Updates Made to Gambling Disorder Clinical Criteria Between DSM-III, DSM-IV, and DSM-5
Jul 8, 2023
The clinical evaluation and assessment of Gambling Disorder has changed since the DSM-III. Now in the DSM 5, Gambling Disorder has been updated for clinical interface with a new demographic and new modes of online gambling and online sports betting.
Gambling disorder is regarded as a complex and multifaceted condition (and set of behaviors) that has been a subject of significant attention in psychiatric classification systems. Since the legalization of online gambling and sports betting in 2018, further attention has been devoted to ensuring the clinical qualifications for gambling disorder are updated. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is amongst the primary references used by providers both nationally and internationally. The DSM has a long and varied history and aims to provide a standardized framework for diagnosing mental and behavioral health disorders. Here, our team examines the evolution of gambling disorder across the DSM-III, DSM-IV, and DSM-5 and explores the changes in diagnostic criteria and understanding of this specific condition.
DSM-III Categorization
DSM-III: In the third edition of the DSM (DSM-III), published in 1980, gambling disorder was not explicitly designated as a distinct clinical entity. Instead, it was categorized under "Impulse Control Disorders Not Elsewhere Classified." Despite its inclusion, this classification reflected a limited understanding of gambling and sports betting-related behaviors, the problems that may arise, and their underlying mechanisms. The diagnostic criteria primarily focused on impulse control issues and lacked a comprehensive characterization of gambling disorder.
Updates Between DSM-III and DSM-IV
DSM-IV: In the fourth edition (DSM-IV), published in 1994, gambling disorder took a significant step forward in terms of both recognition and classification. The DSM-IV introduced the diagnostic category of "Pathological Gambling" and included it within the category of "Impulse Control Disorders." This update from the DSM-III highlighted the problematic nature of gambling, and in turn, went about emphasizing the psychological and behavioral aspects of the disorder.
The DSM-IV diagnostic criteria for pathological gambling consisted of the following five criteria:
Preoccupation: Frequent thoughts about gambling experiences.
Tolerance: Needing to increase the amount of money wagered to achieve the desired excitement.
Withdrawal: Restlessness or irritability when attempting to cut down or stop gambling.
Escape: Gambling as a way to escape problems or negative feelings.
Chasing: Repeated unsuccessful efforts to control, cut back, or stop gambling.
These criteria represented a significant step forward in recognizing gambling disorder as a distinct clinical condition. However, the DSM-IV criteria were criticized for primarily focusing on the behavioral aspects of gambling, neglecting the underlying psychological mechanisms involved.
How was Gambling Disorder changed for the DSM-5?
DSM-5: With the release of the fifth edition of the DSM (DSM-5), published in 2013, further revisions were made to enhance the diagnostic accuracy and clinical utility of gambling disorder. In turn, this empowered clinicians to better understand and diagnose gambling disorder. Among the updates to the DSM-5, gambling disorder was taken out of “Impulse Control Disorders" as a category and instead was included in a novel classification entitled "Substance-Related and Addictive Disorders."
The diagnostic criteria for gambling disorder in DSM-5 expanded upon the previous edition and incorporated new elements. Crucial criteria to inform a diagnosis include:
Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress.
Increasing need to gamble with larger amounts of money to achieve the desired excitement.
Restlessness or irritability when attempting to cut down or stop gambling.
Repeated unsuccessful attempts to control, cut back, or stop gambling.
Preoccupation with gambling (e.g., reliving prior gambling experiences and at-risk gambling behavior, planning the next or ongoing gambling ventures).
Gambling to escape or relieve negative emotions.
Chasing losses (i.e., trying to win back previous gambling losses through further gambling).
Deception regarding the extent of gambling involvement.
Jeopardizing or losing significant relationships, job, educational or career opportunities due to gambling.
Relying on others for financial assistance due to gambling losses.
The diagnosis is not made if gambling behavior is better accounted for by a manic episode.
DSM-5 also introduced a severity specifier for gambling disorder, allowing clinicians to gauge the level of impairment associated with the condition. The severity levels are classified as mild, moderate, or severe, based on the number of diagnostic criteria met.
What’s Next for Further Classifications of Gambling Disorder?
The evolving understanding of gambling disorder across DSM-III, DSM-IV, and DSM-5 highlights the progressive recognition of this condition as a significant mental health issue. The transition from impulse control disorders to substance-related and addictive disorders reflects a growing understanding of the underlying psychological and neurobiological mechanisms involved in gambling disorder.
Throughout the changes made over the past 33+ years, the diagnostic criteria for gambling disorder in DSM-5 have become more comprehensive. As a result, the criteria now capturies a broader range of symptoms and their impact on individuals' lives. Additionally, the inclusion of a severity specifier enhances diagnostic accuracy, and aids clinicians in personalized treatment planning for gambling disorder. However as with all clinical criteria, ongoing clinical research and evidence-based clinical practice are necessary to continue refining the diagnostic criteria and improve the assessment and management of gambling disorder as well as how to recognize behaviors in individuals struggling with gambling and sports betting.
Clinical References:
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). American Psychiatric Publishing.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Publishing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Petry, N. M., Blanco, C., Auriacombe, M., Borges, G., Bucholz, K., Crowley, T. J., ... & Grant, B. F. (2014). An overview of and rationale for changes proposed for pathological gambling in DSM-5. Journal of Gambling Studies, 30(2), 493-502.
Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 49(6), 519-539.
Self Help for Gambling Addiction
Apr 29, 2024
Jonathan
Can poker become an addiction?
Apr 27, 2024
Jonathan
Naltrexone for Gambling Addiction
Apr 26, 2024
Jonathan
Understanding the Stages of Gambling Addiction
Apr 25, 2024
Jonathan
What Are The Negative Effects of Gambling
Apr 22, 2024
Jonathan
Gambling Addiction Intervention
Apr 20, 2024
Jonathan
Overview of 12-Step Program for Gambling Addiction
Apr 19, 2024
Jonathan
Support Groups for Gambling Addiction
Apr 16, 2024
Jonathan
Managing Gambling Addiction Relapses
Apr 12, 2024
Jonathan
U.S. Sports Betting Statistics April 2024: Legalization, growth & addiction rising
Apr 12, 2024
Jonathan
My Mom Has a Gambling Addiction: What to Do
Apr 8, 2024
Jonathan
Understanding In-Network and Out-of-Network Providers for Behavioral Addictions
Apr 1, 2024
Jonathan
Has America become a “society of gamblers”?
Mar 28, 2024
Jonathan
How Can I Stop My Child From Gambling
Mar 27, 2024
Jonathan
Birches Health Partners with BettorEdge
Mar 20, 2024
Jonathan
Birches Health Announces Partnership with SaharaBets
Mar 19, 2024
Jonathan
Gambling Addiction Rates Hit All-Time High in U.S.
Mar 13, 2024
Jonathan
Signs of Teen Gambling
Mar 13, 2024
Jonathan
Free Gambling Addiction Treatment
Feb 29, 2024
Jonathan
SNL Sports Betting sketch spotlights real Gambling Addiction issues
Feb 26, 2024
Jonathan
New U.S. Gambling Stats: Record figures as Addiction also grows
Feb 22, 2024
Jonathan
What will be the social costs of increased gambling? Who will pay them?
Feb 19, 2024
Jonathan
Is it Legal to Bet on the Daytona 500?
Feb 16, 2024
Jonathan
Media Takes Note of America's Increase in Problem Gambling
Feb 15, 2024
Jonathan
What are the Psychological Effects of Gambling?
Jan 31, 2024
Jonathan
Is Day Trading Gambling?
Feb 11, 2024
Jonathan
What are the Different Types of Gamblers?
Feb 12, 2024
Jonathan
Understanding Behavior Disorders
Jan 23, 2024
Jonathan
The Gambling Addiction Recovery, Investment, And Treatment (GRIT) Act
Jan 14, 2024
Jonathan
What is the Cycle of Addiction and How to Break It
Jan 9, 2024
Jonathan
I Lost All My Money Gambling. What Now?
Dec 29, 2023
Jonathan
Your 2024 New Year's Resolution: Stop Sports Betting and Online Gambling
Dec 24, 2023
Elliott
Why Do Addicts Relapse?
Dec 20, 2023
Jonathan
Is Gambling a Sin?
Dec 18, 2023
Jonathan
Staging a Gambling Intervention for a Loved One
Dec 13, 2023
Jonthan
Signs of Gambling Addiction in a Spouse
Nov 30, 2023
Jonathan
Gambling and Divorce: Statistics and Information
Nov 26, 2023
Jonathan
What is DFS Gambling?
Nov 19, 2023
Jonathan
Addiction Specialist: Helping You Overcome Addiction
Nov 18, 2023
Jonathan
Exploring the Different Types of Gambling
Nov 8, 2023
Jonathan
Technology Addiction: Signs and Treatment
Oct 30, 2023
Jonathan
Is Options Trading Gambling?
Oct 23, 2023
Jonathan
Gambling Addiction and Treatment
Oct 16, 2023
Jonathan
Sex Addiction Treatment and Therapy Options
Oct 14, 2023
Jonathan
Signs of Gambling Addiction
Oct 7, 2023
Jonathan
Is the Stock Market Gambling?
Sep 25, 2023
Jonathan
Tips for Finding a Gambling Rehab Center
Sep 24, 2023
Jonathan
Cognitive Behavioral Therapy for Pathological Gambling
Sep 23, 2023
Jonathan
What Causes Porn Addiction?
Sep 18, 2023
Jonathan
Video Game Addiction
Sep 16, 2023
Jonathan
Porn Addiction Signs & Symptoms
Sep 11, 2023
Jonathan
Gambling Addiction Withdrawal Symptoms & Signs
Aug 29, 2023
Jonathan
How to Stop Online Gambling
Aug 27, 2023
Jonathan
Does Medicare Cover Gambling Rehab?
Aug 19, 2023
Jonathan
Gambling and Dopamine
Aug 12, 2023
Jonathan
Porn Addiction Counseling
Aug 7, 2023
Jonathan
Is Fantasy Football Gambling?
Jul 24, 2023
Jonathan
Signs of a Day Trading Problem
Jul 19, 2023
Jonathan
Why is Gambling Addictive?
Jul 18, 2023
Jonathan
The Arizona Lottery and Gambling
Jul 16, 2023
Jonathan
Is Poker Gambling?
Jul 15, 2023
Jonathan
Is Crypto Gambling?
Jul 14, 2023
Jonathan
Gambling and Sports Betting Among College Students
Jul 8, 2023
Jonathan
Updates Made to Gambling Disorder Clinical Criteria Between DSM-III, DSM-IV, and DSM-5
Jul 8, 2023
Cara Anderson
Combatting Gambling and Alcohol Addiction
Jun 30, 2023
Jonathan
Medication for Gambling Addiction
Jun 27, 2023
Jonathan
The Seven Types of Gamblers: Are You One of Them?
Jun 25, 2023
Elliott Rapaport
10 Questions to Ask If You Think Your Loved One Has a Gambling Problem
Jun 24, 2023
Cara Anderson
Exploring the History of Gambling in the US
Jun 17, 2023
Elliott Rapaport
Gambling Treatment in Arizona
Jun 15, 2023
Jonathan
Voluntary Self Exclusion to Stop Online Gambling
Jun 15, 2023
Cara Anderson
Does Blue Cross Blue Shield Cover Gambling Treatment?
Jun 13, 2023
Jonathan
Gambling Addiction Hotline
Jun 5, 2023
Jonathan
How to Stop Gambling
Jun 1, 2023
Jonathan
Can Gambling Addiction Be Cured?
May 31, 2023
Jonathan
Why Is Gambling So Addictive?
May 30, 2023
Elliott Rapaport
Abilify and Compulsive Gambling
May 26, 2023
Jonathan
How to Stop Gambling: Strategies for Regaining Control
May 21, 2023
Cara Anderson
How to Stop Gambling and Save Money
May 18, 2023
Cara Anderson
How to Help Someone with a Gambling Addiction
May 16, 2023
Elliott Rapaport
Cryptocurrency Addiction
May 9, 2023
Tobias Jackson
How Day Trading Can Create a Dangerous Addiction
May 4, 2023
Elliott Rapaport
How Addictive Memes Have Fueled Problem Gamblers
May 2, 2023
Elliott Rapaport
Clinical Screening Tools and Quizzes to Answer the Question: "Do I have a Gambling Problem?"
May 1, 2023
Tobias Jackson
Insurance Coverage for Gambling Addiction in 2023
Apr 29, 2023
Elliott Rapaport
Helping a Loved One with a Gambling Addiction
Apr 27, 2023
Cara Anderson
Self Care for Problem Gamblers
Apr 26, 2023
Cara Anderson
Glamorized Gambling and What To Be Aware Of
Apr 24, 2023
Elliott Rapaport
What is Problem Gambling?
Apr 20, 2023