In 1972 Dr. Robert Custer, a psychiatrist working at a Veterans’ Administration Hospital in Ohio, first proposed a medical syndrome associated with gambling, which he termed “compulsive gambling.” His efforts brought the problems associated with gambling into the health care arena. Dr. Robert Custer has identified three phases to pathological gambling:
1. The adventurous phase — marked by an increasing desire for gambling as excitement and often including a big win which the gambler sees as resulting from their personal abilities;
2. The losing phase — in which the gambler bets increasing amounts of money “chasing” the money they’ve lost;
3. The desperation phase — when gambling becomes a full-time obsession, the gambler increasingly gambles on credit, and takes greater and greater risks.
In 1980, the American Psychiatric Association included “pathological gambling” in its Diagnostic and Statistical Manual of Mental Disorders (DSM). Since then, psychiatry has accepted severe problems associated with gambling as constituting a disorder.
According to the most recent edition of Diagnostic and Statistical Manual of Psychiatric Disorder (DSM-IV-TR), the essential feature of pathological gambling is persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits.
The DSM-IV-TR diagnostic criteria for pathological gambling:
Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:
(1) is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
(2) needs to gamble with increasing amounts of money in order to achieve the desired excitement
(3) has repeated unsuccessful efforts to control, cut back, or stop gambling
(4) is restless or irritable when attempting to cut down or stop gambling
(5) gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)
(6) after losing money gambling, often returns another day to get even (“chasing” one’s losses)
(7) lies to family members, therapist, or others to conceal the extent of involvement with gambling
(8) has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling
(9) has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
(10) relies on others to provide money to relieve a desperate financial situation caused by gambling.
Distortions in thinking (e.g., denial, superstitions, overconfidence, or a sense of power and control) may be present in individuals with pathological gambling. Many individuals with pathological gambling believe that money is both the cause of and solution to all their problems. Individuals with pathological gambling are frequently highly competitive, energetic, restless, and easily bored. They may be overly concerned with the approval of others and may be generous to the point of extravagance.
Community studies estimate the lifetime prevalence of pathological gambling to range from 0.4% to 3.4% in adults, although prevalence rates in some areas have been reported to be as high as 7%. Higher prevalence rates, ranging from 2.8% to 8%, have been reported in adolescents and college students.
Pathological gambling is frequently comorbid with other psychiatric disorders, especially with substance use disorders. For example, a recent study demonstrated that almost three quarters (73.2%) of pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between pathological gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant, even after controlling for sociodemographic and socioeconomic characteristics.
Although pathological gambling is classified as an impulse control disorder in the DSM-IV-TR, pathological gambling is often regarded as a behavioral or non-chemical addiction. Psychologically, the commonality between behavioral and substance dependencies is the enduring engagement in uncontrolled self-destructive behavior, despite its negative consequences.