Change In Gambling Disorder Definition Will Lead To Increase In Diagnosis

Prior to 2013, doctors in the U.S. diagnosed serious gambling problems under the heading of a condition called pathological gambling. However, in May of that year, the American Psychiatric Association eliminated the pathological gambling diagnosis and replaced it with a new, modified diagnosis called gambling disorder.

In a study published in 2014 in the journal Psychology of Addictive Behaviors, a team of American researchers compared the accuracy of the definition for pathological gambling to the accuracy of the definition for gambling disorder. These researchers concluded that the definition for the newer diagnosis has retained a high degree of accuracy in properly identifying affected individuals.

Pathological Gambling

The American Psychiatric Association (APA) included pathological gambling with a larger group of conditions called “impulse control disorders not elsewhere classified.” Other illnesses found in this category included pyromania, an anger control-related condition called intermittent explosive disorder, and kleptomania.

Pathological Gambling Symptoms

Doctors diagnosing pathological gambling looked for the presence of a minimum of five out of 10 potential symptoms. These symptoms included:

• fixation with gambling while not actively involved in gambling,
• demonstrated inability to place limits on gambling participation,
• compulsion to engage in increasingly risky gambling situations, a
• reliance on gambling to cope with or avoid painful emotions or personal problems,
• returning to gambling rapidly after incurring substantial losses,
• concealing the extent of gambling involvement from others,
• relying on other people’s resources for gambling participation,
• gambling-related exposure to serious harm in personal or social relationships, and
• the onset of mental/psychological withdrawal when gambling participation stops or declines

The pathological gambling definition also included funding of gambling through illegal means as a potential symptom.

Gambling Disorder

In 2013, the APA simultaneously eliminated the pathological gambling diagnosis and placed the gambling disorder diagnosis in a new category of conditions called addictive disorders. These disorders are behavioral addictions that stem from problematic involvement in certain pleasurable, everyday activities rather than from the repeated, excessive use of drugs or alcohol. Gambling disorder is the only illness the APA has added to the addictive disorders category.

The definition for this condition largely resembles the previously used definition for pathological gambling. However, the American Psychiatric Association eliminated funding gambling through illegal means from the list of symptoms. In addition, the organization reduced the lower limit for diagnosing gambling disorder to four out of 10 symptoms, compared to the five out 11 symptoms limit used for diagnosing pathological gambling.

Has The Change Affected Accuracy?

In the study published in Psychology of Addictive Behaviors, researchers from the New York State Psychiatric Institute, the National Institutes of Health, and the University of Connecticut used information from a large-scale federal project called the National Epidemiologic Survey of Alcohol and Related Disorders (NESARC) to compare the accuracy of the symptom set used to define pathological gambling to the accuracy of the symptom set used to define gambling disorder. A total of 43,093 people were involved in this comparison. These individuals came from demographic backgrounds reflective of the national population. The researchers analyzed the gambling problems in this group as a whole and in each major demographic subgroup.

After completing their analysis, the researchers concluded that the new gambling disorder definition correctly identifies serious gambling problems in roughly 99 percent of those individuals who would have been diagnosed under the old pathological gambling definition. They also concluded that both definitions do an equally good job of identifying people not affected by serious gambling problems. These findings applied to the NESARC participants as a whole, as well as to all of the demographic subgroups found among the NESARC participants.

The study’s authors concluded that the switch from pathological gambling to gambling disorder and the associated elimination of funding gambling through illegal means as a potential symptom have had a minimal effect on doctors’ ability to accurately diagnose dysfunctional gambling behaviors. However, they also concluded that the lowered symptom requirement for gambling disorder will lead to an uptick in the number of people who receive a diagnosis. Still, despite this uptick, the overall number of people affected by diagnosable gambling problems will continue to be fairly small relative to the total population.