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This is a review of the literature on pathological gambling prepared for the work group on disorders of impulse control, not elsewhere classified of the American Psychiatric Association. It introduces the new DSM-IV criteria as well as outlines the phases of the career of the pathological gambler. Research discussed includes that on pathological gambling and psychiatric disorders, substance abuse, family issues, children, finances, and crime. Psychoanalytic, personality, behavioral, sociological, psychologically based addiction theories, and physiological research are also summarized. Finally, treatment outcome studies are outlined.

Prior studies have reported an association between the presence of the 7 repeat allele of the 48 bp repeat polymorphism of the third cytoplasmic loop of the dopamine D4 receptor gene (DRD4) and novelty seeking behaviors, attention deficit hyperactivity disorder (ADHD), Tourette syndrome (TS), pathological gambling, and substance abuse. However, other studies have failed to replicate some of these observations. To determine whether we could replicate these associations we genotyped 737 individuals from four different groups of control subjects, and 707 index subjects from four different groups of impulsive, compulsive addictive behaviors including substance abuse, pathological gambling, TS, and ADHD. Chi-square analysis of those carrying the 7 allele versus non-7 allele carriers was not significant for any of the groups using a Bonferroni corrected alpha of.0125. However, chi-square analysis of those carrying any 5 to 8 allele versus noncarriers was significant for pathological gambling (p <.0001), ADHD (p

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A broad spectrum of pathological gamblers (N = 222) were queried with regard to physical symptoms when attempting to slow down or stop gambling. Results were compared with a control group of substance‐dependent patients who gambled at least casually. Sixty‐five percent of the pathological gamblers (vs. only 2% of controls) experienced at least one of the following: insomnia (50%), headaches (36%), upset stomach or diarrhea (34%), loss of appetite (29%), physical weakness (27%), heart racing or palpitations (26%), shaking (19%), muscle aches or cramps (17%), difficulty breathing (13%), sweating (12%), and chills or fever (6.5%). In addition, 91% experienced “cravings'and 87% felt “restless and irritable'when attempting to cut down or stop gambling. Contrary to expectations, none of the symptoms correlated with gender, type of gambling, extent of alcohol or drug use while gambling, or self‐described alcoholism or drug addiction. Symptoms did correlate with number of hours spent gambling, severity of the problem as measured by proposed DSM‐IV criteria, and presence of dissociation.

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