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What is Gambling Disorder?

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When Gambling Disorder first entered the lexicon of psychiatry in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), it was a disorder of impulse control, alongside others like Kleptomania and Pyromania. Several decades later, Gambling Disorder is now recognized as most similar to substance use disorders.

Although there is no substance ingestion or state of intoxication, gamblers do have a distinct pattern of hallmark behaviors. Patients appear depressed and display an irritable or anxious mood. They can’t find pleasure in their old hobbies (anhedonia) and often seclude themselves from their loved ones. These people have pervasive issues with finances: over-borrowing, stealing, needing a second job, arguing about money, and trying to convince others to gamble with them. They become irresponsible in other areas of their lives, failing both at work and at home. Problem gambling can even have negative physical health effects: appetite changes, impaired sex drive, and vague physical complaints like headaches and abdominal pain.

The gambler’s fallacy

Gamblers often have a number of rituals, superstitions, or beliefs associated with playing that they use to build an illusory sensation of control over the outcomes of the games they play. Over 80% demonstrate some dependence on “Active Illusory Control”. This term includes schemes of luck and fantasies of skill in games that are, in fact, fundamentally chance-based. The ‘gambler’s fallacy’ is another distortion wherein problem gamblers believe that the outcomes of a short series of random, individual events (such as rolling dice) are predictive of the future outcomes. For example, a gambler may expect a higher chance of rolling two sixes if that combination has not occurred recently. This fuels them to continue gambling to regain losses because they naively believe that a bad ‘run’ must turn in their favor if they keep playing.

Many gamblers are drawn in simply by the availability of games and maintained by the arousing experience. Those who use gambling to retreat from negative emotions, especially people who suffered from depression or anxiety prior to gambling, tend to have more significant difficulties with gambling. For the most severely affected, gambling is only a part of a bigger picture of drug and alcohol issues, personality disorders, and criminality.

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