NCRG Conference on Gambling and Addiction

Sunday, November 16, 2008

Does the Diagnostic Definition of Pathological Gambling Need Revising? Debating DSM-V

To kick-off the opening plenary session of the 2008 NCRG Conference on Gambling and Addiction, NCRG Board Director Glenn Christenson welcomed nearly 350 attendees from across the globe and introduced this year’s conference theme, The Changing Landscape of Treatment, Responsible Gaming and Public Policy. Christenson took a moment to report the news of the recent passing of Dr. Rena Nora, a leader in the field of pathological gambling research, and dedicated the session – titled Debating DSM-V: Will New Research Change the Diagnosis of Pathological Gambling? – to her memory.

Linda B. Cottler, Ph.D., professor of epidemiology in psychiatry at the Washington University School of Medicine, began the session with a presentation on the history of the DSMthe American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders – and its evolving definition of pathological gambling. She also discussed how new research developments could again reshape the definition of the disorder in the DSM-V, which will have profound implications for how pathological gambling is diagnosed and treated. The APA has assembled a Workgroup on Substance Use Disorders to prepare for the next installment of the manual, and Cottler encouraged conference attendees to contact the group to “let your voices be known and your concerns be heard.”

Dr. Thomas Widiger, Ph.D., professor of psychology at the University of Kentucky, discussed how the DSM-V would likely shift from the current categorical classifications of mental disorders toward dimensional classifications of mental disorders, which will better capture the range and intensity of problem behaviors attributed to different disorders. He added that there was no gold standard for diagnosing pathological gambling, explaining that DSM’s prototype of the disorder represents the most severe form of the condition. This, he said, can lead to a large number of sub-threshold cases and poor treatment options.

Dr. Howard J. Shaffer, Ph.D. C.A.S. associate professor of psychology in psychiatry at Harvard Medical School, said that one challenge facing clinicians and researchers was that few people understand the term “diagnosis” in the same way. Shaffer said that diagnosis means “understanding people through and through,” and said that the DSM was a tool for accomplishing that goal. He added that he felt “pathological gambling” was a pejorative term and should no longer be used.

A lively question and answer session with members of the audience followed, during which Cottler, Widiger and Shaffer offered their perspectives on dimensional classification, defining addiction, sharing information with others in the field and developing a flexible definition for pathological gambling that applies to a wide range of demographic groups. Shaffer closed the plenary session by saying that “pathological gambling research is still a young field. We have a long way to go, but we have already accomplished a great deal.”


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