Towards DSM-V: considering other withdrawal-like symptoms of pathological gambling disorder

Despite clinical reports of other withdrawal-like symptoms, the DSM-IV considers only restlessness/irritability as a withdrawal-like criterion comprising pathological gambling disorder (PGD). We explored whether this criterion should be broadened to include other gambling withdrawal-like symptoms.Community-recruited adult gamblers (n = 312) participated in telephone interviews about gambling and related behaviors as a part of a larger psychometric study. Frequency and chi-square analyses described the association of gambling withdrawal-like symptoms by gambling disorder status. Multinomial forward selection logistic regression obtained a multivariate model describing the simultaneous relationship between these symptoms and gambling disorder status.One-quarter of the sample experienced the DSM-IV PGD criterion of restlessness/irritability. However, 41% experienced additional gambling withdrawal-like symptoms when attempting to quit or control gambling. A model including restlessness/irritability and three additional non-DSM-IV withdrawal-like symptoms (i.e. feelings of anger, guilt, and disappointment) is a stronger model of gambling disorder (chi(2) = 217.488; df = 8, p < 0.0001; R(2) = 0.5428; p < 0.0001) than restlessness/irritability alone (chi(2) = 151.278; df = 2, p < 0.0001; R(2) = 0.4133). The overlap of gambling withdrawal-like symptoms with substance use withdrawal (11%) and depressive symptoms (34%) failed to fully account for these associations with gambling disorder status.Future PGD conceptualization and potential criteria revisions for DSM-V may warrant a broader inclusion of gambling withdrawal-like symptoms.