Pathological Gambling: DSM IV Assessment and Screening

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Pathological Gambling DSM IVAssessment and
Screening
Base rate How prevalent in the population- 1-3
Hit rate Correct classifications-
98 Sensitivity Look at true positives-
.95 Specificity Look at true negatives-
.99 Scoring Algorithms Dichotomous- in or
out Continuous scale Discriminant
functional analysis to predict membership Deciding
how to weigh items problematic
(R.
Stinchfiled PhD NCPG 04 Nat. Conf.)
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Pathological Gambling Assessment and Screening

• Development of the test
• Test results
• Disorder present absent
• Positive
• Negative
• False negative the worst error,
• false positive error not as serious

True positive
False positive
True negative
False negative
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Pathological Gambling DSM-IV Criteria

• Pathological Gambling as a psychiatric disorder
  appears in the DSM III for the first time in
  1980.
• Criteria require 4 of 7 items be endorsed.
• The DSM III-R changed the criteria in 1987.
• Requiring 4 of 9 revised criteria.
• The DSM IV requires 5 of 10 revised criteria.

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Pathological Gambling DSM-IV Criteria

• Preoccupation
• Is preoccupied with gambling (e.g., reliving
  past gambling experiences, handicapping or
  planning the next venture, or thinking of ways to
  get money with which to gamble
• Tolerance
• 2. Needs to gamble with increasing amounts of
  money in order to achieve the desired excitement
• Withdrawal
• 3. Is restless or irritable when attempting to
  cut down or stop gambling

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Pathological Gambling DSM-IV Criteria

• Escape
• 4. Gambles as a way of escaping from problems or
  relieving dysphoric mood (feelings of
  helplessness, guilt, anxiety or depression
• Chasing
• 5. After losing money gambling, often returns
  another day in order to get even
• Lying
• 6. Lies to family members, therapists, or
  others to conceal the extent of involvement with
  gambling

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Pathological Gambling DSM-IV Criteria

• Loss of control
• Has made repeated unsuccessful efforts to
  control, cut back, or stop gambling
• Illegal acts
• Has committed illegal acts (forgery, fraud,
  theft, or embezzlement) to finance gambling
• Risked significant relationship
• Has jeopardized or lost a significant
  relationship, job, education or career
  opportunity because of gambling
• Bailout
• 10. Has relied on others to provide money to
  relieve a desperate financial situation caused by
  gambling

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Pathological GamblingDSM IV Criteria

• B. Gambling Behavior is not better explained by
  way of a manic episode.
• Scores
• Pathological gamblers endorse 5 or more of the 10
  criteria.
• Problem Gamblers endorse 3 or 4 of the 10
  criteria.
• At risk gamblers score 1-2 of the criteria.
• Best items 3, 1, 5, 6, 9.

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Pathological Gambling Barry Test

• Do large men sometimes come around and break your
  thumbs
• Have you ever lunged across a table and tried to
  strangle a 73 year old grandmother simply because
  she said Bingo
• Have you ever, after gambling away all your money
  and pawning all your possessions, asked yourself
  Hey, why do I need TWO kidneys?

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Pathological Gambling Barry Test

• Have you ever attempted to place a bet on the
  chariot race in Ben Hur?
• If so, did you bet AGAINST Charlton Heston, your
  reasoning being that, hey , one of these times he
  has to lose.
• Have you ever wager money that you should have
  used to feed your children?
• Have you ever wagered your actual children?

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Pathological Gambling Comparison to Substance
Abuse

• Similarities
• Loss of Control
• Preoccupation
• Negative impact on major life areas
• Tolerance

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Pathological Gambling Comparison to Substance
Abuse

• Similarities
• Withdrawal Symptoms
• Self-help groups
• Biopsychosocial/spiritual disorders
• Family involvement

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Pathological Gambling Comparison to Substance
Abuse

• Differences
• Gambling is not self-limiting
• Behavior not attributable to intoxication
• More intense sense of shame and guilt
• Greater denial and stronger defenses

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Pathological Gambling Comparison to Substance
Abuse

• Differences
• Unpredictable outcome
• Fantasies of success
• No biological test
• Easier to hide

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Pathological Gambling Comparison to Substance
Abuse

• Differences
• Greater financial problems
• Intensity of family anger
• Less public awareness and acceptance

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Subtypes of Pathological Gamblers

• Action
• Early Onset
• Narcissistic
• MDE - Current
• Games of Skill
• Competition/Power
• Winning Phase
• More likely to be male

• Escape
• Later Onset
• Cluster C A
• Dysthymia
• Machine Games (Slots/VP)
• Relief/Dissociation
• No Winning Phase
• Gender Bias?

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Family Issues in the Treatment of Pathological
Gambling

• Financial Vulnerability
• Debt and Restitution
• Money Management
• Emotional Vulnerability
• Dishonesty and Distrust
• Anger
• Lack of Information and Resources
• Abuse and Domestic Violence

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