Antisocial personality disorder and pathological gambling

The prevalence of antisocial personality disorder and its relationship to criminal offenses in pathological gamblers was investigated. A semi-structured interview schedule containing DSM-III criteria for antisocial personality and the California Psychological Inventory Socialisation subscale was administered to a sample of 306 pathological gamblers. Of the total sample, 35% reported no offense. Forty eight percent admitted to the commission of a gambling related offense, 6% to a non-gambling related offense, and 11% to both types of offense. Fifteen percent of subjects met DSM-III diagnostic criteria for antisocial personality disorder. Though these subjects were at greatest risk for committing criminal offenses, offenses were committed independently of DSM-III antisocial personality disorder in the majority of gamblers. It was concluded that features of antisocial personality emerged in response to repeated attempts to conceal excessive gambling and gambling induced financial difficulties.This study was supported by a grant from the Criminology Research Council. The views expressed are the responsibility of the authors and are not necessarily those of the Council. The contribution of Anna Frankova, Research Assistant, is gratefully acknowledged.     

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.     

Pathological Gambling: Influence of Quality of Life and Psychological Distress on Abstinence After Cognitive-Behavioral Inpatient Treatment

The aim of this study is to understand the influence of psychological distress and quality of life on the maintenance of therapy success during a 1 year follow-up in pathological gamblers after inpatient cognitive-behavioral treatment. In a sample of 281 pathological gamblers (247 men, 34 women) the following measures were taken: psychological distress (beginning and end of treatment, and follow up), quality of life and abstinence from gambling. The results showed that relapsed pathological gamblers suffer of higher psychological distress at discharge and of lower quality of life during follow-up than abstinent gamblers. In a mediator analysis the causal relations between the three variables could be clarified: psychological distress has an impact on abstinence during follow-up, and quality of life can be considered a mediator variable for the relation between psychological distress and abstinence from pathological gambling.     

Crime,antisocial personality and pathological gambling

To investigate the hypothesized causal relationship between pathological gambling and gambling-related illegal behaviors, 77 patients seeking behavioral treatment for excessive gambling and 32 members of Gamblers Anonymous were administered a structured interview schedule. Data on the incidence, nature and extent of both gambling and non-gambling related illegal behaviors was obtained and DSM-III (A.P.A., 1980) criteria for Antisocial personality were used as the measure of sociopathy.Of the sample, 54.1% admitted to a gambling related offense and 21.1% were charged. Results showed that 14.6% met DSM-III criteria for Antisocial Personality, Four subgroups were subsequently identified; gamblers who committed no offense (36.7%), gambling only offenses (40.4%), non-gambling only offenses (9.2%) or both gambling and non-gambling offenses (13.7%). Significantly more subjects from the gambling plus non-gambling related offenses subgroup were classified as antisocial personalities.Of pathological gamblers who committed offenses, two thirds reportedly did so as a direct consequence of gambling induced problems. Subjects reporting gambling-only related offenses showed a significant increase in antisocial features after adolescence suggesting that antisocial features emerge as a secondary phenomenon to pathological gambling behavior patterns.Acknowledgments: This study was made possible by a grant from the Criminology Research Council, Australian Institute of Criminology.     

The medical model of pathological gambling: Current shortcomings

Occasional, regular and pathological gambling are distributed in the population as a continuum. Failure to find categorical features of pathological gambling weakens the medical model for this condition, and the implications of this model concerning treatment, both in relation to the possibility of controlled gambling as an acceptable goal, and as to the effectiveness of social manipulations, such as restrictions of gambling outlets. Differences in gambling behavior patterns between pathological and nonpathological gamblers has not been consistently demonstrated and though some support exists for a relationship between addiction to gambling and alcohol, this could be accounted for by other factors than an addiction-prone personality. While findings support a relationship between personality variables and pathological gambling, the concept of a single personality type associated with the behavior seems unlikely. Nevertheless, evidence of physiological differences between pathological gamblers and controls has recently been reported and if established would provide strong support for a medical model, particularly one which allows for an interaction of physiological and sociological factors resulting in dimensional distribution of gambling behaviors.     

An Examination of the Relationship Between Gambling and Antisocial Behavior

Problem gambling is significantly more prevalent in forensic populations than in the general population. Although some previous work suggests that gambling and antisocial behavior are related, the extent and nature of this relationship is unclear. Both gambling and antisocial behavior are forms of risk-taking, and may therefore share common determinants. We investigated whether individual differences in personality traits associated with risk-taking, the Big Five personality traits, and antisocial tendencies predicted gambling and antisocial behavior among 180 male students recruited for a study of gambling (35.0% non-problem gamblers, 36.7% low-risk gamblers, 21.7% problem gamblers, and 6.7% pathological gamblers). All forms of gambling and antisocial behavior were significantly correlated. Personality traits associated with risk-acceptance explained a significant portion of the variance in problem gambling, general gambling involvement, and all forms of antisocial behavior. Antisocial tendencies (aggression and psychopathic tendencies) explained a significant portion of additional variance in severe antisocial behavior but not moderate or minor antisocial behavior. When controlling for personality traits associated with risk-acceptance, the relationship between gambling and antisocial behavior was greatly diminished. The results are consistent with the hypothesis that gambling and antisocial behavior are associated because they are, in part, different manifestations of similar personality traits.     

Online gambling participation and problem gambling severity: is there a causal relationship?

Studies of Internet gambling have consistently shown that online gamblers are more likely to report disordered gambling behaviour than offline gamblers. However, little research has focused on whether this is a causal relationship or whether this risk factor is capturing a relationship with one or more missing variables. To address whether there is a strong causal argument for the effect of online gambling participation on problem gambling severity, we use a secondary data method that corrects for potential omitted variable bias. Once this issue is addressed, we find that past-year participation in online gambling is related to a decrease in problem gambling severity, which is the opposite of the popular view in current literature. The estimates in this study are found to be robust to various forms of online gambling, control variables and problem gambling measurement instruments. The findings were also consistent when using a representative sample from the United Kingdom and when using an online research panel from Ontario, Canada. As a primary force against the widespread adoption of Internet gambling has been public health concern over problem gambling, this study provides evidence that such decisions should be more closely considered by policymakers.     

Health Outcomes in Individuals with Problem and Pathological Gambling: An Analysis of the 2014 North Carolina Behavioral Risk Factor Survey System (BRFSS)

Problem and pathological gambling refers to subclinical and clinical levels of maladaptive gambling, respectively, and is associated with specific sociodemographic characteristics as well as a number of poor health outcomes. We examined such demographic, physical health, mental health, and health-related behaviors in a sample of 7045 low-risk gamblers and 244 problem/pathological gamblers. Participants completed the 2014 North Carolina Behavioral Risk Factor Surveillance System telephone survey. Using the National Opinion Research Center’s Diagnostic Screen for Gambling Disorders-CLiP, participants were categorized as either “problem/pathological gamblers” or “low-risk gamblers.” Problem/pathological gamblers were younger, more likely to be male, of ethnic minority status, unmarried, and of lower education than low-risk gamblers. No physical health variables differentiated the groups but problem/pathological gamblers reported experiencing significantly more adverse childhood experiences and engaging in significantly more tobacco and alcohol use compared to low-risk gamblers. Moreover, gender moderated relationships between gambling group and several of the alcohol use variables such that male problem/pathological gamblers exhibited greater alcohol use behavior than male low-risk gamblers but no such relationship was present in females. Overall, this study expands the current knowledgebase on disordered gambling and highlights the need to assess disordered gambling in public health samples. Clinical implications are discussed.     

Delinquency among pathological gamblers: A causal approach

In a comprehensive research project on gamblers in self-help groups in West Germany one object of investigation was the question of whether or not pathological gambling has a criminogenic effect. 54.5% of the 437 members of Gamblers Anonymous interviewed stated that they had committed illegal actions in order to obtain money for gambling. Comparisons of this sub-group with those interviewees who did not admit having committed criminal offences show distinct differences: Those who admitted illegal action were more excessive in their gambling behavior and experienced a higher degree of subjective satisfaction through gambling. They also showed a more pronounced problem behavior and more psychosocial problems because of gambling. A multiple regression within the framework of path analysis was computed in order to explore causal links between pathological gambling and delinquency. The results support the hypothesis that pathological gambling can lead to delinquent behavior. Forensic implications are discussed.This article is a revised version of a paper presented at the Eighth International Conference on Risk and Gambling in London, U.K., August 15–17, 1990.The content and presentation of this article has benefited from the comments of Agnes Roemer, Department of Psychology, University of Bremen.     

Professional and Pathological Gamblers: Similarities and Differences

Although much recent research has focused on the gambling practices and psychosocial functioning of pathological gamblers, few investigations have examined the characteristics of professional gamblers. The current project sought to address this gap in the literature by conducting a quantitative comparison of professional and pathological gamblers. Pathological gamblers were recruited and balanced with professional gamblers on demographic variables and preferred gambling activity. A total of 22 professional gamblers and 13 pathological gamblers completed an extensive self-report battery including instruments assessing demographics, gambling behaviors and problems, other psychiatric disorders, current psychosocial functioning, recent stressful events, personality characteristics, and intelligence. Pathological and professional gamblers reported similar rates of gambling frequency and intensity and types of games played. Pathological gamblers endorsed poor psychosocial functioning, whereas professional gamblers reported a rate of psychiatric distress within a normative range. Pathological gamblers also reported lower gambling self-efficacy, greater impulsivity, and more past-year DSM-IV Axis I disorders than professional gamblers. The results of the present study shed light on the unique circumstances of professional gamblers, as well as underscore important differences between such individuals and pathological gamblers that could prove fruitful in future research and intervention and prevention efforts.     

Criminal offenses in gamblers anonymous and hospital treated pathological gamblers

The purpose of this study was to compare the nature and prevalence of gambling and non-gambling related offenses in samples of pathological gamblers seeking behavioural treatment from a hospital-based program and those attending Gamblers Anonymous. A semi-structured interview schedule obtaining demographic data and details of the nature, frequency, and consequent legal action of criminal offenses committed was administered to 152 consecutive hospital treated pathological gamblers, and 154 Gamblers Anonymous attendees who volunteered to participate in the study. Of the total sample, 59% admitted a gambling-related offense, and 23% to a conviction. There was no difference in the proportion of hospital treated and Gamblers Anonymous subjects who offended. The most common gambling-related offenses were larceny, embezzlement and misappropriation. Gamblers committed a median of ten offenses over an average ten year period of pathological gambling with a median value of $ A 300¹ per offense. The median value for each non-gambling-related offense was $ A 130. Except for the significantly older mean age of Gamblers Anonymous subjects, hospital treated gamblers did not differ from Gamblers Anonymous attenders on relevant demographic features or parameters of gambling behaviour. Findings were interpreted to suggest a possible causal link between pathological gambling and the commission of non-violent property offenses.This study was supported by a grant from the Criminology Research Council. The views expressed are the responsibility of the authors and are not necessarily those of the Council. The contribution of Anna Frankova, Research Assistant, is gratefully acknowledged.     

In Search of Executive Impairment in Pathological Gambling: A Neuropsychological Study on Non-treatment Seeking Gamblers

Pathological gambling is characterized by a persisting maladaptive and recurrent behavior with severe social and psychological consequences. There is evidence of strong comorbidity with psychiatric manifestations as well as cognitive mainly involving executive functions. This study aimed to investigate impairment in executive functions and working memory, and personality traits in a sample of Greek gamblers. Twenty-four men involved in various gambling activities were recruited from ecological settings as probable pathological gamblers. They were assessed with a comprehensive neuropsychological battery involving several executive tasks, the Zuckerman–Kuhlman Personality Questionnaire, the Hospital Anxiety Depression Scale, and the Difficulties in Emotion Regulation Scale. An age- and education-level matched group of 21 men without history of habitual gambling served as controls. As a group, gamblers displayed significantly lower scores on indices of inhibition, decision making and self-reported emotional awareness, and scored higher on impulsivity/sensation seeking personality traits. Notably, gamblers scored similarly or significantly higher on measures of verbal and visuospatial working memory, cognitive flexibility, processing speed, verbal fluency, and sustained attention. Overall, we argue that gamblers do present with specific cognitive deficits, but there is no evidence for a generalized executive impairment, and further stress the importance of investigating cognitive, personality, and psychiatric aspects of gambling on the basis of an ecologically valid sampling.     

Measuring Self-efficacy in Gambling: The Gambling Refusal Self-Efficacy Questionnaire

This paper reports on the development and psychometric properties of a Gambling Refusal Self-Efficacy Questionnaire (GRSEQ). Two hundred and ninety-seven gamblers from both normal and clinical populations completed an initial set of 31-items of which 26 were selected for inclusion in the final version of the GRSEQ. A series of factor analyses showed four clear factors accounting for 84% of the variance. These factors can be summarised as situations and thoughts associated with gambling, the influence of drugs on gambling, positive emotions associated with gambling and negative emotions associated with gambling. The GRSEQ total score and factors scores showed high internal consistency (Cronbach’s alpha ranging from 0.92 to 0.98). Participants experiencing problems with gambling scored significantly lower on the GRSEQ, and discriminant analyses showed that the scale is able to correctly classify the non-problem (i.e., community and student samples) and problem gamblers (i.e., clinical sample). Furthermore, the GRSEQ showed significant negative relationships with other gambling-related variables (gambling urge and gambling-related cognitions) and negative mood states (depression, anxiety and stress) and was shown to be sensitive to change in treatment of pathological gambling. The results suggest that the GRSEQ is a useful measure of gambling refusal self-efficacy that is suitable for assessment of gamblers from both normal and clinical populations.     

Treatment Goal Selection for Female Pathological Gambling: A Comparison of Abstinence and Controlled Gambling

The current study was an exploratory investigation of the selection of controlled gambling as a goal of treatment for female pathological gambling. Specifically, it aimed to explore: 1) the popularity of controlled gambling as a goal of treatment; 2) the reasons pathological gamblers select abstinence and controlled gambling as goals of treatment; and 3) the characteristics of pathological gamblers attracted to abstinence and controlled gambling. The sample comprised 85 female pathological gamblers attending a cognitive-behavioural treatment program for pathological gambling. The selection of controlled gambling by one-third (34%) of the sample suggests that, at least in the Australian context, controlled gambling is a relatively popular goal of treatment for female pathological gamblers. In this study, the only differences between treatment-seeking female pathological gamblers selecting abstinence and controlled gambling were that those selecting controlled gambling were older and were less likely to endorse the belief that problematic gambling is a disease or affliction that can only be overcome by lifelong abstinence. Further research investigating the characteristics of pathological gamblers associated with controlled gambling as both a goal and outcome of treatment is required in order to ensure that treatment-seeking pathological gamblers can make an informed decision regarding their goal selection.     

Age of Onset in Pathological Gambling: Clinical,Therapeutic and Personality Correlates

We aimed to explore the association between age of onset of gambling problems and current psychopathological and clinical status, personality profile and therapeutic outcome in a sample of pathological gamblers. A total of 904 consecutive pathological gambling patients were administered several instruments about gambling behavior, psychopathology and personality. They received a 4-month cognitive-behavioral group treatment. Information of dropouts and relapses during treatment was registered. Older age of onset of gambling problems was associated with higher general psychopathology (SCL-90-R Paranoid Ideation, Psychoticism, Depression; P < 0.015). Younger age of onset was related to greater severity of pathological gambling (P < 0.015), higher novelty seeking, and lower self-directedness (P < 0.015). No statistically significant association was found between age of onset and relapse and dropouts during treatment. Age of onset of gambling problems seems to influence the clinical presentation of pathological gambling but not treatment outcome.     

Psychological Vulnerability and Problem Gambling: The Mediational Role of Cognitive Distortions

Despite numerous studies demonstrating the influence of cognitive distortions on gambling problem severity, empirical data regarding the role of psychological vulnerability on the latter is limited. Hence, this study assesses the mediating effect of cognitive distortions between psychological vulnerability (personality and mood), and gambling problem severity. It also verifies whether the relationships between these variables differs according to the preferred gambling activity. The sample is composed of 272 male gamblers [191 poker players; 81 video lottery terminal (VLT) players] aged between 18 and 82 years (M = 35.2). Bootstrap analysis results revealed that cognitive distortions mediate the effect of narcissism on gambling problem severity for both groups. The level of depression for VLT players significantly predicted gambling problem severity, both directly and indirectly via the mediating effect of cognitive distortions. Mediation analyses also indicated that narcissism had an indirect impact on problem gambling through cognitive distortions for both groups. These findings suggest that certain vulnerabilities related to personality and mood may influence cognitive distortion intensity and gambling problem severity. In addition, psychological vulnerabilities could differ based on preferred gambling activity. These results may be useful for prevention policies, identifying high risk gamblers and planning psychological interventions.     

Problem Gambling and Comorbid Psychiatric and Substance Use Disorders Among Drug Users Recruited from Drug Treatment and Community Settings

Little is known about gambling rates of drug users recruited from drug treatment compared with those recruited from the community. We use the Diagnostic Interview Schedule (DIS) to provide lifetime prevalence estimates of problem gambling (i.e., at least one gambling problem) and DSM-III-R pathological gambling (i.e., at least four gambling problems) and describe the association between gambling and psychiatric disorders for drug users recruited from drug treatment settings (n = 512) and from the community (n = 478). We also report the relative risk of being a recreational and problem gambler in this sample. The sample was first interviewed in 1989–90 as a partof two NIDA-funded St. Louis-based studies. The prevalence of problem gambling in the overall sample was 22% and the prevalence of pathological gambling was 11%. There were no statistically significant differences in problem and pathological gambling rates for subjects recruited from drug treatment and those recruited from the community. The conditional prevalence rates, that is, the rate of problem and pathological gambling only among gamblers were 27% and 13.5%, respectively. Major findings indicate that problem gambling was associated with Antisocial Personality Disorder (ASPD), even after controlling for recruitment source and socio-demographic characteristics. In fact, when examining the temporal order of these disorders, we found that pathological gambling was always secondary to ASPD, occurring on average 11.4 years after the onset of ASPD. Problem gamblers, compared with everyone else, were more likely to be male, African-American, recruited from drug treatment, have ASPD and be dependent on illicit drugs. Multinomial logistic regression analysis predicted the relative risk of being a recreational and problem gambler (compared with a nongambler) in this sample according to socio-demographics, ASPD, and dependence on illicit drugs. Results imply that screening for gambling problems will need to be broad-based among drug users.     

Adaptive and Maladaptive Coping Strategies in Adult Pathological Gamblers and Their Mediating Role with Anxious-Depressive Symptomatology

Coping plays a central role in the appearance and persistence of pathological gambling. Anxious and depressive symptomatology also influence pathological gambling and are related to coping. This study aimed to analyze pathological gamblers’ coping strategies and styles, as well as associated anxious and depressive symptomatology. The study sample included 167 male pathological gamblers (mean age = 39.29 years) and 107 non-gamblers (mean age = 33.43 years). Measures of gambling, coping, and anxious and depressive symptomatology were used. Results showed that pathological gamblers’ scored higher in all the maladaptive coping strategies, problem- and emotion-focused disengagement, and disengagement subscales. These subscales also correlated with pathological gambling, and anxious and depressive symptomatology. Pathological gamblers also scored higher in emotional expression and emotion-focused engagement, with no differences in the rest of the adaptive coping strategies. Coping was also found to predict pathological gambling and anxious and depressive symptomatology. It was found that coping mediated the relationship between pathological gambling and anxious symptomatology when controlling for the effect of age. Specifically, social withdrawal and disengagement stood out as mediators. These results provide practical information for use in clinical settings with people diagnosed with pathological gambling.     

Impulsivity and Stress Response in Pathological Gamblers During the Trier Social Stress Test

Gambling has been associated with increased sympathetic nervous system output and stimulation of the hypothalamic–pituitary–adrenal axis. However it is unclear how these systems are affected in pathological gambling. This study aimed to investigate the effect of the Trier Social Stress Test (TSST) on cortisol and on cardiac interbeat intervals in relation to impulsivity, in a sample of male pathological gamblers compared to healthy controls. In addition, we investigated the correlation between the TSST, duration of the disorder and impulsivity. A total of 35 pathological gamblers and 30 healthy controls, ranging from 19 to 58 years old and all male, participated in this study. Stress response was measured during and after the TSST by salivary cortisol and cardiac interbeat intervals; impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). Exposure to the TSST produced a significant increase in salivary cortisol and interbeat intervals in both groups, without differences between groups. We found a negative correlation between baseline cortisol and duration of pathological gambling indicating that the longer the duration of the disorder the lower the baseline cortisol levels. Additionally, we found a main effect of impulsivity across groups on interbeat interval during the TSST, indicating an association between impulsivity and the intensity of the neurovegetative stress response during the TSST. Involvement of the hypothalamic–pituitary–adrenal axis in pathological gambling was confirmed together with evidence of a correlation between length of the disorder and diminished baseline cortisol levels. Impulsivity emerged as a personality trait expressed by pathological gamblers; however the neurovegetative response to the TSST, although associated with impulsivity, appeared to be independent of the presence of pathological gambling.     

Personality Disorders Among Pathological Gamblers

The objective of this study was to investigate the prevalence of DSM-III-R diagnostic categories of personality disorders in pathological gamblers and to highlight the possible association between such disorders, psychological distress and selected forms of gambling. The Personality Disorders Questionnaire-Revised and a battery of psychometric measures were administered to a sample of 82 consecutive admissions to a behavioral treatment program for gambling problems at an impulse control disorders research unit in Sydney, Australia. Seventy-three percent of subjects were male. The total sample reported having gambled a mean of 15 years of which, on average, the last 6.4 years were associated with problems. Results indicated that the majority of subjects met diagnostic criteria for at least one Personality Disorder (93%), with an average of 4.6 personality disorders per subject. The majority of gamblers evidenced personality disorders from the Cluster B grouping with particularly high rates of borderline, histrionic, and narcissistic personality disorders which were found to be associated with high levels of impulsivity and affective instability. Antisocial personality disorder and narcissistic personality disorder were both found to be possible mediators of the severity of the problem gambling behaviours.