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Richard J. Rosenthal, M.D. UCLA Gambling Studies Program

This paper explores the categorization of Pathological Gambling (PG) within the context of impulse-control disorders classified as Not Elsewhere Classified (IDNEC). It addresses critical questions regarding whether PG is an addiction or an impulse disorder, and the nature of the IDNEC category. The discussion includes historical perspectives, definitions, and the implications for DSM classifications. It emphasizes that addictions are essentially impulse disorders and examines the challenges in defining impulsivity and its relationship to PG and other compulsive behaviors.

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Richard J. Rosenthal, M.D. UCLA Gambling Studies Program

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  1. The Categorization of Pathological Gambling(PG) and the Impulse-Control Disorders Not Elsewhere Classified(IDNEC) Richard J. Rosenthal, M.D. UCLA Gambling Studies Program

  2. Three Questions 1.) Is PG an addiction or an impulse disorder? 2.) Isn’t the category of IDNEC a wastebasket? 3.) Why is the categorization of the impulse disorders so confusing?

  3. Addictions ARE impulse disorders • The name, IDNEC, tells us there are other impulse-control disorders classified elsewhere • List includes substance dependence • Criteria for PG in DSM-III-R deliberately identical to substance dependence • Preferred definition of PG that of an addiction

  4. The Monomanias • New disease entity introduced by Esquirol, 1810 • Full-fledged but partial insanity • Idee fixe - a single pathological preoccupation in an otherwise sound mind • Irresistible impulse • Expanded the insanity defense, role of the expert witness (Georget, 1825) • Included impulsive homicidal mania, gambling mania, kleptomania, pyromania, dipsomania

  5. Adding to the confusion: • Irresistible impulse - persists but watered down • “chronically and progressively unable to resist impulses to gamble” (DSM-III) • “failure to resist an impulse,drive,or temptation” • No definitions for impulse, impulsive, impulsivity • Difficulty with the construct of impulsivity • Specific, purposive, defensive vs. generalized, purposeless, random • Tension reduction • No definition of tension, ambiguous concept, outdated theories • Ego-syntonic and dystonic omitted from final version of DSM-IV

  6. Possibilities for DSM-V • Keep as is (IDNEC) • Add more disorders - compulsive shopping, Internet addiction, sexual addiction, pathological lying • Clarify essential features • Spectrum disorders • OC spectrum disorder (Hollander) • Affective spectrum (McElroy) • Addiction, behavioral addictions • Primitive subgroups - disorders of acquisition, disorders of grooming • One disorder with different presentations • Relief from feelings of worthlessness (Webster & Jackson) • Primary problem is uncontrollable urges (Kim)

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