1. Females with gambling disorder: characteristics and obstacles for treatment
Lisbon Addictions
October 24th, 2017
University of Hohenheim
Gambling Research Center
Andrea Wöhr M. A.
© University of Hohenheim, Gambling Research Center (502)

2. Disclosure I have no actual or potential conflict of interest
in relation to this presentation. 2

3. Prevalence of males and females with gambling disorder3

4. Lower prevalence as treatment barrier
You can see all the men in the bookies, down the horse races, you very rarely see females playing fruit machines with the men in the bar. I think it’s predominantly a male thing, which is why as a female doing it you feel even worse, you think there’s something wrong with me. (Amy, in: Kaufman et al. 2016) 4

5. Telescoping
Women, even though they begin to gamble later than men, become dependent more quickly than men
Earlier onset of gambling in men; slower development of gambling disorder
(e. g. Blanco et al. 2006, Ladd and Petry 2002, Tavares et al )
National Problem Gambling Clinic (UK): priorisation of women on waiting lists (Mooney and Kaufman 2017) 5

6. Comorbidities On average, females have higher rates of depression
anxiety disorder
PTSD
(e. g. Desai and Potenza 2008, Vogelgesang 2013)
…whereas males show higher rates of
substance use disorders
impulse control disorders
(e. g. Gonzalez-Ortega et al )
address psychiatric disorders in treatment hidden gambling problem in females with psychic disorders 6

7. Biographical background
Example: in-patient clients, n=200
„11% of the male and 22% of the female clients reported having experienced severe and continuous neglect as a child, such as the lack of food and clothing, a bed or blankets“
„4% of the males and 35% of the females reported having been sexually abused during their childhood and youth. In most cases, they had been abused continually and by several persons. On average, females were abused from the age of 8.13 years onwards and were thus significantly younger than the male group (13.33 years).“
(Vogelgesang 2010) 7

8. Mental stress
“female pathological gamblers showed higher mental stress values according to the Global Stress Index (GSI)” (Koschel et al. 2017)
“At the beginning of the treatment, female gamblers … showed a considerably higher degree of mental stress according to the symptom checkist SCL-90R” (Premper 2006)
“Women displayed higher impact scores on the Daily Stress Inventory. Other stress measures, obtained with the Profile of Mood States (POMS), were also significantly elevated” (Tschibelu and Elman 2011) 8

9. Motivation for gambling
On average, females gamble
coping strategy
mood regulation
(e. g. Grant and Kim 2002)
Motives more frequently mentioned by male gamblers
risk-taking
sensation-seeking
(e. g. Ladd and Petry 2002, Ibanez et al. 2002)
“Women must face the very problem they have been avoiding or escaping from through gambling but without their usual coping resource” (Mooney and Kaufman 2017) 9

10. Preferred type of game
Females prefer non-strategic gambling (e. g. Potenza et al. 2001)
“the self-soothing effect is obtained by choosing gambling products which require a low level of skill and provide a high level of absorption” (Karter 2017) 10

11. Treatment-seeking
“Female pathological gamblers are much less likely to enter treatment for a gambling- related problem” (Volberg 1994)
“Women more likely to seek treatment, in part because they are more likely to recognize that they have a problem”
(Slutske et al. 2009) ? 11

12. Males and females in treatment
Persons with GD
2009 n=10.000
2011
n=10.002
2013
n=11.500
2015 n=11.501
total
0,5 %
0,8 %
0,4 %
Relationship
female : male
1 : 2
1 : 4
1 : 7
Source: Federal Center of Health Education
GD main diagnosis
2009 n=6.740
n=9.025
n=11.704
2015
n=12.018
1 : 9
1 : 8
Source: German Addiction Treatment Statistics 12

13. Lower prevalence as treatment barrier
I’ve never seen a female in recovery in a GA meeting… initially they look at you and they said you’re female you should be in the partner’s room, and I’m not a partner, I’m a gambler, I need to be in this room, so you get rejected a lot. (Beth, in: Kaufman et al. 2016) 13

14. Treatment success Merkouris et al. 2016:
systematic review to synthesise the evidence relating to pre-treatment predictors of gambling outcomes following psychological treatment for disordered gambling
50 articles from 1990 to 2016
male gender and low depression levels were the most consistent predictors of successful treatment outcomes 14

15. Concluding remarks
Due to the low number of females with gambling disorder, the results must be considered with caution
High number of treatment samples
No valuation intended
Rainer Sturm  / pixelio.de 15

16. Literature
Blanco, C., Hasin, D. S., Petry, N., Stinson, F. S., & Grant, B. F. (2006). Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 36, 943–953.
Bowden-Jones, Henrietta; Prever, Fulvia (Hg.) (2017): Gambling disorders in women. An international female perspective on treatment and research. Abingdon Oxon, New York NY, La Vergne: Routledge; MyiLibrary.
Desai, Rani A.; Potenza, Marc N. (2008): Gender differences in the associations between past-year gambling problems and psychiatric disorders. In: Social psychiatry and psychiatric epidemiology 43 (3), S. 173–183. DOI: /s z.
Federal Center of Health Education,
German Addiction Treatment Statistics,
Gonzalez-Ortega, I.; Echeburua, E.; Corral, P.; Polo-Lopez, R.; Alberich, S. (2013): Predictors of pathological gambling severity taking gender differences into account. In: European addiction research 19 (3), S. 146–154. DOI: / Grant and Kim 2002
Ibanez, A., Blanco, C., Moreryra, P., & Saiz-Ruiz, J. (2003). Gender differences in pathological gambling. Journal of Clinical Psychiatry, 64(3), 295–301.
Kaufman, Anna; Jones Nielsen, Jessica D.; Bowden-Jones, Henrietta (2016): Barriers to Treatment for Female Problem Gamblers: A UK Perspective. In: Journal of gambling studies. DOI: /s
Koschel, Olivia; Lindenmeyer, Johannes; Heinrichs, Nina (2017): Pathologisches Glücksspielen. Partnerschaft und Geschlecht. In: SUCHT 63 (3), S. 145–156. DOI: / /a
Ladd, G. T., & Petry, N. M. (2002). Disordered gambling among university-based medical and dental patients: A focus on Internet gambling. Psychology of Addictive Behaviors, 16(1), 76–79. 16

17. Literature (continued)
Merkouris, S. S.; Thomas, S. A.; Browning, C. J.; Dowling, N. A. (2016): Predictors of outcomes of psychological treatments for disordered gambling. A systematic review. In: Clinical Psychology Review 48, S. 7–31. DOI: /j.cpr
Potenza, Marc N.; Steinberg, Marvin A.; McLaughlin, Susan D.; Wu, Ran; Rounsaville, Bruce J.; O’Malley, Stephanie S. (2001): Gender- Related Differences in the Characteristics of Problem Gamblers Using a Gambling Helpline. In: AJP 158 (9), S. 1500–1505. DOI: /appi.ajp
Premper, V. (2006): Komorbide psychische Störungen bei Pathologischen Glücksspielern: Pabst.
Slutske, Wendy S.; Blaszczynski, Alex; Martin, Nicholas G. (2009): Sex differences in the rates of recovery, treatment-seeking, and natural recovery in pathological gambling: results from an Australian community-based twin survey. In: Twin research and human genetics : the official journal of the International Society for Twin Studies 12 (5), S. 425–432. DOI: /twin
Tavares, H., Zilberman, M.L., Beites, F.J. et al. J Gambl Stud (2001) 17:
Tschibelu, Evelyne; Elman, Igor (2011): Gender differences in psychosocial stress and in its relationship to gambling urges in individuals with pathological gambling. In: Journal of addictive diseases 30 (1), S. 81–87. DOI: /
Vogelgesang, M. (2010): Traumata, traumatogene Faktoren und pathologisches Glücksspielen. In: Psychotherapeut 55 (1), S. 12–20. DOI: /s x.
Vogelgesang, M. (2013): Stationäre Therapie des pathologischen Glücksspielens. Eine Bestandsaufnahme unter besonderer Berücksichtigung genderspezifischer Aspekte. In: Konturen (1), S. 14–17.
Volberg, R. A. (1994): The prevalence and demographics of pathological gamblers. Implications for public health. In: American Journal of Public Health 84 (2), S. 237–241. 17