title: Comorbidity, family history and personality traits in pathological gamblers compared with healthy controls.
abstract: While DSM-5 classified pathological gambling as an addictive disorder, there is debate as to whether ICD-11 should follow suit. The debate hinges on scientific evidence such as neurobiological findings, family history of psychiatric disorders, psychiatric comorbidity, and personality variables.
  
  
  
  In the "Baden-Württemberg Study of Pathological Gambling", we compared a group of 515 male pathological gamblers receiving treatment with 269 matched healthy controls. We studied differences in sociodemographic characteristics, gambling-related variables, psychiatric comorbidity (lifetime), family history of psychiatric conditions, as well as personality traits such as impulsivity (Barratt Impulsiveness Scale), sensation seeking (Zuckerman's Sensation Seeking Scale) and the NEO-FFI big five. Personality traits were validated in an age- and ethnicity-matched subsample of "pure" gamblers without any psychiatric comorbidity (including nicotine dependence). Data were analyzed using two-sample t-tests, Chi2analyses, Fisher's exact test and Pearson correlation analysis, as appropriate. Bonferroni correction was applied to correct for multiple comparisons.
  
  
  
  Only 1% of the gamblers had been diagnosed with an impulse control disorder other than gambling (ICD-10). Notably, 88% of the gamblers in our sample had a comorbid diagnosis of substance dependence. The highest axis I comorbidity rate was for nicotine dependence (80%), followed by alcohol dependence (28%). Early age of first gambling experience was correlated with gambling severity. Compared to first-degree relatives of controls, first-degree relatives of pathological gamblers were more likely to suffer from alcohol dependence (27.0% vs. 7.4%), pathological gambling (8.3% vs. 0.7%) and suicide attempts (2.7% vs. 0.4%). Significant group differences were observed for the NEO-FFI factors neuroticism, agreeableness and conscientiousness. Gamblers were also more impulsive than controls, but did not differ from controls in terms of sensation seeking.
  
  
  
  Our findings support classifying pathological gambling as a behavioural addiction in the ICD-11. This decision will have a significant impact on the approaches available for prevention (e.g. age limits) and treatment.
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Mann
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lemenager
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Zois
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hoffmann
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Nakovics
authors.affiliation: Kraichtal-Kliniken Am Mühlberg, Kraichtal 76703, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Beutel
authors.affiliation: AHG Klinik Münchwies, Neunkirchen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Vogelgesang
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Wölfling
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Kiefer
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. Electronic address: mira.fauth-buehler@zi-mannheim.de.
authors.forename: M
authors.initials: M
authors.lastname: Fauth-Bühler
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology; D016739:Behavior, Addictive / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D005190:Family / Q000523:psychology*; D005260:Female; D005715:Gambling / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D008875:Middle Aged; D010551:Personality; D010554:Personality Disorders / Q000453:epidemiology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology
keywords: Comorbidity; Family history; Pathological gambling; Personality traits; Treatment-seeking pathological gamblers