Psychological Aspects of the Action and Escape Gambler ... · PDF filePsychological Aspects of...

Psychological Aspects of the Action and Psychological Aspects of the Action and Escape Gambler: Assessment, Personality Escape Gambler: Assessment, Personality

Types, and Treatment Considerations Types, and Treatment Considerations

Presented by Presented by Duane L. Olberding, LSCSW, KCGC, CADC IIIDuane L. Olberding, LSCSW, KCGC, CADC III

Psychological Aspects of Pathological GamblingPsychological Aspects of Pathological Gambling

Overview and ObjectivesOverview and Objectives

DefinitionsDefinitions General Personality TypesGeneral Personality Types Conditioning-learning theoriesConditioning-learning theories Understanding the action and escape gambler- linking personality Understanding the action and escape gambler- linking personality

traitstraits How GA treats personality or character defectsHow GA treats personality or character defects Specific Personality Disorder Considerations- Which treatment Specific Personality Disorder Considerations- Which treatment

milieu is best? Group? Individual? Or combination? milieu is best? Group? Individual? Or combination?


Definitions of Problem Gambling and Pathological Definitions of Problem Gambling and Pathological GamblingGambling

Problem Gambler- a person who suffers some loss of Problem Gambler- a person who suffers some loss of control over his or her gambling behavior leading to control over his or her gambling behavior leading to negative consequences.negative consequences.

Pathological/Compulsive Gambler- A Chronic and Pathological/Compulsive Gambler- A Chronic and progressive psychological disorder characterized by progressive psychological disorder characterized by emotional dependence, loss of control and emotional dependence, loss of control and accompanying negative consequences in the gambler's accompanying negative consequences in the gambler's school, social, or family life.school, social, or family life.

Psychological Aspects of Pathological Gambling Psychological Aspects of Pathological Gambling

Diagnostic criteria for 312.31 Pathological GamblingDiagnostic criteria for 312.31 Pathological Gambling

Persistent and recurrent maladaptive gambling behavior Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:as indicated by five (or more) of the following:

Is preoccupied with gamblingIs preoccupied with gambling Needs to gamble with increasing amounts of money in order to Needs to gamble with increasing amounts of money in order to

achieve the desired excitement.achieve the desired excitement. Has repeated unsuccessful efforts to control, cut back, or stop Has repeated unsuccessful efforts to control, cut back, or stop

gambling.gambling. Is restless or irritable when attempting to cut down or stop Is restless or irritable when attempting to cut down or stop

gambling.gambling. Gambles as a way of escaping from problems or of relieving a Gambles as a way of escaping from problems or of relieving a

dysphoric mooddysphoric mood


Diagnostic criteria for 312.31 Pathological GamblingDiagnostic criteria for 312.31 Pathological Gambling

After losing money gambling, often returns another day After losing money gambling, often returns another day to get even ("chasing" one's losses)to get even ("chasing" one's losses)

Lies to family members, therapist, or others to conceal Lies to family members, therapist, or others to conceal the extent of involvement in gamblingthe extent of involvement in gambling

Has committed illegal acts such as forgery, fraud, theft, Has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gamblingor embezzlement to finance gambling

Has jeopardized or lost a significant relationship, job, Has jeopardized or lost a significant relationship, job, educational or career opportunity because of gamblingeducational or career opportunity because of gambling

Relies on others to provide money to relieve a desperate Relies on others to provide money to relieve a desperate financial situation caused by gamblingfinancial situation caused by gambling


Associated Features of Pathological GamblingAssociated Features of Pathological Gambling

Distortions in thinking (e.g. denial, superstitions, overconfidence, or a Distortions in thinking (e.g. denial, superstitions, overconfidence, or a sense of power and control) sense of power and control)

Increased rates of Mood Disorders, Attention-Deficit/Hyperactivity Increased rates of Mood Disorders, Attention-Deficit/Hyperactivity Disorder, Substance Abuse or Dependence, and Antisocial, Narcissistic, Disorder, Substance Abuse or Dependence, and Antisocial, Narcissistic, and Borderline Personality Disorders have been reported in individuals and Borderline Personality Disorders have been reported in individuals with Pathological Gamblingwith Pathological Gambling

* Source p. 616 Diagnostic and Statistical Manual of Mental Disorders.* Source p. 616 Diagnostic and Statistical Manual of Mental Disorders.


Personality Types Related to Pathological Personality Types Related to Pathological GamblingGambling

Personality type seems to be moderately related to Personality type seems to be moderately related to development of pathological gambling. Two development of pathological gambling. Two personality types consistently emerge in research personality types consistently emerge in research literature. literature.

(1)(1) The impulsive, hyperactive, aggressive type or The impulsive, hyperactive, aggressive type or action gambler. action gambler.

(2)(2) The anxious, depressed, withdrawn type or The anxious, depressed, withdrawn type or escape gambler.escape gambler.

Psychological Aspects of Pathological Psychological Aspects of Pathological GamblingGambling

Personality Types Related to Pathological Gambling DefinedPersonality Types Related to Pathological Gambling Defined

Treatment providers need to assess the personality differences of the Action Treatment providers need to assess the personality differences of the Action and Escape gamblers and plan treatment based on the specific personality and Escape gamblers and plan treatment based on the specific personality traits or disorders of the client.traits or disorders of the client.

Action Gamblers seem to have more associated personality traits and/or Action Gamblers seem to have more associated personality traits and/or disorders such as narcissism, antisocial, histrionic and borderline.disorders such as narcissism, antisocial, histrionic and borderline.

(2)(2) Escape Gamblers seem to have more associated personality traits and/or Escape Gamblers seem to have more associated personality traits and/or disorders such as paranoid, schizoid, schizotypal, obsessive-compulsive, disorders such as paranoid, schizoid, schizotypal, obsessive-compulsive, avoidant, and dependent.avoidant, and dependent.

*Remember that these are generalizations. For example there can be *Remember that these are generalizations. For example there can be narcissistic escape gamblers. narcissistic escape gamblers.


Two types of Pathological GamblersTwo types of Pathological Gamblers

Escape (luck)- often female, non-competitive and Escape (luck)- often female, non-competitive and passive; are often abuse victims or have suffered a passive; are often abuse victims or have suffered a significant loss; possess poor coping skills and poor significant loss; possess poor coping skills and poor assertiveness skills. assertiveness skills.

Action (skill)- often male, competitive and grandiose; Action (skill)- often male, competitive and grandiose; have low frustration tolerance, high tolerance for have low frustration tolerance, high tolerance for ambiguity and possess poor coping skills.ambiguity and possess poor coping skills.


Psychological Explanations Psychological Explanations for Gambling Addictionfor Gambling Addiction

4.4. Monetary rewardMonetary reward5.5. Emotional rewardEmotional reward6.6. Chasing lossesChasing losses7.7. Near missesNear misses8.8. Cognitive biases and illusionsCognitive biases and illusions9.9. Locus of controlLocus of control


Psychological: Monetary reward or emotional Psychological: Monetary reward or emotional rewardsrewards

People become conditioned or learn the habit of People become conditioned or learn the habit of gambling as a consequence of the rewards gambling as a consequence of the rewards obtained, the basic notion of conditioning obtained, the basic notion of conditioning through reinforcement. Gambling mostly through reinforcement. Gambling mostly operates on a random ratio schedule of operates on a random ratio schedule of reinforcement which is known to lead to reinforcement which is known to lead to particularly persistent behavior (Knapp, 1997) particularly persistent behavior (Knapp, 1997)


Psychological: Chasing lossesPsychological: Chasing losses

Fueled by “gamblers fallacy” which is a failure to Fueled by “gamblers fallacy” which is a failure to grasp the point that each event in a series of grasp the point that each event in a series of random events is independent of all others. random events is independent of all others.

People often feel entrapped as they have already People often feel entrapped as they have already invested a large amount of money on a potential invested a large amount of money on a potential win and don’t want to lose their investment. win and don’t want to lose their investment.


Psychological: Near missesPsychological: Near misses

Many games are designed to have built in Many games are designed to have built in near misses (more correctly referred to near misses (more correctly referred to as near wins) which could produce some as near wins) which could produce some of the excitement of a win and in that of the excitement of a win and in that way a player feels they are not so much way a player feels they are not so much constantly losing but constantly nearly constantly losing but constantly nearly winning. winning.


Psychological: Locus of ControlPsychological: Locus of Control

Studies have found groups of gamblers Studies have found groups of gamblers to be higher than normal perception to be higher than normal perception of an external locus of control of an external locus of control (holding the belief that rewards result (holding the belief that rewards result from luck, chance, fate, the influence from luck, chance, fate, the influence of others, or are unpredictable). of others, or are unpredictable). Walker, 1992. Walker, 1992.


Psychological AspectsPsychological Aspects

Psychoanalysts have proposed that gambling served the Psychoanalysts have proposed that gambling served the functions of rebellion against parental authority and functions of rebellion against parental authority and distraction from guilt. Rosenthal (1987) distraction from guilt. Rosenthal (1987)

Bergler (1958) viewed gambling addicts as gambling not to Bergler (1958) viewed gambling addicts as gambling not to win, but rather with the unconscious wish to lose. His win, but rather with the unconscious wish to lose. His ‘wish to lose’ theory became popular, particularly with ‘wish to lose’ theory became popular, particularly with Gamblers Anonymous. Gamblers Anonymous.


Psychological AspectsPsychological Aspects

A gambler’s emotional changes during the act A gambler’s emotional changes during the act of gambling resembles reports of people who of gambling resembles reports of people who consume amphetamines (Hickey et al., consume amphetamines (Hickey et al., 1986) 1986)

Other gamblers report gambling as a kind of Other gamblers report gambling as a kind of self-medication, as an anesthetic or a form self-medication, as an anesthetic or a form of ‘escape seeking’ (Lesieur and Rosenthal, of ‘escape seeking’ (Lesieur and Rosenthal, 1991; Elster, 1999) 1991; Elster, 1999)


Two Types of GamblersTwo Types of Gamblers

Action- An aroused, euphoric state Action- An aroused, euphoric state comparable to the “high” derived from comparable to the “high” derived from cocaine. cocaine.

Escape- A deliberate seeking of emotional Escape- A deliberate seeking of emotional numbness and oblivionnumbness and oblivion


Understanding Action GamblingUnderstanding Action Gambling

Seems to be driven by one or a Seems to be driven by one or a combination of the following: combination of the following: “fantasy,” “narcissistic needs” “fantasy,” “narcissistic needs” and/or the “rush”. and/or the “rush”.


Understanding Action Gambling: FantasyUnderstanding Action Gambling: Fantasy

““I tried to take comfort in the forlorn hope that tomorrow ‘would be I tried to take comfort in the forlorn hope that tomorrow ‘would be different’ As a result, I lived a fantasy life in which happiness was different’ As a result, I lived a fantasy life in which happiness was all but nonexistent.” (From Gamblers Anonymous all but nonexistent.” (From Gamblers Anonymous A Day at a Time.) A Day at a Time.)

“ “ I used to be an expert at unrealistic self-appraisal.” (From Gamblers I used to be an expert at unrealistic self-appraisal.” (From Gamblers Anonymous Anonymous A Day at a Time.) A Day at a Time.)

““I sacrificed every ‘today’ for a dream of some distant tomorrow” I sacrificed every ‘today’ for a dream of some distant tomorrow” (From Gamblers Anonymous (From Gamblers Anonymous A Day at a Time.)A Day at a Time.)


Understanding Action Gambling: The RushUnderstanding Action Gambling: The Rush

A study published in August,2005 A study published in August,2005 Alcoholism: Clinical & Alcoholism: Clinical & Experimental Research by Experimental Research by Tavares, Hodkins, and el-Guebaly “found Tavares, Hodkins, and el-Guebaly “found that individuals who are especially vulnerable to negative emotions that individuals who are especially vulnerable to negative emotions are the ones who will miss alcohol the most when trying to abstain. are the ones who will miss alcohol the most when trying to abstain. Conversely, gambling cravings correlated to the temperament factor Conversely, gambling cravings correlated to the temperament factor responsible for positive emotions.” responsible for positive emotions.”

““Alcohol is more of an anti-anxiety measure.” Alcohol is more of an anti-anxiety measure.”

““Gambling seems to be more of a stimulant and anti-depression Gambling seems to be more of a stimulant and anti-depression measure.” measure.”


Understanding Action Gambling: The RushUnderstanding Action Gambling: The Rush

This suggests that those individuals who naturally lack positive This suggests that those individuals who naturally lack positive emotions and require intense stimuli to experience elation are the emotions and require intense stimuli to experience elation are the ones who will miss gambling the most when trying to abstain.ones who will miss gambling the most when trying to abstain.

Unfortunately this study did not delineate between action and Unfortunately this study did not delineate between action and escape gamblers. escape gamblers.


Psychological Needs: Narcissistic NeedsPsychological Needs: Narcissistic Needs

Casino staff are taught to fulfill “Mr. Bigs” needs- Casino staff are taught to fulfill “Mr. Bigs” needs- “You’re looking great today… like a winner.” “You’re looking great today… like a winner.”

Dr. Jacobs study in 1982 found that almost four in ten Dr. Jacobs study in 1982 found that almost four in ten pathological gamblers surveyed felt as if they took on pathological gamblers surveyed felt as if they took on another identity all the time they gambled. ( GA Blue another identity all the time they gambled. ( GA Blue Book) Book)

““Comps” or Compensations- make the gambler feel Comps” or Compensations- make the gambler feel important- free rooms, meals, etc. important- free rooms, meals, etc.


Understanding Action GamblingUnderstanding Action Gambling

First Step is crucial. “First Step is crucial. “We admitted we were We admitted we were powerless over gambling-that our lives had powerless over gambling-that our lives had become unmanageable” (Gamblers Anonymous)become unmanageable” (Gamblers Anonymous)

Very hard to accept powerlessness when the Very hard to accept powerlessness when the ‘action’ gambler has been seeking feelings of ‘action’ gambler has been seeking feelings of power.power.


From Gamblers Anonymous: From Gamblers Anonymous: A Day at a TimeA Day at a Time

The Gamblers Anonymous meditation book “A Day at a The Gamblers Anonymous meditation book “A Day at a time.” cites powerlessness seven times in the first time.” cites powerlessness seven times in the first month of the meditations; in the second and third month of the meditations; in the second and third months readings it references self-righteousness, months readings it references self-righteousness, inflated ego, grandiosity, prestige and power, and ego inflated ego, grandiosity, prestige and power, and ego mania; in the fourth month it targets fantasy five times. mania; in the fourth month it targets fantasy five times.

As treaters we need to recognize what has been proven As treaters we need to recognize what has been proven to work by GA and use these ideas.to work by GA and use these ideas.

Psychological Aspects: The Escape GamblerPsychological Aspects: The Escape Gambler

The Escape Gambler often feels helpless as the result of The Escape Gambler often feels helpless as the result of a significant relationship loss. a significant relationship loss.

The action of addictive behavior to reverse helplessness The action of addictive behavior to reverse helplessness

explains its purpose. explains its purpose. (Dodes, 2003) (Dodes, 2003)



Psychological Aspects Psychological Aspects

““Virtually every addictive act is preceded by a Virtually every addictive act is preceded by a feeling of helplessness or powerlessness. feeling of helplessness or powerlessness. Addictive behavior functions to repair this Addictive behavior functions to repair this underlying feeling of helplessness. The addictive underlying feeling of helplessness. The addictive action, or decision, creates a sense of being action, or decision, creates a sense of being empowered, of regaining control – over one’s empowered, of regaining control – over one’s emotional experience and life.” (Dodes, 2003) emotional experience and life.” (Dodes, 2003)



““When one feels trapped emotionally or physically When one feels trapped emotionally or physically he or she will sooner or later feel a great anger he or she will sooner or later feel a great anger –a rage, really, at being helpless. It is this rage –a rage, really, at being helpless. It is this rage at helplessness that is the nearly irresistible at helplessness that is the nearly irresistible force that drives addiction.” force that drives addiction.” (Dodes, 2003) (Dodes, 2003)


Psychological Aspects: The Escape Gambler Psychological Aspects: The Escape Gambler

With the escape gambler gambling seems to be a With the escape gambler gambling seems to be a displacement in which anger or rage over the displacement in which anger or rage over the significant relationship loss fuels the gambling significant relationship loss fuels the gambling addiction.addiction.



With the escape gambler “The action is the With the escape gambler “The action is the distraction.”distraction.”

Escape gamblers often talk of spending hours Escape gamblers often talk of spending hours upon hours playing slot machines. upon hours playing slot machines.


Psychological Aspects: The Escape Gambler Psychological Aspects: The Escape Gambler

““The best way to deal with painful loss is to The best way to deal with painful loss is to meet it head on.” (From Gamblers meet it head on.” (From Gamblers Anonymous Anonymous A Day at a Time.)A Day at a Time.)



““When I played the slot machine all that was in When I played the slot machine all that was in front of me was a large black hole that I could front of me was a large black hole that I could sink into and not think about my loss… the loss sink into and not think about my loss… the loss of my husband.” excerpts from an interview of my husband.” excerpts from an interview with Joyce D., an escape gambler.with Joyce D., an escape gambler.


Treatment Considerations: AssessmentTreatment Considerations: Assessment

It is important to understand what psychological It is important to understand what psychological needs that are fulfilled by the gambling activity.needs that are fulfilled by the gambling activity.

Distinction between Action and Escape gamblers and Distinction between Action and Escape gamblers and their concomitant personality traits in the assessment their concomitant personality traits in the assessment process is essential in determining a treatment milieu process is essential in determining a treatment milieu and approach.and approach.


Treatment Planning: The Escape Gambler Treatment Planning: The Escape Gambler

Processing the loss- lots of group workProcessing the loss- lots of group work Refuting the irrational thinking or fantasy Refuting the irrational thinking or fantasy

i.e. gamblers fallacy, etc. i.e. gamblers fallacy, etc.


Treatment Planning: The Action GamblerTreatment Planning: The Action Gambler Establishment of rapport – lots of individual work in Establishment of rapport – lots of individual work in

combination with group work. Treatment alliance is combination with group work. Treatment alliance is paramount prior to financial inventory and ego paramount prior to financial inventory and ego defense work.defense work.

Interpretation of defenses within individual therapy Interpretation of defenses within individual therapy and then bringing this material into group work is and then bringing this material into group work is beneficial.beneficial.

Finding substitutes for the stimulation needs. Finding substitutes for the stimulation needs. Refuting the irrational thinking- fantasy i.e. gamblers Refuting the irrational thinking- fantasy i.e. gamblers

fallacy, etc.fallacy, etc.


Personality and Gambling Treatment ConsiderationsPersonality and Gambling Treatment Considerations

Treatment Planning needs to be based on the individual personality type

The next slides go over the psychodynamic understanding of specific personality types and treatment

considerations


301.0 Paranoid Personality Disorder 301.0 Paranoid Personality Disorder Diagnostic CriteriaDiagnostic Criteria

C.C. Pervasive distrust and suspiciousness of others Pervasive distrust and suspiciousness of others such that their motives are interpreted as such that their motives are interpreted as malevolent, beginning by early adulthood and malevolent, beginning by early adulthood and present in a variety of contexts.present in a variety of contexts.

Gabbard, G. (1994) Psychodynamic Psychiatry in Clinical PracticeGabbard, G. (1994) Psychodynamic Psychiatry in Clinical Practice


301.0 Paranoid Personality Disorder Diagnostic Considerations301.0 Paranoid Personality Disorder Diagnostic Considerations

The key features of the paranoid personality disorder are ego-The key features of the paranoid personality disorder are ego-syntonic. syntonic.

Paranoid clients are usually unconvinced that they are Paranoid clients are usually unconvinced that they are psychiatrically disturbed. Their presenting problems revolve psychiatrically disturbed. Their presenting problems revolve around how others have mistreated and betrayed them. around how others have mistreated and betrayed them.

Their style of thinking is characterized by an unrelenting search Their style of thinking is characterized by an unrelenting search for hidden meanings, for clues to uncover the “truth” behind a for hidden meanings, for clues to uncover the “truth” behind a situations face value. situations face value.

They will present with hyper-alertness of attention, by a They will present with hyper-alertness of attention, by a guardedness related to this attentional monitoring. guardedness related to this attentional monitoring.



301.0 Paranoid Personality Disorder Diagnostic Considerations301.0 Paranoid Personality Disorder Diagnostic Considerations

They will scan the environment for anything out of the ordinary. This They will scan the environment for anything out of the ordinary. This style of thinking exacts a considerable toll in physical and emotional style of thinking exacts a considerable toll in physical and emotional tension. The paranoid person is simply unable to relax.tension. The paranoid person is simply unable to relax.

Paranoid thinking is characterized by a lack of flexibility. The most Paranoid thinking is characterized by a lack of flexibility. The most persuasive argument will generally have no impact on the rigid beliefs persuasive argument will generally have no impact on the rigid beliefs of the paranoid person.of the paranoid person.

People with paranoid personality disorder tend to have remarkably People with paranoid personality disorder tend to have remarkably accurate perceptions of their environment, however, their judgments accurate perceptions of their environment, however, their judgments about these perceptions are generally impaired. Reality is not distorted about these perceptions are generally impaired. Reality is not distorted but the significance of apparent reality is misconstrued. but the significance of apparent reality is misconstrued.



ParanoidParanoidPersonality Disorder Treatment ConsiderationsPersonality Disorder Treatment Considerations

Those persons who attempt to argue with a person who has a paranoid Those persons who attempt to argue with a person who has a paranoid personality disorder will simply find themselves becoming a target of personality disorder will simply find themselves becoming a target of suspicion.suspicion.

A paranoid person believe that no relationship is enduring over time. A paranoid person believe that no relationship is enduring over time. They approach every relationship with the belief that the other person They approach every relationship with the belief that the other person will eventually “slip up” and confirm their suspicions. will eventually “slip up” and confirm their suspicions.

Even with a stable, helpful therapist who has worked with a paranoid Even with a stable, helpful therapist who has worked with a paranoid client for a long period of time one minor disappointment can lead to client for a long period of time one minor disappointment can lead to the paranoid person’s unswerving conviction that the therapist is the paranoid person’s unswerving conviction that the therapist is untrustworthy. untrustworthy.



ParanoidParanoidPersonality Disorder Treatment Approaches Personality Disorder Treatment Approaches

Because of their suspiciousness, paranoid clients usually Because of their suspiciousness, paranoid clients usually do poorly in group psychotherapy. The first step in do poorly in group psychotherapy. The first step in psycho therapy must be to build a therapeutic alliance. psycho therapy must be to build a therapeutic alliance. This process is made more difficult by the tendency of This process is made more difficult by the tendency of paranoid clients to evoke defensive responses in others. paranoid clients to evoke defensive responses in others.

The therapist must be willing to empathize with the The therapist must be willing to empathize with the client’s need to project as a means of emotional survival. client’s need to project as a means of emotional survival. The therapist must be willing to serve as a container for The therapist must be willing to serve as a container for feelings of hatred, badness, impotence, and despair.feelings of hatred, badness, impotence, and despair. Gabbard, G. Gabbard, G. (1994) Psychodynamic Psychiatry in Clinical Practice(1994) Psychodynamic Psychiatry in Clinical Practice


ParanoidParanoidPersonality Disorder Treatment Personality Disorder Treatment Approaches Approaches

Beware of becoming defensive—like everyone else in the Beware of becoming defensive—like everyone else in the client’s environment--as a counter-transference reaction. client’s environment--as a counter-transference reaction.

Openness is by far the best policy with paranoid clients.Openness is by far the best policy with paranoid clients. The therapist should not challenge the clients’ The therapist should not challenge the clients’

construction of events or the client’s perception of the construction of events or the client’s perception of the therapist, no matter how negative. The therapist should therapist, no matter how negative. The therapist should merely ask for more detail and should empathize with merely ask for more detail and should empathize with the client’s feelings and perceptions.the client’s feelings and perceptions.



Schizoid and Schizotypal Personality Disorders Schizoid and Schizotypal Personality Disorders

Although these are distinct entities they will be considered together here Although these are distinct entities they will be considered together here because the dynamic, understanding of, and the therapeutic approaches to because the dynamic, understanding of, and the therapeutic approaches to these disorders have much in common. these disorders have much in common.

The essential feature of the The essential feature of the Schizoid Personality DisorderSchizoid Personality Disorder is a pervasive is a pervasive pattern of detachment from social relationships and a restricted range of pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. expression of emotions in interpersonal settings.

The essential feature of the The essential feature of the Schizotypal Personality DisorderSchizotypal Personality Disorder is a is a pervasive pattern of social and interpersonal deficits marked by acute pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior.cognitive or perceptual distortions and eccentricities of behavior.



Schizoid and Schizotypal Personality Disorder Schizoid and Schizotypal Personality Disorder

Treatment ConsiderationsTreatment Considerations

The schizoid or schizotypal personality represents a splitting or The schizoid or schizotypal personality represents a splitting or fragmentation of the self into different self-representations that fragmentation of the self into different self-representations that remain un-integrated. The result is a diffuse identity – they are not remain un-integrated. The result is a diffuse identity – they are not sure who they are, and they feel buffeted by highly conflictual sure who they are, and they feel buffeted by highly conflictual thoughts, feelings, wishes, and urges. thoughts, feelings, wishes, and urges.



Schizoid and Schizotypal Personality Disorder Schizoid and Schizotypal Personality Disorder Treatment Considerations Treatment Considerations

The fundamental dilemma of schizoid and schizotypal The fundamental dilemma of schizoid and schizotypal clients mandates that they will vacillate between the fear clients mandates that they will vacillate between the fear of driving others away by their neediness, on the one of driving others away by their neediness, on the one hand, and the fear, on the other hand that others will hand, and the fear, on the other hand that others will smother or consume them. As a result all relationships smother or consume them. As a result all relationships are experienced as dangerous and to be avoided. are experienced as dangerous and to be avoided.



Schizoid and Schizotypal Personality Disorders Schizoid and Schizotypal Personality Disorders Treatment Approaches Treatment Approaches

These clients are prime candidates for group psychotherapy.These clients are prime candidates for group psychotherapy.

Group psychotherapy is oriented toward helping client’s with Group psychotherapy is oriented toward helping client’s with socialization which is exactly where they suffer most. socialization which is exactly where they suffer most.

Their peers in a group process can function as a reconstructed Their peers in a group process can function as a reconstructed family eventually being internalized to counterbalance their more family eventually being internalized to counterbalance their more negative internal objects. negative internal objects.

Group therapy may be their only social outlet and if they begin to Group therapy may be their only social outlet and if they begin to feel accepted they will find their worst fears are not realized and feel accepted they will find their worst fears are not realized and will become more comfortable with people. will become more comfortable with people.



Schizoid and Schizotypal Personality Disorders Schizoid and Schizotypal Personality Disorders Treatment ApproachesTreatment Approaches

Difficulties that can arise in group include resentment Difficulties that can arise in group include resentment that the schizoid or schizotypal client doesn’t share as that the schizoid or schizotypal client doesn’t share as much. much.

The group may also simply ignore a withdrawn schizoid The group may also simply ignore a withdrawn schizoid or schizotypal client and proceed as if they aren’t there. or schizotypal client and proceed as if they aren’t there.

May be scapegoatedMay be scapegoated It is also important to remember that as therapists we It is also important to remember that as therapists we

must genuinely respect the client’s need to be different must genuinely respect the client’s need to be different and must not feel compelled to transform a client into and must not feel compelled to transform a client into someone else. someone else.



Cluster B Personality Disorders: Borderline, Antisocial, Cluster B Personality Disorders: Borderline, Antisocial, Narcissistic, and HistrionicNarcissistic, and Histrionic

Borderline Personality Disorder-Pervasive pattern of instability of interpersonal Borderline Personality Disorder-Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts. early adulthood and is present in a variety of contexts.

Antisocial Personality Disorder – Pervasive pattern of disregard for, and violation Antisocial Personality Disorder – Pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and of, the rights of others that begins in childhood or early adolescence and continues into adulthood.continues into adulthood.

Narcissistic Personality Disorder- Pervasive pattern of grandiosity( in fantasy or Narcissistic Personality Disorder- Pervasive pattern of grandiosity( in fantasy or behavior), need for admiration, and lack of empathy, beginning by early behavior), need for admiration, and lack of empathy, beginning by early childhood and present in a variety of contextschildhood and present in a variety of contexts

Histrionic Personality Disorder- Pervasive and excessive emotionality and attention Histrionic Personality Disorder- Pervasive and excessive emotionality and attention seeking behaviors. seeking behaviors.



301.83 Borderline Personality Disorder Diagnostic 301.83 Borderline Personality Disorder Diagnostic ConsiderationsConsiderations

Persons with Borderline Personality Disorder make frantic efforts to Persons with Borderline Personality Disorder make frantic efforts to avoid real or imagined abandonment. The perception of impending avoid real or imagined abandonment. The perception of impending separation or rejection, or the loss of external structure, can lead to separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. profound changes in self-image, affect, cognition, and behavior.

They may believe that this “abandonment” implies they are bad. They may believe that this “abandonment” implies they are bad.

They may switch from idealizing other people to devaluing them. They may switch from idealizing other people to devaluing them. They will present with dramatic shifts in self-image, characterized by They will present with dramatic shifts in self-image, characterized by

shifting goals, values, and vocational aspirations. Sexual identity, shifting goals, values, and vocational aspirations. Sexual identity, values, and types of friends. values, and types of friends. Gabbard, G. (1994) Psychodynamic Psychiatry in Clinical PracticeGabbard, G. (1994) Psychodynamic Psychiatry in Clinical Practice


Borderline Personality Disorder PsychodynamicsBorderline Personality Disorder Psychodynamics

It has been postulated that from a developmental standpoint clients It has been postulated that from a developmental standpoint clients with borderline personality disorder can be viewed as repeatedly with borderline personality disorder can be viewed as repeatedly reliving an early infantile crisis in which they feared that attempts to reliving an early infantile crisis in which they feared that attempts to separate from their mother would result in her disappearance and separate from their mother would result in her disappearance and abandonment of them. They were unable to internalize a whole abandonment of them. They were unable to internalize a whole soothing, internal image of their mother that sustains them in times soothing, internal image of their mother that sustains them in times of her physical absence. In the adult form of this childhood crisis, of her physical absence. In the adult form of this childhood crisis, individuals are unable to tolerate periods of being alone and fear individuals are unable to tolerate periods of being alone and fear abandonment from significant others.abandonment from significant others.



Borderline Personality Disorder Treatment Borderline Personality Disorder Treatment ConsiderationsConsiderations

The goals of individual and group psychotherapy include a) The goals of individual and group psychotherapy include a) strengthening the ego so that patients can better tolerate anxiety strengthening the ego so that patients can better tolerate anxiety and can gain greater control over impulses; b) integrate split self and can gain greater control over impulses; b) integrate split self and object representations so that patients can have a coherent, and object representations so that patients can have a coherent, sustained , and fully rounded view of themselves and others, and, sustained , and fully rounded view of themselves and others, and, c) firmly establish a soothing-holding introject so that separations c) firmly establish a soothing-holding introject so that separations from significant figures can be tolerated.from significant figures can be tolerated.

In order to benefit toward integrating a soothing-holding introject, In order to benefit toward integrating a soothing-holding introject, individual therapy is indicated. Group therapy can aid by giving the individual therapy is indicated. Group therapy can aid by giving the borderline individual an opportunity to understand the defenses of borderline individual an opportunity to understand the defenses of splitting and projective identification which are common in all splitting and projective identification which are common in all groups. groups.



Borderline Personality Disorder Treatment Borderline Personality Disorder Treatment Considerations Considerations

These clients are likely to quit psychotherapy, to act out self-These clients are likely to quit psychotherapy, to act out self-destructively, to make inordinate demands for special treatment, to destructively, to make inordinate demands for special treatment, to provoke ill-advised professional boundary crossing.provoke ill-advised professional boundary crossing.

Very difficult time developing an alliance with their therapist. Very difficult time developing an alliance with their therapist.

Major therapeutic accomplishment is aiding the client in perceiving Major therapeutic accomplishment is aiding the client in perceiving the therapist as a real and separate person who is invested in the therapist as a real and separate person who is invested in helping the patient.helping the patient.



Borderline Personality Disorder Treatment Borderline Personality Disorder Treatment ApproachesApproaches

The consensus is that the borderline client needs The consensus is that the borderline client needs concomitant individual therapy while in the concomitant individual therapy while in the group process. group process.

In group therapy the group process dilutes the In group therapy the group process dilutes the transference and so significantly benefits both transference and so significantly benefits both the borderline client and the therapist.the borderline client and the therapist.



301.7 Antisocial Personality Disorder301.7 Antisocial Personality Disorder

Antisocial Personality Disorder – Pervasive pattern of Antisocial Personality Disorder – Pervasive pattern of disregard for, and violation of, the rights of others that disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues begins in childhood or early adolescence and continues into adulthood. into adulthood.



Antisocial Personality Disorder Antisocial Personality Disorder PsychodynamicsPsychodynamics

The person with antisocial personality disorder never The person with antisocial personality disorder never becomes aware of other people as separate becomes aware of other people as separate individuals with feelings of their own. individuals with feelings of their own.

Suicide attempts among these clients tend to grow Suicide attempts among these clients tend to grow out of narcissistic rage rather than out of genuine out of narcissistic rage rather than out of genuine hopelessness and a wish to die.hopelessness and a wish to die.



Antisocial Personality Disorder Treatment Antisocial Personality Disorder Treatment ConsiderationsConsiderations

There is a broad consensus that clients with serious antisocial There is a broad consensus that clients with serious antisocial behavior are unlikely to benefit from outpatient psychotherapy behavior are unlikely to benefit from outpatient psychotherapy exclusively. Residential treatment in which there is established exclusively. Residential treatment in which there is established control over the lives of the clients so that their usual channels for control over the lives of the clients so that their usual channels for discharging unpleasant affects through action are blocked may discharging unpleasant affects through action are blocked may afford the best outcome for the clients to come to terms with their afford the best outcome for the clients to come to terms with their anxiety and aggression. Therefore the cornerstone of treatment is anxiety and aggression. Therefore the cornerstone of treatment is a tightly controlled structure. a tightly controlled structure.




Therapist may have difficulty engaging antisocial clients Therapist may have difficulty engaging antisocial clients in treatment because they externalize all problems. in treatment because they externalize all problems.

Clinicians may experience counter-transference denial Clinicians may experience counter-transference denial and under-diagnose antisocial personality disorder and and under-diagnose antisocial personality disorder and thus view the client as more treatable than they really thus view the client as more treatable than they really are. are.




Positive Response to Treatment Positive Response to Treatment 4.4. Presence of anxietyPresence of anxiety5.5. Axis I diagnosis of depressionAxis I diagnosis of depression

Negative Response to TreatmentNegative Response to Treatment8.8. History of felony arrestHistory of felony arrest9.9. History of repeated lying, aliases, conning.History of repeated lying, aliases, conning.10.10. History of violence toward othersHistory of violence toward others11.11. Diagnosis of Axis I organic brain impairmentDiagnosis of Axis I organic brain impairment



Narcissistic Personality Disorder Treatment Narcissistic Personality Disorder Treatment ConsiderationsConsiderations

The psycho-dynamic understanding is that the person The psycho-dynamic understanding is that the person with narcissistic personality disorder is developmentally with narcissistic personality disorder is developmentally arrested at a stage where they required specific arrested at a stage where they required specific responses from persons in their environment that were responses from persons in their environment that were not forthcoming. Specifically, the parents did not not forthcoming. Specifically, the parents did not respond to the child’s developmental phase appropriate respond to the child’s developmental phase appropriate displays of exhibitionism with validation and admiration. displays of exhibitionism with validation and admiration.



Narcissistic Personality Disorder Narcissistic Personality Disorder Treatment ConsiderationsTreatment Considerations

Individual psycho-therapy is the treatment of Individual psycho-therapy is the treatment of choice for most clients with narcissistic choice for most clients with narcissistic personality disorder. personality disorder.

The therapist should interpret –rather than The therapist should interpret –rather than

actively gratify- the client’s yearning to be actively gratify- the client’s yearning to be soothed. soothed.



Narcissistic Personality Disorder Treatment ConsiderationsNarcissistic Personality Disorder Treatment Considerations Group psychotherapy can be counter-productive if it is the only Group psychotherapy can be counter-productive if it is the only

treatment used. treatment used. Narcissistic clients may enjoy the idea of having an audience but Narcissistic clients may enjoy the idea of having an audience but

may also resent the fact that other people take some of the may also resent the fact that other people take some of the therapist’s time and attention. therapist’s time and attention.

The literature supports combined individual and group therapy The literature supports combined individual and group therapy benefits narcissistic clients more than either approach alone. benefits narcissistic clients more than either approach alone.

Most authors believe a long preparatory period of individual therapy Most authors believe a long preparatory period of individual therapy that will lead to a solid therapeutic alliance is the best prior to group that will lead to a solid therapeutic alliance is the best prior to group therapy. therapy.



Histrionic Personality DisorderHistrionic Personality Disorder

A pervasive pattern of excessive emotionality and A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and attention seeking, beginning by early adulthood and present in a variety of contexts.present in a variety of contexts.



Psychodynamic Understanding: Histrionic Psychodynamic Understanding: Histrionic PersonalityPersonality DisorderDisorder

In the female the lack of maternal nurturance leads her to turn to her In the female the lack of maternal nurturance leads her to turn to her father for gratification of dependency needs in which she soon learns that father for gratification of dependency needs in which she soon learns that flirtatiousness and dramatic displays of emotions are required to gain flirtatiousness and dramatic displays of emotions are required to gain fathers attention. fathers attention.

The male will experience similar maternal deprivation, will look to his father The male will experience similar maternal deprivation, will look to his father for nurturance and if the father is emotionally unavailable he is faced with for nurturance and if the father is emotionally unavailable he is faced with two alternatives: he may model himself after his mother and develop a two alternatives: he may model himself after his mother and develop a passive, effeminate identity or he may mimic various cultural stereotypes of passive, effeminate identity or he may mimic various cultural stereotypes of hyper-masculinity. hyper-masculinity.



Treatment Considerations of Histrionic Personality Treatment Considerations of Histrionic Personality DisorderDisorder

Generally respond well to individual psychotherapyGenerally respond well to individual psychotherapy Generally the key problems they relate are interpersonal Generally the key problems they relate are interpersonal

relationship problems. relationship problems. Often have an unconscious expectation that the Often have an unconscious expectation that the

therapist understands them intuitively, nonverbally, and therapist understands them intuitively, nonverbally, and globally without details of their intra-psychic world. globally without details of their intra-psychic world.



Treatment Considerations of Histrionic Personality Treatment Considerations of Histrionic Personality DisorderDisorder

Feel as if they are “buffeted by powerful feeling states.” Feel as if they are “buffeted by powerful feeling states.” Need help recognizing the connection of feelings to Need help recognizing the connection of feelings to ideas and beliefs. ideas and beliefs.

Often become “stars” in group therapy. Highly valued Often become “stars” in group therapy. Highly valued by other members for their ability to express feelings by other members for their ability to express feelings directly and for their care and concern about others in directly and for their care and concern about others in the group. the group.



Cluster C Personality Disorders: Obsessive-Cluster C Personality Disorders: Obsessive-Compulsive, Avoidant, and Dependent. Compulsive, Avoidant, and Dependent.

Obsessive-Compulsive- A pervasive pattern of Obsessive-Compulsive- A pervasive pattern of preoccupation with orderliness, perfectionism, and preoccupation with orderliness, perfectionism, and mental and interpersonal control.mental and interpersonal control.

Avoidant- A pervasive pattern of social inhibition, Avoidant- A pervasive pattern of social inhibition, feelings of inadequacy, and a hypersensitivity to feelings of inadequacy, and a hypersensitivity to negative evaluation.negative evaluation.

Dependent- A pervasive and excessive need to be taken Dependent- A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior care of that leads to submissive and clinging behavior and fears of separation. and fears of separation.



Psychodynamic Understanding Obsessive-Psychodynamic Understanding Obsessive-Compulsive Personality DisorderCompulsive Personality Disorder

Individuals with obsessive-compulsive personality suffer from a Individuals with obsessive-compulsive personality suffer from a good deal of self-doubt. Their experience as children was that they good deal of self-doubt. Their experience as children was that they were not sufficiently valued or loved by their parents. were not sufficiently valued or loved by their parents.

They will have strong unfulfilled dependent yearnings and a They will have strong unfulfilled dependent yearnings and a reservoir of rage directed at parents for not being more emotionally reservoir of rage directed at parents for not being more emotionally available. available.

Consequentially they often go to great lengths to demonstrate their Consequentially they often go to great lengths to demonstrate their independence and also will strive for complete control over all independence and also will strive for complete control over all anger. anger.



Treatment Considerations of Obsessive-Compulsive Treatment Considerations of Obsessive-Compulsive Personality DisorderPersonality Disorder

Intimate relationships pose a significant problem. Intimate relationships pose a significant problem. Intimacy raises the possibility of being overwhelmed by Intimacy raises the possibility of being overwhelmed by powerful wishes to be taken care of, with the powerful wishes to be taken care of, with the concomitant potential for frustration of those wishes, concomitant potential for frustration of those wishes, resulting in feelings of hatred and resentment. resulting in feelings of hatred and resentment. Relationships are threatening because hey have the Relationships are threatening because hey have the potential for becoming “out of control.” potential for becoming “out of control.”




They have a quest for perfection and a secret They have a quest for perfection and a secret belief that if they can only reach a stage of belief that if they can only reach a stage of flawlessness they will finally receive the parental flawlessness they will finally receive the parental approval and esteem they missed as children. approval and esteem they missed as children. The irony is they rarely seem satisfied with any The irony is they rarely seem satisfied with any of their achievements. of their achievements.

GGabbard, G. (1994) Psychodynamic Psychiatry in Clinical Practiceabbard, G. (1994) Psychodynamic Psychiatry in Clinical Practice



Generally respond well to individual psychotherapy but the very idea Generally respond well to individual psychotherapy but the very idea of the unconscious threatens their sense of control. They will of the unconscious threatens their sense of control. They will therefore discount therapists insights. therefore discount therapists insights.

May respond to threat of intense affect with obsessional rambling May respond to threat of intense affect with obsessional rambling that serves as a smoke screen to mask their real feelings. that serves as a smoke screen to mask their real feelings.

Group therapy is highly effective in dealing with this problem as the Group therapy is highly effective in dealing with this problem as the client may accept feedback from peers without the same power client may accept feedback from peers without the same power struggle that accompanies feedback from the therapist. struggle that accompanies feedback from the therapist.



Avoidant Personality DisorderAvoidant Personality Disorder

Avoidant Personality Disorder- A pervasive pattern of Avoidant Personality Disorder- A pervasive pattern of social inhibition, feelings of inadequacy, and a social inhibition, feelings of inadequacy, and a hypersensitivity to negative evaluation.hypersensitivity to negative evaluation.


Psychodynamic Understanding: Avoidant Psychodynamic Understanding: Avoidant Personality DisorderPersonality Disorder

Individuals can be shy and avoidant for a variety of Individuals can be shy and avoidant for a variety of reasons. Some research data suggest that the trait of reasons. Some research data suggest that the trait of shyness is of genetic-constitutional origin. Shyness and shyness is of genetic-constitutional origin. Shyness and avoidance defends against embarrassment, humiliation, avoidance defends against embarrassment, humiliation, rejection, and failure. This anxiety must be explored to rejection, and failure. This anxiety must be explored to understand fully its origins with each individual client. understand fully its origins with each individual client.



Treatment Considerations of Avoidant Personality Treatment Considerations of Avoidant Personality DisorderDisorder

Generally respond well to both individual and group Generally respond well to both individual and group psychotherapy. psychotherapy.

Need to explore the underlying causes of shame and Need to explore the underlying causes of shame and their linkages to past developmental experiences. their linkages to past developmental experiences.

If able to confront the feared situation exposure If able to confront the feared situation exposure exercises can help. exercises can help.



Dependent Personality DisorderDependent Personality Disorder

Dependent Personality Disorder- A pervasive and Dependent Personality Disorder- A pervasive and excessive need to be taken care of that leads to excessive need to be taken care of that leads to submissive and clinging behavior and fears of submissive and clinging behavior and fears of separation.separation.



Psychodynamic Understanding: Dependent Psychodynamic Understanding: Dependent Personality DisorderPersonality Disorder

Many clients with dependent personality disorder Many clients with dependent personality disorder have grown up in households where the parents have grown up in households where the parents have communicated in one way or another that have communicated in one way or another that independence is fraught with danger.independence is fraught with danger.

Over-involved and over-intrusive parenting is Over-involved and over-intrusive parenting is common to this group of clients. common to this group of clients.



Treatment Considerations of Treatment Considerations of Dependent Personality DisorderDependent Personality Disorder

Questions? Questions?

Pathological Gambling: Bio-Psycho-Social Pathological Gambling: Bio-Psycho-Social

ReferencesReferencesAmerican Psychiatric Association (1994). American Psychiatric Association (1994). Diagnostic and Statistical Manual of Diagnostic and Statistical Manual of

Mental Disorders, Mental Disorders, 44thth edn. Washington DD: APA edn. Washington DD: APAAustralian Productivity Commission (APC) (1999). Australian Productivity Commission (APC) (1999). Australia’s Gambling Australia’s Gambling

Industries. Industries. Report No. 10, Canberra: Ausinfo. Report No. 10, Canberra: Ausinfo. Bechara, A. (2003). Risky Business: emotion, decision making, and addiction, Bechara, A. (2003). Risky Business: emotion, decision making, and addiction,

Journal of Gambling Studies, Journal of Gambling Studies, 19, 23-51. 19, 23-51. Bellringer, P. (1999). Bellringer, P. (1999). Understanding Problem Gamblers: A Practitioners Guide Understanding Problem Gamblers: A Practitioners Guide

to Effective Intervention, to Effective Intervention, London: Free Association Books. London: Free Association Books. Bergler, E. (1958). Bergler, E. (1958). The Psychology of Gambling, The Psychology of Gambling, London: Harrison. London: Harrison. Bergh, C., Eklund, T., Soedersten, P. and Nordin, C. (1997) Altered dopamine Bergh, C., Eklund, T., Soedersten, P. and Nordin, C. (1997) Altered dopamine

function in pathological gambling. function in pathological gambling. Psychological Medicine. Psychological Medicine. 27, 473-47527, 473-475Brown, R.I.F. (1985) The effectiveness of Gamblers Anonymous, in W.R. Brown, R.I.F. (1985) The effectiveness of Gamblers Anonymous, in W.R.

Eadinton (ed.) Eadinton (ed.) The Gambling Studies: Proceedings of the Sixth National The Gambling Studies: Proceedings of the Sixth National Conference on Gambling and Risk Taking, Conference on Gambling and Risk Taking, 5, 258-284.5, 258-284.


ReferencesReferencesCarroll, D. and Huxley, J.A.A. (1994). Cognitive , dispositional, and psycho-Carroll, D. and Huxley, J.A.A. (1994). Cognitive , dispositional, and psycho-

physiological correlates of dependent slot machine gambling in young physiological correlates of dependent slot machine gambling in young people, people, Journal of Applied Social Psychology, Journal of Applied Social Psychology, 24, 1070-1083. 24, 1070-1083.

Chambers, R.A. and Potenza, M.N. (2003) Neurodevelopment, impulsivity, and Chambers, R.A. and Potenza, M.N. (2003) Neurodevelopment, impulsivity, and adolescent gambling, adolescent gambling, Journal of Gambling Studies, Journal of Gambling Studies, 19, 53-84.19, 53-84.

Comings, D.E., Rosenthal, R.J., Lesieur, H.R., Rugle, L.J., Muhleman, D., Chiu, Comings, D.E., Rosenthal, R.J., Lesieur, H.R., Rugle, L.J., Muhleman, D., Chiu, C., Dietz, G. and Gade, R. (1996) A study of the dopamine D2 receptor C., Dietz, G. and Gade, R. (1996) A study of the dopamine D2 receptor gene in pathological gambling. gene in pathological gambling. Pharmacogenetics, Pharmacogenetics, 6, 223-234.6, 223-234.

Cox, R. and Orford, J. (2004). A qualitative study of the meaning of exercise Cox, R. and Orford, J. (2004). A qualitative study of the meaning of exercise for people labeled as ‘addicted’ to exercise- can ‘addiction’ be applied to for people labeled as ‘addicted’ to exercise- can ‘addiction’ be applied to high frequency exercising?, high frequency exercising?, Addiction Research and Theory, Addiction Research and Theory, 12, 167-188. 12, 167-188.

Custer, R. and Milt, H. (1985) Custer, R. and Milt, H. (1985) When Luck Runs out: Help for Compulsive When Luck Runs out: Help for Compulsive Gamblers and their Families, Gamblers and their Families, New York: Facts on File Publications. New York: Facts on File Publications.

Dickerson, M. (1990). Gambling: the psychology of a non-drug compulsion, Dickerson, M. (1990). Gambling: the psychology of a non-drug compulsion, Drug and Alcohol Review, 9, 187-199. Drug and Alcohol Review, 9, 187-199.


ReferencesReferencesDodes, L., (2002) The Heart of Addiction, New York, NY; HarperCollins Dodes, L., (2002) The Heart of Addiction, New York, NY; HarperCollins

Publishers. Publishers. Eisen, S.A., Lin, N., Lyons, M.J., Scherrer, J.F., Griffith, K., True, W.R., Eisen, S.A., Lin, N., Lyons, M.J., Scherrer, J.F., Griffith, K., True, W.R.,

Goldberg, J. and Tsuang, M.T. (1998) Familial influences on gambling Goldberg, J. and Tsuang, M.T. (1998) Familial influences on gambling behavior: an analysis of 3,359 twin pairs, behavior: an analysis of 3,359 twin pairs, Addiction, Addiction, 93, 1375-1384.93, 1375-1384.

Fisher, S. (1993a) Gambling and pathological gambling in adolescents, Fisher, S. (1993a) Gambling and pathological gambling in adolescents, Journal Journal of Gambling Studies, of Gambling Studies, 9, 277-288. 9, 277-288.

Gabbard, G. (1994) Psychodynamic Psychiatry in Clinical PracticeGabbard, G. (1994) Psychodynamic Psychiatry in Clinical PracticeGriffiths, M. and Sutherland, I. (1998) Adolescent gambling and drug use, Griffiths, M. and Sutherland, I. (1998) Adolescent gambling and drug use,

Journal of Community and Applied Social Psychology, Journal of Community and Applied Social Psychology, 8,8, 423-427. 423-427.Hodgins, D.C., Currie, S.R. and el-Guebaly , N. (2001) Motivational Hodgins, D.C., Currie, S.R. and el-Guebaly , N. (2001) Motivational

enhancement and self-help treatments for problem gambling, enhancement and self-help treatments for problem gambling, Journal of Journal of Consulting and Clinical Psychology, Consulting and Clinical Psychology, 69, 50-57. 69, 50-57.

Ibanez, A., Blanco, C., de Caastro, I.P. Fernandex-Piqueras, J. and Saiz-Ruiz, J. Ibanez, A., Blanco, C., de Caastro, I.P. Fernandex-Piqueras, J. and Saiz-Ruiz, J. (2003). Genetics of pathological gambling, (2003). Genetics of pathological gambling, Journal of Gambling Studies, Journal of Gambling Studies, 19, 19, 11-22. 11-22.


ReferencesReferencesJacobs, D.F. (1993) Evidence supporting a general theory of addiction, in W.R. Eadington Jacobs, D.F. (1993) Evidence supporting a general theory of addiction, in W.R. Eadington

and J.A. Cornelius (eds.) and J.A. Cornelius (eds.) Gambling Behavior and Problem Gambling, Gambling Behavior and Problem Gambling, Reno: University Reno: University of Nevada. of Nevada.

Knapp, T.J. (1997) Behaviorism and public policy: B.F. Skinner’s views on gambling, Knapp, T.J. (1997) Behaviorism and public policy: B.F. Skinner’s views on gambling, Behavior and Social Issues, Behavior and Social Issues, 7, 129-139. 7, 129-139.

Ladouceur, R. and Mayrand, M. (1987) A cognitive perspective of gambling, in P.M. Ladouceur, R. and Mayrand, M. (1987) A cognitive perspective of gambling, in P.M. Slakovskis (ed.) Slakovskis (ed.) Trends in Cognitive and Behavioral Therapies, Trends in Cognitive and Behavioral Therapies, 89-120, New York: 89-120, New York: Wiley. Wiley.

Lawrence, A.D., Evans, A.H., and Lees, A.J. (2003). Compulsive use of dopamine Lawrence, A.D., Evans, A.H., and Lees, A.J. (2003). Compulsive use of dopamine replacement therapy in Parkinson’s disease: reward systems gone awry?, replacement therapy in Parkinson’s disease: reward systems gone awry?, The Lancet, The Lancet, 2, 595-6042, 595-604. .

McCown, W.G. and Chamberlain, L. L. (2000). McCown, W.G. and Chamberlain, L. L. (2000). Best Possible Odds: Contemporary Best Possible Odds: Contemporary Treatment Strategies for Gambling Disorders, Treatment Strategies for Gambling Disorders, New York: Wiley. New York: Wiley.

Miers, D. (1996) The Implementation and effects of Great Britiain’s National Lottery, Miers, D. (1996) The Implementation and effects of Great Britiain’s National Lottery, Journal of Gambling Studies, Journal of Gambling Studies, 12, 343-373. 12, 343-373.


ReferencesReferencesMolina, J.A., Sainz-Artiga, M.J., Fraile, A., Jimenez-Jimenez, F.J., Villanue Orti-Pareja, M. Molina, J.A., Sainz-Artiga, M.J., Fraile, A., Jimenez-Jimenez, F.J., Villanue Orti-Pareja, M.

and Bermejo, F. (2000). Pathologic gambling in Parkinson’s disease: a behavioral and Bermejo, F. (2000). Pathologic gambling in Parkinson’s disease: a behavioral manifestation of pharmacologic treatment, manifestation of pharmacologic treatment, Movement Disorders, Movement Disorders, 15, 869-872. 15, 869-872.

National Research Council, National Academy of Sciences, Committee on the Social and National Research Council, National Academy of Sciences, Committee on the Social and Economic Impact of Pathological Gambling (1999). Economic Impact of Pathological Gambling (1999). Pathological Gambling: A Critical Pathological Gambling: A Critical Review.Review.

Orford,Orford, J., Morison, V. and Soers, M. (1996)J., Morison, V. and Soers, M. (1996) Drinking and gambling: a comparison with Drinking and gambling: a comparison with implications for theories of addiction, implications for theories of addiction, Drug and Alcohol Review, 15, 47-56.Drug and Alcohol Review, 15, 47-56.

Petry, N.M. and Casarella, T. (1999). Excessive discounting of delayed rewards in Petry, N.M. and Casarella, T. (1999). Excessive discounting of delayed rewards in substance abusers with gambling problems, substance abusers with gambling problems, Drug and Alcohol Dependence, Drug and Alcohol Dependence, 56, 25-56, 25-32. 32.

Potenza, M.N., Leung, H.C., Blumberg, H.P. Peterson, B.S., Fulbright, R.K., Lacadie, C.M., Potenza, M.N., Leung, H.C., Blumberg, H.P. Peterson, B.S., Fulbright, R.K., Lacadie, C.M., Skudlarski, P., and Gore, J.C. (2003) an FMRI stroop task study of ventromedial Skudlarski, P., and Gore, J.C. (2003) an FMRI stroop task study of ventromedial prefrontal cortical function in pathological gamblers, prefrontal cortical function in pathological gamblers, American Journal of Psychiatry, American Journal of Psychiatry, 160, 1990-1994. 160, 1990-1994.

Raylu, N. and Oei, T.P. (2004). Role of culture in gambling and problem gambling, Raylu, N. and Oei, T.P. (2004). Role of culture in gambling and problem gambling, Clinical Psychology Review, Clinical Psychology Review, 23, 1087-1114.23, 1087-1114.


ReferencesReferencesReid, R.L. (1986). The psychology of the near miss, Reid, R.L. (1986). The psychology of the near miss, Journal of Gambling Behavior, Journal of Gambling Behavior, 2, 32-2, 32-

39. 39. Room, R., Turner N.E., and Ialomiteanu, A. (1999). Community effects of the opening of Room, R., Turner N.E., and Ialomiteanu, A. (1999). Community effects of the opening of

the Niagara Casino. the Niagara Casino. Addiction, Addiction, 94, 1449-1466. 94, 1449-1466. Rosenthal, R. (1987). The psychodynamics of pathological gambling: a review of the Rosenthal, R. (1987). The psychodynamics of pathological gambling: a review of the

literature in T.Galsk (ed.) literature in T.Galsk (ed.) The Handbook of Pathological Gambling, The Handbook of Pathological Gambling, Springfield, Springfield, Illinois: Charles C. ThomasIllinois: Charles C. Thomas

Shaffer, H. J. (1996). Understanding the means and objects of addiction: technology, the Shaffer, H. J. (1996). Understanding the means and objects of addiction: technology, the internet, and gambling, internet, and gambling, Journal of Gambling Studies, Journal of Gambling Studies, 12, 461-469. 12, 461-469.

Stewart, R.M., and Brown, R.I.F. (1998) An outcome study of Gamblers Anonymous, Stewart, R.M., and Brown, R.I.F. (1998) An outcome study of Gamblers Anonymous, British Journal of Psychiatry, British Journal of Psychiatry, 152, 284-288.152, 284-288.

Walters, G.D. (2002) Behavior genetic research on gambling and problem gambling: a Walters, G.D. (2002) Behavior genetic research on gambling and problem gambling: a preliminary meta-analysis of available data, preliminary meta-analysis of available data, Journal of Gambling Studies, Journal of Gambling Studies, 17, 255-17, 255-271. 271.

Winters, K.C. and Rich, T. (1998) A twin study of adult gambling behavior, Winters, K.C. and Rich, T. (1998) A twin study of adult gambling behavior, Journal of Journal of Gambling Studies, Gambling Studies, 14, 213-225. 14, 213-225.

Psychological Aspects of Alcohol, Drug and Psychological Aspects of Alcohol, Drug and Gambling DisordersGambling Disorders

The EndThe End

Thank YouThank You

Psychological Aspects of the Action and Escape Gambler ... · PDF filePsychological Aspects of...

Documents

Transcript of Psychological Aspects of the Action and Escape Gambler ... · PDF filePsychological Aspects of...