Pathological gambling: Addiction or impulse control disorder

Abstract

In ICD-10 we find pathological gambling in the rest-category “Habit and Impulse Disorders” together with pathological fire setting (pyromania), pathological stealing (kleptomania), trichotillomania and other habit and impulse disorders. In DSM-IV the same disorders have to be attributed to the rest-category named “Impulse control Disorders”. In ICD-10 as well as in DSM-IV the diagnosis impulse (control) disorders should be used for kinds of persistently repeated maladaptive behaviour that are not secondary to a recognized psychiatric syndrome, and in which it appears that there is repeated failure to resist impulses to carry out the behaviour and the patients report a prodromal period of tension with a feeling of release at the time of the act. Without any doubt, pathological gambling cannot be reduced to mere maladaptive behaviour. As we know from clinical praxis, patients suffering from pathological gambling show a much more complex psychopathology. Beside the signs of a strong desire or sense of compulsion to gamble and an impaired capacity to control gambling in terms of its onset, termination, or levels of gambling (which may seem similar to symptoms of impulse control disorders) all other signs of a dependence syndrome (e.g. evidence of tolerance with a need for significantly increased frequency of gambling, preoccupation with gambling, persistent gambling despite clear evidence of harmful consequences, physical withdrawal states) can be observed in patients suffering from pathological gambling. Concluding we may say that pathological gambling is a much more complex disorder than impulse control disorders. Beside phenomenological analyses also comorbidity studies indicate similarities of pathological gambling to substance-related addictions. Therefore we propose for DSM-V that pathological gambling should not longer be part of the rest-category “impulse control disorders” but should be attributed as gambling addiction (or gambling dependence syndrome) together with other substance-related and non-substance related addictions (e.g. internet addiction, buying addiction, working addiction) to a new group of dependence disorders.