The association of pathological gambling with mood disorders has led to suggestions that it is an affective spectrum disorder. Biological differences also exist, including increased activity in the cortico-basal ganglionic-thalamic circuitry described during symptom-provocation studies of OCD and decreased activity in these regions of the brains of pathological gamblers, and the activation of the reward circuit observed in cue elicitation studies of pathological gamblers. For example, gambling has an ego-syntonic nature, meaning it is acceptable to or consistent with a person’s fundamental beliefs and personality, while the nature of compulsions in OCD are ego-dystonic or inconsistent with one’s beliefs. 13 Although ritualistic behaviors are common among people with obsessive-compulsive disorder (OCD) and pathological gambling, other aspects of the conditions are different. The inclusion of pathological gambling within the obsessive-compulsive spectrum is based on the fact that people who are compulsive gamblers tend to have repetitive thoughts and behaviors. 11, 12Īlthough much data support a close relationship between pathological gambling and substance abuse, pathological gambling also has been categorized as an obsessive-compulsive spectrum disorder as well as an affective spectrum disorder. 10 Emerging biological data, such as those identifying genetic contributions to alcohol use and gambling disorders and changes in brain activity underlying gambling urges and cocaine cravings, provide further support for a relationship between pathological gambling and substance abuse. 9 In addition, the telescoping phenomenon, which reflects the rapid rate of progression from initial to problematic behavior in women compared with men, initially described for alcoholism has been applied to pathological gambling. For example, high rates of pathological gambling and substance abuse have been reported during adolescence and young adulthood. 8 Phenomenological data further support a relationship between behavioral and drug addictions. Epidemiological data also support a relationship between pathological gambling and substance abuse, as pathological gamblers are also likely to abuse alcohol and other drugs. Clinical similarities are reflected in the diagnostic criteria for both disorders and include symptoms of tolerance and withdrawal repeated, unsuccessful attempts to cut back or stop and impairment in major areas of life functioning. 5Īlthough pathological gambling is classified as an impulse-control disorder, it has many similarities to substance abuse. 3, 4 Although there have been few prospective studies on the subject, there is a high incidence of pathological gambling among adolescents and young adults and a lower incidence among older adults in addition, periods of abstinence and relapse are common among all pathological gamblers. 1, 2 Although gambling among women has become a significant problem with the proliferation of lottery tickets, casinos, and Internet gambling sites and the gradual acceptance of gambling as a legitimate form of entertainment, epidemiological studies still suggest that men represent the majority of pathological gamblers and that being male appears to be a risk factor for developing a gambling addiction during adolescence. The problem usually begins during adolescence or early adulthood, with males tending to start at an earlier age. Pathological gambling is characterized by persistent and recurrent gambling and is associated with impaired functioning, reduced quality of life, and high rates of bankruptcy, divorce, and criminal activity.
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