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

The DSM-5 is based on knowledge that has been gained in empirical studies and expresses the consensus of the scientific community on the nature of mental disorders (Kupfer, First & Regier, 2002; Rounsaville et al., 2002). It is basic to the development of diagnostic instruments and is often referred to as a criterion of external validity for other measures in various fields of research and practice (Rounsaville et al., 2002). Although the new manual has been developed for North America, it is also widely used in studies elsewhere. Adverse events identified by the therapist or spontaneously reported will be registered in the eCRF of the trial dataset and reported during the weekly clinical meetings. The severity of the adverse event will be evaluated by the trial management group.

Diagnostic Criteria for 312.31 Pathological Gambling

• Illegal acts remains in the section describing the diagnostic features 8, p. 585, but is now subsumed under lying to conceal the extent of gambling.
• These methods consider a range of factors, including behavioral patterns, psychological symptoms, and the impact gambling has on an individual’s daily life.
• The structure underlying the criteria is unidimensional but the disorder is manifested differently depending on disorder severity.
• Fortunately, interest in transdiagnostic processes has grown exponentially recently, primarily as an alternative means for understanding psychopathology 41, 42.
• The present study challenges the current application of the DSM-5 criteria for GD.

These meetings contribute to the overall trial quality and support effective team coordination. Clinicians participating in the trial will be responsible for participant recruitment, delivery of the intervention and data collection. Secondary efficacy analyses of changes in GDT and GD-TLFB from baseline to 12 weeks between the CBT and control groups will be conducted using the same methodology as the primary efficacy analysis. To control the overall Type I error rate for secondary endpoints, an alpha-splitting testing procedure will be employed.

Based on our pilot data 24, we have therefore concluded that a reasonable assumption is a 10-point reduction in the intervention group and a 5-point reduction in the control group. Hence, we calculated the sample size to be able to detect a difference of 5 points between the groups. With a standard deviation of 10, power of 80 percent and significance level of 5 percent, the required group size is 64 individuals per arm or 128 individuals in total.

The health care personnel providing the treatment (psychologists and social worker) cannot be blinded, nor can the research personnel who handle all data. The only personnel that will be blinded is the statistician, who will receive a coded data file. If a participant needs extra support or care after the CBT treatment it will be provided at the clinic or the participant will be referred to the appropriate treatment provider.

To measure symptoms of GD, a Swedish version of the Internet Gaming Disorder Scale 9—Short Form (IGDS9-SF) will be used. This is one of the most frequently used questionnaires internationally for measuring symptoms related to excessive gaming 28. The primary endpoint will be the mean change in IGDS9-SF from baseline to end of treatment and will be distributed at all time points for data collection (see Table 2, Timeline).

Differences in the number of identified factors might be due to different statistical approaches (Muthen, 2006) or cultural differences. Both the ESA and the study on slot machine gamblers were approved by the Ethical Board of the German Society of Psychology (DGPs). The Monotonicity assumption is met when the probability of endorsing each criterion rises analogously to the probability of endorsing others. The assessment of monotonicity was done by graphical evaluation of multiple graphs illustrating the total sum of endorsed criteria on the X-axis and the ratio of people endorsing the criterion on the Y-axis. The research team will have regular meetings to discuss questions concerning participants, ethics and methodology. All digital data will be stored on a safe server only accessible by the involved researchers through personal identification.

Information about education, living situation, occupation, medication, gaming-related somatic symptoms, length and height is obtained, as well as information about gaming habits. The participants are, for example, asked about preferred game genres, main type of platform used for gaming and treatment goals for gaming. The participants will be followed up by telephone three months after the end of treatment. In a subsequent study, the participants will also be followed up after 6, 12, 18 and 24 months, with the same questionnaires as in the study described in this protocol. Data will be collected digitally at several time-points before, during and after the intervention (see Table 2 Timeline). For patients who are not able to access the digital questionnaire service, it will be possible to fill out the questionnaires on paper.

However, the evidence is clear from prospective studies that gambling disorder can be episodic and transitory in nature 63. Retrospective studies also find that one third of individuals with lifetime gambling disorder no longer meet past year criteria for the disorder and these changes are not due to treatment as few sought professional help 64, 65. This is not to say that the disorder is not chronic for some individuals, but that for many it is not a life-long persistent problem. The research community and treatment providers have already moved ahead of DSM-5 by examining and providing interventions for sub-diagnostic gamblers.

The two secondary endpoints—GD-TLFB weekly hours and changes in GDT scores from baseline to 12 weeks—will initially be tested with an alpha level of 0.025 each. Descriptive data will be presented by treatment arm and, where applicable, by timepoint. For numeric variables, summary statistics will include the number of available and missing measurements, mean, standard deviation (SD), median and minimum and maximum values. Treatment comparisons for primary, secondary and exploratory endpoints will be conducted using analysis of covariance (ANCOVA), adjusted for baseline values.

The factor extraction was based on the scree plot assessment (Costello & Osborne, 2005), the ratio of the first-to-second eigenvalue (Solcum-Gori & Zumbo, 2010) and, finally, the theoretical accuracy of the factors. In both samples, the scree plot evaluation and the ratio of first-to-second eigenvalue exceeding 3 supported the one-factor model (Solcum-Gori & Zumbo, 2010). In both samples the first factor’s eigenvalue was significantly larger than the second (5.01 vs. 1.26, and 4.04 vs. 1.08 for GGP and SMG, respectively). In the two-factor models, the first factor loaded on all but the 6th criterion in the GGP sample and on all but the 7th criterion in the SMG sample. Some of the criteria had low factor loadings, one falling below 0.4 in the SMG sample. The General Anxiety Disorder-7-Item Scale was developed as an instrument to measure the presence and severity of symptoms of anxiety 34.

Results from this trial will be reported primarily in relevant scientific journals, reports and international and national conferences. The results will also be made available to the public via press releases and information directed to health care staff and other professionals. To handle day-to-day trial conduct, a trial management group is organised, composed of two researchers connected to the clinic. The purpose of these meetings is to review participant progress and clinical concerns (e.g. AEs), ensure consistency in the CBT-treatment and adherence to the protocol, and address problems related to the implementation of the treatment.

These shared elements include the commandeering of the natural reward pathway, development of tolerance and withdrawal, and engaging in the behavior despite harm experienced by the individual and others 58, 59. Further similarities are found when comparing gambling disorder and substance disorders in the life course, treatment outcome, diagnostic criteria (with some differences), and the content of existing treatment protocols. Petry 60 and Potenza 61 provide a review of the similarities and differences between pathological gambling and substance disorders. Gambling disorder was the first and only non-substance use disorder to be classified into the new substance-related and addictive disorders chapter. However, internet gaming disorder was listed under topics for further consideration given that it is relatively better researched relative to other potential behavioral addictions such as exercise, sex or shopping 8, p. 795, 62. Treating gambling disorder requires continuous support, as there is a significant risk of relapse, especially for those who also struggle with substance use disorders or impulse control disorders.

Assessing Behavioral Trends

Pathological Gambling and Alcoholism are more common in the fathers of males and in the mothers of females with the disorder than in the general population.

At time points 0, 3 and 4, the participants will answer questions regarding physical activity level and sedentary time. In terms of treatment of GD, clinicians may find that improvement from severe GD to moderate GD in terms of number of criteria has little, if any, relationship to change in severity of gambling behavior or functional outcomes. Additionally, if the intensity of GD treatment approaches is stratified based on these severity categories, applying treatment differently between moderate and severe GD clients may be a sub-optimal allocation of treatment resources. Participants included 574 adults with GD who had enrolled in various clinical, neuroimaging, and treatment research studies between 2001 and 2016. Exclusion criteria for these studies included an inability to provide informed consent and inability to complete required assessment procedures.

The score ranges from 9 to 45 (higher https://gullybetofficial.com/ scores reflect more problems related to gaming), with a suggested clinical cut-off at or above 32 41. At least five of the questions answered with “very often” indicates that the criteria for a diagnosis of IGD have been met 28. IGDS9-SF has been validated against weekly gameplay and the IGD-20-test 42 showing good validity and a Cronbach´s alpha of 0.87. In this study, the total score is used as a measure of severity of IGD and will be included at all time points from the first visit (T0) to the follow-up after 3 months (T4). A lower score post-treatment compared to pre-treatment is seen as a positive outcome.

1. Participants

The questionnaires about psychiatric symptoms during treatment will also be used to collect information about AEs, such as worsening of psychiatric symptoms. The Negative Effects Questionnaire used at the end of treatment will also assist in identifying AEs, as well as the follow-up assessments at three months after treatment. Adverse event data from questionnaires will be systematically collected by a designated member of the research team at each scheduled assessment.