A hierarchy of gambling disorders in the community
Article first published online: 3 DEC 2003
Volume 98, Issue 12, pages 1661–1672, December 2003
How to Cite
Toce-Gerstein, M., Gerstein, D. R. and Volberg, R. A. (2003), A hierarchy of gambling disorders in the community. Addiction, 98: 1661–1672. doi: 10.1111/j.1360-0443.2003.00545.x
- Issue published online: 3 DEC 2003
- Article first published online: 3 DEC 2003
- Submitted10 September 2002; initial review completed 5 November 2002; final version accepted 23 May 2003
- impulse control disorders;
- pathological gambling;
- substance-related disorders
Aims To help refine the definition and diagnosis of gambling disorders, we investigated the distribution among US gamblers of the 10 DSM-IV criteria for Pathological Gambling.
Design We drew data from two stratified random surveys (n = 2417, n= 530) of gambling behavior and consequences among community-based samples of US adults. A fully structured questionnaire, administered by trained lay interviewers, screened for the life-time prevalence of problem and Pathological Gambling. Per DSM-IV definitions, anyone meeting five or more of 10 itemized criteria was considered a pathological gambler. We analyzed these criteria among all gamblers who met one or more criteria (n = 399).
Findings Most gamblers who met only one or two criteria reported ‘chasing their losses’. At subclinical levels (three to four criteria), gamblers also reported elevated rates of gambling-related fantasy: lying, gambling to escape and preoccupation. Pathological gamblers with five to seven criteria reported marked elevations of loss of control, withdrawal symptoms and tolerance (internalizing dimensions of dependence); risking their social relationships and needing to be bailed out financially (externalizing dimensions). Most of the highest-level pathological gamblers (eight to 10 criteria) reported committing illegal acts to support gambling.
Conclusion Dependence in a biobehavioral sense appears to be a hallmark of Pathological Gambling, but it marks only one threshold in a qualitative hierarchy of disorders beginning with a common subclinical behavior, ‘chasing’. Epidemiological assessments and future DSM revisions might consider explicit recognition of a problem gambling disorder, identifying people presenting some cognitive symptoms of Pathological Gambling but not clear signs of dependence. Pathological gamblers in turn appear to have two distinct levels of severity.