(c) Q113 & Q114 Gambling Disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

Introduction

Gambling Disorder (GD) is recognised in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a persistent and recurrent problematic pattern of gambling behaviour leading to clinically significant impairment or distress (American Psychiatric Association [APA], 2013). This recognition marked a significant shift from previous editions of the DSM, which had classified pathological gambling under the category of “Impulse-Control Disorders Not Elsewhere Classified.” In the DSM-5, Gambling Disorder is grouped within the section of Substance-Related and Addictive Disorders, acknowledging the similarities between behavioural addictions and substance-use disorders.

Diagnostic Criteria

The DSM-5 outlines nine diagnostic criteria for Gambling Disorder. A diagnosis requires the individual to exhibit at least four or more criteria within a 12-month period (APA, 2013). These criteria include:

  1. Needs to gamble with increasing amounts of money to achieve the desired excitement.

  2. Is restless or irritable when attempting to cut down or stop gambling.

  3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.

  4. Is often preoccupied with gambling (e.g., reliving past experiences, planning the next venture).

  5. Gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).

  6. After losing money, often returns another day to get even (“chasing” one’s losses).

  7. Lies to conceal the extent of involvement with gambling.

  8. Has jeopardised or lost a significant relationship, job, or educational/career opportunity because of gambling.

  9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

Severity is specified as mild (4–5 criteria), moderate (6–7 criteria), or severe (8–9 criteria).

Changes from DSM-IV to DSM-5

The reclassification of Gambling Disorder reflects growing empirical evidence of neurobiological, clinical, and phenomenological parallels between gambling and substance-use disorders (Potenza, 2014). The DSM-5 also eliminated the DSM-IV criterion related to committing illegal acts to finance gambling, as research showed it to be a low-prevalence indicator not necessary for accurate diagnosis (Petry et al., 2013). This adjustment increased the diagnostic validity and reduced stigma by reframing gambling within the framework of addiction science.

Prevalence and Comorbidity

Epidemiological studies suggest that the lifetime prevalence of Gambling Disorder in the general population ranges from 0.4% to 1.0% (Kessler et al., 2008). GD is highly comorbid with mood disorders, anxiety disorders, and substance-use disorders, underscoring its complexity and impact on mental health (Lorains, Cowlishaw, & Thomas, 2011). Additionally, individuals with Gambling Disorder are at increased risk of suicidality, financial hardship, and relational breakdowns.

Neurobiological and Psychological Underpinnings

Research indicates that Gambling Disorder shares commonalities with substance-use disorders in relation to dopaminergic pathways within the brain’s reward system (Leeman & Potenza, 2012). Functional imaging studies have demonstrated that individuals with GD show heightened activity in the ventral striatum and prefrontal cortex during gambling tasks, suggesting impairments in reward processing and impulse regulation. Cognitive distortions, such as the “gambler’s fallacy” and illusions of control, further perpetuate maladaptive gambling behaviours (Fortune & Goodie, 2012).

Treatment Approaches

Treatment for Gambling Disorder typically involves a combination of psychological, pharmacological, and community-based interventions.

  • Cognitive-behavioural therapy (CBT) has proven effective in addressing distorted cognitions and maladaptive behaviours (Cowlishaw et al., 2012).

  • Pharmacological treatments, including opioid antagonists (e.g., naltrexone) and selective serotonin reuptake inhibitors (SSRIs), have shown promise in reducing gambling urges and behaviours (Grant et al., 2006).

  • Self-help groups, such as Gamblers Anonymous, provide community-based support and are frequently used in conjunction with professional treatment.

Conclusion

The DSM-5’s inclusion of Gambling Disorder within the category of Substance-Related and Addictive Disorders represents a paradigm shift in the understanding of behavioural addictions. By aligning GD with substance-use disorders, the DSM-5 recognises its neurobiological basis, clinical seriousness, and significant psychosocial consequences. Continued research and the development of effective interventions remain critical for addressing the public health challenges associated with this disorder.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). APA Publishing.

  • Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. Cochrane Database of Systematic Reviews, 11(11), CD008937.

  • Fortune, E. E., & Goodie, A. S. (2012). Cognitive distortions as a component and treatment focus of pathological gambling: A review. Psychology of Addictive Behaviors, 26(2), 298–310.

  • Grant, J. E., Kim, S. W., Hollander, E., & Potenza, M. N. (2006). Predicting response to opiate antagonists and placebo in the treatment of pathological gambling. Psychopharmacology, 187(3), 297–305.

  • Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer, H. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38(9), 1351–1360.

  • Leeman, R. F., & Potenza, M. N. (2012). Similarities and differences between pathological gambling and substance use disorders: A focus on impulsivity and compulsivity. Psychopharmacology, 219(2), 469–490.

  • Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys. Addiction, 106(3), 490–498.

  • Petry, N. M., Blanco, C., Stinchfield, R., & Volberg, R. (2013). An empirical evaluation of proposed changes for gambling diagnosis in the DSM-5. Addiction, 108(3), 575–581.

  • Potenza, M. N. (2014). Non-substance addictive behaviors in the context of DSM-5. Addictive Behaviors, 39(1), 1–2.