Proposed criteria for DSM-V edition of Disordered Gambling

The work group has proposed that this diagnosis be reclassified from Impulse-Control Disorders Not Elsewhere Classified to Substance-Related Disorders which will be renamed Addiction and Related Disorders

Disordered Gambling

A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:

1. is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble

2. needs to gamble with increasing amounts of money in order to achieve the desired excitement

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

4. is restless or irritable when attempting to cut down or stop gambling

5. gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)

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

7. lies to family members, therapist, or others to conceal the extent of involvement with gambling

8. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling

9. relies on other to provide money to relieve a desperate financial situation caused by gambling

B. The gambling behavior is not better accounted for by a Manic Episode.

Include Pathological (Disordered) Gambling within Addiction and Related Disorders
Pathological (disordered) gambling has commonalities in clinical expression, etiology, comorbidity, physiology and treatment with Substance Use Disorders. These commonalities are addressed in the following selected papers from a relatively large literature:
Blanco C, Hasin DS, Petry N, Stinson FS, Grant BF. 2006. Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2006 Jul;36(7):943-53.
Cavedini P, Riboldi G, Keller R, D’Annucci A, Bellodi L. . 2002 Frontal lobe dysfunction in pathological gambling patients. Biol Psychiatry 51:334-341.
de Ruiter MB, Veltman DJ, Goudriaan AE, Oosterlaan J, Sjoerds Z, van den Brink W. Response perseveration and ventral prefrontal sensitivity to reward and punishment in male problem gamblers and smokers. Neuropsychopharmacology. 2009 Mar;34(4):1027-38. Epub 2008 Oct 1. PubMed PMID: 18830241.
Gerstein DR, Volberg RA, Toce MT, et al. Gambling Impact and Behavior Study: Report to National Gambling Impact Study Commission. Chicago, IL: National Opinion Research Center; 1999.
Goudriaan AE, Oosterlaan J, de Beurs E, van den Brink W. Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls. Addiction. 2006 Apr;101(4):534-47. PubMed PMID: 16548933.
Hodgins DC, Currie SR, el-Guebaly N. 2001 Motivational enhancement and self-help treatments for problem gambling. J Consult Clin Psychol. 69:50-57.
Hodgins DC, el-Guebaly N. 2000, Natural and treatment-assisted recovery from gambling problems: A comparison of resolved and active gamblers. Addiction. 95:777-789.
Hodgins, D.C., Currie, S.R., & el-Guebaly, N. 2001. Motivational enhancement and self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69, 50-57.
Kessler RC, Hwang I, LaBrie R, Petukhova M, Sampson NA, Winters KC, Shaffer HJ. 2008. DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychol Med. ;38:1351-60
National Research Council. Pathological Gambling: A Critical Review. Washington, DC: National Academy Press; 1999.
Petry NM. 2001 Pathological gamblers, with and without substance use disorders, discount delayed rewards at high rates. J Abnorm Psychol; 110:482-487.
Petry NM. 2005. Pathological Gambling: Etiology, Comorbidity and Treatments. Washington, D.C.: American Psychological Association Press.
Petry NM. 2006. Should the scope of addictive behaviors be broadened to include pathological gambling? Addiction, 101,152-160.
Petry NM, Ammerman Y, Bohl J, Doersch A, Gay H, Kadden R, Molina C, Steinberg K 2006 Cognitive-Behavioral therapy for pathological gamblers. J Consult Clin Psychol 74:555-567.
Petry NM, Stinson FS, Grant BF. 2005. Comorbidity of DSM-IV pathological gambling and psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 66:564-574
Potenza MN, Leung HC, Blumberg HP, et al. 2003. An fMRI Stroop task study of ventromedial prefrontal cortical function in pathological gamblers. Am J Psychiatry. 160:1990-1994.
Regard M, Knoch D, Gütling E, Landis T. 2003. Brain damage and addictive behavior: A neuropsychological and electroencephalogram investigation with pathologic gamblers. Cog Behav Neurol. 6:47-53.
Rugle L, Melamed L. 1993. Neuropsychological assessment of attention problems in pathological gamblers. J Nerv Ment Dis. 181:107-112.
Shaffer HJ, Hall MN, Vander Bilt J. 1999. Estimating the prevalence of disordered gambling behavior in the United States and Canada: A research synthesis. Am J Public Health. 89:1369-1376.
Slutske WS, Eisen S, True WR, et al. 2000. Common genetic vulnerability for pathological gambling and alcohol dependence in men. Arch Gen Psychiatry57:666-673.
Welte J, Barnes G, Wieczorek W, Tidwell MC, Parker J. 2001. Alcohol and gambling pathology among U.S. adults. Prevalence, demographic patterns and comorbidity. J Stud Alcohol 62:706-712.
Lower Threshold for Pathological (Disordered) Gambling Diagnosis
Several empirical studies have supported lowering the threshold for a diagnosis of pathological (disordered) gambling. Statistical analyses bearing on this issue are also in progress.
Jiménez-Murcia S, Stinchfield R, Alvarez-Moya E, Jaurrieta N, Bueno B, Granero R, Aymamí MN, Gómez-Peña M, Martínez-Giménez R, Fernández-Aranda F, Vallejo J. 2009. Reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for pathological gambling. J Gambl Stud; 25(1):93-104.
Stinchfield R. 2003. Reliability, validity, and classification accuracy of a measure of DSM-IV diagnostic criteria for pathological gambling. Am J Psychiatry, 160(1):180-2
Stinchfield R, Govoni R, Frisch GR. 2005. DSM-IV diagnostic criteria for pathological gambling: reliability, validity, and classification accuracy. Am J Addict., 14(1):73-82
Eliminate Illegal Act Criterion for Pathological (Disordered) Gambling
The illegal act criterion of pathological (disordered) gambling has been shown to have a low prevalence with its elimination having little or no effect on prevalence and little effect on the information associated with the diagnosis in the aggregate.
Strong DR, Kahler CW. 2007. Evaluation of the continuum of gambling problems using the DSM-IV. Addiction 102:713-721.

Recommendations for severity criteria for this disorder are forthcoming. We encourage you to check our Web site regularly for updates.
A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:
1. is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
2. needs to gamble with increasing amounts of money in order to achieve the desired excitement
3. has repeated unsuccessful efforts to control, cut back, or stop gambling
4. is restless or irritable when attempting to cut down or stop gambling
5. gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)
6. after losing money gambling, often returns another day to get even (“chasing” one’s losses)
7. lies to family members, therapist, or others to conceal the extent of involvement with gambling
8. has committed illegal acts such as forgery, fraud theft, or embezzlement to finance gambling
9. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
10. relies on other to provide money to relieve a desperate financial situation caused by gambling
B. The gambling behavior is not better accounted for by a Manic Episode.


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