ADDICTION CARE_DSM V GAMBLING DISORDER

DSM-V Pathological Gambling Diagnostic Form

Today’s Date

Date

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

IN THE PAST YEAR….

Rows	Yes	No
1. Have you often found yourself thinking about gambling (e.g., reliving past gambling experiences, planning the next time you will play or thinking of ways to get money to gamble)?reliving past gambling experiences, planning the next time you will play or thinking of ways to get money to gamble)?
2. Have you needed to gamble with more and more money to get
3. Have you become restless or irritable when trying to cut down or
4. Have you gambled to escape from problems or when you arefeeling depressed, anxious or bad about yourself?
5. After losing money gambling, have you returned another day in
6. Have you lied to your family or others to hide the extent of your
7. Have you made repeated unsuccessful attempts to control, cut
8. Have you risked or lost a significant relationship, job, educational
9. Have you sought help from others to provide the money torelieve a desperate financial situation caused by gambling?

will play or thinking of ways to get money to gamble)?

the amount of excitement you are looking for?

feeling depressed, anxious or bad about yourself?

or career opportunity because of gambling?

9. Have you sought help from others to provide the money to

Score

**4 or more “yes” answers indicates a diagnosis for Gambling Disorder – please see DSM-V for further diagnostic criteria. **Less than 4 indicates a potential problem and/or at risk indicators which may warrant further support, education and treatment services.

Adapted from the American Psychiatric Association Diagnostic Criteria from the DSM V 2013