A new review suggest that individuals receiving treatment for gambling problems should also be screened for personality disorders.
The recommendation comes after researchers from Monash University in Australia discovered treatment for gambling problems is often complicated because an individual may also suffer from a personality disorder.
Experts say that problem gambling creates a multitude of intrapersonal, interpersonal, and social difficulties.
Gambling problems are a worldwide issue as roughly 2.3 percent of the population suffers from this behavior. Previous research has shown that people with gambling problems suffer from a range of psychiatric disorders affecting their mood, levels of anxiety, and their use of substances.
In the new study, Meredith Brown and colleagues reviewed existing research to establish patterns and factors that link problem gambling and various personality disorders.
They found that people with gambling problems share similar characteristics to people with antisocial, borderline, histrionic and narcissistic personality disorders.
Investigators discovered borderline personality disorder (BPD) is more prevalent among people with gambling problems than those who can control their gambling. This personality disorder is associated with unstable interpersonal relationships and self-image, and marked impulsivity.
The review discovered that the same biological and social factors are at play in causing problem gambling and personality disorders. These include poor parental relationships during childhood, possible abuse, difficulty in controlling emotions, substance abuse, depression, and anxiety disorders.
Individuals with gambling problems and those with BPD tend to be socially isolated, have problematic relationships with their peers, lower self-esteem, and feelings of hopelessness and dissociation.
They are also emotionally more vulnerable, and struggle with anger issues and feelings of shame. People with gambling problems, like people suffering from BPD, also tend to be impulsive, revert to interpersonal violence and often commit suicide.
Brown advises that routine screening for personality disorders be part of any treatment option considered for people with gambling problems. Detection of a personality disorder can help clinicians customize interventions and improve outcomes.
The practice could alert clinicians to potential difficulties in treatment, and to the need to set more stringent behavioral limits. Screening will also help clinicians to adjust their expectations of what treatment may achieve, and how long it may take.
Because people with both problem gambling and personality disorders are three times more likely to drop out of treatment than those with problem gambling but no personality disorders, screening could also help practitioners to be more tolerant towards poor compliance and to encourage adherence to treatment.
The review highlights that dialectical behavior therapy, which has shown success in treating BPD, could also help a subgroup of problem gambling.
This intervention is based on Eastern principles and teaches clients the core skills of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, in combination with more traditional behavioral and motivational strategies.
“The fact that problem gambling and high levels of psychopathology often go together indicates a need to undertake routine and systematic screening and assessment of problem gamblers who sign up for treatment,” said Brown.
“Because the clinical picture of people with gambling problems who also suffer from personality disorders is more complicated, their successful treatment is also more difficult.”