Examination of Proposed DSM-5 Changes to Pathological Gambling in a Helpline Sample

Authors


  • Declarations of Interest: No conflicts of interest are reported.

  • We thank the First Choice Health Systems, Inc., West Virginia Problem Gamblers Help Network and their callers for sharing the data that made this manuscript possible.

Abstract

Objectives

To examine the effect of proposed the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) changes to pathological gambling relative to DSM-IV criteria in a large gambling helpline sample (N = 2,750). Changes in prevalence rates, the diagnostic utility of the illegal acts criterion, and severity of alternative diagnostic formulation thresholds were examined.

Method

Callers to the helpline completed a semistructured interview and DSM-IV criteria were assessed.

Results

Without lowering the diagnostic threshold, removal of the illegal acts criterion resulted in loss of diagnostic status in less than 2% of helpline callers. The DSM-IV prevalence rate in this sample was 81.2%, and DSM-5 formulations with lowered thresholds of 4, 3, and 2 symptoms increased prevalence rates by 9% to 17%. However, item-level symptom endorsement suggested that subclinical gamblers experience significant adverse consequences.

Conclusions

Lowered thresholds may lead to earlier provision of treatment to gamblers and prevent escalation of the disorder, while being more consistent with diagnostic thresholds of other addiction disorders.

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