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DSM-IV pathological gambling in the National Comorbidity Survey Replication
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Background: Little is known about the prevalence or correlates of DSM-IV pathological gambling (PG). Method: Data from the US National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey, were used to assess lifetime gambling symptoms and PG along with other DSM-IV disorders. Age of onset (AOO) of each lifetime disorder was assessed retrospectively. AOO reports were used to study associations between temporally primary disorders and the subsequent risk of secondary disorders. Results: Most respondents (78.4%) reported lifetime gambling. Lifetime problem gambling (at least one Criterion A symptom of PG) (2.3%) and PG (0.6%) were much less common. PG was significantly associated with being young, male, and Non-Hispanic Black. People with PG reported first gambling significantly earlier than non-problem gamblers (mean age 16.7 v . 23.9 years, z =12.7, p <0.001), with gambling problems typically beginning during the mid-20s and persisting for an average of 9.4 years. During this time the largest annual gambling losses averaged US$4800. Onset and persistence of PG were predicted by a variety of prior DSM-IV anxiety, mood, impulse-control and substance use disorders. PG also predicted the subsequent onset of generalized anxiety disorder, post-traumatic stress disorder (PTSD) and substance dependence. Although none of the NCS-R respondents with PG ever received treatment for gambling problems, 49.0% were treated at some time for other mental disorders. Conclusions: DSM-IV PG is a comparatively rare, seriously impairing, and undertreated disorder whose symptoms typically start during early adulthood and is frequently secondary to other mental or substance disorders that are associated with both PG onset and persistence.
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“Epidemiological research indicates that over 50% of PGs have a lifetime mood disorder, over 40% have a lifetime anxiety disorder, and about 23% have ASPD (Kessler et al. 2008; Petry, Stinson & Grant, 2005).”
From Subtyping Pathological Gamblers Based on Impulsivity, Depression, and Anxiety (2010) · cites this paper as Kessler et al. 2008
Experimental — accuracy not yet measuredIn the citing paper
“Gambling disorder often co-occurs with psychiatric disorders, particularly substance use and anxiety disorders (el-Guebaly et al., 2006; Kessler et al., 2008; Lorains, Cowlishaw, & Thomas, 2011; Parhami, Mojtabai, Rosenthal, Afifi, & Fong, 2014).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Kessler et al., 2008
In the citing paper
“For gambling disorder and substance use disorders, it appears this relationship is bi-directional, as the presence of one of either of these conditions often predicts the onset of the other (Afifi, Nicholson, Martins, & Sareen, 2016; Kessler et al., 2008).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Kessler et al., 2008
In the citing paper
“Approximately 37% (range: 14.0% −60.3%) of subthreshold and clinical gamblers suffer from an anxiety disorder (Kessler et al., 2008; Lorains et al., 2011; Petry et al., 2005)”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Kessler et al., 2008
In the citing paper
“Anxiety disorders, however, often precede the onset of gambling disorder or substance use disorders (Blanco et al., 2015; Kausch, Rugle, & Rowland, 2006; Kessler et al., 2008).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Kessler et al., 2008
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Pathological gamblers discount probabilistic rewards less steeply than matched controls.
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“Similar to the gender distribution of BED and PG in the general population (Kessler et al, 2013; Kessler et al, 2008), our sample had more PG males and only females with BED.”
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“…constitutes part of the vulnerability to develop DG. Previous studies that have assessed the temporal relation between DG and AUD in individuals with a history of both disorders have generally found that AUD precedes the development of DG (Cunningham-Williams et al., 2000; Kessler et al., 2008).”
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“Gambling problems are associated with increased gambling frequency ( Kessler et al., 2008).”
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“4% of the nationally representative sample reported lifetime gambling activity and 3% were problem or pathological gamblers according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria (Kessler et al., 2008).”
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“Finally, research has indicated that problem gambling is frequently associated with negative affective states, such as negative mood (Griffiths, 1995; Matthews, Farnsworth, & Griffiths, 2009) and/or anxiety disorders (e. g., Kessler et al., 2008; Petry, Stinson, & Grant, 2005).”
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“That is, substance use problems may precede gambling in many instances, while gambling problems precede substance use in others; although substance use disorders overall may be most likely to predate problematic gambling in time (Kessler et al., 2008).”
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“Studies examining differences between full- and subthreshold pathological gamblers have found comparable patterns of co-morbidity (Kessler et al. 2008), but lower levels of novelty seeking in subthreshold gamblers (Cunningham-Williams et al. 1998).”
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“The low rate of treatment-seeking for PG has been replicated in a more recently published United States national survey, the National Comorbidity Survey Replication (NCS-R) conducted in 2001–2003, in which nobody sought formal treatment for their gambling problems (Kessler et al., 2008).”
BackgroundGenetic and Environmental Influences on Disordered Gambling in Men and Women
Slutske, W. S., Zhu, G., Meier, M. H., & Martin, N. G. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.51 · Cited by 116
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“IV mood, anxiety, impulse-control and SUDs, and that gambling disorder also predicted the subsequent onset of GAD, PSTD and substance dependence (Kessler et al. 2008).”
A double-blind, placebo-controlled trial of topiramate for pathological gambling
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“Pathological gambling (PG) has a prevalence of about 1%, and co-morbid psychiatric conditions are common (Petry et al. 2005; Cunningham-Williams et al. 2005, 2007; Kessler et al. 2008).”
BackgroundReward-based decision making in pathological gambling: The roles of risk and delay
Wiehler, A., & Peters, J. (2014) · Neuroscience Research · doi:10.1016/j.neures.2014.09.008 · Cited by 111
Wohl, M. J. A., Davis, C. G., & Hollingshead, S. J. (2017) · Computers in Human Behavior · doi:10.1016/j.chb.2017.01.025 · Cited by 109
“Unfortunately, a small portion of players will become overly involved in terms of the amount of money and time they invest, despite the substantial mental and physical health, interpersonal, and financial problems that result (see Kessler et al., 2008; Petry, Stinson, & Grant, 2005).”
BackgroundA scoping review of co-morbidity in individuals with disordered gambling
Yakovenko, I., & Hodgins, D. C. (2017) · International Gambling Studies · doi:10.1080/14459795.2017.1364400 · Cited by 117
“Epidemiology of co-occurrence appears to be a common form of study: co-morbidity of substance use disorders and other psychiatric disorders is common in both general and clinical populations across multiple geographic locations around the world (Kessler et al., 2008; SAMHSA, 2014).”
BackgroundCarlbring, P., Jonsson, J., Josephson, H., & Forsberg, L. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070903190245 · Cited by 109
“the individual (Kessler et al., 2008).”
BackgroundGambling and the COVID-19 pandemic: A scoping review
Brodeur, M., Audette-Chapdelaine, S., Savard, A.-C., & Kairouz, S. (2021) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2021.110389 · Cited by 106
Age of Onset in Pathological Gambling: Clinical, Therapeutic and Personality Correlates
Jiménez‐Múrcia, S., Álvarez‐Moya, E. M., Stinchfield, R. D., Fernández‐Aranda, F., Granero, R., Aymamí, N., Gómez‐Peña, M., Jaurrieta, N., Bove, F. I., & Menchón, J. M. (2010) · Journal of Gambling Studies · doi:10.1007/s10899-009-9175-3 · Cited by 105
Cowlishaw, S., & Kessler, D. S. (2015) · European Addiction Research · doi:10.1159/000437260 · Cited by 102
Volberg, R. A., Munck, I. M. E., & Petry, N. M. (2011) · American Journal on Addictions · doi:10.1111/j.1521-0391.2011.00118.x · Cited by 102
Gainsbury, S., Russell, A. M. T., Wood, R., Hing, N., & Blaszczynski, A. P. (2014) · New Media & Society · doi:10.1177/1461444813518185 · Cited by 100
“…that drug use may be more common amongst Internet PGs, which is consistent with a large body of evidence demonstrating high rates of comorbidity between substance use and gambling disorders (Kessler et al., 2008; Petry et al., 2005) and may be facilitated by the privacy of Internet gambling.”
BackgroundImpulse-Control Disorders in a College Sample
Odlaug, B. L., & Grant, J. E. (2010) · The Primary Care Companion to The Journal of Clinical Psychiatry · doi:10.4088/pcc.09m00842whi · Cited by 99
Gambling advertising: A critical research review
Binde, P. (2014) · doi:10.11575/prism/9519 · Cited by 96
Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences
Moragas, L., Granero, R., Stinchfield, R. D., Fernández‐Aranda, F., Fröberg, F., Aymamí, N., Gómez‐Peña, M., Fagundo, A. B., Islam, M. A., del Pino‐Gutiérrez, A., et al. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0459-0 · Cited by 95
“Several studies show greater emotional instability and psychopathology in women, especially with regard to depression and anxiety [47,49].”
BackgroundBlack, D. W., Shaw, M. C., McCormick, B. A., & Allen, J. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.07.001 · Cited by 94
Mindfulness-based cognitive therapy for problem gambling
de Lisle, S. M., Dowling, N. A., & Sabura Allen, J. (2011) · Clinical Case Studies · doi:10.1177/1534650111401016 · Cited by 92
Non–Substance-Addictive Behaviors in Youth: Pathological Gambling and Problematic Internet Use
Brezing, C., Derevensky, J. L., & Potenza, M. N. (2010) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2010.03.012 · Cited by 100
Stigma and problem gambling: current knowledge and future research directions
Hing, N., Holdsworth, L., Tiyce, M., & Breen, H. M. (2013) · International Gambling Studies · doi:10.1080/14459795.2013.841722 · Cited by 93
“…co-morbidity have consistently been found amongst people with gambling problems, ranging between 37%– 71% for depression, 41%–60% for anxiety disorders, 48%–72% for alcohol dependence, and around 38% for drug dependence (Kessler et al., 2008; Petry, Stinson, & Grant, 2005; Thomas & Jackson, 2008).”
BackgroundBarnes, G. M., Welte, J. W., Tidwell, M. O., & Hoffman, J. H. (2015) · International Gambling Studies · doi:10.1080/14459795.2014.990396 · Cited by 92
“Despite a low overall percentage of lifetime pathological gambling diagnosis in this study (0.6%), pathological gambling showed strong associations with substance use disorders with odds ratios ranging from 3.9 for nicotine dependence to 5.8 for alcohol or drug dependence (Kessler et al., 2008).”
BackgroundResultInfluentialGambling, gambling activities, and problem gambling.
Holtgraves, T. (2009) · Psychology of Addictive Behaviors · doi:10.1037/a0014181 · Cited by 92
Martin, R. J., Usdan, S., Cremeens, J. L., & Vail‐Smith, K. (2013) · Journal of Gambling Studies · doi:10.1007/s10899-013-9367-8 · Cited by 92
“Moreover, this study found that pathological gamblers were 5.5 times more likely than non-pathological gamblers to have had a substance abuse disorder in their lifetime, 4 times more likely to experience a mood disorder, and 3 times more likely to have an anxiety disorder (Kessler et al. 2008).”
InfluentialXian, H., Giddens, J. L., Scherrer, J. F., Eisen, S. A., & Potenza, M. N. (2013) · Addiction · doi:10.1111/add.12407 · Cited by 87
“Kessler RC, Hwang I, LaBrie R, Petukhova M, Sampson NA, Winters KC, et al. DSM-IV pathological gambling in the National Comorbidity Survey Replication.”
MethodThe Risk of Online Gambling: a Study of Gambling Disorder Prevalence Rates in Spain
Montañés, M. C., Marcos, M., & Mateo, J. L. (2019) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00067-4 · Cited by 87
“Men will exhibit higher rates of pathological gambling and problem gambling than women, consistent with most prevalence studies of pathological gambling (Kessler et al. 2008; Shaffer et al. 1997).”
Park, S., Cho, M. J., Jeon, H. J., Lee, H. W., Bae, J. N., Park, J. I., Sohn, J. H., Lee, Y. R., Lee, J., & Hong, J. P. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0102-9 · Cited by 86
“ological and problem gamblers, and explored concurrent substance use disorders [3, 9, 36], only two national surveys, both in the United States, have examined associations between pathological gambling and a wide range of psychiatric disorders [17, 29].”
BackgroundResultInfluentialNational gambling experiences in the United States: will history repeat itself?
Petry, N. M., & Blanco, C. (2012) · Addiction · doi:10.1111/j.1360-0443.2012.03894.x · Cited by 83
“Although psychiatric disorders in general, including mood and anxiety disorders, increase the risk for development of pathological gambling [8], there is strong evidence that pathological gambling and substance use disorders share comorbidity, genetics, physiology and outcomes to substance use disorders [17–19].”
BackgroundStriatal dopamine release codes uncertainty in pathological gambling
Linnet, J., Mouridsen, K., Peterson, E., Møller, A., Doudet, D. J., & Gjedde, A. (2012) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2012.04.012 · Cited by 82
Wounded Healers: A Multistate Study of Licensed Social Workers’ Behavioral Health Problems
Straussner, S. L. A., Senreich, E., & Steen, J. T. (2018) · Social Work · doi:10.1093/sw/swy012 · Cited by 85
“8 percent) is similar to rates found in the general population (Kessler et al., 2008).”
BackgroundResultInfluentialPoole, J. C., Kim, H. S. A., Dobson, K. S., & Hodgins, D. C. (2017) · Journal of Gambling Studies · doi:10.1007/s10899-017-9680-8 · Cited by 83
“Aside from PTSD, exposure to trauma or adversity-particularly in childhood-has been consistently associated with disordered gambling (Hodgins et al. 2010; Kraus et al. 2003; Najavits et al. 2010; Petry and Steinberg 2005; Taber et al. 1987).”
InfluentialGambling and substance use: Comorbidity and treatment implications
Grant, J. E., & Chamberlain, S. R. (2019) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2019.109852 · Cited by 85
Neophytou, K., Theodorou, M., Artemi, T.-F., Theodorou, C., & Panayiotou, G. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.01.004 · Cited by 96
Håkansson, A., Karlsson, A., & Widinghoff, C. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00426 · Cited by 80
“5 percent of the adult population are known to suffer from a level of problem gambling severe enough to fulfill criteria for a diagnosis (1, 2), hitherto defined as pathological gambling in the International Classification of Diseases (ICD-10) (3) and, since 2013, as gambling disorder in the Diagnostic and Statistical…”
BackgroundSvensson, J., Romild, U., & Shepherdson, E. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-1087 · Cited by 78
“Problem gamblers report lower levels of general and mental health than others, and suffer from higher rates of depression, anxiety and suicide ideation than the general population [8-14].”
BackgroundTabri, N., Xuereb, S., Cringle, N., & Clark, L. (2021) · Addiction · doi:10.1111/add.15642 · Cited by 78
Predictors of Problem Gambling in the U.S
Welte, J. W., Barnes, G. M., Tidwell, M.-C. O., & Wieczorek, W. F. (2017) · Journal of Gambling Studies · doi:10.1007/s10899-016-9639-1 · Cited by 82
“Using data from the U.S. National Comorbidity Survey Replication, Kessler et al. (2008) found positive comorbidity between pathological gambling and depression and anxiety disorder.”
MethodScherrer, J. F., Xian, H., Slutske, W. S., Eisen, S. A., & Potenza, M. N. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.2497 · Cited by 79
Håkansson, A., Mårdhed, E., & Zaar, M. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00255 · Cited by 76
“Am J Public Health (1994) 84(2):237–41.”
BackgroundCurrent pharmacotherapy for gambling disorder: a systematic review
Kraus, S. W., Etuk, R., & Potenza, M. N. (2020) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2019.1702969 · Cited by 83
“sample, 96% of individuals with GD had one or more co-occurring psychiatric disorder and 64% had three or more disorders [3].”
BackgroundKoot, S., Zoratto, F., Cassano, T., Colangeli, R., Laviola, G., van den Bos, R., & Adriani, W. (2011) · Neuropharmacology · doi:10.1016/j.neuropharm.2011.11.002 · Cited by 81
“1% gambled more than 1000 times (Kessler et al., 2008).”
InfluentialBuddhist philosophy for the treatment of problem gambling
Shonin, E., Gordon, W. V., & Griffiths, M. D. (2013) · Journal of Behavioral Addictions · doi:10.1556/jba.2.2013.001 · Cited by 78
“Higher rates are reported for the US and Canada where point prevalence estimates are in the region of 2.5% (Chou & Afifi, 2011; Kessler et al., 2008).”
BackgroundInfluentialDowling, N. A., Merkouris, S. S., & Lorains, F. K. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.02.012 · Cited by 73
Metadata
- Authors
- Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer, H. J.
- Affiliations
- Harvard University (US)
- Cambridge Health Alliance (US)
- University of Minnesota (US)
- Corresponding author
- Kessler, R. C.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2008-02-07
- Volume
- 38
- Issue
- 9
- Pages
- 1351-1360
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC2293303
- OpenAlex
- W2121784510
- Cited by
- 928
- References
- 29
- Citations by year
- 2026: 26 · 2025: 27 · 2024: 28 · 2023: 34 · 2022: 40 · 2021: 49 · 2020: 89 · 2019: 76 · 2018: 67 · 2017: 51 · 2016: 66 · 2015: 62 · 2014: 75 · 2013: 64 · 2012: 65
- FWCI
- 40.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Robert Wood Johnson Foundation
- John D. and Catherine T. MacArthur Foundation
- John W. Alden Trust
- World Health Organization
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration
- Johnson and Johnson
- Pan American Health Organization
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, U01-MH-60220, U13MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (R01-TW006481, R03TW006481)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- gambling addiction, problem gambling, prevalence, age of onset, comorbidities, anxiety disorders, mood disorders, impulse control disorders, substance use disorders, generalized anxiety disorder, post-traumatic stress disorder, substance dependence, gambling losses, treatment utilization, DSM-IV diagnostic criteria
- MeSH terms
- Adolescent, Adult, Mental Disorders, Data Collection, Ethnicity, Female, Gambling, Humans, Disruptive, Impulse Control, and Conduct Disorders, Male, Predictive Value of Tests, Retrospective Studies, Socioeconomic Factors, United States, Comorbidity, Prevalence, Odds Ratio, Age of Onset, Age Distribution, Sex Distribution, Diagnostic and Statistical Manual of Mental Disorders
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