Gambling disorder as a clinical phenomenon

Abstract

The exact origins of gambling have faded into obscurity but its presence dates back to antiquity. Archaeological findings offer evidence of games of chance played circa 4000 years BC, with many forms laying the foundation for subsequent gambling where items of values were exchanged on the outcome of chance events. Societal acceptance of gambling has fluctuated from extremes of widespread indulgence to attempted suppression, the latter in response to the social and economic impacts of excessive gambling. In the early 1900s, psychological theories were applied in an attempt to explain excessive gambling and operationally define the condition as a clinical disorder. The inclusion of ‘pathological gambling’ within ICD-9 in 1975 and DSM-III in 1980 consolidated the clinical status of the disorder, but debate on symptomatology and its classification as an impulse control or addictive behaviour remains. Although traditionally the focus has been directed predominately towards establishing diagnostic criteria and developing instruments to measure prevalence rates, contemporary efforts are turning their attention to assessing gambling-related harms across the full spectrum of gambling behaviours. This is reflected in the growing use of the term ‘problem gambling’ to refer to gambling behaviour that is resulting in harm and is consistent with a wider public health harm minimization approach that complements the clinical management of gambling disorders.