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The Diagnostic and Statistical Manual of Mental Disorders (DSM) serves as the primary classification system for mental health disorders, providing standardized diagnostic criteria for clinicians and researchers. First published by the American Psychiatric Association (APA) in 1952, the DSM has undergone several revisions to reflect evolving psychiatric understanding. The fifth edition, DSM-5, released in 2013, introduced key updates that expanded diagnostic categories and modified diagnostic...
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Is subclinical gambling really subclinical?

Jeremiah Weinstock1, Laura M April1, Selmi Kallmi2

  • 1Saint Louis University, United States.

Addictive Behaviors
|May 23, 2017
PubMed
Summary

Subclinical gamblers, those with 2-3 criteria, show psychosocial dysfunction similar to mild substance use disorder (SUD) patients. This level of impairment significantly differs from healthy individuals, suggesting a need to re-evaluate gambling disorder diagnostic thresholds.

Keywords:
Diagnostic thresholdEquivalence testingGambling disorderSubstance use disorders

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Area of Science:

  • Psychiatry
  • Psychology
  • Epidemiology

Background:

  • Gambling disorder and substance use disorders (SUD) share etiological factors and diagnostic features like preoccupation and loss of control.
  • Current diagnostic criteria differ, with 2-3 SUD criteria warranting a diagnosis, while 2-3 gambling disorder criteria do not.
  • This disparity raises questions about the diagnostic threshold for gambling disorder.

Purpose of the Study:

  • To investigate if individuals meeting 2-3 criteria for gambling disorder (subclinical gamblers) experience psychosocial dysfunction comparable to those diagnosed with mild SUD (2-3 criteria).
  • To determine if this level of dysfunction in subclinical gamblers significantly differs from individuals with no psychopathology.
  • To inform potential revisions of diagnostic thresholds for gambling disorder.

Main Methods:

  • Utilized data from the first wave of the Quinte Longitudinal Study, a large epidemiological sample (N=4121).
  • Employed psychometrically validated measures to assess psychosocial functioning and Axis-I psychiatric disorders.
  • Conducted cross-sectional analyses using ANCOVA to compare psychosocial functioning across groups, controlling for covariates.

Main Results:

  • Subclinical gamblers reported significantly poorer psychosocial functioning compared to individuals with no psychopathology.
  • Equivalency testing revealed that subclinical gamblers' psychosocial functioning was not significantly different from, and thus equivalent to, individuals with mild SUD.
  • The psychosocial impairment experienced by subclinical gamblers was significantly greater than that of healthy individuals.

Conclusions:

  • Subclinical gamblers exhibit psychosocial impairment levels similar to individuals with mild SUD.
  • The current diagnostic threshold for gambling disorder may underestimate the functional impairment associated with subclinical presentations.
  • Re-examination of the diagnostic criteria for gambling disorder is warranted to better reflect clinical reality.