Effects of Gambling Diagnostic Criteria Changes from DSM-IV to DSM-5 on Mental Disorder Comorbidity Across Younger, Middle-Aged, and Older Adults in a Nationally Representative Sample

  • Ryan Nicholson
  • Corey Mackenzie
  • Tracie O. Afifi
  • Jitender Sareen
Original Paper


Changes in Diagnostic and Statistical Manual (DSM) criteria for a gambling disorder from DSM-IV to DSM-5 included a drop in the minimum number of criteria required to qualify for a diagnosis. This threshold reduction resulted in a near doubling of prevalence in non-gambling focused populations. However, the impact of this change on psychiatric comorbidity with gambling is unknown. The current study aimed to: (a) examine whether the diagnostic change affected the severity of those diagnosed with a gambling disorder with respect to mental disorder comorbidity, and (b) determine whether this relationship differed across younger (18–34 years old), middle-aged (35–54 years old), and older (55 years old and over) age groups. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions. Results indicated that the prevalence of comorbid mental health/substance use disorders did not significantly change between the DSM-IV pathological gambling group and DSM-5 gambling disorder group in the overall sample. However, among older adults, the DSM-5 gambling disorder were more likely to exhibit any anxiety disorder as well as any comorbid mental health/substance-use disorder compared to the DSM-IV pathological gamblers. No other significant differences were observed in mental health or substance-use disorders within age-specific groupings. Findings suggest that the new, less restrictive DSM-5 criteria for gambling addiction capture older gamblers with more severe clinical presentations in terms of co-occurring mental disorders, contrary to our expectation that the lowered threshold for diagnosis would result in less severe clinical cases.


Disordered gambling DSM Diagnostic Comorbidity Age 



This study was funded by a Manitoba Gambling Research Program Studentship (Nicholson).

Compliance with Ethical Standards

Conflict of interest

Mr. Nicholson declares that he has no conflict of interest. Dr. Mackenzie declares that he has no conflict of interest. Dr. Afifi declares that she has no conflict of interest. Dr. Sareen declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ryan Nicholson
    • 1
  • Corey Mackenzie
    • 1
  • Tracie O. Afifi
    • 2
    • 3
  • Jitender Sareen
    • 1
    • 2
    • 3
  1. 1.Department of PsychologyUniversity of ManitobaWinnipegCanada
  2. 2.Department of Community Health SciencesUniversity of ManitobaWinnipegCanada
  3. 3.Department of PsychiatryUniversity of ManitobaWinnipegCanada

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