Clinical gender differences among adult pathological gamblers seeking treatment

Age of pathological gambling onset: clinical and treatment-related features

OBJECTIVES

This study examined differences in the clinical and treatment-related features of pathological gambling (PG) on the basis of the age of PG onset among pathological gamblers who sought treatment.

METHODS

A total of 702 male outpatients with a primary diagnosis of PG and who were treated in a clinical practice were assessed by retrospective chart review. We selected the age of 25 years and younger as the threshold for "group 1." We then stratified the participants into 4 groups on the basis of the age of PG onset in 10-year intervals. Analysis of covariance with a covariant of age and the Pearson χ test were used for analyses.

RESULTS

We found that the earlier-onset gamblers were less likely to be escape type (P < 0.05), used significantly more Internet-based gambling (P < 0.001), and were less likely to engage in nonstrategic gambling (P < 0.05) than the later-onset gamblers. In addition, the earlier-onset gamblers took anticraving medication, such as naltrexone, significantly more often (P < 0.05), and sought treatment significantly more slowly after the onset of PG than the later-onset group (P < 0.01). Regarding adherence to treatment, however, there was no significant difference among the 4 groups on the basis of the age of PG onset.

CONCLUSIONS

The age of PG onset is associated with several important clinical and treatment features. More studies are needed to advance prevention and treatment strategies for each age group.

Male and female pathological gamblers: bet in a different way and show different mental disorders

Although in the last years several studies comparing male and female pathological gamblers have been published, most of them have been carried out using only samples of males. The aim of this study was to investigate gender differences in a sample of subjects diagnosed with pathological gambling (PG) attending three specialized outpatient units. Retrospective study was carried out of 96 patients (49% female and 51% male), comparing the main socio-demographic, clinical, and behavioral data. Most subjects (94%) met the criteria for pathological gambling. No significant differences between sexes were found in the severity of gambling behavior or the socio-demographic variables studied. Whereas slot machines were the main type of game for most subjects, a higher percentage of women were addicted to bingo (χ2 (1, 4) = 5.19, p = .029 Cohen's d = 0.48) and had more than one type of game as a secondary addiction χ2 (1, 4) = 7.63, p = .006; Cohen's d = 0.59) . Women started gambling at a later age than men (t (94) = 2.95, p = .004; Cohen's d = 0.60), but developed a pattern of addiction faster ( t (94) = 2.95, p = .004; Cohen's d = -0.61) . Women also had higher comorbidity with other psychiatric disorders (χ2 (1) = 7.28, p = .007; Cohen's d = 0.57), specifically with affective (χ2 (1) = 11.31, p = .001; Cohen's d = 0.73) and personality disorders (χ2 (1) = 4.71, p = .030; Cohen's d = 0.45). Our results indicate the existence of differences between women and men in the pattern of gambling behavior and in psychiatric comorbidity. These aspects should be considered in the design of treatment programs for pathological gamblers.

Problem gambling and family violence: prevalence and patterns in treatment-seekers

The primary aim of this study was to explore the prevalence and patterns of family violence in treatment-seeking problem gamblers. Secondary aims were to identify the prevalence of problem gambling in a family violence victimisation treatment sample and to explore the relationship between problem gambling and family violence in other treatment-seeking samples. Clients from 15 Australian treatment services were systematically screened for problem gambling using the Brief Bio-Social Gambling Screen and for family violence using single victimisation and perpetration items adapted from the Hurt-Insulted-Threatened-Screamed (HITS): gambling services (n=463), family violence services (n=95), alcohol and drug services (n=47), mental health services (n=51), and financial counselling services (n=48). The prevalence of family violence in the gambling sample was 33.9% (11.0% victimisation only, 6.9% perpetration only, and 16.0% both victimisation and perpetration). Female gamblers were significantly more likely to report victimisation only (16.5% cf. 7.8%) and both victimisation and perpetration (21.2% cf. 13.0%) than male gamblers. There were no other demographic differences in family violence prevalence estimates. Gamblers most commonly endorsed their parents as both the perpetrators and victims of family violence, followed by current and former partners. The prevalence of problem gambling in the family violence sample was 2.2%. The alcohol and drug (84.0%) and mental health (61.6%) samples reported significantly higher rates of any family violence than the gambling sample, while the financial counselling sample (10.6%) reported significantly higher rates of problem gambling than the family violence sample. The findings of this study support substantial comorbidity between problem gambling and family violence, although this may be accounted for by a high comorbidity with alcohol and drug use problems and other psychiatric disorders. They highlight the need for routine screening, assessment and management of problem gambling and family violence in a range of services.

Sex differences in addictive disorders

Gender-dependent differences in the rate of initiation and frequency of misuse of addicting drugs have been widely described. Yet, men and women also differ in their propensity to become addicted to other rewarding stimuli (e.g., sex, food) or activities (e.g., gambling, exercising). The goal of the present review is to summarize current evidence for gender differences not only in drug addiction, but also in other forms of addictive behaviours. Thus, we first reviewed studies showing gender-dependent differences in drug addiction, food addiction, compulsive sexual activity, pathological gambling, Internet addiction and physical exercise addiction. Potential risk factors and underlying brain mechanisms are also examined, with particular emphasis given to the role of sex hormones in modulating addictive behaviours. Investigations on factors allowing the pursuit of non-drug rewards to become pathological in men and women are crucial for designing gender-appropriate treatments of both substance and non-substance addictions.

Pathological gamblers and a non-psychiatric control group taking gender differences into account

The current study aimed to identify personality traits, emotional states and adjustment variables in a sample of pathological gamblers as compared to a non-gambling control group taking gender differences into account. The sample for this study consisted of 206 subjects (103 pathological gamblers and 103 non-psychiatric subjects from the general population matched for age and gender). Pathological gamblers had a lower educational level and a family history of alcohol abuse higher than non-gamblers. In turn, female gamblers were affected by unemployment and a lower socioeconomic status more often than female non-gamblers. Pathological gamblers were more anxious and impulsive and suffered from a poorer self-esteem than non-gamblers. Likewise, pathological gamblers had a greater history of other Axis I psychiatric disorders and were more often affected by anxiety and depression symptoms and showed a more problematic adjustment to everyday life than non-gamblers. Alcohol abuse was not higher in pathological gamblers than in non-gamblers, but, when gender was taken into account, male gamblers were more affected by alcohol abuse than male non-gamblers. Importantly 68.6% of female gamblers versus 9.8% of control group women reported being victims of intimate partner violence. These findings can be used to specifically inform prevention and intervention efforts.

Are psychology university student gamblers representative of non-university students and general gamblers? A comparative analysis

Students recruited from psychology undergraduate university populations are commonly used in psychology research, including gambling studies. However, the extent to which the use of this subpopulation produces findings that can be extrapolated to other groups is questionable. The present study was designed to compare results from university-recruited psychology student gamblers to those obtained from a sample of gamblers recruited from the general population that also included students. An online survey measuring gambling behavior and Internet gambling, attitudes and knowledge about gambling and problem gambling severity was posted on websites accessed by gamblers. Participants were recruited from two sources, a psychology undergraduate university population (n = 461) and online websites (n = 4,801). Results showed university-recruited students differed significantly from both adults and students recruited from the general population in respect to demographic variables and gambling behavior. Psychology undergraduate students were younger, more likely to be female, and had lower incomes. When relevant demographic variables were controlled, psychology undergraduate students were found to gamble less frequently, at different times, and to be at lower-risk for gambling-related problems, but had more irrational beliefs and more negative attitudes towards gambling than gamblers recruited from the general population. Results suggest that caution should be used in extrapolating findings from research using university-recruited psychology student gamblers to wide community populations due to differences related to gambling thoughts, attitudes and behaviors.

A proof of concept study of tolcapone for pathological gambling: relationships with COMT genotype and brain activation

Pathological gambling (PG) is a disabling disorder experienced by 1-3% of adults, and empirically validated treatments are lacking. Perturbations of prefrontal-dependent cognitive functions are implicated in the pathophysiology of PG. The enzyme catechol-O-methyl-transferase (COMT) is responsible for degradation of dopamine in the cortices and thereby is known to regulate such cognitive functions and their neural substrates. The objective of this study was to determine whether tolcapone, a COMT inhibitor, improves symptoms of PG and to explore whether such effects are dependent on COMT val-158-met polymorphism status and relate to concomitant changes in fronto-parietal activation. Twenty-four individuals with PG were enrolled in an 8-week trial of oral tolcapone (100mg/day titrated to 100mg thrice/day) and 12 undertook pre- and post-treatment fMRI to examine brain activation during an executive planning task in a pre-defined fronto-parietal network. At baseline, patients with PG showed fronto-parietal under-activation versus controls during executive planning. Treatment was associated with statistically significant reductions on PG-Yale Brown Obsessive Compulsive Scale (PG-YBOCS), the extent of which correlated significantly with augmentation of planning-related fronto-parietal activation. Symptom improvement was also significantly more pronounced in subjects with the val/val COMT polymorphism. Tolcapone improved PG symptoms, and the extent of symptomatic improvement was significantly related to augmentation of fronto-parietal activation (fMRI probe) and COMT status. Objective genetic and fMRI markers hold promise in the search for targeting treatment and elucidating brain mechanisms associated with optimal clinical outcomes.

Problem gambling and family violence: family member reports of prevalence, family impacts and family coping

There exists only a small number of empirical studies investigating the patterns of family violence in problem gambling populations, although some evidence exists that intimate partner violence and child abuse are among the most severe interpersonal correlates of problem gambling. The current article reports on the Australian arm of a large-scale study of the patterns and prevalence of co-occurrence of family violence and problem gambling in Australia, New Zealand and Hong Kong. The current study screened 120 help-seeking family members of problem gamblers in a range of clinical services for both family violence and problem gambling. The main results showed that 52.5% reported some form of family violence in the past 12 months: 20.0% reported only victimisation, 10.8% reported only perpetration and 21.6% reported both victimisation and perpetration of family violence. Parents, current and ex-partners were most likely to be both perpetrators and victims of family violence. There were no gender differences in reciprocal violence but females were more likely to be only victims and less likely to report no violence in comparison to males. Most of the 32 participants interviewed in depth, reported that gambling generally preceded family violence. The findings suggest that perpetration of family violence was more likely to occur as a reaction to deeply-rooted and accumulated anger and mistrust whereas victimisation was an outcome of gambler’s anger brought on by immediate gambling losses and frustration. While multiple and intertwined negative family impacts were likely to occur in the presence of family violence, gambling-related coping strategies were not associated with the presence or absence of family violence. The implications of the findings for service providers are discussed.

Cross-species approaches to pathological gambling: a review targeting sex differences, adolescent vulnerability and ecological validity of research tools

Decision-making plays a pivotal role in daily life as impairments in processes underlying decision-making often lead to an inability to make profitable long-term decisions. As a case in point, pathological gamblers continue gambling despite the fact that this disrupts their personal, professional or financial life. The prevalence of pathological gambling will likely increase in the coming years due to expanding possibilities of on-line gambling through the Internet and increasing liberal attitudes towards gambling. It therefore represents a growing concern for society. Both human and animal studies rapidly advance our knowledge on brain-behaviour processes relevant for understanding normal and pathological gambling behaviour. Here, we review in humans and animals three features of pathological gambling which hitherto have received relatively little attention: (1) sex differences in (the development of) pathological gambling, (2) adolescence as a (putative) sensitive period for (developing) pathological gambling and (3) avenues for improving ecological validity of research tools. Based on these issues we also discuss how research in humans and animals may be brought in line to maximize translational research opportunities.

Predictors of pathological gambling severity taking gender differences into account

BACKGROUND

The current study aims to identify predictors of pathological gambling (PG) severity, taking gender differences into account, in an outpatient sample of pathological gamblers seeking treatment.

METHODS

The sample for this study consisted of 103 subjects (51 women and 52 men) meeting current DSM-IV-TR criteria for PG. Linear and logistic regression analyses were used to examine different risk factors (gender, age, impulsivity, sensation seeking, self-esteem) and risk markers (depression, anxiety, gambling-related thoughts, substance abuse) as predictors of PG severity.

RESULTS

Impulsivity, maladjustment in everyday life and age at gambling onset were the best predictors in the overall sample. When gender differences were taken into account, duration of gambling disorder in women and depression and impulsivity in men predicted PG severity. In turn, a high degree of severity in the South Oaks Gambling Screen score was related to older age and more familiy support in women and to low self-esteem and alcohol abuse in men. Female gamblers were older than male gamblers and started gambling later in life, but became dependent on gambling more quickly than men.

CONCLUSIONS

Further research should examine these data to tailor treatment to specific patients' needs according to sex and individual characteristics.

Personality dimensions and disorders in pathological gambling

PURPOSE OF REVIEW

This review presents the most current research in personality dimensions and disorders with respect to pathological gambling.

RECENT FINDINGS

Personality dimensions, such as impulsivity and impulsivity-related variables, are important aspects that may shape our understanding of the pathogenesis and treatment of pathological gambling. Furthermore, a large percentage of pathological gamblers have a co-occurring personality disorder which may impact the clinical presentation of pathological gambling.

SUMMARY

Evidence suggests that pathological gamblers exhibit impulsivity or impulsivity-related traits, as well as a range of personality disorders. Subtyping pathological gamblers based on personality domains has been proposed; however, more research is needed to provide support for these models. Overall, recent research represents an advancement in our understanding of how personality impacts pathological gambling, but further research is warranted to better understand how personality impacts the clinical presentation and treatment outcomes of pathological gambling.