This article was downloaded by: [2.139.177.

140] On: 01 April 2014, At: 09:12 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

International Gambling Studies

Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rigs20

Pathological gambling and the DSM-V

Nancy M. Petry
a a

University of Connecticut Health Center , Farmington, CT, USA Email: Published online: 11 Aug 2010.

To cite this article: Nancy M. Petry (2010) Pathological gambling and the DSM-V, International Gambling Studies, 10:2, 113-115, DOI: 10.1080/14459795.2010.501086 To link to this article: http://dx.doi.org/10.1080/14459795.2010.501086

PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the Content) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions

International Gambling Studies Vol. 10, No. 2, August 2010, 113115

EDITORIAL Pathological gambling and the DSM-V

The American Psychiatric Association (APA) is in the process of updating the fth of edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is the primary classication system for diagnosing mental disorders in the United States, and it is widely used in other countries as well. Currently, pathological gambling is classied in the Impulse-Control Disorders Not Elsewhere Classied section of the DSM-IV (American Psychiatric Association, 1994). The Substance Use Disorders Workgroup of the APAs DSM committee has made a recommendation to move pathological gambling to its chapter. This suggestion was based on a vast body of literature demonstrating high rates of comorbidity between substance use disorders and pathological gambling (Petry, Stinson & Grant, 2005; Kessler et al., 2008), similarities in some symptom presentations (Petry, 2006), some potential parallel biological dysfunction (Potenza et al., 2003), evidence of shared genetic liability (Slutske et al., 2000), and overlap in treatment approaches (Hodgins, Curry & el-Guebaly, 2001; Petry et al., 2006; Petry, Weinstock, Ledgerwood & Morasco, 2008). In addition to recommending a change in location in DSM-V, the Workgroup has suggested that the name of the disorder be altered. The term pathological conjures pejorative thoughts among providers, patients and the public. A working suggestion is disordered gambling. Terms such as problem gambling and compulsive gambling were considered but decided against. The former has often been used to refer to a sub-diagnostic threshold condition and hence could lead to future confusion related to severity, and the latter shares overlap with disorders in the anxiety disorders section of the DSM. The nal name for pathological gambling will be determined when the overall chapter name is decided. The most recent version of the DSM (revision IV) lists 10 criteria for pathological gambling (American Psychiatric Association, 1994). Statistical analyses generally nd these 10 criteria tap a single uniform underlying construct (Strong & Kahler, 2007). However, one of the ten criteria is rarely endorsed and appears to add little to diagnostic classication accuracy. The criterion related to committing illegal acts (e.g. forgery, fraud, theft or embezzlement) to nance gambling is the least often endorsed criterion in a number of population surveys (Blanco, Hasin, Petry, Stinson & Grant, 2006; Gerstein et al., 1999; Strong & Kahler, 2007), and item response theory reveals it adds little to classication accuracy (Grant, 2010). Hence, the Workgroup has suggested that this criterion be dropped in the next version of the DSM. The other recommendation of the Workgroup is to reduce the number of criteria necessary for a diagnosis of pathological gambling. Several population based studies reveal that meeting four criteria, rather than the ve currently necessary for a diagnosis,
ISSN 1445-9795 print/ISSN 1479-4276 online q 2010 Taylor & Francis DOI: 10.1080/14459795.2010.501086 http://www.informaworld.com

Downloaded by [2.139.177.140] at 09:12 01 April 2014

114

Editorial

Downloaded by [2.139.177.140] at 09:12 01 April 2014

nez-Murcia et al., 2009; Stincheld, 2003; improves classication accuracy (Jime Stincheld, Govoni & Frisch, 2005). Additional analyses were undertaken on the NESARC data when the legal criterion was eliminated, and similar results were found as noted in the published studies with the threshold of four criteria (Grant, unpublished data, 2010). Hence, the Workgroup recommends that pathological gambling be diagnosed when one meets four of nine criteria in the next version of the DSM. The Substance Use Disorders Workgroup received over 400 comments related to its proposed changes during a period of open public commentary. Although not all responses were favorable about all aspects of proposed changes to substance use disorders, the overwhelming vast majority of comments related to pathological gambling were in support of moving gambling to an Addiction and Related Disorders section. Some argued to reduce the number of criteria necessary for a diagnosis even lower than four (e.g. to two or three criteria), but analyses from large population databases reveal that such changes would substantially impact the prevalence rate of the disorder, by more than doubling the rate of this disorder (Blanco et al., 2006; Welte, Barnes, Wieczorek, Tidwell & Parker, 2001). Moreover, lowering the threshold for the rst non-substance related addictive behaviour may set a precedence for setting the bar too low for future putative behavioural addictions that may be introduced in subsequent versions of the DSM. Ultimately, low thresholds for diagnoses could undermine the system of psychiatric classication more broadly and prove a disservice to individuals with substantial psychiatric distress (Martin & Petry, 2005). Moving pathological gambling to the substance use disorders section and reducing the criteria and diagnosis threshold are likely to improve screening and treatment efforts in high-risk populations. A new name for the disorder is also likely to be a welcome change. It is hoped that these suggested alterations will improve diagnosis, treatment and research efforts to better understand and ultimately prevent this disorder.

References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. Blanco, C., Hasin, D.S., Petry, N., Stinson, F.S., & Grant, B.F. (2006). Sex differences in subclinical and DSM-IV pathological gambling: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 36, 943 953. Gerstein, D.R., Volberg, R.A., Toce, M.T., Harwood, H., Johnson, R.A., Buie, T. et al., (1999). Gambling impact and behavior study: Report to the National Gambling Impact Study Commission. Chicago, IL: National Opinion Research Center. Grant, B.F. (2010). Unpublished data analysis from the National Epidemiological Survey of Alcohol and Related Conditions. 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. nez-Murcia, S., Stincheld, R., Alvarez-Moya, E., Jaurrieta, N., Bueno, B., Granero, R. et al. Jime (2009). Reliability, validity, and classication accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for pathological gambling. Journal of Gambling Studies, 25, 93 104. Kessler, R.C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N.A., Winters, K.C. et al. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38, 1351 1360. Martin, P.R., & Petry, N.M. (2005). Are non-substance-related addictions really addictions? American Journal on Addictions, 14, 1 7. Petry, N.M. (2006). Should the scope of addictive behaviors be broadened to include pathological gambling? Addiction, 101, 152 160.

International Gambling Studies

115

Downloaded by [2.139.177.140] at 09:12 01 April 2014

Petry, N.M., Ammerman, Y., Bohl, J., Doersch, A., Gay, H., Kadden, R. et al. (2006). Cognitivebehavioral therapy for pathological gamblers. Journal of Consulting and Clinical Psychology, 74, 555 567. Petry, N.M., Stinson, F.S., & Grant, B.F. (2005). Comorbidity of DSM-IV pathological gambling and psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66, 564 574. Petry, N.M., Weinstock, J., Ledgerwood, D., & Morasco, B. (2008). A randomized trial of brief interventions for problem and pathological gamblers. Journal of Consulting and Clinical Psychology, 76, 318 328. Potenza, M.N., Leung, H.C., Blumberg, H.P., Peterson, B.S., Fulbright, R.K., Lacadie, C.M. et al. (2003). An fMRI Stroop task study of ventromedial prefrontal cortical function in pathological gamblers. American Journal of Psychiatry, 160, 1990 1994. Slutske, W.S., Eisen, S., True, W.R., Lyons, M.J., Goldberg, J., & Tsuang, M. (2000). Common genetic vulnerability for pathological gambling and alcohol dependence in men. Archives of General Psychiatry, 57, 666 673. Stincheld, R. (2003). Reliability, validity, and classication accuracy of a measure of DSM-IV diagnostic criteria for pathological gambling. American Journal of Psychiatry, 160, 180 182. Stincheld, R., Govoni, R., & Frisch, G.R. (2005). DSM-IV diagnostic criteria for pathological gambling: Reliability, validity, and classication accuracy. American Journal on Addictions, 14, 73 82. Strong, D.R., & Kahler, C.W. (2007). Evaluation of the continuum of gambling problems using the DSM-IV. Addiction, 102, 713 721. Welte, J., Barnes, G., Wieczorek, W., Tidwell, M.C., & Parker, J. (2001). Alcohol and gambling pathology among U.S. adults. Prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol, 62, 706 712.

Nancy M. Petry University of Connecticut Health Center Farmington, CT, USA Email: npetry@uchc.edu