Before you read on
Casino games are games of chance with a built-in house edge, no strategy changes the odds in the player’s favor over time, and most players lose money over time. Nobody should gamble money they cannot afford to lose. This article describes, in general terms, how clinical manuals define a condition. It is not a diagnostic tool and cannot tell anyone whether they have it. Only a qualified health professional can assess that, and anyone struggling with gambling can contact a local support service.
Two main reference systems
Clinicians usually rely on one of two major classification systems. One is the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association and known as the DSM. The other is the International Classification of Diseases, maintained by the World Health Organization and known as the ICD. Both use the name “gambling disorder” in their current editions (DSM-5 and ICD-11), though they word the definition differently.
The purpose of a manual is to give clinicians a shared vocabulary so that assessments, research and treatment records mean roughly the same thing across settings. The manuals are revised from time to time, so wording and categories can change.
How the label changed
Earlier editions of the DSM used the term “pathological gambling” and grouped it with impulse-control disorders. In the DSM-5, published in 2013, it was renamed gambling disorder and moved into a chapter on substance-related and addictive disorders. It was the first behavioral condition placed in that group. The move reflected research suggesting overlaps with substance use disorders in areas such as brain responses and patterns of symptoms. The change was discussed and not everyone agrees on how close the similarity really is, which is one reason the topic is still debated.
The ICD-11 likewise places gambling disorder among disorders due to addictive behaviors and recognizes both online and offline forms.
The DSM-5 criteria in plain language
The DSM-5 describes a persistent and recurrent pattern of problematic gambling that causes significant distress or impairment. A diagnosis is considered when a person shows at least four of nine features within a 12-month period. In paraphrase, those features are:
- Needing to gamble with larger amounts to feel the same excitement.
- Restlessness or irritability when trying to cut down or stop.
- Repeated unsuccessful efforts to control, reduce or stop gambling.
- Frequent preoccupation with gambling, such as reliving past play or planning the next session.
- Gambling when feeling distressed, for example anxious or low.
- Returning another day to get even after losing, which is often described as chasing losses.
- Lying to conceal how much one gambles.
- Risking or losing an important relationship, job or educational or career opportunity because of gambling.
- Relying on other people to supply money to relieve a desperate financial situation caused by gambling.
The manual also notes that the behavior should not be better explained by a manic episode.
This list is a paraphrase for general understanding. The manual’s exact wording is what clinicians use, and assessing these features properly requires a conversation, context and clinical judgment.
Severity levels
The DSM-5 grades severity by the number of features present. Four or five are described as mild, six or seven as moderate, and eight or nine as severe. Severity is a rough guide to how much of a person’s life is affected, and it is not a measure of character or willpower. Someone at the mild level may still be experiencing real distress and can benefit from help. The manual also allows for the idea of episodic and persistent patterns, as well as remission, since people’s circumstances change over time.
How clinicians approach assessment
A clinician will usually ask about gambling habits, finances, mood, sleep, substance use, relationships and any history of other conditions. Gambling difficulties often occur alongside other issues such as depression, anxiety or alcohol and drug problems, so sorting out what is related to what is a common part of the process. Screening questionnaires exist and are used in many settings, but they are screening aids and not diagnoses.
What a diagnosis does and does not mean
A diagnosis is a tool for describing a pattern and guiding care. It does not mean someone is weak, immoral or beyond help. It also does not require reaching a specific level of losses. A person can meet the description without large financial ruin, and another can lose a lot of money without meeting it.
Not everyone who experiences harm from gambling meets full criteria. Many people sit somewhere on the spectrum described in the wider overview of problem gambling, with some of these features but not enough to count. Such harm is still worth taking seriously, and the common warning signs are a useful way to notice early patterns.
What the manuals do not cover
Manuals describe the condition. They do not set out treatment steps, and they do not predict how any individual’s life will unfold. They also cannot say how common the condition is in any place without data, and this article gives no figures. Prevalence estimates vary by country, method and year, and anyone wanting numbers should look for current published surveys from reputable health bodies rather than rely on a number repeated online.
Getting an assessment
Anyone concerned about their own gambling, or a loved one’s, can speak with a doctor, a counselor or a mental health professional experienced in addictive behaviors. Many places also have free, confidential helplines. If a conversation with someone close seems daunting, a calm gambling conversation focused on concern and not blame is often a better start than confrontation. If you feel in immediate danger or are thinking of harming yourself, contact local emergency services or a crisis line right away.