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Feeling hot, hot, hot: A brief look at sex and the sun

Most people now accept that weather can affect mood state and for some people can lead to extreme depression in the form of Seasonal Affective Disorder. There also seems to be some evidence that weather can affect people’s sex lives. Being too hot or too cold is likely to lessen the desire to engage in sexual behaviour. Most academic research appears to indicate that sex drives are higher in spring and summer. One of the reasons given for this is that during spring and summer, there is more sun, and that a particular hormone – Melanocyte Stimulating Hormone (MSH) – stimulates sex, particularly in women.

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A number of studies have also indicated that during the spring and summer months, the body produces more seretonin (the so-called ‘feel good neurotransmitter’) because increased luminosity of sunlight. During the winter months as the amount of sunlight decreases, the body produces more melatonin, and this appears to inhibit sex drives. However, there is wide individual variation and the weather and subsequent hormone stimulation differs highly from one person to the next. As an online article by Shiv Joshi confirms:

“Sunlight has a direct effect on the brain’s serotonin production, according to researchers at the Human Neurotransmitter Laboratory and Alfred and Baker Medical Unit, Baker Heart Research Institute, Australia. Our serotonin levels increase with increase in luminosity. And how does that matter? Among other things, serotonin also regulates arousal, says Ray Sahelian, MD, author of Mind Boosters…Not just serotonin, but sunlight affects many other hormones in our body as well, some of which are associated with mood and pleasure feelings, according to professor Carmen Fusco, an instructor in pharmacology. It decreases melatonin, norepinephrine, and acetylcholine and increases cortisol, serotonin, GABA, and dopamine. The summer heat is good for your sex life too. It works on your muscles, by relaxing them and intensifies sensations of the skin. Further, the heat slows us down. This helps us get in touch with our more subdued sensual side, according to psychologist Stella Resnick, PhD, author of The Pleasure Zone”.

German researchers Winfried März and colleagues examined the relationship between vitamin D production (aided by sunny weather) and sex hormones (published a 2010 issue of the journal Clinical Endocrinology). In a study of 2,299 men, the researchers found that levels of Vitamin D were associated with androgen (i.e., testosterone) production with peak levels in August (the sunniest time of year in Germany). They concluded that testosterone and Vitamin D levels “are associated in men and reveal a concordant seasonal variation. Randomized controlled trials are warranted to evaluate the effect of vitamin D supplementation on androgen levels”. The study was replicated by Dr. Katharina Nimptsch and her colleagues among a sample of 1,362 men (also published in the same journal in 2012), and they found the same association between Vitamin D and testosterone production (although they found no seasonal effect). However, a more recent 2014 study published by Dr. Elizabeth Lerchbaim and her colleagues in the journal Andrology found no association (but it was on a much smaller sample of 225 men).

Although I have been unable to track down the academic source, an article by Sam Rider in Coach Magazine claimed that:

 “Exposing the skin to sunlight for just 15-20 minutes can raise your testosterone levels by 120%, says a report from Boston State Hospital in the US. The research also found that the hormone increased by a whopping 200% when genital skin was exposed to the sun. Stick to the privacy of your own garden though – we don’t want any arrests”.

In previous blogs I briefly reviewed some of the many studies into courtship requests by Dr. Nicolas Guéguen (which you can read here and here). In one of his studies (published in a 2013 issue of Social Influence), Guéguen examined the effect of sunshine on romantic relationships (reasoning that sunny weather puts people in a better mood than non-sunny weather). In this study, an attractive 20-year old man approached young women walking alone in the street and asked them for their telephone number in two conditions (sunny or cloudy days). The temperature was controlled for and all days of the experiment were dry. The results showed that more women gave the man their telephone numbers on the sunny days. Guéguen concluded that positive mood induction by the sun may explain the success in courtship solicitation.

Finally, in his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr. Aggrawal was quoted as saying that “like allergies, sexual arousal may occur from anything under the sun including the sun”. In fact, Aggrawal’s book arguably contains the most references to fetishes that concern the weather. This includes fetishes and paraphilias in relation to sexual arousal to sunny weather (actirasty), sexual arousal from the cold or winter (cheimaphilia), sexual arousal from snow (chionophilia), sexual arousal from thunderstorms (brontophilia), sexual arousal from thunder and lightning (keraunophilia), sexual arousal from fog (nebulophilia), sexual arousal from rain and being rained upon (ombrophilia and pluviophilia), and love of thunder (tonitrophilia). However, as far as I am aware, no scientific research has ever investigated any of these alleged fetishes.

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

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Amanad, V. (2012). Does weather affect your sex drive? Only My Health, June 29. http://www.onlymyhealth.com/does-weather-affect-your-sex-drive-1340990772

Guéguen, N. (2013). Weather and courtship behavior: A quasi-experiment with the flirty sunshine. Social Influence, 8, 312-319.

Herbert, E. (2009). Sex: Weather-driven desire? Elle, July 28. Located at: http://www.elle.com/life-love/sex-relationships/sex-tips-women

Hurwood, B.J. (1965). The Golden Age of Erotica. Los Angeles, CA: Sherbourne Press.

Joshi, S. (2010). Summer and intimacy: Felling hot, hot, hot. Complete Wellbeing, May 11. Located at: http://completewellbeing.com/article/feeling-hot-hot-hot/

Lerchbaum, E., Pilz, S., Trummer, C., Rabe, T., Schenk, M., Heijboer, A. C., & Obermayer‐Pietsch, B. (2014). Serum vitamin D levels and hypogonadism in men. Andrology, 2(5), 748-754.

Nimptsch, K., Platz, E. A., Willett, W. C., & Giovannucci, E. (2012). Association between plasma 25‐OH vitamin D and testosterone levels in men. Clinical Endocrinology, 77(1), 106-112.

Rider, S. (2015). How to boost your testosterone levels (the natural way). Coach Magazine, October 5. Located at: http://www.coachmag.co.uk/lifestyle/1558/10-ways-boost-testosterone

Wehr, E., Pilz, S., Boehm, B. O., März, W., & Obermayer‐Pietsch, B. (2010). Association of vitamin D status with serum androgen levels in men. Clinical Endocrinology, 73(2), 243-248.

Fun in the sun? Does ‘tanorexia’ (addiction to sunshine) really exist?

If the many media reports are to be believed, a 2014 study published in the journal Cell claimed that “sunshine can be addictive like heroin”. In an experiment carried out on mice, a research team led by Dr. Gillian Fell at the Harvard Medical School in Boston (US) reported that ultraviolet exposure leads to elevated endorphin levels (endorphins being the body’s own ‘feel good’ endogenous morphine), that mice experience withdrawal effects after exposure to ultraviolet light, and that chronic ultraviolet causes dependency and ‘addiction-like’ behaviour.

Although the study was carried out on animals, the authors speculated that their findings may help to explain why we love lying in the sun and that in addition to topping up our tans, sunbathing may be the most natural way to satisfy our cravings for a ‘sunshine fix’ in the same way that drug addicts yearn for their drug of choice.

Reading the findings of this study took me back to 1998 when I appeared as a ‘behavioural addiction expert’ on Esther Rantzen’s daytime BBC television show that featured people who claimed they were addicted to tanning (and was dubbed by the researchers on the programme as ‘tanorexia’). I have to admit that none of the case studies on the show appeared to be addicted to tanning at least based on my own behavioural addiction criteria (i.e., salience, mood modification, tolerance, withdrawal, conflict, and relapse) but it did at least alert me to the fact that some people thought sunbathing and tanning was addictive (in fact, the people on the show said their excessive tanning was akin to nicotine addiction).

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There certainly appeared to be some similarities between the people interviewed and nicotine addiction in the sense that the ‘tanorexics’ knew they were significantly increasing their chances of getting skin cancer as a direct result of their risky behaviour but felt they were unable to stop doing it (similar to nicotine addicts who know they are increasing the probability of various cancers but also feel unable to stop despite knowing the health risks).

Since then, tanorexia has become a topic for scientific investigation (and I looked at the topic in a previous blog). For instance, in a 2006 study published in the Journal of the American Academy of Dermatology by Dr. Mandeep Kaur and colleagues reported that frequent tanners (those who tanned 8-15 times a month) that took an endorphin blocker normally used to treat drug addictions (i.e., naltrexone) significantly reduced the amount of tanning compared to a control group of light tanners.

A 2005 study published in the Archives of Dermatology by Dr. Molly Warthan and colleagues claimed that a quarter of the sample of 145 “sun worshippers” would qualify as having a substance-related disorder if ultraviolet light was classed as the substance they crave. Their paper also reported that frequent tanners experienced a “loss of control” over their tanning schedule, and displayed a pattern of addiction similar to smokers and alcoholics.

A 2008 study published in the American Journal of Health Behavior by Dr. Carolyn Heckman and colleagues reported that 27% of 400 students they surveyed were classified as “tanning dependent”. The authors claimed that those classed as being tanning dependent had a number of similarities to substance use, including (i) higher prevalence among youth, (ii) an initial perception that the behaviour is image enhancing, (iii) high health risks and disregard for warnings about those risks, and (iv) the activity being mood enhancing.

Another study by Dr. Heckman and her colleagues in the American Journal of Health Promotion surveyed 306 female students and classed 25% of the respondents as ‘tanning dependent’ based upon a self-devised tanning dependence questionnaire. The problem with this and most of the psychological research on tanorexia to date is that almost all of the research is carried out on relatively small convenience samples using self-report and non-psychometrically validated ‘tanning addiction’ instruments.

Based on my own six criteria of behavioural addiction although some studies suggest some of these criteria appear to have been met, I have yet to be convinced that any of the published studies to date show genuine addiction to tanning (i.e., that there is evidence of all my criteria being endorsed) but that doesn’t mean it’s not theoretically possible. However, I’ve just done a study on tanorexia with my research colleagues at the University of Bergen and when we publish our findings I’ll be sure to let my blog readers know about it.

(Please note: A version of this article first appeared in The Conversation and The Washington Post)

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

Further reading

Fell, G.L., Robinson, K.C., Mao, J., Woolf, C.J., & Fisher, D.E. (2014). Skin β-endorphin mediates addiction to UV light. Cell, 157(7), 1527-1534.

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

Griffiths, M.D. (2014). Sunshine addiction is a hot topic – but does ‘tanorexia’ really exist? The Conversation. June 20. Located at: https://theconversation.com/sunshine-addiction-is-a-hot-topic-but-does-tanorexia-really-exist-28283

Griffiths, M.D. (2014). Sunshine: As addictive as heroin? Washington Post. June 24. Located at http://www.washingtonpost.com/posteverything/wp/2014/06/24/sunshine-as-addictive-as-heroin/

Heckman, C.J., Cohen-Filipic, J., Darlow, S., Kloss, J.D., Manne, S.L., & Munshi, T. (2014). Psychiatric and addictive symptoms of young adult female indoor tanners. American Journal of Health Promotion, 28(3), 168-174.

Heckman, C.J., Darlow, S., Kloss, J.D., Cohen‐Filipic, J., Manne, S.L., Munshi, T., … & Perlis, C. (2014). Measurement of tanning dependence. Journal of the European Academy of Dermatology and Venereology, 28(9), 1179-1185 .

Heckman, C.J., Egleston, B.L., Wilson, D.B., & Ingersoll, K.S. (2008). A preliminary investigation of the predictors of tanning dependence. American Journal of Health Behavior, 32(5), 451-464.

Kaur, M., Liguori, A., Lang, W., Rapp, S.R., Fleischer, A.B., & Feldman, S.R. (2006). Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. Journal of the American Academy of Dermatology, 54(4), 709-711.

Warthan, M.M., Uchida, T., & Wagner, R.F. (2005). UV light tanning as a type of substance-related disorder. Archives of Dermatology, 141(8), 963-966.

Fantastic or drastic? Can plastic surgery be addictive?

“Plastic surgery addiction may sound like a joke but it is actually a serious problem that more and more people are suffering from in modern times” (http://plasticsurgeryaddiction.net/)

In many circumstances, the use of using plastic surgery to help correct a facial or body deformity, whether congenital or caused by an accident of some description, is clearly a helpful and beneficial treatment to individuals. However, in the world of celebrity media, ‘plastic surgery addiction’ is up there with alcohol and drug addictions as one of the addictions that those in the public eye are most likely to succumb to. We can all think of celebrities that are known to have repeatedly gone under the surgeon’s knife (Michael Jackson, Cher, David Gest, Micky Rourke). There are understandable reasons as to why celebrities are a higher risk group for seeking out cosmetic surgery. Firstly, there is an almost obsessive need in the ‘showbiz’ world to look as (aesthetically) good as possible. Secondly, they have the money and can afford to do it repeatedly. As long as the person has the money to pay for the surgery and the doctor is willing to perform it, there are no guidelines as to when to stop (unlike the regulation of prescription drugs, and other medical and/or surgical procedures).

As I noted in a previous blog, I am unconvinced that any of these high profile celebrity cases are “addicted” to plastic surgery but like ‘tanorexia’ there is certainly the desire to look good as a way of feeling good about themselves. However, there are certainly cases of individuals who seek out constant plastic surgery because they suffer from Body Dysmorphic Disorder (BDD). As I noted in a previous blog on BDD, it typically manifests itself as a preoccupation with an imagined physical defect or an exaggerated concern about a minimal defect. Furthermore, the perceived flaw or defect may not even be noticeable to other people. This leads the BDD sufferer to want cosmetic surgery in an attempt to try to change or eliminate the perceived defect. Even people who are outwardly (and objectively) very attractive can perceive themselves to be very unattractive.

Empirical research carried out among patients undergoing plastic surgery, have typically reported that between 5% and 15% of the sample have BDD. Even if the constant seeking out of cosmetic surgery is not a genuine addiction, BDD sufferers appear to have a higher risk of developing addictions to alcohol and illegal drugs as they are often used to cope with and/or forget about the symptoms and consequences of the disorder. They also engage in more ‘safety behaviours’ (such as staying indoors and avoiding social contact) that in some cases develops into social phobias. This can then result in relationship and/or family discord, and affect education and/or work (depending upon age and life circumstances of the sufferer).

The British psychiatrist Dr David Veale (The Priory Hospital North London) and his colleagues have published a number of studies on BDD with specific reference to those seeking plastic surgery. In one of his team’s first studies, a quarter of 50 BDD patients attending a British psychiatric clinic were reported to have been successful in obtaining at least one cosmetic surgical procedure. In another study, Dr Veale reported that 25 of his BDD patients had received a total of 46 cosmetic surgery operations.

Dr Katharine Phillips (Professor of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, USA), and arguably the world’s leading authority on BDD, has also examined the relationship between BDD and cosmetic surgery. In one of her team’s studies of 58 BDD sufferers who had undergone cosmetic surgery, they reported that the vast majority of the patients (83%) felt no better or were worse after their cosmetic operation(s). Veale has also reported similar findings (i.e., that BDD sufferers experience increasing dissatisfaction following surgery).

However, Dr Veale also reports that there are some cosmetic procedures where BDD patients tend to experience increased (rather than decreased) satisfaction. For instance, operations involving the pinning back of protruding ears (pinnaplasty), and breast augmentation or breast reduction (mammaplasty), tend to show higher satisfaction ratings among BDD sufferers than those undergoing cosmetic nose surgery (rhinoplasty). However, over 50% of BDD patients often have more than one concern about their bodily appearance so even if one surgical procedure produces short-term satisfaction, this may be replaced with anxiety about another body part (resulting in a desire for further cosmetic surgery).

Dr Veale also notes that some BDD patients are very distinct from others (for instance, those with BDD seeking reconstructive nose surgery appear to be distinct from other types of BDD sufferer). Prior to seeking medical help, BDD sufferers wanting rhinoplasty often attempt ‘do-it-yourself’ surgery to correct their perceived defects and flaws. Examples of ‘‘DIY’’ surgery among this type of BDD patient include (i) using a pair of pliers in an attempt to make the nose thinner, (ii) using sticky tape to flatten the nose, and (iii) placing tissue in the nostrils to try to make the nose look more curved. Compared to patients with other body image disorders, those who have attempted DIY surgery appear to have high rates of both depression and attempted suicide.

Despite relatively consistent findings, it should be noted that most of the studies on the relationship between BDD and cosmetic surgery comprise relatively small sample sizes so the findings suffer from issues around generalizability. Perhaps of more concern – and something that Dr Veale points out – is the fact that published studies comprise people seeking treatment in psychiatric settings so there is a high selection bias of people in favour of treatment failures (i.e., if a BDD sufferer is happy with their cosmetic surgical procedure they don’t tend to come in for further treatment as their symptoms and problems dissipate and/or disappear).

A just published study in the journal Psychological Medicine examined whether people who opt for medically unnecessary cosmetic surgery are psychologically vulnerable. A Norwegian team of researchers led by Dr Tilmann von Soest began some longitudinal research two decades ago on 12,000 school students (aged 12 to 19 years in 1992) and have been sampling them periodically over the intervening years. In 2005 there were 2,890 participants left of which 106 people (78 women and 28 men) had cosmetic surgery. Their results indicated that women with psychological problems were more likely to opt for surgery. The female participants who had cosmetic surgery were more likely to have had a history of poorer mental health (e.g., depression, anxiety, more illicit drug use, self-harm, and suicide attempts. With one exception (breast augmentation), having cosmetic surgery didn’t benefit the psychological health of the women. The researchers concluded there was “no evidence that cosmetic surgery should be used to alleviate mental health problems in women dissatisfied with their appearance”.

If plastic surgery addiction exists (and I am sceptical to say the least), it is not (as some people argue) a common side effect of cosmetic surgery (i.e., if someone is considering a cosmetic surgical procedure, they should not be concerned with fear of future reliance on – or  “addiction” to – surgery. That is not to say that repeated cosmetic surgery can’t be problematic. For instance, there are reports of individuals who have had excessive rhinoplasty that has reduced the nasal cavity so many times that they can no longer blow their nose properly. There are also countless reports involving repeated reconstructive facial surgery that has resulted in muscle tissue collapse, unsightly scarring, and permanent nerve damage (leading to permanent loss of sensation and feeling in the affected area for the rest of the patient’s life).

The good news is that most studies report that people are generally happy with the outcome of cosmetic procedures (although arguably, rigorous evaluation has not been carried out). The results of empirical research have tended to conclude that more extensive (“type change”) procedures (e.g., rhinoplasty) appear to require greater psychological adjustment by patients than “restorative” procedures (e.g., facelifts). Cosmetic surgery patients who have unrealistic expectations of the operation’s outcome are more likely to be dissatisfied with cosmetic procedures.

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

Further reading

Castle, D.J., Roberta J Honigman, R.J. & Phillips, K.A. (2004). Does cosmetic surgery improve psychosocial wellbeing? Medical Journal of Australia, 176, 601-604.

Phillips, K.A., Grant, J., Siniscalch,i J, et al. (2001). Surgical and non psychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics, 42, 504-510.

Sarwer, D.B., Wadden, T.A., & Pertschuk, M.J., et al. (1998). Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plastic Reconstructive Surgery, 101, 1644-1649.

Suissa, A.J. (2008). Addiction to cosmetic surgery: Representations and medicalization of the body. International Journal of Mental Health and Addiction, 6, 619-630.

Veale, D., De Haro, L., & Lambrou, C. (2003). Cosmetic rhinoplasty in body dysmorphic disorder. British Journal of Plastic Surgery, 56, 546-51.

Veale, D. (2000). Outcome of cosmetic surgery and ‘‘DIY’’ surgery in patients with body dysmorphic disorder. Psychiatry Bulletin, 24, 218-21.

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

Veale, D., Boocock, A., Gournay, K., et al. (1996). Body dysmorphic disorder. A survey of fifty cases. British Journal of Psychiatry, 169, 196-201.

von Soest, T., Kvalem, I. & Wichstrøm, L. (2012). Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females. Psychological Medicine, 42 , 617-626

Tanorexia: Can excessive tanning be an addiction?

Back in June 1997, I appeared as the obligatory “addiction expert” on the BBC television programme ‘Esther’ talking about people who said they were addicted to tanning (and was dubbed by the researchers on the programme as ‘tanorexia’ – a term that – at the time – I had not come across and is still considered slang even by academics researching in the area). I have to admit that none of the case studies on the programme appeared to be addicted to tanning (at least based on my own addiction criteria) but it did at least alert me to the fact that some people at least claimed to be addicted to tanning.

There certainly appeared to be some similarities between the people interviewed and nicotine addiction in the sense that the ‘tanorexics’ knew they were significantly increasing their chances of getting skin cancer as a direct result of their risky behaviour but felt they were unable to stop doing it (similar to nicotine addicts who know they are increasing the probability of various cancers but also feel unable to stop despite knowing the health risks).

Since my appearance on the programme, tanning addiction – typically involving the repeated daily use of sun beds by women – appears to have become a topic for scientific investigation. If memory serves me correctly, most of the people who appeared on the show appeared to be using tanning as a way of raising their self-esteem and to feel better about themselves. Given that when we are exposed to ultraviolet rays from the sun or tanning bed, our bodies produce it’s own mood-inducing morphine-like substances (i.e., endorphins), the idea that someone could become addicted to tanning is not as far-fetched as it could be.

In fact, in a 2006 study published in the Journal of the American Academy of Dermatology by researchers at Wake Forest University Baptist Medical Center (USA) reported that frequent tanners (those who tanned 8-15 times a month; n=8) who took an endorphin blocker (naltrexone) similar to what a person undergoing alcohol or drug withdrawal suffers), whereas infrequent tanners (n=8) experienced no withdrawal symptoms under identical conditions. However, with only 16 participants in total, the results must be treated with some caution.

Symptoms and consequences of tanorexia are alleged to include (i) intense anxiety if sun bed sessions are missed by the tanorexic, (ii) competition among other tanorexics to see who can get the darkest tan, (iii) chronic frustration by the tanorexic that their skin colour is too light, and (iv), the belief by tanoexics that their skin colour is lighter than it actually is (similar to anorexics believing that they are much heavier than they actually are). Some academics claim that tanorexia is not actually the same as tanning addiction, and argue that tanorexics primary motivation is to get a deep coloured tan. However, there is little empirical research to show whether these tanning behaviours are different or part of the same syndrome.

A 2005 study conducted by researchers at the University of Texas (USA) and published in the US journal Archives of Dermatology claimed that more than half of beach lovers could be considered tanning addicts. They then went on to further claim that just over a quarter of the sample (26%) of “sun worshippers” would qualify as having a substance-related disorder if UV light was classed as the substance they crave. Their paper also reported that frequent tanners experienced a “loss of control” over their tanning schedule, and displayed a pattern of addiction similar to smokers and alcoholics.

Another study carried out in 2008 on 400 students and published in the American Journal of Health Behavior reported that 27% of the students were classified as “tanning dependent”. The authors claimed that those classed as being tanning dependent had a number of similarities to substance use, including (i) higher prevalence among youth, (ii) an initial perception that the behavior is image enhancing, (iii) high health risks and disregard for warnings about those risks, and (iv) the activity being mood enhancing. Independent predictors of tanning dependence included ethnicity (i.e., Caucasians more likely than African Americans to be tanning dependent), lack of skin protective behaviours (i.e., those sunbathing without sun cream and experiencing sunburn more likely to be tanning dependent), smoking (smokers more likely to be tanning dependent), and body mass index (obese people less likely to be tanning dependent).

There is also some interesting empirical evidence that in extreme cases, excessive tanning may be an indication of body dysmorphic disorder (BDD), a mental psychological condition where people are obsessively critical of their physique or self-image. A short article published in the Journal of the American Academy of Dermatology reported the case of 11 patients with BDD who used tanning in an attempt to conceal or improve the appearance of a perceived physical defect.

Overall, the evidence as to whether tanorexia and/or tanning addiction exists is limited with the vast majority of empirical data collected by dermatologists rather than psychologists and biologists. As I noted in a previous blog, I am not convinced – yet – that tanorexics experience a real dependence and/or addiction based on the published empirical evidence. However, at least there are research teams (particularly in the US) empirically investigating its existence.

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

Further reading

Heckman, C.J., Egleston, B.L., Wilson, D.B. & Ingersoll, K.S. (2008). A preliminary investigation of the predictors of tanning dependence. American Journal of Health Behavior, 32, 451-464.

Hunter-Yates J., Dufresne, R.G. & Phillips, K.A. (2007). Tanning in body dysmorphic disorder. Journal of the American Academy of Dermatology, 56(5 Supplement), S107-S109.

Kaur, M., Liguori, A., Lang, W., Rapp, S., Fleischer, A., Feldman, S. (2006). Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. Journal of the American Academy of Dermatology, 54, 709-711.

Warthan, M., Uchida, T. & Wagner, R. (2005). UV light tanning as a type of substance-related disorder. Archives of Dermatology, 141, 963-966.

Each to their own: Five weird (non-sexual) addictions, compulsions and obsessions

On a recent rainy Sunday afternoon and out of sheer boredom I typed in the words ‘weird addictions’ into Google. There were a large number involving various sexual acts that I will leave for another blog. Today’s article briefly overviews what I found that didn’t involve sex along with a brief commentary on the extent to which these behaviours can really be said to be an addiction, compulsion or obsession.

Tanning addiction: Addiction to tanning – typically involving the repeated daily use of sun beds by women – is something that I have commented on a number of times in the British national media and relates to an apparent unhealthy dependence on tanning as a way of raising a person’s self-esteem. Back in the 1990s, the media often referred to this condition as “tanorexia”, and this term has now been taken up by some members of the academic research community. For instance, a study carried out in 2008 on 400 students and published in the American Journal of Health Behavior reported that 27% of the students were classified as “tanning dependent”. Personally, I am not convinced that this is a real dependence and/or addiction based on the empirical evidence to date, but I will look at this issue in more depth in a future blog.

‘BlackBerry’ addiction: There are countlessmedia reports of males in management and other professional occupations who are allegedly addicted to their Blackberry (or ‘Crackberry’ as the media often likes to term it). Symptoms include such things as (i) hearing a “phantom rings” and/or experiencing phantom vibrations, (ii) constantly checking e-mails and/or texts. Apparently, the content of emails and texts makes the person feel important and (like ‘tanorexia’) helps raise a person’s self esteem. Although I have often written and researched into ‘technological addictions’ I have yet to come across a case of genuine case of Blackberry addiction myself. If such an addiction does exist, there are also issues around whether the Blackberry is just a means to fuel particular addictive behaviour (e.g., texting) or whether people are addicted to the Blackberry itself.

Cosmetic surgery addiction:Again, there are many examples in the popular media of patients who allegedly have an addiction to plastic surgery.  There are certainly well documented cases of high profile individuals who have undergone countless operations in their desire to achieve (what they perceive to be) the perfect face and/or body (Michael Jackson, Cher, Jocelyn ‘Cat Woman’ Wildenstein, David Gest, Micky Rourke). Such people appear to be initially satisfied once they have had the procedure in question but then start to think “just one more (operation)”. Again, I am unconvinced that any of these high profile cases are “addicted” to plastic surgery but like ‘tanorexia’ there is certainly the desire to look good as a way of feeling good about themselves. However, there are cases of individuals who seek out constant plastic surgery because they suffer from Body Dysmorphic Disorder (BDD). BDD can affect sexes and typically manifests itself as a preoccupation with an imagined physical defect or an exaggerated concern about a minimal defect. This may lead the BDD sufferer to a cosmetic surgeon in an attempt to try to change or eliminate the perceived defect. The patient is never happy with the changes so it begins another cycle of surgery. The exact cause or causes of BDD is unknown, but most clinicians believe it to be a complex disorder with biopsychosocial underpinnings.

Addiction to chewing ice: On first glance, ice chewing might seem to be a completely made up behaviour yet compared to the other activities on this list, there is quite an established empirical literature. Ice eating is known in the scientific literature by the name of pagophagia and is a particular expression of the more general phenomenon of pica (an eating disorder whose name derives from the Latin word for magpie, a bird known for its peculiar eating behaviours). Pica is defined as the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food. Pica more often occurs in pregnant women, children, and adults of lower socioeconomic status. Other types of pica in addition to ice chewing include the eating of clay and soil (geophagia) and starch (amylophagia). Pagophagia is also closely associated with iron deficiency anemia. Empirical reviews suggest that pagophagia (and pica more generally) is part of the obsessive-compulsive disorder spectrum of diseases. Some case studies even suggest that ice chewing compromises their ability to maintain jobs or personal relationships. Although there are some claims in the literature that pagophagia can be addictive, the more likely is that it may be a compulsion in extreme cases.

Compulsive lying: Telling lies is widespread yet there appears to be some empirical evidence that in extreme cases it can be chronic, compulsive and/or pathological. Often, compulsive lying may be an adjunct to other mental illnesses such as Munchausen’s Syndrome (where a person persistently seeks medical treatment for illnesses that do not exist) or pathological gambling (where persistent lying is needed to prevent others realizing there is a gambling problem). Other sufferers may include those with False Memory Syndrome where the person actually believes the lies that they tell. Writings relating to pathological lying first appeared in the psychiatric literature over 100 years ago and have been given names such as ‘pseudologia fantastica and ‘mythomania’. Pathological lying has been defined by Dr Charles Dike and his colleagues at Yale University as “falsification entirely disproportionate to any discernible end in view, may be extensive and very complicated, and may manifest over a period of years or even a lifetime”. It s thought to affect men and women equally with an onset in late adolescence. There are no reliable prevalence figures although one study estimated that one in a 1000 repeat juvenile offenders suffered from it.  A study published in the British Journal of Psychiatry reported differences in brain structure between pathological liars and control groups. Pathological liars showed a relatively widespread increase in white matter (approximately one-quarter to one-third more than controls) and suggested that this increase may predispose some individuals to pathological lying.

These five activities were just the tip of the iceberg. I also came across alleged addictions to heavy metal music, teeth whitening, body modification (piercing and tattoos), animal hoarding, and reading. They will have to wait for another time.

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

Further reading

Chatterjee, A. (2007). Cosmetic neurology and cosmetic surgery: Parallels, predictions, and challenges.Cambridge Quarterly of Healthcare Ethics, 16, 129-137.

Dike, C.C., Baranoski, M. & Griffith, E.E. (2005). Pathological lying revisited. Journal of the American Academy of Psychiatry and the Law, 33, 342–349.

Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemadej, U.J., Cole, O.J., Westney, O.E.,  Jones, S. Laryea, H. &  Westney, L.S. (1994). Pica in an urban environment. Journal of Nutrition (Supplement), 124, 954-962.

Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Griffiths, M.D. (2008). Internet and video-game addiction. In C. Essau (Ed.), Adolescent Addiction: Epidemiology, Assessment and Treatment. pp.231-267.  San Diego: Elselvier.

Hata, T., Mandai, T., Ishida, K., Ito, S., Deguchi, H. & Hosoda, M. (2009). A rapid recovery from pagophagia following treatment for iron deficiency anemia and TMJ disorder accompanied by masked depression. Kawasaki Medical Journal, 35, 329-332.

Heckman, C.J., Egleston, B.L., Wilson, D.B. & Ingersoll, K.S. (2008). A preliminary investigation of the predictors of tanning dependence. American Journal of Health Behavior, 32, 451-464

Joshi, S. & Lalbeg, V.K. (2011). Texting mania – A social dilemma. International Journal of Research in Commerce, Economics, and Management, 1(3), 132-135.

King, B.H. & Ford, C.V. (1988). Pseudologia fantastica. Acta Psychiatrica Scandinavica, 77, 1-6

Kirchner, J.T (2001). Management of Pica: A Medical Enigma. American Family Physician, 63, 1177-1178.

Osman, Y.M., Wali, Y.A. & Osman, O.M. (2005). craving for ice and iron-deficiency anemia: a case series. Pediatric Hematology and Oncology, 22, 127-131.

Yang, Y., Raine, A., Narr, K., Lencz, T., LaCasse, L. Colleti, P., & Toga, A. (2007). Localisation of increased prefrontal white matter in pathological liars. British Journal of Psychiatry, 190, 174-175.