Dimensions of Impulsivity in Gambling Disorder

Abstract

Impulsivity is a multidimensional construct. Although gambling disorder (GD) has been associated with high impulsivity, impulsivity across multiple domains has not been thoroughly investigated in this population. We first aimed to examine whether associations between three facets of impulsivity (response impulsivity, choice impulsivity and impulsive tendency) varied between GD patients and healthy controls (HC). We next aimed to evaluate relationships between these three types of impulsivity, as proposed by theoretical models of impulsivity, and their associations with GD severity. The sample included 97 treatment-seeking adult men with GD, diagnosed according to DSM-5 criteria, and 32 male HCs recruited from the general population. Greater impulsivity in all three domains was found in men with GD in comparison to men without GD. Associations between impulsivity facets were found in both groups, with response impulsivity being the only domain associated with GD severity. Our findings confirm that multiple domains of impulsivity are relevant in GD. Future studies should examine the extent to which treatments aimed at targeting specific aspects of impulsivity improve outcomes. Although impulsivity has been proposed as a multifactorial construct 1 , there is still a lack of consensus regarding its definition and the independence of impulsivity domains 2. Impulsivity has been defined as a tendency to respond with little forethought, often with disregard to the negative consequences to the impulsive individual or others 3. Impulsivity has been found to factor into multiple forms, including response and choice forms, that can be measured across species 4-7. While multiple theoretical models have been proposed different types of impulsivity, the proposal by MacKillop et al. 8 is widely used and validated in different populations. This model posits that impulsivity can be partitioned into three main domains: response impulsivity, choice impulsivity and impulsive tendencies. Response impulsivity, also termed impulsive action or motor impulsivity, involves impairments in delaying, withholding or interrupting inappropriate responses 4,9. High levels of this type of impulsivity have been associated with gambling disorder (GD), with GD participants demonstrating differences in response impulsivity in comparison with healthy control (HC) participants 10 , including within treatment-seeking samples 11. Multiple studies suggest gambling severity is positively correlated with motor impulsivity 9,12,13 and one recent meta-analysis found GD to be associated with significant impairments in motor and attentional inhibition 14. Delay discounting relates to impulsive choice and the extent to which an individual prefers a smaller-sooner over a larger-later reward 5,15. In the case of GD, cognitive disturbances related to risk-reward decision making have been reported 16,17 , and individuals with GD tend to discount rewards more steeply than controls 18-21. Increasing evidence supports that people with gambling problems prefer to obtain ...

Considering Motor Excitability During Action Preparation in Gambling Disorder: A Transcranial Magnetic Stimulation Study

“…In line with the relative independence of those two types of impulsivity, GDPs were affected differently depending on the assessed component. Our findings at the MCQ revealed that GDPs had significantly steeper discounting rates than HCs, highlighting a higher choice impulsivity in this group of patients, as shown previously (35,75,76). This predisposition to prefer smallersooner rewards over larger-delayed ones was also supported by our measures of trait impulsivity.…”

“…Finally, our sample was entirely male. Although this is consistent with gender biases in the GD population (30,76,94), this limits the generalizability of our findings to females.…”

“…Indeed, GDPs obtained higher scores than controls on the "non-planning" and "lack of premeditation" subscales of the BIS-11 questionnaire and the UPPS Impulsive Behavior Scale, respectively, implying that those individuals are more oriented to the present rather than the future and tend to act without consideration of the consequences. In this line, an association between scores on both subscales and discounting rates has been previously reported (61,76,77). Altogether, this pattern of results is likely to contribute to the tendency of GDPs to favor immediate bets, despite the negative consequences of their gambling behavior.…”

Trans-diagnostic measurement of impulsivity and compulsivity: A review of self-report tools

“…in terms of genetics, or neurobiology), as well as in terms of identifying trans-diagnostic treatments and understanding treatment response or resistance across conditions. Potential value of the dimensional approach has been discussed in detail, for example in the context of the RDoC initiative (Cuthbert & Insel, 2013).Impulsivity and compulsivity are excellent candidates for dimensional modelling, as they are present in background populations but, in extreme forms, can be components in a number of clinical disorders, such as ADHD, OCD, substance use disorders and behavioural addictions (Chamberlain et al, 2019, Ioannidis et al, 2019, Brooks et al, 2017, Berlin and Hollander, 2014Chambers & Potenza, 2003;Mestre-Bach et al, 2020). Partly as a result of this, they have received growing research interest in recent years (Figure 1 and 2).…”

Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions

“…The fact that people with addictive disorders are more prone to suicidal behavior has been attributed to the observation that such behavior is often driven by impulsivity [ 28 ] and that addictive disorders are characterized precisely by high levels of impulsivity, as well as difficulties in inhibitory control [ 29 , 30 , 31 ]. In a recent systematic review and meta-analysis, the authors identified that the highest risk of suicidal ideation in individuals with substance use disorders were associated with smoking, history of sexual abuse, depressive symptomatology, and alcohol and cannabis use disorders.…”