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PATHOLOGICAL GAMBLING AND COMORBIDITIES
REZA ABDOLLAHNEJAD PAUL DELFABBRO LINLEY DENSON School of Psychology University of Adelaide South Australia
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Literature review Gambling can contribute to several mental,
physical and social problems. Many studies have examined co-morbidities in
pathological gamblers For example, one study revealed that 60% and
40% of gamblers had lifetime mood disorders and anxiety disorders respectively (Black & Moyer 1998).
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Literature review cont… There are also reports of higher rates of
Generalised anxiety disorder, Panic disorder and depression among pathological gamblers( Kerber et al., 2008).
Furthermore, there is a large number of studies indicating a high prevalence of Personality disorders.
32% of pathological gamblers had at least one personality disorder (Echeburua & Fernandez-Montalvo 2008)
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Literature review cont… The most prevalent personality disorders were
Borderline Personality disorders and/or Antisocial personality disorders(Echeburua and Fernandez-Montalvo, 2008; Pelletier et al., 2008; Bagby, 2008)
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Aims We sought to examine psychiatric disorders
differences between pathological gamblers and regular non-pathological gamblers.
We are testing for differences, clusters of pathology / co-morbidity and the relationship between certain forms of psycho-pathology and erroneous beliefs about gambling.
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Methodology The sample comprises 140(59 Males and 81 Females)
gamblers with an at least fortnightly level of participation in continuous forms of gambling.
These people were recruited from the general community We used both the PGSI and NODS-SA. The mean score on the NODS-SA was M=4.83
(SD=3.04) The frequency of NODS severity level: At-risk gambler accounted for 37(26.4%) Problem gambler comprised 30(21.4%) Pathological gambler consisted of 73(52.1%)*
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Project Method cont… More than 70% of participants were problem
gamblers or pathological gamblers. PGSI was M=9.58(SD=6.71) The frequency of PGSI severity level:
Low-risk gambler accounted for 10(7.1%) moderate risk gambler 44(31.4%) problem gambler was 77(55.0%)
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Measures Measures: NORC DSM-IV Screen Self- administered (NODS-SA) for
gambling problems(Gerstein, Hoffmann, Larison et al., 1999; Fager, 2007)
Gambling Severity Index (PGSI) (Ferris & Wynne, 2002) The Mini International Neuropsychiatric Interview (Sheehan et
al., 1998) The Personality Diagnostic Questionnaire-4th Edition (PDQ-
4)(PDQ-4; Haley, 1994) Many other measures were included, but are yet to be
analysed
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Results Table 1 summarises the prevalence of MINI
classifications within the sample. As indicated, pathological gamblers were
significantly more likely to be screened as having psychiatric disorders.
These included: suicidality, bi-polar disorder, panic disorder, social phobia, PTSD, generalised anxiety disorder, substance dependence and Mood disorder with psychotic feature.
Results cont...
Category Non-pathological gamblers
Pathological gamblers
Bipolar I 3(4.5) 15(20.5) 8.0** PDA^ 5(7.5) 24(32.9) 13.7*** Social phobia
3(4.5) 15(20.5) 8.00**
PTSD# 1.(1.5) 11.(15.1) 8.2** GAD## 5(7.5) 16(21.9) 5.7* Substance Dependence
2(3.0) 12(16.4) 7.0*
MDPF^^ 1(1.5) 12(16.4) 9.2** Suicidality 7(10.4) 26(35.6) 12.3***
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*p<0.05; **p<0.01; *** p < .001 ^ Panic disorder with Agoraphobia; # Post-traumatic Stress disorder ^^Mood Disorder with Psychotic Feature; ## Generalized Anxiety disorder
Table 1. Prevalence of MINI classified psychiatric disorders in pathological and non-pathological gamblers
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Result Cont… Due to the probability of gender differences
regarding prevalence of some disorders, logistic regression was undertaken to ascertain whether pathological gambling is associated with psychiatric disorders after controlling for gender.
As indicated, all differences remained significant even after gender had been controlled for.
Result Cont...
Mental Disorders
Variable Parameter Wald Odd-ratio/ 95% CI
Suicidality NODS Gender
.3
.6 16.2 1.5
1.4*(1.9-1.7) 1.8(.7-4.5)
Bipolar I NODS Gender
.4 -1.8
14.4 14.4
1.5***(1.2-1.9) .16(.1-.5)
Bipolar II NODS Gender
.3 -.9
4.4 1.6
1.3*(1.0-1.7) .4(.1-1.7)
PDA^ NODS Gender
.4 -.4
17.4 .7
1.4***(1.2-1.7) .7(.3-1.7)
Social Phobia
NODS Gender
.2
.2 6.9 .1
1.3**(1.1-1.6) 1.2(.4-3.5)
OCD# NODS Gender
.2 -.2
6.2 .2
1.3*(1.1-1.5) .8(.3-2.3)
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Table 2. Logistic regression: Pathological gambling scores (NODS) are predictors of MINI classifications after controlling for gender
*p<0.05; **p<0.01; *** p < .001 ^ Panic disorder with Agoraphobia; # Obsessive-compulsive disorder
Result Cont…
Mental Disorders
Variable Parameter Wald Odd-ratio/95% CI
PTSD# NODS Gender
.5 -.4
11.3 .4
1.7**(1.2-2.3) .6
Substance Dependence
NODS Gender
.4 -.4
9.5 .5
1.4**(1.1-1.8) .7(.2-2.2)
GAD## NODS Gender
.2
.2 6.6 1.3
1.3**(1.1-1.5) 1.2(.4-3-3.3)
MDPF^ NODS Gender
.3
.2 6.5 .15
1.4*(1.1-1.7) 1.3(.4-4.6)
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Table 2 cont…
*p<0.05; **p<0.01; *** p < .001 # Post-traumatic Stress disorder ^Mood Disorder with Psychotic Feature; ## Generalized Anxiety disorder
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Result Cont… Table 3 indicates the prevalence of personality
disorders within the sample. As indicated, personality disorders were
significantly more prevalent in the sample of pathological gamblers, apart from Depressive and Obsessive-Compulsive Personality disorders.
The strongest differences were observed in Avoidant and Dependent personality disorders.
Result Cont…
Personality Disorders
Non-pathological gamblers
Pathological gamblers
Paranoid PD 10(14.9) 22(30.1) 4.6*
Schizoid 4(6.0) 13(17.8) 4.6*
Schizotypal 5(7.5) 14(19.2) 4.1*
Antisocial 3(4.5) 12(16.4) 5.2*
Borderline 7(10.4) 18(24.7) 4.8*
Narcissistic 0(0.0) 5(6.8) 4.7*
Histrionic 0(0.0) 6(8.2) 5.7*
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Table 3. Prevalence of personality disorders (PDQ-4) in pathological and non-pathological gamblers
*p<.05 **p< .01 a = Fisher Exact probability
Result Cont...
Personality Disorders
Non-pathological gamblers
Pathological gamblers
χ2
Avoidant 13 (19.4) 31 (42.5) 8.6**
Dependent 0 (0.0) 7 (9.6) 6.7**
OCPD 15 (22.4) 23 (31.5) 1.5
Negativistic 4 (6.0) 14 (19.2) 5.4*
Depressive 10 (14.9) 20 (27.4) 3.2
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*p<0.05; **p<0.01; ***p<0.001
Table 3. Cont...
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Result Cont… Once again, a logistic regression was undertaken to
confirm whether gambler status predicted the presence of the disorder after gender had been controlled (Table 4).
The results showed that pathological gambling status was still a significant predictor for some personality disorders after controlling for gender.
These included: Schizotypal, anti-social, borderline, narcissistic , histrionic, avoidant, dependent and negativistic personality disorders.
Result Cont…
Personality Disorders
Variable Parameter Wald Odd-ratio/95% CI
Schizoid NODS Gender
.2 -.2
4.0 .1
1.2*(1.0-1.4) .8(.3-2.4)
ASP^ NODS Gender
.4 10.1 1.4***(1.1-1.8) .4(.1-1.2)
BPD^^ NODS Gender
.2 -.4
8.1 .7
1.2**(1.0-1.5) .7(.3-1.7)
Narcissistic NODS Gender
.4 -1.1
4.5 1.5
1.5*(1.0-2.3) .3(.5-2.0)
Histrionic NODS Gender
.4 -.7
4.4 .6
1.4*(1.0-2.0) .5(.9-2.7)
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Table 4. Logistic regression: Pathological gambling and personality disorders after controlling for gender
*p<0.05; **p<0.01; ***p<0.001;^Antisocial Personality Disorder; ^^Borderline Personality Disorder;
Result Cont…
Personality disorders
Variable Parameter Wald Odd-ratio/95% CI
Avoidant NODS Gender
.2
.1 7.7 .1
1.2**(1.0-1.4) 1.1(.5-2.4)
Dependant NODS Gender
.3 -1.7
4.6 3.6
1.4*(1.0-1.8) .2(.3-1.5)
Negativistic NODS Gender
.2 -.9
6.9 3.1
1.3**(1.0-1.5) .4(.1-1.1)
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Table 4 Cont…
*p<0.05; **p<0.01; ***p<0.001
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Discussion The result of this study suggested that there were
associations between pathological gambling and axis I psychiatric disorders.
Also, the prevalence of some psychiatric disorders were significant among pathological gamblers compared to non-pathological gamblers
That was most evident in Bipolar I, Panic disorder with agoraphobia, social phobia, PTSD, Generalised anxiety disorder, Substance dependence, Mood disorder with Psychotic feature and suicidality.
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Discussion
Pathological gambling predicted some axis I psychiatric disorders even after controlling gender.
These psychiatric disorders included: Bipolar I, Bipolar II, Panic disorder with agoraphobia, social phobia, OCD, PTSD, Generalised anxiety disorder, Suicidality and Mood disorder with psychotic feature.
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Discussion The study also indicated that personality
disorders were more prevalent among pathological gamblers to non-pathological gamblers.
These included all personality disorders in PDQ-4 except Obsessive-compulsive and depressive personality disorder.
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Discussion
Likewise axis I, pathological gambling predicted some of personality disorders.
These personality disorders were Schizoid, Antisocial, Borderline, Narcissistic, Histrionic, Avoidant, dependant, Negativistic personality disorders.
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Discussion The findings of this study are consistent with a
large number of studies, which indicated the high prevalence of axis I and II psychiatric disorders among pathological gamblers compare to recreational gamblers or non-pathological gamblers(Black and Moyer,1998;
Lorains et al. 2011; Kerber et al. 2008; Thomas & Jackson, 2008; Petrey et al. 2005).
Also, it is consistent with several study regarding the prediction of psychiatric disorders by pathological gambling.
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Discussion This study had some strength such as
recruiting samples from the general public, high response rate and also having non-pathological gamblers for comparison.
Furthermore, there were some limitations in the study such as cross-sectional nature of the study, examining only lifetime prevalence of some disorders, and all psychiatric disorders were not covered.
Discussion The results of this study showed that
psychiatric disorders and comorbidities needs to be taken into accounts in the treatment of pathological gamblers.
Particularly, cluster B in personality disorders, that is Anti-social, Borderline, Narcissistic and Histrionic personality disorder, and also anxiety disorders.
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Discussion Furthermore, the study revealed
given the high rate of psychiatric disorders among pathological gamblers, screening and assessment for pathological gambling in the treatment is vital.
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Discussion Next analysis in this study will be: looking at the relationship between co-
morbidity and erroneous beliefs Investigating the relationship of
pathological gamblers and substance disorders and also their impact on each other.
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