DSM-5 criteria for gambling disorder: Underlying structure and applicability to specific groups of gamblers

Abstract

Background and AimsDSM-5 provides nine diagnostic criteria for gambling disorder. All criteria have a pre-assumed equal diagnostic impact and are applied to all individuals and groups in an equal manner. The aims of the study are to analyse the structure underlying the diagnosis and to assess whether DSM-5 is equally applicable to different groups of gamblers.MethodsData from the 2009 German Epidemiological Survey of Substance Abuse and from a study on slot machine gamblers were used. Item Response Theory analysis was applied to estimate discrimination and severity parameters of the criteria. With the use of Differential Item Functioning analysis, potential criterion biases were analysed. We analysed data from 107 participants from the general population sample and 376 participants from the slot machine gamblers’ sample who answered a 19-item diagnostic questionnaire based on the DSM criteria for gambling disorder.ResultsA single underlying factor, the severity of gambling disorder, was identified in both samples. In the general population sample the criteria of preoccupation and chasing were least severe and showed low discriminatory power. Bailout, withdrawal and jeopardized matters criteria had highest severity and discriminatory power. The comparison of the two samples revealed two criterion biases in the preoccupation and tolerance criteria.ConclusionsThe structure underlying the criteria is unidimensional but the disorder is manifested differently depending on disorder severity. The assumed equal impact of each criterion lacks support in the findings. The DSM-5 criteria measure a partially different construct in slot machine gamblers than in gamblers in the general population.

Proactive coping and gambling disorder among young men

“…In the current study, the internal reliability coefficient was α MLS  = 0.91. Item Response Theory studies provide arguments for viewing GD as a continuum of gambling-related problems starting at no problems at all and ending in severe GD (e.g., Sleczka, Braun, Piontek, Bühringer, & Kraus, 2015; Strong & Kahler, 2007). Thus, the number of endorsed criteria was used to reflect the severity of GD.…”

The predictive capacity of DSM-5 symptom severity and impulsivity on response to cognitive-behavioral therapy for gambling disorder: A 2-year longitudinal study

“…This system is used as an indicator of GD severity and is divided into three levels: mild (four to five criteria), moderate (six to seven), and severe (eight or nine) [1,29]. However, this new classification has proven to be controversial among researchers and clinicians alike, highlighting the need to assess whether severity, as measured by these criteria, is clinically relevant [29][30][31].…”

Gambling disorder, DSM-5 criteria and symptom severity

“…Thus, this simple criteria sum as an overall severity indicator was used for substance use disorders and then extension for GD: mild (four to five criteria), moderate (six to seven), and severe (eight or nine). Recent research, however, suggests that the individual criteria may not all be equivalent in terms of their contributions to the severity of the behavior [8]. For example, jeopardizing important matters, experiencing withdrawal, and needing financial assistance were all associated with a more severe level of GD than were chasing losses or being preoccupied with gambling (Sleczka et al, 2015).…”

“…Recent research, however, suggests that the individual criteria may not all be equivalent in terms of their contributions to the severity of the behavior [8]. For example, jeopardizing important matters, experiencing withdrawal, and needing financial assistance were all associated with a more severe level of GD than were chasing losses or being preoccupied with gambling (Sleczka et al, 2015). In a sample of gamblers recruited from the general population, endorsement of the item 'social, financial, or occupational losses due to gambling' was most indicative of more severe GD [9].…”