![]() The consequences of pathological gambling vary with each case and can range from financial loss, divorce, substance abuse, domestic violence, lost time/productivity, and illegal activity. 10 It is unclear what is being genetically inherited, although the trait for risk-taking preference, absence of loss aversion, or sensitivity to immediate rewards may be responsible. 8,9 Pathological gambling has been shown to be a condition with high genetic transmission and heritability. 7 Vulnerable groups include males persons with comorbid psychiatric disorders, especially substance abuse, attention-deficit/hyperactivity disorder, and antisocial personality disorder the elderly adolescents the disabled and those with low socioeconomic status. The course of pathological gambling can vary from a chronic relapsing condition to one with a short time course. Since pathological gambling is a hidden addiction that cannot be detected by physical examination, the use of screening tools is essential. 6 Presenting symptoms can be vague and might include commonly seen problems, such as insomnia, stress, depression, anxiety, or interpersonal problems. Most pathological gamblers do not present with a chief complaint of “being addicted to gambling.” Research has shown that only 10% of pathological gamblers present for treatment. Patients in substance abuse treatment settings have been known to switch addictions during the recovery process. 5 Frequent screening for pathological gambling is recommended. There are several validated, simple screens for pathological gambling ( Table 1) that can be used in different languages, as well as a quick 2-question (Lie-Bet) tool that can be used. Most clinicians can recognize signs and symptoms of gambling addiction, but screening is not routine. This is similar to substance abuse in that the gamblers’ lives are being harmed by gambling, but full criteria are not satisfied. Problem gamblers are considered those who meet 1 or more of the diagnostic criteria for pathological gambling but less than 5. Criteria that are specific to pathological gambling include chasing losses, committing illegal acts to finance gambling, and having others pay gambling debts. Some of the cardinal symptoms include preoccupation with gambling, tolerance (need to increase the size of bets), loss of control, inability to cut down, and lost opportunities as a result of gambling. ![]() 4 Finally, pathological gambling may be viewed as a stand-alone impulse control disorder with unique characteristics, disease course, and pathophysiology.Īccording to current DSM-IV criteria, pathological gambling is characterized by continued gambling despite harmful consequences. 3 Another possibility is to view pathological gambling as an obsessive-compulsive spectrum disorder because of the shared symptoms of preoccupation tension and repetitive, almost ritualistic behaviors. ![]() One viewpoint is to include pathological gambling as an addictive disorder because both conditions share core features-namely, loss of control in the face of adverse consequences. There is an ongoing debate as to where to include pathological gambling in DSM-V. As a result, clinicians may not recognize the signs and symptoms of pathological gambling and may lack the training and experience to provide state-of-the-art treatment.ĭSM-IV lists pathological gambling in the section on impulse control disorders. Screening and treatment for pathological gambling-otherwise known as compulsive gambling, gambling addiction, or disordered gambling-is not generally taught in medical school, during psychiatry residency, or during training for mental health or substance abuse counselors. 2 This prevalence is similar to that of schizophrenia and bipolar disorder, yet pathological gambling often goes unrecognized by most health care providers. Beyond this, approximately 1% to 2% of the population currently meets criteria for pathological gambling. 1 The majority of people who gamble do so socially and do not incur lasting adverse consequences or harm. Surveys show that approximately 60% of the general population has gambled within the past 12 months. Gender Differences Should Be Considered in Treatment of Addiction ![]() Psychiatric Comorbidity Associated With Pathological GamblingĬlinical Assessment and Management of Pathological Gambling
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