Prevalence and Diagnostic Correlates of DSM-IV Pathological Gambling in Psychiatric Outpatients

Studies of the prevalence of pathological gambling (PG) in psychiatric and substance abusing patients suggest that the disorder is not rare. Most studies have been of substance abusers in treatment, and the rate of PG has been found to be several times higher than the rate found in community based epidemiological surveys. However, only one study has examined the prevalence of PG in a heterogeneous sample of patients, and this was a study of psychiatric inpatients. We are not aware of any prior study of the prevalence of PG in a psychiatric outpatient sample. In the present report from the Rhode Island Methods to Improve Diagnosis and Services (MIDAS) project we examined the current and lifetime prevalence of PG in 1,709 psychiatric outpatients interviewed with a semi-structured diagnostic interview that included a module to diagnose DSM-IV PG. Forty (2.3%) patients had a lifetime history of DSM-IV PG, all of whom had at least one other DSM-IV axis I disorder. Patients with PG had significantly more axis I disorders than patients without PG, and had significantly higher rates of bipolar disorder, social phobia, panic disorder with agoraphobia, alcohol use disorder, and other impulse control disorders. Possible reasons for the low prevalence of PG in our sample are discussed.     

Pathological Gambling in Estonia: Relationships with Personality,Self-Esteem,Emotional States and Cognitive Ability

Due to changes in gambling accessibility during the last decade gambling has become more widespread in Estonia and the prevalence of pathological gambling has sharply increased. The present study attempts to identify psychological characteristics of Estonian pathological gamblers. It has been shown that a wide range of social, economic, and individual factors (e.g. personality traits and emotional states) predict the likelihood of becoming a pathological gambler. In the present study, pathological gamblers’ (N = 33) personality traits, self-esteem, self-reported emotional states and cognitive ability were compared to the respective characteristics in a non-gambling control group (N = 42) matched for age, gender and educational level. It was found that compared to controls, pathological gamblers had higher scores on Neuroticism (especially on its immoderation facet) and lower scores on Conscientiousness (especially on its dutifulness and cautiousness facets) and on self-esteem scale. They reported more negative emotional states during the previous month (especially depression and anxiety). Finally, pathological gamblers had lower general cognitive ability. In a logistic regression model, the likelihood of being a pathological gambler was best predicted by high immoderation score and low cognitive ability.

Rates and Correlates of Pathological Gambling Among VA Mental Health Service Users

The rate and correlates of diagnosed pathological gambling (PG) among mental health patients in the Veterans Health Administration, the only national system of mental health care, have not been studied. Using fiscal year 2009 (FY2009) VA administrative data, a case–control study compared those with an ICD code of 312.31 (PG) versus those without. The analytic group was limited to 1,102,846 Veterans Affairs (VA) specialty mental health (MH) services users because 94.5% of all those diagnosed with PG in the U.S. VA health system received such services. Chi-square tests and logistic regression assessed associations between demographic and clinical factors and PG diagnosis. The past-year rate of PG diagnosis among veterans treated in specialty MH program was 0.2%, significantly lower than prevalence rates in other treatment samples and the general U.S population, suggesting under-diagnosis and/or a low-income sample. Being female, ages 40–74, and higher income increased the risk of PG diagnosis, as did past-year homelessness (Odds Ratio (OR) = 2.2), alcohol use disorders (OR = 2.8), bipolar disorder (OR = 2.1) and personality disorders (OR = 2.1). Depression, schizophrenia, and anxiety disorders other than PTSD, were also positively associated with PG diagnosis. Drug use disorder had no significant independent association with PG. PTSD, dementia, and living in isolated rural areas conferred reduced risk. More systematic screening and surveillance of PG among MH service users generally, and veterans with heavy alcohol use, severe mental illness, and homelessness specifically, appears warranted.     

A Canadian Population Level Analysis of the Roles of Irrational Gambling Cognitions and Risky Gambling Practices as Correlates of Gambling Intensity and Pathological Gambling

Using population data (N = 11,562) drawn from five Canadian gambling prevalence surveys conducted between 2000 and 2005, the current study investigated the relationship between irrational gambling cognitions and risky gambling practices upon (a) gambling intensity, as measured by percent of income spent on gambling and (b) tolerance, a diagnostic indicator of pathological gambling. First, we found irrational gambling cognitions and risky gambling practices to be positively related. Second, irrational gambling cognitions moderated the relationship between risky gambling practices and gambling intensity. Specifically, people engaging in risky practices, spent less of their income on gambling when they had fewer irrational gambling cognitions compared to those with more irrational cognitions. Third, irrational gambling cognitions moderated the relationship between risky gambling practices and tolerance. Of the people engaging in risky practices, those with no irrational cognitions reported lower levels of tolerance than those with at least one irrational cognition. Interactions with gender are reported and discussed. These findings demonstrate the importance of both gambling cognitions and gambling practices upon the intensity of gambling and pathological gambling.

Pre/Early Adolescent Onset of Gambling and Psychosocial Problems in Treatment-Seeking Pathological Gamblers

This study examined the association between pre- or early-adolescent onset of gambling and severity of gambling and psychosocial problems in treatment-seeking adult pathological gamblers. A total of 236 pathological gamblers entering outpatient treatment completed the South Oaks Gambling Screen (SOGS) and the Addiction Severity Index (ASI). Using a quartile split procedure, gamblers who began gambling during their pre- or early-adolescent years (mean age of 10.5 years; 1st quartile) were compared to gamblers who began gambling later in life (mean age of 23.0 years; 2nd to 4th quartiles). Compared to later onset gamblers, pre/early adolescent onset gamblers reported increased severity of psychiatric, family/social, and substance abuse problems on the ASI. They were more likely to report cognitive problems (trouble understanding, concentrating, or remembering), suicidal ideation, and a history of inpatient psychiatric treatment, and were less likely to be satisfied with their current living situation. Pre/early adolescent onset gamblers also reported earlier age of initiation of drinking, and were more likely to have received treatment for an alcohol use disorder, and to have used cannabis and cocaine in their lifetimes. Taken together, these data suggest that pre/early adolescent-onset of gambling may be a risk factor for later-life psychiatric, family/social, and substance abuse problems in treatment-seeking pathological gamblers.     

Pathways to Pathological Gambling: Component Analysis of Variables Related to Pathological Gambling

Research examining cognitive perceptions among children has suggested the importance of perceived skill and luck in initiating and maintaining gambling behavior. Using an experimentally manipulated gambling paradigm modifying rates of reinforcement the results suggest, in general, that one can modify these cognitions. More importantly, the results from the gambling task were found to generalize to multiple forms of gambling and were maintained over a relatively short period of time. The modifications of these perceptions appear to be easier for younger children (age 10 vs 12), with differential effects being found for boys and girls. The results are discussed in light of our current prevention initiatives and programs.     

Differential Item Functioning of Pathological Gambling Criteria: An Examination of Gender, Race/Ethnicity, and Age

This study tested for the presence of differential item functioning (DIF) in DSM-IV Pathological Gambling Disorder (PGD) criteria based on gender, race/ethnicity and age. Using a nationally representative sample of adults from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), indicating current gambling (n = 10,899), Multiple Indicator-Multiple Cause (MIMIC) models tested for DIF, controlling for income, education, and marital status. Compared to the reference groups (i.e., Male, Caucasian, and ages 25–59 years), women (OR = 0.62; P < .001) and Asian Americans (OR = 0.33; P < .001) were less likely to endorse preoccupation (Criterion 1). Women were more likely to endorse gambling to escape (Criterion 5) (OR = 2.22; P < .001) but young adults (OR = 0.62; P < .05) were less likely to endorse it. African Americans (OR = 2.50; P < .001) and Hispanics were more likely to endorse trying to cut back (Criterion 3) (OR = 2.01; P < .01). African Americans were more likely to endorse the suffering losses (OR = 2.27; P < .01) criterion. Young adults were more likely to endorse chasing losses (Criterion 9) (OR = 1.81; P < .01) while older adults were less likely to endorse this criterion (OR = 0.76; P < .05). Further research is needed to identify factors contributing to DIF, address criteria level bias, and examine differential test functioning.     

A Preliminary Study of the Neural Correlates of the Intensities of Self-Reported Gambling Urges and Emotions in Men with Pathological Gambling

Although self-reported gambling urge intensities have clinical utility in the treatment of pathological gambling (PG), prior studies have not investigated their neural correlates. Functional magnetic resonance imaging (fMRI) was conducted while 10 men with PG and 11 control comparison (CON) men viewed videotaped scenarios of gambling, happy or sad content. Participants rated the intensity of their emotions and motivations and reported the qualities of their responses. Relative to the CON group, the PG group reported similar responses to sad and happy scenarios, but stronger emotional responses and gambling urges when viewing the gambling scenarios. Correlations between self-reported responses and brain activations were typically strongest during the period of reported onset of emotional/motivational response and more robust in PG than in CON subjects for all conditions. During this epoch, corresponding with conscious awareness of an emotional/motivational response, subjective ratings of gambling urges in the PG group were negatively correlated with medial prefrontal cortex activation and positively correlated with middle temporal gyrus and temporal pole activations. Sadness ratings in the PG group correlated positively with activation of the medial orbitofrontal cortex, middle temporal gyrus, and retrosplenial cortex, while self-reported happiness during the happy videos demonstrated largely inverse correlations with activations in the temporal poles. Brain areas identified in the PG subjects have been implicated in explicit, self-referential processing and episodic memory. The findings demonstrate different patterns of correlations between subjective measures of emotions and motivations in PG and CON subjects when viewing material of corresponding content, suggesting in PG alterations in the neural correlates underlying experiential aspects of affective processing.     

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.     

Individual, Family, and Peer Correlates of Adolescent Gambling

The primary purpose of this study was to determine the individual, family, and peer factors that correlate with adolescent gambling. High school students from three states ( N = 1,846) completed an anonymous questionnaire assessing the behavior of themselves, their parents, and their peers. Participants also reported on their gambling behavior via the SOGS-RA, which was used to create five adolescent gambling groups (i.e., Non-Gamblers, Non-Problem Gamblers, At-Risk Gamblers, Problem Gamblers, and Probable Pathological Gamblers). In a discriminant function analysis using demographic, individual, family, and peer factors as potential discriminators, two functions emerged that accounted for 94% of the variance between groups. The first function was linear, with the Probable Pathological Gamblers reporting the highest level of peer and parent gambling, susceptibility to peer pressure, conduct problems, binge drinking, suicide attempts, drug use, and being male. The second function highlighted three unique qualities of individuals in the two outlying groups: Probable Pathological Gamblers and Non-Gamblers. These findings suggest that demographic, individual, family, and peer variables are all important correlates of probable pathological gambling in adolescents. Results also support the utility of a five-group classification scheme based on the SOGS-RA. The clinical implications of these results are discussed.     

Gambling and Correlates of Gambling Among Minnesota Public School Students

This study examines the prevalence of gambling and measures the relationships between gambling behavior and a number of demographic, psychosocial, and behavioral variables among Minnesota public school students. The sample includes 78,582 male and female Minnesota public school students enrolled in the 9th and 12th grades. Students were administered the 1998 Minnesota Student Survey, a 121-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple health-related content domains, including gambling behavior. The majority of students were found to have gambled at least once during the past year, however, most students did not report gambling frequently, nor did they report problems associated with their gambling. Boys reported gambling more often than girls, and older students gambled more often than younger students. A larger percentage of Mexican/Latin American, African American, American Indian, and mixed race students gambled at weekly and daily rates than Asian American and Caucasian students. Variables associated with gambling frequency included antisocial behavior, gender (being a male), alcohol and tobacco use, age, feeling bad about the amount of money they bet, a desire to stop gambling, and increased sexual activity. Gambling appears to be related to other risk-taking behaviors and may be a part of the adolescent experimentation with adult behaviors.     

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.     

The Clinical Correlates of Reported Childhood Sexual Abuse: An Association Between Age at Trauma Onset and Severity of Depression and PTSD in Adults

This study investigated the relationship between the age of -self‐reported sexual abuse occurrence and the development of post-traumatic stress disorder and/or depressive symptoms in adulthood. Subjects were evaluated for the presence of post-traumatic stress disorder and/or depressive symptoms as well as for a self-reported history of sexual abuse before the age of 18. Results found that relative risk of having severe post-traumatic stress disorder symptoms was 10 times higher in patients reporting sexual abuse after age 12 than in those reporting sexual abuse before age 12. Relative risk of having severe depressive symptoms was higher for those abused before the age of 12 than for those abused after the age of 12. Findings suggest that the impact of reported sexual abuse at different stages of development may lead to distinct psychiatric symptoms in adulthood.     

Neural Correlates of Pathological Gamblers Preference for Immediate Rewards During the Iowa Gambling Task: An fMRI Study

The Iowa Gambling Task (IGT) involves exploratory learning via rewards and penalties, where most advantageous task performance requires subjects to forego potential large immediate rewards for small longer-term rewards to avoid larger punishments. Pathological gambling (PG) subjects perform worse on the IGT compared to controls, relating to their persistence at high risk decisions involving the continued choice of potential large immediate rewards despite experiencing larger punishments. We wished to determine if neural processing of risk and reward within striatal and frontal cortex is associated with this behaviour observed in PG. Functional magnetic resonance imaging (fMRI) was used to assess brain activity in response to a computerized version of the IGT. Thirteen male PG subjects with no active comorbidities were compared to 13 demographically matched control subjects. In agreement with previous behavioural studies, PG subjects performed worse on the IGT and made more high-risk choices compared to controls, particularly after experiencing wins and losses. During high-risk gambling decisions, fMRI demonstrated that PG subjects exhibited relatively increased frontal lobe and basal ganglia activation, particularly involving the orbitofrontal cortex (OFC), caudate and amygdala. Increased activation of regions encompassing the extended reward pathway in PG subjects during high risk choices suggests that the persistence of PG may be due to the increased salience of immediate and greater potential monetary rewards relative to lower monetary rewards or potential future losses. Whether this over activation of the reward pathway is associated with the development of PG warrants further investigation.     

Evaluation and Treatment of Pathological Gambling

The aim of this article was to describe a model for evaluating and implementing cognitive-behavioral treatment for pathological gambling. The model takes into account the fact that pathological gamblers form a heterogeneous group with varied biopsychosocial characteristics.     

Pathological Gambling,Co-occurring Disorders,Clinical Presentation,and Treatment Outcomes at a University-Based Counseling Clinic

It is the intent of this study to examine the relationship between the number of co-occurring disorders in a sample of pathological gamblers and variables associated with clinical presentation and treatment outcomes. Participants were given screening tools for four common psychological disorders: the hands depression screen, the Mood Disorder Questionnaire, the Carroll-Davidson generalized anxiety disorder screen, and the Sprint-4 PTSD Screen. The number of co-occurring disorders, as indicated by the results of these screening instruments, was compared to severity of gambling problems at outset of treatment, as measured by the NORC diagnostic screen for gambling problems-self administered. The number of co-occurring disorders was also compared to psychosocial functioning at the outset of treatment, as well as level of improvement in psychosocial functioning through treatment. Psychosocial functioning was measured using the Outcome Questionnaire 45 (OQ-45). The number of co-occurring disorders was compared to participant satisfaction with the therapeutic relationship as measured by the working alliance inventory-short form. Results suggest that co-occurring disorders are commonplace among treatment seeking pathological gamblers. Over 86 % of the sample screened positively for at least one of the four targeted psychological disorders. Furthermore, the number of co-occurring disorders was found to be positively related to severity of gambling problems at outset of treatment and negatively related to level of psychosocial functioning at outset of treatment. However, the number of co-occurring disorders was not found to be significantly related to level of improvement in psychosocial functioning through treatment. Overall, those that attended at least six sessions reported significantly improved psychosocial functioning by the end of their sixth session. Finally, the number of co-occurring disorders was not found to be significantly related to participants’ reported level of satisfaction with the therapeutic relationship.     

Heterogeneity of Loss Aversion in Pathological Gambling

Pathological gambling (PG) is characterized by continual repeated gambling behavior despite negative consequences. PG is considered to be a disorder of altered decision-making under risk, and behavioral economics tools were utilized by studies on decision-making under risk. At the same time, PG was suggested to be a heterogeneous disorder in terms of personality traits as well as risk attitude. We aimed to examine the heterogeneity of PG in terms of loss aversion, which means that a loss is subjectively felt to be larger than the same amount of gain. Thirty-one male PG subjects and 26 male healthy control (HC) subjects underwent a behavioral economics task for estimation of loss aversion and personality traits assessment. Although loss aversion in PG subjects was not significantly different from that in HC subjects, distributions of loss aversion differed between PG and HC subjects. HC subjects were uniformly classified into three levels (low, middle, high) of loss aversion, whereas PG subjects were mostly classified into the two extremes, and few PG subjects were classified into the middle range. PG subjects with low and high loss aversion showed a significant difference in anxiety, excitement-seeking and craving intensity. Our study suggested that PG was a heterogeneous disorder in terms of loss aversion. This result might be useful for understanding cognitive and neurobiological mechanisms and the establishment of treatment strategies for PG.     

Pause for Thought: Response Perseveration and Personality in Gambling

In a sample of normal volunteers, response perseveration (RP) on a computerised gambling task, the card perseveration task, was examined under two conditions: No pause (Standard task) and a 5-s pause (Pause task) following feedback from previous bet. Behavioural outcomes comprised number of cards played (and cash won/lost) and latency of response. Individual differences in these outcomes were conceptualised in terms of the reinforcement sensitivity theory of personality. Results showed that, on the Standard task only, sub-scales of the Carver and White (J Pers Social Psychol 67:319–333, 1994) Behavioural Approach System scale positively correlated with number of cards played and amount of money lost (indicative of impaired RP), but these associations were abolished with the imposition of a 5-s pause between feedback and the opportunity to make the next bet—this pause also had an overall main effect of improving RP and reducing losses. As related research shows that such a pause normalises the RP deficit seen in pathological gamblers, these findings hold potentially valuable implications for informing practice in the prevention and treatment of pathological gambling, and point to the role played by individual differences in approach motivation.