Gambling & Bipolar Disorder

Bipolar Disorder is a complex mental illness that presents itself through different fluctuating episodes of mania and depression. The disorder radically affects a patient's mood, behavior and activities. As a popular pastime, gambling is an activity that can be affected by bipolar episodes: growing beyond simple entertainment into a disturbing mental condition known as pathological gambling. The combination of these two conditions occurs often and is serious enough to find reference among the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV): pathological gambling as one of the diagnosis criteria for bipolar disorder's manic state.

Pathological Gambling

• Pathological gambling is categorically different than typical gambling or gambling for entertainment purposes. Pathological gambling involves recurrent incidences of persistent gambling. Beyond even habitual gambling, pathological gamblers are unrelenting and determined, regardless of outcome. This is why pathological gambling is often associated with mental illnesses or substance abuse. It involves impaired functioning that, as the gambler continues, reduces his quality of life and can lead to bankruptcy, divorce and even criminal activity.

Bipolar Disorder

• Bipolar disorder is one of the most serious forms of mental illness a person can be diagnosed with. This is because of the radical ways it affects a patient's mental and physical capacities. The two most common and most recognizable forms are mania (hyperactivity, increased energy, elevated mood) and depression (decreased activity, lower mood, lack of energy). Although the APA reports that bipolar patients more commonly experience depressive episodes, it is the experience of manic episodes which is associated with risky behavior like addictions and compulsive gambling.

Expert Insight

• Although problem gambling has long been associated with bipolar disorder, recent studies have narrowed the exact medical and environmental situations in which the two are most likely to occur. According to the Journal of Affective Disorders (Sept. 2007), research has found that Bipolar I Disorder (characterized by one or more manic/depressive episodes in a given year) has a strong correlation with problem gambling. The data showed that these patients were twice as likely to compulsively or pathologically gamble as the general population at large. It has therefore been suggested that any patient diagnosed with Bipolar I Disorder be screened for problematic gambling, particularly if the use of alcohol or illicit substances is involved.

Considerations

• Pathological gambling as its own mental condition has the symptomatic ability to mimic bipolar disorder's manic episodes. This is because the act of gambling releases a number of neurochemicals in the brain that give off pleasurable sensations and increase energy levels. The result is that the person is able to remain awake and attentive for extended periods of time, much like bipolar patients do during their manic episodes. This mimicry is a common reason pathological gambling, as a disorder, is often misdiagnosed as bipolar disorder, especial when the patient has not been sufficiently evaluated. The primary difference between pathological gambling alone and pathological gambling as a result of bipolar disorder lies in the extent of the neurological "high": with gambling alone it will eventually wear off after a few days and the gambler will "crash" into exhaustion, but with bipolar patients the neurological "high" can be sustained for a week or more at a time.

Treatment

• Research has long shown the positive affects of lithium in treating bipolar patients as well as its similarly positive affects on pathological gambling in association with the disorder. Featured in the New York State Journal of Medicine (1980) and reaffirmed in the American Journal of Psychiatry (2005), lithium carbonate appears to blunt the exhilaration associated with gambling. Similarly, sustained-release lithium demonstrated a reduction of impulse gambling in pathological gamblers with bipolar disorder versus a placebo (an inert, "dummy" medication identical in appearance, flavor and odor to the original).

Misconceptions

• Despite the APA recognition of pathological gambling as a criterion for bipolar disorder, clinical observation often misses the bipolar context when the patient is evaluated: according to William George McCown and William A. Howatt, co-authors of "Treating Gambling Problems," many identified gambling behaviors are actually missed diagnoses of the varying types of bipolar disorder. Additionally, gambling relapse is likely even when the bipolar symptoms are reduced or controlled. McCown and Howatt suggest that more research is needed regarding the two conditions. They represent a sizable therapeutic and evaluation challenge, and need to be treated as aggressively as bipolar disorder itself.