Blog Archives

Gripped by ‘crypt’: A brief look at ‘crypto-trading addiction’

Last week I was approached by Rupert Wolfe-Murray, a PR representative of a well-known addiction treatment clinic (Castle Craig) asking what my views were on Bitcoin and cryptocurrency trading (colloquially known as ‘crypto trading’) and whether the activity could be addictive. More specifically he wrote:

“I write to you about the research we’re doing into addiction to Bitcoin and cryptocurrency trading. We’ve had an enquiry about this at Castle Craig and they would treat it as a gambling addiction. We think it’s a new type of behavioural addiction and we plan to publish a web page (and FAQ) with the intention of alerting people that the online trading of cryptocurrencies may be addictive. It would be very helpful if we could get a quote from you, putting it into perspective. Do you think it’s a growing problem? There’s very little information about this issue online but there is an active forum of ‘crypto addicts’ on Reddit, where I got some friendly feedback…The therapist I often turn to when writing about gambling and the behavioural addictions told me that it sounds like addiction to day trading. Would you agree?”

In short, I couldn’t agree more although my own view is that this is not a ‘new’ addiction but a sub-type of online day-trading addiction (on which I first published an article about back in 2000 for GamCare, the gambling charity I co-founded with Paul Bellringer in 1997) and/or stock market trading addiction (which I’ve written a couple of previous blogs about, here and here, and an article in iGaming Business Affiliate magazine). However, I decided to do a bit of research into the issue.


A recent January 2018 article in the Jakarta Post by Ario Tamat examined this issue which was a personal account of his own experiences (‘Bitcoin trading: Addictive ‘hobby’ that could break my bank’). He wrote:

“I was always interested in Bitcoin, not that I really understand the technology, but first impressions were appealing: a decentralized currency, mined by solving mathematical equations and potentially accessible to anyone…Fast forward to 2017. Discussions on cryptocurrencies had entered the public consciousness, Bitcoin prices were sky high… A few friends introduced me to a local site on cryptocurrency trading – the most suitable term for the entire affair, actually – Taking the leap, I took some money out of my measly savings and bought myself some Bitcoin…In three days, I had made 6 percent. I was hooked… I’ve noticed that the whole cryptocurrency trading trend is like placing bets on a never-ending horse race, where new horses are introduced to the race almost daily”.

Another article by Douglas Lampi on the Steemit website noted that “the elements of addiction and gambling are a consistent risk that traders must always be on the guard against” and provided some signs to readers that they may be trading impulsively. These included (i) feeling muscle tension, (ii) feeling background anxiety, (iii) checking the price of Bitcoin and alt coins several times through the day, and (iv) thinking about trading while engaged in other activities. While these ‘symptoms’ and behaviours might be found among those addicted to crypto day trading, on their own they are arguably little more than mildly problematic. These signs applied to gambling or social media use would be unlikely to raise many worries among addiction treatment practitioners.

I also visited the online Bitcoin Forum where one of the topics was ‘Is crypto trading an addiction’ prompted by a Russian who allegedly committed suicide after losing all his money crypto trading. Most of the people on the forum didn’t think it was an addiction and claimed the suicide was reminiscent of the suicides that occurred at the time of the 2009 stock market crash (although a couple of individuals believed that crypto trading was a potentially ‘addicting’ activity). One participant in the discussion noted:

“Yes [crypto trading is] highly addictive, specially formulated if you start to notice that need, urge in side you, to check the price even in the middle of the night. Find yourself skipping your daily routines it is and can be addictive if you don’t know how to control you and your emotions. I have found somewhere that some say that it is like being in casino, betting, playing rules etc. because like every coin was made mostly for pure profit and it’s all speculation rather than to have their own sole purpose which when I think of it can make sense to even why it can be addictive”.

Another individual on the Bitcoin Pub website wrote:

“I think I might actually have an unhealthy addiction to [crypto trading]. I’d say 3/4 times when I unlock my phone I’m checking Blockfolio, when I’m at work, at home, with my girlfriend, or even between sets at the gym. I’m starting to think I need to discipline myself to NOT check it or limit it to maybe 1-2 times a day as its noticeably impacting my passions and in turn my mental state. I’m not a day trader, I hold all my coins in cold storage. So there’s really no reason for me to be checking that frequently, or watching crypto analysis YouTube videos, or reading articles about it several times a day”.

The issue was also discussed in a recent February 2018 article in the Irish Times by Fiona Reddan (‘It’s addictive’: Why investors are still flocking to bitcoin and crypto’). Interviewing Nicholas Charalambous (Managing Director of Alpha Wealth) was quoted as saying: “Previously, I would have described cryptos as ‘shares on steroids’; now I would say they’re shares with jetpacks and boosters and then some”. While Bitcoin shares have fallen, there are plenty of new cryptocurrencies that individuals can dabble buying shares in (ethereum, litecoin, ripple, putincoin and dogecoin) and all can be akin to gambling. Reddan also interviewed Jonathan Sheehan (Managing Director, Compass Private Wealth) who said:

“It has the exact same risk and return characteristics as a naive gambler, who has opened their first online betting account. There is absolutely no valuation metric for these currencies and allocating capital to them is an extreme and unnecessary risk”.

One country that has taken crypto trading addiction seriously is South Korea. Their government’s Office for Government Policy Coordination has introduced new rules to inhibit the speculation on cryptocurrencies. According to a Market Watch article:

“The proposed measures…range from levying capital-gain taxes on trading cryptocurrencies, to restricting financial firms from holding, acquiring and investing in them…The new regulations come amid mounting concern within South Korea about the potential for people to become addicted to bitcoin trading”.

The country’s prime minister Lee Nak-yon went as far as to say that the increasing interest in cryptocurrencies could “lead to some serious distorted or pathological phenomenon”.

I did quickly check what had been written about academically. I came across a couple of papers on Google Scholar that mentioned possible addiction to crypto trading. Justine Brecese (in a 2013 ‘research note’ on the socioeconomic implications of cyber‐currencies for ASA Risk Consultants) asserted that risks with virtual currency include the potential for addiction and resultant over-spending” (but providing little in the way of empirical evidence for the claim). In a paper by Haraši Namztohoto on ‘cryptocoin avarice’, he noted:

“Reason often discretely quits the cognitive battlefield whenever hoarding tendencies of human beings are coupled with addictive behaviour which financial derivate trading surely is, thus leaving humans prone to caprices of mass psychology”.

Given that addictions rely on constant rewards and reinforcement, there is no theoretical reason why crypto trading cannot be addictive. However, there is only anecdotal evidence of addicted individuals and if they are addicted a case could be made that this is a type of gambling addiction.

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

Further reading

Brecese, J. (2013). Research note – Money from nothing: The socioeconomic implications of “cyber-currencies”. Seattle, WA: ASA Institute for Risk & Innovation

Griffiths, M.D. (2000). Day trading: Another possible gambling addiction? GamCare News, 8, 13-14.

Griffiths, M.D. (2009). Internet gambling in the workplace. Journal of Workplace Learning, 21, 658-670.

Griffiths, M.D. (2013). Financial trading as a form of gambling. i-Gaming Business Affiliate, April/May, 40.

Namztohoto, H. (2013). Myth, machinery and cryptocoin avarice. Located at:

Jeong, E-Y. & Russolillo, S. (2017). South Korea mulls taxing cryptocurrency trade as fears mount about bitcoin addiction, speculation. Market Watch, December 13. Located at:

Lampi, D. (2018). Two sure signs YOU are a crypto trading addict. February. Located:

Reddan, F. (2018). ‘It’s addictive’: Why investors are still flocking to bitcoin and crypto. Irish Times, February 13. Located at:

Tamat, A. (2018). Bitcoin trading: Addictive ‘hobby’ that could break my bank. The Jakarta Post, January 8. Located at:

Hoard focus: A brief overview of Diogenes Syndrome

In a previous blog on animal hoarding I made a passing reference to Diogenes Syndrome (DS) that is sometimes referred to as ‘senile squalor syndrome’ (as it typically occurs in elderly individuals – although it has occasionally been reported in young adults). According to a paper by Alberto Pertusa and colleagues in a 2010 issue of Clinical Psychology Review:

“Squalor has been defined in various ways including, ‘social breakdown of the elderly’, ‘Diogenes syndrome’ and ‘severe domestic squalor’…These definitions have usually encompassed both domestic neglect and a lack of personal hygiene…The majority of case observations and studies on squalor have focused on elderly populations recruited from nursing or disability services…These studies initially suggested that those living in squalor were likely to be over the age of 60, primarily female, living alone and unmarried…Hypotheses on the etiology of squalor have moved from the phenomenon possibly being uni-dimensional to having heterogeneous causes such as physical disabilities, brain damage, psychiatric conditions, and personality disorders…A study on squalor reported the prevalence to be 0.005% in the United Kingdom”.

Hoarding is often a consequence of having DS but is associated with self-neglect and much of the items excessively hoarded are typically items of trash with little or no value. Like animal hoarders, those with DS often live on their own in severe domestic squalor and unsanitary conditions. As I noted in my previous blog, DS is characterized by extreme self-neglect, apathy, domestic squalor, social withdrawal, compulsive hoarding of rubbish, and lack of shame. Most sufferers refuse help of others and the onset of DS may sometimes be initiated by a stressful event in their lives (such as death of a loved one). According to a 2013 paper on DS by Dr. Projna Biswas and colleagues in the journal Case Reports in Dermatological Medicine:

“DS is named after the Greek Philosopher “Diogenes of Sinope” (4th century BC) who taught about cynicism philosophy. He kept his need for clothing and food to a minimum by begging. He used to follow some ideas like ‘life according to nature’, ‘self-sufficiency’, ‘freedom from emotion’, ‘lack of shame’, ‘outspokenness’, and ‘contempt for social organization’…The approximate annual incidence of Diogenes is 0.05% in people over the age of 60 [years]. Affected individuals come from any socioeconomic status, but are usually of average or above-average intelligence…It is often associated with other mental illnesses, such as schizophrenia, mania, and frontotemporal dementia…While no clear etiology exists, it is hypothesized that it may be due to a stress reaction in people with certain pre-morbid personality traits, such as being aloof, or certain personality disorders, such as schizotypal or obsessive compulsive personality disorder. There are suggestions that an orbitofrontal brain lesion may lead to such behaviours…while others state that chronic mania symptoms, such as poor insight, can lead to such a condition”.

DS was not included separately in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) although hoarding (syllogomania) is included as a genuine psychiatric diagnosis. Because of deliberate self-isolation, physical neglect and poor eating, DS mortality rates are high with close to half of sufferers dying within five years of DS onset. Biswas and colleagues also note:

“Diogenes syndrome is also known as dermatitis passivata. The term Diogenes syndrome was coined in 1975 by [Clark and colleagues]…DS has been classified as primary or pure which is not associated with mental illness and secondary or symptomatic. Secondary DS is related to mental illness like schizophrenia, depression, and dementia…Alcohol abuse has been identified as a cofactor…Multiple deficiency states have been associated with DS including iron, folate, vitamin B12, vitamin C, calcium and vitamin D, serum proteins and albumin, water, and potassium…Skin lesions are mainly due to uncleanliness which may result in various infestations and infections. These are ignored by the patient. Dirt, dust, bacterial, fungal, and parasitic debris conglomerate to form thick crusts and scales over various parts of the body”.

The paper by Biswas and colleagues’ asserted that four symptoms have been reported as being in almost all DS sufferers. These are that they: (i) never ask for any help despite possessing nothing; (ii) are unusually fond of certain objects (including rubbish); (iii) display unusual behavior with other people (misanthropy) and (iv) display extreme self-neglect. Although hoarding is often present in those with DS, there have been some cases reported where no hoarding was present. In their 2010 review paper, Dr. Pertusa and colleagues noted:

“Research on hoarding has rarely included assessments of severe domestic squalor. Winsberg et al. (1999) noted that clutter inhibited normal activities of daily living – including personal hygiene. A few studies have provided more direct indications of squalor in hoarding. [one study in 2000] surveyed health department officers in Massachusetts who reported that 38% of their hoarding cases were ‘heavily cluttered with filthy environment, overwhelming’. [Another study] focused on cleanliness ratings of the personal appearance and the homes of 62 elderly hoarding individuals. In their sample, 17% of individuals were described as ‘extremely filthy’ and 33% of residences were rated as ‘extremely filthy and dirty’. For 32% of the residences, there was an overpowering odor from rotten food or animal or human feces. Many subjects could not use their refrigerator (45%), kitchen sink (42%), bathtub (42%), or toilet (10%). Lack of standardized instruments to measure squalor have prevented researchers from understanding squalor in compulsive hoarding”.

Dr. Pertusa and his colleagues claim the data on DS is scarce and that the clinical picture between hoarding and DS needs more clinical research. They do conclude that hoarding within a DS diagnosis is clinically different from other types of hoarding (for instance, compulsive hoarders do not display the same core features as those with DS such as squalor and self-neglect). Like many other clinical conditions, Pertusa’s team assert that longitudinal studies will best help uncovering the natural history and link (if any) between both DS and compulsive hoarding.

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

Further reading

Biswas, P., Ganguly, A., Bala, S., Nag, F., Choudhary, N., & Sen, S. (2013). Diogenes syndrome: a case report. Case reports in dermatological medicine,

Clark, A. N., Mankikar, G. D., & Gray, I. (1975). Diogenes syndrome. A clinical study of gross neglect in old age. Lancet, 1(7903), 366−368.

Drummond, L.M., Turner, J., Reid, S. (1996). Diogenes’ syndrome – a load of old rubbish? Irish Journal of Psychiatric Medicine, 14(3), 99–102.

Greve, K.W., Curtis, K.L., & Bianchini, K.J. (2004). Personality disorder masquerading as dementia: A case of apparent Diogenes syndrome. International Journal of Geriatric Psychiatry, 19, 703–705

Irvine, J. D., & Nwachukwu, K. (2014). Recognizing Diogenes syndrome: a case report. BMC Research Notes, 7(1), 276.

Pertusa, A., Frost, R.O., Fullana, M.A., Samuels, J., Steketee, G., Tolin, D., Saxena, S., Leckman, J.F., Mataix-Cols, D. (2010). Refining the diagnostic boundaries of compulsive hoarding: A critical review. Clinical Psychology Review, 30, 371-386.

Rosenthal, M., Stelian, J., & Wagner, J. (1999). Diogenes syndrome and hoarding in the elderly: Case reports. Israel Journal of Psychiatry and Related Sciences, 36, 29–34.

Token gestures: A brief look at ‘sexual trophy collecting’

Back in 2002, I had a little piece published on excessive collecting behaviour in the Guardian newspaper (‘Addicted to hoarding’). In it I wrote:

“I have always been interested in why we have what seems like an innate ability to collect. I would almost go as far as to say that we are ‘natural born hoarders’. Furthermore, there has been surprisingly little research in this area and Freud’s theories on the topic are unfortunately almost empirically untestable. I would also add that for some people, collecting is at the pathological end of the behavioural continuum. There are some that are (for want of a better word) ‘addicted’ to collecting and there are some with obsessive-compulsive disorders who simply cannot throw away anything”.

Since then I’ve published a few articles on the psychology of collecting in this blog and is probably one of the reasons that I have had a few approaches over the last couple months from journalists asking me about the psychology behind various forms of collecting. (In fact, I’ve also been approached to write an academic chapter on the phenomenon too). Two of the most recent media requests included journalists writing articles on why people collect retro video games (which I hope to write about in a future blog) and another on why people collect ‘sexual trophies’.

I have to admit that I am no expert on sexual trophies so I did a little reading on the topic. According to one definition I came across, a sexual trophy is “any item or piece of clothing gained from a sexual encounter as proof of a successful sexual conquest”. To tie in with the release of US comedy I Just Want My Pants Back, MTV conducted a [non-academic] survey and reported that one in three young British people (aged between 18 and 34 years) admitted to owning some sort of sex trophy with one in six of them (16%) claiming they had two or more sex-based trophies (a group that MTV termed ‘Sexual Magpies’).

However, when it comes to the collecting ‘sexual trophies’, I would argue that most academic research that I have come across on the topic relates to more criminal sexual deviance rather than day-to-day sexual encounters. For instance, in the 2010 book Serial Murderers and Their Victims, Dr. Eric Hickey described the case of man – who was a voyeur – from Georgia (US) that used to break into houses and steal women’s underwear. On his eventual arrest they found over 400 pairs of knickers that he had stolen. More disturbing are cases such as this excerpt from a story in the Daily Telegraph. This is arguably more typical of what I perceive to be sexual trophy hunters:

“A company manager and ‘pillar of the community’ has been exposed after 20 years as a serial sex attacker known as the Shoe Rapist. James Lloyd, 49, a long-standing Freemason who took the footwear of his victims as trophies, was finally caught through advances in DNA techniques. Police later found more than 100 pairs of stiletto shoes hidden behind a trap door at the printing works where he was employed… As well as taking their shoes, he often stole jewellery from the women, mainly in their teens and early 20s, between 1983 and 1986” (Daily Telegraph, July 18, 2006).

However, Dr. Hickey’s book describes even worse acts of sexual trophy collecting. He noted that many serial killers are “known for their habits of collecting trophies or souvenirs. Others have collected lingerie, shoes, hats, and other apparel”. A sizeable section of the book concentrates on the types of serial killers that are popular in the media (such as those that commit ‘lust murders‘) and are the subject of many Hollywood films such as the series of films with (my favourite fictional psychopath) Hannibal Lecter. As Hickey notes:

“These are the rapists who enjoy killing and, often, indulging in acts of sadism and perversion. These are the men who have engaged in necrophilia, cannibalism, and the drinking of victims’ blood. Some like to bite their victims; others enjoy trophy collecting – shoes, underwear, and body parts, such as hair clippings, feet, heads, fingers, breasts, and sexual organs…[and] evoke our disgust, horror, and fascination”.

One of the cases discussed is 1950s US serial killer Harvey Glatman (known in the media as ‘The Lonely Hearts Killer’) who used to take photographs of the women he murdered. Citing the work of Dr. Robert Keppel (another expert in serial murder cases and author of Serial Murder: Future Implications for Police Investigations), Dr. Hickey wrote:

“His photos were more than souvenirs, because in Glatman’s mind, they actually carried the power of his need for bondage and control. They showed the women in various poses: sitting up or lying down, hands always bound behind their backs, innocent looks on their faces, but with eyes wide with terror because they had guessed what was to come”.

Other murderers described by Dr. Hickey included a man that liked to surgically remove (and keep) the eyeballs from his sexual victims (most probably 1990s’ serial killer Charles Allbright) and another that skinned his victims and made lampshades, eating utensils, and clothing. In his overview of necrophilic homicide (i.e., those individuals that kill others in order to engage in sexual activity), Hickey also mentions that such necrosadistic murderers often engage in other paraphilias related to necrophilia “including partialism or the desire to collect specific body parts that the offenders finds sexually arousing. This may include feet, hands, hair, and heads, among others”. Hickey also noted that:

“Another important characteristic of these lust killers was the ‘perversion factor’. This subgroup was often prone to carry out bizarre sexual acts. These acts most commonly included necrophilia and trophy collection. Jerry Brudos severed the breasts of some of his victims and made epoxy molds. Brudos, like others, also photographed his victims in various poses, dressed and disrobed. The photos served as trophies and a stimulus to act out again”.

Later in the book, Dr. Hickey examines the case of Jerry Brudos in more detail (please be warned that some of the things written here may offend those of a sensitive nature):

“At an early age, Jerry Brudos developed a particular interest in women’s shoes, especially black, spike-heeled shoes. As he matured, his shoe fetish increasingly provided sexual arousal. At 17, he used a knife to assault a girl and force her to disrobe while he took pictures of her. For his crime he was incarcerated in a mental hospital for 9 months. His therapy uncovered his sexual fantasy for revenge against women, fantasies that included placing kidnapped girls into freezers so he could later arrange their stiff bodies in sexually explicit poses. He was evaluated as possessing a personality disorder but was not considered to be psychotic…He continued to collect women’s undergarments and shoes. Prior to his first murder, he had already assaulted four women and raped one of them. At age 28, Jerry was ready to start killing…He took [his first victim] to his garage, where he smashed her skull with a two-by-four. Before disposing of the body in a nearby river, he severed her left foot and placed it in his freezer. He often would amuse himself by dressing the foot in a spiked-heel shoe. His fantasy for greater sexual pleasure led him…to strangle [another victim] with a postal strap. After killing her, he had sexual intercourse with the corpse, then cut off the right breast and made an epoxy mold of the organ. Before dumping her body in the river, he took pictures of the corpse. Unable to satisfy his sexual fantasies and still in the grasp of violent urges, he found his third victim…After sexually assaulting her, he strangled her in his garage, amputated both breasts, again took pictures, and tossed her body into the river”.

Arguably the most infamous ‘sexual trophy collector’ was 1980s US serial killer Jeffrey Dahmer, the so-called ‘Milwaukee Cannibal’. In Dr. Hickey’s account he noted that:

“Restraining Dahmer, the officers looked around the apartment and counted at least 11 skulls (7 of them carefully boiled and cleaned) and a collection of bones, decomposed hands, and genitals. Three of the cleaned skulls had been spray-painted black and silver. These were to be part of the shrine fantasized by Dahmer. A complete skeleton suspended from a shower spigot and three skulls with holes drilled into them were found throughout the apartment…Chemicals, including muriatic acid, ethyl alcohol, chloroform, and formaldehyde, were also discovered, along with several Polaroid photographs of recently dismembered young men. A complete human head sat in the refrigerator”.

Another infamous case from the early 1970s (that I admit I had never heard of until I read Dr. Hickey’s book) was Ed Kemper, a cannibalistic killer who also collected human trophies and keepsakes of his victims. Citing the book Hunting Humans by Dr. Elliot Leyton, it was reported that:

“At the age of 23, Ed started killing again, a task that would last nearly a year and entail eight more victims. He shot, stabbed, and strangled them. All were strangers to him, and all were hitchhikers. He cannibalized at least two of his victims, slicing off parts of their legs and cooking the flesh in a macaroni casserole. He decapitated all of his victims and dissected most of them, saving body parts for sexual pleasure, sometimes storing heads in the refrigerator. Ed collected ‘keepsakes’ including teeth, skin, and hair from the victims. After killing a victim, he often engaged in sex with the corpse, even after it had been decapitated. In his confession Kemper stated five different reasons for his crimes. His themes centered on sexual urges, wanting to possess his victims, trophy hunting, a hatred for his mother, and revenge against an unjust society (Leyton, 1986)”.

The most obvious question related to these depraved acts is why such people do it in the first place. Writing in the Encyclopedia of Murder and Violent Crime, Nicole Mott provides an answer:

“A trophy is in essence a souvenir. In the context of violent behavior or murder, keeping a part of the victim as a trophy represents power over that individual. When the offender keeps this kind of souvenir, it serves as a way to preserve the memory of the victim and the experience of his or her death. The most common trophies for violent offenders are body parts but also include photographs of the crime scene and jewelry or clothing from the victim. Offenders use the trophies as memorabilia, but also to reenact their fantasies. They often masturbate or use the trophies as props in sexual acts. Their exaggerated fear of rejection is quelled in front of inanimate trophies. Ritualistic trophy taking, as is found with serial offenders, acts as a signature. A signature is similar to a modus operandi (a similar act ritualistically performed in virtually all crimes of one offender), yet it is an act that is not necessary to complete the crime”

In one of my previous blogs on the psychology of collecting more generally, I referred to a paper by Dr. Ruth Formanek in the Journal of Social Behavior and Personality. She suggested five common motivations for collecting: (i) extension of the self (e.g., acquiring knowledge, or in controlling one’s collection); (ii) social (finding, relating to, and sharing with, like-minded others); (iii) preserving history and creating a sense of continuity; (iv) financial investment; and (v), an addiction or compulsion. She also claimed that the commonality to all motivations to collect was a passion for the particular things collected. Personally, I think that the acquisition of sexual trophies – even in the most deranged individuals – can be placed within this motivational typology in that such individuals clearly have a passion for what they do and I would argue that the behaviour is an extension of the self that to some individuals may be a compulsion or addiction.

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

Further reading

Branagh, N. (2012). Third of UK owns sex trophy. March 26. Located at:

Du Clos, B. (1993). Fair Game. New York: St. Martin’s Paperbacks.

Griffiths, M.D. (2002). Addicted to hoarding. The Guardian (Review Section), August 10, p.19.

Formanek, R. (1991). Why they collect: Collectors reveal their motivations. Journal of Social Behavior and Personality, 6(6), 275-286.

Hickey, E. W. (Ed.). (2003). Encyclopedia of Murder and Violent Crime. London: Sage Publications

Hickey, E. W. (2010). Serial Murderers and Their Victims (Fifth Edition). Pacific Grove, CA: Brooks/Cole.

Keppel, R. D. (1989). Serial Murder: Future Implications for Police Investigations. Cincinnati, OH: Anderson.

Leyton, E. (1986a). Hunting Humans. Toronto: McClelland and Stewart.

Leyton, E. (1986b). Compulsive Killers: The Story of Modern Multiple Murder. New York: New York University Press.

Compelling evidence: A beginner’s guide to obsessive- compulsive disorders

Most people’s perceptions of obsession and compulsion – if they have never experienced it personally or have encountered it among family and friends – are probably based on television and film characters who have obsessive-compulsive disorders such as Jack Nicholson playing the novelist Melvin Udall in the film As Good As It Gets, or (my own personal favourite) Tony Shalhoub’s playing Adrian Monk in the detective series Monk. Shalhoub’s portrayal of Monk as a dirt phobic, symmetrically obsessed, ex-policeman who never walks on cracks in the pavement appears to show the condition and the effect on his life in a way that everyone can understand and sympathize.

Unsurprisingly and self-evidently, obsessive–compulsive disorder (OCD) is indicated by the presence of either obsessions and/or compulsions and is a clinically heterogeneous condition. In the most recent International Classification of Diseases (10th Edition) of the World Health Organization, a diagnosis of OCD is indicated if the obsessive and/or compulsive behaviour is present on most days for at least two weeks. To be classed as having OCD, the behaviour(s) must cause significant distress or interfere with a person’s social and/or individual functioning (typically by time wasting). Other psychiatric disorders (e.g., Tourette’s syndrome, depression, schizophrenia) may include OCD behaviours. Furthermore, the World Health Organization ranks OCD as in the top ten most handicapping illnesses as measured by lost income and decreased quality of life.

The psychiatrist Dr David Veale (The Priory Hospital North London) and one the UK’s leading experts on obsessive-compulsive disorders, provides the following two definitions and classic features for compulsions and obsessions:

  • Compulsions: These are repetitive behaviours or mental acts that the person feels driven to perform. A compulsion can either be overt and observed by others (e.g. checking that a light has been switched off) or a covert mental act that cannot be observed (e.g. repeating a certain phrase repeatedly in one’s mind). Covert compulsions are usually more difficult to resist than overt ones as they are viewed as ‘portable’ (and therefore easier to perform). A compulsion is not pleasurable for the person who experiences it. This differentiates it from impulsive acts such as shopping or gambling that are associated with immediate gratification
  • Obsessions: These are defined as unwanted intrusive thoughts, images or urges that repeatedly enters the person’s mind. They are distressing (i.e. the person views the thoughts and/or behaviours as repugnant or inconsistent with their personality) but originate in the person’s mind and not imposed by an outside agency. Unwanted intrusive thoughts, images or urges are almost universal in the general population and their content (e.g., the urge to push someone over, the thought that the oven has been left on, etc.) is indistinguishable from clinical obsessions. However, the difference between a normal intrusive thought and an obsessional thought is the meaning that the person attaches to the occurrence and/or content of the intrusions.

Empirical research suggests that around 2% of the general population suffer from some form of OCD with a roughly equal gender split (although some OCD disorders are more male-based – such as sex and number obsessions – and some are more female based – such as compulsive hand washing). However, prevalence rates are dictated by the screening instruments used (some of which are claimed to over-inflate the problem). However, others claim that the prevalence rates are higher because some sufferers are simply too ashamed to seek the professional help they need.

In a study led by Dr Edna Foa (University of Pennsylvania, USA) on 431 people with OCD, the most common compulsions were checking things such as gas taps (28.8%), cleaning and washing (26.5%), repeating acts (11.1%), mental compulsions such as prayers being constantly repeated (10.9%), ordering, symmetry and/or exactness (5.9%), hoarding and collecting (3.5%), and constant counting (2.1%). The same study found that the most common obsessions were contamination from dirt, germs, viruses, bodily fluids or faeces, chemicals, sticky substances, and dangerous materials (37.8%), fear of harm (23.6%), excessive concern with order or symmetry (10%), obsessions with the body or physical symptoms (7.2%), religious, sacrilegious or blasphemous thoughts (5.9%), sexual thoughts such as being a paedophile or a homosexual (5.5%), urges to hoard useless or worn-out possessions (4.8%), and thoughts of violence or aggression such as stabbing one’s own baby (4.3%).

Similar findings were found in a study led by Dr David Mataix-Cols (Institute of Psychiatry, London) and published in the American Journal of Psychiatry. Following a comprehensive literature review, they reported 12 factor-analytic studies involving more than 2,000 OCD patients were identified. These studies typically showed at least four symptom dimensions. These were (i) symmetry and ordering, (ii) hoarding, (ii) contamination and cleaning, and (iv) obsessions and checking. They concluded that the complex clinical presentation of OCD can be summarized with these few consistent, temporally stable symptom dimensions.

Scientific research has shown that OCD typically develops in early adulthood for females (i.e., in their early twenties) and in late adolescence for males, although children of both sexes can also suffer. Studies using twin and families suggest that genetic factors may also play a role in the expression of OCD although psychological factors are also important in the acquisition, development and maintenance of the disorder. There is also some evidence that OCD is associated with high intelligence. The seriousness and severity of OCD differs from one individual to the next Some people with OCD are able to hide it even from those most close to them. However, more often, OCD seriously affects relationships and can lead to irreconcilable breakdown. It can also disrupt the ability to work or study.

In relation to prognosis, both psychological interventions (e.g., cognitive-behavioural therapy) and pharmacotherapy may lead to a significant decrease in OCD symptoms for typical sufferers. However, symptoms can continue to persist even after treatment. A completely OCD symptom-free period following treatment is relatively uncommon.

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

Further reading

Eddy, K.T., Dutra, L., Bradley, R. & Westen, D. (2004). A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clinical Psychology Review, 24, 1011-1030.

Foa, E.B., Kozak M J, Salkovskis P.M., Coles, M.E. & Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: The Obsessive-Compulsive Inventory. Psychological Assessment, 10, 206-214.

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

Mataix-Cols, D., Conceição do Rosario-Campos, M. & Leckman, J.F. (2005). A multidimensional model of Obsessive-Compulsive Disorder. American Journal of Psychiatry, 162, 228-238.

Rachman, S.J. & Hodgson, R. (1980). Obsessions and Compulsions. Englewood Cliffs, NJ: Prentice Hall.

Veale, D. (2004). Psychopathology of obsessive-compulsive disorder. Psychiatry, 3(6), 65-68.