Psychiatric Comorbidity Associated with Pathological Gambling
What is gambling?
Gambling is a popular recreational activity in the United States, that has grown over time. It is estimated that between 70 and 90 percent of Americans have engaged in some form of gambling throughout their lifetime. Disordered gambling has been recognized for a very long time now; however, pathological gambling (PG) was first introduced to the DSM-III in 1980. It is categorized as an impulse control disorder; however, the criteria is patterned after that of substance dependencies, emphasizing features of tolerance and withdrawal.
More and more, gambling is becoming a public health problem, costing society approximately $5 billion per year and an extra $40 billion in lifetime costs for reduced productivity, social services, and creditor losses. Also, it is no secret that gambling severely impacts one’s quality of life, with its associations with psychiatric disorders, family-related problems, and suicide. In fact, psychiatric comorbidity is extremely common in persons with PG.2 It is important for clinicians to evaluate the individual’s psychiatric comorbidity along with their gambling behavior and its impact on their life.2
Substance Abuse and Gambling
Substance abuse has a clear association with PG.2 In fact, the National Opinion Research Center study found that the rate of both alcohol and drug use was seven times higher in individuals with PG than it was in individuals who gambled recreationally or not at all.4 Gerstein and colleagues found that 16.8 percent of individuals with PG reported using illicit drugs within the past year.4 The lifetime prevalence of a substance use disorder is 38.1 percent among PG individuals.4
Gambling and Mood Disorders
Three recent studies have found that there is a high association among problem gamblers and mood disorders, especially major depression, bipolar, and suicidality. Bland and colleagues found that there were higher rates of mood disorders in problem gamblers than in the general population, with the statistics being 33.3 percent to 14.2 percent respectively. Also, Cunningham-Williams and colleagues stated that rates of major depression were much higher in their sample of individuals with PG. However, the largest, and most recent, study reports that 49.6 percent of individuals with PG have a mood disorder, with mania being the most strongly related.
There is also a strong association between problem gambling and anxiety disorders. Kessler and colleagues found that 60.3 percent of individuals in their study had an anxiety disorder: 52.2 percent had phobias, 21.9 percent had panic disorder, 16.6 percent had generalized anxiety disorder, and 14.8 percent had posttraumatic stress disorder. Also, some researchers believe that PG is associated with obsessive-compulsive disorder.2 They state that the similarities are persistent thoughts and repetitive behaviors; however, the differences are that OCD is unwanted and gambling is often pleasurable.2 Studies suggest that up to 20 percent of problem gamblers have OCD.
Problem gambling is also associated with attention-deficit/hyperactivity disorder (ADHD). Rugle and Melamed conducted a study in which they compared 33 non-substance abusing persons with problem gambling to nine attention measures and childhood behavior questionnaires. Results showed that the persons with problem gambling performed worse on the attention measures and reported more childhood ADHD behaviors.11 Another study, conducted by Castellani and Rugle evaluated 843 individuals who were admitted to inpatient treatment for PG, alcohol dependence, or cocaine abuse. Individuals with PG scored higher on measures of impulsivity than those with alcohol dependence or cocaine abuse.12
Overall, there is a connection between problem gambling and comorbid psychiatric disorders, such as addictive disorders, mood disorders, anxiety disorders, and ADHD. Future research is focusing on the role of the comorbid disorders on the course and outcome of the illness progression and treatment.
 Raylu N, Oei TP. Pathological gambling: a comprehensive review. Clin Psychol Rev. 2002;22:1009-1061.
 Black, D.W. and Shaw, M. (2008, Oct. 1). Psychiatric Comorbidity Associated with Pathological Gambling. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/gambling/content/article/10168/1342537.
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.
 Gerstein DR, Volberg RA, Toce MT, et al. Gambling Impact and Behavior Study: Report to the National Gambling Impact Study Commission. Chicago: National Opinion Research Center; 1999. http://cloud9.norc.uchicago.edu/dlib/ngis.htm.
 Black DW, Moyer T. Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior. Psychiatr Serv. 1998;49:1434-1439.
 Bland RC, Newman SC, Orn H, Stebelsky G. Epidemiology of pathological gambling in Edmonton. Can J Psychiatry. 1993;38:108-112.
 Cunningham-Williams RM, Cottler LB, Compton WM 3rd, Spitznagel EL. Taking chances: problem gamblers and mental health disorders—results from the St Louis Epidemiologic Catchment Area Study. Am J Public Health. 1998;88:1093-1096.
 Petry NM, Stinson FS, Grant BF. Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2005;66:564-574.
 Kessler RC, Hwang I, LaBrie R, et al. DSM-IV pathological gambling in the National Comorbid-ity Survey Replication. Psychological Medicine. Cambridge University Press; 2008. doi:10.1017/ S0033291708002900.
 Specker SM, Carlson GA, Edmonson KM, et al. Psychopathology in pathological gamblers seeking treatment. J Gambl Stud. 1996;12:67-81.
 Rugle L, Melamed L. Neuropsychological assessment of attention problems in pathological gamblers. J Nerv Ment Dis. 1993;181:107-112.
 Castellani B, Rugle L. A comparison of pathological gamblers to alcoholics and cocaine misusers on impulsivity, sensation seeking, and craving. Int J Addict. 1995;30:275-289. Gambling.