What Is A Gambling Disorder? New NCRG Video Explains The Facts

The National Center for Responsible Gaming (NCRG) is excited to share a new resource today!

To help answer the question:“What is a gambling disorder?”, the NCRG created a video that uses research-based facts to provide a better understanding of gambling disorders, whom and how many people they impact and how they are diagnosed and treated.

This is the first video of the NCRG’s newest educational initiative, which was developed to help the public better understand gambling disorders and responsible gaming. The NCRG video series supports the organization’s ongoing mission to advance public education about gambling disorders and responsible gaming. The organization will release additional videos throughout the year to address and explain other relevant topics.

In apress releaseannouncing the video, the NCRG’s Senior Research Director, Christine Reilly, said:

“There is a lot of information on gambling disorders and responsible gaming – some of it is difficult to understand and some of it is not based on scientific studies. This resource, as well as future NCRG videos, will explain the latest research on gambling disorders in a quick, easy-to-understand format that can be easily shared among those interested in learning more about this issue, as well as the impact that NCRG-funded research has made since 1996.”

The NCRG offered a sneak peak of the video during last month’s American Psychiatric Association annual meeting. There, NCRG researchers and staff members had a unique opportunity to educate more than 13,000 psychiatrists about gambling disorders and the changes for the disorder that are included in the fifth edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM-5).

We encourage you to share the video with your friends and colleagues. Here are three ways you can pass it along:

As always, we welcome your feedback in the comments section below.

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NCRG On The Road: Next Stop – Las Vegas And Boston

This post was written by Amy Kugler, the NCRG’s communications and outreach manager. Make sure to follow all of the NCRG’s activities onTwitterandFacebook.

NCRG Communications and Outreach Manager Amy Kugler

Christine Reilly, Nathan Smith and I have been traveling quite a bit lately. As you’ve probably seen by our posts on Gambling Disorders 360, Facebook and Twitter, we had a wonderful time and learned a great amount of information at the American Psychiatric Association’s annual conference in San Francisco. We were happy to meet new people and forge new partnerships, and had a unique opportunity to educate more than 13,000 psychiatrists about gambling disorders and the changes with thefifth edition of theDiagnostic and Statistical Manual of Mental Disorders(DSM-5).

We’re hitting the road next week for two stellar conferences. If you’re attending either of these, we hope you’ll stop by our booth or say hello during a session!

From May 27 to 31, I’m traveling to Las Vegas to be a part of the15th International Conference on Gambling and Risk Taking, presented in partnership by UNLV’s International Gaming Institute and the Institute for the Study of Gambling and Commercial Gaming at the University of Nevada, Reno. The agenda is packed with some interesting sessions that examine research and experiences of those who study gambling from across the world. I’m looking forward to being a part of the Panel Of Centers, and our goal is to find ways to collaborate on new initiatives that help to increase the quality of research and education on gambling disorders and responsible gaming.

In addition to following the NCRG’s social media channels, you can followUNLV’s Twitter account @UNLVIGIfor the latest news from the conference.

After this conference, I’ll be flying to Boston to participate in theAmerican College Health Association’s annual conferencewith Christine and Nathan. Not only will the NCRG be at booth #236 sharing more aboutCollegeGambling.organd our plans for the future of that resource, but we will also have an NCRG-funded researcher presenting his latest research during a keynote session.Clayton Neighbors, Ph.D.,from the University of Houston, will be talking about the online screening and brief intervention that he developed and tested over the past two years. This will be the first screen of its kind, and once it is finished, it will be available onCollegeGambling.orgfor all students to use. This presentation will be on Sat., June 1 at 8 a.m. ET.

As always, we’ll bring you live updates on the NCRG’s Twitter and Facebook pages, and we’ll blog about our experiences here at Gambling Disorders 360. Additionally, we’ll launch a brand new resource for clinicians, researchers and public health professionals next week, so stay tuned!

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Nida Director Reports On New Substance Use Disorders Research At Apa

On Monday May 20, Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA), reported on new research findings and treatment opportunities at an hour-long lecture for the American Psychiatric Association’s annual meeting. Because of the high rate of co-occurring addictive disorders among individuals with a gambling disorder, it is important to keep abreast of new developments in the field of substance use disorders.

Here are some highlights from Dr. Volkow’s presentation:

  • Historically, the research finding that the prefrontal cortex is implicated in addiction was very controversial at first. The prefrontal cortex is the region of the brain involved in functions such as executive function and decision-making.
  • The addicted brain shows disruptions in the prefrontal cortex resulting in an individual’s ability to ‘not have brakes’ in terms of dealing or stopping excessive substance use.
  • Psychotherapy can modify the prefrontal cortex by focusing on the development of greater self control.
  • Research has shown that dysfunction in the brain’s dopamine D2 receptors increase an individual’s risk for addiction. Animal studies also have demonstrated that gene therapy can correct that dysfunction.
  • Research on vaccines for substance use disorders seeks to enable the body to create antibodies that prevents the impact of the substance on the brain.

For more information about research on substance use disorders, visitwww.drugabuse.gov.

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Apa Considers Potential Internet Gaming Disorder

Has the reclassification of gambling disorder as a addictive behavior in the the fifth edition of theDiagnostic and Statistical Manual of Mental Disorders(DSM-5) opened the floodgates to other non-substance based addictions? The American Psychiatric Association (APA) announced yesterday that Internet Gaming Disorder is identified in Section III of theDSM-5as a condition warranting more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder.

Wilson Compton, M.D., of theDSM-5work group on Substance Use Disorders and the National Institute on Drug Abuse reported that the DSM-5 group was persuaded to highlight Internet Gaming Disorder because of studies, mainly from researchers in Asian countries. This research showed that excessively playing social online games could indicate a robust phenomenon potentially deserving of a diagnostic category. The “gamers” play compulsively, to the exclusion of other interests, and their persistent and recurrent online activity results in clinically significant impairment or distress. Studies indicate that young males are most at risk for this problem. Keep in mind that the research cited for this phenomenon is focused on gaming, not Internet gambling although the proposed criteria parallel the symptoms for a gambling disorder.

The research base for Internet Gaming Disorder remains underdeveloped and, therefore, a number of limitations characterize this body of work. For example, studies measuring the prevalence of the condition used different measures and have wildly different results, from 6 to 64 percent. Many of the studies used a sample of convenience, meaning that the individuals who were surveyed were not representative of the entire population.

The recognition of this condition raises a number of questions:

– Could this condition be culture-bound and only specific to the Asian countries in which the bulk of the research has been conducted?

– Will the openness to behavioral addictions in addition to gambling disorder result in an eventual laundry list of different addictive behaviors focused on the target of the addiction rather than the underlying causes of addiction? The concept of addiction as syndrome, a concept proposed by Shaffer et al. (2004), provides an alternative framework that would preclude such a development.

– Will the label ‘Internet Gaming Disorder’ be misconstrued as gambling, especially with the expansion of Internet gambling?

What do you think of Internet Gaming Disorder? Share your comments below.

References

Shaffer, H.J., LaPlante, D.A., LaBrie, R.A., Kidman, R.C., Donato, A., & Stanton, M.V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology.Harvard Review of Psychiatry, 12(6), 367-374.

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Clarification Of The Dsm-5 Revisions By The Substance Use Disorders Work Group

To coincide with the release of the American Psychiatric Association’s (APA)Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the APA developed a conference track consisting of more than 10 sessions to educate clinicians about the changes to the new diagnostic code. The first session, titled “Substance Use Disorders in DSM-5,” featured leaders of theDSM-5work group in charge of substance use and related conditions who presented an overview of theDSM-5changes and some of the controversies the committee faced when reviewing the new manual.

The biggest, and probably most controversial, change to theDSM-5substance abuse criteria is the merging of the two former diagnoses (substance “abuse” and the more severe “dependence”) and their separate scales into one category and scale that now includes three levels of severity: “mild,” moderate” and “severe”. This change prompted worries from the audience about whether insurance companies may be reluctant to fund treatments for a disorder that is “mild” by definition.

TheDSM-5work group answered these worries with assurances that some disorders already use the term “mild” without any ill effects to insurance coverage. They also offered a reminder that the Affordable Care Act (ACA) emphasizes funding prevention for health issues before they become a more serious disorder – a focus that will certainly include the treatment of “mild” disordered behavior. To help clinicians understand how the ACA will impact treatment and prevention services of gambling disorders, a representative from the U.S. Department of Health and Human Services will address this issue at the14thannual NCRG Conference on Gambling and Addiction.

The second set of changes the DSM-5 committee discussed were directly related to gambling disorders. The changes included the change in nomenclature from “pathological gambling” to “gambling disorder”, the deletion of the “illegal acts” criterion from the diagnostic symptoms for the disorder, the reduction from 5 to 4 criteria to be diagnosed with the disorder, and the movement of the disorder from to the “Addictions and Related Disorders” category. We were pleased to see that the committee specifically referenced several studies funded by the National Center for Responsible Gaming (NCRG) over the past 17 years, including studies byJon Grant, J.D., M.D., M.P.Hlat The University of Chicago,Ron Kessler, Ph.D.at Harvard School of Public Health, andHoward Shaffer, Ph.D.at Cambridge Health Alliance, a teaching affiliate of Harvard Med School.

All of theDSM-5 work groups will be leading more than 10 sessions throughout the APA annual meeting to educate clinicians about the impact of the manual’s revisions. Stay tuned toGambling Disorders 360°and the NCRG’sTwitterandFacebookpages for more details about the happenings here at the APA convention in San Francisco, Calif..

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The Evolving Definition Of Pathological Gambling In The Dsm-5

To clarify the various revisions in the American Psychiatric Association’s fifth edition of theDiagnostic and Statistical Manual (DSM-5)relating to gambling disorders,the National Center for Responsible Gaming (NCRG) authored a white paper, titled ‘The Evolving Defintion of Pathological Gambling in the DSM-5.’ Below is an excerpt of that white paper that outlines the specific changes. For a free download of the white paper, visitwww.ncrg.org/resources/white-papers.

CHANGES FOR PG IN DSM-5

Reclassification: From Impulse Control Disorder to Addiction

In the DSM-IV, pathological gambling (PG) was classified under the section titled, “Impulse Control Disorders Not Elsewhere Classified,” along with Compulsive Hair Pulling (Trichotillomania); Intermittent Explosive Disorder; Kleptomania; and Pyromania. TheDSM-5work group proposed that PG be moved to the category Substance-Related and Addictive Disorders.

The rationale for this change is that the growing scientific literature on PG reveals common elements with substance use disorders. Many scientists and clinicians have long believed that problem gamblers closely resemble alcoholics and drug addicts, not only from the external consequences of problem finances and destruction of relationships, but, increasingly, on the inside as well.According to Dr. Charles O’Brien, chair of the Substance-Related Disorders Work Group for DSM-5, brain imaging studies and neurochemical tests have made a “strong case that [gambling] activates the reward system in much the same way that a drug does.” Pathological gamblers report cravings and highs in response to their stimulus of choice; it also runs in families, often alongside other addictions. Neuroscience and genetics research has played a key role in these determinations.

Internet addiction was considered for this category, but work group members decided there was insufficient research data for it to be included. Another so-called behavioral addiction, “sex addiction,” also was not included because the work group found no scientific evidence that “reward circuitry is operative in the same way as in addictive areas.”

Renaming: From PG to Gambling Disorder

Officially changing the name to “Gambling Disorder” is a welcome revision for many researchers

and clinicians who have expressed concern that the label “pathological” is a pejorative term that

only reinforces the social stigma of being a problem gambler.5

Renaming: From PG to Gambling Disorder

Officially changing the name to “Gambling Disorder” is a welcome revision for many researchers and clinicians who have expressed concern that the label “pathological” is a pejorative term that only reinforces the social stigma of being a problem gambler.

Changes in Diagnostic Criteria and Lowering of Threshold for a Diagnosis

One major change in the DSM-5’s clinical description of gambling disorders is the elimination of the criterion “has committed illegal acts such as forgery, fraud theft or embezzlement to finance gambling.” The rationale for this change is the low prevalence of this behavior among individuals with gambling disorder. In other words, no studies have found that assessing criminal behavior helps distinguish between people with a gambling disorder and those without one. Studies suggest that its elimination will have little or no effect on prevalence rates and little effect on diagnosis. However, although committing illegal acts will no longer be a stand-alone criterion for diagnosis, the text will state that illegal acts are associated with the disorder. In particular, the criterion related to lying to others to cover up the extent of gambling will be described to include specific mention of illegal activities as one potential form of lying.

Other changes in the criteria are as follows:

• “Is preoccupied with gambling” will be “Is often preoccupied with gambling” to clarifythat one need not be obsessed with gambling all of the time to meet this diagnostic criteria.

• “Gambles as a way to escape from problems” will be “Gambles when feeling distressed.”

• In the text accompanying the criteria, “chasing one’s losses” is clarified as the frequent,and often long-term, “chase” that is characteristic of gambling disorder, not short-term chasing.

TheDSM-5work group observed that several empirical studies have supported lowering the threshold for a more accurate diagnosis of a gambling disorder from five to four criterion. For example, Stinchfield found that a cutoff score of four made modest improvements in classification accuracy and, most importantly, reduced the rate of false negatives. Anotherrecent study conducted in France found that theDSM-5criteria (the DSM-IV criteria without the illegal acts criterion and with a cutoff of four symptoms) performed better than theDSM-IVcriteria alone, the DSM-IV criteria without the illegal acts criterion and a new instrument based on theDSMcriteria for substance abuse.

Finally, to diagnose a gambling disorder, the critiera that are displayed among the individualmust occur within a 12-month period, unlike theDSM-IVwhich did not provide a time period for symptoms. In other words, if the person had two symptoms years ago and two symptoms in the past year, he or she would not qualify for a diagnosis.

References

American Psychiatric Association. DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. Fourth ed.Washington, DC: American Psychiatric Association; 1994.

Holden C. Behavioral addictions debut in proposed DSM-V. Science. 2010;327(5968):935.

Potenza MN, Xian H, Shah K, Scherrer JF, Eisen SA. Shared genetic contributions to pathological gambling and major depression in men. Archives of General Psychiatry. Sep 2005;62(9):1015-1021.

Strong DR, Kahler CW. Evaluation of the continuum of gambling problems using the DSM-IV. Addiction. 2007;102(5):713-721.

Petry NM, Blanco C, Auriacombe M, et al. An Overview of and Rationale for Changes Proposed for PathologicalGambling in DSM-5. J Gambl Stud. 2013.

Stinchfield R. Reliability, validity, and classification accuracy of a measure of DSM-IV diagnostic criteria forpathological gambling. Am J Psychiatry. 2003;160(1):180-182.

Denis C, Fatseas M, Auriacombe M. Analyses related to the development of DSM-5 criteria for substance userelated disorders. An assessment of Pathological Gambling criteria. Drug Alcohol Depend. Apr 1 2011;122(1-2):22-27.

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American Psychiatric Association Releases Dsm-5

DSM-5 panel

Drs. Lieberman, Kupfer and Regier announce the launch of the DSM-5

As the release of the American Psychiatric Association’s (APA) fifth edition of theDiagnostic and Statistical Manual (DSM-5)looms, more than 13,000 psychiatrists descended upon San Francisco, Calif. For the APA, the first order of business was to launch theDSM-5and answer the many questions about the revisions – and controversy – of this much-anticipated publication.

DSM-5’s New Organization

Among the many changes within theDSM-5’s pages, what theDSM-5Task Force is most excited about are the revisions with the organization of the manual. Not only are the more than 15 significant changes to disorders, but the authors reorganized theDSM-5to make it easier to use for clinicians.

“The process wasn’t so pretty,” said Jeffrey A. Lieberman, M.D., president-elect of the APA. “Regardless, we believe this represents the gold standard of psychiatric diagnosis based on the research available to date.”

The newest addition to the overall structure of the manual is the last section that includes key components to help translate this research into practical, daily use for clinicians, researchers and others. First, this section includes conditions that require further research before they’re considered to be a formal disorder. Some of these disorders, such as anxious depression and sensory processing disorder, lacked enough scientific evidence to consider it a “done deal” – coined by David Kupfer, M.D., chair of the DSM-5 Task Force.

Additionally, this section of theDSM-5includes a toolkit that helps mental health professionals learn about and apply these diagnoses in clinical settings. This toolkit also covers self-assessment tools and various resources that address cultural components as they relate to diagnosis and treatment options.

“The Glossary of Cultural Concepts of Distress in theDSM-5’s third section was an important piece to include,” said Dilip V. Jeste, M.D., president of the APA. “Mental illness is something that crosses cultural barriers, and we wanted clinicians some tools to address the culturally sensitive nature of some mental health issues.”

A Call for More Research

A topic that some of the media wanted to focus on during theDSM-5launch was the perceived difference of opinion between the National Institute of Mental Health Director Thomas Insel, M.D. and the APA’s revisions. (The NCRG covered this debate with aGambling Disorders 360°postlast week). When asked about it, theDSM-5Task Force and APA leadership discussed the need to have research bring forth biomarkers and so that the diagnostic criteria could be further refined and the mental health field could advance.

“While we don’t have the biomarkers that are on the verge of discovery in research, patients can’t keep waiting,” said Dr. Kupfer.

Make sure to follow the NCRG onTwitter,FacebookandStorifyfor the latest news from the APA annual meeting.

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Help The NCRG Recognize Excellence: Submit A Nomination For The 2013 NCRG Scientific Achievement Award

Dr. Randy Stinchfield receives the 2012 Scientific Achievement Award

Do you know a pioneer in the field of research on gambling disorders? Each year, theNational Center for Responsible Gaming(NCRG) recognizes outstanding contributions to the field of research on gambling disorders with theNCRG Scientific Achievement Award.This year’s award will be presented during theNCRG Conference on Gambling and Addictionin Las Vegas, taking place Sept. 22-24, 2013

Nominations may include:

  • Research investigators at any stage in their career—early stage, mid-career or senior– whose research has made significant contributions to the knowledge base about gambling disorders;
  • Educators who have successfully mentored young investigators in the field or have excelled at promoting public awareness and education about gambling disorders and responsible gaming; and/or
  • A recent publication in a scientific, peer-reviewed journal that represents seminal work in the field.

The nomination package must include the following:

  • Letter of recommendation: A detailed letter of recommendation describing the worthiness of the nominee, specifying his or her contribution to the field of gambling research or the significance of the publication nominated.
  • Curriculum vitae (CV): For individual nominees, include an up-to-date CV.
  • For research investigators, include a comprehensive bibliography of the nominee’s publications.
  • Publications: For research investigators, submit no more than five scientific publications representative of the nominee’s work. In the case of a nomination of a publication, include a copy of the published version of the article. The publication must have been published in the same year as or the year prior to the nomination.

Submit nomination materials in PDF format to NCRG Senior Research Director Christine Reilly (creilly@ncrg.org) by Aug. 1, 2013. The selection committee, composed of distinguished scientists in the addictions field, will select one recipient to receive the 2013 award.

Each NCRG Scientific Achievement Award winner has an intriguing story to tell, and last year’s winner was no exception.Watch Randy Stinchfield, Ph.D., L.P.P., of the University of Minnesota, receive the 2012 NCRG Scientific Achievement Award for his contributions to research on youth gambling. You can also visit theaward websitefor a list of past recipients.

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Want To Learn More About The Dsm-5 And This Year's Apa Meeting? The NCRG Has It Covered!

Visit the NCRG at APA - Booth #2128

Today, the NCRG staff is traveling to San Francisco to prepare for the American Psychiatric Association’s (APA) annual meeting. The buildup for this event is coming to a peak as the APA releases their highly anticipated fifth edition of theDiagnostic and Statistical Manual for Mental Disorders (DSM-5)on May 21. Christine Reilly, Nathan Smith and Amy Kugler will be on-site to provide the latest information aboutDSM-5revisions, updates from the conference and insights from the conference sessions.

There are a few ways to connect with the NCRG’s coverage of the APA’s conference and the many updates:

  • Follow the NCRG’s Storify, titled“Unveiling theDSM-5”. Amy will be posting the most relevant information from the NCRG and related organizations, media opinions and insights from social media.
  • Subscribe toGambling Disorders 360°,the NCRG’s blog, for posts about some of the APA conference sessions andDSM-5announcements.
  • Connect with the NCRG on Twitter (@theNCRG; #DSM5) and Facebook (Facebook.com/theNCRG).
  • Visit the NCRG and talk with Christine, Nathan and Amy at Booth #2128 in the APA exhibit hall.

The NCRG has been watching this timeline closely, as some of theDSM-5’s revisions impact the field of gambling disorders and addictions. To understand some of the changes that the new diagnostic code will include relating to gambling disorders, download the NCRG’s white paper, titled “The Evolving Definition of Pathological Gambling in theDSM-5.”

Have a question or comment about theDSM-5revision? Leave your thoughts in the comment section below.

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Rdoc And Dsm-5: The Future Of Diagnosis

National Institutes of Mental Health

The debut of thefifth editionof theAmerican Psychiatric Association’s(APA)Diagnostic and Statistical Manual of Mental Disorders (DSM)at the upcoming APA annual meeting might be regarded as the year’s most anticipated event in the mental health field. Its release has been covered in the media, including theWashington PostandThe New York Times,andexperts have weighed in with their viewof how this publication will impact clinicians, researchers and those diagnosed with mental disorders. However, an initiative underway for several years at theNational Institute of Mental Health(NIMH) could have more far-reaching effects on the diagnosis and treatment of mental health disorders and addiction.

TheNIMH’s Research Domain Criteria(RDoC) project was born of the inability of previous editions of theDSMto achieve both of their ultimate scientific objectives: produce areliable diagnostic codefor clinicians to use, and prove that these diagnoses arevalid(i.e. the measure to which the DSM accurately diagnosis what it claims to diagnose).1On the one hand, theDSM-IIIandDSM-IVachieved the first objective of insuringreliabilityof the diagnostic constructs across different research and clinical settings through the use of diagnostic criteria, providing a “common language” among clinicians and ensuring “that a diagnosis is both accurate and consistent; for example, that a diagnosis of schizophrenia is consistent from one clinician to another, and means the same thing to both of these clinicians, whether they reside in the United States or other international settings.”2

On the other hand, the objective of establishing thevalidityof the diagnostic categories has not been achieved.1Unlike definitions of medical illness, such as heart disease or AIDS, “theDSMdiagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure,” such as found in genetics and brain imaging research.3

NIMH Director Dr. Thomas Insel

Consequently under the leadership of NIMH DirectorThomas Insel, M.D., the institute concluded that a new strategic framework was essential for generating research–unconstrained by theDSMcategories– that will eventually enable health care professionals to diagnose mental disorders as precisely as identifying strep throat by a throat swab. To achieve this goal, the NIMH will place a priority on collecting the imaging, genetic, physiologic and cognitive data on mental disorders–not just the symptoms–and see how they relate to treatment.3In other words, the emphasis will be on the causes of the disorder, not the symptoms.4

In this light, the utility of neuroscience and genetic studies on disordered gambling for developing treatment strategies becomes clearer. As Dr. Insel has noted, “Symptoms alone rarely indicate the best choice of treatment.”3For example, a study of the brain’s circuitry rather than a focus on symptoms might suggest which areas of brain are implicated in the impulsivity and poor decision-making of disordered gambling and, therefore, offer a region at which drug treatment can be targeted.5,6

One critique of RDoC is that the research base has not developed fully enough to supply the data needed to transform diagnosis and treatment. In response to Dr. Insel’s blog about RDoC andDSM-5,David Kupfer, M.D., chair of APA’sDSM-5Task Force, argued that although “efforts like the National Institute of Mental Health’s Research Domain Criteria [RDoC] are vital to the continued progress of our collective understanding of mental disorders,’ the RDoC vision of a system based on biological and genetic markers ‘remains disappointingly distant’ and ‘cannot serve us in the here and now.’7It ‘merely hand[s] patients another promissory note that something may happen sometime.”7

What do you think of the RdoC approach? Please leave your thoughts or comments in the section below.

The National Center for Responsible Gaming (NCRG) will also be at the APA Annual Meeting from May 17 to 22 as theDSM-5is released. NCRG staff members Christine Reilly, Nathan Smith and Amy Kugler will be live blogging and updating the NCRG’s Facebook and Twitter pages with news and insights. The NCRG will also be at Booth #2128 in the APA Exhibit Hall. Please follow us online or in person as the events unfold at the APA Annual Meeting!

References

1. DSM-5 and the NIMH Research Domain Criteria Project – Psychiatric Times. 2011. Available at: http://www.psychiatrictimes.com/blog/dsm-5/content/article/10168/1842906. Accessed May 6, 2013.

2. American Psychiatric Association. DSM-5 Development. 2010. Available at: www.dsm5.org.

3. Insel T. NIMH Director’s Blog.Transform. Diagn.2013. Available at: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml.

4. Belluck P, Carey B. Psychiatry’s New Guide Falls Short, Experts Say.The New York Times. http://www.nytimes.com/2013/05/07/health/psychiatrys-new-guide-falls-short-experts-say.html. Published May 6, 2013. Accessed May 7, 2013.

5. Balodis IM, Kober H, Worhunsky PD, Stevens MC, Pearlson GD, Potenza MN. Diminished frontostriatal activity during processing of monetary rewards and losses in pathological gambling.Biol. Psychiatry. 2012;71(8):749–757. doi:10.1016/j.biopsych.2012.01.006.

6. Potenza MN. Pharmacological approaches to treating pathological gambling. In:What Clinicians Need to Know about Gambling Disorders.Vol 7. Increasing the Odds: A Series Dedicated to Understanding Gambling Addiction. Washington, DC: National Center for Responsible Gaming; 2012:52–60. Available at: http://www.ncrg.org/resources/monographs. Accessed April 30, 2013.

7. American Psychiatric Association. Psychiatric News Alert.David Kupfer Md Responds Crit. Dsm-5 Nimh Dir.Available at: http://alert.psychiatricnews.org/2013/05/david-kupfer-md-responds-to-criticism.html?spref=tw. Accessed May 6, 2013.

NCRG staffResearch UpdateDr. InselDr. KupferDSM-5NIMHRDoC

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