Addiction (1997) 92(1), 75-87

RESEARCH REPORT

Impulsivity in pathological gambling: the

antisocial impulsivist

A. BLASZCZYNSKI/ Z. STEEL^ & N. McCONAGHY^

^School of Psychiatry, University of New South Wales, Australia & ^University of New
South Wales, Australia

Abstract
The construct of impulsivity has to date remained relatively unexplored in the pathological gambling
literature. This is in spite of recent claims suggesting that impulsivity may be an important feature
characterizing a subgroup of pathological gamblers who are claimed to suffer from a Multi-Impulse
Personality Disorder. The present study exammed the potential role of impulsivity using the Eysenck
Impulsivity Scale among 115 pathological gamblers. Results indicate that heightened impulsivity is associated
with the degree of severity of psychological and behavioural change in pathological gamblers. However, the
findings also indicate that impulsivity closely mirrors components contained in Eysenck Personality Question-
naire Psychoticism Scale, the California Personality Inventory Socialization Scale and DSM-UI Antisocial
Personality Disorder. This is manifest both in terms of high intercorrelations between the measures of
psychopathy and impulsivity and in their predictive relationship to the level of psychological distress suggesting
a uniform impulsivity/psychopathy construct. Thus, the research supports a model of pathological gambling
in which the severity of associated behavioural and psychological disturbance is mediated by a impulsivity/
psychopathy construct.

Introduction intended, and gambling behaviour that compro-

DSM-III and its later revisions (APA, 1980,
1994) includes pathological gambling within the
residual category of Disorder of Impulse Control
Not Elsewhere Classified alongside Kleptoma-
nia, Pyromania, Trichotillomania and Intermit-
tent Explosive Personality.
Pathological gamblers by definition exhibit de-
pendence on gambling manifested by the re-
peated failure to resist the urge to gamble, an
inability to cease gambling once commenced,
expending more time and/or money than
mises personal, financial, famihal, legal and/or
social functioning. Once stimulated to gamble,
pathological gamblers describe an increasing
urge and preoccupation with gambling that may
persist for several hours and involve elaborately
considered premeditated plans and actions to
obtain licit or iUicit funds to gamble (Lesieur,
1984; Blaszczynski & McConaghy, 1992).
Although impulsivity is conceptualized as an
imponant component of pathological gambling,
most studies have not operationally defined or

Correspondence to: Professor Alex Blaszczynski, Psychiatry Research and Teaching Unit, Level 4 Health Services
Building, Liverpool Hospital, NSW 2170, Australia.
Submitted 9th November 1994; initial review completed 16th February 1995; final version accepted 8th March
1996.

0965-2140/97/010075-13 S9.50 © Society for the Study of Addiction to Alcohol and Other Drugs

76 A. Blaszczynski et al.
emphasized that its complex construct incorpor-
ated features of cognitive style, oven behaviours
and physiological functioning. Others have re-
ferred to aspects of reaction time, attention to
detail, planning and accuracy on motor tasks
(Poneus, 1965), creativity (Rawlings, 1984) and
cognitive reflection and performance on the
Matching Familiar Figures Test (Messer, 1976).
Suicidality and explosive aggressiveness have
also been used as indices of impulsivity. Conse-
quently, it is possible that findings putatively
linked to impulsivity in fact refiect the infiuence
of varied components such as cognitive style,
physiological responsivity or personality traits of
extroversion and sociability.
Empirical evidence in suppon of the notion
that pathological gamblers or subgroups of
pathological gamblers manifest elevated traits of
impulsivity is limited and the central relevance of
impulsivity traits to the disorder remains unde-
monstrated. A number of studies have made
reference to elevated impulsivity levels in at least
a subset of gamblers. Moran (1970) developed a
qualitative taxonomy to categorize pathological
gambling subtypes based on structured interview
data. He defined five subtypes: impulsive, sub-
cultural, neurotic, psychopathic and symp-
tomatic gamblers. The impulsive subtype was
described as showing "gambling associated with
loss of control and ambivalence to the activity"
(Moran, 1970, p. 594) with levels of impulsivity
associated with higher degrees of disturbance.
Criteria for determining specific subtypes were
not delineated weakening the validity of the
defined categories.
In a factor analytic study of pathological gam-
bling, Zimmerman, Meeland & Krug (1985) de-
scribed a factor loading on items suggestive of
high energy levels, enjoyment from initiating
projects and risk-taking behaviours which they
labelled impulsive.
McCormick et al. (1987) found that both
pathological gamblers and substance abusers had
significantly lower California Personality Inven-
tory (CPI) Ego Control scores than a sample of
medical patient controls. The Ego Control Scale
is based on a weighted linear combination of
primary CPI scales to derive a second-order
measure defined as the "ability to moderate im-
pulses and inhibit action" (p. 5). A comparison
between substance and non-substance abusing
pathological gamblers revealed the former to
have higher Ego Control, indicating that abuse
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was associated with higher impulsiveness.
Carlton et al. (1987) found a sample of 14
abstinent pathological gamblers to be more likely
to repon histories of Attention Deficit Disorder
behaviours than a comparison group, a finding
similar to that of Rugle & Melamed (1993). If it
is accepted that impulsivity is a pnmary feature
of Attention Deficit Disorder (Oas, 1983), their
finding strengthens the hypothesis that patholog-
ical gamblers show elevated impulsivity traits.
Of potential relevance is the relationship be-
tween impulsivity and the closely related con-
struct of psychopathy. Close associations
between impulsivity and psychopathy have been
noted (Eysenck & Eysenck, 1977; Oas 1985;
Dickman, 1990) with at least one index of psy-
chopathy found to be raised amongst pathologi-
cal gamblers (McCormick et al., 1987).
Similarly, the presence of Antisocial Personahty
Disorder may be indicative of heightened impul-
sivity given that impulsivity is considered to be a
feature of Antisocial Personality Disorder, and
given that several studies have shown that be-
tween 14% and 40% of pathological gamblers
meet diagnostic criteria for such a personality
disorder (McCormick et al., 1987; Bland et al.,
1993; Blaszczynski & McConaghy, 1994 a,b).
While the close conceptual similarity between
antisocial personality disorder and psychopathy
is noted the emphasis of the former on
"antisocial behaviours" as opposed to personality
traits has been argued (Wells, 1988; Hare, Han
& Harpur, 1991) to indicate that the constructs
should be treated separately.
The only two studies administering a psycho-
metric measure of impulsivity to samples of
pathological gamblers reponed contradictory re-
sults. AUcock & Grace (1988) compared Zucker-
man's Sensation Seeking Scale (Zuckerman et
al., 1972) and Barratt's Impulsivity Scale (Bar-
ratt, 1965) scores of 10 pathological gamblers,
10 alcoholics, 10 heroin addicts and 25 control
subjects drawn from a population of hospital
staff. Pathological gamblers did not differ
significantly from controls on either scale but
heroin addicts had significantly elevated Barratt
Impulsivity Scale scores compared to controls.
Although acknowledging the need for replica-
tion, these authors concluded that gamblers were
not impulsive. Carlton & Manowitz (1994),on
the other hand, found that a sample of 12 mem-
bers of Gamblers Anonymous had significantly
higher Barratt Impulsivity scale scores than a

control group of 15 medical staff and their asso-
ciates. Impulsivity was not correlated with re-
poned personal and social disruption due to
gambling. However, the absence of a relationship
with personal and social disruption may have
been accounted for by the fact that gamblers were
in the recovery phase of their problems and had
not gambled for a mean penod of 68 months.
The present study investigates impulsivity and
antisocial personality features in a sample of
pathological gamblers using a battery of stan-
dardized psychological measures, and explores
the extent to which these two factors are associ-
ated with significant demographic and psychoso-
cial features. Factors included age and years
gambling, gambling-related debt, employment
stability, panicipation in criminal activity, sub-
stance abuse and psychometric indices of dis-
tress.
Method
Subjects
Subjects were a subset of 115 pathological gam-
blers selected from a database of 306 pathological
gamblers (Blaszczynski & McConaghy, 1992)
who had completed the Eysenck Impulsivity
Scale (EIS) (Eysenck & Eysenck, 1977). Only a
subset of gamblers completed the EIS because
this measure was introduced into the assessment
package at a late stage of the research project
specifically to investigate the question of impul-
sivity. The sample consisted of 80 consecutive
pathological gamblers seeking treatment from a
general hospital psychiatric inpatient behaviour
therapy unit, and 35 Gamblers Anonymous at-
tenders who volunteered to panicipate in the
study. In total there were 154 Gamblers Anony-
mous panicipants in the main study. No record
was maintained of the number of refusers but this
figure is estimated to be less than 10% of those
approached. There were 101 males (88%) and 14
(12%) females. The mean age of the total sample
was 39.3 years (SD=17 years; range =17-73
years).
All hospital subjects met DSM-III (APA,
1980) diagnostic criteria for pathological gam-
bling. No structured diagnostic assessment of the
Gamblers Anonymous sample was performed
given the constraint imposed by their already
burdensome task of completing a semi-structured
gambling interview and psychometric tests dur-
ing tlie course of a meeting.
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Impulsivity in pathological gambling 11
The combination of the hospital and Gamblers
Anonymous samples to form one large group was
justified on the basis of the results of earlier
studies which, with the exception of age, revealed
no significant differences between these popula-
tions on key demographic and psychological vari-
ables (Blaszczynski & McConaghy, 1992,
1994a). Gamblers Anonymous members (aver-
age age = 40 years) are older than hospital-
treated gamblers (average age = 37 years) but
although statistically different, the difference is
not considered to be of such a magnitude as to
invalidate combination of both groups for pur-
poses of the present study.
Measures
Subjects were administered a semi-structured in-
terview and battery of psychological measures.
The semi-structured interview was designed to
obtain information on patterns of gambling be-
haviour while the psychological measures were
selected to assess aspects of impulsivit>s anti-
social personality, depression and boredom
proneness. Although there is some overlap in the
boundary of constructs being measured, there are
no identical items repeated or items containing
direct reference to gambling behaviours across
psychological measures.
(1) A 65-item semi-structured interview. Each
subject completed a 65-item semi-structured
interview schedule designed to obtain general
demographic descriptions, a history of early
and peak gambling behavioural patterns, major
source of gambling revenue and details of any
gambling and non-gambling related offences, and
legal action initiated in response to these of-
fences. Gambling-related was defined as offences
motivated by the desire to obtain money speci-
fically to gamble or to cover shonfalls in financial
commitments caused by gambling losses; acts of
breaking and entering, armed robbery, misappro-
priation, embezzlement and larceny/theft. ATow-
gambling-related T^ftrTGd to offences motivated for
other reasons: offences of assault, car theft, drug
dealing or shoplifting or where proceedings of
misappropnation, embezzlement, amied robbery
and larceny were spent on personal benefit;
purchasing goods or investments.
(2) DSM-III checklist for Antisocial Personality
Disorder. The semi-structured interview schedule
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78 A. Blaszczvnski et al.

contained DSM-III criteria for antisocial person- cause it shows good inter-correlations with other
ality (APA, 1980). Criteria include features of measures of impulsivity (Dickman, 1990).
continuous and chronic antisocial behaviours
commencing prior to age 15 years and extending
(5) California Psychological Inventory Socializa-
into adulthood. For diagnosis, three of 12 clini-
tion Subscale (CPI So) (Gough, 1969). The 54-
cal features before age 15 years, and four of nine
item Socialization scale is based upon a
features after age 15 years are required. Pre-
role-taking theory of sociopathy which is consist-
adolescence features are truancy, expulsion or
ent with Cleckley's (1976) conception of psycho-
suspension from school, running away from
pathy. The scale purpons to indicate the degree
home, delinquency, persistent lying, sexual
of social maturity, integrity and rectitude which
promiscuity, repeated drunkenness or substance
the individual has attained. Low scorers on the
abuse, theft, vandalism, school grades below
scale are described as defensive, resentful, rebel-
expectation, chronic misbehaviour and initia-
lious, undependable, deceitful in dealing with
rion of aggressive behaviour. Post adolescent
others and as given to excess and exhibition in
features are an inability to sustain consistent
their behaviour.
employment, failure to function as a responsible
parent, inability to maintain long-term attach-
ments, irritability and aggressiveness, failure to (6) Eysenck Personality Questionnaire (EPQ)
honour financial obligations, lack of forward (Eysenck & Eysenck 1975). Three personality
planning or impulsiveness, repeated lying, 'con- dimensions are derived from this questionnaire;
ning' others for personal profit and reckless neuroticism (N) describing people who are char-
driving. acteristically anxious, worried and emotionally
over-reactive; extroversion (E) referring to traits
of sociability, excitement-seeking and impulsiv-
(3) Beck Depression Inventory (BDI) (Beck et ity; and psychoticism (P) reflecting coldness of
a/., 1961). The BDI is a 21-item clinically de- feeling, aggressiveness and unconventionality. A
rived self-assessment scale measuring the degree lie (L) subscale is included as a validation check
of state depression conceptualized as "an abnor- for social desirable responding. Given the focus
mal state of the organism manifested by signs of the present study on psychopathy and impul-
and symptoms such as low subjective mood, sivity, the psychoticism scale, which has been
pessimism and nihilistic attitudes, loss of sponta- demonstrated to show construct validity as a
neity and specific negative signs" (Beck, 1967, p. measure of psychopathy (Eysenck & Eysenck
202). 1975), was of primary concem and was used to
complement the measure of psychopathy from
(4) Eysenck Impulsivity Scale (Eysenck & the CPL Eysenck et al. (1985) and Rawlings
Eysenck, 1977). This 43-item self-repon mea- (1984) found that psychoticism scale scores cor-
sure assesses a broad construct of impulsivity related significantly with psychometric and be-
considered to be composed of four factors; im- havioural measures of impulsivity.
pulsiveness (Imp), non-planning (Np), risk-
taking (Rt) and liveliness (Liv). The impulsivity
subscale is regarded a measure of "narrow im- (7) Symptom checklist 90—Revised (SCL-90-R)
pulsivity". Attesting to the primacy of the narrow (Derogatis, Lipman & Covi, 1973). The SCL90-
measure of impulsivity Eysenck et al. (1985) R is a self-repon clinical rating scale consisting of
removed the other throe subscales from the most 90 items measuring nine primary symptom con-
recent version of the impulsiveness question- structs: somatization; obsessive-compulsive; in-
naire. Narrow impulsiveness is regarded as the terpersonal sensitivity; depression; anxiety;
more pathological of the traits correlating with hostility; phobic anxiety, paranoid ideation; and
the Psychoticism and Neuroticism scales of the psychoticism. Positive Symptom Total and Glo-
Eysenck Personality Questionnaire, and the Dys- bal Severity Index represent overall indices of
functional Impulsivity scale of Dickman (1990). distress.
This measure was chosen because the narrow
impulsivity subscale has increasingly become the (8) Boredom proneness (BP) (Farmer & Sund-
gold standard that is used to validate other mea- berg, 1986). This 38-item self-repon measure
sures (Gerbing, Ahadi & Patton, 1987) and be- was developed to assess an individual's proclivity
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Impulsivity in pathological gambling 79

Table 1. Cnminal behaviour and associated characteristics in a sample of 115 pathological gamblers

Gambling-related offences Yes No

Committed offence 67 48
Charged for offence 26 41
Mean SD Min. 10
Age first gambling-related illegal act 27.18 10.89 Max. 60
Awareness of magnitude of crime when Yes Some None
committing (16 missing) 27 9 15
Commenced gambling-related act under Always Sometimes None
influence of alcohol (4 missing) 6 5 52
Non-gambling-related offences Yes No
Committed offence 24 91
Charged for offence 15 9
Age when committed first non-gambling- Mean SD Min. 8
related illegal act 18.9 7.65 Max. 36
Awareness of magnitude of crime when Yes Some None
committing (4 missing) 12 0 8
Committed non-gambling-related act under Always Sometimes None
influence of alcohol (2 missing) 5 6 11

to experience boredom. Viewed as an indepen- Personality Disorder, 40 (35%) were borderline,

dent construct but exhibiting some overlap with
depression, boredom-prone individuals manifest
a lack of interest and varying degrees of de-
pression, hopelessness, loneliness and distracti-
bility.
Results
The total mean number of years of gambling of
the 115 subjects was 19.6 years (SD =10.6 years;
range = 1-50 years) with a mean 11.5 years
(SD = 8.6 years; range = 1-40 years) of gambling
at problematic levels. The median gambling ex-
penditure per session was estimated to be SA200,
with a median maximum gambling-related debt
of SA4500 (range = SA0-SA250 000).
Of the sample, 65 (56.5%) were married or in
a partnership, 19 (16.5%) separated or divorced
and 31 (27.0%) were single. Table 1 summarizes
data relating to gambling- and non-gambling-
related criminal offending. Overall, 74 (65%) of
the total sample had engaged in some form of
illegal activity and, of these, 41 (36%) had been
charged for their respective offence/s. Fifty-one
subjects reponedly committed only gambling-
related offences and eight only non-gambling-
related offences. A further 16 subjects engaged in
both forms.
The DSM-III Antisocial Personality Disorder
Checklist embedded in the semi-structured inter-
view indicated that 18 (15.5%) of the patliologi-
cal gamblers met criteria for Antisocial
with 11 (10%) meeting the under 15 years of age
criteria, and 29 (25%) meeting the over 15 years
of age criteria. Fifty-seven (49.5%) subjects did
not meet either criteria.
Descriptive statistics for psychological mea-
sures are given in Table 2. Where possible for
each measure, sample data from a normative
population of males with a comparable mean age
as the present study's sample were selected for
purposes of statistical comparisons. r-Test com-
parisons revealed that subjects had significantly
higher EIS impulsivity (r = 4.868, df=448, p<
0.0001) and non-planning (r= 3.905, df=348,
p < 0.0001) and significantly lower risk-taking
(r-3.560, df=348, p < 0.001) subscale scores
compared to Bysenck & Eysenck's (1978) norma-
tive data. Liveliness subscale scores did not differ
(r= 0.608, df=348, NS).
EPQ subscale scores showed subjects had
significantly higher neuroticism (r = 10.010,
d f - 5 1 7 , />< 0.0001) and psychoticism (r =
5.658, df= 517,p<0.0001) but lower extrover-
sion (f= 2.292, df= 517, p < 0.05) and lie scale
scores (r= -2.973, df=517, p<0.01) com-
pared to age-appropriate male normative data
(Eysenck & Eysenck, 1975).
Subjects obtained elevated BDI scores
(mean = 14.6, SD = 8.7) which placed them in
the mild to moderately depressed range.
Evidence of overall point-in-time general psy-
chopathoiogy was revealed through significantly
elevated SCL90-R Positive Symptom Total
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80 A. Blaszczvnski et al.

Table 2. Comparisons between pathological gamblers and normative data on the Boredom Proneness (BP),
Cahfomia Psychological Inventory (CPI), Eysenck Personahty Questionnaire (EPQ), symptom checklist
90-revised (SCL90-R) and Eysenck's Impulsivity Scale (EIS) measttres

Pathological
gambling
subjects Normative data
Standard Standard
Mean deviation Mean deviation
BP 14.73 6.11 9.40 5.59**
n - 110 M = 40
35 males; 5
females)
Age = 37.3 10.4
CPI 23.39 6.39 29.92 6.08**
n= 115 « - 1000
(males)
Age not
specified
EPQ
Extra version 11.68 5.17 12.85 4.73*
Lie 6.17 3.61 7.53 4.51**
Neuroticism 14.88 5.47 9.33 5.18**
Psychoticism 4.95 3.01 3.27 2.75**
n - 115 n-404
(males)
Mean age not
specified:
range 30 to
39 years
SCL90-R
Positive symptom total 45.05 22.86 19.29 15.48**
n= 112 « = 974
(494 males.
480 females)
Age = 46.0 14.7
EIS
Impulsivity 8.36 3.41 6.53 3.25**
Risk taking 5.00 2.61 6.08 2.66**
Non-planning 7.73 2.45 6.59 2.62**
Liveliness 3.51 1.41 3.40 1.67
n - 115 w-235
(males)
Mean age not
specified:
range 20 to
30 years
** -p<0.0001.

Scores compared to mixed male/female popu- reponed by Blaszczynski, McConaghy &

larion normative data (gamblers' mean PST
score = 45.05, r= 15.92, df= 1,084, />< 0.001)
(Derogatis, et al., 1973).
The mean boredom proneness scores for sub-
jects was 14.73 (SD ^ 6.11), a figure higher than
the undergraduate male students mean score of
10.44 provided by Farmer & Sundberg (1986)
but consistent with that of 14.96 (SD = 6.40)
Frankova (1990) for a separate sample of hospi-
tal-treated pathological gamblers. Using
Blaszczynski et al.'s (1990) data derived fi-om a
group of 40 family physician general medical
patients for comparative purposes, subjects in the
present study were significantly more prone to the
experience of boredom (r-4.83 df= 148, p<
O.OOOl).
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Impulsivity in pathological gambling 81

Table 3. Correlations between Eysenck Impulsivity Scale (ElS-Imp), Califor-

nia Psychological Inventor^' socialization scale (CPI So), the Eysenck Personality
Questionnaire (EPQ-P) and remaining psychometric measures

ElS-imp CPI So EPQ-P

BDI 0.42** -0.43** 0.35**

BP 0.57** -0.53** 0.45**
CPI -0.59** 1.00 -0.52**
EPQ
Extroversion 0.08 0.05 -0.03
Neuroticism 0.52** -0.51** 0.31**
Psychoticism 0.47** -0.52** 1.00
Lie -0.30** 0.21 -0.34**
SCL90-R
Positive symptom total 0.36** -0.38** 0.33**
EIS
Impulsivity 1.00 -0.59** 0.47**
Risk taking 0.41** -0.30** 0.27
Non-planning 0.44** -0.20 0.28**
Liveliness -0.00 0.09 -0.01

* ^ One-tailed significance at 0.01; ** = one-tailed significance at 0.001.

Table 4. Mean (standard deviation) California Psychological Inventory Socialization Scale (CPI So) and Eysenck
Personality Questionnaire (EPQ-P) scores by DSM-III Antisocial Personality Disorder and significant contrasts

(1) (2)
No Borderline (3) (4)
anti-social met criteria Borderline Anti-social
personality for under met criteria personality
disorder 15 for over 15 disorder
in = 57) («-ll) (" - 29) («=18)
Mean Mean Mean Mean CPI EPQ
(SD) (SD) (SD) (SD) Contrasts (S) (P)

California 25.860 18.636 23.551 18.222 1 vs. 2

Personality (6.09) (5.33) (5.33) (5.00) 1 vs. 3
Inventory 1 vs. 4 *
EPQ 3.772 6.819 5.035 7.389 2 vs. 3
Psychoticism (2.54) (3.25) (2.13) (3.57) 2 vs. 4
Scale 3 vs. 4 * *

* — Significant Scheffe adjusted contrast at 0.05 level.

Impulsivity and antisocial personality features
Tlie extent to which impulsivity and antisocial
personality features shared variance with the
high scores on self-repon measures of psycho-
pathoiogy was investigated. Table 3 presents the
inter-correlation matrix of the ElS-Imp (impul-
sivity) subscale score, the CPI So (socialization)
scale and EPQ-P (psychoticism) scale scores
with remaining psychological measures.
The ElS-Imp score correlated significantly
v^dth depression, inability to tolerate boredom,
neuroticism, psychoticism and SCL90-R Posi-
tive Symptom Total scores. The ElS-Imp score
also conelated positively with the EIS risk-taking
and non-planning subscales.
The CPI So and EPQ-P subscales, putatively
reacting aspects of antisocial personality, showed
a similar pattern of association.
The relationship of the ElS-Imp subscale with
interview derived data was investigated \aa a
series of simple univariate regressions and one-
way analyses of variances.
Univariate regressions. Univariate regressions
revealed that ElS-Imp was negatively associated
uath the average period of employment

82 A. Blaszczynski et al.
(r= - 0 . 3 1 , F=11.46, df= 1,109, p ^ O .
and positively with self-rated impulsiveness of
gambling-related illegal acts (r=0.28, F=1.9H,
df= 1,95, p - 0 . 0 0 5 7 ) .
Scores on the CPI So were significantly corre-
lated with age began gambling (r=0.32,
F = 12.87, df= 1,112, p-0.0005), level of
educarion (r = 0.20, F = 4.52, p = 0.036), average
period of employment (r=0.31, F^ 10.13,
df = 1,95, p = 0.002 and r - 0 . 3 1 , F = 11.848,
df= 1,109, p = 0.0008, respectively), self-rated
impulsiveness of gambling (r^ - 0.21, F= 4.47,
df = 1,95, p = 0.0375) and non~gambling-related
offences (r= - 0 . 2 0 , F=4.479, df= 1,104,
p = 0.0367. EPQ-P scores had a similar pattern of
relationship with age began gambling
(r= - 0 . 1 9 , F - 4 . 2 7 7 , df= 1,112, p = 0.0409),
average period of employment ( r - - 0 . 2 6 ,
F = 6.626, df= 1,95,^ = 0.0116 and r= - 0 . 2 8 ,
i^-9.568, df= 1,109, p - 0 . 0 0 2 5 , respectively)
self-rated impulsiveness of gambling-related
( r - 0 . 2 2 , i^-4.949, df= 1,95, p = 0.0285) and
non-gambling-related offences (r = 0.22,
F = 5.098, df= 1,104, p = 0.026). These scales
did not correlate with age, years gambling or age
of first offence.
One-way analyses of variance. One-Way
ANOVAs with Scheffe controlled simple contrasts
indicate that gamblers in unskilled or semi-skilled
occupadons had higher impulsivity scores
(mean = 8.87, SD = 2.88) than those in skilled or
professional occupations (mean = 7.10, SD =
4.10). Divorced gamblers (mean = 10, SD = 2.0)
were found to have significantly higher impulsivity
scores than both single (mean = 8.0, SD = 3.6)
and married/t/e facto (mean = 7.8, SD = 3.4)
gamblers.
Higher ElS-Imp scores were also found among
those who had engaged in gambling-related
offences (offence: mean = 9.01, SD - 3.06; no
offence: mean = 7.4, SD = 3.71), gamblers who
consumed alcohol prior to or while gambling
(alcohol: mean = 9.19, SD = 3.09; no alcohol:
mean = 7.88, SD = 3.5) and those with a history
of drinking problems (history of alcohol:
mean = 9.44, SD = 2.70; no history; mean =
7.95, SD = 3.60). Significantly higher ElS-Imp
scores were also obtained by gamblers exhibiting
a history of suicidal ideation (suicidal ideation:
mean = 8.96, SD = 2.75; no suicidal ideation:
mean = 7.49, SD = 4.06)3 and suicidal gesture
13600443, 1997, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1997.tb03639.x by Health Research Board, Wiley Online Library on [04/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
(attempts: mean - 9.48, SD = 2.41; no attempt:
mean-0.798, SD = 3.62).
As anticipated, CPI So and EPQ-P scales which
reflect aspects of psychopathy were significantly
negatively correlated (r= - 0.52). Although only
27% of variance is shared between the two con-
stnicts, their pattern of association with the inter-
view derived data was similar suggesting that these
all measure some shared aspect of the same
construct.
The series of one-way ANOVAs on interview
data-derived predictors also revealed that
gamblers employed in unskilled or semi-skilled
occupations had higher levels of EPQ-P
(mean = 5.4, SD = 3.3) and lower CPI So scores
(mean = 22.8, SD = 6.0) than those employed in
skilled or professional occupations (EPQ-P:
mean = 3.9, SD = 2.1; CPI So: mean = 25.5,
SD = 6.5).
As with ElS-Imp, divorced gamblers had low-
ered CPI scores (mean = 20.1, SD = 4.17) than
marhed/de facto gamblers (mean = 24.8,
SD = 6.4). Gamblers reponing chasing losses
when first gambling also obtained lower CPI So
scale scores (chasing: mean = 21.9, SD = 6.2; no
chasing: mean = 24.6, SD = 6.3). EPQ-P scores
did not differ between the two groups.
Gamblers committing gambling-related of-
fences had significantly higher EP-Q P scores
(mean = 5.54, SD = 2.93) than those not repon-
ing such acts (mean = 4.11, SD = 2.98).
However, contrary to expectations no significant
difference between these groups was found on the
CPI So subscale scores although the trend was in
the expected direction (offences: mean = 22.93,
SD-6.04; no offences: mean = 24.00,
SD = 6.93).
Gamblers who engaged in non-gambling-
related offences had significantly lower CPI So
(mean-20.25, SD = 5.38) and higher EPQ-P
(mean = 6.125, SD = 3.26) scores than those who
had not (CPI So: mean = 24.28, SD = 6.42;
EPQ-P:mean = 4.652; SD = 2.91).
Gamblers consuming alcohol prior to or during
gambling session had lower CPI So scores
(mean = 21.2, SD = 6.2) compared to those not
consuming alcohol (mean = 24.6, SD = 6.2).
Similarly, elevated EPQ-P scores were found
among gamblers who consumed alcohol prior to
or during gambling sessions (mean = 5.7,
SD = 3.1) compared to those who did not
(mean = 4.3, SD = 2.8) and those with a history
of alcohol problems had lowered CPI So scores
 13600443, 1997, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1997.tb03639.x by Health Research Board, Wiley Online Library on [04/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Impulsivity in pathological gambling 83

(mean = 20.4, SD = 5.3) than those without obtained for a number of the analyses of vari-
(mean = 24.5, SD = 6.4). EPQ-P scores were ance, none of the Scheffe simple contrasts
significantly higher for problem drinkers reached significance. This finding makes in-
(mean = 6.6. SD = 3.0) compared to non-prob- terpretation of the direction of the difference
lem drinkers (mean = 4.3, SD = 2.8). Illicit drug between the ASPD groups problematic. Never-
users also had heightened EPQ-P scores (drug theless, those meeting full or partial criteria for
users: mean = 6.3, SD = 3.2; non-users: ASPD tended to commence gambling earlier,
mean = 4.6, SD = 2.9) and lowered CPI So tended to have more years of problematic gam-
scores (drug users: mean - 20.5, SD = 6.3; non- bling, shoner periods of employment and re-
users: mean = 24.2, SD = 5.9). poned feeling that any gambling-related criminal
Finally, lowered CPI So scores were found acts were conducted in an impulsive manner. No
among those with a history of suicidal ideation differences were found on the dimensions of
(ideation: mean = 22.0, SD = 5.8; no ideation: years gambling, fi-equency of gambling, age, self-
mean 25.4, SD = 6.7) and suicidal gesture (at- rated impulsivity and age of first offence.
tempt: mean ~ 21.1, SD = 5.8; no attempt:
mean = 24.2, SD = 6.4).
Discussion
In contrast to the findings of AUcock & Grace
Antisocial personahty disorder (1988), the results of the present study suggest
The relationship between Antisocial Personality that a subpopulation of pathological gamblers
Disorder (ASPD), impulsivity, psychometric presenting to a hospital or Gamblers Anonymous
measures and interview data was explored. for help manifest elevated levels of impulsivity
One difficulty confronting the authors was the and that a continuum of psychological distress
classification for statistical purposes of subjects exists which is mediated by impulsivity and re-
who met panial critena for ASPD; that is, those lated antisocial personality characteristics.
meeting criteria under age 15 years but not over A possible explanation for the discrepant
15 years and vice versa. As seen in Table 4, findings between this and Allcock & Grave's
one-way analyses of variance with Scheffe ad- study relates to the substantial differences in
justed multiple comparisons of CPI So and EPQ statistical power between the two studies. All-
P with the ASPD criteria (CPI So: F= 11.1390, cock & Grace (1988) used 10 gamblers and 25
df-3,111, ;j<0.0001; EPQ-P: F = 10.2558, controls compared to 115 subjects in this study.
d f = 3 , l l l , p<0.0001) revealed that borderline Interestingly, the effect size of the difference in
cases did not resemble either ASPD or non- impulsivity scores between gamblers and con-
ASPD cases. Consequently, it was decided to trols is virtually identical in both studies (0.52 in
treat the under and over 15 years age groups, the Allcock & Grace study and 0.56 in the
those meeting full criteria, and those not meeting present study).
any criteria as four distinct categories. While heightened levels of impulsivity have
A series of one-way analysis of variance been identified it could be argued that its effect
(ANOVAs) Scheffe adjusted (p-0.05) using size is only medium and therefore of limited
psychometric measures as the dependent vari- clinical significance. However, the relationship
ables and ASPD as the independent variable between impulsivity and variables such as an
were carried out (see Table 5). Significant differ- increased frequency of jobs, shoner periods of
ences were found on the BDI, the Positive employment, higher rates of separation or div-
Symptom Total scale of the SCL90-R and EIS- orce due to gambling, history of gambling-
Imp such that the direction of difference indi- related illegal acts, alcohol consumption, history
cated that those who met full ASPD criteria had of suicidal ideation and attempts and psycho-
higher levels of psychological distress. No metric indices of distress and disturbance does
significant differences were found between suggest that the trait impulsivity in association
groups on EPQ E and N, or EIS risk-taking, with psychopathy is of clinical relevance to the
non-planning and liveliness scale scores. understanding of pathological gambling.
Table 6 contrasts the significant comparisons Funher, age and impulsivity are negatively
fi-om the series of one-way ANOVAs carried out correlated (Eysenck & Eysenck, 1977) and clini-
on interview data. While significant results were cal features of psychopathy are also found to
 13600443, 1997, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1997.tb03639.x by Health Research Board, Wiley Online Library on [04/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
84 A. Blaszczynski et al.

Table 5, Significant results from one-way analysis of variance comparisons with Antisocial Personality Disorder (ASPD)
and self-repon measures

ASPD ASPD
No under 15 over 15 Full
ASPD criteria criteria ASPD
(n-57) (n= 11) (" - 29) (n = 18) Sheffe
Mean Mean Mean Mean simple
(SD) (SD) (SD) (SD) p-value contrasts
BDI 12.68 17.91 14.19 19.39 0.0183 1 vs. 4
(7.99) (4.97) (7.94) (11.81)
EPQ 7.733 5.636 4.759 5.056 0.0052 1 vs. 3
Lie scale (3.83) (3.72) (3.01) (2.55)
SCL90-R
Positive symptom total 39.684 44.909 48.321 58.562 0.02340 1 vs. 4
(22.00) (17.78) 22.78 (24.33)
EIS
Impulsivity 7.3158 9.1818 8.8276 10.389 0.00390 1 vs. 4
(3.611) (2.64) (3.33) (1.97)

Table 6. Significant result from one-way analysis of variance comparisons with Antisocial Personality Disorder (ASPD)
and numerical variables from the semi-structured interview

ASPD ASPD
No under 15 over 15 Full
ASPD cnteria critena ASPD
(n - 57) («= 11) (n = 29) ( n - 18)
Mean Mean Mean Mean
(SD) (SD) (SD) (SD) p-value

Age first commenced gambling 20.8 14.9 18.0 16.2 0.0414

(9.0) (5.0) (7.9) (4.3)
Number of years problem gambling 9.4 16.2 11.7 14.6 0.0250
(7.1) (11.6) (7.0) (11.2)
Average length of each job (months) 65 38 52 21 0.0385
(61) (43) (65) (190)
Self-rated impulsivity of gambling-related 14 37 28 41 0.0482
illegal act (%) (29) (40) (42) (43)

Only comparisons with a probability level less than 0.05 have been reported.

decline with age. That contrary to expectations,
subjects in the present study manifest elevated
impulsivity despite their age falling predomi-
nantly in the older 35-40-year age bracket, can
be legitimately interpreted as providing addi-
tional suppon for the validity of our findings.
However, replication and further clarification of
this findings is required before a definitive con-
clusion can be drawn.
Implicit in the concept of an impulse disorder
is the presence of a repeated tendency to exhibit
behaviours that are characteristically sudden, un-
predictable and/or spontaneous, that occur with-
out due deliberation or regard for their
consequences and that occur "under the
influence of a compelling pressure that restricts
the subject's freedom of will" (Sims, 1988, p.
260) Impulsive behaviours do not occur only in
the context of the specified Impulse Control
Disorders but are found across a broad spectrum
of psychiatric disorders such as bulimia nervosa,
sexual paraphilias, substance abuse disorders,
borderline personality disorders and violent sui-
cidal acts (Lacey & Evans, 1986). While each are
associated with manifest behaviours suggestive of
a loss of control, it is unclear whether impaired
control is specifically linked to an overall height-
ened trait of impulsiveness.
In their review, Lacey & Evans (1986)
ascribed the term Multi-Impulsive Personality

Disorder to a distinct subgroup of patients
characterized by heightened levels of impulsiv-
ity as manifested by multiple forms of recurrent
impulsive behaviours. Some evidence of co-
morbid multiple impulsive behaviours in patho-
logical gamblers has been found. Pathological
gamblers report increased rates of suicide (Mc-
Cormick et al.y 1984; Lmden, Pope & Jonas,
1986; Blaszczynskij 1988), substance abuse dis-
order (Ramirez et ai, 1983; Lesieur, Blume &
Zoppa, 1986), antisocial personality features
(Blaszczynski & McConaghy, 1992), compul-
sive overspending, compulsive overeating and
heterosexual addictive patterns (Lesieur &
Rosenthal, 1991).
Although Lacey & Evans (1986) provided no
empirical evidence to support an association
between co-morbid impulsive behaviours and
impulsivity traits, McCown (1988) found elev-
ated Eysenck's Impulsivity Questionnaire scores
in multiple compared to single substance
abusers. Similarly, O'Boyle & Barratt (1993)
found that multiple substance dependence was
associated with higher Barratt Impulsivity scale
and Eysenck Personality Questionnaire Psy-
choticism scale scores as well as being associ-
ated with Cluster A, B and C personality
disorders. Stanford & Barratt (1992), drawing
on the criminal records and prison files of 75
convicted male inmates, found elevated Barratt
Impulsivity Scale scores in those prisoners
meeting multiple impulse disorder criteria. Self-
report measures of impulsiveness were found to
be directly related to the number of impulse
control disorders present.
In the light of these studies the current
findings can be viewed as adding support to the
potential clinical importance of identifying a
multi-impulsive personality disorder among
subsets of pathological gamblers presenting for
treatment or help. It also extends the under-
standing of the clinical features of such a
Multi-Impulsive personality disorder by exam-
ining a range of demographic, life history and
psychological self-report indices which can be
seen as providing an initial profile of the impul-
sivist in the realm of pathological gambling. As
described above, this profile suggests that the
impulsivist pathological gambler differs from
other pathological gamblers in that they mani-
fest impaired psychosocial and psychological
functioning. In short, the Impulsivist is a highly
disturbed individual manifesting multiple psy-
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Impulsivity in pathological gambling 85
chological problems some of which are in the
realms of impulse control difficulties.
Another significant finding from the present
research relates to the high correlations be-
tween narrow impulsivity, CPI socialisation and
FPQ psychoticism and the similarity of their
association with the other self-report indices,
and the indices of severity of psychosocial dis-
turbance and psychological distress from the
semi-structured interview. Such conceptual and
measurement similarities between these two
constructs has been reported in the literature
previously (Eysenck & Eysenck, 1977; Rawl-
ings, 1984; Eysenck et al., 1985; Oas, 1985),
and combined with the current findings suggest
that it is difficult to maintain a distinction be-
tween the constructs of impulsivity and psycho-
pathy. It also seems warranted that this
conclusion should be extended to Antisocial
Personality Disorder given heightened impulsiv-
ity, psychopathy and socialization scores in
gamblers meeting full criteria for ASPD.
This has significant implications as it sug-
gests that the concept of the Multi-Impulsive
Personality Disorder proposed by Lacey &
Evans overlaps with a subgroup already
identified under the Antisocial Personality Dis-
order category. It also suggest that attempts to
distinguish the construct of impulsivity from
psychopathy may be unsuccessful. That is, the
current study suggests that impulsivity and psy-
chopathy are one and the same thing. It may,
thus, be more informative to speak of the anti-
social impulsivist.
In conclusion, while the construct of impul-
sivity has to date remained relatively unex-
plored in the pathological gambling literature,
the present study supports the claim by authors
such as Lacy & Evans (1986) of its role in
understanding important correlates of disorders
such as pathological gambling. In the present
study impulsivity was found to contribute to
the severity of behavioural and psychological
disturbance in a population of pathological
gamblers seeking treatment.
The findings that impulsivity closely mirrors
psychopathy, socialization and antisocial per-
sonality, manifest both in terms of high inter-
correlations between the measures of
psychopathy and impulsivity and in their pre-
dictive relation to the indices of associated be-
havioural and psychological distress, suggests a
uniform impulsivity/psychopathy construct.

86 A. Blaszczynski et al.
Thus, the research suppons a model of patho-
logical gambling in which the severity of associ-
ated behavioural and psychological disturbance
in those seeking treatment is mediated by an
impulsivity-psychopathy construct. It remains to
be seen if such a concept is applicable to prob-
lem gamblers in the community who do not seek
treatment from a hospital setting or Gamblers
Anonymous.
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