61 While problematic gambling behavior has been recognized for centuries, it was often ignored by the psychiatric community. Bleuler,17 citing Kraepelin,16 considered PG, or “gambling mania,”

a special impulse disorder. Criteria for PG were first enumerated in 1980 in DSM-III. 62 The criteria were subsequently modified, and in DSM-IV-TR, 10 are patterned after those used for substance dependencies and emphasize the features of tolerance and withdrawal. PG is defined as “persistent and recurrent maladaptive gambling behavior (criterion A) that disrupts personal, Inhibitors,research,lifescience,medical family, or vocational pursuits…” Ten specific maladaptive behaviors are listed, and >5 are required for the diagnosis. The criteria focus on loss of control of gambling behavior; progressive deterioration of the disorder; and continuation despite negative consequences. The diagnosis can only be made when mania is ruled out (Criterion B). In an attempt to reconcile nomenclature and measurement methods, Shaffer and Hall63 developed a generic multilevel Inhibitors,research,lifescience,medical classification scheme that is now widely accepted by gambling researchers. PG is presently classified as a disorder of impulse control in DSM-IV-TR. 10 On the one hand, some

investigators have suggested that PG is related to OCD,1,64 yet others argue against such a relationship.65 Inhibitors,research,lifescience,medical On the other hand, PG is widely considered an addictive disorder.66,67 It has recently been proposed as a candidate for inclusion in a new category for “behavioral addictions.” 15 Recent estimates of lifetime prevalence Inhibitors,research,lifescience,medical for PG range from 1.2% to 3.4% in the general population.68,69 Prevalence rates have risen in areas where gambling availability has increased.70.71 A national survey showed that the availability of a casino within 50 miles is associated with a nearly twofold increase in PG prevalence.59 Gambling behavior typically begins in adolescence,

with PG developing by the late 20s or early 30s,72 though it can begin Inhibitors,research,lifescience,medical at any age through senescence. Rates of PG are higher in men, but the gender gap may be narrowing.PG has a later onset in women yet progresses more rapidly (“telescoping”) than in men,73 at a rate similar to that observed in alcohol disorders. Populations at risk include adults with mental health or substance-use disorders, persons who have been incarcerated, African-Americans, and persons with low socioeconomic status.74,75 Research has not validated PG subtypes, but perhaps the most widely discussed distinction is between “escape-seekers” and “sensation-seekers.” Brefeldin_A 76 lifescience escape-seekers are often older persons who gamble out of boredom, from depression, or to fill time, and choose passive forms of gambling such as slot machines. Sensation-seekers tend to be younger, and prefer the excitement of card games or table games that involve active input.76 Blaszczynski and Nower77 have proposed a “pathways” model that integrates biological, developmental, cognitive, and other determinants of disordered gambling.