1. Richard J. Rosenthal, M.D. UCLA Gambling Studies Program
The Categorization of Pathological Gambling(PG) and the Impulse-Control Disorders Not Elsewhere Classified(IDNEC)
Richard J. Rosenthal, M.D.
UCLA Gambling Studies Program

2. Three Questions
1.) Is PG an addiction or an impulse disorder?
2.) Isn’t the category of IDNEC a wastebasket?
3.) Why is the categorization of the impulse disorders so confusing?

3. Addictions ARE impulse disorders
The name, IDNEC, tells us there are other impulse-control disorders classified elsewhere
List includes substance dependence
Criteria for PG in DSM-III-R deliberately identical to substance dependence
Preferred definition of PG that of an addiction

4. The Monomanias New disease entity introduced by Esquirol, 1810
Full-fledged but partial insanity
Idee fixe - a single pathological preoccupation in an otherwise sound mind
Irresistible impulse
Expanded the insanity defense, role of the expert witness (Georget, 1825)
Included impulsive homicidal mania, gambling mania, kleptomania, pyromania, dipsomania

5. Adding to the confusion:
Irresistible impulse - persists but watered down
“chronically and progressively unable to resist impulses to gamble” (DSM-III)
“failure to resist an impulse,drive,or temptation”
No definitions for impulse, impulsive, impulsivity
Difficulty with the construct of impulsivity
Specific, purposive, defensive vs. generalized, purposeless, random
Tension reduction
No definition of tension, ambiguous concept, outdated theories
Ego-syntonic and dystonic omitted from final version of DSM-IV

6. Possibilities for DSM-V
Keep as is (IDNEC)
Add more disorders - compulsive shopping, Internet addiction, sexual addiction, pathological lying
Clarify essential features
Spectrum disorders
OC spectrum disorder (Hollander)
Affective spectrum (McElroy)
Addiction, behavioral addictions
Primitive subgroups - disorders of acquisition, disorders of grooming
One disorder with different presentations
Relief from feelings of worthlessness (Webster & Jackson)
Primary problem is uncontrollable urges (Kim)