Psychological Medicine

Original Articles

DSM-IV pathological gambling in the National Comorbidity Survey Replication

R. C. Kesslera1 c1, I. Hwanga1, R. LaBriea2, M. Petukhovaa1, N. A. Sampsona1, K. C. Wintersa3 and H. J. Shaffera2

a1 Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

a2 Division on Addictions, Cambridge Health Alliance and Harvard Medical School, Boston, MA, USA

a3 Department of Psychiatry, University of Minnesota, MN, USA


Background Little is known about the prevalence or correlates of DSM-IV pathological gambling (PG).

Method Data from the US National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey, were used to assess lifetime gambling symptoms and PG along with other DSM-IV disorders. Age of onset (AOO) of each lifetime disorder was assessed retrospectively. AOO reports were used to study associations between temporally primary disorders and the subsequent risk of secondary disorders.

Results Most respondents (78.4%) reported lifetime gambling. Lifetime problem gambling (at least one Criterion A symptom of PG) (2.3%) and PG (0.6%) were much less common. PG was significantly associated with being young, male, and Non-Hispanic Black. People with PG reported first gambling significantly earlier than non-problem gamblers (mean age 16.7 v. 23.9 years, z=12.7, p<0.001), with gambling problems typically beginning during the mid-20s and persisting for an average of 9.4 years. During this time the largest annual gambling losses averaged US$4800. Onset and persistence of PG were predicted by a variety of prior DSM-IV anxiety, mood, impulse-control and substance use disorders. PG also predicted the subsequent onset of generalized anxiety disorder, post-traumatic stress disorder (PTSD) and substance dependence. Although none of the NCS-R respondents with PG ever received treatment for gambling problems, 49.0% were treated at some time for other mental disorders.

Conclusions DSM-IV PG is a comparatively rare, seriously impairing, and undertreated disorder whose symptoms typically start during early adulthood and is frequently secondary to other mental or substance disorders that are associated with both PG onset and persistence.

(Received August 02 2007)

(Revised January 11 2008)

(Accepted January 14 2008)

(Online publication February 07 2008)


c1 Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: