Pathological Gambling Definition

“Gambling Disorder” is the term used by the American Psychiatric Association in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe the most severe form of the disorder (American Psychiatric Association, 2013). According to the DSM-5, gambling disorder is indicated by four (or more) of the following. Officially changing the name to “Gambling Disorder” is a welcome revision for many researchers and clinicians who have expressed concern that the label “pathological” is a pejorative term that only reinforces the social stigma of being a problem gambler. Changes in Diagnostic Criteria and Lowering of Threshold for a Diagnosis.

Pathological gambling disorder is seen as gambling which is uncontrollable and can alter and adversely affect the individual’s recreational and social activities. This disorder has an extremely disruptive and adverse affect on the life of the individual that suffers from it. As a result of this pathological gambling, individuals may end up losing all of their life savings, and may also be forced to commit various crimes including forging checks, stealing or embezzling in order to acquire more money to fulfill their compulsive habit. This disorder can also lead to the development of major problems in relationships as well as jobs.

Gambling addiction, also known as pathological gambling, compulsive gambling, problem gambling, or gambling disorder involves maladaptive patterns of gambling behavior that the individual persists with, despite negative consequences. This is consistent with behavior patterns observed in other addictions. Pathological gambling: A review of the neurobiological evidence relevant for its classification as an addictive disorder.

Pathological gambling can also be described as an Impulse Control Disorder1 or process addiction which is different from addictions to elements such as alcohol, food, tobacco and drugs. These types of addictions include a ‘high’ or a ‘rush’ which is gained when certain actions are performed as part of the addictive behavior. In case of gambling, the individuals may gain the ‘high’ from the overall setting and atmosphere of the place, for example a bingo hall, casino, race track and other places. The feeling that the individual gets from taking risks in this environment can evoke the addiction further. In many cases it is seen that compulsive gamblers own a piece of clothing or accessory which they claim is lucky for their gambling, and hence wear it every time they participate in a gambling activity. Some of these individuals use the piece of clothing or accessory to acquire the ‘high’ or ‘rush’ before gambling.

Causes:

The definite causes of pathological gambling disorder are unknown, although there are a number of studies and surveys that indicate that there is a significant difference on biological levels, between the general population and the compulsive gamblers. These surveys however cannot form the basis of the causes of pathological gambling. Many people tend to use their habit of gambling in order to gain an escape from signs of depressions which is more commonly seen in women than in men. Some of the gamblers seek to gamble in order to alter their moods because of the intense amount of energy and excitement that is commonly seen in gambling rooms. Thus, it is common to find that some people may be interested in other aspects of gambling than simply the money that is involved. It can be said that they ‘rush’ or ‘high’ that is seen in individuals suffering from pathological gambling disorders may not be associated with the money.

Symptoms:

Some of the most common symptoms that are seen in individuals suffering from pathological gambling disorder include immense amount of preoccupation with activities associated with gambling which tend to interfere with the individual’s social, occupational and personal life. The individual fells that he/she cannot control these gambling instincts and thus continues to visit casinos to place bets, failing to stop or cut down on the habit. One of the most commonly seen behaviors among compulsive gamblers is known as chasing. Chasing refers to placing bets of large amounts of money and thus taking more risks. This is done in order to make up for money that has been lost in gambling previously by the individual. The individual is also prone to immoral activities such as lying, forgery, stealing, fraud involved with credit cards, embezzling, and various other behaviors that are associated with acquiring money for gambling.

Demographics:

Gambling disorder affects more males than females in the United States with a sex ratio of 2:1. Over all as many as 4% of the population of the United States might meet the criteria for the disorder. In some countries this percentage is as high as 7%.

Diagnosis:

The disorder is usually diagnosed when an affected persons family or spouse become concerned and is seldom self reported. The most common symptom that most patients suffer from is Denial.

The Diagnostic and Statistical Manual of Mental Disorders(4th edition), specifies that a person affected with pathological gambling disorder must have at least 5 of the following symptoms to meet the diagnostic criteria for the disorder:

• The person thinks about gambling almost all the time
• The person keeps using larger and larger amounts of money every time when gambling
• The person has tried to stop gambling but has been unable to do so
• Whenever the gambling is stopped, the person becomes moody or cranky
• The person uses gambling as a method to escape problems
• The person continues to gamble in order to win back the money that has been lost (“chasing”)
• The person lies about the severity and extent of gambling
• The person has engaged in illegal or immoral behavior in order to make money for gambling
• The person has problems at home or work because of the gambling
• The person tends to rely on other people to get out of financial problems that have been caused by gambling

Treatments:

There are many treatments available for pathological gambling disorder:

• Psychodynamic Psychotherapy
• Cognitive Behavioral Therapy
• Substance Abuse Treatment
• Relaxation Techniques
• Aversion Therapy
• Gamblers Anonymous

References:

Impulse Control Disorders: A Clinician’s Guide to Understanding and Treating Behavioral Addictions Jon E. Grant

APA: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text revision

Pathological gambling

201620172018201920202021Billable/Specific Code

• F63.0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• The 2021 edition of ICD-10-CM F63.0 became effective on October 1, 2020.
• This is the American ICD-10-CM version of F63.0 - other international versions of ICD-10 F63.0 may differ.

• Compulsive gambling
• Gambling disorder

• gambling and betting NOS (

  Gambling and betting

  201620172018201920202021Billable/Specific CodePOA Exempt

  Type 1 Excludes

  • compulsive or pathological gambling (F63.0)
  Z72.6)

• excessive gambling by manic patients (

  Manic episode

  201620172018201920202021Non-Billable/Non-Specific Code

  Includes

  • bipolar disorder, single manic episode
  • mixed affective episode

  Type 1 Excludes

  • bipolar disorder (F31.-)
  • major depressive disorder, single episode (F32.-)
  • major depressive disorder, recurrent (F33.-)
  F30,
  ICD-10-CM Diagnosis Code F31

  Bipolar disorder

  201620172018201920202021Non-Billable/Non-Specific Code

  Includes

  • bipolar I disorder
  • bipolar type I disorder
  • manic-depressive illness
  • manic-depressive psychosis
  • manic-depressive reaction

  Type 1 Excludes

  • bipolar disorder, single manic episode (F30.-)
  • major depressive disorder, single episode (F32.-)
  • major depressive disorder, recurrent (F33.-)
  F31)
• gambling in antisocial personality disorder (

  Antisocial personality disorder

  201620172018201920202021Billable/Specific Code

  Applicable To

  • Amoral personality (disorder)
  • Asocial personality (disorder)
  • Dissocial personality disorder
  • Psychopathic personality (disorder)
  • Sociopathic personality (disorder)

  Type 2 Excludes

  • borderline personality disorder (F60.3)
  F60.2)

• Applicable To annotations, or
• Code Also annotations, or
• Code First annotations, or
• Excludes1 annotations, or
• Excludes2 annotations, or
• Includes annotations, or
• Note annotations, or
• Use Additional annotations

• F01-F99
  2021 ICD-10-CM Range F01-F99

  Mental, Behavioral and Neurodevelopmental disorders

  Type 2 Excludes

  • symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)
  Mental, Behavioral and Neurodevelopmental disorders
• F63
  ICD-10-CM Diagnosis Code F63

  Impulse disorders

  201620172018201920202021Non-Billable/Non-Specific Code

  Type 2 Excludes

  • habitual excessive use of alcohol or psychoactive substances (F10-F19)
  • impulse disorders involving sexual behavior (F65.-)
  Impulse disorders

Pathological Gambling Disorder Definition

• Compulsive gambling
• Gambling disorder
• Gambling disorder, in early remission
• Gambling disorder, in sustained remission
• Gambling disorder, mild
• Gambling disorder, moderate
• Gambling disorder, severe

• A disorder characterized by a preoccupation with gambling and the excitement that gambling with increasing risk provides. Pathological gamblers are unable to cut back on their gambling, despite the fact that it may lead them to lie, steal, or lose a significant relationship, job, or educational opportunity.
• Many people enjoy gambling, whether it's betting on a horse or playing poker on the internet. Most people who gamble don't have a problem, but some lose control of their gambling. Signs of problem gambling include
  • always thinking about gambling
  • lying about gambling
  • spending work or family time gambling
  • feeling bad after you gamble, but not quitting
  • gambling with money you need for other things
  many people can control their compulsive gambling with medicines and therapy. Support groups can also help.

• 883 Disorders of personality and impulse control

Convert F63.0 to ICD-9-CM

• 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
• 2017 (effective 10/1/2016): No change
• 2018 (effective 10/1/2017): No change
• 2019 (effective 10/1/2018): No change
• 2020 (effective 10/1/2019): No change
• 2021 (effective 10/1/2020): No change

• Type 1 Excludes: Z72.6
  ICD-10-CM Diagnosis Code Z72.6

  Gambling and betting

  201620172018201920202021Billable/Specific CodePOA Exempt

  Type 1 Excludes

  • compulsive or pathological gambling (F63.0)

• Betting and gamblingZ72.6
  ICD-10-CM Diagnosis Code Z72.6

  Gambling and betting

  201620172018201920202021Billable/Specific CodePOA Exempt

  Type 1 Excludes

  • compulsive or pathological gambling (F63.0)
  • pathological F63.0 (compulsive)
• • gambling F63.0
• Disorder (of) - see also Disease
  • gambling F63.0
• GamblingZ72.6
  ICD-10-CM Diagnosis Code Z72.6

  Gambling and betting

  201620172018201920202021Billable/Specific CodePOA Exempt

  Type 1 Excludes

  • compulsive or pathological gambling (F63.0)
  • pathological F63.0 (compulsive)
• Pathologic, pathological - see also condition
  • gambling F63.0

Pathological Gambling Definition Dictionary

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.