A Psychometric Evaluation of the DSM-IV Pathological Gambling Diagnostic Criteria

Abstract

Specific diagnostic criteria for pathological gambling (PG) have been available for 25 years, since the publication of DSM-III. Little research has examined the psychometric performance of the diagnostic criteria. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine the sensitivity, specificity and predictive values of the DSM-IV PG criteria for psychiatric outpatients who screened positive for a gambling problem. A total of 1709 psychiatric outpatients were evaluated with a semistructured diagnostic interview for PG. Of all patients 88 screened positive for PG, 40 of whom met DSM-IV diagnostic criteria for a lifetime history of PG. All ten DSM-IV criteria were significantly more frequent in the PG group. The sensitivity of the criteria ranged from 25.0% to 90.0% (mean = 67.8%), whereas specificity ranged from 62.5% to 100% (mean = 81.9%). Positive predictive values ranged from 64.1% to 100% (mean = 78.9%), and negative predictive values ranged from 61.5% to 90.7% (mean = 77.1%). Guidelines are recommended for determining whether a diagnostic criterion should be retained as part of the set of diagnostic criteria, and our results suggested that two of the DSM-IV PG criteria are candidates for elimination (criterion 8--commitment of illegal acts; criterion 10--reliance on others for financial assistance to relieve a desperate financial problem).

Emerging Conceptual Models of Excessive Behaviors

“…Studies that assess the performance of individual diagnostic criterion for pathological gambling (Duvarci et al 1997;Zimmerman et al 2006) partially support this model. Neither of the criteria recommended for deletion in the outpatient psychiatry clinic study (Zimmerman et al 2006), criterions 8 (committed illegal acts) or criterion 10 (reliance on others for financial assistance) assess components of the Griffiths model of addiction.…”

“…A study of 1,709 psychiatric outpatients in Rhode Island (USA) recommended eliminating criterions 8 (committed illegal acts) and 10 (reliance on others for financial assistance (Zimmerman et al 2006). A study of 35 Turkish pathological gamblers and 24 controls found that criterion 8 (illegal acts) and criterion 5 (escape gambling) failed to discriminate non problem from pathological gamblers (Duvarci et al 1997).…”

“…Although limited in number, studies of the general psychometric performance of the DSM-IV pathological gambling criteria (Duvarci et al 1997;Stinchfield 2003;Stinchfield et al 2005;Zimmerman et al 2006) have uniformly found satisfactory reliability, validity and classification accuracy. The studies of the psychometric performance of the DSM-IV pathological gambling criteria support the utility of the substance dependence model.…”

“…Neither of the criteria recommended for deletion in the outpatient psychiatry clinic study (Zimmerman et al 2006), criterions 8 (committed illegal acts) or criterion 10 (reliance on others for financial assistance) assess components of the Griffiths model of addiction. Neither of criteria that did not distinguish between non-problem and pathological gamblers in the Turkish study (Duvarci et al 1997) criterion 8 (illegal acts) and criterion 5 (escape gambling) directly relate to components of the Griffiths model.…”

Pathological Gambling: Psychiatric Models

“…Studies of the general psychometric performance of the DSM-IV pathological gambling criteria (Duvarci et al 1997;Stinchfield 2003;Stinchfield et al 2005;Zimmerman et al 2006) have uniformly found satisfactory reliability, validity and classification accuracy. However, two concerns about the criteria are (1) the ability to assess the severity of gambling problems along a continuum of behavior from normal gambling through severe pathological gambling and (2) inability to diagnose sub threshold gambling problems (Toce-Gerstein et al 2003).…”