An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers

The primary aims of this study were to examine the prevalence of personality disorders in problem gamblers, to explore the relationship between personality disorders and problem gambling severity, and to explore the degree to which the psychological symptoms highlighted in the biosocial developmental model of borderline personality disorder (impulsivity, distress tolerance, substance use, PTSD symptoms, psychological distress and work/social adjustment) are associated with problem gambling. A secondary aim was to explore the strength of the relationships between these symptoms and problem gambling severity in problem gamblers with and without personality disorder pathology. Participants were 168 consecutively admitted problem gamblers seeking treatment from a specialist outpatient gambling service in Australia. The prevalence of personality disorders using the self-report version of the Iowa Personality Disorders Screen was 43.3 %. Cluster B personality disorders, but not Cluster A or C personality disorders, were associated with problem gambling severity. All psychological symptoms, except alcohol and drug use, were significantly higher among participants with personality disorder pathology compared to those without. Finally, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for problem gamblers with personality disorder pathology, while impulsivity, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for those without personality disorder pathology. High rates of comorbid personality disorders, particularly Cluster B disorders, necessitate routine screening in gambling treatment services. More complex psychological profiles may complicate treatment for problem gamblers with comorbid personality disorders. Future research should examine the applicability of the biosocial developmental model to problem gambling in community studies.     

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.     

Alterations in the Emotional Regulation Process in Gambling Addiction: The Role of Anger and Alexithymia

This study aims at the assessment of alexithymia and anger levels in 100 treatment-seeking pathological gamblers compared with controls, who were matched for age, gender and education. Furthermore a positive correlation between alexithymia, anger and severity of gambling disorder and a relationship between gambling behaviour and anger after controlling for alexithymia, are investigated. Finally the role that gender plays in anger in pathological gamblers was also evaluated. Psychological assessment includes the South Oaks Gambling Screen, State-Trait Anger Expression Inventory-2 and the twenty-item Toronto Alexithymia Scale. Statistical analysis of the results shows a higher level of anger in pathological gamblers than in controls, together with alterations in emotional processing. Severity of gambling behaviour positively correlates with alexithymia scores, state-anger and trait-anger. Moreover, a significant contribution of anger in predicting gambling behaviour was suggested after controlling for alexithymia. In conclusion, anger and alexithymia must be regarded as relevant components of the assessment of pathological gamblers, in order to select the best therapeutical strategies to prevent self-defeating behaviours and to reduce drop-out from treatments.     

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.     

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.     

Cortisol Rise Following Awakening Among Problem Gamblers: Dissociation from Comorbid Symptoms of Depression and Impulsivity

Gambling pathology has been associated with elevated levels of distress, depression and impulsivity. The present investigation assessed whether these behavioral features would be evident among problem gamblers as they are among pathological gamblers. As well, given that gambling has been associated with increased life stress, as an objective index of ongoing distress, elevations of morning cortisol levels were assessed in problem and pathological gamblers relative to recreational gamblers, and their relations to depressive symptoms and impulsivity were assessed. Recreational, problem, and pathological gamblers (N = 140) completed the Beck Depression Inventory and the Barratt Impulsiveness Scale-11, and provided saliva samples at awakening, 30 min, 3.5 h, and 5.5 h afterward. Consistent with the view that problem and pathological gambling are associated with elevated life stressors, the rise of morning cortisol from awakening to 30 min following awakening was greater than in recreational gamblers. Heightened impulsivity was evident among both problem and pathological gamblers, whereas depressive symptoms were only evident among pathological gamblers. In neither instance were these psychological indices related to the morning cortisol rise. Indeed, increased depressive symptoms were not evident among problem gamblers, despite the fact that elevated morning cortisol levels were evident. The elevated morning cortisol rise may be secondary to gambling problems or distress related to gambling problems. Furthermore, the sustained morning cortisol elevations may be indicative of allostatic overload, and could potentially be a harbinger for potential health risks among problematic gamblers.     

Gambling Disorder and Affect Regulation: The Role of Alexithymia and Attachment Style

The aim of the present study was to explore the dimensions of alexithymia and attachment styles in a group of disordered gamblers and to evaluate the relationship between alexithymia, attachment styles, and the severity of gambling disorder. Sixty disordered gamblers diagnosed according to the diagnostic and statistical manual-5 filled out the Kurzfragebogen zum Glücksspielverhalten, the 20-Item Toronto Alexithymia Scale, and the Experiences in Close Relationships-Revised. Approximately 70 % of the sample displayed ‘intermediate’ and ‘severe’ gambling severity levels on the Kurzfragebogen zum Glücksspielverhalten, and 77 % showed ‘high’ or ‘borderline’ levels of alexithymia on the Toronto Alexithymia Scale (mean = 56.40). Regarding attachment styles, 70 % of the sample displayed an ‘insecure’ attachment, with a particularly high prevalence of the ‘fearful’ style (26.66 %). A linear regression analysis revealed that only the anxiety dimension of the Experiences in Close Relationships questionnaire predicted the severity of gambling. Our data appear to confirm that gambling disorder is characterised by emotional and relational dysregulation, and that pathological gambling behaviours may serve as external regulators of internal undifferentiated emotional states.     

Use of online crowdsourcing platforms for gambling research

Crowdsourcing platforms like Amazon’s Mechnical Turk and Crowdflower have been touted to be a cost-effective way to collect large amounts of behavioural data. Across four large-n studies, gambling-related behaviours, tendencies and traits among participants in these labour markets were examined. In Studies 1 and 2, both conducted on Crowdflower, problem gamblers (as measured by the benchmark Problem Gambling Severity Index) comprised 24.5% and 21.9% of participants, respectively. In Study 3, conducted on Mechanical Turk, problem gamblers comprised 9.0% of participants. In Study 4, a two-wave longitudinal study conducted on Crowdflower, problem gamblers comprised 13.5% of participants in wave one and 14.8% of participants in wave two. In Studies 2 and 3, strong convergent associations were demonstrated across various measures of problem gambling tendencies and general gambling involvement. Furthermore, it was demonstrated that gambling was associated with personality traits (impulsivity, sensation-seeking, self-control), risk attitudes, affect, and behavioural risk-taking consistent with previous research. In Study 4, it was demonstrated that measures of problem gambling have acceptable test-retest reliability. Online crowdsourcing platforms appear to offer access to samples with remarkably high proportions of problem gamblers. However, this characteristic means that such samples are not necessarily representative of gambling tendencies among more general populations.     

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.     

Sub-clinical Alcohol Consumption and Gambling Disorder

While it is well established that gambling disorder is associated with alcohol use disorder, less is known regarding whether sub-clinical alcohol consumption increases gambling behavior. This study examined the effects of varying levels of alcohol consumption on clinical and cognitive measures. The sample consisted of 572 non-treatment seeking gamblers age 18–29 who were divided into three groups: non-current drinkers, current drinkers who did not qualify for an alcohol use disorder, and those with an alcohol use disorder (AUD). All subjects were assessed on gambling pathology, severity and impulsivity using the Structured Clinical Interview for Gambling Disorder, Yale Brown Obsessive Compulsive Scale for Pathologic Gambling and the Barratt Impulsive Scale-11 and select cognitive tests. In all of the clinical measures, controlling for age, gender and education, the AUD group was significantly more likely than the non-current and current drinkers to be a pathologic gambler and to be impulsive, compulsive and depressed. On cognitive tasks, controlling for age, gender and education, the AUD group had significantly worse strategy use on a spatial working memory task than both other groups. This study suggests that the relationship between alcohol and gambling may only exist when pathology in both alcohol consumption and gambling behavior is present. Examining this relationship with alcohol consumption as a continuous variable would provide additional insight into the potential effects alcohol consumption has on gambling behavior.     

Reward-Sensitivity,Inhibition of Reward-Seeking,and Dorsolateral Prefrontal Working Memory Function in Problem Gamblers not in Treatment

Given the central role of perseverative chasing in problem gambling, the present study sought to find evidence for three hypothesized components of perseveration in problem gamblers: reward-sensitivity dominance, deficient inhibition of reward-seeking behavior, and working memory deficits. This was the first attempt to examine working memory deficits in problem gamblers using a conditional association task, which is associated with posterior-dorsolateral prefrontal functioning. In a sample that was not in treatment, and representative in terms of comorbidity, problem gamblers performed significantly worse on the conditional association working memory tasks after controlling for general memory function, compared to demographically-matched controls. This is significant because deficits in the dorsolateral prefrontal region have been consistently associated with perseveration, which suggests that problem gamblers’ perseverative chasing may be associated with a working memory deficit. Problem gamblers were not significantly higher than at-risk gamblers in terms of reward-sensitivity dominance (measured as a personality trait in terms of extraversion) suggesting that it may not be specifically associated with problem gambling. Sensation-seeking was also not associated with problem gambling in a sample that corrected for the methodological problems of previous studies which examined it. The need for gambling research to focus specifically on the perseverative inability to stop gambling is emphasized, and the present findings of specific working memory deficits in problem gamblers suggest the need for further examination of working memory as a potential risk factor for problem gambling. We propose that subsequent studies examine working memory in terms of the self-regulatory capacity for goal maintenance where attention must specifically be allocated to resist interference.     

Impulsivity,compulsivity and pathological gambling: an exploratory study of pathological gambling as an impulsivity-compulsivity spectrum disorder

The current study was conducted to examine pathological gambling as an impulsivity-compulsivity spectrum disorder. University students (N=162) who gambled a minimum of twice monthly completed measures of impulsivity, compulsivity and pathological gambling. Instruments completed included: measures of problem gambling severity (South Oaks Gambling Screen, NORC DSM-IV Screen for Gambling Problems, Canadian Problem Gambling Index, Victorian Gambling Screen), the Padua Inventory, the Barratt Impulsivity Scale and the Tridimensional Personality Questionnaire. Results supported previous research indicating that pathological gamblers had elevated scores on measures of impulsivity and compulsivity, as well as personality factors correlated with these two constructs. Moreover, impulsivity and compulsivity were found to be interrelated as proposed by the impulsivity-compulsivity spectrum model.     

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.     

Impulsivity and pathological gambling across depressive versus bipolar disorders

Impulsivity has been implicated in the development of pathological gambling (PG); sensation seeking and urgency in particular have predicted gambling pathology in undergraduate and psychiatric samples. In light of the relevance of both depressed and elevated mood to impulsivity and gambling, the components of impulsivity associated with PG across mood disorders warrants investigation. The aim of the current investigation was to examine the association between impulsivity and gambling pathology severity across depressive versus bipolar disorders. A total of 275 participants with lifetime depressive or bipolar disorder completed measures of impulsivity and gambling. Urgency was consistently associated with gambling pathology indicators; lack of perseverance was specifically associated with gambling pathology within participants with depressive disorders. Reckless action during negative mood is associated with gambling pathology across mood disorders, whereas difficulty remaining focused is associated with PG solely within depressive disorders. Impulsivity and affective comorbidity may inform current understanding of PG.     

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.     

Impulsivity and Gambling Type Among Treatment-Seeking Disordered Gamblers: An Explorative Study

Several studies have found that certain traits of impulsivity are associated with gambling disorder, and influence its severity. Furthermore, it has been suggested that some forms of gambling, particularly electronic gambling machines, are particularly widespread among pathological gamblers. In the present, exploratory study, we aim to clarify the role played by impulsivity in influencing the choice of specific gambling activities, by examining the relation between individual dimensions of impulsivity, and the choice of specific gambling activities in a clinical population. 100 consecutively admitted pathological gamblers at the National Problem Gambling Clinic in London (UK) in 2014 were administered the UPPS-P and BIS-11 impulsivity questionnaires, the Problem Gambling Severity Index, and underwent a structured interview concerning their gambling activities in the month and year prior to assessment. The correlation between individual gambling activities and impulsivity dimensions was analyzed both at a bivariate level, and using logistic regression. We found a significant correlation between Negative Urgency, Motor impulsivity and low-stakes machine gambling on multivariate analysis. Negative urgency (i.e. the tendency to act impulsively in response to negative affect), and Motor impulsivity (a tendency to rash action and restlessness) might be mediating factors in the choice of electronic gambling machines, particularly among patients whose gambling is escape-oriented. Structural and situational characteristics of gambling machines, particularly the widespread availability of low-stakes—rather than high-stakes—gaming machines, might concur to the choice of this form of gambling among individuals who present higher negative urgency and restlessness.     

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.     

Gambling Behavior Among Adolescents with Attention Deficit/Hyperactivity Disorder

Impulsivity is inherent to both problem gambling and ADHD. The purpose of this study is to examine ADHD key symptoms, and gambling behaviors and problem severity among adolescents. Additionally, internalizing and externalizing behaviors exhibited among these individuals and the role of these symptoms in gambling are examined. We used a cross-sectional study design and survey 1,130 adolescents aged 12–19. Results indicated that adolescents who screened positive for ADHD were significantly more likely than non-ADHD adolescents to engage in gambling and significantly more likely to develop gambling problems. Those who screened positive as predominantly inattentive and those who screened positive for ADHD Combined (Inattention and Hyperactivity–Impulsivity) were equally likely to gamble, but the latter were twice as likely to have gambling problems. However, we found no significant interaction between the key ADHD symptoms and gambling as the severity of hyperactivity–impulsivity or inattention did not significantly differ with respect to gambling pathology. Emotional problems and depressive affect were the only variables that could significantly differentiate the ADHD types and gambling severity. Our Results highlight the clinical importance of considering the subtype of ADHD among gamblers and the greater association of depressive affect and emotional problems with gambling among adolescents.     

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.     

Clinical Profiles as a Function of Level and Type of Impulsivity in a Sample Group of At-risk and Pathological Gamblers Seeking Treatment

Level and type of impulsivity are essential variables to be taken into consideration during the initial evaluation of a pathological gambler. The aim of this study was to measure the score for 4 impulsivity-related traits (Urgency, (lack of) Premeditation, (lack of) Perseverance and Sensation seeking) in a sample group of at-risk and pathological gamblers, and to highlight any links with certain elements of clinical data. The UPPS Impulsive Behaviour Scale was administered to 84 problem gamblers seeking treatment. The severity of gambling disorders was evaluated using the diagnostic criteria of the DSM-IV. Psychiatric and addictive comorbidities were also explored. The results indicated that the score for the Urgency facet had a positive correlation with the severity of gambling disorders. It appeared that participants displayed different clinical profiles according to the level and type of impulsivity. Several of the UPPS scales were identified as risk factors for mood disorders, risk of suicide, alcohol use disorders, and Attention Deficit/Hyperactivity Disorder (ADHD). The results confirm both the complexity of the multi-dimensional concept of impulsivity and the reason why the UPPS is of interest for a more in-depth study of the subject.