Exploring Facets of Personality and Escapism in Pathological Gamblers

Abstract

This study explored facets of personality between pathological gamblers (n = 69) and nonpathological gamblers (n = 55) in a convenience sample in Los Angeles, California. Pathological gamblers were more prone to mood disturbance, impulsivity, feelings of frustration, interpersonal sensitivity, vulnerability to distress, and distrust of others as measured by the NEO Personality Inventory–Revised. Pathological gamblers also reported diminished competence and self-discipline as well as tendencies toward hasty decision making when compared to nonpathological gamblers. A categorical analysis of subtypes revealed that those who gambled to escape experienced significantly greater levels of neuroticism and facets of impulsivity.

Full text

Journal of Social Work Practice in the Addictions, 11:60–74, 2011
Copyright ©Taylor & Francis Group, LLC
ISSN: 1533-256X print/1533-2578 online
DOI: 10.1080/1533256X.2011.547071
Exploring Facets of Personality and Escapism
in Pathological Gamblers
RORY C. REID, PHD, LCSW
Research Psychologist, Department of Psychiatry and Biobehavioral Sciences, University of
California, Los Angeles, California, USA
DESIREE S. LI, BS
Research Associate, Department of Psychiatry and Biobehavioral Sciences, University of
California, Los Angeles, California, USA
JEAN LOPEZ, BA
Research Associate, Yale University School of Medicine, New Haven, Connecticut, USA
MICHAEL COLLARD, MA
Research Associate, Department of Psychiatry and Biobehavioral Sciences, University of
California, Los Angeles, California, USA
IMAN PARHAMI, MD
Research Coordinator, Department of Psychiatry and Biobehavioral Sciences, University of
California, Los Angeles, California, USA
REEF KARIM, DO
Assistant Clinical Professor, Department of Psychiatry and Biobehavioral Sciences, University
of California, Los Angeles, California, USA
TIMOTHY FONG, MD
Associate Professor, Department of Psychiatry and Biobehavioral Sciences, University of
California, Los Angeles, California, USA
This study explored facets of personality between pathological
gamblers ( n=69) and nonpathological gamblers ( n=55) in
a convenience sample in Los Angeles, California. Pathological
Received July 2, 2010; revised November 19, 2010; accepted November 23, 2010.
The research for this article was funded by National Institute on Drug Abuse Grant
5K23DA019522–04.
Address correspondence to Rory C. Reid, Semel Institute for Neuroscience and Human
Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los
Angeles, 760 Westwood Boulevard, Suite 38-260, Los Angeles, CA 90024, USA. E-mail: rreid@
mednet.ucla.edu
60
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Escapism in Pathological Gamblers 61
gamblers were more prone to mood disturbance, impulsivity,
feelings of frustration, interpersonal sensitivity, vulnerability to
distress, and distrust of others as measured by the NEO Personality
Inventory–Revised. Pathological gamblers also reported diminished
competence and self-discipline as well as tendencies toward hasty
decision making when compared to nonpathological gamblers. A
categorical analysis of subtypes revealed that those who gambled to
escape experienced significantly greater levels of neuroticism and
facets of impulsivity.
KEYWORDS escapism, gambling, impulsive behavior, pathologi-
cal gamblers, personality
Pathological gambling has been classified as an impulse-control disorder in
the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revi-
sion [DSM–IV–TR]; American Psychiatric Association, 2000), with a lifetime
prevalence rate estimated between 1% and 3% among North American adult
populations (Petry, Stinson, & Grant, 2005; Shaffer & Hall, 2001). Because
approximately 70% to 90% of adults have participated in some form of gam-
bling (Raylu & Oei, 2002), the lifetime prevalence rates suggest the vast
majority of gambling behavior does not escalate to a pathological level.
However, with the proliferation of gambling opportunities via online venues,
it is plausible that the number of individuals with problematic and patho-
logical gambling issues might increase, subsequently requiring additional
demands for treatment.
Problem gambling can create a constellation of issues for the gam-
bler, the gambler’s family, and society. Consequences include a diminished
quality of life for the gambler (Scherrer et al., 2005) as well as financial
problems, high divorce rates, legal challenges, and interpersonal problems
(Grant & Kim, 2001). Suicide attempts are common in this population, with
rates as high as 12% to 24% (Blaszczynski & Farrell, 1998; Maccallum &
Blaszczynski, 2003). Society also pays the cost of gambling-related crimes
that are committed to satisfy gambling debts and perpetuate gambling
activities (Blaszczynski & Silove, 1996; Lahn, 2005; Potenza, Steinberg,
McLaughlin, Rounsaville, & O’Malley, 2000).
Despite the vast array of problems created by pathological gambling,
evidence-based treatment options are limited (Shaffer, Labrie, Laplante,
Kidman, & Donato, 2005). Conceptualizing the associated characteristics
of gambling behavior through the lens of personality traits can provide
clinicians with valuable insights as they attempt to intervene with this pop-
ulation. For example, is there a pattern of personality characteristics that
make individuals more vulnerable to pathological gambling? Understanding
correlations between pathological gambling and facets of personality can
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62 R. C. Reid et al.
enable clinicians to generate theories and hypotheses to guide future out-
come research. Personality traits among pathological gamblers (PGs) might
also predict responsiveness or receptivity to treatment interventions as well
as help clinicians understand comorbidity and subtyping issues in this
population.
There is some preliminary evidence that PGs might possess distinct per-
sonality traits as measured by the Five-Factor Model of personality (FFM;
Digman, 1990). One of the earliest studies of personality characteristics
among male PGs (N=100) found tendencies toward disregard for authority,
impulsivity, feelings of masculinity, and inadequacy (Graham & Lowenfeld,
1986). The study was limited to a sample of inpatient veterans and used the
Minnesota Multiphasic Personality Inventory (MMPI), which arguably cap-
tures more aspects of psychopathology than personality traits based on the
FFM. Another study examined predictive values of personality traits among
gamblers (N=114) and found that impulsivity, sensation seeking, and com-
petitiveness all had strong positive relationships with pathological gambling
behaviors (Parke, Griffiths, & Irwing, 2004). In comparing personality char-
acteristics of PGs with those of nonpathological gamblers (NPGs), Bagby
and colleagues (2007) found that PGs were significantly more impulsive,
emotionally unstable, and distrusting of others. PGs also had a low opin-
ion of their own abilities. Interestingly, no group differences were found
on facets of excitement-seeking traits, suggesting that this trait characterizes
gambling behavior in general rather than pathological gambling specifically.
Novelty seeking however, has been implicated in PGs and studies have also
found significantly higher levels of emotional distress (e.g., neuroticism),
impulsiveness, and less openness among PGs (Kaare, Mottus, & Konstabel,
2009).
In understanding PGs and their associated traits, it should be noted that
this group is a heterogeneous population. For example, not all are primarily
characterized by personality traits such as impulsiveness (Blaszczynski
& Nower, 2002; Toneatto & Ladouceur, 2003; Toneatto & Millar, 2004).
Furthermore, depression, loneliness, and other unpleasant affective experi-
ences hypothesized as motivators for pathological gambling are not consid-
ered universal (Getty, Watson, & Frisch, 2000; Trevorrow & Moore, 1998).
These findings have led researchers to begin exploring typologies and sub-
types of gamblers (Blaszczynski & Nower, 2002; Ledgerwood & Petry, 2006).
The field of gambling research is evolving and is moving toward sub-
typing among PGs. For example, some studies have explored affective
motivational states as they pertain to gamblers with comorbid alcohol abuse,
showing greater gambling frequency and alcohol consumption among those
with emotional coping skills compared to those PGs who had emotional dys-
regulation (Stewart, Zack, Collins, Klein, & Fragopoulos, 2008). Others have
sought to understand subtypes based on patterns of gambling behaviors
such as those who chase their losses (continuation of gambling, often with
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Escapism in Pathological Gamblers 63
increased wagers, following a sequence of losing bets) compared to those
who do not (Breen & Zuckerman, 1999). In a review of subtyping, Westphal
(2007) noted that studies have attempted to classify gamblers based on
readiness to change, preferred gambling activities, and comorbid psychiatric
disorders.
One subtype of gamblers that has emerged in the literature comprises
those who use gambling as a form of escapism from unpleasant mood states
(Blaszczynski & Nower, 2002; Rockloff & Dyer, 2006; Rockloff, Greer, Fay,
& Evans, 2010). These individuals report continuing to gamble despite the
realization that further gambling would not resolve their long-term prob-
lems (Wood & Griffiths, 2007). Despite negative consequences, these PGs
turn to their mood-altering experience to avoid feelings such as boredom
and loneliness (Blaszczynski, McConaghy, & Frankova, 1990; Ledgerwood
& Petry, 2006; Porter, Ungar, Frisch, & Chopra, 2004). Such deficits in mod-
ulating affect might be a precipitating risk factor for escapism that motivates
gambling and appears to exacerbate gambling behaviors (Toce-Gerstein,
Gerstein, & Volberg, 2003). However, relationships between personality and
tendencies of escapism have yet to be explored, despite important impli-
cations for treatment. For instance, if escapism tendencies were correlated
with higher levels of personality traits such as stress proneness, tendencies
to become easily frustrated, or interpersonal sensitivity, then strategies to
intervene in these domains could be developed that would aid social work-
ers and other clinicians to better help patients with this subtype of gambling
behavior.
PURPOSE OF STUDY
The purpose of this study was to explore group differences between non-
treatment-seeking PGs and NPGs on facets of personality as measured by
the NEO Personality Inventory–Revised (Costa & McCrae, 1992). NPGs were
selected as a comparison group to differentiate possible traits that uniquely
characterize those who gamble recreationally in nonpathological ways from
those who develop serious problems with gambling behaviors. This study is
also intended to specifically explore relationships between facets of person-
ality and tendencies to use gambling as a means of escapism (e.g., coping
with loneliness or boredom). Finally, we discuss results as they pertain to
clinical interventions with this population.
METHODS
Participants
All participants were obtained from a convenience sample in the Los
Angeles area through advertisements recruiting individuals who gambled.
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64 R. C. Reid et al.
Participants were required to read and write English, be at least 18 years
of age, and not be seeking treatment. Individuals were excluded if they
reported the use of recreational or psychoactive drugs that met criteria for
a substance-related disorder. These criteria reduced the initial sample of 144
to a final sample of 124 participants, who formed the basis for this study.
Eligible participants received $40 in grocery store coupons.
All participants signed informed consents, and study procedures were
approved by the Institutional Review Board for Human Subject Research
at the University of California, Los Angeles. The recruitment of participants
occurred during 2008 and 2009.
The PG group consisted of men (n=55) and women (n=14), and eth-
nic representation included Caucasian (n=31), African American (n=19),
Hispanic (n=7), Asian (n=9), and Native American (n=3). Participants
ranged from 22 to 66 years of age (M=42.9, SD =11.2). Relationship status
included never married (n=34), married (n=14), divorced (n=15), sep-
arated (n=3), and cohabitating (n=3). Employment status consisted of
full time (n=24), part time (n=22), student (n=4), and retired, disabled,
or unemployed (n=19).
The NPG group consisted of men (n=36) and women (n=19),
and ethnic representation among the sample included Caucasian (n=31),
African American (n=13), Hispanic (n=6), and Asian (n=5). Participants
ranged from 18 to 82 years of age (M=43.0, SD =15.65). Relationship
status included never married (n=31), married (n=11), divorced (n=8),
widowed (n=3), separated (n=1), and cohabitating (n=1). Employment
status consisted of full time (n=27), part time (n=10), student (n=6),
and retired, disabled, or unemployed (n=12).
Measures
Participants completed a small battery of self-report measures, including
the NEO Personality Inventory–Revised, the South Oaks Gambling Screen–
Revised, a demographic questionnaire, and a urine drug test to exclude illicit
substance users. Additionally, diagnostic clinical interviews for pathological
gamblers were conducted using the National Opinion Research Center DSM
Screen for Gambling Problems (NODS).
The NODS is a short, 17-item brief structured interview based on the
DSM–IV criteria (Gerstein et al., 1999) and has been demonstrated to be
a valid, reliable, and clinically useful tool to screen for gambling-related
disorders (Hodgins, 2004; Wickwire, Burke, Brown, Parker, & May, 2008).
Participants who answered positively to five or more items were classified
as PGs (n=69), whereas those who answered positively to less than five
criteria were considered NPGs (n=55).
The South Oaks Gambling Screen–Revised (SOGS–R) was also used to
characterize gambling behaviors and the severity of gambling problems. The
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Escapism in Pathological Gamblers 65
SOGS–R (Lesieur & Blume, 1993) is a 16-item self-report questionnaire based
on DSM criteria for pathological gambling that measures problems with gam-
bling over the past 3 months and inquires about specific gambling behavior.
It is scored on a scale from 0 to 20, with scores of 5 or higher categorized as
probable PGs. The SOGS–R is a validated and reliable instrument that serves
to screen clinical populations of alcoholics and drug abusers as well as gen-
eral populations for pathological gambling (Lesieur & Blume, 1987, 1993).
The SOGS–R was used in this study to characterize the samples based on
gambling behaviors and also to provide an index of the severity of gambling
problems.
The NEO Personality Inventory–Revised (NEO–PI–R; Costa & McCrae,
1992), designed to measure the FFM, was used to assess self-reported per-
sonality traits. The NEO has 240 items, consisting of self-statements such as “I
am a worrier,” answered on a 5-point Likert scale ranging from 0 =strongly
disagree to 4 =strongly agree with some items reversed scored. The NEO
assesses 30 facets, 6 for each dimension of the FFM. Raw scores are stan-
dardized as T-scores (M=50, SD =10) using respective sex norms reported
in the NEO manual. Evidence on convergent and discriminant validity is pre-
sented in the NEO manual (Costa & McCrae, 1992), including cross-observer
agreement and prediction of external criteria (e.g., psychological well-being,
needs, motives, creativity, educational and occupational achievements, and
coping mechanisms). The NEO was selected because it has been broadly
used in numerous studies to capture elements of personality and has demon-
strated good psychometric properties. It is also widely available to clinicians
who might want to use it in clinical practice.
Escapism tendencies among participants were queried during a diag-
nostic interview to determine if they used gambling to cope with and escape
from feelings of (a) loneliness, (b) boredom, or (c) sadness or depres-
sion. Participants reported whether these patterns were true for them as
it pertained to patterns of gambling behaviors. Those who reported gam-
bling frequently to escape at least one of these uncomfortable feelings
were classified in the escapism group. Frequent gambling behaviors among
the participants included playing cards (n=67), betting on animal races
(n=25), betting on sports (n=33), playing dice games (n=31), lot-
teries (n=59), playing bingo (n=14), slot machines (n=37), and skill
gambling (n=14).
RESULTS
Comparing Pathological Gamblers With Controls
Means, standard deviations, and effect sizes for the study variables are found
in Table 1. First, PGs were compared to the control group of NPGs with a
multivariate analysis of variance (MANOVA) on the five NEO factor domain
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66 R. C. Reid et al.
TABLE 1 Means, Standard Deviations, Significance, and Effect Size for NEO–PI–R Scores
NPGsaPGsbCohen’s
NEO Domains/facets MSDMSD F d
Neuroticism 46.04 12.19 59.80 12.22 38.88∗∗∗ 1.13
Anxiety 46.71 13.22 57.07 11.81 21.20∗∗∗ 0.83
Angry hostility 46.65 13.27 59.86 12.40 32.60∗∗∗ 1.03
Depression 46.73 10.28 60.30 11.16 48.57∗∗∗ 1.27
Self-consciousness 45.62 12.59 56.07 12.01 22.23∗∗∗ 0.85
Impulsiveness 48.62 12.49 58.07 11.00 19.81∗∗∗ 0.80
Vulnerability 45.09 12.01 58.52 14.12 31.55∗∗∗ 1.03
Extraversion 54.00 7.32 53.06 10.48 0.32 0.11
Warmth 52.04 11.21 47.54 12.61 4.30∗0.38
Gregariousness 53.40 10.94 49.29 9.83 4.84∗0.40
Assertiveness 56.07 9.87 53.10 10.25 2.66 0.30
Activity 50.24 10.40 52.49 10.42 1.44 0.22
Excitement-seeking 56.49 9.11 58.52 8.96 1.55 0.22
Positive emotions 55.25 9.45 48.49 11.27 12.67∗∗∗ 0.65
Openness 52.45 9.59 48.74 11.01 3.90∗0.36
Fantasy 50.93 10.08 55.09 10.02 5.25∗0.41
Aesthetics 51.58 10.49 51.33 11.22 0.02 0.02
Feelings 51.58 10.91 50.42 11.44 0.39 0.11
Actions 47.85 11.87 45.78 10.82 1.03 0.18
Ideas 55.05 10.96 48.70 12.77 8.59∗∗ 0.54
Values 52.96 10.37 47.48 8.80 10.15∗∗ 0.57
Agreeableness 48.58 12.07 39.96 9.36 20.10∗∗∗ 0.81
Trust 48.42 13.20 37.33 12.65 22.61∗∗∗ 0.86
Straightforwardness 48.82 11.17 42.84 13.35 7.07∗∗ 0.49
Altruism 52.93 13.36 6.61 12.27 7.50∗∗ .49
Compliance 8.42 12.66 9.90 12.15 14.50∗∗∗ 0.69
Modesty 7.05 9.31 4.84 9.77 1.64 .23
Tender-mindedness 4.38 11.49 7.59 10.81 11.41∗∗∗ 0.61
Conscientiousness 51.42 11.66 5.81 10.53 7.89∗∗ .51
Competence 3.38 12.85 2.52 12.04 23.47∗∗∗ 0.87
Order 50.11 10.21 7.00 10.76 2.67 .30
Dutifulness 50.00 11.94 1.77 10.33 16.92∗∗∗ 0.74
Achievement striving 53.04 10.89 8.54 11.08 5.13∗.41
Self-discipline 0.87 11.98 0.19 12.52 23.15∗∗∗ 0.87
Deliberation 4.22 13.68 3.58 11.20 22.67∗∗∗ 0.86
Note. NEO–PI–R =NEO Personality Inventory–Revised; PG =pathological gambler; NPG =nonpatho-
logical gambler.
an=55. bn=69.
∗p≤.05. ∗∗p≤.01. ∗∗∗p≤.001.
scores. The groups were significantly different overall (Wilks’s λ=.674),
F(5, 118) =11.42, p<.001. Post-hoc univariate analysis revealed that this
overall difference arose primarily from differences in Neuroticism, F(1, 122)
=38.87, p<.001; Openness, F(1, 122) =3.77, p<.001; Agreeableness, F(1,
122) =20.12, p<.001; and Conscientiousness, F(1, 122) =7.89, p<.01,
such that PGs, as a group, exhibited more neuroticism and were less open,
agreeable, and conscientious than NPGs. Note, however, that the magni-
tudes of the differences were modest for Openness, with only 4 T-score
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Escapism in Pathological Gamblers 67
points separating the groups. This is reflected in the effect size of .36, which
is generally regarded as small to moderate (Cohen, 1988). Analysis of dif-
ferences based on gender and ethnicity did not produce any meaningful
results, likely due to the small sample size.
Because multivariate statistical comparisons for four of the five NEO
domains yielded significant results, post-hoc univariate examination of the
facet scores was justified without correction for multiple comparisons. These
scores are noted in Table 1. These data reveal several differences between
the groups, including large effect sizes (i.e., Cohen’s d≥.80) that emerged
on three of four impulsivity traits, with PGs scoring higher on facets of
Impulsiveness, Self-Discipline, and Deliberation compared to NPGs. Large
effect sizes and significant differences between the groups also suggest that
the PG sample experienced greater neuroticism when compared to NPGs.
Neuroticism, as measured by the NEO–PI–R, generally captures elements of
emotional distress and maladjustment, although it is possible to obtain high
scores on the domain of Neuroticism without meeting criteria for a psychi-
atric disorder. Other differences of clinical interest included data suggesting
that PGs exhibited greater tendencies toward stress proneness, greater will-
ingness to manipulate others or use deception, more competitive behavior,
and more interpersonal aggression compared to the NPG group. PGs also
experienced fewer positive emotions, less trust for others, lower opinions
of their abilities, and were less likely to be governed by their conscience in
comparison to NPGs.
Comparing Subtypes of Gamblers on Tendencies of Escapism
Categorical analysis was conducted based on whether participants endorsed
using gambling to escape (e.g., reporting frequently gambling to distract or
escape from feelings of loneliness, boredom, or depression). As noted pre-
viously, this information was gathered by asking each participant to indicate
the extent to which he or she pursued gambling to escape uncomfort-
able feelings. Those who endorsed frequent escapism patterns of gambling
across multiple domains were classified as such. Although a minority of the
entire combined sample reported escapism tendencies (52/124; 42%), a chi-
square analysis revealed that PGs made up a significantly greater percentage
of the escapism gambling group (39/52; 75%) compared to NPGs (13/52;
25%), χ2(1, N=124) =13.59, p=.001. When participants were classified
within their own respective gambling group, 57% (39/69) of PGs reported
escapism tendencies compared to 24% of NPGs (13/55). Although a majority
of PGs gambled to escape (57%), slightly less than half of this group denied
escapism tendencies. Therefore, some individuals who gamble pathologi-
cally do so for other reasons than escapism, and such persons belong to
a group exhibiting significantly less impulsivity and neuroticism than those
who report using gambling to escape. Escapism, however, does appear to be
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68 R. C. Reid et al.
TABLE 2 Group Differences for Gambling Based on Escapism, Combined Sample
EscapismaNonescapismbCohen’s
Study variables MSDMSD F d
SOGS–R total 10.88 4.48 5.97 5.09 31.07∗∗∗ 1.03
NEO Neuroticism facets
Anxiety 56.19 13.43 49.79 12.87 7.199∗∗ 0.49
Angry hostility 58.25 13.05 50.93 14.53 8.34∗∗ 0.53
Depression 58.37 11.39 51.33 12.84 9.94∗∗∗ 0.58
Self-consciousness 54.90 11.80 48.93 13.80 6.37∗∗ 0.47
Vulnerability 57.35 13.24 49.11 14.95 10.07∗∗∗ 0.58
NEO Impulsivity facets
Impulsiveness 57.44 11.72 51.35 12.57 7.51∗∗ 0.50
Excitement-seeking 59.69 8.94 56.13 8.88 4.84∗0.40
Self-discipline 40.77 12.96 47.93 12.89 9.28∗∗ 0.55
Deliberation 43.48 12.04 51.78 13.34 12.66∗∗∗ 0.65
Note. N =124. SOGS–R =South Oaks Gambling Screen–Revised. Impulsiveness is a facet on the
Neuroticism domain but was included with the other facets hypothesized to capture impulsive tendencies
for the purposes of presentation.
an=52. bn=72. ∗p≤.05. ∗∗p≤.01. ∗∗∗p≤.001.
a distinguishing factor between the groups, given that NPGs demonstrated
much less prevalence toward tendencies of escapism (76% denied escapism
patterns). Group differences among gamblers based on escapism tendencies
were explored using one-way analysis of variance. The means, standard
deviations, and effect sizes of this analysis are reported in Table 2. To justify
the analysis, we specifically focused on facets of emotional dysregulation
captured by neuroticism and traits associated with impulsivity. As can be
seen in Table 2, those who used gambling to escape were much more
likely to exhibit neurotic tendencies and were significantly more impulsive.
When simultaneously examining level of pathology and level of escapism,
interactions were not present.
DISCUSSION
In comparing a sample of PGs to NPGs, significant differences with moderate
to large effect sizes were observed for a number of facets of personality. In
particular, facets reflecting neuroticism produced large effect sizes between
the groups, suggesting that when compared to NPGs, the PG sample expe-
rienced greater anxiety, frustration proneness, depression, sensitivity to
personal ridicule, and proneness to feelings of inferiority. Additionally, PGs,
compared to NPGs, were significantly less trusting and straightforward and
perceived themselves as lacking competence. Not surprisingly, PGs, on aver-
age, exhibited greater traits associated with impulsivity compared to NPGs.
Tendencies to use gambling as a form of escapism appear to be impor-
tant among some, but not all, of those who gamble. This appears to be
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Escapism in Pathological Gamblers 69
disproportionately true among PGs, as they reported significantly more
gambling behaviors associated with escapism. Although normal controls are
also likely to gamble to escape at times, those who gambled frequently
to escape were on average more emotionally distressed as measured by
personality facets of neuroticism. This finding provides support for the
notion that impulse control is often sacrificed in times of emotional dis-
tress, when individuals give special status and priority to affect regulation
(Tice, Bratslavsky, & Baumeister, 2001). In essence, when individuals feel
unpleasant emotion, they generally seek some type of symptom relief, and
this desire is perceived as urgent. Thus, the inability to regulate unpleasant
affective experiences undermines impulse control because emotional dis-
tress creates a short-term focus on the present moment, whereas impulse
control requires future-directed thinking (e.g., recognizing the benefits of
delayed gratification to obtain a more distant goal). This pattern is not unique
to pathological gambling and has been noted in other populations with
impulse-control problems, such as hypersexual individuals (Reid, 2010; Reid,
Carpenter, Spackman, & Willes, 2008), individuals with substance-related
disorders (Ashton & Stepney, 1982; Hull, Young, & Jouriles, 1986; Pickens,
Hatsukami, Spicer, & Svikis, 1985), and individuals with eating disorders
(Heatherton, Herman, & Polivy, 1991; Heatherton, Striepe, & Wittenberg,
1998).
The findings from this study support treatment strategies that focus on
affect regulation, especially for those who might use gambling as a form
of escapism. However, clinicians should exercise caution in assuming that
interventions targeting affect regulation are required for all PGs. A significant
portion of those who gambled for reasons other than escapism met criteria
for pathological gambling, but did not appear to experience neuroticism
or significant deficits in general impulse control. This finding supports the
notion of heterogeneity among PGs. Perhaps this subset of gamblers experi-
ence a loss of impulse control that is unique to context-specific factors (e.g.,
gambling opportunities) rather than experiencing impulsive characteristics
in general.
The reason for the lack of trust and straightforwardness among PGs
compared to NPGs is unclear, because mixed explanations exist in the
literature regarding these associations. For example, attachment theories sug-
gest that those who distrust are less likely to be emotionally vulnerable in
their interpersonal relationships, which in turn, exerts a negative effect on
emotional well-being. Others have suggested that emotions influence trust
depending on the direction of the emotion’s valence, such that positive
valence (e.g., happiness) increases trust, whereas negative valence (e.g.,
sadness or depression) decreases trust (Dunn & Schweitzer, 2005; Lerner
& Keltner, 2000, 2001). The degree to which these interactions, regardless
of directionality, might influence gambling behavior is not clear. However,
given the current data, the relevance of the finding might be a topic for future
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70 R. C. Reid et al.
research and for discussion with those seeking treatment for pathological
gambling.
Relevance of Findings for Clinical Practice
The findings of this study provide clinicians with a number of insights about
associated characteristics among PGs. The pragmatic implications for these
findings suggest that the following considerations and interventions might
be useful when working with this population in clinical practice:
1. Clinicians will likely benefit from conceptualizing pathological gambling
as a phenomenon in which many, but not all, individuals seek relief from
emotional distress. The findings of this study support the notion that PGs
disproportionately experience unpleasant mood states when compared
to individuals in a control group. If this is true, it will be important to
balance time spent in therapy between attempting to arrest problematic
gambling behaviors and focusing on underlying emotional issues that
might perpetuate these patterns.
2. Clinicians should help clients identify situations in which they are likely to
experience unpleasant emotions and elucidate the process of how such
affective experiences translate into problematic gambling.
3. Given the paucity of positive emotions among the PGs in this study,
clinicians might want to explore the expectations of clients about things
that create happiness in their lives. It is plausible that negative attention
bias or other cognitive distortions among these clients predispose them to
negative mood states. Alternatively, unrealistic expectations might leave
them vulnerable to serial disappointments in their lives. This hypothesis
needs to be explored further.
4. Clinicians might consider strategies that increase tolerance for uncomfort-
able affective experiences. In many ways, experiential therapists might
afford clients the opportunity to process these emotionally difficult states
in a safe environment where they can discover their ability to survive
unpleasant affect they might otherwise fear or avoid. Mindfulness exer-
cises are one example of a treatment strategy that can facilitate this type
of increased coping with unpleasant affective states (Toneatto & Nguyen,
2007).
5. Emotional distress, which was highly correlated with pathological gam-
bling in this study, can also be modulated through interventions targeting
physiological processes. For example, biofeedback exercises that help
reduce internal arousal (e.g., perceived emotional stress or anxiety)
have shown to be helpful in the reduction of these states, which
could in turn reduce the perceived need to escape (Fedotchev, 2010).
Additionally, interventions to target physiological processes might include
neurofeedback as a tool for regulatory control, mindfulness meditation to
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Escapism in Pathological Gamblers 71
enhance focused attention, yoga, and breathing exercises for anxiety and
affect stabilization.
Limitations of Study
Despite a number of interesting findings, this study was limited in several
ways. First, this study is correlational and therefore does not address whether
facets of personality, including neuroticism, exert a causal or interactive
effect on pathological gambling. It is also difficult to assert directionality
about impulsivity and escapism without further research. This study also
possesses the limitations commonly associated with self-report measures
and was conducted in a small sample demographically constrained to Los
Angeles, California. Inferences about our findings beyond those listed in this
study should be made with caution, in part because our sample consisted
of non-treatment-seeking individuals. Although this study lacked participants
with comorbid substance-related disorders, this dynamic afforded the oppor-
tunity to minimize potential confounds that could have complicated the
interpretation of our results.
CONCLUSION
This study examined group differences between non-treatment-seeking sam-
ples of PGs and NPGs regarding facets of personality. PGs were more likely
to exhibit facets of personality reflecting neuroticism, impulsivity, distrust of
others, and low sense of competence when compared to NPGs. Individuals
who gambled as a form of escapism from unpleasant affective experiences
were more likely to exhibit pathological tendencies, including greater impul-
sivity and emotional dysregulation compared to those who gambled for
reasons other than escapism. However, this pattern of escapism will need
to be explored on an individual basis because our findings provide further
evidence of heterogeneity among PGs.
Future research might consider further investigation of subtypes among
pathological gambling populations, as well as outcome studies that explore
the efficacy of treatment interventions, such as those targeting affect regula-
tion. Continued clinical trials exploring pharmacological interventions with
PGs should also be considered (Grant, Kim, & Potenza, 2003; Topf, Yip, &
Potenza, 2009).
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