The revelation that addicts often have underlying physical or mental health disorders does not exactly qualify as a shocker. Compulsive behaviors are often a coping mechanism for those who feel overwhelmed by the world and feel a desperate urge to escape from their troubles. But naturally those troubles only multiply when addiction develops, as obstacles that once seemed difficult become all but insurmountable. The relationship between problem gambling and pre-existing personality disorders provides the perfect example of this dynamic in action. When suffering from a personality disorder, pathological gamblers who seek treatment are three times more likely to drop out of rehab than the average problem gambler. For a condition that is badly undertreated to begin with (fewer than 10 percent of problem gamblers will seek help), this reality shifts the likelihood of recovery into the realm of the remote. To get a clear read on the depth of the problem, professor Meredith Brown from Monash University in Australia carried out a systematic review of the existing literature on the compulsive gambling – personality disorder connection. To no one’s surprise, she discovered that personality disorders of several types are quite common among problem gamblers. Among the most frequently diagnosed are antisocial, histrionic, narcissistic and borderline disorders. Borderline personality disorder (BPD) appears to be particularly well-represented, and this particular condition seems to complicate treatment for gambling addiction more than any other type of disorder. People who suffer from BPD are known to be impulsive, have a history of unstable relationships and lack a positive self-image—and not coincidentally, each of these personality traits is common in problem gamblers as well.
Is Problem Gambling a Symptom of a Personality Disorder?
Looking further below the surface, Brown was able to identify a significant number of characteristics and life experiences that people suffering from personality disorders and pathological gambling conditions tend to share. The list of these mutual disorder predictors includes:
- Childhood abuse (physical and/or emotional)
- Troubled relationships with parents during youth
- History of substance abuse, depression or anxiety
- Social isolation
- Poor self-esteem
- Anger management issues
- Pattern of overreaction to disappointment
- Undefined sense of shame or guilt
- Dissociation, hopelessness
Such commonalities raise the possibility that problem gambling might in some fundamental way be a symptom or an offshoot of a personality disorder, at least in some instances. Given the submerged, subconscious nature of such a psychological orientation, it is not surprising to learn that people with personality disorders drop out of gambling rehab at high rates. Ideally they would receive treatment for their personality disorders as well as their gambling problems, but in many instances the existence of the former goes unrecognized. And when a crucial factor like this is overlooked, it will almost inevitably undermine a gambling addiction treatment regimen before it ever gets off the ground.
Screening Problem Gamblers for Personality Disorders
The presence of undiagnosed personality disorders can sabotage the best efforts of gambling treatment experts to help pathological gamblers regain control of their lives. Each human being who seeks rehabilitation services for an addiction has distinctive characteristics and a unique life history that shouldn’t be ignored—and can’t be ignored without damaging the recovery process. This is why Brown concludes her Journal of Gambling Studies article by recommending regular, intensive screening assessments for problem gamblers who come to therapists or rehab centers seeking treatment. This seems like common sense and it is surprising to learn that such a routine is not already in place on a universal basis. Certainly the more information treatment professionals have, the more focused and effective they will be when working with their patients. Information about underlying mental health conditions is vitally important and can only have a constructive impact on a treatment specialist’s performance. It would also be an excellent idea for psychiatrists and psychologists working with people who have personality disorders to ask them about their gambling habits. The risk of a gambling addiction appears to be quite real for those dealing with such issues, and it would be wise for therapists to keep this in mind when they are in session with patients whose behavior and personality indicate the presence of a personality condition.