Department of Psychology, University of Manitoba, 190 Dysart Rd.,, Winnipeg, MB, R3T 2N2, Canada.
Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Canada.
J Gambl Stud. 2019 Sep;35(3):829-847. doi: 10.1007/s10899-019-09839-y.
Substantial changes were made with the creation of the Substance Related and Addictive Disorders category in the fifth edition of the Diagnostic and Statistical Manual (DSM-5; APA in Diagnostic and statistical manual of mental disorders, 5th edn, American Psychiatric Publishing, Arlington, 2013a), including the addition of gambling disorder to the category and a reduction in the minimum threshold of diagnostic criteria required for a gambling disorder. As gambling shares many similarities with substance use disorders, it stands to reason that comorbidity rates of other psychiatric disorders would be similar among gambling and substance use disorders. The current study examines whether changes in gambling diagnostic criteria from DSM-IV to DSM-5 correspond to changes in prevalence of comorbid psychiatric disorders among disordered gamblers that result in prevalence rates more similar to those observed in alcohol and cannabis use disorders. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions (NESARC). Results suggested that the prevalence for any comorbid disorder among disordered gamblers appeared to be similar from DSM-IV (56.7%) to DSM-5 (53.7%). Comorbidity using DSM-5 criteria were just slightly closer to, but still noticeably higher than, comorbidity prevalence observed in alcohol (25.3%) and cannabis (37.7%) disorders, with similar trends across addictions observed in most examined comorbid disorders/groupings. Our findings suggest that lowering the threshold for minimum diagnosis of gambling disorder resulted in a slight decrease in comorbidity rates though substantial differences remain between comorbid rates of disordered gambling and substance use disorders. Future DSM editions may consider a further diagnostic threshold reduction, which might result in comorbidity rates being more similar to other substance use disorders and increasing disorder similarity within the Substance Related and Addictive Disorders category.
实质性的变化是创建的物质相关和成瘾障碍类别在第五版的诊断和统计手册（DSM-5; APA 在诊断和精神障碍统计手册，第 5 版，美国精神病学出版社，阿灵顿，2013a），包括赌博障碍的添加到类别和减少的最低阈值的诊断标准所需的赌博障碍。由于赌博与物质使用障碍有许多相似之处，因此可以合理地认为其他精神障碍的共病率在赌博和物质使用障碍中是相似的。本研究检验了从 DSM-IV 到 DSM-5 的赌博诊断标准的变化是否与赌博障碍患者共患精神障碍的患病率变化相对应，从而导致患病率更接近酒精和大麻使用障碍的观察结果。本研究利用了国家酒精和相关条件流行病学调查（NESARC）的数据。结果表明，从 DSM-IV（56.7%）到 DSM-5（53.7%），障碍性赌徒的任何共病障碍的患病率似乎相似。使用 DSM-5 标准的共病率略高，但仍明显高于酒精（25.3%）和大麻（37.7%）障碍中观察到的共病率，大多数研究的共病障碍/分组中观察到相似的趋势。我们的研究结果表明，降低赌博障碍的最低诊断阈值导致共病率略有下降，但障碍性赌博和物质使用障碍之间的共病率仍存在实质性差异。未来的 DSM 版本可能会考虑进一步降低诊断阈值，这可能会导致共病率与其他物质使用障碍更为相似，并增加物质相关和成瘾障碍类别中的障碍相似性。
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