Blog Archives

World of the Weird: The A-Z of strange and bizarre addictions

Today’s blog takes a brief look at some of the stranger addictions that have been written about in the academic literature (or academics that have tried to argue these behaviours can be addictive). Some of these ‘addictions’ listed are not addictions by my own criteria but others have argued they are. The papers or books that have argued the case for the cited behaviour being a type of addiction are found in the ‘Further reading’ section.

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  • Argentine tango addiction: A French study published in a 2013 issue of the Journal of Behavioral Addictions by Remi Targhetta and colleagues argued that a minority of 1129 Argentine tango dancers they surveyed may be addicted to dancing. In 2015, I and some of my Hungarian colleagues developed the Dance Addiction Inventory (published in PLoS ONE) and also argued that a minority of dancers (more generally) might be addicted to dance and conceptualized the behaviour as a form of exercise addiction.
  • Badminton addiction: While there are many behaviours I could have chosen here including addictions to box set television watching (aka ‘box set bingeing), bargain hunting, bungee jumping, blogging, and bodybuilding, a recent 2018 paper published in NeuroQuantology by Minji Kwon and colleagues carried out a neuroimaging study on a sample 45 badminton players. Using the Korean Exercise Addiction Scale, 20% of the sample were defined as being addicted to badminton.
  • Carrot eating addiction: Again, there are many behaviours I could have chosen here including alleged addictions to crypto-trading, chaos, collecting, crosswords, and cycling, there are a number of published case studies in the psychological literature highlighting individuals addicted to eating carrots including papers by Ludek Černý and Karel Černý, K. (British Journal of Addiction, 1992), and Robert Kaplan (Australian and New Zealand Journal of Psychiatry, 1996).
  • Death addiction: A recent paper by Dr. Marc Reisinger entitled ‘Addiction to death’ in the journal CNS Spectrums attempted to argue that attraction to death be considered an addiction similar to gambling addiction. Reisinger related the concept to individuals who have left Europe to join the jihad in Syria, and outlined the case of 24-year-old French-Algerian Mohamed Merah who committed several attacks in Toulouse in 2012 and who ‘glorified’ death. Te paper claimed that this “addiction to death is taught by Salafist preachers, whose videos, readily accessible on the internet, are kind of advertisements for death, complete with depictions of soothing fountains and beautiful young girls”.
  • Entrepreneurship addiction: There are a couple of papers by April Spivack and Alexander McKelvie (a 2014 paper in the Journal of Business Venturing, and a 2018 paper Academy of Management) arguing that entrepreneurship can be addictive. They define ‘entrepreneurship addiction’ as “the excessive or compulsive engagement in entrepreneurial activities that results in a variety of social, emotional, and/or physiological problems and that despite the development of these problems, the entrepreneur is unable to resist the compulsion to engage in entrepreneurial activities”. They also make the case that that entrepreneurship addiction is different from workaholism.
  • Fortune telling addiction: Although I could have included addictions to financial trading or fame, a 2015 paper in the Journal of Behavioral Addictions by Marie Grall-Bronnec and her colleagues reported the case study of a woman (Helen) that was ‘addicted’ to fortune tellers. They used my addiction criteria to assess whether Helen was addicted to fortune telling, and argued that she was.
  • Google Glass addiction: In previous blogs I have written on addictions to gossip and gardening (although these were based more on non-academic literature). However, a 2015 paper published by Kathryn Yung and her colleagues in the journal Addictive Behaviors, published the first (and to my knowledge) only case of addiction to Google Glass (wearable computer-aided glasses with Bluetooth connectivity to internet-ready devices. The authors claimed that their paper, (i) showed that excessive and problematic uses of Google Glasscan be associated with involuntary movements to the temple area and short-term memory problems, and (ii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass.
  • Hacking addiction: Back in the late 1990s and early 2000s I wrote a number of papers on internet addiction and included ‘hacking addiction’ as a type of internet addiction. Given the criminal element of this type of internet addiction I wrote about it in criminological-based journals such as The Probation Journal (1997) and The Police Journal (2000). One of the most infamous cases that I have written about took place in London in 1993, where Paul Bedworth was accused of hacking-related crime causing over £500,000 worth of damage. On the basis of expert witness testimony, he was acquitted on the basis that he was addicted to hacking. Since then, various papers have been published arguing that hacking can be an addiction. For instance, in an in-depth interview study of 62 hackers, Siew Chan and Lee Yao used addiction as a framework to explain their participants’ behaviour (see their paper in the Review of Business Information Systems, 2005).
  • Internet search addiction: Although I was tempted to go for IVF addiction, I thought I would go for ‘internet search addiction’ which basically refers to constant ‘googling’ where individuals spend hours and hours every day using online databases to go searching for things. This behaviour was first alluded to by Kimberley Young in her 1999 classification of different types of internet addiction which she called ‘information overload’ and was defined as compulsive web surfing or database searches. More recently, Yifan Wang and her colleagues developed the Questionnaire on Internet Search Dependence (QISD) published in Frontiers in Public Health (FiPH). I criticized the QISD in a response paper published in FiPH, not because I didn’t think internet search addiction didn’t exist (because theoretically it might do, even though I’ve never come across a genuine case) but because the items in the instrument had very little to do with addiction.
  • Joyriding addiction: There have been a number of academic papers published on joyriding addiction. Arguably the most well-known study was published by Sue Kellett and Harriet Gross in a 2006 issue of Psychology, Crime and Law. The study comprised semi-structured interviews with 54 joyriders (aged 15 to 21 years of age) all of whom were convicted car thieves (“mainly in custodial care”). The results of the study indicated that all addiction criteria occurred within the joyriders’ accounts of their behaviour particularly ‘‘persistence despite knowledge and concern about the harmful consequences’’, ‘‘tolerance’’, ‘‘persistent desire and/or unsuccessful attempts to stop’’, “large amounts of time being spent thinking about and/or recovering from the behaviour’’ and “loss of control”. The paper also cited examples of ‘withdrawal’ symptoms when not joyriding, the giving up of other important activities so that they could go joyriding instead, and spending more time participating in joyriding than they had originally intended.
  • Killing addiction: The idea of serial killing being conceptualized as an addiction in popular culture is not new. For instance, Brian Masters book about British serial killer Dennis Nilsen (who killed at least 12 young men) was entitled Killing for Company: The Story of a Man Addicted to Murder, and Mikaela Sitford’s book about Harold Shipman, the British GP who killed over 200 people, was entitled Addicted to Murder: The True Story of Dr. Harold Shipman. In Eric Hickey’s 2010 book Serial Murderers and Their Victims, Hickey makes reference to an unpublished 1990 monograph by Dr. Victor Cline who outlined a four-factor addiction syndrome in relation to sexual serial killers who (so-called ‘lust murderers’ that I examined in a previous blog). One of the things that I have always argued throughout my career, is that someone cannot become addicted to an activity or a substance unless they are constantly being rewarded (either by continual positive and/or negative reinforcement). Given that serial killing is a discontinuous activity (i.e., it happens relatively infrequently rather than every hour or day) how could killing be an addiction? One answer is that the act of killing is part of the wider behaviour in that the preoccupation with killing can also include the re-enacting of past kills and the keeping of ‘trophies’ from the victims (which I overviewed in a previous blog).
  • Love addiction: In the psychological literature, the concept of love addiction has been around for some time dating back to works by Sigmund Freud. Arguably the most cited work in this area is the 1975 book Love and Addiction by Stanton Peele and Archie Brodsky. Their book suggested that some forms of love are actually forms of addiction, and tried to make the case that some forms of love addiction may be potentially more destructive and prevalent than widely recognized opiate drugs. There have also been a number of instruments developed assessing love addiction including the Love Addiction Scale (developed by Hunter, Nitschke, and Hogan, 1981), and the Passionate Love Scale (developed by Hatfield, and Sprecher, 1986).
  • Muscle dysmporphia as an addiction: In a paper I published with Andrew Foster and Gillian Shorter in a 2015 issue of the Journal of Behavioral Addictions, we argued that muscle dysmorphia (MD) could be classed as an addiction. MD is a condition characterised by a misconstrued body image in 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 body dysmorphic disorder, an eating disorder, and/or part of the obsessive-compulsive disorder symptomatology. Reviewing the most salient literature on MD, we proposed an alternative classification of MD that we termed the ‘Addiction to Body Image’ (ABI) model. We argued the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating specific foods, taking specific drugs (e.g., anabolic steroids), shopping for specific 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 (rather than addiction to exercise or certain types of eating disorder). Based on empirical evidence, we proposed that MD could be re-classed as an addiction due to the individual continuing to engage in maintenance behaviours that may cause long-term harm.
  • News addiction: Although I could have chosen nasal spray addiction or near death addiction, a recent 2017 paper on ‘news addiction’ was published in the Journal of the Dow University of Health Sciences Karachi by Ghulam Ishaq and colleagues. The authors used some of my papers on behavioural addiction to argue for the construct of ‘news addiction’ as a construct to be empirically investigated. The authors also developed their own 19-item News Addiction Scale (NAS) although the paper didn’t give any examples of any of the items in the NAS. In relation to personality types (and like other addictions), they found news addiction was positively correlated with neuroticism and negatively correlated with conscientiousness. Given that this is the only study on news addiction that I am aware of, I’ll need a lot more research evidence before I am convinced that it really exists.
  • Online auction addiction: A number of academics have made the claim that some individuals can become addicted to participating in online auctions. In a 2004 paper on internet addiction published in American Behavioral Scientist, Kimberley Young mentioned online auction [eBay] addiction in passing. The same observation was also made in a later 2009 paper by Tonino Cantelmi and Massimo Talls in the Journal of CyberTherapy and Rehabilitation. Other researchers have carried out empirical studies including a (i) 2007 paper by Cara Peters and Charles Bodkin in the Journal of Retailing and Consumer Services, (ii) 2008 paper by Chih-Chien Wang in the Proceedings of the Asia-Pacific Services Computing Conference, and (iii) 2011 study carried out by Dr. Ofir Turel and colleagues published in the MIS Quarerly. These papers indicated that those with problematic online auction use experienced (i) psychological distress, (ii) habitual usage, (iii) compulsive behaviour, (iv) negative consequences, and/or (v) dependence, withdrawal and self-regulation.
  • Pinball addiction: Although I could have listed alleged addictions to plastic surgery and poetry, as far as I am aware, I am the only academic to have published a paper on pinball addiction. Back in 1992, I published a case study in Psychological Reports. My paper featured the case of a young man (aged 25 years) who (based on classic addiction criteria) was totally hooked on pinball. It was the most important thing in his life, used the behaviour to modify his moods, got withdrawal symptoms if he was unable to play pinball, had engaged in repeated efforts to cut down or stop playing pinball, and compromised all other activities in his life (education, occupation and relationships). To me, this individual had a gaming addiction but it was pinball rather than videogame addiction.
  • Qat addiction: Qat (sometimes known as khat, kat, cat, and ghat) is a flowering plant traditionally used as a mild stimulant in African and Middle East countries (Somalia, Yemen, Ethiopia). Heavy qat users can experience many side effects including insomnia, anxiety, increased aggression, high blood pressure, and heart problems. There are numerous reports in the medical literature of qat addiction (see papers by Rita Manghi and colleagues in the Journal of Psychoactive Drugs, and Nezar Al-Hebshi and Nils Skuag in Addiction Biology).
  • Rock climbing addiction: Over the past two years, a couple of papers by Robert Heirene, David Shearer, and Gareth Roderique-Davies have looked at the addictive properties of rock climbing specifically concentrating on withdrawal symptoms and craving. In the first paper on withdrawal symptoms published in 2016 in the Journal of Behavioral Addictions, the authors highlighted some previous research suggesting that there are similarities in the phenomenology of substance-related addictions and extreme sports (in this case rock climbing). The study concluded that based on self-report, rock climbers experienced genuine withdrawal symptoms during abstinence from climbing and that these were comparable to individuals with substance and other behavioural addictions. In a second investigation just published in Frontiers in Psychology, the same team reported the development of the Rock Climbing Craving Questionnaire comprising three factors (‘positive reinforcement’, ‘negative reinforcement’ and ‘urge to climb’).
  • Study addiction: I was spoilt for choice on the letter ‘S’ and could have mentioned addictions to speeding, selfie-taking, shoplifting, Sudoko, and stock market speculation. However, there are now a number of published papers on ‘study addiction’ (individuals addicted to their academic study), three of which I have co-authored (all in the Journal of Behavioral Addictions and led by my colleague Pawel Atroszko). We have conceptualised study addiction as a type of work addiction (or a pre-cursor to work addiction) and in a series of studies (including longitudinal research) we have found empirical evidence of ‘study addiction’. Italian researchers (Yura Loscalzo and Marco Giannini) have also published research on ‘overstudying’ and ‘studyholism’ too (in the journals ARC Journal of Psychiatry, 2017; Social Indicators Research, 2018).
  • Tanning addiction: There is now lots of empirical research examining ‘tanorexia’ (individuals who crave tanning and spend every day on sunbeds). However, I along with my colleagues in Norway recently reconceptualised tanorexia as a ‘tanning addiction’ and developed a scale to assess it (which was recently published in a 2018 issue of the British Journal of Dermatology). Our study was the largest over study on tanning (over 23,000 participants) and our newly developed scale (the Bergen Tanning Addiction Scale) had good psychometric properties.
  • Upskirting addiction: Upskirting refers to taking a photograph (typically with a smartphone) up someone’s skirt without their permission. In the UK there have been a number of high profile court cases including Paul Appleby who managed to take 9000 upskirting photos in the space of just five weeks (suggesting that he was doing it all day every day to have taken so many photos), and Andrew MacRae who had amassed 49,000 upskirt photos and videos using hidden cameras at his workplace, on trains, and at the beach. Both men avoided a custodial sentence because their lawyers argued they were addicted and/or had a compulsion to upskirting. In a 2017 issue of the Law Gazette, forensic psychologist Julia Lam made countless references to upskirting in an overview of voyeuristic disorder. Dr. Lam also talked about her treatment of upskirting voyeurs and recounted one case which she claimed was a compulsion (and who was successfully treated). The case involved a male university student who was very sport active but who masturbated excessively whenever major sporting events or important exams were imminent as a coping strategy to relieve stress.
  • Virtual reality addiction: Back in 1995, in a paper I entitled ‘Technological addictions’ in the journal Clinical Psychology Forum, I asserted that addiction to virtual reality would be something that psychologists would be seeing more of in the future. Although I wrote the paper over 20 years ago, there is still little empirical evidence (as yet) that individuals have become addicted to virtual reality (VR). However, that is probably more to do with the fact that – until very recently – there had been little in the way of affordable VR headsets. (I ought to just add that when I use the term ‘VR addiction’ what I am really talking about is addiction to the applications that can be utilized via VR hardware rather than the VR hardware itself). Of all the behaviours on this list, this is the one where there is less good evidence for its existence. Perhaps of most psychological concern is the use of VR in video gaming. There is a small minority of players out there who are already experiencing genuine addictions to online gaming. VR takes immersive gaming to the next level, and for those that use games as a method of coping and escape from the problems they have in the real world it’s not hard to see how a minority of individuals will prefer to spend a significant amount of their waking time in VR environments rather than their real life.
  • Water addiction: In a blog I wrote back in 2015, I recounted some press stories on individuals who claimed they were ‘addicted’ to drinking water. My research into the topic led to a case study of ‘water dependence’ published a 1973 issue of the British Journal of Addiction by E.L. Edelstein. This paper reported that the excessive drinking of water can dilute electrolytes in an individual’s brain and cause intoxication. This led me to a condition called polydipsia (which in practical terms means drinking more than three litres of water a day) which often goes hand-in-hand with hyponatraemia (i.e., low sodium concentration in the blood) and in extreme cases can lead to excessive water drinkers slipping into a coma. There are also dozens and dozens of academic papers on psychogenic polydipsia (PPD). A paper by Dr. Brian Dundas and colleagues in a 2007 issue of Current Psychiatry Reports noted that PPD is a clinical syndrome characterized by polyuria (constantly going to the toilet) and polydipsia (constantly drinking too much water), and is common among individuals with psychiatric disorders. A 2000 study in European Psychiatry by E. Mercier-Guidez and G. Loas examined water intoxication in 353 French psychiatric inpatients. They reported that water intoxication can lead to irreversible brain damage and that around one-fifth of deaths among schizophrenics below the age of 53 years are caused this way. Whether ‘water intoxication’ is a symptom of being ‘addicted’ to water depends upon the definition of addiction being used.
  • X-ray addiction: OK, this one’s a little bit of a cheat but what I really wanted to concentrate on what has been unofficially termed factitious disorder (FD). According to Kamil Jaghab and colleagues in a 2006 issue of the Psychiatry journal FD is sometimes referred to as hospital addiction, pathomimia, or polysurgical addiction”. The primary characteristic of people suffering from FD is that they deliberately pretend to be ill in the absence of external incentives (such as criminal prosecution or financial gain). It is called a factitious because sufferers feign illness, pretend to have a disease, and/or fake psychological trauma typically to gain attention and/or sympathy from other people. Again, whether such behaviours can be viewed as an addiction depends upon the definition of addiction being used.
  • YouTube addiction: I unexpectedly found my research on internet addiction being cited in a news article by Paula Gaita on compulsive viewing of YouTube videos (‘Does compulsive YouTube viewing qualify as addiction?‘). The article was actually reporting a case study from a different news article published by PBS NewsHour by science correspondent Lesley McClurg (‘After compulsively watching YouTube, teenage girl lands in rehab for digital addiction’). The story profiled a student whose obsessive viewing of YouTube content led to extreme behaviour changes and eventually, depression and a suicide attempt. Not long after this, I and my colleague Janarthanan Balakrishnan published what we believe is the only ever study on YouTube addiction in the Journal of Behavioral Addictions. In a study of over 400 YouTube users we found that YouTube addiction was more associated with content creation than watching content
  • ‘Zedding’ addiction: OK, I’m using the Urban Dictionary’s synonym here as a way of including ‘sleep addiction’. The term ‘sleep addiction’ is sometimes used to describe the behavior of individuals who sleep too much. Conditions such as hypersomnia (the opposite of insomnia) has been referred to ‘sleeping addiction’ (in the populist literature at least). In a 2010 issue of the Rhode Island Medical Journal, Stanley Aronson wrote a short article entitled “Those esoteric, exoteric and fantabulous diagnoses” and listed clinomania as the compulsion to stay in bed. Given the use of the word ‘compulsive’ in this definition, there is an argument to consider clinomania as an addiction or at least a behaviour with addictive type elements.

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

Further reading

Al‐Hebshi, N., & Skaug, N. (2005). Khat (Catha edulis) – An updated review. Addiction Biology, 10(4), 299-307.

Andreassen, C.S., Pallesen, S. Torsheim, T., Demetrovics, Z. & Griffiths, M.D. (2018). Tanning addiction: Conceptualization, assessment, and correlates. British Journal of Dermatology. doi: 10.1111/bjd.16480

Aronson, S. M. (2010). Those esoteric, exoteric and fantabulous diagnoses. Rhode Island Medical Journal, 93(5), 163.

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.

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.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D., Pallesen, S. (2016). The relationship between study addiction and work addiction: A cross-cultural longitudinal study. Journal of Behavioral Addiction, 5, 708–714.

Balakrishnan, J. & Griffiths, M.D. (2017). Social media addiction: What is the role of content in YouTube? Journal of Behavioral Addictions, 6, 364-377.

Black, D., Belsare, G., & Schlosser, S. (1999). Clinical features, psychiatric comorbidity, and health-related quality of life in persons reporting compulsive computer use behavior. Journal of Clinical Psychiatry, 60, 839-843.

Burn, C. (2016). Poesegraphilia – Addiction to the act of writing poetry. Poetry Changes Lives, May 27. Located at: http://www.poetrychangeslives.com/addiction-to-the-act-of-writing-poetry/

Cantelmi, T & Talls, M. (2009). Trapped in the web: The psychopathology of cyberspace. Journal of CyberTherapy and Rehabilitation, 2, 337-350.

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

Chan, S. H., & Yao, L. J. (2005). An empirical investigation of hacking behavior. The Review of Business Information Systems, 9(4), 42-58.

Daily Mail (2005). Aquaholics: Addicted to drinking water. May 16. Located at: http://www.dailymail.co.uk/health/article-348917/Aquaholics-Addicted-drinking-water.html

de Leon, J., Verghese, C., Tracy, J. I., Josiassen, R. C., & Simpson, G. M. (1994). Polydipsia and water intoxication in psychiatric patients: A review of the epidemiological literature. Biological Psychiatry, 35(6), 408-419.

Dundas, B., Harris, M., & Narasimhan, M. (2007). Psychogenic polydipsia review: etiology, differential, and treatment. Current Psychiatry Reports, 9(3), 236-241.

Edelstein, E.L. (1973). A case of water dependence. British Journal of Addiction to Alcohol and Other Drugs, 68, 365–367.

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.

Gaita, P. (2017). Does compulsive YouTube viewing qualify as addiction? The Fix, May 19. Located at: https://www.thefix.com/does-compulsive-youtube-viewing-qualify-addiction

Grall-Bronnec, M. Bulteau, S., Victorri-Vigneau, C., Bouju, G. & Sauvaget, A. (2015). Fortune telling addiction: Unfortunately a serious topic about a case report. Journal of Behavioral Addiction, 4, 27-31.

Griffiths, M.D. (1992). Pinball wizard: A case study of a pinball addict. Psychological Reports, 71, 160-162.

Griffiths, M.D. (2000). Computer crime and hacking: A serious issue for the police. Police Journal, 73, 18-24.

Griffiths, M.D. (2017). Commentary: Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 5, 95. doi: 10.3389/fpubh.2017.00095

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.

Hatfield, E., & Sprecher, S. (1998). The passionate love scale. In Fisher, T.D., Davis, C.M., Yarber, W.L. & Davis, S. (Eds.). Handbook of sexuality-related measures (pp. 449-451). London: Sage.

Heirene, R. M., Shearer, D., Roderique-Davies, G., & Mellalieu, S. D. (2016). Addiction in extreme sports: An exploration of withdrawal states in rock climbers. Journal of Behavioral Addictions, 5(2), 332-341.

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

Hunter, M. S., Nitschke, C., & Hogan, L. 1981. A scale to measure love addiction. Psychological Reports, 48, 582-582.

Ishaq, G., Rafique, R., & Asif, M. (2017). Personality traits and news addiction: Mediating role of self-control. Journal of Dow University of Health Sciences, 11(2), 31-53.

Jaghab, K., Skodnek, K. B., & Padder, T. A. (2006). Munchausen’s syndrome and other factitious disorders in children: Case series and literature review. Psychiatry (Edgmont), 3(3), 46-55.

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

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

Kennedy, J. G., Teague, J., & Fairbanks, L. (1980). Qat use in North Yemen and the problem of addiction: a study in medical anthropology. Culture, medicine and psychiatry, 4(4), 311-344.

Kwon, M., Kim, Y., Kim, H., & Kim, J. (2018). Does sport addiction enhance frontal executive function? The case of badminton. NeuroQuantology, 16(6), 13-21.

Lam, J. (2017). Fifty shades of sexual offending – Part 1. The Law Gazette, July. Located at: http://v1.lawgazette.com.sg/2017-07/1910.htm

Loscalzo, Y, & Giannini, M. (2017).  Evaluating the overstudy climate at school and in the family: The Overstudy Climate Scale (OCS). ARC Journal of Psychiatry, 2(3), 5-10.

Loscalzo, Y., & Giannini, M. (2018). Study engagement in Italian university students: A Confirmatory Factor Analysis of the Utrecht Work Engagement Scale—Student Version. Social Indicators Research, Epub ahead of print. https://doi.org/10.1007/s11205-018-1943-y

Manghi, R. A., Broers, B., Khan, R., Benguettat, D., Khazaal, Y., & Zullino, D. F. (2009). Khat use: lifestyle or addiction? Journal of Psychoactive Drugs, 41(1), 1-10.

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.

Masters, B. (1986). Killing for Company: The Story of a Man Addicted to Murder. New York: Stein and Day.

McClurg, L. (2017). After compulsively watching YouTube, teenage girl lands in rehab for ‘digital addiction’. PBS Newshour, May 16. Located at: http://www.pbs.org/newshour/rundown/compulsively-watching-youtube-teenage-girl-lands-rehab-digital-addiction/

Menninger, K. A. (1934). Polysurgery and polysurgical addiction. The Psychoanalytic Quarterly, 3(2), 173-199.

Mercier-Guidez, E., & Loas, G. (2000). Polydipsia and water intoxication in 353 psychiatric inpatients: an epidemiological and psychopathological study. European Psychiatry, 15(5), 306-311.

Orosz, G., Bőthe, B., & Tóth-Király, I. (2016). The development of the Problematic Series WatchingScale (PSWS). Journal of Behavioral Addictions, 5(1), 144-150.

Peele, S. & Brodsky, A. (1975), Love and addiction. New York: Taplinger.

Peters, C.  & Bodkin, C.D. (2007). An exploratory investigation of problematic online auction behaviors: Experiences of eBay users. Journal of Retailing and Consumer Services, 14(1), 1-16.

Reisinger, M. (2018). Addiction to death. CNS Spectrums, 23(2), 166-169.

Relangi, K. (2012). Gossip, the ugly addiction. Purple Room Healing, June 12. Located at: https://deadmanswill.wordpress.com/2012/06/02/gossip-the-ugly-addiction/

Roderique-Davies, G. R. D., Heirene, R. M., Mellalieu, S., & Shearer, D. A. (2018). Development and initial validation of a rock climbing craving questionnaire (RCCQ). Frontiers in Psychology, 9, 204. doi: 10.3389/fpsyg.2018.00204

Sitford, M. (2000). Addicted to Murder: The True Story of Dr. Harold Shipman. London: Virgin Publishing.

Sparrow, P. & Griffiths, M.D. (1997). Crime and IT: Hacking and pornography on the internet. Probation Journal, 44, 144-147.

Spivack, A., & McKelvie, A. (2018). Entrepreneurship addiction: Shedding light on the manifestation of the ‘dark side’ in work behavior patterns. The Academy of Management Perspectives. https://doi.org/10.5465/amp.2016.0185

Spivack, A. J., McKelvie, A., & Haynie, J. M. (2014). Habitual entrepreneurs: Possible cases of entrepreneurship addiction? Journal of Business Venturing, 29(5), 651-667.

Targhetta, R., Nalpas, B. & Perney, P. (2013). Argentine tango: Another behavioral addiction? Journal of Behavioral Addictions, 2, 179-186.

Turel, O., Serenko, A. & Giles, P. (2011). Integrating technology addiction and use: An empirical investigation of online auction users. MIS Quarterly, 35, 1043-1061.

Walton-Pattison, E., Dombrowski, S.U. & Presseau, J. (2017). ‘Just one more episode’: Frequency and theoretical correlates of television binge watching. Journal of Health Psychology, doi:1359105316643379

Wang, C-C. (2008). The influence of passion and compulsive buying on online auction addiction. Proceedings of the Asia-Pacific Services Computing Conference (pp. 1187 – 1192). IEEE.

Wang, Y., Wu, L., Zhou, H., Xu, J. & Dong, G. (2016). Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 4, 274. doi: 10.3389/fpubh.2016.00274

Wright, M. R. (1986). Surgical addiction: A complication of modern surgery? Archives of Otolaryngology–Head & Neck Surgery, 112(8), 870-872.

Wulfsohn, I. (2013). A dangerous addiction: Qat and its draining of Yemen’s water, economy, and people. Middle East Economy, 3(10), 1-5.

Young, K. S. (1999). Internet addiction: Evaluation and treatment. Student British Medical Journal, 7, 351-352.

Young, K. S. (2004). Internet addiction: A new clinical phenomenon and its consequences. American Behavioral Scientist, 48, 402–415.

Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2014). Internet Addiction Disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program. Addictive Behaviors, 41, 58-60.

“Every breath you take”: A brief look at love obsessions in popular music

“You are an obsession/I cannot sleep/I am your possession/Unopened at your feet
/There’s no balance/No equality/Be still I will not accept defeat/I will have you/Yes, I will have you/I will find a way and I will have you/Like a butterfly/A wild butterfly/I will collect you and capture you” (Lyrics to the song ‘Obsession’ by Animotion)

Like the word ‘addiction’, one thing we can say about the word ‘obsession’ that there is no absolute agreed definition. Dictionary definitions of obsession refer to an obsession as:

  • “…an idea or thought that continually preoccupies or intrudes on a person’s mind” or “a state in which someone thinks about someone or something constantly or frequently especially in a way that is not normal” (Oxford Dictionary).
  • “…unable to stop thinking about something; too interested in or worried about something” (Cambridge Dictionary)
  • http://dictionary.cambridge.org/dictionary/english/obsessed
  • “…a state in which someone thinks about someone or something constantly or frequently especially in a way that is not normal” (Merriam-Webster Dictionary)
  • “…an emotional state in which someone or something is so important to you that you are always thinking about them, in a way that seems extreme to other people” (Macmillan Dictionary).

More medical definitions (such as Dorland’s Medical Dictionary) describe obsession as a recurrent, persistent thought, image, or impulse that is unwanted and distressing (ego-dystonic) and comes involuntarily to mind despite attempts to ignore or suppress it”. Given all these overlapping but differing definitions, it can be concluded that obsession means slightly different things to different people. In the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an obsession must be distressing to be classed as a disorder. (And that’s why my obsession with music is not problematic).

I deliberately mentioned my self-confessed obsession with music because this article is a (somewhat self-admittedly) frivolous look at obsession in song lyrics. The first song I remember listening to called ‘Obsession’ was in 1981 by Scottish band Scars (from one of my all-time favourite LPs Author! Author!), quickly followed by Siouxsie and the Banshees’ song ‘Obsession’ on their 1982 LP A Kiss In The Dreamhouse (which reached No.11 in the UK albums chart). Arguably the most famous song entitled ‘Obsession’ was 1984’s top five hit by the US band Animotion (which was actually a cover version as the original was released by Holly Knight and Michael Des Barres) and later covered by The Sugababes and Karen O (lead singer of Yeah Yeah Yeahs, and the theme song to the US TV mini-series Flesh and Bone). Many artists have recorded songs simply called ‘Obsession’ including Tich, Tinie Tempah, Future Cut, The Subways, Jake Quickenden, Jesus Culture, and Blue Eyed Christ (amongst others).

Almost all songs with the title of ‘Obsession’ have been about being obsessed (or obsessively in love) with another person and are probably not that far removed from songs about love addiction (such as Roxy Music’s ‘Love Is The Drug’, Robert Palmer’s ‘Addicted To Love’, and Nine Inch Nail’s ‘The Perfect Drug’). Not all obsessional songs have the word ‘obsession’ in their title and probably the most famous songs about being obsessed with someone are ‘Every Breath You Take’ (The Police) and ‘Stan’ (Eminem; in fact the word ‘Stan’ is now sometimes used as a term for overly-obsessive fans of someone or something). As the Wikipedia entry on ‘Every Breath You Take’ notes:

Sting wrote the song in 1982 in the aftermath of his separation from [actress] Frances Tomelty and the beginning of his relationship with [actress, film producer and director] Trudy Styler. The split was controversial…The lyrics are the words of a possessive lover who is watching ‘every breath you take; every move you make’. [Sting said he] ‘woke up in the middle of the night with that line in my head, sat down at the piano and had written it in half an hour…It sounds like a comforting love song. I didn’t realize at the time how sinister it is. I think I was thinking of Big Brother surveillance and control…[Sting] insists [the song is] about the obsession with a lost lover, and the jealousy and surveillance that follow”.

Sting’s experience of writing from what you know and feel is a staple motivation for many songwriters (and probably no different from academics like myself – I tend to write about what I know about). An article in the New York Post by Kirsten Fleming (‘When rockers are stalkers: ‘Love songs’ that cross into obsession‘) features a top ten list of ‘obsessional love’ songs (although I think very few of them are. Much better is the list of ‘greatest stalking songs’ put together by The Scientist on the Rate Your Music website). However, I do think the song-writing process can border on the obsessional and I think the Canadian-American singer-songwriter Alanis Morissette has a realistic (and perhaps representative) take on her song-writing as she noted in an online article:

“For me, what writes songs is passion. So if I’m passionately angry about something or if I’m passionately in love with something or if I’m passionately addicted to something or if I’m passionately curious or scared, this is what creates worlds in art. I think love and anger are two of the most gorgeous life forces, with love being the only one that is bottomless. All of these different feelings that I’ve been running away from my whole life, the only one that has remained bottomless and endless is love. All other emotions seem to ebb and flow and move through once they get my attention long enough to really feel, but love is the one that remains limitless”.

In this interview extract, Morissette uses the word “addicted” in an arguably positive way and echoes a quote I used in a previous blog from Dr. Isaac Marks who said that “life is a series of addictions and without them we die”. Morissette (in a different interview) was also quoted as saying:

“My top addictions are really recovering from love addictions, which is a tough withdrawal that I’ve also written records in the midst of. Probably the worst withdrawal I’ve experienced. Food addiction, which I’ve been struggling with since I was 14, and work addiction it’s the respectable addiction in the west, but it’s actually an addiction to busy-ness and the fear of stopping and being still, and all that would come up from that. Those three are my top ones, and I’ve dabbled in all the other ones but none of them have grasped hold of me like the first one did”.

The band that I think have lyrically explored obsessive love more than any other is Depeche Mode. I’ve followed them from before their first hit right up until the present day. I’ve included their songs on almost every mix tape I’ve made for any girlfriend I’ve had over the last 35 years. Their main songwriter, Martin Gore, explores the dark side of love better than any lyricist I can think of. Whereas Adam Ant wins the prize for the most songs about different types of fetishes and paraphilias, Martin Gore is the lyrical king of obsessive love (although he does occasionally wander into more paraphilic kinds of love such as the sado-masochisticMaster and Servant’. Here are just a few selected lyrics that I hope help argue my case:

  • Extract 1: “Dark obsession in the name of love/This addiction that we’re both part of/
Leads us deeper into mystery/
Keeps us craving endlessly/Strange compulsions/That I can’t control/Pure possession of my heart and soul
/I must live with this reality/I am you and you are me” (‘I Am You’ from Exciter, 2001)
  • Extract 2: I want somebody who cares for me passionately/With every thought and with every breath/Someone who’ll help me see things in a different light/All the things I detest I will almost like” (‘Somebody’ from Some Great Reward, 1984)
  • Extract 3: “Well I’m down on my knees again/And I pray to the only one/Who has the strength to bear the pain/To forgive all the things that I’ve done/Oh girl, lead me into your darkness/When this world is trying it’s hardest
/To leave me unimpressed/
Just one caress from you and I’m blessed” (‘One Caress’ from Songs Of Faith And Devotion, 1993).
  • Extract 4: “Taking hold of the hem of your dress/
Cleanliness only comes in small doses/
Bodily whole but my head’s in a mess/Do you know obsession that borders psychosis?/It’s a sad disease/Creeping through my mind/Causing disabilities/Of the strangest kind/Getting lost in the folds of your skirt/There’s a price that I pay for my mission/Body in heaven and a mind full of dirt/How I suffer the sweetest condition” (‘The Sweetest Condition’ from Exciter, 2001)
  • Extract 5: “It’s only when I lose myself with someone else/That I find myself/I find myself/Something beautiful is happening inside for me/Something sensual, it’s full of fire and mystery/I feel hypnotized, I feel paralized/I have found heaven/Did I need to sell my soul/For pleasure like this?/Did I have to lose control/To treasure your kiss?/Did I need to place my heart/In the palm of your hand?/Before I could even start/To understand” (‘Only When I Lose Myself’ from The Singles, 86-98)
  • Extract 6: “I want you now/
Tomorrow won’t do/
There’s a yearning inside/And it’s showing through/Reach out your hands/And accept my love/We’ve waited for too long/Enough is enough/I want you now” (‘I Want You Now’ from Music For The Masses, 1987)
  • Extract 7: “Don’t say you’re happy/Out there without me/I know you can’t be
/’Because it’s no good/I’m going to take my time/I have all the time in the world
/To make you mine/It is written in the stars above” (‘It’s No Good’ from Ultra, 1997)
  • Extract 8: “Wisdom of ages/Rush over me/Heighten my senses/Enlighten me/Lead me on, eternally/And the spirit of love/Is rising within me/Talking to you now/Telling you clearly/The fire still burns” (‘Insight’ from Ultra, 1997).

These are just a few of the ‘obsessional’ lyrics from Depeche Mode’s back catalogue (and there are plenty of other songs I could have featured). I often think that the lyrics in songs or poetry say far more about the human condition than any paper I have published on the topic, and that is why I am (and will continue to be) a music obsessive.

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

Further reading

Dorrell, P. (2005). Is music a drug? 1729.com, July 3. Located at: http://www.1729.com/blog/IsMusicADrug.html

Fleming, K. (2014). When rockers are stalkers: ‘Love songs’ that cross into obsession. New York Post, July 2. Located at: http://nypost.com/2014/07/02/the-10-creepiest-musical-stalkers/

Griffiths, M.D (1999). Adam Ant: Sex and perversion for teenyboppers. Headpress: The Journal of Sex, Death and Religion, 19, 116-119.

Griffiths, M.D. (2012). Music addiction. Record Collector, 406 (October), p.20.

Morrison, E. (2011). Researchers show why music is so addictive. Medhill Reports, January 21. Located at: http://news.medill.northwestern.edu/chicago/news.aspx?id=176870

Salimpoor, V.N., Benovoy, M., Larcher, K. Dagher, A. & Zatorre, R.J. (2011). Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nature Neuroscience 14, 257–262.

Smith, J. (1989). Senses and Sensibilities. New York: Wiley.

In dependence days: A brief overview of behavioural addictions

Please note: A version of this blog first appeared on addiction.com

Conceptualizing addiction has been a matter of great debate for decades. For many people the concept of addiction involves the taking of drugs. Therefore it is perhaps unsurprising that most official definitions concentrate on drug ingestion. Despite such definitions, there is now a growing movement that views a number of behaviours as potentially addictive including those that do not involve the ingestion of a drug. These include behaviours diverse as gambling, eating, sex, exercise, videogame playing, love, shopping, Internet use, social networking, and work. I have argued in many of my papers that all addictions – irrespective of whether they are chemical or behavioural – 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 behaviour (deterioration of socialized behaviour). 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 May 2013, the new criteria for problem gambling (now called ‘Gambling Disorder’) were published in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), and for the very first time, problem gambling was included in the section ‘Substance-related and Addiction Disorders’ (rather than in the section on impulse control disorders as had been the case since 1980 when it was first included in the DSM-III). Although most of us in the field had been conceptualizing extreme problem gambling as an addiction for many years, this was arguably the first time that an established medical body had described it as such.

There had also been debates about whether or not ‘Internet Addiction Disorder’ should have been included in the DSM-5. As a result of these debates, the Substance Use Disorder Work Group recommended that the DSM-5 include ‘Internet Gaming Disorder’ [IGD] in Section III (“Emerging Measures and Models”) as an area that required further research before possible inclusion in future editions of the DSM. To be included in its own right in the next edition, research will have to establish the defining features of IGD, obtain cross-cultural data on reliability and validity of specific diagnostic criteria, determine prevalence rates in representative epidemiological samples in countries around the world, and examine its associated biological features. Other than gambling and gaming, no other behaviour (e.g., sex, work, exercise, etc.) has yet to be classified as a genuine addiction by established medical and/or psychiatric organizations.

In one of the most comprehensive reviews of chemical and behavioural addictions, Dr. Steve Sussman, Nadra Lisha and myself examined all the prevalence literature relating to 11 different potentially addictive behaviours. We reported overall prevalence rates of addictions to cigarette smoking (15%), drinking alcohol (10%), illicit drug taking (5%), eating (2%), gambling (2%), internet use (2%), love (3%), sex (3%), exercise (3%), work (10%), and shopping (6%). However, most of the prevalence data relating to behavioural addictions (with the exception of gambling) did not have prevalence data from nationally representative samples and therefore relied on small and/or self-selected samples.

Addiction is an incredibly complex behaviour 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 behaviour.

There are many individual (personal vulnerability) factors that may be involved in the acquisition, development and maintenance of behavioural addictions (e.g. personality traits, biological and genetic predispositions, unconscious motivations, learning and conditioning effects, thoughts, beliefs, and attitudes), although some factors are more personal (e.g. financial motivation and economic pressures in the case of gambling addiction). However, there are also some key risk factors that are highly associated with developing almost any (chemical or behavioural) addiction such as having a family history of addiction, having co-morbid psychological problems, and having a lack of family involvement and supervision. Psychosocial factors such as low self-esteem, loneliness, depression, high anxiety, and stress all appear to be common among those with behavioural addictions.

This article briefly demonstrates that behavioural addictions are a part of a biopsychosocial process and not just restricted to drug-ingested (chemical) behaviours. Evidence is growing that excessive behaviours of all types do seem to have many commonalities and this may reflect a common etiology of addictive behaviour. Such commonalities may have implications not only for treatment of such behaviours but also for how the general public perceive such behaviours.

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.

Banned aid? A brief guide to compulsive helping

Back in the early 2000s, I (and one of my colleagues, Dr. Michael Larkin) carried out some research at the Promis addiction clinic down in Kent. We were researching people’s phenomenological experiences of addiction, and our interviews with the addicts receiving treatment were really helpful in the writing of what I personally thought were some really interesting papers (see ‘Further reading’ below). However, what interested me even more were the conversations I had with the clinic’s Director, Dr, Robert Lefever who told me of his interest and research into ‘compulsive helping’. Dr. Lefever has written a number of articles online about compulsive helping. In one of them he began by stating:

“Of all the addictive behaviours those surrounding relationships like sex and love addiction, relationship addiction or compulsive helping can be the most difficult to understand. This is further hindered by the confusing terminology used to describe it. Just as addiction means as many different things to as many people so do terms like co-dependency. We have tried to help clarify the situation by using different terms for different behaviours. Where people are addicted to someone they have a relationship with we call it relationship addiction, where people are addicted to helping others with their problems we call it compulsive helping”.

Dr. Lefever says that by giving these behaviours descriptive titles (like ‘compulsive helping’ and ‘relationship addiction’) help the affected person to identify the specific behaviour that they are actually addicted to. He also argues that such labels help the affected person relaise that the person responsible for the addictive behaviour is the individual and not someone or something else. However, Dr. Lefever is the first to admit that “the concept of compulsive helping can be particularly difficult to get one’s head around”.

Obviously not all helping is harmful but Lefever distinguishes between ‘caring’ (which he views as healthy) and caretaking (which he views as unhealthy). Compulsive helping occurs when the ‘caretaker’ (rather than a carer) continually takes on the responsibilities of someone else (very often a person who they love), and in essence runs that person’s life for them. Compulsive helpers often help other people that have an addiction (such as an alcoholic or a gambling addict) but Lefever claims that compulsive helpers can also end up compulsively helping people that doesn’t have problems themselves. (However, those without a problem are far more likely to notice compulsive helping behaviour in other people if they feel it is significantly and continually interfering in their day-to-day life and business). More specifically:

“Caring is lovely and healthy. I would never wish to change that characteristic in anyone. Caretaking however, is over-caring for someone, taking on the other person’s responsibilities for themselves and not allowing the other person to have the consequences of his or her behaviour…Helping is loving. Compulsive helping is destructive of both self and the other person. It is destructive of my own life and destructive of the person whom I am trying to compulsively help. That is not what I would call a loving action”.

Another short article on ‘compulsive helping’ by Rochelle Craig on her Piece By Piece Recovery website has a slightly different take and notes that:

“Compulsive Helping is when the individual finds it impossible to say no each and every time they are asked. A compulsive helper will always help regardless of what the situation is whether it is convenient for them or not. This can result in the compulsive helper building up resentment against the other person or persons and feeling like a doormat. When this happens the compulsive helper begins to resent being asked”

Like Dr. Lefever, Rochelle Craig believes that compulsive helpers take on too much responsibility, and therefore take away responsibility away from other people. Craig is adamant that people should examine their motivation for their helping behaviour to assess the extent to which it is helpful. If the act of helping others is a continual source of gaining self-worth, it may be indicative of compulsive helping. Other signs of compulsive helping is carrying on helping even if it is putting one’s own health, job, and/or other relationships at risk, Craig asserts that:

“It is important to remember that we are talking about addictive behaviour, we are talking about extremes, and we are talking about situations where the compulsive helper is so absorbed with helping others that they lose their own identity. Recovery is about self-discovery, self-improvement and building on self-esteem without relying on constantly helping others. It is about self-care first and everyone else second! Recovery is about recognising the difference between compulsive helping and genuine acts of kindness and most importantly it is learning to say no!”

In another (different) article on compulsive helping, Dr. Lefever refers to ‘compulsive helping’ as ‘co-dependency’ and claims that compulsive helping “is the most perverse, widespread and destructive of all addictive or compulsive behaviours” and the ‘need to be needed’. In fact Dr. Lefever claims that:

“Behind any addict of any kind will be a compulsive helper, or a bunch of them, taking responsibility for them. The compulsive helpers try to solve problems and ferret out information on causes and treatments. They give incessant advice and generally get in the way of addicts having any chance of learning or doing things for themselves – which, ultimately, are the only things that are going to help. Those of us who are afflicted by it go out of our way to give uninvited help. We want to feel useful and constructively helpful. These are admirable characteristics. But they can be very destructive when they are applied without thought to the consequences…When people have too much done for them, they fail to develop their own skills. They become part of the dependency culture”.

Dr. Lefever and psychologists at the University of Kent have published a number of empirical studies on addiction including compulsive helping. In a study led by Professor Geoffrey Stephenson and published in a 1995 issue of the journal Addiction Research, the researchers evaluated addiction in 16 behavioural areas on 471 patients (using 191 male addicts and 281 female admitted to Lefever’s Promis Recovery Centre). The addicted patients’ questionnaires were subjected to a factor analysis and results showed there to be two fundamentally different types of addiction labeled as ‘nurturance’ and ‘hedonism’. ‘Nurturance’ included caffeine, work, exploitative relationships (submissive), shopping, exercise, food bingeing, food starving and compulsive helping. ‘Hedonism’ included alcohol, nicotine, recreational drugs, gambling, exploitative relationships (dominant), sex, and prescription drugs.

A follow-up study published in 2004 by Stephenson and Lefever in the journal Addictive Behaviors, confirmed these earlier results but also suggested that ‘hedonism’ could further be divided into a ‘drug use’ factor and an ‘interpersonal dominance’ factor. The nurturance addictions comprised of both ‘self-regarding’ and ‘other-regarding’ factors. A more recent study in a 2010 issue of Addictive Behaviors by Dr. Vance MacLaren and Dr. Lisa Best confirmed the results among a student population (n=938). Despite this empirical research, it should be remembered that all of the data on compulsive helping has been done using the instrument that Lefever and his colleagues developed. There’s certainly a need for research to be carried out with instruments that weren’t developed and/or carried out by the people who have a vested interest in the ‘compulsive helping’ construct.

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

Further reading

Craig, R. (2012). Compulsive helping. Located at: http://www.piecebypiecerecovery.co.uk/index.php?pageid=8

Griffiths, M.D. & Larkin, M. (2004). Conceptualizing addiction: The case for a ‘complex systems’ account. Addiction Research and Theory, 12, 99-102.

Haylett, S., Stephenson, G.M. & Haylett, S. (2004). Covariation in addictive behaviours: A study of addictive orientations using the Shorter PROMIS Questionnaire. Addictive Behaviors, 29, 61-71.

Larkin, M. & Griffiths, M.D. (2002).  Experiences of addiction and recovery: The case for subjective accounts. Addiction Research and Theory, 10, 281-311.

Larkin, M. & Griffiths, M.D. (2004). Dangerous sports and recreational drug-use: Rationalising and contextualising risk. Journal of Community and Applied Social Psychology, 14, 215-232.

Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.

Lefever, R. (2012). Compulsive helping. Located at: http://promis.co.uk/addiction-info/addiction/compulsive-behaviours/

Lefever, R. (2012). Compulsive helping. Located at: http://www.doctor-robert.com/compulsive-helping/

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

Stephenson, G.M., Maggi, P., Lefever, R.M.H. & Morojele, N.K. (1995). Excessive Behaviours: An Archival Study of Behavioural Tendencies reported by 471 patients admitted to an addiction treatment centre. Addiction Research, 3, 245-265.

Sex starved: A beginner’s guide to sexual anorexia

In previous blogs I have looked at anorexia nervosa in the context of addictive eating disorders, ‘tanorexia’ (excessive tanning) and ‘fanorexia’ (excessive following of a celebrity or sports team). Today’s blog takes a brief look at ‘sexual anorexia’ that according to Dr. Douglas Weiss in his 1998 book Sexual Anorexia, Beyond Sexual, Emotional and Spiritual Withholding, typically refers to “the active, almost compulsive withholding of emotional, spiritual and sexual intimacy from the primary partner”. The 12-Step group Sex and Love Addicts Anonymous offers this definition and analogy:

“As an eating disorder, anorexia is defined as the compulsive avoidance of food. In the area of sex and love, anorexia has a similar definition: Anorexia is the compulsive avoidance of giving or receiving social, sexual, or emotional nourishment”

A paper by Dr. Randy Hardman and Dr. David Gardner in a 1986 issue of the Journal of Sex Education and Therapy compared anorexia nervosa and sexual anorexia. They highlighted the four most significant characteristic similarities of these self-perpetuating disorders from both an intrapsychic and interpersonal level. These were (i) control (i.e., overt personal control and covert relationship power), (ii) fear (i.e., fear of losing control and fear of personal sexuality), (iii) anger (i.e., passive and active expressions of anger based on devaluation), and (iv) justification (i.e., an elaborate system of denial, delusion, and misperception).

Along with Dr. Weiss, most of the key writings on the topic have been written by Dr. Patrick Carnes (the author of many articles and books on sex addiction). Dr. Carnes defines sexual anorexia as: “an obsessive state in which the physical, mental and emotional task of avoiding sex dominates one’s life. Like self-starvation with food, deprivation with sex can make one feel powerful and defended against all hurts.” In a 1998 paper in the journal Sexual Addiction and Compulsivity, he also notes that: “the term “sexual anorexia” has been used to describe sexual aversion disorder [in the Diagnostic and Statistical Manual of Mental Disorders], a state in which the patient has a profound disgust and horror at anything sexual in themselves and others”.

According to the Wikipedia entry on sexual anorexia, the term ‘sexual anorexia’ has been around for over 35 years, and the first use it the term is generally attributed to psychologist Nathan Hare, a psychologist who coined the term in his 1975 PhD thesis. (However, I have failed to track this down, and none of the academic papers I have read on sexual anorexia ever mention Hare).

Dr. Carnes claims to have identified three causative factors in the formation of sexual anorexia. These are (i) a probable history of sexual exploitation or severely traumatic sexual rejection, (ii) family history of extremes in thought or behavior (often very repressive/religious or it’s polar opposite of “anything-goes” permissiveness), and (iii) cultural, social or religious influences that view sex negatively and supports sexual oppression and repression. Dr. Weiss adds that there are three key criteria in the formation of anorexia: (i) sexual abuse, (ii) attachment disorder with the opposite sex parent and (iii) sex addiction.

In his 1997 book Sexual Anorexia: Overcoming Sexual Self-Hatred, Dr. Carnes views the symptom cluster of the sexual anorexic as primarily sexual and includes: (i) a dread of sexual pleasure, (ii) a morbid and persistent fear of sexual contact, (iii) obsession and hyper-vigilance around sexual matters, (iv) avoidance of anything connected with sex, (v) preoccupation with others being sexual, (vi) distortions of body appearance, (vii) extreme loathing of body functions, (viii) obsessional self-doubt about sexual adequacy, (ix) rigid, judgmental attitudes about sexual behaviour, (x) excessive fear and preoccupation with sexually transmitted diseases, (xi) obsessive concern or worry about the sexual intentions of others, (xii) shame and self-loathing over sexual experiences, (xiii) depression about sexual adequacy and functioning, (xiv) intimacy avoidance because of sexual fear, and (xv) self-destructive behavior to limit, stop, or avoid sex.

The 1998 paper published in the journal Sexual Addiction and Compulsivity by Dr. Carnes is one of the very few in the literature to collect empirical data. The data were collected from 144 patients at his treatment clinic that were diagnosed with sexual anorexia. Of these, 41% were male and 59% female aged between 19 and 58 years (all of whom were Caucasian). The main findings were that:

  • 67% reported a history of sexual abuse
  • 41% reported a history of physical abuse
  • 86% reported a history of emotional abuse
  • 65% reported members of the immediate family as some type of addict
  • 40% reported having a sex addict in the immediate family
  • 60% described their family as “rigid”
  • 67% described their family as “disengaged”

Carnes also reported that over two-thirds of the sexually anorexic population claimed to have other compulsive and/or addictive problems including alcoholism (33%), substance abuse (25%), compulsive eating (25%), caffeine abuse (26%), nicotine addiction (23%), compulsive spending (22%), and/or bulimia/anorexia with food (19%). Of most interest was the fact that Carnes compared his group of sexual anorexics with a group of sex addicts (also from his treatment centre). Carnes concluded that:

“By contrasting that profile with data from sex addicts who were in the same patient pool, some important contrasts can be made. The data for sex addicts and sexual anorexics were very parallel in terms of family system, abuse history, and related patterns of addiction, compulsion, and deprivation. Even the criteria for sex addiction and sexual anorexia have important parallels in terms of powerlessness, obsession, consequences, and distress…Such comparisons tend to confirm the proposition that extreme sexual disorders stem from many of the same factors and are variations of the same illness. Of equal importance is the possibility that extreme behaviors in various disorders (food, chemical, sexual, financial) whether in excess or in deprivation are for many patients interchangeable parts representing much deeper patterns of distress”

Finally, if you would like to know if you are sexually anorexic, you can take this simple test that I found at the Freedom In Grace website (and appears to be based on the world of Weiss and Carnes). If you endorse five or more of the following nine statements you or your partner are currently struggling with sexual anorexia”.

  • Withholding love from partner
  • Withholding praise or appreciation from partner
  • Controlling by silence or anger
  • Ongoing or ungrounded criticism causing isolation
  • Withholding sex from your partner
  • Unwillingness or inability to discuss feelings with partner
  • Staying so busy that they have no relational time for the partner
  • Making the problems or issues about your partner instead of owning their own issues
  • Controlling or shaming partner with money issues

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

Further reading

Carnes, P. (1997). Sexual Anorexia: Overcoming Sexual Self-Hatred. Center City, MN: Hazelden.

Carnes, P. (1998). The case for sexual anorexia: An interim report on 144 patients with sexual disorders. Sexual Addiction and Compulsivity, 5, 293–309.

Hardman, R.K. & Gardner, D.J. (1986). Sexual anorexia: A look at inhibited sexual desire. Journal of Sex Education and Therapy, 12, 55-59.

Nelson, Laura (2003). Sexual addiction versus sexual anorexia and the church’s impact. Sexual Addiction and Compulsivity, 10, 179–191.

Sex and Love Addicts Anonymous (undated). Sexual anorexia. Located at: http://www.slaauk.org/files/anorexia.pdf

Weiss, D. (1998). Sexual Anorexia, Beyond Sexual, Emotional and Spiritual Withholding. Fort Worth, TX: Discovery

Weiss, D. (2005). Sexual anorexia: A new paradigm for hyposexual desire disorder. Located at: http://www.sexaddict.com/eBooks/SAeBk.pdf

Wikipedia (2012). Sexual anorexia. Located at: http://en.wikipedia.org/wiki/Sexual_anorexia

Lovestruck: A brief look at de Clérambault’s Syndrome

In previous blogs I have looked at both love addiction and obsessional love. Since writing my blog on obsessional love and noting that it is also known as erotomania, I have received a couple of emails from clinicians saying that obsessional love is not necessarily erotomania by definition. The problem with the wider area of obsessions, compulsions and addiction more generally is that academics and clinicians have different definitions of what it is to be obsessed or addicted to something.

In clinical circles, erotomania is known as de Clérambault’s syndrome (DCS), and was named after a paper published in 1921 (Les Psychoses Passionelles) by the French psychiatrist Gaëtan de Clérambault. Those with DCS typically have a delusional belief that another person (typically someone famous, high status and/or a stranger) is in love with them. Some of the scientific literature suggests that DCS sufferers may have experienced loss of people that were emotionally close to them, and that therefore they may feel emotionally and psychologically safer by attaching themselves to people who are unattainable. Such actions prevent any further losses. In a 1983 issue of Psychological Medicine, Dr. P. Taylor and colleagues described the main components of DCS:

  • The presence of a delusion that the individual (usually described as a female) is loved by a specific man;
  • The woman has had little or no contact with the man;
  • The man is unattainable in some way, because he is already married or because he has no personal interest in her;
  • The man is perceived as watching over, protecting or following the woman;
  • Despite the erotic delusion, the woman remains chaste.

One of the reasons I am personally interested in DCS is that back in the early 1990s, my then girlfriend (who was – and still is – a clinical psychologist) was the object of affection by a DCS sufferer. The man who fell in love with my girlfriend was slightly brain damaged following a bad motorcycling accident. The accident had also left him paralyzed and had to use a wheelchair. As part of her job, my girlfriend worked with the charity Headway (a brain injury association), and it was when she was caring for this head injured and paralyzed man that he fell in love with her and believed that the feelings were reciprocal. The condition was so intense that he even booked a wedding date, sent out wedding invitations, and told all his family and friends that he was marrying my girlfriend. I even started to question my girlfriend’s fidelity because I couldn’t comprehend that someone could organize a whole wedding if nothing had ever happened between them. (Even though I was a psychologist when this happened I had never come across DCS).

The research literature on DCS suggests that the delusional behaviour is usually part of psychotic behaviour (typically schizophrenia, bipolar disorder, or borderline personality disorder) and can therefore be treated using atypical anti-psychotics (however, most DCS sufferers do not ask for help or seek treatment as they don’t believe they are doing anything wrong). According to the Wikipedia entry on DCS (and based on a paper published in a 1998 issue of the Journal of Neuropsychiatry and Clinical Neuroscience by Dr. C. Anderson and colleagues):

“During an erotomanic episode, the patient believes that a ‘secret admirer’ is declaring his or her affection to the patient, often by special glances, signals, telepathy, or messages through the media. Usually the patient then returns the perceived affection by means of letters, phone calls, gifts, and visits to the unwitting recipient. Even though these advances are unexpected and unwanted, any denial of affection by the object of this delusional love is dismissed by the patient as a ploy to conceal the forbidden love from the rest of the world”.

In a 2002 issue of the journal History of Psychiatry, Dr. German Berrios and Dr. N. Kennedy describe four convergences in the history of erotomania.

  • Convergence 1: From classical times to the early eighteenth century, erotomania was viewed as a ‘general disease caused by unrequited love’.
  • Convergence 2: During the nineteenth century, erotomania was viewed as a disease of ‘excessive physical love (nymphomania)’
  • Convergence 3: During the twentieth century, erotomania was viewed as a form of ‘mental disorder’
  • Convergence 4: Currently, erotomania is viewed as a ‘delusional belief of being loved by someone else’.

Berrios and Kennedy also note that there are differences between Anglo-Saxon and French views surrounding the meaning or coherence of “the much-abused English eponym ‘de Clérambault syndrome’. Erotomania is a construct, a mirror reflecting Western views on spiritual and physical love, sex, and gender inequality and abuse. On account of this, it is unlikely that there will ever be a final, ‘scientific’ definition rendering erotomania into a ‘natural kind’ and making it susceptible to brain localization and biological treatment”.

Empirical research suggests that women are more likely than men to suffer from DCS, and that DCS sufferers tend to have social and intimacy difficulties, and are therefore typically loners. Developmentally, they are likely to have a poor sense of self and may have suffered abuse during childhood and/or adolescence. Much of the published theorizing about erotomania is from a psychodynamic perspective or genetic/neurochemical presispositions. I’m far more eclectic in my approach to understanding human behaviour and believe that environmental, psychological, pharmacological and physiological factors most likely trigger a predisposed person into developing DCS. It’s also been speculated that learning through the media (television, radio, books, etc.) has influenced the development of DCS.

Dr. Louis Schlesinger in his 2004 book Sexual Murder: Catathymic and Compulsive Homicides writes about DCS sufferers in relation to possible stalking behaviour. He notes that: “some stalkers are unable to give up a prior intimate relationship (Zona, Sharma, and Lane, 1993). Some develop delusional beliefs about the target (Goldstein, 1987), while others develop strong obsessional thoughts about virtual strangers (Spitzberg and Cupach, 1994). Meloy (1992) and Kienlen (1998) believe that a disturbance of attachment begins in the offender’s early childhood and stalking starts when some type of loss in adulthood resurrects these early conflicts”

In some individuals, DCS can remain with the person for a long time. For instance, Dr. Harold Jordan and colleagues published a paper in a 2006 issue of the Journal of the National Medical Association. They reviewed two cases of DCS that they had followed for over 30 years making these some of the longest, single-case longitudinal studies yet reported”. They noted that DCS remains a “ubiquitous nosological psychiatric entity with uncertain prognosis”. De Clerambault’s original paper presented the case of a woman whose chronic, erotic delusion remained with her for 37 years, and the cases reported by Dr. Jordan and his colleagues also demonstrated that the delusion can remain unchanged for decades. I have yet to come across any research that estimates the prevalence of DCS among the general population but given most published papers are clinical case reports, it suggests the disorder is relatively rare.

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

Further reading

Anderson CA, Camp J, Filley CM (1998). Erotomania after aneurismal subarachnoid hemorrhage: Case report and literature review. Journal of Neuropsychiatry and Clinical Neuroscience, 10, 330-337.

Berrios G.E. & Kennedy, N. (2002). Erotomania: a conceptual history. History of Psychiatry, 13, 381-400.

Jordan, H.W., Lockert, E.W., Johnson-Warren, M., Cabell, C., Cooke, T., Greer, W. & Howe, G. (2006). Erotomania revisited: Thirty-four years later. Journal of the National Medical Association, 98, 487-793.

Schlesinger, L.B. (2004). Sexual murder: Catathymic and compulsive homicides. London: CRC Press.

Taylor, P., Mahendra, B. & Gunn J. (1983). Erotomania in males. Psychological Medicine, 13, 645-650.

Zona, M., Sharma, K., and Lane, J. (1993). A comparative study of erotomania and obsessional subjects in a forensic sample. Journal of Forensic Sciences, 38, 894–903.

Yearning power: A beginner’s guide to obsessive love

In a previous blog, I briefly looked at to what extent love can be addictive. However, recent history has seen the rise of the term ‘obsessive love’.  Obsessive love is typically associated with unrequited love, but there are relationships in which individuals could be said to obsess over each other and relationships in which one member obsesses over their partner. According to Dr. Helen Fisher in her 2005 book Why We Love: The Nature and Chemistry of Romantic Love, some people believe that all love is obsessive as it can be characterised by feelings of exhilaration, and intrusive, obsessive thoughts about the object of one’s affection. One common view is that love and relationships are a specialized kind of mutual addiction.

It may be useful to categorise obsessive love as an addiction because the behaviour is often similar. It is possible to see the resemblance between the definitions given for obsessions and addictions. In 2003, Griffin and Tyrrell stated that “obsessions are thoughts, images or impulses that cause marked degrees of anxiety or distress”. Similarly, Stanton Peele and Archie Brodsky in their 1975 book Love and Addiction defined addiction as “a single overwhelming involvement with one thing that serves to cut a person off from life, to close him or her off to experience, to debilitate him, to make him less open, free, and positive in dealing with the world”. From this it is obvious that there is a resemblance in the fact that both can be debilitating. However, though it seems that certain aspects of obsessive love resemble a behavioural addiction, it has not been fully investigated.

Current literature uses the term ‘obsessive love’ to describe erotomania or love addiction. Obsessive love can therefore be seen as an umbrella term that covers subgroups such as erotomanics and love addicts, although no literature has been found that uses both concepts within the context of obsessive love. A common conception of obsessive love is generally that of a person being infatuated with a particular individual. However, another category includes those who feel the need to be in love generally. These are commonly known as ‘love addicts’. A more medically accepted category of obsessive love is that of erotomania.

Erotomania is a ‘rare delusional disorder’ also known as De Clerembault’s Syndrome. This type of obsessive lover develops a fixation on a person and becomes convinced that they are having a romantic relationship regardless of attempts by the recipient to convince them otherwise. Although erotomania and love addiction are dealt with as individual disorders, they share a number of characteristics. Obsessive love is seen predominantly in women although it has been realised that there are male sufferers. Also, more specifically, erotomania usually occurs in unmarried women that are isolated and lonely and have low self-esteem. However, recent studies have shown the disorder to be present in men who have a history of substance abuse or mental illness.

Obsessive lovers lack the ability to develop and are obsessed with impossible needs and unrealistic expectations. They engage in desperate hopes and unending fears. Obsessive lovers often have a past history of mental illness and/or a criminal record. Erotomania is also often associated with other mental disorders, in particular paranoid schizophrenia. Only ten percent of those that suffer erotomania do not suffer any other forms of mental illness. Typically the recipient is often higher in social status – often a boss or a celebrity. Symptoms of this form of obsessive love include delusions of passion followed by delusions of persecution. The individual creates reasons as to why the recipient cannot be with them such as their job or shyness. The person also believes that the recipient is more in love with them than vice versa.

Obsessive love can take place both in and out of a relationship. It can be a past partner, a friend, an acquaintance or even a stranger. Characteristics shared by all types of obsessive love include addictive personalities and low self-esteem. Obsessive lovers also have a tendency for violence and self-destruction. A person with such an obsession is likely to avoid change, and is typically dependent with a need for security. As this disorder is of an obsessive nature, the love the person feels is not particularly intimate. It is often the case that the love interest is the biggest thing in their life and so they dedicate lots of time to it.

Generally, the obsessed person’s life revolves around the person they are obsessed with. Whether in a relationship or not, the happiness of the obsessed is a direct result of the actions of the love object. As a result of this, the obsessed may beg to be told of how to make the other person happy so that they become the person the love object would want them to be. Obsessive lovers will go to great lengths to achieve or maintain the love of the love interest. Behaviour can become unpleasant for the recipient. Such actions include obscene phone calls, criminal damage or even physical violence and stalking. Their behaviour may necessitate the interest of the law.

This is frequently an occupational hazard for celebrities. In 1995, Madonna was stalked by Robert Hoskins. The man suffered from erotomania and believed that she was his wife. In an attempt to see his ‘wife’ he gained access to her home and assaulted a security guard. He was sentenced to ten years imprisonment. There are always fans that take their love for their idol into obsession.

Stalking is clearly a form of obsessive behaviour, and it has been found that those patients who have been stalked have described it as ‘psychological rape’. This can only further illustrate the devastating consequences of obsessive love. Stalking has even been given the clinical term ‘obsessional following’, and can be defined as the wilful, malicious and repeated following and harassing of another person. There is no single stalker profile and no two research centres can agree on what to call different types of stalkers.  The only exception is erotomania. This is the only psychiatric diagnosis routinely associated with stalking.

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

Further reading

Bogerts, B. (2005). Delusional jealousy and obsessive love – causes and forms. MMW Fortschritte der Medizin, 147(6), 28-9.

Debbelt, P. & Assion, H.J. (2001). Paranoia erotica (de Clerambault syndrome) in affective disorder. Der Nervenarzt. 72, 879-83.

Fisher, H. (2005). Why We Love: The Nature and Chemistry of Romantic Love. New York: Henry Holt and Company.

Graziano, W.G. & Musser L.M. (1982). The joining and parting of the ways. In Duck, S (Ed.). Personal Relationships 4: Dissolving Personal Relationships (pp.75-106). London: Academic Press.

Kennedy, N., McDonough, M., Kelly, B., & Berrios, G.E. (2002). Erotomania revisited: Clinical course and treatment. Comprehensive Psychiatry, 43, 1-6.

McCann, J.T. (1998). Subtypes of stalking (obsessional following) in adolescence. Journal of Adolescence, 21, 667-75.

Meloy, J. R. (1998). The psychology of stalking: Clinical and Forensic Perspectives. New York: Academic Press.

Orion, D. (1997). I Know You Really Love Me: A Psychiatrist’s Journal of Erotomania, Stalking, and Obsessive Love. London: MacMillan Publishing Company.

Peabody, S. (1994). Addiction to love. California: Celestial Arts.

Peele, S. & Brodsky, A. (1975). Love and Addiction. New York: Taplinger.

Sinclair, H.C, and Frieze, I.H. (2000). Initial courtship behaviour and stalking: how should we draw the line? Violence and Victims. 15(1), 23-40.

Stanbury, A. & Griffiths, M.D. (2007). Obsessive love as an addiction. Psychology Review, 12(3), 2-4.

A whole in the heart: Can love really be addictive?

“You like to think that you’re immune to the stuff/It’s closer to the truth to say you can’t get enough/You know you’re gonna have to face it, you’re addicted to love”

(Robert Palmer, Addicted To Love, 1986)

“Stitched up tight, can’t break free/Love is the drug, got a hook on me/Oh, oh, catch that buzz/Love is the drug I’m thinking of/Oh, oh, can’t you see/ Love is the drug for me”

(Roxy Music, Love Is The Drug, 1975)

If evidence for love addiction was purely based on the lyrics of pop songs, there would be little doubt that love addiction exists. For those in the academic community who believe in the concept of ‘love addiction’ unsurprisingly define it as the condition in which people become addicted to the feelings of being in love.

Historically, in the psychological literature, the concept of love addiction has been around for some time. Freud’s case study of the Sergei Pankejeff (nick-named the ‘Wolf Man’ after he told Freud about a strange dream involving a tree full of white wolves), noted his “liability to compulsive attacks of falling physically in love …a compulsive falling in love that came on and passed off by sudden fits”. However, it is generally thought that Dr. Sándor Radó (the Hungarian psychoanalyst) first described the characteristics of ‘’love addicts” that used love to simultaneously increase sexual satisfaction and heighten self-esteem.

Arguably the most cited work in this area is the 1975 book Love and Addiction by Dr. Stanton Peele and Dr. Archie Brodsky. Their book suggested that some forms of love are actually forms of addiction, and tried to make the case that some forms of love addiction may be potentially more destructive and prevalent than widely recognized opiate drugs. However, Peele later said his main points had been somewhat sidelined and used for others’ own agendas. He said that the book had intended to be: ‘”a social commentary on how our society defines and patterns intimate relationships…all of this social dimension has been removed, and the attention to love addiction has been channeled in the direction of regarding it as an individual, treatable psychopathology”.

In 1981, a paper on the development of a 20-item ‘Love Addiction Scale’ by Dr. Mary Hunter and colleagues was published in the journal Psychological Reports. They said that the defining characteristics of love addiction were:

  • Wanting the partner to fill a felt void in one’s life
  • Wanting the reassurance of constancy of partner
  • Feeling that the partner is necessary to make life bearable
  • Feeling that the sole source of one’s gratification, and pleasure is one’s partner.

However, the actual paper was a one-page summary and did not actually report what the individual 20 items were. Since then, the term ‘love addiction’ has been uncritically and extensively used in popular psychology and self-help books (such as Robin Norwood’s Women Who Love Too Much, and Susan Peabody’s Addiction to Love, and John Moore’s Confusing Love with Obsession). Jim Hall claims there are at least nine types of love addict in his book The Love Addict in Love Addiction. He claims that some individuals “become painfully obsessed with avoidant and/or narcissistic relationship partners” and that others can become addicted to individuals outside of a romantic relationship.

Readers of my research in the general area of behavioural addiction will know that I use the components model of addiction to operationally define whether addictions to certain behaviours exist. If love addiction exists, I would expect to see people with the following criteria:

  • Salience: This would be when loving somebody becomes the most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings), and behaviour (deterioration of socialized behaviour).
  • Mood modification: This would refers to the subjective experiences that people report as a consequence of being in love with someone and – if it was a genuine addiction – would be used as a coping strategy to feel better about themselves (i.e., they experience love as an arousing “buzz” or a “high” or paradoxically a tranquilizing feel of “escape” or “numbing” that helps them to cope with other more stressful things in their life).
  • Tolerance: This would be the process whereby the love they feel for someone plays an increasingly bigger and more important part in that persons’ life to achieve the former mood modifying effects.
  • Withdrawal symptoms: These would be the unpleasant feeling states and/or physical effects that occur when love is discontinued (e.g., the other person ends the relationship or the person loved dies).
  • Conflict: This would be where being in love with someone resulted in the feelings love interfering and compromising all other activity in that person’s life (e.g., job, hobbies, social friendships, etc.).
  • Relapse: Here this might refer to “getting somebody out of their system” only for all the feelings of love to return when they are in the person’s company or engage in an act (e.g., kissing) that re-kindles all the previous feelings they had for that person.

By applying these basic criteria to love, I would guess (as I have never done any empirical research on this topic) that there would be very few genuine ‘love addicts’. When people first meet and fall in love, many of the criteria above may be temporarily experienced, but this is due to the effect of novelty, and may not be particularly long lasting. There is certainly some empirical evidence by Dr. Thomas Timmreck (California State University, USA) suggesting that relationship break-ups and death of life-partners can lead to a range of symptoms that resemble withdrawal effects in more traditional addictions.

As I have said many times before in many different contexts, the difference between healthy enthusiasms and addictions is that healthy enthusiasms add to life whereas addictions take away from them. For the vast majority of people, falling in love (and being in love with somebody), is something that is life affirming and life enhancing and in no way problematic.

I recently co-authored (along with Dr Steve Sussman and Nadra Lisha, from the University of Southern California) a review paper on addiction prevalence across 11 different potentially addictive behaviours (including love addiction). We reported that one study by MacLaren and Best in 2010, provided estimates of 12% for relationship submissive/love addiction among a sample of young adults. Most studies I have read report the prevalence of love addiction at around 3% to 6%. However, most of these studies are methodologically questionable (small samples, sample bias, etc.) and are more likely to be estimating or assessing preoccupation with love rather than genuine addiction.

Despite the lack of conclusive evidence that love addiction actually exists, we can all probably think of people we know where their love for somebody has bordered on the obsessive and/or addictive. There are also clinical cases of de Clérambault’s Syndrome in which the affected person suffers from the delusion that another person (typically a stranger or very casual acquaintance, or somebody famous or of high-status), is in love with them. This type of obsessive love is often found in people with other psychological and/or psychiatric disorders such as bipolar disorders, psychoses, and schizophrenia (and as such is a different clinical entity to love addiction).

One of the problems with the concept of ‘love addiction’ is that if it does exist, there is potential crossover and confounding effects with ‘sex addiction’ particularly as they often appear to have a symbiotic relationship. Although love and sex are different entities, they can be highly intertwined. On this note I will leave you with a couple of my favourite quoatesAs actor and film director Woody Allen once said: “Love is the answer. But while you’re waiting for the answer, sex raises some pretty good questions” and “Sex alleviates tension. Love causes it”.

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

Further reading

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

Hunter, M.S., Nitschke, C. & Hogan, L. (1981). A scale to measure love addiction. Psychological Reports, 48, 582.

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

Peele, S. & Brodsky, A. (1975), Love and addiction. New York: Taplinger.

Rado, S. (1928). The problem of melancholia. International Journal of Psycho-Analysis, 9, 420.

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.

Timmreck, T.C, (1990). Overcoming the loss of a love: preventing love addiction and promoting positive emotional health. Psychological Reports, 66, 12-14.