Disordered gambling across the lifespan: an examination of comorbidity and diagnosis from DSM-IV to DSM-5
| dc.contributor.author | Nicholson, Ryan | |
| dc.contributor.examiningcommittee | Keough, Matthew (Psychology) | en_US |
| dc.contributor.examiningcommittee | Sareen, Jitender (Psychiatry) | en_US |
| dc.contributor.examiningcommittee | Afifi, Tracie (Community Health Sciences) | en_US |
| dc.contributor.examiningcommittee | Giroux, Isabelle (University of Laval) | en_US |
| dc.contributor.supervisor | Mackenzie, Corey (Psychology) | en_US |
| dc.date.accessioned | 2018-12-04T15:59:06Z | |
| dc.date.available | 2018-12-04T15:59:06Z | |
| dc.date.issued | 2018 | en_US |
| dc.date.submitted | 2018-11-27T05:57:38Z | en |
| dc.degree.discipline | Psychology | en_US |
| dc.degree.level | Doctor of Philosophy (Ph.D.) | en_US |
| dc.description.abstract | First introduced in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), pathological gambling was traditionally viewed as an 'impulse control disorder'. The publication of the DSM's fifth edition reclassified gambling (now disordered gambling) as a 'substance-related and addictive disorder' and reduced the minimum criteria required for a diagnosis. To examine the impact of these changes, and to better understand gambling disorder across the adult lifespan, this dissertation examined psychiatric comorbidity and other gambling-related features associated with DSM gambling and other substance-use disorders across younger (18-34 years old), middle-aged (35-54 years old), and older (55 years and above) adults using secondary analyses of data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Study 1 examined whether changes from DSM-IV to DSM-5 affected the severity of those diagnosed with a gambling disorder with respect to mental disorder comorbidity across age groups. Results indicated that the prevalence of comorbid disorders did not change in the overall sample, although older adults were more likely to exhibit a comorbid anxiety disorder and any comorbid mental health/substance-use disorder using DSM-5 criteria. Study 2 examined whether changes in diagnostic criteria from DSM-IV to DSM-5 correspond to shifts in comorbid psychiatric disorder prevalence that are more similar to those observed in alcohol and cannabis use disorders. Findings suggested that moving from DSM-IV to DSM-5 gambling criteria resulted in a slight decrease in comorbidity rates, although substantial differences remained between comorbid rates of disordered gambling and substance use disorders. Study 3 examined mental and physical functioning, comorbid psychological disorders, and other gambling-related features in gamblers meeting at least one DSM-5 diagnostic criterion across age groups. The three age groups differed on a variety of measures. Notably, older adults had lower physical functioning, reduced help-seeking behaviour, and lower prevalence of comorbid psychiatric conditions compared to other age groups. In sum, changes from DSM-IV to DSM-5 were not uniform, with older adults appearing to differ most between the two sets of DSM criteria. Older adults meeting a DSM gambling diagnosis (four or more criteria) were found to have higher comorbid disorder prevalence than young and middle age groups while older adults meeting one or more DSM gambling criterion had a lower comorbid disorder prevalence than other age groups. I discuss these age-related findings within the context of Charles’ (2010) strength and vulnerability integration' theory, noting that meeting minimal gambling criteria does not appear to be a severe stressor that decreases overall well-being in older adults due to strengths afforded through aging. With the increased availability of gambling, the differences in disordered gambling across the lifespan and accompanying comorbid psychiatric conditions, as observed in this research, will need to be taken into account in order to achieve the best possible treatment outcomes. | en_US |
| dc.description.note | February 2019 | en_US |
| dc.identifier.citation | Nicholson, R., Mackenzie, C., Afifi, T. O., & Sareen, J. (2018). Changes in gambling diagnostic criteria from DSM-IV to DSM-5: Effects on mental disorder comorbidity across younger, middle-aged, and older adults in a nationally-representative sample. Journal of Gambling Studies. Advance online publication. doi:10.1007/s10899-018-9801-z | en_US |
| dc.identifier.uri | http://hdl.handle.net/1993/33584 | |
| dc.language.iso | eng | en_US |
| dc.rights | open access | en_US |
| dc.subject | Gambling | en_US |
| dc.subject | Disordered gambling | en_US |
| dc.subject | Substance-related disorders | en_US |
| dc.subject | DSM | en_US |
| dc.title | Disordered gambling across the lifespan: an examination of comorbidity and diagnosis from DSM-IV to DSM-5 | en_US |
| dc.type | doctoral thesis | en_US |