Conceptualization of Gambling and the DSM

In the earlier editions of the the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM ) “Pathological Gambling” (now called “Gambling Disorder”) was categorized under impulse-control disorders (ICDs) and conceptualized as either addictive or compulsive behavior, but in the latest edition (DSM-5) Gambling Disorder is moved to the category Substance-Related and Addictive Disorders as a Non-Substance-Related Disorder.

Many researchers and clinicians believe that problem gamblers closely resemble alcoholics and drug addicts, not only from the external consequences of  the addiction, but also from the internal brain chemistry side as well.

Brain imaging studies and neurochemical tests have shown that gambling activates the reward circuitry in the same way as an addictive drug does.  For example, pathological gamblers report cravings and “highs” in response to gambling similar to drug addicts.

Many people expressed concern that the label “pathological” is a pejorative term that only reinforces the social stigma of being a problem gambler, and over such concerns the DSM-5 renamed the disorder “Gambling Disorder.” However, it is not gambling that is the problem, it is pathological gambling, and politically incorrect or not, it is a more descriptive term.

As does substance abuse, pathological gambling runs in families (is genetic), is often co-morbid with other addictions, and up to half of the people being treated for Gambling Disorder have suicidal thoughts.