Gambling Disorder

If we retrace this brief overview of addiction-related conditions, I previously explained how not only substances can trigger the reward circuits, but also certain behaviors. I also mentioned that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes only one type of non-substance-related disorder, namely Gambling Disorder.

But why gambling and not other types of behaviors (such as compulsive shopping, sex, etc.)? As I’ve already pointed out, the scientific literature available so far only provides enough evidence to systematize this behavior. We’ll have to wait and see whether the sixth edition of the manual will include other non-substance-related disorders.

The category of gambling includes games in which one bets or invests money with the goal of earning much more than was wagered. Examples include scratch-off lottery tickets, slot machines, and all the typical casino games. A person might engage in several types of gambling, but what makes the behavior problematic is not the frequency of play or the amount of money spent — rather, it’s the way the person approaches gambling and how it impacts their life.

Some common features among individuals with gambling problems include distorted thoughts, such as believing they can control or predict “luck.” They often perceive money as both the solution to their problems and the cause of them. Gambling typically occurs during moments of personal vulnerability. Unfortunately, Gambling Disorder is strongly associated with suicide, with about half of individuals experiencing suicidal ideation (imagining their own suicide) and more than one in six having attempted suicide.

According to the DSM-5, Gambling Disorder is characterized by the presence of four or more of the following symptoms occurring within a one-year period and not explained by a manic episode:

• A need to gamble with increasing amounts of money to achieve the desired excitement.
• Becoming irritable when attempting to stop or reduce gambling.
• Repeated unsuccessful efforts to control or stop gambling behavior.
• Persistent preoccupation with gambling (thinking constantly about when and how to play).
• Gambling during times of personal distress or vulnerability.
• Chasing losses (gambling to recover lost money).
• Lying to conceal the extent of involvement in gambling.
• Gambling has caused significant problems in social, occupational, or relationship functioning.
• Relying on others to provide money to relieve desperate financial situations caused by gambling.

Sources:

• American Psychiatric Association (2013) – Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
• Bernhill, J. W. (2014) – DSM-5 Clinical Cases

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