American Psychiatric Association to operationally define the disorder. The definition includes 10 criteria, which describe both the individual attributes of sufferers and the social consequences that result from their behavior. Also described are associated features and disorders, specific culture and gender features, prevalence, course, familial pattern, differential diagnosis, and exclusion criteria. As such, the criteria are intended to provide guidance for clinically diagnosing pathological gambling as a disorder of impulse control. To be diagnosed as a pathological gambler, an individual must meet at least five criteria (Bradford et al., 1996; Lesieur and Rosenthal, 1998). For the criteria and full text of the DSM-IV definition, see Appendix B.
The 10 criteria that resulted from this process represent three clusters or dimensions: damage or disruption, loss of control, and dependence. In the category of dependence are tolerance (needs to gamble with increasing amounts of money in order to achieve desired excitement), withdrawal (restless or irritable when attempting to cut down or stop), preoccupation with gambling, and gambling as a way to escape from problems. The wording and selection of items and the diagnostic cut-off point of five or more were based on clinical data; a partial exclusion criterion was then added: "The gambling behavior is not better accounted for by a Manic Episode." Although somewhat controversial, this exclusion was added because excessive gambling may result when a patient is experiencing acute mania, without the disorder itself being present (American Psychiatric Association, 1994).
The current description of pathological gambling in DSM-IV has been found to characterize pathological gambling in relatively precise operational terms; to provide the basis for measures that are reliable, replicable, and sensitive to regional and local variation; to distinguish gambling behavior from other impulse disorders; and to suggest the utility of applying specific types of clinical treatments (Shaffer et al., 1994). Moreover, the DSM-IV criteria appear to have worked well for clinicians for the past five years. However, because it is a clinical description with little empirical support beyond treatment populations, there still are problems with its use to define the nature and origins of pathological gambling, and when trying to estimate prevalence.