Gambling Disorder Explained: DSM-5, ICD-11 and Screening Tools

For many years gambling problems were seen mainly as a failure of character. Today they are recognised in both of the world’s main diagnostic systems as a health condition that can be assessed and treated. This article explains how clinicians define gambling disorder, how it differs from the broader idea of “problem gambling”, and where self-tests fit in.

This page is for general information. It is not a substitute for assessment by a doctor, psychologist or other qualified professional.

From “pathological gambling” to “gambling disorder”

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders first included “pathological gambling” in 1980, classified as an impulse-control disorder. When DSM-5 was published in 2013, the condition was renamed gambling disorder and moved into the chapter on Substance-Related and Addictive Disorders. It was the first behavioural (non-substance) addiction placed there.

The move reflected research showing that gambling disorder shares features with substance addictions: changes in the brain’s reward system, a need for increasing “doses” to achieve the same effect, distress when cutting down, and repeated unsuccessful attempts to stop.

The DSM-5 criteria

DSM-5 describes gambling disorder as persistent and recurrent problematic gambling leading to clinically significant impairment or distress, indicated by four or more of the following within a 12-month period:

1. Needs to gamble with increasing amounts of money to achieve the desired excitement.
2. Is restless or irritable when attempting to cut down or stop.
3. Has made repeated unsuccessful efforts to control, cut back or stop.
4. Is often preoccupied with gambling, such as reliving past experiences or planning the next venture.
5. Often gambles when feeling distressed, for example helpless, guilty, anxious or depressed.
6. After losing money, often returns another day to get even (“chasing” losses).
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardised or lost a significant relationship, job, or educational or career opportunity because of gambling.
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

The behaviour must not be better explained by a manic episode. Clinicians also note whether the pattern is episodic or persistent, and whether the person is in early or sustained remission.

Severity levels

Criteria met	Severity
4–5	Mild
6–7	Moderate
8–9	Severe

You can walk through these criteria privately with our DSM-5 checklist. It is a reflection aid, not a diagnosis.

The ICD-11 definition (6C50)

The World Health Organization’s International Classification of Diseases, 11th revision (ICD-11), came into effect on 1 January 2022. It lists gambling disorder under code 6C50, within “disorders due to addictive behaviours”, alongside gaming disorder (6C51).

ICD-11 describes a persistent or recurrent pattern of gambling, online or offline, characterised by:

• impaired control over gambling (onset, frequency, intensity, duration, termination, context);
• increasing priority given to gambling, to the extent that it takes precedence over other interests and daily activities; and
• continuation or escalation despite negative consequences.

The pattern must cause significant impairment in personal, family, social, educational, occupational or other important areas of life. It is normally evident over at least 12 months, although a shorter period may be enough if symptoms are severe.

ICD-11 also distinguishes between 6C50.0, predominantly offline and 6C50.1, predominantly online gambling disorder — a recognition of how much gambling has moved to phones and computers.

Problem gambling and the harm spectrum

Outside clinics, you will more often see terms such as “problem gambling”, “at-risk gambling” or “gambling harm”. These come from public-health research and population surveys rather than diagnostic manuals. They are useful because many people experience real harm — debt, conflict, anxiety — without meeting the full criteria for a disorder.

Screening tools

Tool	What it is	Typical use
PGSI	Nine questions about the past 12 months, each scored 0–3 (total 0–27)	National surveys, self-assessment
Lie/Bet	Two yes/no questions about lying and needing to bet more	Quick first check in health settings
BBGS	Three questions mapped to DSM criteria	Brief screening in clinics and research

The PGSI, drawn from the Canadian Problem Gambling Index, groups scores as follows: 0 non-problem gambling, 1–2 low risk, 3–7 moderate risk and 8 or more problem gambling. Researchers have debated these cut-offs, and some services use slightly different thresholds, so treat the categories as a guide.

What causes gambling disorder?

There is no single cause. Research points to a combination of factors:

• Biological — differences in reward sensitivity and impulsivity; a family history of gambling or substance problems.
• Psychological — cognitive distortions such as the gambler’s fallacy or illusions of control (see gambler’s fallacy and cognitive biases); using gambling to cope with difficult emotions.
• Social and environmental — easy access, heavy advertising, early exposure, financial stress, and peer norms.
• Product design — fast play, near-misses, frequent small wins and continuous availability.

Gambling disorder also commonly occurs alongside depression, anxiety, alcohol or drug problems and ADHD.

Recovery is common

Gambling disorder is treatable. Cognitive behavioural therapy, motivational approaches, peer support such as Gamblers Anonymous, and in some cases medication can all help. Many people recover fully. Our guide to treatment options explains what to expect, and the help directory lists services by country.

If a checklist or screen has raised concerns for you, the most useful next step is a conversation — with a helpline, a GP or a specialist service — rather than further self-scoring.