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.     

Subtyping Non-treatment-seeking Problem Gamblers Using the Pathways Model

This study examined whether distinct subgroups could be identified among a sample of non-treatment-seeking problem and pathological/disordered gamblers (PG) using Blaszczynski and Nower’s (Addiction 97:487–499, 2002) pathways model (N = 150, 50% female). We examined coping motives for gambling, childhood trauma, boredom proneness, risk-taking, impulsivity, attention-deficit/hyperactivity disorder (ADHD), and antisocial personality disorder as defining variables in a hierarchical cluster analysis to identify subgroups. Subgroup differences in gambling, psychiatric, and demographic variables were also assessed to establish concurrent validity. Consistent with the pathways model, our analyses identified three gambling subgroups: (1) behaviorally conditioned (BC), (2) emotionally vulnerable (EV), and (3) antisocial-impulsivist (AI) gamblers. BC gamblers (n = 47) reported the lowest levels of lifetime depression, anxiety, gambling severity, and interest in problem gambling treatment. EV gamblers (n = 53) reported the highest levels of childhood trauma, motivation to gamble to cope with negative emotions, gambling-related suicidal ideation, and family history of gambling problems. AI gamblers (n = 50) reported the highest levels of antisocial personality disorder and ADHD symptoms, as well as higher rates of impulsivity and risk-taking than EV gamblers. The findings provide evidence for the validity of the pathways model as a framework for conceptualizing PG subtypes in a non-treatment-seeking sample, and underscore the importance of tailoring treatment approaches to meet the respective clinical needs of these subtypes.     

Reward Preferences of Pathological Gamblers Under Conditions of Uncertainty: An Experimental Study

Among many personality traits, impulsivity represents one of the most important traits associated with pathological gambling. Empirical research has highlighted the multidimensional nature of impulsivity, which includes different heterogeneous traits and behavioral tendencies. The present study experimentally examined reward preferences of pathological gamblers under conditions of uncertainty using the Balloon Analogue Risk Task (BART). Furthermore it also examined the relationship between impulsivity, time perspective, inability to tolerate delay in gratification, and risk-taking. The present study is the first to simultaneously examine all these variables simultaneously in a sample of pathological gamblers (n = 54) and healthy controls (n = 54) from Italy. All participants participated in the BART and were also administered Italian versions of the South Oaks Gambling Screen, the Barratt Impulsiveness Scale, the Consideration of Future Consequences, and the Monetary Choice Questionnaire. Analyses revealed that compared to HCs, PGs were more risk prone on the BART, and reported elevated levels of impulsivity, steeper discounting rates and a shorter time perspective. All the measures correlated with the gambling severity and strong correlations between the BIS, CFC-14 and BART were observed. Logistic regression analysis demonstrated that impulsivity and risk-taking were strong predictors of pathological gambling.     

Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center,Randomized, Double-Blind Clinical Trial

Gambling disorder (GD) is a prevalent condition for which no pharmacological treatment has yet been approved, although there is evidence that topiramate can reduce impulsivity in GD and craving in various addictive behaviors. The goal of this study was to investigate the effectiveness of topiramate combined with cognitive restructuring for GD in a two-center, randomized, double-blind clinical trial. Participants were individuals seeking outpatient treatment for GD (n = 30), treated with either topiramate or placebo combined with a brief cognitive intervention, over a 12-week period, the dose of topiramate being tapered up during the first 8 weeks. The main outcome measures were gambling craving, behavior, and cognitive distortions; impulsivity; depression and social adjustment. Topiramate proved superior to placebo in reducing gambling craving (P = 0.017); time and money spent gambling (P = 0.007 and P = 0.047, respectively); cognitive distortions related to gambling (P = 0.003); and social adjustment (P = 0.040). We found no significant effects on impulsivity or depression. These findings are in contrast with data from a previous clinical trial with topiramate for GD. In the current study, we found that topiramate affects features specifically related to gambling addiction and had no significant effect on associated phenomena such as impulsiveness and depression. We believe that this response could be due to synergistic interaction between topiramate and the cognitive intervention.     

Toward a Neuropsychology of Personality in Sex Offenders Against Children: An Exploratory Psychometric Study

Little is known about the relationship between neuropsychological functioning and normal personality in sex offenders. The aim of this study was to examine the relations between personality traits and executive functioning in child molesters. The NEO-Five Factor Inventory was used to assess personality, and the Trail Making Test (parts A and B) was used to assess executive functioning in a sample of child molesters (n?=?33). We found the time required to complete Trail Making Test part A significantly predicted Extraversion scores, whereas the time to complete Trail Making Test part B significantly predicted Openness scores. Brief measures of executive functioning can thus predict the score in Extraversion and Openness in child molesters. These personality traits may be related to the functioning of brain areas implicated in having to complete the Trail Making Test.     

The Relationship Between Problem Gambling and Attention Deficit Hyperactivity Disorder

Recent studies indicate that treatment-seeking problem gamblers display elevated rates of ADHD and that adolescents who screen positive for ADHD are more likely to engage in gambling, develop gambling problems, and experience a greater severity in gambling problems. This study aimed to (a) compare the prevalence of ADHD in treatment-seeking problem gamblers to the general population; (b) investigate the relationships between ADHD and problem gambling severity, cluster B personality disorders, motor impulsivity, alcohol use, substance use, gender, and age; and (c) investigate the degree to which these factors moderate the relationship between ADHD and problem gambling severity. Participants included 214 adults (154 males, 58 females, 2 unspecified) who sought treatment for their gambling problems at a specialist gambling agency in Melbourne, Australia. Almost one-quarter (24.9 %) of treatment-seeking problem gamblers screened positively for ADHD, which was significantly higher than the 14 % prevalence in a community sample. ADHD was significantly positively correlated with problem gambling severity, motor impulsivity, and cluster B personality disorders, but was not associated with alcohol and substance use, gender or age. None of the factors significantly moderated the relationship between ADHD and problem gambling severity. These findings suggest that a considerable proportion of treatment-seeking problem gamblers report ADHD and that their clinical profile is complicated by the presence of high impulsivity and cluster B personality disorders. They highlight the need for specialist gambling agencies to develop screening, assessment, and management protocols for co-occurring ADHD to enhance the effectiveness of treatment.     

Revisiting the Role of Impulsivity and Compulsivity in Problematic Sexual Behaviors

Impulsivity and compulsivity are transdiagnostic features associated with clinically relevant aspects of psychiatric disorders, including addictions. However, little research has investigated how impulsivity and compulsivity relate to hypersexuality and problematic pornography use. Thus, the aims of the present study were to investigate (a) self-reported impulsivity and compulsivity with respect to hypersexuality and problematic pornography use and (b) the similarities and possible differences between hypersexuality and problematic pornography use in these domains. Utilizing structural equation modeling (SEM) in a large community sample (N = 13,778 participants; female = 4,151, 30.1%), results indicated that impulsivity (β = .28, β = .26) and compulsivity (β = .23, β = .14) were weakly related to problematic pornography use among men and women, respectively. Impulsivity had a stronger relationship (β = .41, β = .42) with hypersexuality than did compulsivity (β = .21, β = .16) among men and women, respectively. Consequently, impulsivity and compulsivity may not contribute as substantially to problematic pornography use as some scholars have proposed. On the other hand, impulsivity might have a more prominent role in hypersexuality than in problematic pornography use. Future research should examine further social and situational factors associated with problematic pornography use.     

Assessing Personality Using Body Odor: Differences Between Children and Adults

Many studies have demonstrated that smell is an important sense in social interactions, and recently it was determined that olfactory cues might also convey information concerning certain personality traits. The present study investigated whether personality traits might be recognized using olfactory cues in contexts other than male–female interactions. 75 children (35 girls and 40 boys, M = 8.29 years) and 75 young adults (41 women and 34 men, M = 20.5 years) rated the personality traits of 50 unknown individuals (24 women and 26 men, M = 24.02 years) based on their body odor. The correlations between scent ratings and the self-assessed personality dimensions of odor donors were analyzed. The results show that both children and adults assess neuroticism relatively accurately, whereas only adults recognized dominance. These results suggest that olfaction supplements visual and auditory cues throughout our whole lives, contributing to the first impression accuracy of certain personality traits.     

Gambling Disorder Due to Brazilian Animal Game (“Jogo do bicho”): Gambling Behavior and Psychopathology

Gambling is currently widespread across the globe and despite legally restricted, it is significantly common in Brazil. A traditional and common form of gambling in Brazil is the Brazilian animal game (BAG)—“Jogo do bicho” in Portuguese. In 2013, BAG activities collected approximately 19 billion Brazilian reais—equivalent to more than 8 billon American dollars, a figure almost 60 % higher than legal lotteries. Although a common form of gambling, the gambling behavior and psychopathology of gambling disorder (GD) associated with BAG has never been systematically studied. The aim of this study is to conduct, the first research approaching GD due to BAG. We assessed 897 participants of whom 63 subjects (7.0 %) presented with GD due to BAG and 834 with GD associated with other forms of gambling. After comparing these two groups, major differences were found in demographics, gambling behavior elements and psychopathological variables. This research reinforces the need for further research on BAG and the need for specific approaches in GD. The particularities of BAG may affect treatment strategies as, for example, suggest some adaptations in social and psychotherapeutic approaches. We also highlight the need to acknowledge the “hidden” BAG as a potential addictive game.     

Executive functioning in Asian pathological gamblers

Two decades of neuropsychological research on predominantly Caucasian problem gamblers has unveiled significantly poorer performance on several domains of executive functioning (EF) relative to healthy controls. However, contradictory findings are widespread and evidence that pathological gamblers (PGs) are ‘impaired’ remains inconclusive. The study examined multiple facets of EF in 30 male, PGs seeking outpatient treatment in Singapore and 30 matched controls. CANTAB® tests of planning and organization/problem-solving, set-shifting, working memory and reflection impulsivity, were administered alongside the Barratt Impulsiveness Scale, Cognitive Failures Questionnaire and Dysexecutive Questionnaire. No significant group differences were found on any of the EF performance parameters, with performance falling in the healthy, unimpaired range for both groups. PGs did, however, report significantly greater impulsivity, everyday cognitive failures and symptoms of the dysexecutive syndrome. Exploratory analysis on a subgroup of PGs addicted to non-strategic gambling activities revealed poorer EF performance than among those addicted to strategic gambling activities. The findings suggest an absence of EF deficits despite higher trait impulsivity in Asian, predominantly strategic PGs. Hence, psychological interventions such as CBT and treatment approaches that emphasize the use of self-monitoring and informed decision-making to reduce impulsive behaviours should be suited to this population.     

Gambling,Risk-Taking,and Antisocial Behavior: A Replication Study Supporting the Generality of Deviance

Research suggests that high frequency gambling is a component of the “generality of deviance”, which describes the observation that various forms of risky and antisocial behavior tend to co-occur among individuals. Furthermore, risky and antisocial behaviors have been associated with such personality traits as low self-control, and impulsivity, and sensation-seeking. We conducted a replication (and extension) of two previous studies examining whether high frequency gambling is part of the generality of deviance using a large and diverse community sample (n = 328). This study was conducted as a response to calls for more replication studies in the behavioral and psychological sciences (recent systematic efforts suggest that a significant proportion of psychology studies do not replicate). The results of the present study largely replicate those previously found, and in many cases, we observed stronger associations among measures of gambling, risk-taking, and antisocial behavior in this diverse sample. Together, this study provides evidence for the generality of deviance inclusive of gambling (and, some evidence for the replicability of research relating to gambling and individual differences).     

Neuropsychological Correlates of Performance Based Functional Status in Elder Adult Protective Services Referrals for Capacity Assessments

We have previously described high rates of executive function impairment in clients referred by Adult Protective Services (APS) to geriatric psychiatry for decision-making capacity assessments. The purpose of this study was to determine the independent relationship between neuropsychological screening instruments, particularly instruments sensitive to executive function, and performance-based functional tasks in elder referrals. Our retrospective medical review (n = 75/157 referrals completed all neuropsychological and functional assessments) revealed that only the Executive Interview (EXIT25) contributed independent variance to money management performance (R² = 0.29, p < 0.001), telephone use ability (R² = 0.39, p < 0.001), and summed performance (R² = 0.45, p < 0.001). Executive instruments may specifically inform decision-making capacity assessments.     

Personality, Perceived Luck and Gambling Attitudes as Predictors of Gambling Involvement

A quantitative observational study was undertaken to examine the relationship between individual factors and level of gambling involvement, in particular problem gambling (PG). The specific factors under study were personality, perceived luck, and attitudes towards gambling. A sample of university students (N = 185) completed a battery of questionnaires, consisting of the 16PF, Canadian Problem Gambling Index, Belief in Good Luck Scale (BIGL), Gambling Attitudes Scale (GAS), and the Impulsive Non-Conformity subscale (ImpNon) from the Oxford-Liverpool Inventory of Feelings and Experiences. Four groups were formed (Non-PG, Low-Risk, Moderate-Risk, and PG). Personality profiles varied between groups, and there were significant main effects and interaction effects on gender and personality factors. The PG group was higher on impulsivity, and belief in luck, and had more positive attitudes towards gambling. Multiple Regression Analysis and Discriminant Functions Analysis, using variables including some 16PF factors, BIGL and GAS variables, produced models that were highly predictive of gambling severity and gambling membership. In both models, impulsivity was the strongest predictor. These results were discussed in terms of their implications for future research and treatment of PG.     

Risk and protective factors in problem gambling: an examination of psychological resilience

Psychological resilience – successful adaptation when faced with adversity – is a product of the balance of risk and protective factors relevant to an outcome. This study examined if protective factors (perceived resilience; mindfulness; grit; self-efficacy) explained variance in problem gambling tendencies (assessed with the Problem Gambling Severity Index) beyond the HEXACO personality traits (honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, openness to experience) and risk factors for problem gambling (gender; age; socio-economic status; high frequency gambling behaviour; harsh unpredictable childhood environments; sensation-seeking; impulsivity; self-control; stress). This study used a crowdsourced community sample (n = 469) recruited from Amazon Mechanical Turk. Bivariate analyses showed that risk factors and some HEXACO traits (especially honesty-humility) were associated with problem gambling issues. Among protective factors, only trait mindfulness showed a bivariate association with problem gambling issues. Somewhat surprisingly, regression analyses revealed that protective factors did not explain variance in problem gambling beyond HEXACO traits and risk factors. However, in exploratory analyses, mindfulness and self-efficacy – both modifiable protective factors – moderated the relationship between high-frequency gambling (a key proximate antecedent of problem gambling) and problem gambling tendencies. These results suggest mindfulness and self-efficacy may serve as ‘buffers’ against the development of problem gambling issues and may be promising targets for clinical interventions.     

Temperament and Character in Pathological Gambling

Objective We have studied temperament and character in pathological gambling (PG). Methods Thirty-eight DSM-IV verified pathological gamblers (31 males and 7 females; mean age 35.4 ± 10.4 years) were tested with Cloninger’s Temperament and Character Inventory (TCI). Matched controls were chosen from the normal population. Results Pathological gamblers scored higher on the temperament factors novelty seeking (NS) and harm avoidance (HA). The most pronounced difference was found in the character factor self-directedness (SD). The pathological gamblers differed from controls in cooperativeness and self-transcendence. A personality disorder was found in 29% of the pathological gamblers 84% of whom scored either low on SD and high on impulsivity or had a more dishonest behaviour. Two-thirds of pathological gamblers showed immature character with or without high HA in temperament. The other third showed normal-character extravagant behaviour (86%), high impulsivity (36%) and less responsibility (50%) being the most common personality traits. Conclusion HA and NS might be trait-like characteristics in PG.     

A latent class analysis of young adult gamblers from the Manitoba Longitudinal Survey of Young Adults

Informed by the Pathways Model, the current study utilized latent class analysis (LCA) to empirically derive subtypes of gamblers based on measures of impulsivity, anxiety, depression, drug use and alcohol dependence. The sample in this study (N = 566) was comprised of young adult gamblers (18–22 years of age) who participated in the Manitoba Longitudinal Survey of Young Adults (MLSYA). Multinomial regression was utilized to examine how demographic variables and participant scores on the Problem Gambling Severity Index (PGSI) predicted membership in gambler classes from the LCA. Results of the LCA revealed three classes of gamblers: emotionally vulnerable, non-problem and impulsive. Multinomial regression showed that older age (i.e. 20–22 years of age), lower income (< $20,000 per year), living independently and PGSI scores were associated with increased odds of being classified as an impulsive gambler. Identifying as European, living independently and PGSI scores were associated with increased odds of being grouped in the emotionally vulnerable class of gambler. These results suggest that young adult gamblers are not a homogeneous group but instead are best understood as falling into different subtypes based on shared characteristics outlined in the Pathways Model.     

Predicting Problem Gambling in Australian Adults Using a Multifaceted Model of Impulsivity

Impulsivity is a factor that has been linked strongly to problem gambling; however, conceptualization problems have impeded research in this area. Research suggests that there may be as many as five impulsivity subtypes and that some but not all of these subtypes are involved in problem gambling. This cross-sectional and correlational study used the multifaceted UPPS-P Impulsive Behaviour Scale as a predictor of problem gambling in a community (N = 200) sample of Australian adult gamblers. Of the five impulsivity subtypes, negative urgency, positive urgency and sensation seeking were found to be positively related to problem gambling, while lack of premeditation and lack of perseverance were unrelated. Multiple regression analyses revealed that positive urgency and negative urgency were the only significant predictors of problem gambling, suggesting that individuals who have the tendency to act rashly when in a positive or negative mood are more likely to display problem gambling behaviour. The results provide further evidence of the significant role of strong emotions in problem gambling. Further, it appears that problem gambling can be motivated both by the impulsive desire to avoid negative mood states and by the impulsive desire to maintain and enhance positive mood states.     

Personality Typologies for Conservative Christians in Intensive Marital Therapy

In our study we used a two-step cluster analytic approach to identify personality typologies for conservative Christians seen in intensive marital therapy (N = 207). Sixteen Personality Factor Fifth Edition results revealed significant personality differences based on gender as well as five significantly different personality clusters: (1) abstract, deferential, trusting, and tolerates disorder; (2) reactive and deferential; (3) reserved, abstract, serious, grounded, traditional, and self-reliant; (4) grounded; and (5) socially bold, abstracted, forthright, and open to change. Conclusions are drawn related to how these results compare with other personality studies in the literature and how these differing personality types might fit together in Christian marriage dyads.     

Is Pathological Gambling Moderated by Age?

The age of a patient is a strong moderator of both the course and the evolution of disorders/diseases. However, the effects of current age in pathological gambling (PG) have rarely been examined. The aim of this study is to explore the moderating effects of the patients’ current age in relation to personality traits and clinical outcomes of PG. A total sample of 2,309 treatment-seeking patients for PG, diagnosed according to DSM-IV criteria, participated in this study and were assessed with the Diagnostic Questionnaire for Pathological Gambling according to DSM-IV criteria, the South Oaks Gambling Screen, the Symptom Checklist, the Temperament and Character Inventory-R, and other clinical and psychopathological measures. Orthogonal polynomial contrasts showed linear trends in the relationship between age and PG: the older the patient, the more comorbid health problems were visible. The presence of additional quadratic trends also suggests that age plays a significant role in moderating the possibility of existing PG problems and general psychopathology. No interaction term was found between age and sex, but it was present for age and some personality traits: self-transcendence and reward dependence (these two traits were only relevant to the level of impairment due to PG at specific ages). This study suggests that the patients’ age influences psychopathological and clinical aspects associated to PG. Intervention in the earliest manifestations of this complex problem is essential in order to better address the need of successful treatment planning.     

Do Children With Gender Dysphoria Have Intense/Obsessional Interests?

This study examined whether children clinically referred for gender dysphoria (GD) show increased symptoms of autism spectrum disorder (ASD). Circumscribed preoccupations or intense interests were considered as overlapping symptoms expressed in GD and ASD. In gender-referred children (n = 534; 82.2% male) and their siblings (n = 419; 57.5% male), we examined Items 9 and 66 on the Child Behavior Checklist, which measure obsessions and compulsions, respectively. Non-GD clinic-referred (n = 1,201; 48.5% male) and nonreferred (n = 1,201; 48.5% male) children were also examined. Gender-referred children were elevated compared to all other groups for Item 9, and compared to siblings and nonreferred children for Item 66. A gender-related theme was significantly more common for gender-referred boys than male siblings on Item 9 only. A gender-related theme was not significantly more common for gender-referred girls compared to their female siblings on either item. The findings for Item 9 support the idea that children with GD show an elevation in obsessional interests. For gender-referred boys in particular, gender-related themes constituted more than half of the examples provided by their mothers. Intense/obsessional interests in children with GD may be one of the factors underlying the purported link between GD and ASD.