Compulsive gambling, formally known as pathological gambling, is a psychiatric disorder characterised by a persistent obsession with gambling, even when it leads to serious negative personal or social consequences. It is officially categorised under “impulse control disorders not otherwise specified” and is often associated with other impulsive behaviours. Current guidelines do not differentiate between subtypes of compulsive gamblers. However, a study published in the Canadian Journal of Psychiatry suggests that compulsive gamblers can be classified into four distinct subtypes, two of which are linked to specific personality disorders.
The American Psychiatric Association (APA), which sets the standard definitions for mental illness in the United States, identifies ten symptoms of compulsive or pathological gambling. These symptoms include:
- A persistent preoccupation with gambling.
- Repeated unsuccessful attempts to control or stop gambling.
- Increased irritability or moodiness when not gambling.
- Frequent lying about gambling activities.
- A need to gamble with increasing amounts of money for excitement.
- Recurrent need for financial bailouts due to gambling losses.
- Rapid return to gambling after losing money.
- Using gambling as a way to escape from problems or to relieve a dysphoric mood.
- Committing illegal acts to finance gambling.
- Gambling behaviour that jeopardises or damages significant relationships or career opportunities.
To be diagnosed with pathological gambling, an individual must exhibit at least five of these symptoms.
Mental health professionals increasingly view pathological gambling through the lens of addiction. Initially, a person may feel they can control their gambling behaviour, but over time, this sense of control diminishes, leading to an involuntary need to gamble that overshadows other priorities. Factors that can increase the likelihood of this shift include substance addiction and the presence of antisocial personality disorder or certain forms of schizophrenia.
Since pathological gambling was recognised as a mental illness, an inability to control the gambling impulse has been a critical diagnostic criterion. However, the study published in the Canadian Journal of Psychiatry challenges this notion. By examining the psychological profiles of over 1,100 compulsive gamblers, researchers concluded that these individuals fall into four distinct subtypes based on their personality traits.
Type 1: These individuals exhibit personality traits similar to those seen in schizotypal personality disorder. They are well-oriented to reality but show significant emotional disorganisation, instability, and impulsivity, which typically emerge early in life.
Type 2: These individuals have personality traits associated with schizoid personality disorder. Unlike those with schizotypal personality disorder, schizoid individuals are indifferent to the personal or social disruptions caused by their condition.
Type 3: These gamblers are driven by an impulsive need for excitement and do not exhibit symptoms of any specific personality disorder.
Type 4: These individuals possess a “globally adaptive” personality, allowing them to alter their behaviour based on their environment without traits indicative of a particular personality disorder.
The study authors argue that only individuals with Type 2 pathological gambling exhibit a combination of personality disorder-related traits and impulsive or uncontrolled behaviour that qualifies as “pathological.” The other subtypes have identifiable issues but do not reach the same level of mental illness. Despite these findings guidelines for diagnosing compulsive or pathological gambling have not been updated to reflect this nuanced understanding.
