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.
- 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
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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.
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
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.
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).
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
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.
“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.
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
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.
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.