Pathological gambling is being unable to resist impulses to gamble, which can lead to severe personal or social consequences.

Pathological gambling usually begins in early adolescence in men, and between ages 20 and 40 in women.

Pathological gambling often involves repetitive behaviors. People with this problem have a hard time resisting or controlling the impulse to gamble. Although it shares features of obsessive compulsive disorder, pathological gambling is likely a different condition.

In people who develop pathological gambling, occasional gambling leads to a gambling habit. Stressful situations can worsen gambling problems.

People with pathological gambling often feel ashamed and try to avoid letting others know of their problem. The American Psychiatric Association defines pathological gambling as having 5 or more of the following symptoms:

• Spending a lot of time thinking about gambling, such as past experiences or ways to get more money with which to gamble
• Needing to gamble larger amounts of money in order to feel excitement
• Having had many unsuccessful attempts to cut back or quit gambling
• Feeling restless or irritable when trying to cut back or quit gambling
• Gambling to escape problems or feelings of sadness or anxiety
• Gambling larger amounts of money to try to make back previous losses
• Lying about the amount of time or money spent gambling
• Committing crimes to get money to gamble
• Losing a job, relationship, or educational or career opportunity due to gambling
• Needing to borrow money to get by due to gambling losses

A psychiatric evaluation and history can be used to diagnose pathological gambling. Screening tools such as the Gamblers Anonymous 20 Questions can help with the diagnosis.

Treatment for people with pathological gambling begins with recognizing the problem. Because pathological gambling is often associated with denial, people with the illness often refuse to accept that they are ill or need treatment. Most people with pathological gambling enter treatment under pressure from others, rather than voluntarily accepting the need for treatment.

Treatment options include:

• Cognitive behavioral therapy, has been found to be effective.
• Self-help support groups, such as Gamblers Anonymous. Gamblers Anonymous is a 12-step program similar to Alcoholics Anonymous. Principles related to stopping the habit (abstinence) that apply to other types of addiction, such as substance abuse and alcohol dependence, can also be helpful in the treatment of pathological gambling.
• A few studies have been done on medications for the treatment of pathological gambling. Early results suggest that antidepressants and opioid antagonists (Naltrexone) may help treat the symptoms of pathological gambling. However, it is not yet clear which people will respond to medications.

Like alcohol or drug addiction, pathological gambling is a chronic disorder that tends to get worse without treatment. Even with treatment, it's common to start gambling again (relapse), but people with pathological gambling can do very well with the right treatment.

People with pathological gambling often have problems with substance abuse, depression, and anxiety. Some also have alcohol and drug abuse problems. People with pathological gambling often consider suicide, and some of them attempt it.

People with pathological gambling tend to have financial, social, and legal problems. These can include bankruptcy, divorce, job loss, and time in prison. The stress and excitement of gambling can lead to heart attacks in people at risk for them. Getting the right treatment can help prevent many of these problems.

Call your health care provider or mental health professional if you believe you have symptoms of pathological gambling.

Exposure to gambling may increase the risk of developing pathological gambling. Limiting exposure may be helpful for people who are at risk. Public exposure to gambling, however, continues to increase in the form of lotteries, electronic and Internet gambling, and casinos. Intervention at the earliest signs of pathological gambling may prevent the disorder from getting worse.