An Examination of Comorbid Psychiatric Disorders in Disordered Gamblers Versus Other Substance-Related Disorders

Substantial changes were made with the creation of the Substance Related and Addictive Disorders category in the fifth edition of the Diagnostic and Statistical Manual (DSM-5; APA in Diagnostic and statistical manual of mental disorders, 5th edn, American Psychiatric Publishing, Arlington, 2013a), including the addition of gambling disorder to the category and a reduction in the minimum threshold of diagnostic criteria required for a gambling disorder. As gambling shares many similarities with substance use disorders, it stands to reason that comorbidity rates of other psychiatric disorders would be similar among gambling and substance use disorders. The current study examines whether changes in gambling diagnostic criteria from DSM-IV to DSM-5 correspond to changes in prevalence of comorbid psychiatric disorders among disordered gamblers that result in prevalence rates more similar to those observed in alcohol and cannabis use disorders. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions (NESARC). Results suggested that the prevalence for any comorbid disorder among disordered gamblers appeared to be similar from DSM-IV (56.7%) to DSM-5 (53.7%). Comorbidity using DSM-5 criteria were just slightly closer to, but still noticeably higher than, comorbidity prevalence observed in alcohol (25.3%) and cannabis (37.7%) disorders, with similar trends across addictions observed in most examined comorbid disorders/groupings. Our findings suggest that lowering the threshold for minimum diagnosis of gambling disorder resulted in a slight decrease in comorbidity rates though substantial differences remain between comorbid rates of disordered gambling and substance use disorders. Future DSM editions may consider a further diagnostic threshold reduction, which might result in comorbidity rates being more similar to other substance use disorders and increasing disorder similarity within the Substance Related and Addictive Disorders category.