Endorsement of Criminal Behavior Amongst Offenders: Implications for DSM-5 Gambling Disorder

The fifth edition of the diagnostic and statistical manual (DSM) has changed the scoring threshold for a gambling disorder (GD) from five criteria to four and eliminated the illegal acts criterion. The impact of these changes was examined with data from a correctional population (N = 676) in Ontario, Canada. The offenders completed a self-report survey that included the Canadian problem gambling index, the South Oaks Gambling Screen and the DSM-IV criteria. Changing the threshold from 5 to 4 improved the convergent validity for GD and resulted in an increase in the percentage of offenders diagnosed with a GD from 7.4 to 10.2 %. The results also indicate that the illegal acts criterion contributes to the convergent validity of GD. The evidence supports the change in the threshold from five to four, but also reinforces the importance of examining illegal acts when dealing with an offender population. The incorporation of illegal acts into the “lying to others” criteria appears to make up, to some extent, for the removal of the illegal acts criterion.     

Reliability, Validity, and Classification Accuracy of a Spanish Translation of a Measure of DSM-IV Diagnostic Criteria for Pathological Gambling

The aim of this study was to measure the reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling (PG). Participants were 263 male and 23 female patients seeking treatment for PG and a matched non-psychiatric control sample of 259 men and 24 women. A Spanish translation of a 19-item measure of DSM-IV diagnostic criteria for PG (Stinchfield 2003) was administered along with other validity measures. The DSM-IV diagnostic criteria were found to be internally consistent with a coefficient alpha of .95 in the combined sample. Evidence of satisfactory convergent validity included moderate to high correlations with other measures of problem gambling. Using the standard DSM-IV cut-score of five, the ten criteria were found to yield satisfactory classification accuracy results with a high hit rate (.95), high sensitivity (.92), high specificity (.99), low false positive (.01), and low false negative rate (.08). Lowering the cut score to four resulted in modest improvements in classification accuracy and reduced the false negative rate from .08 to .05. The Spanish translation of a measure of DSM-IV diagnostic criteria for PG demonstrated satisfactory psychometric properties and a cut score of four improved diagnostic precision.     

A Psychometric Evaluation of the DSM-IV Pathological Gambling Diagnostic Criteria

Specific diagnostic criteria for pathological gambling (PG) have been available for 25 years, since the publication of DSM-III. Little research has examined the psychometric performance of the diagnostic criteria. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine the sensitivity, specificity and predictive values of the DSM-IV PG criteria for psychiatric outpatients who screened positive for a gambling problem. A total of 1709 psychiatric outpatients were evaluated with a semistructured diagnostic interview for PG. Of all patients 88 screened positive for PG, 40 of whom met DSM-IV diagnostic criteria for a lifetime history of PG. All ten DSM-IV criteria were significantly more frequent in the PG group. The sensitivity of the criteria ranged from 25.0% to 90.0% (mean = 67.8%), whereas specificity ranged from 62.5% to 100% (mean = 81.9%). Positive predictive values ranged from 64.1% to 100% (mean = 78.9%), and negative predictive values ranged from 61.5% to 90.7% (mean = 77.1%). Guidelines are recommended for determining whether a diagnostic criterion should be retained as part of the set of diagnostic criteria, and our results suggested that two of the DSM-IV PG criteria are candidates for elimination (criterion 8—commitment of illegal acts; criterion 10—reliance on others for financial assistance to relieve a desperate financial problem).     

Which Diagnostic Criteria are Most Useful in Discriminating Between Social Gamblers and Individuals with Gambling Problems? An Examination of DSM-IV and DSM-5 Criteria

The current study sought to identify which diagnostic criteria for gambling disorder have the greatest ability to differentiate between social and problem gamblers. This study was conducted on a sample of male and female college student athletes across the U.S. (n = 8674). Classification and regression tree analysis represents an appropriate technique when addressing the question of an item’s diagnostic value, as it sequentially selects variables to isolate sets of observations with similar outcomes. The current results suggest that the item related to preoccupation (“Have there been periods in the past year where you spent a lot of time thinking about gambling?”) was the DSM-5 item best able to differentiate between male and female social and problem gamblers in this sample. When considering only the nine criteria retained in the DSM-5, three criteria were identified as key for distinguishing between social and disordered gamblers among men, and one criterion was identified for distinguishing between groups of women. In addition, these results do not support the notion that the illegal acts criterion has a particularly low base rate and found that it can be an important indicator of disordered gambling in a college-aged sample.     

Reliability,Validity, and Cut Scores of the South Oaks Gambling Screen (SOGS) for Chinese

We examined the reliability, validity, and classification accuracy of the South Oaks Gambling Screen (SOGS) when adopted for use in Chinese. The DSM-IV criteria for pathological gambling served as the standard against which the classification accuracy of the SOGS was tested. A total of 283 Chinese adults in the community and 94 Chinese treatment-seeking gamblers were recruited. The internal reliability of the SOGS was satisfactory for the general sample and acceptable for the gambling sample. The SOGS was correlated with the DSM-IV criteria items as well as psychosocial and gambling-related problems. Relative to the DSM-IV criteria, the SOGS tended to overestimate the number of pathological gamblers in both samples. In general, we were relatively confident that individuals were not pathological gamblers if the SOGS scores were between 0 and 4 and were pathological gamblers if the SOGS were between 11 and 20. There was about 50–50 chance of being pathological gamblers if the SOGS scores were between 8 and 10. However, the probability of individuals being pathological gamblers was about 0.30 if the SOGS scores were between 5 and 7. We proposed a SOGS cut score of 8 to screen for probable pathological gambling in Chinese societies.     

Do the DSM-5 diagnostic revisions affect the psychometric properties of the Brief Biosocial Gambling Screen?

Several significant changes in the diagnostic criteria for gambling disorder occurred with the newest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The changes aim to simplify and streamline the diagnosis without compromising its validity. Yet many of the tools used to screen and diagnose the disorder are based upon the prior fourth edition of the DSM, and it is unclear how they perform with the revised diagnostic criteria. The aim of this study is to examine the psychometric properties of a common pathological gambling screen, the Brief Biosocial Gambling Screen (BBGS; Gebauer, LaBrie, & Shaffer, 2010), in the context of DSM-5 criteria within a help-seeking sample. Gamblers calling a helpline (N = 2750) completed a semi-structured interview assessing DSM-IV past-year pathological gambling criteria with a trained clinician. Sensitivity, specificity, positive predictive value, negative predictive value and differences by sex were examined. The BBGS had high sensitivity as well as positive and negative predictive values. In light of the revisions made to the diagnostic criteria in DSM-5, the BBGS remains a psychometrically supported instrument for gambling disorder.     

Daily and season-long fantasy sports participation and gambling-related problems among a sample of college students at three universities

Traditionally, fantasy sports have been played in season-long leagues, but recently daily fantasy sports (DFS) have emerged, allowing participants to play fantasy contests over shorter periods of time. Although participating in fantasy sports contests with entry fees or deposits could be considered a form of gambling, very few studies have examined associations between fantasy sport participation and gambling-related problems. Using a 2016 sample of college students (N = 941) at three institutions, this study examined associations between fantasy sports participation (season-long and DFS) and (1) gambling, (2) gambling frequency, and (3) endorsing DSM-5 gambling disorder (GD) criteria. The study found that engagement with fantasy sports and paying to play increased the likelihood of gambling and more frequent gambling. Respondents who paid an entry fee/deposit to play fantasy sports gambled more frequently than those who did not, and respondents who participated in DFS endorsed more DSM-5 GD criteria than those who did not. Because of the association found between DFS play and gambling-related problems in some participants, the study suggests that mental health professionals who treat clients with gambling problems be cognizant of DFS and that some clients might be experiencing problems with DFS.     

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.     

Twelve-Month Prevalence of DSM-5 Gambling Disorder and Associated Gambling Behaviors Among Those Receiving Methadone Maintenance

This study sought to: (1) determine the prevalence of gambling disorder using the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM-5; American Psychiatric Association in Diagnostic and statistical manual of mental disorders, American Psychiatric Publishing, Arlington, 2013) criteria; (2) identify the frequency and amount of money spent on gambling behaviors; and (3) determine demographic and treatment related predictors associated with gambling disorder in a substance using population. People receiving methadone maintenance treatment (N = 185) in an urban medical center consented to participate in the study. We used DSM-5 criteria to assess the 12-month prevalence of gambling disorder. Questions adapted from a previously developed measure were used to identify, describe and quantify the frequency of use and amount of money spent on gambling behaviors. Most participants were African-American (71.4 %), male (54.1 %), unmarried (76.8 %), unemployed (88.1 %) and had an income of <$20,000 (88.5 %). On average, participants were receiving 81.0 mg of methadone (SD: 22.8) daily. Nearly half (46.2 %) of participants met DSM-5 criteria for gambling disorder. Compared to those without gambling disorder, those with gambling disorder did not differ significantly with respect to demographic characteristics nor methadone dose. However, those with gambling disorder had been in methadone maintenance treatment for significantly less time. Those with gambling disorder were significantly more likely to report engaging in a variety of gambling behaviors. Given that the 12-month prevalence of DSM-5 defined gambling disorder was nearly 50 % future efforts to screen and treat gambling disorder in the context of methadone maintenance treatment are clearly warranted.     

Sociodemographic,Psychopathological and Clinical Characteristics of Pathological Slot-Machine Gamblers in Treatment: A Descriptive Study of Spanish Male Gamblers

The purpose of this study is to describe the sociodemographic, psychopathological, and clinical characteristics of a sample of Spanish male pathological slot-machine gamblers in treatment. The sample was made up of 80 men who met the criteria of the DSM-IV for pathological gambling. The mean age was 29 years, and the mean age at which they had started slot-machine gambling was 20 years, with a mean problem duration of three years before they sought treatment. Regarding employment status, service sector workers were the most frequently represented (36.3%), followed by students (20%) and the unemployed (15%). The most influential psychopathological variables noted were the prevalence of affective disorders (36.2%), past abuse of alcohol (12.5%), and regular use of illegal substances (26.3%), either in the past or at the time of seeking treatment. Also discussed is the low age of the men seeking treatment for gambling problems, the way they finance their gambling and explanations for their gambling behaviour.     

Episodic and Binge Gambling: An Exploration and Preliminary Quantitative Study

The DSM-5 includes provisions for episodic forms of gambling disorder, with such changes aligned with earlier accounts of potential binge gambling behaviours. However, there is little research that indicates the utility of these classifications of episodic or binge gambling, and this study considered their characteristics in a clinical sample. It involved administration of a new binge gambling screening tool, along with routine measures, to n = 214 patients entering a specialist treatment clinic for gambling problems. Results indicated that episodic gambling was common in this clinical context, with 28 and 32% of patients reporting gambling episodes that were (a) regular and alternating, and (b) irregular and intermittent, respectively. These patterns were distinguished by factors including associations with covariates that indicated differences from continuous gamblers. For example, the irregular episodic gamblers, but not the regular pattern, demonstrated lower levels of problem gambling severity and comorbidity. Rates of potential binge gambling, which was defined in terms of additional criteria, were around 4% and numbers were insufficient for comparable analyses. The findings support inclusion of episodic forms of gambling disorder in the DSM-5, but highlight the need for improved recognition and research on heterogeneous forms of episodic gambling.     

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.     

Understanding the Link: “Homosexuality,” Gender Identity,and the DSM

This article reviews the historical and present notions of identity, in relation to sexual orientation and gender identity within counseling. It also discusses the link between the historical pathologizing of homosexuality and gender identity, as well as summarizes the implications of the diagnosis of gender dysphoria (GD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (5th ed.; DSM-5). The ethics of maintaining GD in the DSM-5 and future diagnostic manuals is discussed. Finally, a brief explanation of the role of the counselor in working with transgender individuals is given.     

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.     

An Assessment of the Psychometric Properties of Italian Version of CPGI

The aim of this study was to adapt to the Italian context a very commonly used international instrument to detect problem gambling, the canadian problem gambling index (CPGI), and assess its psychometric properties. Cross-cultural adaptation of CPGI was performed in several steps and the questionnaire was administered as a survey among Italian general population (n = 5,292). Cronbach’s alpha reliability coefficient was 0.87 and can be considered to be highly reliable. Construct validity was assessed first by means of a principal component analysis and then by means of confirmatory factor analysis, showing that only one factor, problem gambling, was extracted from the CPGI questionnaire (an eigenvalues of 4,684 with percentage of variance 52 %). As far as convergent validity is concerned, CPGI was compared with Lie/Bet questionnaire, a two-item screening tool for detecting problem gamblers, and with both depression and stress scales. A short form DSM-IV CIDI questionnaire was used for depression and VRS scale, a rating scale, was used for rapid stress evaluation. A strong convergent validity with these instruments was found and these findings are consistent with past research on problem gambling, where another way to confirm the validity is to determine the extent to which it correlates with other qualities or measures known to be directly related to problem gambling. In sum, despite the lack of a direct comparison with a classic gold-standard such as DSM-IV, the Italian version of CPGI exhibits good psychometric properties and can be used among the Italian general population to identify at-risk problem gamblers.     

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.     

Commentary: Problems with the Sexual Disorders Sections of DSM-5

There are a number of problems with the sexual disorders sections of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. These problems must be understood in a historical context, namely the evolution of criteria for psychosexual disorders from DSM-II (1968) to DSM-5 (2013). There are many inconsistencies in the DSM-5 criteria for different sexual disorders. Given these inconsistencies—and the history of diagnostic criteria for homosexuality and gender identity disorder from DSM-II to DSM-5—it is possible that, like homosexuality, DSM-5 gender dysphoria could disappear from future editions of the manual. Even if that does not happen, there are numerous problems with the DSM-5 sexual disorders that require attention.     

DSM-5: An Overview of Changes and Controversies

The DSM-5 offers many changes in the criteria and categories used in clinical diagnosis. The provocative and sometimes controversial nature of the changes has enlivened debate in the mental health field about how we should best understand our clients. I selectively survey what is new in DSM-5, why changes were made, and what about them is so controversial. First, I summarize the main metastructural and organizational changes, including elimination of the multiaxial system and changed chapter groupings. Second, I survey the most important new categories of disorder and the most important changes to the diagnostic criteria for existing categories of disorder. I focus on particularly controversial changes, such as those to substance use and addictive disorders, autism spectrum disorders, and posttraumatic stress disorder. Pros and cons are provided for changes in criteria as well as for the addition of new disorder categories, such as hoarding disorder and binge eating disorder. Finally, I offer a more in-depth review and analysis of the changes to the depressive disorders chapter, which was subject to some of the most intense controversies and had some of the most extensive changes.     

An Overview of and Rationale for Changes Proposed for Pathological Gambling in DSM-5

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. It will include several changes to the diagnosis of pathological gambling: the name of the disorder will be altered, the threshold for diagnosis will decrease, and one criterion will be removed. This paper reviews the rationale for these changes and addresses how they may impact diagnosis and treatment of the disorder, as well as potential for future research in the field.     

An Exploratory Study of Clinical Measures Associated with Subsyndromal Pathological Gambling in Patients with Binge Eating Disorder

Both binge eating disorder (BED) and pathological gambling (PG) are characterized by impairments in impulse control. Subsyndromal levels of PG have been associated with measures of adverse health. The nature and significance of PG features in individuals with BED is unknown. Ninety-four patients with BED (28 men and 66 women) were classified by gambling group based on inclusionary criteria for Diagnostic and Statistical Manual-IV (DSM-IV) PG and compared on a range of behavioral, psychological and eating disorder (ED) psychopathology variables. One individual (1.1% of the sample) met criteria for PG, although 18.7% of patients with BED displayed one or more DSM-IV criteria for PG, hereafter referred to as problem gambling features. Men were more likely than women to have problem gambling features. BED patients with problem gambling features were distinguished by lower self-esteem and greater substance problem use. After controlling for gender, findings of reduced self-esteem and increased substance problem use among patients with problem gambling features remained significant. In patients with BED, problem gambling features are associated with a number of heightened clinical problems.