Pathological Gambling: Update on Assessment and Treatment

Psychiatric Comorbidity Associated With Pathological Gambling

Clinical Assessment and Management of Pathological Gambling

Gender Differences Should Be Considered in Treatment of Addiction

Surveys show that approximately 60% of the general population has gambled within the past 12 months.¹ The majority of people who gamble do so socially and do not incur lasting adverse consequences or harm. Beyond this, approximately 1% to 2% of the population currently meets criteria for pathological gambling.² This prevalence is similar to that of schizophrenia and bipolar disorder, yet pathological gambling often goes unrecognized by most health care providers.

Screening and treatment for pathological gambling-otherwise known as compulsive gambling, gambling addiction, or disordered gambling-is not generally taught in medical school, during psychiatry residency, or during training for mental health or substance abuse counselors. As a result, clinicians may not recognize the signs and symptoms of pathological gambling and may lack the training and experience to provide state-of-the-art treatment.

Diagnostic issues

DSM-IV lists pathological gambling in the section on impulse control disorders. There is an ongoing debate as to where to include pathological gambling in DSM-V. One viewpoint is to include pathological gambling as an addictive disorder because both conditions share core features-namely, loss of control in the face of adverse consequences.³ Another possibility is to view pathological gambling as an obsessive-compulsive spectrum disorder because of the shared symptoms of preoccupation; tension; and repetitive, almost ritualistic behaviors.⁴ Finally, pathological gambling may be viewed as a stand-alone impulse control disorder with unique characteristics, disease course, and pathophysiology.

According to current DSM-IV criteria, pathological gambling is characterized by continued gambling despite harmful consequences. Some of the cardinal symptoms include preoccupation with gambling, tolerance (need to increase the size of bets), loss of control, inability to cut down, and lost opportunities as a result of gambling. Criteria that are specific to pathological gambling include chasing losses, committing illegal acts to finance gambling, and having others pay gambling debts.

Problem gamblers are considered those who meet 1 or more of the diagnostic criteria for pathological gambling but less than 5. This is similar to substance abuse in that the gamblers’ lives are being harmed by gambling, but full criteria are not satisfied.

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