Libro Il Fallimento piu riuscito della mia vita
Mood states and personality traits in Pathological Gamblers sample and their family members
Gianni Savron*,Paolo Pitti**,Rolando De Luca***
*Affective Disorders Center - Pavanello, Ponte di Brenta, Padova, Italy; **Lahuén, Center, Psychotherapy and Work, Morrano, Orvieto, Italy; ***Pathological Gamblers Treatment Center, Campoformido, Udine, Italy
Gambling represents a serious problem due to the psychological, social and financial repercussions it brings about. Pathological Gambling (PG) compromises seriously the relationship within a family, because it determines severe conflicts with repercussions upon the psychophysical integrity of both the gambler and his/her family.
Eighty-one consecutive Pathological Gamblers, 28 gamblers' wives and 26 gamblers' parents, referred to the Pathological Gamblers Treatment Center of Campoformido (Udine), were evaluated with the previous consent of all subjects.
In PG group inclusion criteria were:
a) primary diagnosis of DSM-IV criteria for Pathological Gambling;
b) a minimal duration of PG at least one year;
c) age between 18- 65.
The exclusion criteria were:
d) presence of psychopathology (psychosis, major depression);
e) neurological disorders;
f) alcohol and drug abuse.
All subjects were assessed before treatment with an Italian translation of psychometric battery that were found to be valid and sensitive instruments.
The aim of this study was that of:
1) evaluating the psychological differences in states and traits between a sample of pathological male gamblers (n=81), and a control group (n=81) matched for social-demographic variables;
2) investigating the same dimensions between the gamblers' wives (n=28) and the female control group (n=28);
3) assessing the parents' psychological characteristics (n=26).
assessing differences between all 3 groups.
Brief Psychiatric Rating Scale (BPRS) (Overall & Gorham, 1962): this is a clinical interview that consists of 18 items, each of 4 point scale, that allow to explore the presence of psychopathology (major depression and psychosis).
South Oaks Gambling Screen (SOGS) (Lasieur & Blume, 1987): this is a valid and reliable instrument employed to assess pathological gambling behavior. Twenty questions are counted and 5 or more indicate a probable gambling problem. A score of 9 or more indicates a severe gambling problem.
Anxiety Sensitivity Index (ASI) (Peterson & Reiss, 1986). this is a 16-item self-report questionnaire that measures fear of anxiety. For each item, individuals rate their degree of concern on a Likert-type scale ranging from 0 (very little) to 4 (very much).
Symptom Questionnaire (SQ) (Kellner, 1987): this is a yes/no questionnaire, with 92 brief and simple items, that covers scales of anxiety, depression, anger-hostility, and somatic symptoms.
Emotional Inhibition Scale ( EIS) (Kellner, 1986): this is a self-rating scale of a person's beliefs measuring the extent to which he can express his feelings and emotions. The EIS consists of 16 items, each on a 5-point scale (1-no, 5-always), that explore verbal inhibition, timidity, disguise of feelings, and self control. Range 16 to 80.
Tridimensional Personality Questionnaire (TPQ) (Cloninger, 1985): this is a true/false self-report questionnaire that consists of 100 questions and provides three major dimensions of personality: novelty seeking (ns), harm avoidance (ha), and reward dependence (rd).
Statistical methods
For the comparison between PG and control groups, independent two-tailed t-test were used. Person's product moment method was used to compute the correlations. For the comparison of all groups a non parametric statistic Kruskal-Wallis test was used.
Compared to the control group the gamblers result to present more distress (anxiety, depression, hostility, somatic symptoms), fear of anxiety symptoms, verbal inhibition, disguise of feeling, along with high scores in novelty seeking and low scores in reward dependence TPQ scales (Table I). Thus they present personality traits of excitability, impulsiveness, eccentricity, rigidity, practicality and emotional detachment.
The group of wives compared with the control group of women results to have higher distress (anxiety, depression, hostility, somatic symptoms) and higher anxiety sensitivity, verbal inhibition and timidity (Table II). They also present higher scores in the TPQ traits of harm avoidance and reward dependence, then traits of chronic anticipatory anxiety, timidity, inhibition and characteristics of persistence, dependence and sentimentalism.
Wives differ from their husbands in their higher reward dependence and lower novelty seeking and from their husbands' parents in their higher scores in harm avoidance and reward dependence (Table II).
A further comparison between gamblers and their parents revealed higher somatic symptoms and lower scores in novelty seeking (Table II).
The specific differences are defined by a comparison between all groups. (Table III).
In the Gamblers' group, the ASI was negatively related to TPQrd, and positively related to emotional inhibition. The TPQns was significantly related to the anxiety, depression and hostility scores, instead the TPQha score with distress (anxiety, depression, somatic symptoms, hostility).
TPQrd score was negatively related with depression and verbal inhibition (Table IV).
In the control group (Table V), ASI and TPQns scores were positively related with distress.
Personality trait of TPQrd was positively correlated with depression, and TPQns had not any correlation.
Cloninger (1987) pointed out that personality features could represent risk factors for the development of specific mental disorders and could be predictive of the pattern of comorbidity. The same author postulates three genetically independent temperamental traits: harm avoidance (ha), reward dependence (rd) and novelty seeking (ns).
Individuals with higher than average scores on ns tend to be curious, impulsive, excitable, extravagant and disorderly; those low in ns are reflective, stoical, reserved and orderly.
Individuals with high scores on ha tend to be characterized by anticipatory worry, fear of uncertainty, shyness of strangers and fatigability; those low in ha are optimistic, confident, sociable and energetic.
Individuals with high scores on rd tend to be sentimental, socially sensitive, persistent and dependent on approval of others; those low in rd are insensitive, practical irresolute and detached.
Ha and anxiety sensitivity (fear of anxiety, based on the belief that anxiety sensations have harmful physical, psychological, or social consequences) may be risk factors to developing agoraphobia and panic disorder (Saviotti, et al., 1991; Mc Nally, 1999).
Cognitive anxiety and somatic anxiety are most striking characterized by elevated score in ha and ha are a state -dependent phenomenon (Starcevic et al., 1992). In contrast, ns and rd seem independent of current mood.
High ha is present in patients suffering from panic and depression (Mulder et al., 1994), and Ampollini et al. (1999) reported high score in ha and rd which might represent a stable temperamental trait of patients with depressive and anxiety disorders.
The study identified and defined the psychopathological characteristics of state and trait in both the gamblers and their family members.
The three groups present higher distress, sensitivity to anxiety, emotional inhibition as compared to the control groups. The trait anxiety (harm avoidance), higher anxiety sensitivity, altruism, persistence and dependence specifically characterize the gamblers' wives. Gamblers, instead, are characterized by higher impulsiveness, inconstancy, eccentricity, novelty seeking, emotional detachment (insensitive, practical, tough-minded) and lower chronic anxiety. The group of parents differentiates itself from the group of wives for a lower trait-anxiety, pessimism and lower dependence, however, both present higher levels of somatic anxiety than the gamblers. The group of wives, due to their characteristics of state and trait, seems to have the risk of developing cases of severe depression. Each group presents a specific personality and psychological model along with peculiar clinical manifestations, different from the control groups