Predisposing factors

In the presence of social pressures, predisposed individuals are propelled towards pathological gambling. Some of the factors involved in this predisposition are discussed below.

Morbid risk-taking

Since gambling is a type of risk-taking, it lends itself to be used by those who, for reasons related to their personality, have a high need for risk. They spend large sums of money on the intangible commodity of risk, which may easily pass unnoticed because it is fleeting.

This morbid propensity to take risks shows itself in other ways. Thus, the incidence of attempted suicide appears to be about eight times the expected rate among those who gamble pathologically.^)

Other personality factors

Freud(14) asserted that gambling resembles masturbation, is a substitute for it, and is resorted to in the context of unresolved Oedipal difficulties. Also, pathological gambling may be a manifestation of self-punishment, with an unconscious desire to lose arising from a psychological mechanism that has been referred to as 'psychic masochism'.(15)

Those who gamble pathologically appear to have other predisposing personality traits. They view their behaviour as being largely determined by factors outside their personal control. They also tend towards greater impulsivity. (5,16)

Learning processes

Apart from the winnings and losses, the gambling situation itself may affect learning. As far as the random processes inherent in gambling are concerned, all participants, even a total failure, stand on an equal footing. This may be the only circumstance in which some people have this experience. Gambling may therefore provide a means of dealing with morbid anxiety in the presence of feelings of inferiority, leading to a conditioned avoidance reaction. In this situation, there is more likely to be psychological dependence on gambling and loss of control. (1 18)

Mental disorder

Pathological gambling may occur in any mental disorder. However, it is most commonly associated with depression. More usually, a neurotic type of depression occurs after a bout of heavy gambling with large losses. In symptomatic pathological gambling, the depression is primary and a response to the tension and feelings of guilt that occur in depression. This latter situation is similar to alcohol misuse and shoplifting, as part of the depressive syndrome. Pathological gambling may also be a manifestation of antisocial personality disorder.

Misuse of alcohol and pathological gambling can occur together; either may be the primary disorder and either may lead to the other.

Constitutional and physical factors

Twin studies have demonstrated that the likelihood of pathological gambling occurring in a person is influenced, to an important degree, by inherited factors and/or experiences shared during childhood. (1ยง>

There also appears to be a significant association between pathological gambling and genetic abnormalities involving the dopamine reward pathways. (20> Disturbances of serotonergic, noradrenergic, and dopaminergic neurotransmitter systems have all been implicated in the aetiology of pathological gambling. This is particularly so in relation to the arousal, behavioural initiation, behavioural disinhibition, and reward/reinforcement mechanisms that are evident in this condition. (21>

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