View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by NORA - Norwegian Open Research Archives Pathological Gambling Treatment and Personality Factors Helga Myrseth Dissertation for the degree philosophiae doctor (PhD) University of Bergen, Norway 2011 “Life is the art of drawing sufficient conclusions from insufficient premises” Samuel Butler, 1835-1902 1 Contents ACKNOWLEDGEMENTS..................................................................................................................4 LIST OF PAPERS ................................................................................................................................6 SUMMARY...........................................................................................................................................7 ABBREVIATIONS.............................................................................................................................10 1. INTRODUCTION ....................................................................................................................12 1.1 DEFINITION AND DIAGNOSIS ..................................................................................................12 1.2 HISTORICAL OVERVIEW.........................................................................................................13 1.3 THEORIES OF ADDICTION.......................................................................................................16 1.3.1 Behavioral Addictions.................................................................................................18 1.4 THEORETICAL PERSPECTIVES ON PATHOLOGICAL GAMBLING................................................20 1.4.1 Psychodynamic Perspective ........................................................................................20 1.4.2 Biological Perspective.................................................................................................21 1.4.3 Behavioral Perspective................................................................................................29 1.4.4 Cognitive Perspective..................................................................................................33 1.4.5 Cognitive Behavioral Perspective ...............................................................................38 1.5 INTEGRATED MODELS OF PATHOLOGICAL GAMBLING............................................................41 1.5.1 A Pathways Model of Problem and Pathological Gambling .......................................41 1.5.2 A Comprehensive Biopsychosocial Model of Pathological Gambling .......................44 1.5.3 Similarities and Differences between the Models .......................................................46 1.6 PREVALENCE OF PATHOLOGICAL GAMBLING ........................................................................47 1.7 RISK FACTORS.......................................................................................................................50 1.7.1 Demographic Risk Correlates .....................................................................................50 1.7.2 Genetics.......................................................................................................................54 1.9 CO-MORBIDITY OF PATHOLOGICAL GAMBLING .....................................................................55 1.9.1 Substance Use Disorders and Pathological Gambling.................................................55 1.9.2 Mood Disorders and Pathological Gambling ..............................................................56 1.9.3 Anxiety Disorders and Pathological Gambling ...........................................................57 1.9.4 Other Axis I Psychiatric Disorders and Pathological Gambling .................................58 1.9.5 Personality Disorders and Pathological Gambling......................................................58 1.10 PERSONALITY FACTORS ...................................................................................................61 1.10.1 MMPI Profiles of Pathological Gamblers...................................................................62 1.10.2 The Five-Factor Model of Personality ........................................................................65 1.10.3 Impulsivity ..................................................................................................................68 1.10.4 Sensation Seeking .......................................................................................................71 1.11 SUB-TYPING PATHOLOGICAL GAMBLERS ..........................................................................73 1.12 ASSESSMENT OF PATHOLOGICAL GAMBLING....................................................................77 1.12.1 Issues in Measuring Gambling Behavior.....................................................................79 2 1.13 RELEVANCE OF THE PRESENT RESEARCH..........................................................................80 1.14 THE PRESENT RESEARCH AIMS ........................................................................................83 1.14.1 Aim I ...........................................................................................................................83 1.14.2 Aim II..........................................................................................................................84 1.14.3 Aim III.........................................................................................................................84 2. METHODS................................................................................................................................86 2.1 SAMPLES AND PROCEDURES...................................................................................................86 2.1.1 Sample and Procedure: Study I ...................................................................................86 2.1.2 Sample and Procedure: Study II..................................................................................88 2.1.3 Sample and Procedure: Study III.................................................................................89 2.2 POWER ANALYSIS STUDY I.....................................................................................................90 2.3 TREATMENT CONDITIONS IN STUDY I................................................................................90 2.3.1 Cognitive Behavioral Therapy ....................................................................................90 2.3.2 Escitalopram................................................................................................................91 2.4 ETHICS ...................................................................................................................................93 2.5 INSTRUMENTS ...................................................................................................................93 2.5.1 Instruments in Study I .................................................................................................93 2.5.2 Instruments in Study II ................................................................................................95 2.5.3 Instruments in Study III...............................................................................................96 2.6 STATISTICS........................................................................................................................98 2.6.1 Statistics in Study I......................................................................................................98 2.6.2 Statistics in Study II ....................................................................................................99 2.6.3 Statistics in Study III.................................................................................................100 3. RESULTS................................................................................................................................102 3.1 RESULTS STUDY I.................................................................................................................102 3.2 RESULTS STUDY II ...............................................................................................................102 3.3 RESULTS STUDY III ..............................................................................................................103 4. DISCUSSION..........................................................................................................................106 4.1 SUMMARY OF FINDINGS AND GENERAL DISCUSSION............................................................106 4.1.1 Treatment of Pathological Gambling ........................................................................106 4.1.2 Predictors of Pathological Gambling ........................................................................110 4.1.3 Psychopathology and Personality Characteristics .....................................................112 4.2 METHODOLOGICAL CONSIDERATIONS ..................................................................................116 4.2.1 Sample Size...............................................................................................................117 4.2.2 Representativeness ....................................................................................................120 4.2.3 Validity of Self-Report..............................................................................................122 4.2.4 Attrition.....................................................................................................................124