DSM-IV and the South Oaks Gambling Screen: diagnosing and assessing pathological gambling in Turkey

The main purpose of this study was to investigate the effectiveness of the DSM-IV diagnostic criteria and the South Oaks Gambling Screen (SOGS) in identifying Turkish pathological gamblers. Fifty-nine subjects participated in the study. The subjects were diagnosed as either pathological gamblers or not (comparison group) through the use of the DSM-IV criteria and were given the Turkish version of the SOGS. Four of the ten DSM-IV criteria were found to be problematic in the diagnosis of Turkish pathological gamblers. The data concerning reliability and validity of the Turkish version of the SOGS suggested that the SOGS can be used as a reliable and valid instrument in identifying Turkish pathological gamblers. Most (16 out of 20) of the items of the SOGS appear to work well in discriminating pathological gamblers from the subjects in the comparison group. In the case of the two DSM-IV criteria and the four SOGS items that failed to discriminate, cultural factors seemed to be responsible for the failure.     

Examining DSM-IV Criteria for Pathological Gambling: Psychometric Properties and Evidence from Cognitive Biases

We examined the DSM-IV criteria for pathological gambling as assessed with the DSM-IV-based Diagnostic Interview for Gambling Severity (DIGS; Winters, Specker, & Stinchfield, 2002). We first analyzed the psychometric properties of the DIGS, and then assessed the extent to which performance on two judgment and decision-making tasks, the Georgia Gambling Task (Goodie, 2003) and the Iowa Gambling Task (Bechara, Damasio, Damasio, & Anderson, 1994), related to higher reports of gambling pathology. In a sample of frequent gamblers, we found strong psychometric support for the DSM-IV conception of pathological gambling as measured by the DIGS, predictive relationships between DIGS scores and all cognitive performance measures, and significant differences in performance measures between individuals with and without pathological gambling. Analyses using suggested revisions to the pathological gambling threshold (Stinchfield, 2003) revealed that individuals meeting four of the DSM-IV criteria aligned significantly more with pathological gamblers than with non-pathological gamblers, supporting the suggested change in the cutoff score from five to four symptoms. Discussion focuses on the validity of the DSM-IV criteria as assessed by the DIGS and the role of cognitive biases in pathological gambling.     

Screening for college problem gambling in Chinese societies: psychometric properties of the Chinese version of the South Oaks Gambling Screen (C-SOGS)

A total of 979 Chinese college students were recruited in order to examine the psychometric properties of the Chinese version of the South Oaks Gambling Screen (C-SOGS). The C-SOGS was internally consistent and correlated with gambling-related problems and negative mental health status. Results of likelihood ratios (LRs) and receiver operating characteristic (ROC) curve supported the C-SOGS as a valid screening instrument for probable pathological gambling. Using the DSM-IV criteria for pathological gambling, the conventional cut score of 5 on the C-SOGS showed satisfactory sensitivity, specificity and false negative rates. This cut score identified 85% of the true positives and 95% of the true negatives. In general, the C-SOGS overestimated the number of pathological gamblers relative to DSM-IV criteria. Future research on Chinese gambling should build on current empirical work on the SOGS to refine the C-SOGS for use with Chinese populations.     

The classification accuracy of four problem gambling assessment instruments in population research

Improved methodology was used to re-examine the weak correspondence between problem and pathological gamblers identified in population surveys and subsequent classification of these individuals in clinical interviews. The SOGS-R, the CPGI, the NODS and the Problem and Pathological Gambling Measure (PPGM), as well as questions about gambling participation and expenditures, were administered to a total of 7272 adults. Two clinicians then assessed each person's status, based on comprehensive written profiles derived from these questionnaire responses. Instrument classification was then compared to clinical classification. All four instruments correctly classified most non-problem gamblers (i.e. had good to excellent sensitivity, specificity and negative predictive power). However, the PPGM was the only instrument with good classification of problem gamblers (i.e. excellent sensitivity and positive predictive power). The CPGI and SOGS-R had weak positive predictive power and the NODS had only adequate sensitivity and positive predictive power. Improvement in the classification accuracy of the CPGI occurred when a 5+ cut-off was used and when a 4+ cut-off was used with the SOGS. In general, the classification accuracy of the NODS, SOGS and CPGI is better than prior research suggested but overall accuracy is still modest. With adjusted cut-offs, all three instruments are reasonably congruent with clinical ratings.     

Is the SOGS an Accurate Measure of Pathological Gambling Among Children, Adolescents and Adults?

The South Oaks Gambling Screen (SOGS) is widely used to assess the prevalence of pathological gambling. For a variety of reasons, this instrument may not provide an accurate rate of the prevalence of pathological gambling. In this paper, one source of error in data provided by the SOGS is investigated. It is argued that individuals may not fully understand the meaning of some items, and that clarification of the meaning of misunderstood items may in some cases lead to a changed score on the scale. The present study evaluates respondents' understanding of the SOGS items. The results from three studies are reported, each using a different sample: grade school children, adolescents and adults. It was hypothesised that (1) participants would not understand some items of the SOGS, (2) problem gamblers and probable pathological gamblers would be more inclined to interpret items incorrectly than would non-problem gamblers and, (3) consistent with the first two hypotheses, clarification of items would decrease the number of participants identified as problem gamblers or probable pathological gamblers. The data obtained supported hypotheses 1 and 3. Furthermore, hypothesis 2 was supported for grade school children, but not for adolescents or adults. These results are consistent with recent literature on endorsement and acquiescence phenomena, and have implications for prevalence studies of probable pathological gambling.     

Reliability and Validity of the Pathological Gambling Adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS)

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.     

The factorial structure of pathological gambling

Pathological gambling has been characterised by DSM-III-R and DSM-IV as a disorder of impulse control with a proportion of gamblers identified as meeting criteria for a co-morbid diagnosis of Antisocial Personality Disorder. To date, empirical evidence in support of the notion that pathological gamblers as a group manifest elevated traits of impulsivity remains equivocal. Principal components analysis was used to investigate relationships between the constructs of impulsivity, psychopathy, DSM-III-R criteria for Antisocial Personality Disorder, psychological distress, criminal offending behavior and a range of other common psychological measures employed with pathological gamblers. The sample comprised 115 pathological gamblers, 80 consecutive gamblers seeking treatment from a general hospital psychiatric inpatient behavior therapy unit, and 35 volunteer Gamblers Anonymous attenders. Four primary factors were determined: psychological distress, sensation seeking, crime and liveliness, and impulsive-antisocial. Results suggest that pathological gambling consists of a number of discrete and reproducible factorial structures. The impulsive antisocial factor was found to be associated with gambling behavior and indices of poor psychosocial functioning.     

Problem Gambling Within a Chinese Speaking Community

The purpose of this study was to obtain preliminary data on pathological gambling rates within a metropolitan Chinese community to determine if more costly extensive epidemiological surveys were justified. Two thousand survey questionnaires were distributed to parents through children attending a local Chinese speaking school. A response rate of 27.4% was obtained. Over a quarter of respondents were born overseas in either Mainland China or Hong Kong. Results indicated that gambling was not a popular activity with 60.0% of respondents stating that they never gambled. Of those who gambled, a third of respondents identified lotto as the preferred form. Using a Chinese translation version of the SOGS and a cut-off score of 10, a prevalence estimate of 2.9% for pathological gambling was found with males showing a higher rate (4.3%) as compared to females (1.6%). Respondents reporting a prior history of gambling in their country of origin were more likely to be classified as probable pathological gamblers. Despite the use of a sample of convenience, changes to the wording of two items in the Chinese translation of the SOGS and the possibility of false positive cases in the present study, it is concluded that further research into problem gambling in this community should be undertaken.     

Loss of Control as a Discriminating Factor Between Different Latent Classes of Disordered Gambling Severity

Analyses of disordered gambling assessment data have indicated that commonly used screens appear to measure latent categories. This stands in contrast to the oft-held assumption that problem gambling is at the extreme of a continuum. To explore this further, we report a series of latent class analyses of a number of prevalent problem gambling assessments (PGSI, SOGS, DSM-IV Pathological Gambling based assessments) in nationally representative British surveys between 1999 and 2012, analysing data from nearly fifty thousand individuals. The analyses converged on a three class model in which the classes differed by problem gambling severity. This identified an initial class of gamblers showing minimal problems, a additional class predominantly endorsing indicators of preoccupation and loss chasing, and a third endorsing a range of disordered gambling criteria. However, there was considerable evidence to suggest that classes of intermediate and high severity disordered gamblers differed systematically in their responses to items related to loss of control, and not simply on the most ‘difficult’ items. It appeared that these differences were similar between assessments. An important exception to this was one set of DSM-IV criteria based analyses using a specific cutoff, which was also used in an analysis that identified an increase in UK problem gambling prevalence between 2007 and 2010. The results suggest that disordered gambling has a mixed latent structure, and that present assessments of problem gambling appear to converge on a broadly similar construct.     

Brief Communications Analysis of a Casino's Self-Exclusion Program

As gambling facilities become more available, the number of pathological gamblers increases. Effective therapeutic and preventive interventions should be developed and systematically evaluated. Self-exclusion programs may be a useful means to facilitate self-control among problem gamblers. This paper describes the characteristics of individuals who decided to bar themselves from a Canadian casino. Two hundred twenty individuals participated in the present study and completed a questionnaire including four sections: (1) socio-demographic data, (2) the South Oaks Gambling Screen, (3) gambling habits, and (4) prior experiences with the self-exclusion program. According to the SOGS, 95% of the participants were classified as severe pathological gamblers on the SOGS (Mean score = 9.87). Furthermore, based on self-reported observation, 30% of the participants completely stopped gambling once enrolled in this program. No one scored within the interval of non-problem gamblers. Suggestions to improve self-exclusion programs are discussed.     

Gambling over the life course and treatment-seeking

The purpose of this study is to investigate change in gambling behaviours over the life course, and, correspondingly, the treatment-seeking behaviours of 86 people who met the criteria for at-risk (participants endorsing two to four items on the South Oaks Gambling Screen [SOGS]) and problem gamblers (participants endorsing five or more items on the SOGS) over the last five years. Data were obtained from informants during semi-structured interviews using Structured Clinical Interview for DSM-IV axis I and axis II disorders (SCID I and II), SOGS and treatment-seeking interviews. The results showed three groups of gambling behaviours over the life course. A first group started gambling early on and continued participating in recreational gambling until its participants were between 40 and 50 years of age, during which time they became problem gamblers. A second group transitioned from recreational gambling to problem gambling over a short period of time; its participants were aged between 40 and 50. Lastly, a third group which was exposed to gambling later on in life, mostly after retirement, developed gambling problems quickly. Psychopathology was prevalent in all groups, given that 98% suffered from a mental health problem during their life, and 62% within the last six months. Participants who made use of the services available mostly turned to medical and specialized mental services for brief periods, usually when in crisis. In terms of problem gambling, the results argue in favour of maintaining dedication toward treatment, especially in the presence of co-morbidity.     

Problem gambling in a federal prison population: results from the South Oaks Gambling Screen

Three hundred and sixty three medium security federal prison inmates were interviewed with the South Oaks Gambling Screen (SOGS) with 5.2% of the sample achieving SOGS scores greater than 4 and another 7.4% attaining scores of 3 or 4, traditional markers of pathological gambling and problem gambling, respectively. Attempts were made to evaluate the relative accuracy of the continuum and dichotomy models of problem gambling by contrasting three groups of subjects (SOGS < 3, SOGS = 3 or 4, SOGS > 4) on a series of gambling-related measures and comparing the relative ability of the SOGS and a dichotomized version of the SOGS to account for residual variance in these same gambling-related measures. Results were consistent with the view that problem gambling embodies features of both a continuum and dichotomy. Nearly half the subjects had desisted from problem gambling on their own, although self-remitters displayed less severe and extensive patterns of problem gambling than non-remitting subjects.     

A Comparison of Horse-Race, Bingo, and Video Poker Gamblers in Brazilian Gambling Settings

In the present study Brazilian gamblers from different settings were compared on socio-demographic characteristics, gambling behavior, and use of drugs. The SOGS was administered to 171 subjects at bingo (BG), video poker (VP), and horse-racing clubs (HR) of São Paulo. BG concentrated most women, VP the youngest and single gamblers, and HR the lowest income subjects. More VP than HR or BG gamblers reported taking time off work to gamble, as well as returning another day to win back lost money. They also had a higher number of scorable responses on the SOGS. The differences observed suggest that VP gamblers bear a greater risk of developing a pathological gambling pattern. The authors suggest that measures should be taken aimed at the prevention of pathological gambling, particularly among the young population of video poker gamblers.     

Gambling Behavior and Pathology in Relation to Impulsivity, Sensation Seeking, and Risky Behavior in Male College Students

Sensation seeking and impulsivity are two constructs of personality that are generally believed to be associated with risky behavior, including gambling. Despite the fact that pathological gambling is classified as an Impulsive Control Disorder in the DSM-IV, relatively little empirical research has investigated the relationship between gambling and impulsivity. The purpose of this study was to investigate the relationship between sensation seeking, impulsivity, risky behaviors and gambling. One hundred and forty-four male undergraduate university students completed several inventories measuring sensation seeking, impulsivity, gambling, and risky behaviors. Statistical analyses revealed a very high percentage of participants were classified in the pathological gambler range of scores. In addition, a significant difference was found between the relationships of sensation seeking, impulsivity, and risky behaviors with gambling scores in the pathological versus non-pathological groups. Pathological gambler's scores on measures of sensation seeking and impulsivity did not correlate with their degree of gambling pathology. In contrast, the sensation seeking and impulsivity scores of non-pathological gamblers did correlate with their scores of gambling pathology. These results have implications on Jacob's General Theory of Addiction. The findings of this study also suggest that the classification of gambling as an impulse control disorder rather than an addictive disorder needs to be reevaluated.     

Alexithymia and Gambling: A Risk Factor for All Gamblers?

The purpose of this study was to investigate alexithymia (in relation with depression) in three groups of French gamblers (n = 186) recruited in their gambling location: at the racetracks (n = 80 males; mean age 28.1 years), in the slot machine rooms (n = 65; 29 males, 36 females; mean age 34.6 years), and in the traditional gaming rooms (n = 41 males; mean age 36 years). Gambling behavior was measured by the South Oaks Gambling Screen and DSM-IV criteria for pathological gambling, Alexithymia by the Toronto Alexithymia Scale (TAS-20) and depression with the Beck Depression Inventory (BDI-13). For racetracks and slot machine gambling, pathological gamblers differed from non-pathological gamblers, regarding their alexithymia scores. These results remained stable after controlling for depression scores among the racetracks gamblers only. The relationship between alexithymia and depression depends on the type of pathological gambler. These findings are consistent with the idea of identifying clinically distinct subgroups of gamblers.     

Impulsiveness,Locus of Control,Motivation and Problem Gambling

A questionnaire consisting of demographic items, questions about gambling behavior, the South Oaks Gambling Screen (SOGS), a depression inventory, the Eysenck Impulsiveness Questionnaire, Levensons Internality, Powerful Others and Chance Scales of locus of control and the Gambling Motivation Scale, was completed by a non-random sample of 147 New Zealand university students who gambled for money, median age 24 years. Approximately 17 of the sample was classified as problem gamblers, the rest as non-problem gamblers. Multivariate analysis of variance showed that there were significant differences between problem and non-problem gamblers on gambling frequency, number of activities, parents gambling, depression, impulsiveness and motivation, but not on locus of control. Amotivation (apathy) and motivation towards stimulation correlated with powerful others and chance locus of control, and motivation to impress others with powerful others locus of control. Hierarchical regression analysis showed that: (1) beyond gambling frequency, number of activities and parents gambling, motivation explained a substantial proportion of variance in SOGS scores, with impulsiveness accounting for a lesser amount, and (2) predictors of problem gambling included impulsiveness, amotivation and the motivations for accomplishment and tension release. It was concluded that gambling motivation is a more useful construct than locus of control in explaining problem gambling. Suggestions were made for future research, and aspects of gambling motivation were discussed in terms of a treatment program with groups of problem gamblers.     

Psychological characteristics of volunteers in studies on gambling

Advertisements were published in local newspapers asking for volunteers to participate in a study on gambling. A battery of eleven questionnaires was mailed to the subjects assessing pathological gambling behavior, sociodemographic characteristics, motivation to gamble, erroneous perceptions about gambling, superstitious beliefs, depressive symptoms, social anxiety and avoidance, alcohol and drug abuse, problem-solving skills, and marital satisfaction. Subjects received $10 when they returned the questionnaires fully completed. Response rate was over 95%. Surprisingly, 29% of the respondents met the criterion for probable pathological gambling (score of 5 or more on the SOGS) and a further 16% were identified as potential pathological gamblers (scores of 3 or 4). The potential and probable pathological gamblers showed significant differences on motivational and cognitive variables related to gambling compared to those subjects who showed no signs of pathological gambling. The probable pathological gamblers reported significantly more signs of poor psychosocial functioning than the other two groups, including depressive symptoms, poor problem orientation, drug and alcohol abuse, and interpersonal conflict. The practical and theoretical implications of these results are discussed.     

The Impact of Social Desirability Biases on Self-Report Among College Student and Problem Gamblers

The impacts of two types of social desirability bias, self-deceptive enhancement (SDE) and impression management (IM), were examined on self-reports of gambling problems, measured by the South Oaks Gambling Screen (SOGS), and recent gambling behavior, as measured by the Timeline Followback (TLFB) method, in a sample of college students (N = 191), and a sample of treatment-seeking problem gamblers (N = 49). Consistent with our expectations, IM was negatively associated with SOGS scores in both samples. IM was most highly correlated with SOGS scores among treatment-seeking participants (r = −.44, p < .01). Substantial numbers of participants in both samples had high enough IM scores as to call into question the validity of their self-report gambling data, according to published interpretive guidelines. With respect to SDE, we had predicted that it would be positively related to gambling behaviors and gambling-related problems, but found that SDE was inversely related to SOGS scores in both samples. Very little evidence was found for social desirability effects on TLFB scores. Thus, preliminary evidence was obtained that self-report data on gambling problems, but not on gambling behavior (frequency of gambling and amount of time and money spent), may be susceptible to the effects of impression management in both college students and treatment-seeking gamblers.     

Reliability,Validity and Classification Accuracy of the South Oaks Gambling Screen in a Brazilian Sample

The purpose of this study was to examine the reliability, validity and classification accuracy of the South Oaks Gambling Screen (SOGS) in a sample of the Brazilian population. Participants in this study were drawn from three sources: 71 men and women from the general population interviewed at a metropolitan train station; 116 men and women encountered at a bingo venue; and 54 men and women undergoing treatment for gambling. The SOGS and a DSM-IV-based instrument were applied by trained researchers. The internal consistency of the SOGS was 0.75 according to the Cronbach’s alpha model, and construct validity was good. A significant difference among groups was demonstrated by ANOVA (F _(2.238) = 221.3, P < 0.001). The SOGS items and DSM-IV symptoms were highly correlated (r = 0.854, P < 0.01). The SOGS also presented satisfactory psychometric properties: sensitivity (100), specificity (74.7), positive predictive rate (60.7), negative predictive rate (100) and misclassification rate (0.18). However, a cut-off score of eight improved classification accuracy and reduced the rate of false positives: sensitivity (95.4), specificity (89.8), positive predictive rate (78.5), negative predictive rate (98) and misclassification rate (0.09). Thus, the SOGS was found to be reliable and valid in the Brazilian population.     

Measuring pathological gambling in children: The case of fruit machines in the U.K.

The alleged incidence of addiction to fruit machine gambling among children in the U.K. has highlighted the need for a measure to define and count pathological gambling in children. The DSM-IV criteria, which are being refined to diagnose pathological gambling in adults, was adapted for use with pre-adult gamblers. The resulting DSM-IV-J criteria were tested using a questionnaire survey on a sample of 467 schoolchildren aged between 11 and 16 years. Those children who were defined as probable pathological gamblers by the DSM-IV-J index were significantly more likely to be involved in behaviours hitherto associated with dependency, than were the control group. DSM-IV-J appears to be a major advance in the discrimination of pathological gambling in children.The author would like to thank the Economic and Social Research Council for funding this work through a Research Studentship Grant. The author would also like to thank Henry Lesieur Ph.D. and Mark Dickerson Ph.D. for their helpful comments in the design stage of this research.