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DSM-IV pathological gambling in the National Comorbidity Survey Replication

  • R. C. Kessler (a1), I. Hwang (a1), R. LaBrie (a2), M. Petukhova (a1), N. A. Sampson (a1), K. C. Winters (a3) and H. J. Shaffer (a2)...

Little is known about the prevalence or correlates of DSM-IV pathological gambling (PG).


Data from the US National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey, were used to assess lifetime gambling symptoms and PG along with other DSM-IV disorders. Age of onset (AOO) of each lifetime disorder was assessed retrospectively. AOO reports were used to study associations between temporally primary disorders and the subsequent risk of secondary disorders.


Most respondents (78.4%) reported lifetime gambling. Lifetime problem gambling (at least one Criterion A symptom of PG) (2.3%) and PG (0.6%) were much less common. PG was significantly associated with being young, male, and Non-Hispanic Black. People with PG reported first gambling significantly earlier than non-problem gamblers (mean age 16.7 v. 23.9 years, z=12.7, p<0.001), with gambling problems typically beginning during the mid-20s and persisting for an average of 9.4 years. During this time the largest annual gambling losses averaged US$4800. Onset and persistence of PG were predicted by a variety of prior DSM-IV anxiety, mood, impulse-control and substance use disorders. PG also predicted the subsequent onset of generalized anxiety disorder, post-traumatic stress disorder (PTSD) and substance dependence. Although none of the NCS-R respondents with PG ever received treatment for gambling problems, 49.0% were treated at some time for other mental disorders.


DSM-IV PG is a comparatively rare, seriously impairing, and undertreated disorder whose symptoms typically start during early adulthood and is frequently secondary to other mental or substance disorders that are associated with both PG onset and persistence.

Corresponding author
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email:
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J Angst , R Sellaro , KR Merikangas (2000). Depressive spectrum diagnoses. Comprehensive Psychiatry 41, 3947.

RM Cunningham-Williams , LB Cottler , WM Compton III, EL Spitznagel (1998). Taking chances: problem gamblers and mental health disorders – results from the St. Louis Epidemiologic Catchment Area Study. American Journal of Public Health 88, 10931096.

RM Cunningham-Williams , LB Cottler , WM Compton , EL Spitznagel , A Ben-Abdallah (2000). Problem gambling and comorbid psychiatric and substance use disorders among drug users recruited from drug treatment and community settings. Journal of Gambling Studies 16, 347376.

RM Cunningham-Williams , RA Grucza , LB Cottler , SB Womack , SJ Books , TR Przybeck , EL Spitznagel , CR Cloninger (2005). Prevalence and predictors of pathological gambling: results from the St. Louis personality, health and lifestyle (SLPHL) study. Journal of Psychiatric Research 39, 377390.

SS Halli , KV Rao , SS Halli (1992). Advanced Techniques of Population Analysis. Plenum: New York, NY.

RC Kessler , J Abelson , O Demler , JI Escobar , M Gibbon , ME Guyer , MJ Howes , R Jin , WA Vega , EE Walters , P Wang , A Zaslavsky , H Zheng (2004 a). Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). International Journal of Methods in Psychiatric Research 13, 122139.

RC Kessler , P Berglund , WT Chiu , O Demler , S Heeringa , E Hiripi , R Jin , B-E Pennell , EE Walters , A Zaslavsky , H Zheng (2004 b). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 6992.

RC Kessler , KA McGonagle , S Zhao , CB Nelson , M Hughes , S Eshleman , HU Wittchen , KS Kendler (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 819.

B Knauper , CF Cannell , N Schwarz , ML Bruce , RC Kessler (1999). Improving the accuracy of major depression age of onset reports in the US National Comorbidity Survey. International Journal of Methods in Psychiatric Research 8, 3948.

HC Kraemer , KA Wilson , C Hayward (2006). Lifetime prevalence and pseudocomorbidity in psychiatric research. Archives of General Psychiatry 63, 604608.

CB Nelson , AC Heath , RC Kessler (1998). Temporal progression of alcohol dependence symptoms in the U.S. household population: results from the National Comorbidity Survey. Journal of Consulting and Clinical Psychology 66, 474483.

NM Petry , FS Stinson , BF Grant (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 66, 564574.

JF Scherrer , WS Slutske , H Xian , B Waterman , KR Shah , R Volberg , SA Eisen (2007). Factors associated with pathological gambling at 10-year follow-up in a national sample of middle-aged men. Addiction 102, 970978.

HJ Shaffer , GB Eber (2002). Temporal progression of cocaine dependence symptoms in the US National Comorbidity Survey. Addiction 97, 543554.

HJ Shaffer , MN Hall , J Vander Bilt (1999). Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis. American Journal of Public Health 89, 13691376.

SM Specker , GA Carlson , KM Edmonson , PE Johnson , M Marcotte (1996). Psychopathology in pathological gamblers seeking treatment. Journal of Gambling Studies 12, 6781.

RA Volberg (1994). The prevalence and demographics of pathological gamblers: implications for public health. American Journal of Public Health 84, 237241.

J Welte , G Barnes , W Wieczorek , MC Tidwell , J Parker (2001). Alcohol and gambling pathology among U.S. adults: prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol 62, 706712.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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