DSM IV:
Question 1: Are you preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)?
-Here the word "preoccupied" does not mean the same as "all the time." This term really is best to be thought of as "inappropriate"; for example, thinking about gambling, planning gambling experiences, tracking outcomes, or getting money to gamble or pay off gambling debts while at work, at meals with family/friends, during daily life.
2. Do you need to gamble with increasing amounts of money in order to achieve the desired excitement?
-Some people seem to get over focused on the term "desired excitement" because they are not gambling for excitement. Consideration of the following questions can clarify this one a bit further: Are you gambling with more money than a few years ago? When you win does your wager size tend to increase? Would small bets become boring to you?
3. Have you made repeated unsuccessful efforts to control, cut back, or stop gambling?
-This question is confusing for people that have not ever tried to stop in the past, if this is your situation then you might want to honestly contemplate what it might be like if you did try to stop gambling for an extended period of time, like 6 months or a year, or forever?????
4. Are you restless or irritable when attempting to cut down or stop gambling?
-See number 3, also this might not apply is someone knew that they were only stopping for a short time.
5. Do you gamble as a way of escaping from problems or of relieving feelings of helplessness, guilt, anxiety, or depression?
-Does gambling make you less concerned about the damage it is causing to family, yourself, or finances.
6. After losing money gambling, do you often return another day to get even? Chasing losses is a sign of problem gambling as the disorder develops this is replaced with a feeling that "I can not ever get even so why even try."
7. Do you lie to family members, therapists, or to others to conceal the extent of involvement with gambling?
-This includes ANY behavior that is minimizes the time spent, the dollar amount, or any aspect of the behavior, this also would include attempt to hide the behavior in any manner.
8. Have you committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling?
-This would include check fraud, such as bouncing checks or writing checks that can not be covered if immediately deposited (while the latter is not technically theft if one has overdraft protection, it might be pushing the limits of acceptable banking practices.
9. Have you jeopardized or lost a significant relationship, job or educational or career opportunity because of gambling?
-This can be very difficult to see at first, I have had many clients find new and better jobs after a year or more of not gambling, when they refocus on their lives.
10. Do you rely on others to provide money to relieve a desperate financial situation caused by gambling?
-Essentially this would be any loan from anyone, it could include lending institutions as well.
SCORING KEY:
Scoring the DSM -IV is controversial to some extent , it is published that a person would need 5 or more symptoms to be likely to have a diagnosis of Impulse Control Disorder, however I have spoken with one of the original researchers who developed this and he stated that the research showed that 4 symptoms were more than adequate to differentiate between those who have Pathological Gambling and those who do not, but because this list is controlled by the American Psychiatric Association they insisted on a more strict number (one that would result in fewer false positives (i.e., saying someone has it when they don't). However, my view is that if the person does not have very many symtoms one has to factor in two things:
Is the person affluent?
and
Have they ever tried to stop before
Because these two questions alone will eliminate as much as 40% of the possible symptoms. Also, some symptoms are so severe that if a person just has one of them I think they likely have Pathological gambling disorder e.g. questions 8, 9, and 10 for sure and probably #3 and 5 for problem gambling. Which brings up another major limitation of this, it does not detect problem gambling only pathological if the 5 yes responses is used, and finally there is no indication of degree. I use the following scale in my office after a full interview:
none, mild, moderate, severe, extreme
