Reliability, Validity, and Classification Accuracy of the DSM-5 Diagnostic Criteria for Gambling Disorder and Comparison to DSM-IV.

Randy Stinchfield,Jon Grant,Ken C Winters,Susana Jimenez-Murcia,John Mccready,John Welte,Nancy M Petry,Heather Chapman,Nigel E Turner

doi:10.1007/s10899-015-9573-7

Abstract

The DSM-5 was published in 2013 and it included two substantive revisions for gambling disorder (GD). These changes are the reduction in the threshold from five to four criteria and elimination of the illegal activities criterion. The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the DSM-5 diagnostic criteria for GD. Second, to compare the DSM-5–DSM-IV on reliability, validity, and classification accuracy, including an examination of the effect of the elimination of the illegal acts criterion on diagnostic accuracy. To compare DSM-5 and DSM-IV, eight datasets from three different countries (Canada, USA, and Spain; total N = 3247) were used. All datasets were based on similar research methods. Participants were recruited from outpatient gambling treatment services to represent the group with a GD and from the community to represent the group without a GD. All participants were administered a standardized measure of diagnostic criteria. The DSM-5 yielded satisfactory reliability, validity and classification accuracy. In comparing the DSM-5 to the DSM-IV, most comparisons of reliability, validity and classification accuracy showed more similarities than differences. There was evidence of modest improvements in classification accuracy for DSM-5 over DSM-IV, particularly in reduction of false negative errors. This reduction in false negative errors was largely a function of lowering the cut score from five to four and this revision is an improvement over DSM-IV. From a statistical standpoint, eliminating the illegal acts criterion did not make a significant impact on diagnostic accuracy. From a clinical standpoint, illegal acts can still be addressed in the context of the DSM-5 criterion of lying to others.

Highlights

Participants were recruited from outpatient gambling treatment services to represent the group with a gambling disorder (GD) and from the community to represent the group without a GD
Accurate diagnosis of gambling disorder (GD) is important in order to measure the prevalence of GD in the general population, manage public health efforts, diagnose patients in clinical settings, and measure treatment outcome
The same analyses were computed for the DSM-IV, and the results indicate that the DSM-5 is slightly more internally consistent than DSM-IV

Summary

Introduction

Accurate diagnosis of gambling disorder (GD) is important in order to measure the prevalence of GD in the general population, manage public health efforts, diagnose patients in clinical settings, and measure treatment outcome. Diagnostic criteria for GD were first introduced in 1980, under the diagnosis of pathological gambling (PG) in DSM-III (American Psychiatric Association 1980) and were revised in 1987 for DSM-III-R (American Psychiatric Association 1987; Lesieur 1988), and again in 1994 for DSM-IV (American Psychiatric Association 1994), and most recently in 2013 for DSM-5 (American Psychiatric Association 2013). The original criteria and subsequent revisions were written by committees of experts based upon a number of factors including a review of the literature and their clinical experience and expertise. Lesieur and Rosenthal’s (1991) literature review for the DSM-IV committee found little data regarding the diagnostic criteria other than clinician opinions and anecdotal reports. Subsequent to the publication of DSM-IV, there were only a small number of empirical studies on the reliability, validity, and classification accuracy of diagnostic criteria for PG (National Research Council 1999; Petry et al 2013; Zimmerman et al 2006)

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