ICD-116C50	GAMBLING DISORDER Gambling disorder
ICD-10F63.0	Pathological gambling
DSM-5-TRF63.0	Gambling Disorder

1. Definition and nosology

Gambling disorder (ICD-11: 6C50; ICD-10: F63.0; DSM-5-TR: F63.0) is a persistent or recurrent pattern of gambling behaviour characterised by impaired control, increasing priority given to gambling over other interests, and continuation despite negative consequences. It causes significant functional impairment. Gaming is a separate ICD-11 category — 6C51 Gaming disorder.

2. History

• DSM-IV (1994) — “Pathological Gambling” within the impulse control disorders.
• DSM-5 (2013) — “Gambling Disorder” was moved to the substance use and addiction category (similar neurobiology).
• ICD-11 (2019) — the behavioural addictions block was expanded: alongside gambling (6C50), gaming disorder (6C51) was added as a separate category.

3. Epidemiology

• Gambling Disorder lifetime prevalence: 0.2–5.3% (wide range).
• Sex: gambling is more prevalent in men; the sex difference narrows in online gambling.
• Comorbidity: MDD, anxiety, other substance use, ADHD, BPD, suicide risk.

4. Aetiology and pathogenesis

• Heritability 50–60%.
• Neurobiological — dysregulation of the reward circuit (dopamine), similar to substance use disorders.
• Personality — impulsivity, sensation-seeking.

5. Clinical features

• Persistent/recurrent gambling behaviour.
• Loss of control.
• Occupational, family, social, and academic impairment.
• “Chasing losses” (in gambling) — attempts to win back losses.
• Lying, financial disruption, concealment.
• Comorbid MDD and high suicide risk.

6. Diagnosis

6.1 Unified diagnostic criteria

Gambling (DSM-5-TR): ≥ 4 of 9 symptoms within a 12-month period:

1. Gambling with increasing amounts — tolerance;
2. Irritability or restlessness when cutting down gambling — withdrawal;
3. Unsuccessful attempts to cut down;
4. Preoccupation with gambling;
5. Gambling when distressed;
6. “Chasing” after losses;
7. Lying;
8. Loss of relationships/job;
9. Reliance on financial bailouts.

6.2 Source-specific clarifications

• ICD-11 (6C50) — subtypes: 6C50.0 predominantly offline, 6C50.1 predominantly online, 6C50.Z unspecified. Diagnosis normally requires ≥ 12 months; the duration may be shortened if all diagnostic requirements are met and symptoms are severe.
• DSM-5-TR — “Gambling Disorder” (F63.0) is the only behavioural addiction in the main text; DSM-5 (2013) moved it from impulse-control disorders to substance-related and addictive disorders. Unlike 6C51, the 6C50 requirements admit significant distress alongside functional impairment.

6.3 Diagnostic algorithm

1. Clinical interview.
2. SOGS (South Oaks Gambling Screen) or PGSI (Problem Gambling Severity Index).
3. Comorbid substance use, MDD, suicide.
4. Assessment of the financial situation.

6.4 Differential diagnosis

7. Examination and assessment

• Comorbidity scales.
• C-SSRS for suicide.

8. Treatment

1. CBT — first line; trigger management, behavioural activation, cognitive restructuring (“near miss” and “gambler's fallacy”). Cowlishaw S. Cochrane 2012 meta-analysis.
2. Naltrexone, nalmefene — the evidence base is evolving (reviews by Grant J.E.).
3. SSRIs — for comorbid MDD/anxiety.
4. Self-help (Gamblers Anonymous, Gam-Anon) — adjunct.
5. Financial counselling — critical in gambling.

Treatment methods

1. CBT for gambling — Correction of cognitive distortions, exposure (reducing responses to triggers), problem-solving.
2. Naltrexone off-label — Reduction of cravings; 50–150 mg/day.
3. Self-help groups (GA) — 12-step model.

9. Prognosis

• Remission with CBT 30–50%.
• Comorbid MDD predicts a poor prognosis.

10. Myths and misconceptions

Myth 1: “Gambling addiction is a ‘character’ disorder”

Evidence: DSM-5, ICD-11 — it is a medical/behavioural disorder; neurobiological and genetic predisposition.

Myth 2: “The patient will get out of debt with a ‘big win’”

Evidence: “chasing losses” is a diagnostic feature of gambling disorder; the pattern of losses is statistically inevitable.

Myth 3: “Financial support alone is sufficient”

Evidence: reliance on bailouts is a diagnostic feature; psychosocial intervention is required.

Myth 4: “The patient will ‘grow out of it’”

Evidence: active intervention is required; risk of chronicity.

11. Sources

1. WHO. ICD-11. 6C50 Gambling disorder. 2024.
2. APA. DSM-5-TR. 2022.
3. Cowlishaw S. et al. Psychological therapies for pathological and problem gambling. Cochrane Database Syst Rev 2012;(11):CD008937.
4. Grant J.E. et al. Pharmacotherapy for gambling disorder. Curr Top Behav Neurosci 2016;26:135–149.