The onset of gambling disorder can occur during adolescence or young adulthood, but in other individuals it manifests during middle or even older adulthood. Generally, gam- bling disorder develops over the course of years, although the progression appears to be more rapid in females than in males. Most individuals who develop a gambling disorder evidence a pattern of gambling that gradually increases in both frequency and amount of wagering. Certainly, milder forms can develop into more severe cases. Most individuals with gambling disorder report that one or two types of gambling are most problematic for them, although some individuals participate in many forms of gambling. Individuals are likely to engage in certain types of gambling (e.g., buying scratch tickets daily) more fre- quently than others (e.g., playing slot machines or blackjack at the casino weekly). Fre- quency of gambling can be related more to the type of gambling than to the severity of the overall gambling disorder. For example, purchasing a single scratch ticket each day may not be problematic, while less frequent casino, sports, or card gambling may be part of a gambling disorder. Similarly, amounts of money spent wagering are not in themselves in- dicative of gambling disorder. Some individuals can wager thousands of dollars per month and not have a problem with gambling, while others may wager much smaller amounts but experience substantial gambling-related difficulties.
Gambling patterns may be regular or episodic, and gambling disorder can be persis- tent or in remission. Gambling can increase during periods of stress or depression and during periods of substance use or abstinence. There may be periods of heavy gambling and severe problems, times of total abstinence, and periods of nonproblematic gambling.
Gambling disorder is sometimes associated with spontaneous, long-term remissions.
Nevertheless, some individuals underestimate their vulnerability to develop gambling disorder or to return to gambling disorder following remission. When in a period of re- mission, they may incorrectly assume that they will have no problem regulating gambling and that they may gamble on some forms nonproblematically, only to experience a retum to gambling disorder.
Early expression of gambling disorder is more common among males than among fe- males. Individuals who begin gambling in youth often do so with family members or friends. Development of early-life gambling disorder appears to be associated with impul- sivity and substance abuse. Many high school and college students who develop gambling disorder grow out of the disorder over time, although it remains a lifelong problem for some. Mid- and later-life onset of gambling disorder is more common among females than among males.
There are age and gender variations in the type of gambling activities and the preva- lence rates of gambling disorder. Gambling disorder is more common among younger and middle-age persons than among older adults, Among adolescents and young adults, the disorder is more prevalent in males than in females. Younger individuals prefer different forms of gambling (e.g., sports betting), while older adults are more likely to develop problems with slot machine and bingo gambling. Although the proportions of individuals who seek treatment for gambling disorder are low across all age groups, younger individ- uals are especially unlikely to present for treatment.
Males are more likely to begin gambling earlier in life and to have a younger age at on- set of gambling disorder than females, who are more likely to begin gambling later in life and to develop gambling disorder in a shorter time frame. Females with gambling disor- der are more likely than males with gambling disorder to have depressive, bipolar, and anxiety disorders. Females also have a later age at onset of the disorder and seek treatment sooner, although rates of treatment seeking are low (<10%) among individuals with gam- bling disorder regardless of gender.
Temperamental. Gambling that begins in childhood or early adolescence is associated with increased rates of gambling disorder. Gambling disorder also appears to aggregate with antisocial personality disorder, depressive and bipolar disorders, and other sub- stance use disorders, particularly with alcohol disorders.