Journal of Gambling Studies

, Volume 32, Issue 4, pp 1079–1100 | Cite as

An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers

  • M. Brown
  • E. Oldenhof
  • J. S. Allen
  • N. A. Dowling
Original Paper


The primary aims of this study were to examine the prevalence of personality disorders in problem gamblers, to explore the relationship between personality disorders and problem gambling severity, and to explore the degree to which the psychological symptoms highlighted in the biosocial developmental model of borderline personality disorder (impulsivity, distress tolerance, substance use, PTSD symptoms, psychological distress and work/social adjustment) are associated with problem gambling. A secondary aim was to explore the strength of the relationships between these symptoms and problem gambling severity in problem gamblers with and without personality disorder pathology. Participants were 168 consecutively admitted problem gamblers seeking treatment from a specialist outpatient gambling service in Australia. The prevalence of personality disorders using the self-report version of the Iowa Personality Disorders Screen was 43.3 %. Cluster B personality disorders, but not Cluster A or C personality disorders, were associated with problem gambling severity. All psychological symptoms, except alcohol and drug use, were significantly higher among participants with personality disorder pathology compared to those without. Finally, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for problem gamblers with personality disorder pathology, while impulsivity, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for those without personality disorder pathology. High rates of comorbid personality disorders, particularly Cluster B disorders, necessitate routine screening in gambling treatment services. More complex psychological profiles may complicate treatment for problem gamblers with comorbid personality disorders. Future research should examine the applicability of the biosocial developmental model to problem gambling in community studies.


Problem gambling Personality disorder Biosocial developmental model Borderline personality disorder 


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM V. Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  2. Berlin, H. A., & Rolls, E. T. (2004). Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients. Journal of Personality Disorders, 18(4), 358–378.CrossRefPubMedGoogle Scholar
  3. Blaszczynski, A., & McConaghy, N. (1994). Antisocial personality disorder and pathological gambling. Journal of Gambling Studies, 10(2), 129–145.CrossRefPubMedGoogle Scholar
  4. Blaszczynski, A., & Nower, L. (2002). A pathway model of problem and pathological gambling. Addiction, 97(5), 487–499.CrossRefPubMedGoogle Scholar
  5. Blaszczynski, A., & Steel, Z. (1998). Personality disorders among pathological gamblers. Journal of Gambling Studies, 14(1), 51–71.CrossRefPubMedGoogle Scholar
  6. Blaszczynski, A., Steel, Z., & McConaghy, N. (1997). Impulsivity in pathological gambling: The antisocial impulsivist. Addiction, 92, 75–87.CrossRefPubMedGoogle Scholar
  7. Brown, M., Allen, J. S., & Dowling, N. A. (2014). The application of an etiological model of personality disorders to problem gambling. Journal of Gambling Studies, 31(4), 1179–1199.CrossRefGoogle Scholar
  8. Cella, M., Sharpe, M., & Chalder, T. (2011). Measuring disability in patients with chronic fatigue syndrome: Reliability and validity of the Work and Social Adjustment Scale. Journal of Psychosomatic Research, 71(3), 124–128.CrossRefPubMedGoogle Scholar
  9. Chapman, A. L., Leung, D. W., & Lynch, T. R. (2008). Impulsivity and emotion dysregulation in borderline personality disorder. Journal of Personality Disorders, 22(2), 148–164.CrossRefPubMedGoogle Scholar
  10. Christensen, D. R., Dowling, N. A., Jackson, A. C., Brown, M., Russo, J., et al. (2013). A proof of concept for using brief dialectical behavior therapy as a treatment for problem gambling. Behaviour Change, 30(2), 117–137.CrossRefGoogle Scholar
  11. Clarkin, J. F., Lenzenweger, M. F., Yeomans, F., Levy, K. N., & Kernberg, O. F. (2007). An object relations model of borderline pathology. Journal of Personality Disorders, 21(5), 474–499.CrossRefPubMedGoogle Scholar
  12. Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135(3), 495–510.CrossRefPubMedPubMedCentralGoogle Scholar
  13. de Lisle, S., Dowling, N., & Allen, J. (2011). Mindfulness-based cognitive therapy for problem gambling. Journal of Clinical Case Studies, 10, 210–228.CrossRefGoogle Scholar
  14. de Lisle, S., Dowling, N. A., & Allen, S. J. (2012). Mindfulness and problem gambling: A review of the literature. Journal of Gambling Studies, 28(4), 719–739.CrossRefPubMedGoogle Scholar
  15. de Lisle, S., Dowling, N. A., & Allen, S. J. (2014). Mechanisms of action in the relationship between mindfulness and problem gambling behaviour. International Journal of Mental Health and Addiction, 12, 206–225.Google Scholar
  16. Dowling, N. A., & Brown, M. (2010). Commonalities in the psychological factors associated with problem gambling and Internet dependence. Cyberpsychology, Behavior, and Social Networking, 13(4), 437–441.CrossRefGoogle Scholar
  17. Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2014). The prevalence of comorbid personality disorders in treatment-seeking problem gamblers: A systematic review and meta-analysis. Journal of Personality Disorders, 29(6), 735–754.CrossRefPubMedGoogle Scholar
  18. Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015). The prevalence of psychiatric comorbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 49(6), 519–539.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Echeburua, E., & Fernandez-Montalvo, J. (2008). Are there more personality disorders in treatment-seeking pathological gamblers than in other kind of patients? A comparative study between the IPDE and the MCMI. International Journal of Clinical and Health Psychology, 8(1), 53–64.Google Scholar
  20. Ferris, J., & Wynne, H. (2001). The Canadian Problem Gambling Index: Final report. Retrieved July 13, 2007, from
  21. Fonagy, P., & Bateman, A. (2008). The development of borderline personality disorder—A mentalizing model. Journal of Personality Disorders, 22(1), 4–21.CrossRefPubMedGoogle Scholar
  22. Fossati, A., Barratt, E. S., Caretta, I., Leonardi, B., Grazioli, F., & Maffei, C. (2004). Predicting borderline and antisocial personality disorder features in nonclinical subjects using measures of impulsivity and aggressiveness. Psychiatry Research, 125, 161–170.CrossRefPubMedGoogle Scholar
  23. Francis, K. L., Dowling, N. A., Jackson, A. C., Christensen, D. C., & Wardles, H. (2015). Gambling motives: Validation of the reasons for gambling questionnaire in an Australian population survey. Journal of Gambling Studies, 31(3), 807–823.CrossRefPubMedGoogle Scholar
  24. Fruzzetti, A. E., Shenk, C., & Hoffman, P. D. (2005). Family interaction and the development of borderline personality disorder: A transactional model. Development and Psychopathology, 17, 1007–1030.CrossRefPubMedGoogle Scholar
  25. Germans, S., van Heck, G., & Hodiamont, P. (2012). Results of the search for personality disorder screening tools: Clinical implications. Journal of Clinical Psychiatry, 73(2), 165–173.CrossRefPubMedGoogle Scholar
  26. Germans, S., van Heck, G., Langbehn, D., & Hodiamont, P. (2010). The Iowa Personality Disorders Screen: Preliminary results of the validation of a self-administered version in a Dutch population. European Journal of Psychological Assesssment, 26(1), 11–18.CrossRefGoogle Scholar
  27. Gibbon, S., Duggan, C., Stoffers, J., Huband, N., Vollm, B., Ferriter, M., & Lieb, K. (2010). Psychological interventions for antisocial personality disorder. The Cochrane Database for Systematic Reviews, 2010(6), CD007668.Google Scholar
  28. Glenn, C. R., & Klonsky, E. D. (2009). Emotion dysregulation as a core feature of borderline personality disorder. Journal of Personality Disorders, 23(1), 20–28.CrossRefPubMedGoogle Scholar
  29. Grall-Bronnec, M., Wainstein, L., Augy, J., Bouju, G., Feuillet, F., Venisse, J. L., & Sebille-Rivain, V. (2011). Attention deficit hyperactivity disorder among pathological and at-risk gamblers seeking treatment: A hidden disorder. European Addiction Research, 17(5), 231–240.CrossRefPubMedGoogle Scholar
  30. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioural Assessment, 26(1), 41–54.CrossRefGoogle Scholar
  31. Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2014). Multivariate Data Analysis (7th ed.). Essex: Pearson Education Limited.Google Scholar
  32. Hawthorne, G., & Elliot, P. (2005). Imputing cross-sectional missing data: Comparison of common techniques. Australian and New Zealand Journal of Psychiatry, 39, 583–590.CrossRefPubMedGoogle Scholar
  33. Kerber, C. S., Black, D. W., & Buckwalter, K. (2008). Comorbid psychiatric disorders among older adult recovering pathological gamblers. Issues in Mental Health Nursing, 29, 1018–1028.CrossRefPubMedGoogle Scholar
  34. Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.-L. T., & Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.CrossRefPubMedGoogle Scholar
  35. Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189.CrossRefPubMedGoogle Scholar
  36. Korman, L., Collins, J., Littman-Sharp, N., Skinner, W., McMain, S., & Mercado, V. (2008). Randomized control trial of an integrated therapy for comorbid anger and gambling. Psychotherapy Research, 18(4), 454–465.CrossRefPubMedGoogle Scholar
  37. Krudelbach, N., Walker, H. I., Chapman, H. A., Haro, G., Mateu, C., & Leal, C. (2006). Comorbidity on disorders with loss of impulse-control: Pathological gambling, addictions and personality disorders. Actas Españolas De Psiquiatría., 34(2), 76–82.Google Scholar
  38. Langbehn, D. R., Pfohl, B. M., Reynolds, S., Clark, L. A., Battaglia, M., Bellodi, L., & Links, P. (1999). The IOWA Personality Disorders Screen: Development and preliminary validation of a brief screening interview. Journal of Personality Disorders, 13(1), 75–89.CrossRefPubMedGoogle Scholar
  39. Lee, T. K., LaBrie, R. A., Grant, J. E., Kim, S. W., & Shaffer, H. J. (2008). The structure of pathological gambling among Korean gamblers: A cluster and factor analysis of clinical and demographic characteristics. International Journal of Mental Health and Addiction, 6, 551–563.CrossRefGoogle Scholar
  40. Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys. Addiction, 106, 490–498.CrossRefPubMedGoogle Scholar
  41. Lorains, F., Stout, J. C., Bradshaw, J. L., Dowling, N. A., & Enticott, P. (2014). Self reported impulsivity and inhibitory control in problem gamblers. Journal of Clinical and Experimental Neuropsychology, 36(2), 144–157.CrossRefPubMedGoogle Scholar
  42. Marshall-Berenz, E., Vujanovic, A., Bonn-Miller, M., Bernstein, A., & Zvolensky, J. (2010). Multimethod study of distress tolerance and PTSD symptom severity in a trauma-exposed community sample. Journal of Traumatic Stress, 23(5), 623–630.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Morse, J., & Pilkonis, P. (2007). Screening for personality disorders. Journal of Personality Disorders, 21(2), 179–198.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Mundt, J. C., Marks, I. M., Shear, K., & Greist, J. H. (2002). The work and social adjustment scale: A simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464.CrossRefPubMedGoogle Scholar
  45. Neal, P., Delfabbro, P., & O’Neil, M. (2005). Problem gambling and harm: Towards a national definition. Melbourne: Gambling Research Australia.Google Scholar
  46. Olsson, I., Sorebo, O., & Dahl, A. (2011). A cross-sectional testing of the Iowa personality disorder screen in a psychiatric outpatient setting. BMC Psychiatry, 11, 105–113.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Pagura, J., Stein, M. B., Bolton, J. M., Cox, B. J., Grant, B., & Sareen, J. (2010). Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. Journal of Psychiatric Research, 44(16), 1190–1198.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Pallant, J. (2007). SPSS survival manual: A step by step guide to data analysis using SPSS. Sydney: Allen & Unwin.Google Scholar
  49. Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology, 51(6), 768–774.CrossRefPubMedGoogle Scholar
  50. Pelletier, O., Ladouceur, R., & Rheaume, J. (2008). Personality disorders and pathological gambling: Comorbidity and treatment dropout predictors. International Gambling Studies, 8(3), 299–313.CrossRefGoogle Scholar
  51. Pietrzak, R. H., & Petry, N. M. (2005). Antisocial personality disorder is associated with increased severity of gambling, medical, drug and psychiatric problems among treatment seeking pathological gamblers. Addiction, 100, 1183–1193.CrossRefPubMedGoogle Scholar
  52. Pietrzak, R. H., & Petry, N. M. (2006). Severity of gambling problems and psychological functioning in older adults. Journal of Geriatric Psychiatry and Neurology, 19(2), 106–113.CrossRefPubMedGoogle Scholar
  53. Preacher, K.J., (2002). Calculation for the test of the difference between two independent correlation coefficients (Computer software). Found at
  54. Prins, A., Ouimette, P., Kimerling, R., Cameron, R. P., Hugelshofer, D. S., Shaw-Hegwer, J., & Sheikh, J. J. (2004). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9, 9–14.CrossRefGoogle Scholar
  55. Reeves, M., James, L. M., Pizzarello, S. M., & Taylor, J. E. (2010). Support for Linehan’s Biosocial Theory from a nonclinical sample. Journal of Personality Disorders, 24(3), 312–326.CrossRefPubMedGoogle Scholar
  56. Saez-Abad, C., & Bertolin-Guillen, J. M. (2008). Personality traits and disorders in pathological gamblers versus normal controls. Journal of Addictive Diseases, 27(1), 33–40.CrossRefPubMedGoogle Scholar
  57. Sasone, R. A., Hahn, H. S., Dittoe, N., & Wiederman, M. W. (2011). The relationship between childhood trauma and borderline personality symptomatology in a consecutive sample of cardiac stress test patients. International Journal of Psychiatry in Clinical Practice, 15, 275–279.CrossRefGoogle Scholar
  58. Scholes-Balog, K. E., Hemphill, S. A., Dowling, N. A., & Toumbourou, J. W. (2014). A prospective study of risk and protective factors for problem gambling among young adults. Journal of Adolescence, 37, 215–224.CrossRefPubMedGoogle Scholar
  59. Scholes-Balog, K. E., Hemphill, S. A., Toumbourou, J. W., & Dowling, N. A. (2015a). Problem gambling patterns among Australian young adults: Associations with prospective risk and protective factors and adult adjustment outcomes. Addictive Behaviors, 55, 38–45.CrossRefGoogle Scholar
  60. Scholes-Balog, K. E., Hemphill, S. A., Toumbourou, J. W., & Dowling, N. A. (2015b). Problem gambling and internalizing symptoms: A longitudinal analysis of common and specific social environmental protective factors. Addictive Behaviors, 46, 86–93.CrossRefPubMedGoogle Scholar
  61. Shonin, E., van Gordon, W. V., & Griffiths, M. D. (2014). Cognitive behavioural therapy (CBT) and meditation awareness training (MAT) for the treatment of co-occurring schizophrenia and pathological gambling: A case study. International Journal of Mental Health and the Addictions, 12(2), 181–196.Google Scholar
  62. Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: Development and validation of a self-report measure. Motivation and Emotion, 29(2), 83–102.CrossRefGoogle Scholar
  63. Skodol, A., Gunderson, J. G., McGlashan, T. H., Dyck, I. R., Stout, R. L., Bender, D. S., & Oldham, J. M. (2002). Functional impairment in patients with schizotypal, borderline, avoidant or obsessive-compulsive personality disorder. American Journal of Psychiatry, 159(2), 276–283.CrossRefPubMedGoogle Scholar
  64. Specker, S. M., Carlson, G. A., Edmonson, K. M., Johnson, P. E., & Marcotte, M. (1996). Psychopathology in pathological gamblers seeking treatment. Journal of Gambling Studies, 12(1), 67–81.CrossRefPubMedGoogle Scholar
  65. Spinella, M. (2007). Normative data and a short form of the Barratt Impulsiveness Scale. International Journal of Neuroscience, 117(3), 359–368.CrossRefPubMedGoogle Scholar
  66. Stevens, M., & Young, M. (2008). Gambling screens and problem gambling estimates: A parallel psychometric assessment of the South Oaks Gambling Screen and the Canadian Problem Gambling Index. Journal of the National Association for Gambling Studies, 20(1), 13–36.Google Scholar
  67. Stiglmayr, C. E., Grathwol, T., Linehan, M. M., Ihorst, G., Fahrenberg, J., & Bohus, M. (2005). Aversive tension in patients with borderline personality disorder: A computer based field study. Acta Psychiatrica Scandinavica, 111, 372–379.CrossRefPubMedGoogle Scholar
  68. Stoffers, J. M., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 8, CD005652.Google Scholar
  69. Suomi, A., Dowling, N. A., & Jackson, A. C. (2014). Problem gambling subtypes based on psychiatric distress, alcohol abuse and impulsivity. Addictive Behaviors, 39, 1741–1745.CrossRefPubMedGoogle Scholar
  70. Toneatto, T., Vettese, L., & Nguyen, L. (2007). The role of mindfulness in the cognitive-behavioural treatment of problem gambling. Journal of Gambling Issues, 19, 91–100.CrossRefGoogle Scholar
  71. Tsikriktsis, N. (2005). A review of technqiues for treating missing data in OM survey research. Journal of Operations Management, 24, 53–62.CrossRefGoogle Scholar
  72. UCLA: Statistical Consulting Group. (2015). Regression with stata, from
  73. Walter, M., Gunderson, J. G., Zanarini, M. C., Sanislow, C. A., Grilo, C. M., McGlashan, T. H., & Skodol, A. E. (2009). New onsets of substance use disorders in borderline personality disorder over 7 years of follow-ups: Findings from the collaborative longitudinal personality disorders study. Addiction, 104, 97–103.CrossRefPubMedPubMedCentralGoogle Scholar
  74. Westphal, J. R., & Johnson, L. J. (2007). Multiple co-occurring behaviors among gamblers in treatment: Implications and assessment. International Gambling Studies, 7(1), 73–99.CrossRefGoogle Scholar
  75. Williams, R. J., Volberg, R. A., & Stevens, R. M. G. (2012). The population prevalence of problem gambling: Methodological influences, standardized rates, jurisdictional differences, and worldwide trends. Report prepared for the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term Care.Google Scholar
  76. Winslow, M., Subramaniam, M., Qiu, S., & Lee, A. (2010). Socio-demographic profile and psychiatric comorbidity of subjects with pathological gambling. Annals of the Academy of Medicine, Singapore, 39(2), 122–128.PubMedGoogle Scholar
  77. Zahra, D., Qureshi, A., Henley, W., Taylor, R., Quinn, C., Pooler, J., et al. (2014). The work and social adjustment scale: Reliability, sensitivity and value. International Journal of Psychiatry in Clinical Practice, 18(2), 131–138.CrossRefPubMedGoogle Scholar
  78. Zanarini, M. C., Frankenburg, F. R., Weingeroff, J. L., Reich, D. B., Fitzmaurice, G. M., & Weiss, R. D. (2010). The course of substance use disorders in patients with borderline personality disorder and Axis II comparison subjects: A 10 year follow-up study. Addiction, 106, 342–348.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • M. Brown
    • 1
  • E. Oldenhof
    • 1
    • 2
  • J. S. Allen
    • 1
  • N. A. Dowling
    • 2
    • 3
    • 4
  1. 1.School of Psychological SciencesMonash UniversityClaytonAustralia
  2. 2.School of Psychology, Faculty of HealthDeakin UniversityBurwoodAustralia
  3. 3.Melbourne Graduate School of EducationUniversity of MelbourneParkvilleAustralia
  4. 4.Centre for Gambling ResearchAustralian National UniversityCanberraAustralia

Personalised recommendations