# 165 - 6C50 Gambling disorder

# 6C50 Gambling disorder

507
Disorders due to substance use or addictive behaviours
Gambling disorder
Essential (required) features
• A persistent pattern of gambling behaviour – which may be predominantly online (i.e. 
over the internet or similar electronic networks) or offline – is required for diagnosis, 
manifested in all of the following:
• impaired control over gambling behaviour (e.g. onset, frequency, intensity, duration, 
termination, context);
• increasing priority given to gambling behaviour to the extent that gambling takes 
precedence over other life interests and daily activities;
• continuation or escalation of gambling behaviour despite negative consequences (e.g. 
marital conflict due to gambling behaviour, repeated and substantial financial losses, 
negative impact on health).
• The pattern of gambling behaviour may be continuous or episodic and recurrent, but is 
manifested over an extended period of time (e.g. 12 months).
• The gambling behaviour is not better accounted for by another mental disorder (e.g. a 
manic episode) and is not due to the effects of a substance or medication.
• The pattern of gambling behaviour results in significant distress or impairment in personal, 
family, social, educational, occupational or other important areas of functioning.
Specifiers for online or offline behaviour
Note: the order of specifiers is different than for 6C51 Gaming disorder.
Gambling disorder, predominantly offline
• This refers to gambling disorder that predominantly involves gambling behaviour that is 
not conducted over the internet or similar electronic networks (i.e. offline).
Gambling disorder, predominantly online
• This refers to gambling disorder that predominantly involves gambling behaviour that is 
conducted over the internet or similar electronic networks (i.e. online).
Gambling disorder, unspecified
6C50
6C50.0
6C50.1
6C50.Z
Disorders due to addictive behaviours | Gambling disorder

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders
Additional clinical features
• If symptoms and consequences of gambling behaviour are severe (e.g. gambling behaviours 
persist for days at a time without respite, or have major effects on functioning or health) 
and all other diagnostic requirements are met, it may be appropriate to assign a diagnosis 
of gambling disorder following a period that is briefer than 12 months (e.g. 6 months).
• Individuals with gambling disorder may make numerous unsuccessful efforts to control 
or significantly reduce gambling behaviour, whether self-initiated or imposed by others.
• Individuals with gambling disorder may increase the amount of money gambled over time 
to maintain or exceed previous levels of excitement, or to avoid boredom. They may also 
engage in a pattern of increasing intensity of gambling behaviour, increasing the amount of 
their wagers, or otherwise altering their gambling strategies in order to try to compensate 
for significant monetary loses (“chasing” their losses).
• Individuals with gambling disorder often experience urges or cravings to engage in 
gambling behaviour during other activities.
• Individuals with gambling disorder may exhibit substantial disruptions in diet, sleep, 
exercise and other health-related behaviours that can result in negative physical and 
mental health outcomes.
• Some individuals with gambling disorder may engage in deceitful behaviour to conceal 
the extent of their losses from loved ones, or attempt to obtain money in order to repay 
their debts.
• Some individuals with gambling disorder may engage in gambling behaviour in response 
to feelings of depression, anxiety, boredom, loneliness or other negative affective states. 
Although not diagnostically determinative, consideration of the relationship between 
emotional and behavioural cues and gambling behaviour can inform treatment planning.
• Gambling disorder commonly co-occurs with disorders due to substance use, mood 
disorders, anxiety and fear-related disorders, and personality disorder. Among individuals 
seeking treatment for gambling disorder, suicidal ideation and suicide attempts are 
common.
• In adults, gambling behaviour is associated with chronic medical conditions, obesity and 
poorer subjective health status.
Boundary with normality (threshold)
• Gambling disorder should not be diagnosed merely on the basis of repeated or persistent 
gambling (online or offline), such as in the context of social or professional gambling. 
Typically, these forms of gambling are limited to discrete periods, with monetary losses 
that are acceptable to the individual, and occur in the absence of the other characteristic 
features of the disorder.
• Daily gambling behaviour (e.g. buying lottery tickets) as a part of a routine or the use 
of gambling for purposes such as changing mood, alleviating boredom or facilitating 
social interaction in the absence of the other required features is not a sufficient basis for 
assigning a diagnosis of gambling disorder.
Disorders due to addictive behaviours | Gambling disorder

509
Disorders due to substance use or addictive behaviours
Course features
• The course of gambling disorder is variable, with recovery a common outcome even in the 
absence of intervention, especially for adolescents and young adults. However, for many, 
gambling disorder persists across the lifespan.
• Gambling behaviour can follow a continuous or episodic pattern. The intensity of gambling 
behaviour often fluctuates in relation to stress, depressive symptoms and substance use.
• Gambling disorder tends to develop gradually over the course of years, as frequency of 
gambling behaviour and monetary value of wagers increase.
Developmental presentations
• Gambling disorder typically has its onset in adolescence or young adulthood. Early onset 
is associated with higher levels of impulsivity. Prevalence of gambling disorder among 
adolescents tends to be higher than among adults.
• Onset of gambling disorder in older adulthood is uncommon.
Culture-related features
• Prevalence of gambling disorder varies by sociocultural background. For example, 
community-based prevalence in the United States is lower among immigrants than among 
United States-born individuals. Indigenous populations in several counties (e.g. Canada, 
New Zealand and the United States) appear to have higher prevalence than other ethnic 
groups, possibly due to greater financial hardship, the hope that gambling may help 
advance social goals, and the location of casinos on tribal lands.
• Endorsement of specific symptoms of gambling disorder may also vary cross-culturally. For 
example, among individuals with gambling problems in the United States, Asian Americans 
may be less likely to describe being preoccupied with gambling, while Latin Americans 
and African Americans may be more likely to describe attempts to reduce gambling.
Sex- and/or gender-related features
• Lifetime prevalence of gambling disorder is higher among males. In adulthood, the ratio of 
men to women diagnosed with gambling disorder is approximately 2:1. This gap is wider 
during adolescence (ratio of 4:1), which may reflect boys’ tendency to start gambling earlier.
Disorders due to addictive behaviours | Gambling disorder

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders
• Due to earlier onset, the course of gambling disorder is typically more protracted among 
men. Men also appear more likely to recover without intervention than women. Although 
onset among women tends to be later, symptoms often intensify more quickly. Women are 
more likely to seek treatment sooner than men, though treatment-seeking is low (less than 
10%) across both genders.
• Women with gambling disorder are more likely to have co-occurring mood disorders or 
anxiety and fear-related disorders, whereas men are more likely to exhibit problems with 
substance abuse and externalizing behaviours.
Boundaries with other disorders and conditions (differential diagnosis)
Boundary with hazardous gambling or betting
The category of hazardous gambling or betting from Chapter 24 on factors influencing health 
status or contact with health services may be assigned to individuals who exhibit problematic 
patterns of gambling without the other features of gambling disorder. Hazardous gambling or 
betting refers to a pattern of gambling that appreciably increases the risk of harmful physical 
or mental health consequences, to the individual or to others around the individual, that may 
require intervention or monitoring but is not considered a disorder.
Boundary with gaming disorder
Unlike gambling disorder, gaming disorder does not involve the betting of money or other 
valuables with the hope of obtaining something of greater value. If gaming behaviour is focused 
on wagers (e.g. internet poker), gambling disorder is generally the more appropriate diagnosis.
Boundary with bipolar and related disorders
Increased goal-directed activity – including impaired ability to control gambling behaviour – can 
occur during manic, mixed or hypomanic episodes. A diagnosis of gambling disorder should 
only be assigned if there is evidence of a persistent pattern of gambling behaviour that meets all 
diagnostic requirements for the disorder, and occurs outside of mood episodes. Some individuals 
with gambling disorder may exhibit symptoms while gambling that appear similar to those 
observed during manic episodes (e.g. euphoric mood and increased energy level). However, in 
mood episodes, such symptoms are not limited to the gambling context.
Boundary with obsessive-compulsive disorder
Gambling behaviour can sometimes be described as “compulsive” by lay people and also by some 
health professionals. Compulsions observed in obsessive-compulsive disorder are almost never 
experienced as inherently pleasurable; they typically occur in response to intrusive, unwanted 
and generally anxiety-provoking obsessions, which is not the case with gambling behaviour in 
gambling disorder.
Boundary with personality disorder
Some individuals with personality disorder with prominent dissocial features or prominent 
features of disinhibition may engage in problematic gambling behaviour. A diagnosis of gambling 
disorder can be assigned together with a personality disorder diagnosis if the diagnostic 
requirements for both are met.
Disorders due to addictive behaviours | Gambling disorder