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 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 317-320

Neuropsychopathology of gambling disorder

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy

Date of Submission01-Jun-2021
Date of Acceptance27-Jul-2021
Date of Web Publication03-Sep-2021

Correspondence Address:
Dr. Chidiebere Emmanuel Okechukwu
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mgmj.mgmj_32_21

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Gambling disorder (GD) is characterized by a pattern of continual or persistent gambling behavior, which may be online or offline, demonstrated by impaired control over gambling (e.g., inception, rate, passion, duration, cessation, and perspective). GD entails growing precedence given to gambling activities to the point that gambling takes priority over other daily activities and continuation and intensification of gambling despite the rate of negative consequences. The pattern of gambling behavior may be constant or episodic and recurrent. With regard to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, gambling behavior and associated characteristics are usually apparent over at least 12 months for a diagnosis to be assigned, although the required period may be reduced if all the diagnostic criteria are met and the symptoms are severe.

Keywords: Addiction, behavior disorders, gambling, mood disorder, pathological

How to cite this article:
Okechukwu CE. Neuropsychopathology of gambling disorder. MGM J Med Sci 2021;8:317-20

How to cite this URL:
Okechukwu CE. Neuropsychopathology of gambling disorder. MGM J Med Sci [serial online] 2021 [cited 2022 Jan 25];8:317-20. Available from: http://www.mgmjms.com/text.asp?2021/8/3/317/325540

  Background Top

Addiction alters the brain’s reward system. Neurons situated in the brain’s reward system adapt to the modification of epigenetic mechanisms, which increases over time because of the higher levels of exposure to an addictive stimulus [Figure 1]. Gambling disorder (GD) is a behavioral addiction that can impair an individual’s physical and mental well-being.[1] GD is characterized by persistent and recurrent problematic gambling behavior, leading to clinically significant impairment or distress. Gambling can increase during periods of stress or depression and during periods of substance use or abstinence. Emotional signs of GD are anxiousness, sadness and depression, suicide ideation, suicide attempts, and hopelessness. In contrast, the physical signs of GD are insomnia, weight loss or gain, and lack of personal hygiene. GD is associated with tachycardia, angina, and increases in cortisol levels because of stress. With regard to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (section 312.31), an individual must exhibit at least four or more of the nine diagnostic criteria in the 12 months to confirm GD [Table 1]. The required duration may be reduced if all the diagnostic criteria are met and symptoms are severe. Cognitive-behavioral therapy is the benchmark for the management of GD.[2]
Figure 1: Pathways of addiction (Source: https://www.nationalgeographic.com/magazine/issue/september-2017, Copyright© 2015–2021 National Geographic Partners, LLC. All rights reserved)

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Table 1: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Criteria for GD

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Psychiatric consequences of GD

GD is associated with increased occurrence rates of suicidal thoughts and behavior. GD often co-occurs with substance use disorders and this manifests as diminished control over substance use, obsession with substance use, and compulsive gambling and substance abuse, despite the negative consequences.[3] Most individuals with GD met the diagnostic criteria for at least one or more behavioral disorders, mood disorders, alcohol use disorders, and drug use disorders.[3] Patients with GD frequently report having repeatedly intensifying intervals of tension depicting impulsivity before gambling, and this tension is mostly eased when they gamble. Issues associated with GD are majorly characterized by instant satisfaction while playing and adverse psychological consequences over a longer period.

Neurobiology of GD

The ventral striatum has been characterized as the brain reward center, and it is involved in reward processing. The prefrontal cortex, which is involved in decision making, control of impulses, and cognitive function, is associated with GD.[4] Numerous studies have demonstrated that patients with GD showed less activation of the prefrontal cortex in response to gambling-related cues. Patients with GD usually find it difficult to control their impulses because of the decreased activation of the prefrontal cortex.[5] Both behavioral addiction and substance use disorders operate via the mesolimbic pathway in the brain.[3]

Neuroimaging and clinical outcomes

Outcomes of a neuroimaging investigation showed that the brain regions involved in GD are mostly the anterior cingulate, the orbitofrontal cortex, and the midbrain reward circuitry, and they are also involved in substance use disorders, which means that there are higher chances of comorbidity.[6]

Neurochemistry and clinical outcomes

Findings from neurochemical studies showed fluctuations in dopamine and norepinephrine levels among patients with GD.[7] The concentrations of dopamine were lower in cerebrospinal fluid among individuals with GD when compared with the controls.[7] Moreover, greater levels of dopamine release in the ventral striatum are associated with higher individual excitement and gambling severity. There was an increase in noradrenergic activities among patients with GD while gambling, demonstrating that norepinephrine is associated with the urge to gamble.[8]

Neuropsychiatric effects of GD

Chronic sleep deprivation is a common symptom of GD, which is developed over time because of 24-h gambling online on virtual games such as poker, without feeling the need to sleep.[9] The negative impact of chronic sleep deficiency on mental wellbeing includes motor and cognitive impairment, depression, and mood swings.[8] Gambling addiction initiates or worsens symptoms of depression and anxiety. Mood disorders are frequently diagnosed among patients with GD with high comorbidity rates of unipolar and bipolar depression.[10]

  Conclusion Top

When the brain adjusts to the long-term influences of gambling activities, sequential changes occur in the brain regions associated with reward, memory, and emotion, decision-making, and stress regulation, thereby leading to impaired control over gambling cues and mental distress, which can be diagnosed as GD after the appropriate diagnostic criteria are met.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Potenza MN, Balodis IM, Derevensky J, Grant JE, Petry NM, Verdejo-Garcia A, et al. Gambling disorder. Nat Rev Dis Primers 2019; 5:51.  Back to cited text no. 1
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth Ed.). Arlington, VA: American Psychiatric Publishing. 2013.  Back to cited text no. 2
Rash CJ, Weinstock J, Van Patten R. A review of gambling disorder and substance use disorders. Subst Abuse Rehabil 2016;7: 3-13.  Back to cited text no. 3
Antons S, Brand M, Potenza MN. Neurobiology of cue-reactivity, craving, and inhibitory control in non-substance addictive behaviors. J Neurol Sci 2020;415:116952.  Back to cited text no. 4
Tanabe J, Thompson L, Claus E, Dalwani M, Hutchison K, Banich MT. Prefrontal cortex activity is reduced in gambling and nongambling substance users during decision-making. Hum Brain Mapp 2007;28:1276-86.  Back to cited text no. 5
Hartstra E, Oldenburg JF, Van Leijenhorst L, Rombouts SA, Crone EA. Brain regions involved in the learning and application of reward rules in a two-deck gambling task. Neuropsychologia 2010;48:1438-46.  Back to cited text no. 6
Bergh C, Eklund T, Södersten P, Nordin C. Altered dopamine function in pathological gambling. Psychol Med 1997;27:473-5.  Back to cited text no. 7
Meyer G, Schwertfeger J, Exton MS, Janssen OE, Knapp W, Stadler MA, et al. Neuroendocrine response to casino gambling in problem gamblers. Psychoneuroendocrinology 2004;29:1272-80.  Back to cited text no. 8
Hamel A, Bastien C, Jacques C, Moreau A, Giroux I. Sleep or play online poker?: Gambling behaviors and tilt symptoms while sleep deprived. Front Psychiatry 2020;11:600092.  Back to cited text no. 9
Kim SW, Grant JE, Eckert ED, Faris PL, Hartman BK. Pathological gambling and mood disorders: Clinical associations and treatment implications. J Affect Disord 2006;92:109-16.  Back to cited text no. 10


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