Severity is based on the number of criteria endorsed. Individuals with mild gambling dis- order may exhibit only 4—5 of the criteria, with the most frequently endorsed criteria usu- ally related to preoccupation with gambling and "chasing" losses. Individuals with moderately severe gambling disorder exhibit more of the criteria (i.e., 6—7). Individuals with the most severe form will exhibit all or most of the nine criteria (i.e., 8—9). Ieopardiz- ing relationships or career opportunities due to gambling and relying on others to provide money for gambling losses are typically the least often endorsed criteria and most often oc- cur among those with more severe gambling disorder. Furthermore, individuals present- ing for treatment of gambling disorder typically have moderate to severe forms of the disorder.
Gambling involves risking something of value in the hopes of obtaining something of greater value. In many cultures, individuals gamble on games and events, and most do so without experiencing problems. However, some individuals develop substantial impair- ment related to their gambling behaviors. The essential feature of gambling disorder is persistent and recurrent maladaptive gambling behavior that disrupts personal, family, and / or vocational pursuits (Criterion A). Gambling disorder is defined as a cluster of four or more of the symptoms listed in Criterion A occurring at any time in the same 12-month period.
A pattern of ”chasing one’s losses” may develop, with an urgent need to keep gam- bling (often with the placing of larger bets or the taking of greater risks) to undo a loss or series of losses. The individual may abandon his or her gambling strategy and try to win back losses all at once. Although many gamblers may ”chase” for short periods of time, it is the frequent, and often long-term, ”chase” that is characteristic of gambling disorder (Criterion A6). Individuals may lie to family members, therapists, or others to conceal the extent of involvement with gambling; these instances of deceit may also include, but are not limited to, covering up illegal behaviors such as forgery, fraud, theft, or embez- zlement to obtain money with which to gamble (Criterion A7). Individuals may also en- gage in “bailout” behavior, turning to family or others for help with a desperate financial situation that was caused by gambling (Criterion A9).
Distortions in thinking (e.g., denial, superstitions, a sense of power and control over the outcome of chance events, overconfidence) may be present in individuals with gambling disorder. Many individuals with gambling disorder believe that money is both the cause of and the solution to their problems. Some individuals with gambling disorder are im- pulsive, competitive, energetic, restless, and easily bored; they may be overly concerned with the approval of others and may be generous to the point of extravagance when win- ning. Other individuals with gambling disorder are depressed and lonely, and they may gamble when feeling helpless, guilty, or depressed. Up to half of individuals in treatment for gambling disorder have suicidal ideation, and about 17% have attempted suicide.
The past-year prevalence rate of gambling disorder is about 0.2%—0.3% in the general pop- ulation. In the general population, the lifetime prevalence rate is about 0.4%—1.0%. For fe- males, the lifetime prevalence rate of gambling disorder is about 0.2%, and for males it is about 0.6%. The lifetime prevalence of pathological gambling among African Americans is about 0.9%, among whites about 0.4%, and among Hispanics about 0.3%.