Pathological gambling: Addiction or impulse control disorder?

Pathological gambling is the most widespread and severe form of non-chemical addiction. It is challenging to categorize pathological gambling into just one category, ie. into a disorder characterized by impulsivity or into behavioral addiction, since there are obvious overlaps. With the above in mind, the changes within the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the eleventh revision of the International Classification of Diseases (ICD-11) are not surprising. Although not listed in the diagnostic criteria, impulsivity and neuropsychological deficits are an integral part of gambling disorder. For this reason, they are essential for a more complete understanding of the profile of pathological gamblers. The strongest arguments in favor of the reclassification of pathological gambling under the category of addiction are: similarities with the diagnostic characteristics of addiction to psychoactive substances (PAS); high degree of comorbidity between these two disorders; their common features including aspects related to the reward system; findings that the same brain structures are involved in both disorders. There are similarities in the way gambling disorders are reclassified within DSM-5 and ICD-11. As in DSM-5, pathological gambling is recognized as a form of addiction. In ICD-11, it was renamed gambling disorder and classified as behavioral addictions. The latest revisions of both classifications (DSM and ICD) have the same development path and essentially the same foundations, and a change in the perception of gambling within diagnostics is clearly visible. Pathological gambling is a very complex disease that is accompanied by neuropsychological deficits and impulsive behavior, both characteristic of addicts and people with impulse control disorders. Reclassification is significant for several reasons. First, there are similarities with the diagnostic characteristics of chemical addiction. Second, there is a high degree of comorbidity between impulse control disorders and addiction. Third, both involve the reward system and activate the same parts of the brain. It is assumed that these similarities led to the reclassification in both DSM-5 and ICD-11. It is still not entirely clear how this change in the perception of gambling within diagnostics will affect the actual treatment of pathological gambling.