Sex differences among treatment-seeking adult pathologic gamblers
Introduction
Pathologic gambling (PG), included as an impulse control disorder not otherwise specified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV) [1], is characterized by a failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others.
Gambling has traditionally been viewed as a male leisure activity. One culturally based explanation is related to the social acceptance of this form of entertainment. However, epidemiologic studies aimed at valuing differences by sex showed that regular gambling patterns are more prevalent in men; rates of PG are double for males [2], [3], [4], [5], [6], [7], [8], [9], [10]. However, there is evidence that, similar to other addictive behaviors such as alcoholism and drug dependence, gambling problems have increased among women in recent years [11], [12], [13]. Available data on the etiology and treatment of PG have involved predominantly male subjects [14], [15]. Some authors found that the proportion of males that had been seeking treatment in the Unites States was about 86% [16]. In Spain, in a recent study conducted in our hospital, the percentage of women on a professional treatment program was 9.8% [17]. There are also differences by sex in the course of the disorder: women usually report less duration between the age of onset of the disorder and their own perception of the problem [5], [12], [18], [19], [20], [21]. Women also report different risk factors for the origin and persistence of the disorder: gambling is used for regulating negative emotional states associated with life events, dissatisfaction, and frustration [6], [22], [23].
One of the main differences in the gambling behaviors of men and women is the type of gambling that generates the addiction [3], [5], [19], [22], [24], [25]. Most researchers suggest that women prefer nonstrategic games, such as slot machines and bingo, whereas men tend to choose strategic gambling, such as sport betting and cards, and especially those with high levels of sensation seeking [19], [26], [27]. However, some studies do not emphasize this distinction based on sex and found that women reported bingo as their principal gambling problem and men reported slot machines [24], [28], [29].
Regarding the age of onset, men begin to gamble during their youth. A strong association has been found between an early onset disorder as well as psychosocial problems in treatment-seeking adult pathologic gamblers [30], particularly substance use and depressive disorders [31]. Some studies also indicate that the age of onset is higher for women, whereas the addiction is quicker than for men [3], [18], [21], [24], [25], [32].
Contradictory results have been published regarding the age of advice for consultation. Although some studies indicate that women are older when they seek help [19], [25], [26], others suggest the opposite [7], and some do not find differences for sex [21]. Petry [33] found that older pathologic gamblers that used professional psychiatric services were usually women, began the disorder in adult life, and had the most financial problems. However, women also reported less antisocial and legal problems [3], [18], [24], [34].
Pathologic gambling is also related to significant psychiatric comorbidity [35], [36], and a positive association has been found between the presence of comorbidities in axes I and II and the rapid advance of the disorder [21]. Some researchers did not find differences in terms of sex between PG and comorbidities [24], but others suggested that women had a higher risk of other psychiatric disorders, such as mood disorders [37], [38], [39], generalized anxiety, alcohol dependence, and use and abuse of drugs [40]. Some authors, on the contrary, have associated the use of alcohol, tobacco, and drugs especially to men [41], [42].
Personality studies have found higher levels of sensation seeking or impulsivity [43], [44] and low self-directedness in PG [45], even when compared with other clinical groups or healthy controls [46]. Some sex-specific differences were also observed; namely, women with PG displayed higher harm avoidance and cooperativeness than control women, whereas men with PG reported higher reward dependence and persistence than control men [17].
Finally, most studies that explored differences in gambling behaviors because of sex have been carried out in community populations. There have been few studies of disordered patients, and these usually include small samples. This study included a large sample of treatment-seeking pathologic gamblers who attended a specialized unit at a hospital in Barcelona, Spain.
The specific goals of this research were 3-fold: (a) to assess clinical and psychopathologic differences between females and males with PG, (b) to analyze differential personality profiles in PG when considering sex, and (c) to assess the incremental predictive accuracy of sex on the severity of the disorder in consideration of other sociodemographic and psychometric characteristics.
Section snippets
Participants
The total sample comprised 286 Spanish pathologic gamblers admitted during January 2003 and August 2007 to our pathological gambling unit. One hundred forty-three were female, and they constituted all of the women that were consecutively admitted to the unit requesting treatment because of their problems and impairment due to the disorder. The 143 males with PG were selected at random from a larger pool of patients catered for during the same period (total number of males 689) at our Unit.
The
Sociodemographic characteristics of the sample
Most subjects had primary (60.1%) or secondary studies (36.6%) (P = .121 for sex comparison). Fifty percent of patients were married or lived with a partner, 30% were single, and 20% were separated or divorced (comparison by sex: P = .090). Of the men and women, 28.7% and 47.1% were unemployed (P = .001), respectively. Male pathologic gamblers reported higher monthly means for personal (1257 euros for men and 719 euros for women, P < .0005) and family income (2115 euros for men and 1558 euros
Discussion
We examined differences in pathologic gamblers based on sex in a clinical sample of consecutively admitted individuals with PG. Our results showed that although gambling profiles are quite similar for disordered men and women, psychopathologic profiles and some specific personality traits vary across sex.
Acknowledgments
Financial support was received from CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), which is an initiative of ISCIII (CB06/03/0034), Fondo de Investigación Sanitaria of Spain (FIS: PI-040619), and Generalitat de Catalunya (2005SGR00322).
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