Comorbidity of DSM-IV Pathological Gambling and Other Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Nancy M. Petry, Ph.D.; Frederick S. Stinson, Ph.D.; and Bridget F. Grant, Ph.D., Ph.D.

Objective: To present nationally representative data on lifetime prevalence and comorbidity of pathological gambling with other psychiatric disorders and to evaluate sex differences in the strength of the comorbid associations.

Method: Data were derived from a large national sample of the United States. Some 43,093 household and group quarters residents age 18 years and older participated in the 2001-2002 survey. Prevalence and associations of lifetime pathological gambling and other lifetime psychiatric disorders are presented. The diagnostic interview was the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Fifteen symptom items operationalized the 10 pathological gambling criteria.

Results: The lifetime prevalence rate of pathological gambling was 0.42%. Almost three quarters (73.2%) of pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between pathological gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant (p < .05), even after controlling for sociodemographic and socioeconomic characteristics. Male sex, black race, divorced/separated/widowed marital status, middle age, and living in the West and Midwest were associated with increased risk for pathological gambling. Further, associations between alcohol dependence, any drug use disorder, drug abuse, nicotine dependence, major depressive episode, and generalized anxiety disorder and pathological gambling were stronger among women than men (p > .05).

Conclusion: Pathological gambling is highly comorbid with substance use, mood, anxiety, and personality disorders, suggesting that treatment for one condition should involve assessment and possible concomitant treatment for comorbid conditions.

(J Clin Psychiatry 2005;66:564-574)

Received Sept. 8, 2004; accepted Dec. 2, 2004. From the Department of Psychiatry, University of Connecticut Health Center, Farmington, Conn. (Dr. Petry), and the Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, Md. (Drs. Stinson and Grant).

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was conducted and funded by the National Institute on Alcohol Abuse and Alcoholism, with supplemental support from the National Institute on Drug Abuse. Preparation of this article was supported in part by grants R01-MH60417, R01-MH60417-Supp, R01-DA13444, R01-DA14618, R01-DA016855, P50-AA03510, and P50-DA09241 from the National Institutes of Health, Bethesda, Md.

In the spirit of full disclosure and in compliance with all ACCME Essential Areas and Policies, the faculty for this CME activity were asked to complete a full disclosure statement. The information received is as follows: Drs. Grant, Petry, and Stinson have no significant commercial relationships to disclose relative to the presentation.

The hard work, dedication, and professionalism of the over 1800 U.S. Census Bureau field representatives who administered the NESARC interview are gratefully acknowledged.

The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring agencies or the U.S. government.

Corresponding author and reprints: Bridget F. Grant, Ph.D., Ph.D., Laboratory of Epidemiology and Biometry, Room 3077, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, M.S. 9304, 5635 Fishers Ln., Bethesda, MD 20892-9304 (e-mail: bgrant@willco.niaaa.nih.gov).