Psychiatric disorders, cognitive distortions and substance use disorders in pathological gamblers.

Abstract

The present thesis aimed to contribute to research and practice by investigating psychiatric disorders, dysfunctional beliefs and substance use disorders in pathological gamblers. The four empirical studies utilised a large Australian community sample of regular gamblers to examine the prevalence and role of Axis I and Axis II psychiatric disorders in regular and pathological gamblers’ behaviour and thoughts. In Paper 1, the prevalence of psychiatric disorders within a community sample of regular gamblers was investigated. Psychiatric disorders were found to be more prevalent among pathological gamblers than other regular gamblers. Mood and anxiety related disorders were twice as common. Furthermore, almost all personality disorders (apart from depressive and obsessive-compulsive personality disorder) were more prevalent among pathological gamblers than non-pathological gamblers. These differences remained significant even after controlling for gender. Paper 2 examined pathological gambling and gambling-related cognitions to ascertain to what extent they were related to personality disorders and general dysfunctional beliefs. The results showed that pathological gambling was strongly related to borderline personality disorder measure as well as gambling-specific belief scores. A path analysis showed that borderline personality disorder is only weakly related to gambling-related belief after controlling for delusion-proneness. In other words, there is evidence of a pathway between borderline personality disorder scores, delusion-proneness scores and Gambling Related Cognition Scale scores which, in turn, are positively associated with pathological gambling scores. These results support suggestions that dysfunctional beliefs which are associated with borderline personality disorder may make people more susceptible to gambling-related erroneous cognitions. The study reported in Paper 3 compared the prevalence of psychiatric co-morbidity between pathological gamblers who did, and did not, additionally meet criteria for an alcohol use disorder (dual diagnosis). The findings indicated that psychiatric disorders were most prevalent amongst those with a dual diagnosis, followed by those who only met criteria for pathological gambling. Both of these groups had a higher prevalence of psychiatric co- morbidity than those regular gamblers in the sample who did not meet criteria for either pathological gambling or alcohol use disorder. Paper 4 examined associations between pathological gambling and gambling-related dysfunctional belief scores once alcohol use disorder has been controlled for. Pathological gamblers scored higher than other regular gamblers on all these measures. Although alcohol use disorder was not directly related to delusion proneness, a combination of higher alcohol use disorder and delusion proneness was associated with higher gambling-related cognition scores. The findings confirm previous evidence supporting an association between pathological gambling and greater endorsement of erroneous gambling-related cognitions. Alcohol misuse and delusion proneness may be factors that strengthen this association. By clarifying links between dysfunctional beliefs, Axis I and II psychiatric disorders, substance use and pathological gambling, and suggesting new directions for research and practice, the thesis potentially contributes to better research and outcomes for problem gamblers, clinicians, families and communities.