce the level of positive effects”… According to our results, tango dancing satisfies several criteria of addiction: feelings of tension or arousal and craving state before dancing, pleasure or relief when dancing, tolerance characterized by a need to increase time spent dancing, and finally physical withdrawal symptoms following abstinence. Altogether this suggests that dependence on tango could exist…[However] tango dependence is associated with several strong and sustained positive effects (pleasure, self-esteem, reduced stress, physical health, etc.) while negative effects are weak”.

There are obviously some major limitations to the study in that the data were based purely on self-report, and the sample was totally self-selected (and was likely to include the most fanatical tango dancers as they were subscribers to a very specialist tango magazine). The authors concluded that if tango addiction exists, it most resembles exercise addiction (in fact, the authors cited our work on exercise addiction to support their argument). Personally, I think it would take more robust data to convince me that excessive tango dancing could be classed as an addiction, but at least there is now an empirical study that future research can build upon.

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

Further reading

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

Berczik, K., Szabo, A., Griffiths, M. D., Kurimay, T., Kun, B., Rand, R. & Demetrovics, Z. (2012). Exercise addiction: Symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403–417.

Demetrovics, Z. & Griffiths, M.D. (2012). Behavioral addictions: Past, present and future. Journal of Behavioral Addictions, 1, 1-2.

Goodman, A. (1990). Addiction: Definition and implications. British Journal of Addiction, 85, 1403–1408.

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

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

Targhetta, R., Nalpas, B. & Perney, P. (2013). Argentine tango: Another behavioral addiction? Journal of Behavioral Addictions, DOI: 10.1556/JBA.2.2013.007.