Changes in Diagnostic Criteria

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 clarify that 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.
The DSM-5 work 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, Stinchfield12 found that a cutoff score of four made modest improvements in classification accuracy and, most importantly, reduced the rate of false negatives. Another recent study conducted in France found that the DSM-5 criteria (the DSM-IV criteria without the illegal acts criterion and with a cutoff of four symptoms) performed better than the DSM-IV criteria alone, the DSM-IV criteria without the illegal acts criterion and a new instrument based on the DSM criteria for substance abuse.13 Finally, to diagnose a gambling disorder, the critiera that are displayed among the individual must occur within a 12-month period, unlike the DSM-IV which 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.

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