Applying the Emerging Concept of Impulsivity to Gambling

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Applying the Emerging Concept of Impulsivity to
Gambling

• James R. Westphal, M.D.
• Clinical Professor, Department of Psychiatry,
  University of California, San Francisco

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Definitions of Impulsivity

• DSM-IV mentioned, but undefined
• Impulse control disorder psychodynamic definition
• Psychometric - trait

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Impulsivity Associated with Multiple Disorders

• Axis I
• Affective Disorders
• Substance Use Disorders
• Axis II
• Cluster B Personality Disorders

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Multiple Measures of Impulsivity

• Psychometric
• Barrett
• Eyesend?
• Behavioral
• Deficient Impulse Control Behaviors
• Minnesota
• Multi-Impulsive Personality Disorder

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Multiple Factors Involved with Impulsivity

• Psychometric
• Behavioral
• Behavioral and Psychometric factors often do not
  correlate

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Multi-Impulsive Personality
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Proposed Definition of Impulsivity
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Implications for Pathological Gambling
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Brief Research of Impulsivity Gambling Studies
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Objectives

• Briefly review the current psychiatric literature
  on the concept of impulsivity.
• Apply the current understanding to the assessment
  of gambling disorders.
• Discuss the clinical and public health aspects
  changing the definition of gambling disorders
  based on a more modern understanding of impulsive
  behavior.

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Method

• literature review

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Results

• Impulsivity is not defined in the DSM-IV.
• Impulsive behavior has several factors including
  decreased sensitivity to negative consequence,
  lack of planning, lack of concern for long term
  consequences.
• Impulsive behavior may not be a diagnostic
  category in itself, but a dimension of behavior
  associated with several Axis I and II diagnostic
  categories.
• Impulsiveness may be a state or a trait behavior
  or both.

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Results

• Self-report, event-related potentials, or
  behavioral laboratory measures can measure
  impulsiveness.
• The more severely impulsive patient is likely to
  manifest multiple impulsive behaviors.
• Current recommendations for assessment include an
  index of several measures.
• Impaired reward choice paradigm performance has
  been associated with gambling disorders.

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Conclusion

• The development of an impulsive index with self-
  report to measure trait aspects, reward choice
  paradigm to measure state aspects and an
  inventory of other impulsive behaviors could be
  useful for clinicians and research.
• Public and regulatory understanding that a
  subgroup of the population may lack the cognitive
  ability to gamble responsibly may assist in
  developing a public health approach to gambling.