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Tabri N, Salmon MM, Wohl MJA. Advancing the Pathways Model: Financially Focused Self-concept and Erroneous Beliefs as Core Psychopathologies in Disordered Gambling. J Gambl Stud 2023; 39:13-31. [PMID: 35061165 DOI: 10.1007/s10899-022-10105-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 12/15/2022]
Abstract
In the Pathways Model, there are three distinct etiological subtypes of disordered gambling (Behaviourally Conditioned, Emotionally Vulnerable, and Anti-Social Impulsive Risk-Taker). The Pathways Model also posits that erroneous gambling beliefs are a maintenance factor of disordered gambling across the subtypes. Yet, etiological factors and erroneous beliefs have largely been examined separately when determining disordered gambling subtype. Moreover, there may be heretofore unexamined maintenance factors that span the disordered gambling subtypes. In the current research, we addressed this gap by using latent profile analyses to assess the role both erroneous beliefs and financially focused self-concept (a novel maintenance factor) play in the determination of disordered gambling subtype. In Study 1, community members with gambling problems (n = 215) completed the Gambling Pathways Questionnaire and Financially Focused Self-Concept Scale. In Study 2 (n = 290), participants also completed the Gambling Beliefs Questionnaire. Results from both studies revealed three profiles that coincide with the subtypes in the Pathways Model as providing the best fit to the data. The three profiles were largely distinguished by low, medium, or high scores on the etiological factors, which is consistent with the disordered gambling subtypes being on different parts of the same continuum of psychopathology severity. Financial focus (Studies 1 and 2) and erroneous gambling beliefs (Study 2) were elevated across the three profiles, and both were higher among profiles with more severe psychopathology. Findings support a dimensional understanding of gambling disorder psychopathology and suggest that a financially focused self-concept may be a maintenance factor of disordered gambling.
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Affiliation(s)
- Nassim Tabri
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
- Mental Health and Well-Being Research and Training Hub, Carleton University, Ottawa, ON, Canada.
| | - Melissa M Salmon
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Michael J A Wohl
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
- Mental Health and Well-Being Research and Training Hub, Carleton University, Ottawa, ON, Canada
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Kurilla A. Is Subtyping of Gamblers Based on the Pathways Model of Problem and Disordered Gambling Valid? A Systematic Review. J Gambl Stud 2021; 37:983-1006. [PMID: 33386516 DOI: 10.1007/s10899-020-09995-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 02/07/2023]
Abstract
Gamblers are a heterogenous group in terms of the presence of comorbid psychopathology, maladaptive personality traits, and motivation to gamble. The Pathways Model, the most promising comprehensive framework to explain this heterogeneity, classifies gamblers into three subtypes. The aim of this review was to determine whether or not subtyping of gamblers based on the Pathways Model of problem and disordered gambling is valid. A literature review was conducted using the following online databases: Academic Search Complete, PubMed, Web of Science, and PsychINFO. Studies were selected or excluded based on meeting predetermined criteria. Fourteen studies examining subtyping of gamblers based on the Pathways Model were reviewed and evaluated. Results suggest that in the adult population there are three subtypes of gamblers that largely coincide with the subtypes defined in the Pathways Model. Of these, the emotionally vulnerable subtype is the most problematic and inconsistent. In contrast, for adolescents, at least four gambler subtypes have been identified. The extant literature on subtyping of gamblers suffers from some severe limitations. Further research is required to fully validate the Pathways Model.
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Affiliation(s)
- Adam Kurilla
- Psychology Department, College of Humanities and Sciences, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284-2018, USA.
- Center for Treatment of Drug Dependencies, Hranicna 2, 821 05, Bratislava, Slovak Republic.
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Abstract
This study examined whether distinct subgroups could be identified among a sample of non-treatment-seeking problem and pathological/disordered gamblers (PG) using Blaszczynski and Nower's (Addiction 97:487-499, 2002) pathways model (N = 150, 50% female). We examined coping motives for gambling, childhood trauma, boredom proneness, risk-taking, impulsivity, attention-deficit/hyperactivity disorder (ADHD), and antisocial personality disorder as defining variables in a hierarchical cluster analysis to identify subgroups. Subgroup differences in gambling, psychiatric, and demographic variables were also assessed to establish concurrent validity. Consistent with the pathways model, our analyses identified three gambling subgroups: (1) behaviorally conditioned (BC), (2) emotionally vulnerable (EV), and (3) antisocial-impulsivist (AI) gamblers. BC gamblers (n = 47) reported the lowest levels of lifetime depression, anxiety, gambling severity, and interest in problem gambling treatment. EV gamblers (n = 53) reported the highest levels of childhood trauma, motivation to gamble to cope with negative emotions, gambling-related suicidal ideation, and family history of gambling problems. AI gamblers (n = 50) reported the highest levels of antisocial personality disorder and ADHD symptoms, as well as higher rates of impulsivity and risk-taking than EV gamblers. The findings provide evidence for the validity of the pathways model as a framework for conceptualizing PG subtypes in a non-treatment-seeking sample, and underscore the importance of tailoring treatment approaches to meet the respective clinical needs of these subtypes.
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Maremmani AGI, Gazzarrini D, Fiorin A, Cingano V, Bellio G, Perugi G, Maremmani I. Psychopathology of addiction: Can the SCL90-based five-dimensional structure differentiate Heroin Use Disorder from a non-substance-related addictive disorder such as Gambling Disorder? Ann Gen Psychiatry 2018; 17:3. [PMID: 29371875 PMCID: PMC5769351 DOI: 10.1186/s12991-018-0173-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the Gambling Disorder (GD), there is no exogenous drug administration that acts as the central core of the traditional meaning of addiction. A specific psychopathology of Substance Use Disorders has been proposed recently. In a sample of Heroin Use Disorder (HUD) patients entering opioid agonist treatment, it became possible to identify a group of 5 mutually exclusive psychiatric dimensions: Worthlessness-Being trapped (W-BT), Somatic Symptoms (SS), Sensitivity-Psychoticism (SP), Panic Anxiety (PA) and Violence-Suicide (VS). The specificity of these dimensions was suggested by the absence of their correlations with treatment choice, active substance use, psychiatric comorbidity and the principal substance of abuse and by the opportunity, through their use, of fully discriminating HUD from Major Depression patients and, partially, from obese non-psychiatric patients. To further support this specificity in the present study, we tested the feasibility of discriminating HUD patients from those affected by a non-substance-related addictive behaviour, such as GD. In this way, we also investigated the psychopathological peculiarities of GD patients. METHODS We compared the severity and frequency of each of the five aspects found by us, in 972 (83.5% males; mean age 30.12 ± 6.6) HUD and 110 (50% males; average age 30.12 ± 6.6) GD patients at univariate (T test; Chi square) and multivariate (discriminant analysis and logistic regression) level. RESULTS HUD patients showed higher general psychopathology indexes than GD patients. The severity of all five psychopathological dimensions was significantly greater in HUD patients. Discriminant analysis revealed that SS and VS severity were able to discriminate between HUD (higher severity) and GD patients (lower severity), whereas PA and SP could not. W-BT severity was negatively correlated with SS and VS; GD patients were distinguished by low scores for SS and VS low scores associated with high ones for W-BT. Psychopathological subtypes characterized by SS and VS symptomatology were better represented in HUD patients, whereas PA symptomatology was more frequent in GD individuals. No differences were observed regarding the W-BT and SP dimensions. At multivariate level, the one prominent characteristic of HUD patients was the presence of SS (OR = 5.43) as a prominent qualification for psychopathological status. CONCLUSIONS Apart from the lower severity of all psychopathological dimensions, only the lower frequency of SS typology seems to be the prominent factor in GD patients. The SCL90-defined structure of opioid addiction seems to be useful even in non-substance-related addictive disorders, as in the case of GD patients, further supporting the possible existence of a psychopathology specific to addiction.
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Affiliation(s)
- Angelo G I Maremmani
- Department of Psychiatry, North-Western Tuscany Region Local Health Unit, Versilian Zone, Viareggio, Italy.,Association for the Application of Neuroscientific Knowledge To Social Aims (AU-CNS), Pietrasanta, Italy.,G. De Lisio Institute of Behavioural Sciences, Pisa, Italy
| | | | - Amelia Fiorin
- Drug Addiction Unit, Castelfranco Veneto, Treviso, Italy
| | | | | | - Giulio Perugi
- G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.,5Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Icro Maremmani
- Association for the Application of Neuroscientific Knowledge To Social Aims (AU-CNS), Pietrasanta, Italy.,G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.,6Vincent P. Dole Dual Diagnosis Unit, Department of Specialty Medicine, Santa Chiara University Hospital, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
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Bonnaire C, Bungener C, Varescon I. Sensation seeking in a community sample of French gamblers: Comparison between strategic and non-strategic gamblers. Psychiatry Res 2017; 250:1-9. [PMID: 28135641 DOI: 10.1016/j.psychres.2017.01.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/21/2017] [Accepted: 01/21/2017] [Indexed: 11/27/2022]
Abstract
The purpose of this research is to examine the relationship between sensation seeking and gambling disorder (GD) in a community sample of gamblers (when controlling for the effect of substance use, gender and age) and see whether sensation seeking scores depend on the gambling activity when comparing strategic and non-strategic gamblers. A total of 380 gamblers was recruited. First, pathological gamblers (PGs) (n =143) were compared to non-pathological gamblers (NPGs) (n =237). Second, strategic gamblers (n =93) were compared to non-strategic gamblers (n =110). Sociodemographic data, gambling behavior (SOGS, DSM-IV), tobacco and alcohol use (CAGE), and sensation seeking (SSS) were evaluated. PGs have higher boredom susceptibility scores than NPGs and this factor is associated with GD. Nevertheless, the relationship between sensation seeking and GD depends on the gambling activity. In fact, sensation seeking is associated with GD in strategic gamblers only. PGs playing strategic games display different profiles from non-strategic PGs. Thus, factors associated with GD differ when the gambling activity is taken into account. These findings are consistent with the idea of it being essential to identify clinically distinct subgroups of PGs in the treatment of GD.
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Affiliation(s)
- Céline Bonnaire
- Paris Descartes University, Laboratory of Psychopathology and Health Processes, Sorbonne Paris Cité, France.
| | - Catherine Bungener
- Paris Descartes University, Laboratory of Psychopathology and Health Processes, Sorbonne Paris Cité, France.
| | - Isabelle Varescon
- Paris Descartes University, Laboratory of Psychopathology and Health Processes, Sorbonne Paris Cité, France.
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Abstract
As most research concerning gambling and depression has been conducted on clinical populations, the present study examined the relationship between gambling and depression across a large sample in Scotland in higher education and the community. A questionnaire-based cluster design involved the distribution of the South Oaks Gambling Screen and the Centre for Epidemiologic Studies Depression Scale mainly to students and staff of higher educational establishments, with small community and gambling samples also included. Thirty-seven colleges and universities across Scotland participated in the research, with a sample of 2,259 people aged sixteen years of age or over ( M = 28.9 yr., SD = 13.4) being obtained. It was found that past-year probable pathological gamblers had significantly higher depression than problem gamblers, nonproblem gamblers, and nongamblers. However, when probable pathological gamblers who had sought treatment were omitted from the analysis, the nontreatment-seeking probable pathological gambling group no longer had significantly higher depression than the problem gambling group. Female problem and probable pathological gamblers had particularly high depressive symptomatology, suggesting comorbid depression may be a prominent feature of problematic female gambling.
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Affiliation(s)
- Crawford Moodie
- Department of Psychology, Glasgow Caledonian University, Cowcaddens Rd., Glasgow G4 OBA, Scotland.
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Lobo D, Quilty L, Martins S, Tavares H, Vallada H, Kennedy J, Bagby R. Pathological gambling subtypes: A comparison of treatment-seeking and non-treatment-seeking samples from Brazil and Canada. Addict Behav 2014; 39:1172-5. [PMID: 24727115 DOI: 10.1016/j.addbeh.2014.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 02/07/2014] [Accepted: 03/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pathological gambling (PG) is a heterogeneous disorder. The identification and characterization of PG subtypes could lead to tailored treatment approaches, which may, in turn, improve treatment outcomes. OBJECTIVE To investigate PG subtypes based on personality traits across two different cultural and clinical settings. Consistent with the Pathways Model, we hypothesized the presence of three subtypes (behaviorally conditioned - BC, emotionally vulnerable - EV, and antisocial impulsivist - AI). METHODS 140 PG adults from São Paulo, Brazil (SP sample) and 352 adults with PG (n=214) or sub-clinical PG (n=138) from Toronto, Canada (TO sample) completed the Temperament and Character Inventory (TCI). Latent-class analysis was used to investigate subtypes. RESULTS A 2-class solution was the best model for the pooled SP and TO samples. Class 1 presented a normative personality profile and was composed exclusively of participants from Toronto (BC subtype). Class 2 was characterized by high novelty seeking, high harm avoidance, and low self-directedness, and included participants from both SP and TO (EV subtype). When sub-clinical PGs were excluded from the analysis, a single-class solution better characterized the SP and TO samples. CONCLUSIONS Our results suggest that PG severity, rather than community or clinical settings, may have an effect on PG subtypes. The generalizability of the results is limited by the demographic and clinical features of the selected samples. Future neurobiological studies may contribute to the categorization of subjects into PG subtypes based on different underlying biological pathways.
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Gupta R, Nower L, Derevensky JL, Blaszczynski A, Faregh N, Temcheff C. Problem gambling in adolescents: an examination of the pathways model. J Gambl Stud 2014; 29:575-88. [PMID: 22695971 DOI: 10.1007/s10899-012-9322-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This research tests the applicability of the Integrated Pathways Model for gambling to adolescent problem gamblers, utilizing a cross-sectional design and self-report questionnaires. Although the overall sample consisted of 1,133 adolescents (Quebec: n = 994, 87.7 %; Ontario: n = 139, 12.3 %: Male = 558, 49.5 %; Female = 569, 50.5 %), only problem gamblers were retained in testing the model (N = 109). Personality and clinical features were assessed using the Millon Adolescent Clinical Inventory, attention deficit hyperactivity (ADHD) using the Conners-Wells' Adolescent Self-Report Scale, and the DSM-IV-MR-J and Gambling Activities Questionnaire to determine gambling severity and reasons for gambling. Latent class analysis concluded 5 classes, yet still provided preliminary support for three distinct subgroups similar to those proposed by the Pathways Model, adding a depression only subtype, and a subtype of problem gamblers experiencing both internalizing and externalizing disorders. ADHD symptoms were found to be common to 4 of the 5 classes.
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Affiliation(s)
- Rina Gupta
- International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University, Montreal, QC, Canada.
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Estevez A, Herrero-Fernández D, Sarabia I, Jauregui P. The Impulsivity and Sensation-Seeking Mediators of the Psychological Consequences of Pathological Gambling in Adolescence. J Gambl Stud 2013; 31:91-103. [DOI: 10.1007/s10899-013-9419-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nower L, Martins SS, Lin KH, Blanco C. Subtypes of disordered gamblers: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addiction 2013; 108:789-98. [PMID: 23072599 PMCID: PMC3961704 DOI: 10.1111/add.12012] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 11/28/2011] [Accepted: 10/01/2012] [Indexed: 02/01/2023]
Abstract
AIMS To derive empirical subtypes of problem gamblers based on etiological and clinical characteristics described in the Pathways Model, using data from a nationally representative survey of US adults. DESIGN & MEASUREMENT: Data were collected from structured diagnostic face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV). SETTING The study utilized data from US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). PARTICIPANTS All disordered gambling participants (n = 581) from a nationally representative cross-sectional sample of civilian non-institutionalized adults aged 18 years or older. FINDINGS Latent class analyses indicated that the best-fitting model was a three-class solution. Those in the largest class (class 1: 50.76%, n = 295) reported the lowest overall levels of psychopathology including gambling problem severity and mood disorders. In contrast, respondents in class 2 (20.06%, n = 117) had a high probability of endorsing past-year substance use disorders, moderate probabilities of having parents with alcohol/drug problems and of having a personality disorder, and the highest probability for past-year mood disorders. Respondents in class 3 (29.18%, n = 169) had the highest probabilities of personality and prior-to-past year mood disorders, substance use disorders, separation/divorce, drinking-related physical fights and parents with alcohol/drug problems and/or a history of antisocial personality disorder (ASPD). CONCLUSIONS Three subtypes of disordered gamblers can be identified, roughly corresponding to the subtypes of the Pathways Model, ranging from a subgroup with low levels of gambling severity and psychopathology to one with high levels of gambling problem severity and comorbid psychiatric disorders.
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Affiliation(s)
- Lia Nower
- Center for Gambling Studies, Rutgers University, New Brunswick, NJ 08901, USA.
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Alvarez-Moya EM, Jiménez-Murcia S, Aymamí MN, Gómez-Peña M, Granero R, Santamaría J, Menchón JM, Fernández-Aranda F. Subtyping study of a pathological gamblers sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:498-506. [PMID: 20723277 DOI: 10.1177/070674371005500804] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To classify into subgroups a sample of pathological gambling (PG) patients according to personality variables and to describe the subgroups at a clinical level. METHOD PG patients (n = 1171) were assessed with the South Oaks Gambling Screen; the Temperament and Character Inventory-Revised; the Symptom Checklist-90-Revised; Eysenck's Impulsivity Scales, a diagnostic questionnaire for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) PG criteria; and the Structured Clinical Interview for the DSM-IV, Axis I disorders, substance use module. Clinical measures were collected through a semi-structured interview. We performed a 2-step cluster analysis based on the above-mentioned personality variables. Clinical data were compared across clusters. RESULTS Four clusters were generated. Type I (disorganized and emotionally unstable) showed schizotypic traits, high impulsiveness, substance and alcohol abuse, and early age of onset, as well as psychopathological disturbances. Type II (schizoid) showed high harm avoidance, social aloofness, and alcohol abuse. Type III (reward sensitive) showed high sensation seeking and impulsiveness but no psychopathological impairments. Type IV (high-functioning) showed a globally adaptive personality profile, low level of substance and alcohol abuse or smoking, and no psychopathological disturbances. CONCLUSIONS At least 4 types of PG patients may be identified. Two types showed a response modulation deficit, but only one of them had severe psychopathological disturbances. Two other types showed no impulsiveness or sensation seeking and one of them even exhibited good general functioning. The different personality and clinical configuration of these clusters might be linked to different therapeutic approaches.
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Affiliation(s)
- Eva Ma Alvarez-Moya
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
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Subtypes of French Pathological Gamblers: Comparison of Sensation Seeking, Alexithymia and Depression Scores. J Gambl Stud 2009; 25:455-71. [DOI: 10.1007/s10899-009-9142-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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González-Ibáñez A, Mora M, Gutiérrez-Maldonado J, Ariza A, Lourido-Ferreira MR. Pathological gambling and age: differences in personality, psychopathology, and response to treatment variables. Addict Behav 2005; 30:383-8. [PMID: 15621411 DOI: 10.1016/j.addbeh.2004.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to ascertain the possible differences in personality, psychopathology, and response to treatment in pathological gambling according to age. The sample, comprising 67 participants, was divided into three groups: 32.6% with ages ranging between 17 and 26 years, 31.3% between 27 and 43 years, and 35.8% over 44 years of age. The participants were administered the following tests, Minnesota Multiphasic Personality Inventory [MMPI; Hathaway, S.R. & McKinley, J.C. (1943, 1961). Cuestionario de personalidad MMPI. Madrid Seccion de Estudios de TEA ed. 1970, 1975], sensation-seeking questionnaire [SSS; Zuckerman, M. (1979). Sensation seeking; beyond the optimal level of arousal. Hillsdale, NJ: Lawrence Erlbaum Associates], and the Symptom Check List Revised [SCL-90-R; Derogatis, L.R. (1977). Symptom check list-90 revised. Administration scoring and procedures manual. Baltimore]. All underwent a group treatment programme that was carried out in the Pathological Gambling Unit at Ciutat Sanitaria i Universitaria de Bellvitge (CSUB), Teaching hospital, Barcelona, Spain. The findings show differences depending on age in the participants' personality and in psychopathology and in their response to treatment.
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Affiliation(s)
- A González-Ibáñez
- Pathological Gambling Unit, Ciutat Sanitària i Universitària de Bellvitge, (CSUB)-Teaching Hospital, Feixa Llarga s/n 08907 L'Hospitalet, Barcelona, Spain.
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