PURPOSE
The article reviewed and evaluated the literature that had subtyped pathological gamblers on the basis of psychopathology, personality, and/or gambling motivations. It highlighted the major consistencies between the subtyping schemes and the empirical research literature that provided evidence for their validity. The results were presented in the context of Blaszczynski and Nower's (2002) pathways model of pathological gambling (PG), a theoretically driven model that incorporates developmental, neurobiological, cognitive, and personality variables in presenting various causal pathways to the development of PG subtypes. The model suggests three major pathways, each associated with specific vulnerability factors, demographic features, and etiological processes that lead to the development of PG. Behaviourally conditioned gamblers fluctuate between regular and excessive gambling mainly because of the effects of conditioning, distorted cognitions, and/or bad judgments or poor decision-making. This subtype is associated with the least severe gambling and gambling-related difficulties. These individuals do not demonstrate signs of major premorbid psychopathology, substance abuse, impulsivity, or antisocial behaviours. Emotionally vulnerable gamblers exhibit identical environmental determinants, conditioning processes, and cognitive schemas about gambling as behaviourally conditioned gamblers, but they also present with premorbid depression and/or anxiety, a history of inadequate coping and problem-solving skills, and negative family background experiences. The emotionally vulnerable gamblers' gambling is largely motivated by a desire to regulate dysphoric (i.e., negative) mood states and/or to meet specific psychological needs. Antisocial impulsivist pathological gamblers are considered the most psychopathological subtype. They exhibit substantial psychological disturbance from gambling, and are characterized by signs of potential neurological or neurochemical dysfunction. They are distinguished from emotionally vulnerable gamblers by features of impulsivity, antisocial personality disorder, and attention deficit. They also report a range of behavioural difficulties independent of their gambling. Their gambling commences early in life, reaches severe levels, and is associated with early entry into gambling-related crime.
PROCEDURE
A literature search was conducted on PsychINFO and MedLine databases for the period 1900-2009. Articles were also retrieved from reference lists of relevant articles. Eighteen papers provided empirically and clinically significant subtyping models of PG and were reviewed.
KEY RESULTS
Differences were found between the studies in the definition and measurement of psychopathology and personality, statistical methods employed to classify gamblers, and gambling subtyping schemes produced; however, three distinct subtypes of pathological gamblers emerged. These subtypes were consistent with those that Blaszczynski and Nower (2002) outlined in their pathways model of PG. The three subtypes differ based on their motivations for gambling, as well as their psychopathological and personality presentations. Subtype 1: Emotionally Vulnerable. This PG subtype demonstrated elevated levels of depression and/or anxiety and was referred to as the neurotic, depressive or anxious, recurringly depressed, depression-prone, escape seeker, psychologically distressed, emotionally vulnerable, escape, coping, or demoralized gambler. Subtype 2: Antisocial Impulsivist. This PG subtype showed marked impulsivity and gambled to increase levels of arousal and/or decrease boredom. This PG subtype was referred to as an impulsive, passive–aggressive, emotionally unstable, chronically under stimulated, boredom prone, action seeking, antisocial, egotistic, enhancement, or hedonic gambler. Subtype 3: Behaviourally Conditioned. This PG subtype did not exhibit serious premorbid signs of psychopathology or maladaptive personality traits, and was reported to gamble largely due to external factors and/or behavioural conditioning. This PG subtype was referred to as a subcultural, normal, behaviourally conditioned, social, low emotion regulation, and simple gambler.
LIMITATIONS
All but one of the studies employed a cross-sectional research design which limits knowledge about the stability of gambling subtypes over time, the ability to evaluate whether elements related to the subtypes have a role in the development of PG, and the ability to predict various gambling-related outcomes based on subtype. The order of onset of psychopathology, maladaptive personality traits, and PG was not measured in any of the subtyping studies. Empirical investigation of the association between gambling typologies and treatment outcomes was limited. Most studies included few, if any, female pathological gamblers. It is unknown if there is consistency in gambling subtypes across the genders. Further, the PG typology literature largely utilized treatment-seeking gamblers. It is unknown if the PG subtypes derived using treatment-seeking samples have external validity to pathological gamblers within the community.
CONCLUSIONS
The literature review revealed that three PG subtypes consistently emerge. These subtypes closely parallel the three types of gamblers presented in Blaszczynski and Nower’s (2002) conceptual pathways model. Future research on PG subtypes should build upon the theoretical framework of the model, but also address the limitations of previous studies.
