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PSYCHIATRY

Cards on the table

Prizewinning thesis defines personality of pathological gamblers

If you know someone who talks a lot about betting and only feels happy when absorbed in bingo cards, slot machines, lotteries, card games or horse races, take care. Obstinacy for betting is a trait of the pathological gambler, an unbalanced personality that, if not controlled, may go to the extreme of robbing or killing to stay in the game, just like – in a comparison now sustained scientifically – the chemically dependent.

Diagnosed precisely in Brazil a few years ago, the pathological gambler was easily mistaken for the bearer of an obsessive-compulsive disorder (OCD), an individual who suffers from manias: washing hands all the time, or always keeping the house impeccably tidy, for example. But they are different categories, as it was demonstrated by doctor Hermano Tavares in his doctorate at the School of Medicine of the University of São Paulo (USP). The work won the recognition of the National Council on Problem Gambling (NCPG), an American organization dedicated to understanding and containing the vice of games of chance: Tavares was awarded an engraved plaque and invited to give a lecture at the institution’s annual congress in Dallas, United States, on the 14th of this month.

In his thesis, supervised by Valentim Gentil Filho, Tavares researched the personality traits peculiar to the bearers of this disorder, little studied in Brazil. With the team from the Clinic for Pathological Gambling and Other Impulsive Disorders (Amjo), of USP’s Institute of Psychiatry, he compared 40 pathological gamblers, 40 patients with OCD and 40 persons with none of these problems.

One of the most important conclusions is that, although there is a combination of impulsive traits (little reflection, followed by rapid reaction, prodigality, and scant appreciation for rules and standards) and compulsive ones (fear of uncertainty), besides the obsession for gambling for money, the personality of the pathological gambler is clearly different from that of the OCD sufferers. “The thesis demonstrates that there are more similarities between pathological gambling and chemical dependency than with OCD”, reveals the researcher, who is doing post-doctoral studies at the University of Calgary, Canada. For him, the best definition of pathological gambling is a behavioral dependency. The sensation of ecstasy – similar to ecstasy caused by drugs – comes from betting, from the emotion of getting good results and from winning.

The mind does not leave the betting environment. “The pathological gambler is constantly concerned with the game, awaiting the time to be able to make a new bet, concocting strategies for winning or imagining how to get money to pay gambling debts”, says Tavares. Another sign: the desire to recover lost money, in a continuous movement that nourishes the debt and anxiety. “The lack of control over behavior”, he goes on, “is revealed in frustrated attempts to cut down or to abstain from gambling, lies to conceal the extent of the dependency, and involvement in illegal activities, such as forging checks and theft, to finance gambling”.

Tavares adopted personality scales habitually used to distinguish pathological gamblers from OCD sufferers. In 2000, the year when the thesis was concluded, the complete results on one of the scales, the Temperament and Character Inventory (TCI) came out in the Revista de Psiquiatria Clínica (Clinical Psychiatry Magazine). This conceives the development of the personality as a two-way road, between temperament and character: hereditary factors of temperament (the search for novelty, dependence on reward and persistency, for example) motivate factors of character (self-direction and cooperativeness, amongst others), which in turn activate the mechanisms of response to a stimulus (the will to gamble, for example).

Social problem
“The search for treatment has skyrocketed after the electronic bingo games and video games, in particular the poker games and bingo itself, spread throughout the country in the 90s”, Tavares notes. His study and those of other specialists show a clear correlation between permitting the practice of gambling – more accessible all the time – and the increase in the confirmed diagnoses of pathological gamblers.

There are no statistics in Brazil, but those from abroad indicate that between 1% and 4% of the population suffers from this disorder, which is regarded as a dependency, although less frequent than alcohol and tobacco and prescription drugs like tranquilizers and amphetamines, for example. But it is more common than dependency on cocaine and crack and than the classic psychiatric disturbances, amongst them schizophrenia.

“The effects of pathological gambling, such as going chronically into debt, suicide attempts and the increase in criminality, should be taken into account at this moment when the reintroduction of casinos is being discussed in Brazil”, warns the researcher, who launches an appeal: “It’s high time for us to begin a study on the frequency and the impact of pathological gambling on Brazilian society, at least in the big cities, where the electronic bingo games and video games have become popular”.

It is known beforehand that women can be more affected than men. In 2001, Tavares published a work in the Journal of Gambling Studies showing that women develop the condition of pathological gambling twice as quickly. “Statistics today indicate a proportion of two men to every woman”, he says, “but, as gambling gets more popular, more women are gambling, and the tendency in future is for the proportion to drop to one woman for each man”.With home video games, the danger seems smaller. According to Tavares, in principle, dependency only sets in from games of chance, defined by two characteristics: the skill of the player does not increase the chances of winning, and the final results are usually random. But he warns that one cannot be sure of this, because there are still no studies that relate an excessive interest of children with video games with the appearance of pathological gambling in adult life.

In Canada, with Nady el-Guebaly and David Hodgins, veteran researchers in the area, Tavares is working on applying his data to a local sample and on comparing gamblers and alcoholics as to their personality and greed. The preliminary results point to a correlation between greed and impulsive personality traits. The researcher, who intends to come back in December, believes that criteria for classifying pathological gamblers into subtypes will come from this – predominantly impulsive or compulsive, for example – and therapeutic variations. “The treatment of the impulsive ones would focus on greed as a factor of risk for relapses; and with the compulsive ones, the negative emotions like anxiety and depression, in precipitating relapses”.

THE PROJECT
Pathological Gambling and its relationship with the impulsive-compulsive spectrum
Modality
Grant for a doctorate
Coordinator
Valentim Gentil Filho – USP
Investment
R$ 40,585.32

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