Contribution of Illegal Acts to Pathological Gambling Diagnosis: DSM-5 Implications

Abstract

The purposes of this study were to examine the specific contribution of illegal acts to the diagnostic criteria of pathological gambling, to assess the possibility of differential item functioning across patients' sex and age, and to explore the existence of different clinical phenotypes based on the presence of illegal acts. The sample consisted of 2,155 patients seeking treatment for pathological gambling at the University Hospital of Bellvitge in Barcelona, Spain. The illegal acts item did not show different item functioning, and younger patients presented higher latent means than middle-aged and older patients, whereas no differences were found across sex. This item also showed the lowest discrimination coefficient; its exclusion would maintain satisfactory internal consistency for the remaining 9 symptoms and was poorly related to psychopathology and the severity of the gambling behavior. The relevance of the illegal acts as a diagnostic criterion appears to be limited, and its elimination from the Diagnostic and Statistical Manual for Mental Disorders, 5th edition, seems justified. However, illegal acts have implications for both the clinical and legal domains and contribute to increase the patients' impairment.

A Clinical Economy of Speculation: Financial Trading and Gambling Disorder in Spain

“…In her view, illegal behavior was a consequence of severe gambling disorder rather than a diagnostic symptom. The illegal-acts criterion in the DSM-4 included "forgery, fraud, theft, or embezzlement to finance gambling" (American Psychiatric Association 2000, 674), and was introduced as a diagnostic criterion to establish a clear distinction between pathogenic elements and ensuing gambling-disordered behaviors (see also Granero et al 2014). Most clinicians recognized that the recalibration of diagnosis could affect the legal definition of gambling.…”

Gambling Disorder in the DSM-5: Opportunities to Improve Diagnosis and Treatment Especially in Substance Use and Homeless Populations

“…Others [10–11] highlight the conceptual role of illegal acts as a diagnostic criterion and whether these behaviors represent a core component of the underlying psychopathology or rather represent a possible consequence of the disorder. Consequences of mental disorders are less likely to be useful diagnostic indicators, especially if they occur further into disease severity or disease progression as appears to be the case for gambling-related illegal acts.…”

“…Clinicians likely do see higher proportions of treatment-seeking gamblers reporting illegal acts (23–41%) [10, 12, 16–17], especially as compared to population-based samples of gamblers (0.1–0.4%) [6, 8] and even community samples of those meeting DSM-IV gambling criteria (19%) [7]. Gamblers seeking treatment tend to be higher on the severity spectrum, and, as noted above, illegal acts are more prevalent among these higher severity gamblers.…”

“…With respect to clinical utility, the presence of illegal acts is associated with more severe GD, greater dysfunction in other domains (e.g., unemployment; psychiatric comorbidity, suicide attempts), and more gambling-related debt [10, 12, 16]. These gamblers benefit from treatment, but do not reach subthreshold diagnostic levels as typical of those without a history of such behavior [16], suggesting that individuals reporting gambling-related illegal acts may need more intensive or longer duration gambling treatments.…”

Gambling disorder-related illegal acts: Regression model of associated factors

“…It can also lead to legal consequences, such as check forgery, embezzlement, theft, larceny, armed robbery, bookmaking, hustling, running con games, fencing stolen goods, loan fraud, tax evasion, burglary, pimping, prostitution, and sale of drugs ( Lesieur & Rosenthal, 1991 ). Gambling-related illegal activities were considered as a diagnostic criterion until the DSM-IV-TR ( APA, 2000 ) and several epidemiological studies demonstrated its almost exclusive relationship with the most severe forms of the disorder ( Carragher & McWilliams, 2011 ; Granero et al., 2014 ; McBride, Adamson, & Shevlin, 2010 ; Strong & Kahler, 2007 ). The prevalence of illegal acts in individuals with gambling disorder ranges from 14% to 30% ( Granero et al., 2015 ).…”