Pathological gambling disorder Health Article

Symptoms

The symptoms of pathological gambling include preoccupation with gambling activity, often to the extent of interfering with the person's occupational or social functioning. The person is often unable to control the gambling behavior, continuing to place bets or go to casinos in spite of attempts to cut back or stop. A common behavior in persons with pathological gambling disorder is "chasing," which refers to betting larger sums of money or taking greater risks in order to undo or make up for previous losses. The person may also lie about their gambling or engage in such antisocial behaviors as stealing, credit card fraud, check forgery, embezzling from an employer, or similar dishonest behaviors in order to obtain more money for gambling.

Demographics

More males than females in the United States are diagnosed with pathological gambling disorder; the sex ratio is thought to be about 2:1. Relatively few women, however, are in treatment programs for the disorder, most probably because of the greater social stigmaattached to women who gamble. As a rule, men diagnosed with pathological gambling disorder began gambling as teenagers, whereas women tend to start compulsive gambling at a later age. Pathological gambling disorder tends to be more common in minority groups and in people with lower socioeconomic status. About 25% of people diagnosed as pathological gamblers had a parent with the disorder. People who smoke tobacco or abuse alcohol are more likely to have pathological gambling disorder than people who do not use these substances.

As many as 4% of the general population in the United States may meet criteria for pathological gambling disorder at some point in their lives. In some countries such as Australia the number is thought to be as high as 7%.

Diagnosis

Pathological gambling disorder is more likely to be diagnosed when the affected person's spouse or family becomes concerned than to be self-reported. Denialis common among persons with the disorder. The professional handbook, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, or DSM-IV-TR, specifies that the patient must have at least five of the following symptoms to meet criteria for the disorder:

• thinks about gambling all the time
• uses larger and larger amounts of money when gambling
• has tried to stop gambling but failed
• is moody or cranky when trying to stop gambling
• uses gambling as a way to escape problems
• keeps gambling to try to make back money that had previously been lost ("chasing")
• lies about the extent of gambling
• has tried to make money for gambling by engaging in illegal or immoral behavior
• has problems at work or home caused by the gambling
• relies on other people to get him or her out of financial problems caused by the gambling

Pathological gambling disorder is distinguished from social gambling, in which the person is typically socializing with friends, gambling for a limited period of time, and gambling with a limited sum of money that they can afford to lose. Pathological gambling disorder is also distinguished from professional gambling, in which participants limit their risks and discipline their behavior. Lastly, pathological gambling disorder must be distinguished from a manic episode; in most cases, the distinguishing feature of the disorder is that the manic-like behavior disappears after the person leaves the gambling setting.

Treatments

There are a number of different treatments for pathological gambling disorder. Psychodynamic psychotherapyattempts to uncover any underlying psychological factors that trigger the gambling. For people who are gambling to escape, such as those who are depressed, this approach may be very successful. Treating any substance abuse problems that may coexist with the pathological gambling can also be helpful. Other types of treatments involve behavioral techniques used to teach relaxation and avoidance of stimuli associated with gambling. Aversion therapyappears to be successful in treating pathological gambling disorder in highly motivated patients with some insight into the problem, but is not helpful for patients who are less educated or resistant to behavioral methods of treatment.

Gamblers Anonymous, or GA, is a Twelve-Step program patterned on the model of Alcoholics Anonymous (AA). The gambler's admission that she or he does have a gambling problem and a willingness to go to meetings are considered the first steps in treating pathological gambling disorder. Looking realistically at what gambling has done to a person's life, and a willingness to work hard to stop gambling are also important parts of the GA program. People involved in this program are expected to attend meetings regularly, try to make amends for wrongs that their gambling has caused, and find a sponsor (usually of the same sex) to help them through the program. Gamblers Anonymous also expects that people who stop gambling to understand that they probably will never be able to gamble again socially, just as recovering alcoholics cannot drink socially.